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Emotionally Focused Family Therapy offers an important breakthrough
in the practice of family therapy. In this wonderfully written book,
Furrow, Palmer, Johnson, Faller, and Olsen apply the wisdom and
exceptional clinical skills refined over decades in emotionally focused
couple therapy to family therapy. Grounded in the same base in attach-
ment and emotion as the couple therapy, Furrow and colleagues astutely
and artfully recreate this therapy in a form that addresses the unique
sorts of issues that arise and typical problems in focus in family therapy.
Filled with rich clinical vignettes, this is the book and treatment manual
to consult to learn emotionally focused family therapy, as well as more
broadly the use of emotion and attachment in work with families.
Jay L. Lebow, Ph.D., Senior Scholar and Senior therapist, Family
Institute at Northwestern University, and Editor, Family Process

Long anticipated, Emotionally Focused Family Therapy elegantly details

the family version of emotionally focused couples therapy, one of the
most popular and well-­respected theories in contemporary practice. In
addition to clearly outlining the model step-­by-step, Johnson and
Furrow provide practical guidance for using the approach not only in
common situations such as internalizing and externalizing childhood
disorders but also with more challenging cases involving trauma and
blended families. Without a doubt, this book will be essential reading in
the field of family therapy for years to come, transforming how we con-
ceptualize and approach work with children and families.
Diane R. Gehart, Ph.D., Author, Mastering Competencies in Family
Therapy and Professor, California State University

EFT revolutionized couple therapy. Now, these groundbreaking pioneers

have extended the approach to work with families. This delightfully
engaging book is overflowing with enlightening clinical examples and
session transcripts that demonstrate the power of emotion in family
therapy. It should be required reading for all family therapists.
Andrea K. Wittenborn, Ph.D., Associate Professor of Human
Development and Family Studies and Associate Professor of Psychiatry
and Behavioral Medicine, Michigan State University
 EMOTIONALLY
FOCUSED FAMILY
THERAPY
Restoring Connection and
Promoting Resilience

James L. Furrow,
Gail Palmer,
Susan M. Johnson,
George Faller, and
Lisa Palmer-­Olsen
First published 2019
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2019 Taylor & Francis
The right of James L. Furrow, Gail Palmer, Susan M. Johnson, George Faller, and
Lisa Palmer-­Olsen to be identified as authors of this work has been asserted by
them in accordance with sections 77 and 78 of the Copyright, Designs and Patents
Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilized
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent to
infringe.
Library of Congress Cataloging-­in-Publication Data
A catalog record for this title has been requested
ISBN: 978-1-138-94801-3 (hbk)
ISBN: 978-1-138-94802-0 (pbk)
ISBN: 978-1-315-66964-9 (ebk)
Typeset in Sabon
by Wearset Ltd, Boldon, Tyne and Wear
 Contents

ABOUT THE AUTHORS vii

INTRODUCTION ix

PART I Theory and Practice 1

Chapter 1 Emotionally Focused Family

Therapy 3

Chapter 2 Families and Emotion—Sharing the

Language of Attachment 29

Chapter 3 Exploring the EFFT Process of

Change 63

PART II Following the Stages and Steps 87

Chapter 4 Alliance and Assessment of Family

Patterns 89

Chapter 5 Working through Relational Blocks 116

Chapter 6 Engaging Family Vulnerability 148

Chapter 7 Restructuring Attachment and

Caregiving Responses 179

Chapter 8 Consolidating Security in the Family

System 200

v
vi Contents  

PART III Exploring Clinical Realities 217

Chapter 9 Case Example—EFFT and Treating

an Internalizing Disorder 219

Chapter 10 Case Example—EFFT and Treating

an Externalizing Disorder 243

Chapter 11 Case Example—EFFT and Working

with Stepfamilies 270

Chapter 12 Case Example—EFFT and

Traumatic Loss 294

EPILOGUE 318
APPENDIX—ANNOTATED STAGES AND STEPS 325
INDEX 329
 About the Authors

