Jan DiSanto, RN, MS, MFT
Licensed Psychotherapist
Published Articles
by Jan DiSanto


By Jan DiSanto, RN, MFT

Emotionally Focused Therapy for Couples (EFT) developed by Susan Johnson is a very technical, complex model, but it has some simple concepts that help define secure attachment in relationships.  We are all hard wired for attachment:  we need love and security.  How we deal with this vulnerability is what determines how we are in relationships.  When love doesn’t work, it hurts, and secure emotional attachment is the cure.

Love is about being emotionally responsive, and most couples come to treatment when they are stuck in a pattern that doesn’t work and is causing distress.  In EFT, we talk about these patterns as a “dance” (S. Johnson).  We help couples step out of their negative dance and create a new dance that is safer, closer, and more satisfying.

We’re social animals, and men and women have the same attachment needs.  Our brains are not wired to do things alone.  If we have love and security (whether from a partner, friend, family, community, spiritual resource, pet, etc.), it’s easier to face the world.  Studies done on 9-11 survivors revealed that the people who could share their experience with others felt stronger afterwards, and the ones who didn’t have someone to share with developed PTSD symptoms.  We’ve also learned from neuroscience research that “proximity to an attachment figure tranquilizes the nervous system.” (S. Johnson)

Couples come to therapy because there is a rupture in the attachment system.  When they fight, it’s about the nature of their emotional connection.  Fighting is often separation protest.  Even if people have never experienced security or seen a good relationship, they will fight for connection and love.  One way to think about this and talk to couples about it is using the acronym:  the “ABC’S of attachment” which refers to Acceptance, Belonging, Comfort, and Safety (Rebecca Jorgensen, EFT Trainer).  These are the basic needs of attachment that we all have.
Acceptance -- Am I acceptable to you?  Do you honor and value me as I am?
Belonging -- Am I important to you?  Do I matter?  Will you share with me?  Can you see me and take me in?  Will you be my touchstone and my shelter from the storms of life?

Comfort -- Are you emotionally present?  If I reach for you will you be there?  Will you come when I call and put me first when I’m in distress and comfort me?

Safety -- Can I trust you to be a safe haven for me?  Can I be vulnerable with you and express my deeper feelings and be held and reassured by you?

So how do we create secure attachment in EFT?  This struggle for secure connection typically takes one of three forms:  Pursue-Withdraw (aka criticize-defend), Attack-Attack (aka blame-blame), or Withdraw-Withdraw.  Couples with a trauma history have what is known as a complex cycle and they can both pursue and withdraw. Stage One of EFT begins by framing the pattern as a “negative cycle” or “negative dance”, and then moves into mapping out this cycle. The mapping consists of identifying the behaviors, the secondary reactive emotions, the thoughts, beliefs, perceptions of each partner, as well as the primary emotions and attachment needs.  The primary feelings that pursuers generally feel are disconnected, abandoned, invisible, and shut out.  They especially want comfort and belonging.  Withdrawers typically feel rejected, inadequate, emotionally numb, and overwhelmed and need acceptance and safety.
These underlying primary feelings are transformed into secondary or reactive emotions in order to protect our vulnerability when we experience unmet attachment needs and conclude that attachment is dangerous.  But the secondary emotions work against us by making it harder to get our needs met and by pushing people away.  Common secondary emotions are:  frustration, irritation, annoyance, fury, indignation, revenge, resentment, disgust, anger, contempt, hatred, spite, envy, jealousy.

As we’re mapping the cycle, we’re connecting these expressions of the cycle within each person and between the two partners to see the dance which we are continually reflecting back to them in an attachment context using attachment language.  As the couple begins to see, experience, and process their cycle and the emotions that go with it, they de-escalate.
Once de-escalated, the couple moves to Stage Two of EFT.

In Stage Two, the couples become more emotionally open and express their deeper fears, longings, needs, and feelings which we sometimes refer to as “raw spots” (S. Johnson).  As they do this, partners become aware of their true unmet needs ( the ABC’s).  The therapist facilitates the expression of these needs and promotes acceptance of them by their partner.  Experiencing their true, unmet needs evokes healthier emotions from their partner and a desire to fulfill those needs.  This creates powerful bonding events which forge a new positive relationship dance.

The third stage of EFT is consolidating and integrating the gains they’ve made and putting them to work in the relationship.  The couple has a more secure attachment in place, they are accessible to one another, emotionally responsive, and engaged.  The ultimate goal of EFT is a healthy interdependence where couples can give and accept love, reach for their partner and receive from their partner.  This emotional responsiveness has three main aspects which are related to the ABC’s which Sue Johnson calls  “A.R.E.”  They are: Accessibility -- being there for the partner and staying open and connected, Responsiveness -- they can rely on their partner to prioritize them and respond when they call, and Engagement -- knowing that they are valued and will both stay close.  In other words: “Are you there, are you with me?” (S. Johnson).

EFT provides an explicit road map for the process of working with couples and shifting their dynamics.  It has a broad theoretical base combining attachment and  systems theories,  emotional processing and co-regulation, and mindfulness.  This provides a lens through which to organize the information that is continually coming in, and it informs the specific interventions that EFT therapists do to elucidate and shift the couple’s process in the direction of a more secure attachment.  “When EFT is successfully implemented, each partner becomes a source of security, protection, and contact comfort for the other” (Sue Johnson).


Jan DiSanto, RN, MS, MFT, is in private practice in Mill Valley. She has been working with couples and individuals since 1973 when couples therapy was in its early stages, and has experienced the subsequent evolution of the field.  She is the first therapist to be certified in Marin County as a practitioner and supervisor of Emotionally Focused Therapy for Couples, is also certified in the Gottman Method of Couples Therapy, and is an experienced EMDR therapist working with trauma. With individuals she uses an integrative experiential attachment oriented framework. She is available for referrals and consultations.

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