JAMES L. FURROW is co-­author of Becoming an EFT Therapist: The

Workbook, Emotionally Focused Couple Therapy for Dummies and
co-­editor of The EFT Casebook: New Directions in Couple Treat-
ment. James formerly served as the Freed Professor of Marital and
Family Therapy and Department Chair, at Fuller Graduate School of
Psychology, Pasadena, CA.
GAIL PALMER, MSW, RMFT, has specialized in emotionally focused
therapy for the past 30 years. A trainer and supervisor, she gives
workshops internationally and is the Director of Education for the
International Centre of Emotionally Focused Therapy. Her practice is
located in Ottawa and Victoria, Canada.
SUSAN M. JOHNSON, Ed.D., is the leading developer of emotionally
focused therapy (or EFT). She is a Professor Emeritus of Clinical
Psychology at the University of Ottawa, Distinguished Research Pro-
fessor in the Marital & Family Therapy Program at Alliant Univer-
sity in San Diego, and Director of the International Centre for
Excellence in Emotionally Focused Therapy (ICEEFT). www.drsue
johnson.com
GEORGE FALLER, LMFT, is a retired Lieutenant of the NYC Fire
Department and the President of the New York Center for Emotion-
ally Focused Therapy. He teaches EFT courses at the Ackerman Insti-
tute for the Family and is the director of training at the Center for
Hope and Renewal in Greenwich, CT. George is the coauthor of the
books: True Connection and Sacred Stress. www.georgefaller.com
LISA PALMER-­OLSEN, Psy.D., LMFT, is a Certified EFT Trainer and
co-­founder and co-­director of the Emotionally Focused Couples
Training and Research Institute at Alliant International University.
She is founder and clinic director of the Alliant Couple and Family
Clinic, in San Diego, CA.

vii
 INTRODUCTION

Emotionally focused family therapy (EFFT) actively promotes the devel-

opment and renewal of attachment bonds in family relationships defined
by patterns of emotional distance and distress resulting from enduring
conflicts and relational injuries. The EFT therapist seeks to transforms
these problematic patterns, which often undermine a family’s safety and
wellbeing. Following empirically supported practices, parent and child
relationships are redefined through new experiences of trust and vulner-
ability, thereby restoring the flexible connection and responsiveness
families need to maintain healthy emotional bonds. These bonds
enhance resilience among families facing changing developmental needs
and unanticipated demands common to family life.
The practice of EFFT is based on decades of psychotherapy research
which has shown that the shared experience of emotion remains a
powerful catalyst for growth and therapeutic change. Pioneers in emo-
tionally focused couple therapy (Johnson, 2004) and emotion-­focused
therapy (Greenberg, 2002) repeatedly demonstrate empirical support for
the use of emotion-­focused treatments for adult depression, anxiety, and
couple distress. Susan Johnson first explored the application of EFT to
families in in her book The Practice of Emotionally Focused Therapy:
Creating Connection (Johnson, 1996). Johnson noted that EFT’s couple
theory and interventions offered similar promise to distressed family
relationships, which was demonstrated in a pilot study testing the effec-
tiveness of EFFT with bulimic adolescents and their parents (Johnson,
Maddeaux, & Blouin, 1998). Further elaboration of the approach
appears in Johnson’s second edition of Creating Connection (Johnson,
2004) and Becoming an Emotionally Focused Therapist: The Work-
book (Johnson et al., 2005).
The clinical process described in this book is based on the funda-
mental practices of emotionally focused therapy outlined principally in
The Practice of Emotionally Focused Therapy: Creating Connection
(Johnson, 2004), Becoming an Emotionally Focused Therapist: The

ix
x Introduction  

Workbook (Johnson et al., 2005), and Attachment Theory in Practice

(Johnson, 2019). Johnson and colleagues highlight three core principles
that illustrate the contribution of attachment theory to this relational
change model offering promise to both couple and family intervention
approaches (Johnson, Lafontaine, & Dalgleish, 2015). These principles
are reflected in recent summaries of attachment-­based treatment (ABT)
practices used in various treatment and educational approaches guiding
clinician’s work with adolescents and their families (e.g., Kobak, Zajac,
Herres, & Krauthamer Ewing, 2015; Steele & Steele, 2018).

• Therapist as an attachment figure and resource for exploration. The

therapist’s emotional presence is responsive, accessible, and engaged
with each person accepting and validating the varied experiences of
individual in relational distress. Attachment processes guide the
focus and quality of the therapist alliance with couples and families.
In EFT the therapist serves as a process consultant that offers a
secure base for exploring the underlying experiences and needs that
are often disowned or disregarded in moments of relational distress.
Kobak and colleagues (2015) highlight the therapist’s role in implic-
itly modeling secure attachment behaviors in ABT treatments. The
therapist’s attuned ability to track, reflect, and explore relational
injuries and empathic failures in family relationships increases indi-
vidual exploration of self and other at more adaptive emotional
levels, which are congruent with the importance of these relation-
ships in their lives. The role of the EFT therapist in EFFT is defined
by the core elements of a secure connection: Accessibility, respon-
siveness, and emotional engagement (Johnson, 2019).
• Attachment and emotion as a catalyst for change. The EFT therapist
uses an attachment lens to orient and organize relational processes.
Emotion takes precedence as a high-­level information system that
informs the actions, attributions, and experiences of partners and
family members and the connections they seek. The therapist works
with these experiences providing a unique resource for regulating
emotional experience normalizing and validating the varied experi-
ences of relationships under distress. Attachment theory provides a
logical or predictable map for the more extreme emotional
responses associated with relational distress. Relational problems
seen as reactive patterns “make sense” in an attachment frame
where the predictable responses to separation distress result in dys-
regulated emotional responses (e.g., primal panic).

Kobak and colleagues (2015) point to the principle role of emotional

processing and attachment narrative in promoting security in transform-
ing adolescent and parent relationships. The authoring of a “security
script” defines the confidence that youth have in parental availability
which is established through working through primary emotional
    Introduction xi

experiences. Working through these more vulnerable emotions provides

motivation and resource for shifting the family toward a more secure
pattern, or “secure cycle”. In EFT, emotion is both the target and agent
of change (Johnson, 2004) and in EFFT the therapist targets the deeper
emotions underlying relational blocks and uses these emotions as
motivation and means for restoring confidence in parental availability
through enacting a child’s attachment-­related needs. Johnson (2008,
2019) described these conversations as “Hold me tight” conversations
framing the restoration of safety and security found through responsive
emotional engagement in couples and families.

• Corrective Emotional Experiences. Attachment theory informs the

basis for defining relational repair, recovery, and further growth.
Restructuring affection bonds in couple and family relationships is
guided by a clear understanding of the relational processes associ-
ated with felt security, e.g., accessibility, responsiveness, and emo-
tional engagement. In EFT specific intervention practices focusing
on restructuring rigid position through accessing processing and
engaging attachment-­related emotions and needs result in a shift in
individual experience but also a new context that provides a psycho-
logical catalyst for growth (Mikulincer & Shaver, 2016) and a
resource for resilience (Wiebe & Johnson, 2017).

In ABT treatments reflective dialogue provides the means for

attachment-­based change where the goal of these conversations is found
in the ability of a parent and child to see one another where conversa-
tions are more attuned and accurate in their understanding of the child’s
needs and parental responses (Kobak et al., 2015). The safety and
security of parent–child relationships promotes a level of vulnerability
where more implicit responses are made explicit and shared relationally.
These conversations are characterized by emotional balance and the
ability to confront and address differences and changes as parents and
children work through messy moments of development being in sync,
out of sync, and back in sync (Tronick, 2007). These conversations
promote opportunities for family members to “see” and be “seen” in
the significance the relationships they hold.
In summary, the process of change in ABFT follows a logical progres-
sion. As Kobak and colleagues (2013) suggest, the focus of treatment
begins addressing specific situations relevant to attachment and care-
giving and attending to the emotions associated with distress in these
relationships. The therapist then uses these emotional experiences to
foster awareness and understanding of relational injuries and empathic
failures that result in relational distress. This prepares the family for
new attachment/caregiving interactions where repair is made possible
through repairing ruptures and redressing injuries with responsive and
accessible caregiving. This is a familiar logic to the EFT therapist whose
xii Introduction  

focus on emotion as the basis for corrective emotional experiences that

prime and promote new family patterns that provide a safe and sound
basis for human flourishing.
As Johnson (2019) suggests EFT, as an ABT, offers the therapist a
well-­researched process for harnessing the power of emotions to trans-
form relationships and inspire personal growth. The EFT process is
guided by an accessible and responsive therapist who readily responds
to the attachment-­related dynamics that organize interpersonal and
intrapersonal processes. Through assembling and deepening affect, the
therapist provides emotional regulation and exploration targeting
the emotions underlying self-­protective responses. The therapist shifts
the family focus from problems to negative interactions including inflex-
ible family positions that result from the loss of emotional balance
rooted in these insecure patterns. This sets the stage for the EFT thera-
pist’s use of emotion to transform these patterns by deepening a child’s
vulnerability and promoting parental acceptance and availability to
child’s unacknowledged and unmet needs. Through choreographed
enactments the effective sharing of attachment needs and attuned care-
giving responses. These in-­session moments provide corrective emo-
tional experiences that enable parents, partners, and child to gain new
confidence in the felt security of the family. The attachment process is
brought to life in session through a process that enables emotion regula-
tion, exploration, and engagement at the most fundamental level of
family life. EFT brings to light and to life the attachment processes that
guide love in family relationships and offers families renewed opportun-
ities to repair and renew the affectional ties that are the substance of a
secure and loving family.

Purpose

Emotionally Focused Family Therapy: Restoring Connection and Pro-

moting Resilience provides an essential resource to the development and
practice of EFFT. The book provides a manual for applying EFT prin-
ciples to family therapy. EFFT provides a unique framework for the
family therapist that is based on empirically established practices used
to transform emotional experience and restructure relationship patterns.
EFFT focuses on restoring the family as a safe haven and secure base
where family members more effectively emotionally respond, and can
make repairs with a renewed sense of confidence, cohesion, and belong-
ing. The principle aim of this book is to provide a substantive rationale,
practice friendly resource, and reliable guide to EFT practice in family
therapy.
    Introduction xiii

About this Book

This book is organized into three sections. In Part I we describe EFT

theory and practice applied to family therapy. This review focuses on
EFT and its relationship to family systems theory and other attachment-­
related models of family therapy (Chapter 1). We review contributions
from the studies of attachment and emotion regulation to family func-
tioning and implications for EFT treatment (Chapter 2). The EFT
process of change is applied to family therapy including a specific focus
on the EFT tango meta-­framework (Johnson, 2019) used to summarize
the core moves in the EFT process (Chapter 3). Throughout this section
key differences in the EFT therapist’s conceptualization of and interven-
tion with emotional processes in a family environment are clarified.
The second part describes the process of EFFT following the nine
steps of the EFT model. Each chapter reviews the process and practices
associated with specific steps in the EFT approach to families. Each
chapter includes the goals and therapist access points associated with
the specific EFT steps. These access points guide the therapist to marks
for clinical intervention at each step of the process. The use of EFT
interventions typically associated with these steps are described and a
case example is used to illustrate the EFT process at work. Chapters in
this section include:

• Chapter 4. Steps 1 and 2: EFFT assessment and alliance building

review specific steps for managing assessment and alliance building
in dyads, triads, and whole family sessions, recognizing the varied
nature of family compositions and presenting problems.
• Chapter 5. Steps 3 and 4: Working through relational blocks high-
lights the specific focus on family relationships where attachment
and caregiving responses are disrupted. The chapter describes the
therapist’s process of working through these blocks in the broader
context of the family’s negative interaction pattern.
• Chapter 6. Steps 5 and 6: Exploring and engaging family vulner-
ability turns the treatment focus to a child’s unmet attachment-­
related emotions and needs and working through parental
accessibility and responsiveness to these shared concerns. The
process includes deeper emotional work targeting the parent and
child’s view of self and view of other as new possibilities for paren-
tal availability and attachment vulnerability are realized.
• Chapter 7. Step 7: Restructuring family positions focuses on the
essential enactment used to promote a family’s corrective emotional
experience. The phases of this enactment are reviewed and illus-
trated through a family’s active engagement of caregiving in
response to clear and coherent attachment-­related need.
• Chapter 8. Steps 8 and 9: Consolidating security in the family
describes the therapist focus on revisiting past problems from new
xiv Introduction  

positions of security and consolidating the meaning these shifts

toward connection and support have made to the family’s efficacy
and identity.

Throughout these chapters common EFT interventions are described

and clinical transcripts illustrate how these interventions are applied to
families through the steps and stages of the EFFT process. Key EFFT
change events are illustrated highlighting the five key moves in the EFT
tango process. Special attention is given to the ways that corrective steps
in one family relationship often inspire review in other relationships
prompting opportunities for working through other relational blocks or
enhancing felt security across the family.
The final section provides practical illustrations of EFFT treatment
through case examples. Four chapters illustrate EFFT practice with trau-
matic loss, stepfamilies, externalizing disorders, and internalizing dis-
orders. These chapters demonstrate important EFT principles and
practices relevant to the application of EFFT to these clinical presenta-
tions. Detailed case examples highlight the therapist’s use of EFT inter-
ventions in the context of a successful account of EFFT treatment with a
specific family.
Throughout the text we use parent, caregivers, and parents inter-
changeably. We recognize that families form in numerous ways that a
single term may exclude. We found it impractical to list or attempt to
account for all foreseeable family compositions, so we have opted to use
these terms more generically. We also recognize that certain parental
terms including mother and father may represent traditional family
forms that advance particular cultural conventions related to gender and
sexual orientation. Often these terms reflect the cases we have used to
illustrate EFFT treatment and are in these instances particular to these
family examples. The function of caregiving is essential in formulating
an understanding of separation distress in family functioning, and we
recognize that the function of caregiving is better defined by the role of
attachment figure than by the biological status of that caregiver. We rely
primarily on examples of parent and child relationships to illustrate the
EFFT treatment process. Clinical examples demonstrate a range of
application with families including a range of children from school-­age
to young adulthood. However, we also suggest that EFFT has promise
as a resource to intergenerational relationships as the relationship of
attachment needs and caregiving processes remain relevant across the
life span.
In our efforts to provide concrete illustrations of EFFT in practice we
have relied extensively on clinical examples that represent a broad array
of client families who have received EFFT treatment and who have given
permission for their material to be used in professional training, presen-
tations, and writing. Some examples include verbatim transcripts and in
other examples the case material is a compilation based upon similar