Couples therapy has undergone many changes over the years. Different models of therapy, as well as an understanding of the neuroscience of relationships, have emerged on the psychology scene. In my evolution as a couples therapist I have done much reading and studying of different models and have found that Sue Johnson’s model of Emotionally Focused Couples Therapy not only resonates most for me but also for the many couples that come to my practice and are helped by this way of seeing relationship.
“My, How Couples Therapy Has Changed! Attachment, Love and Science” is an article by Sue Johnson from the website Pschotherapy.Net. I find it to be a terrific overview of couples therapy and am presenting excerpts from the article here. To read the entire article go to www.psychotherapy.net/article/couples/couples-therapy-attachment
Couples therapy has experienced a revolution. The key element in this revolution is the development of a new science of love and love relationships. As Yogi Berra told us, “If you don’t know where you are going, you wind up somewhere else.” Without a clear model of love and the process of connection and disconnection, it is difficult to know how to focus interventions on the defining issues and moments in a relationship. It is hard to know what changes will really make a difference and what the overall goal should be in couples therapy. If love is, as Marilyn Yalom in her book The History of the Wife suggests, “an intoxicating mixture of sex and sentiment that no one can understand,” then couples therapy is just appropriate sitcom material. As she suggests, sex and emotion do seem to be intrinsic to love, but it does not have to be a complete mystery.
There are many strands in this new science of love relationships, but they all came together in the growing literature on adult attachment, a relatively recent extension of the English psychiatrist John Bowlby’s work on the emotional bonds between mothers and children. The attachment perspective gives the couples therapist a meaningful and effective map to the drama of distress between partners.
A new scientific and practical theory of love
The multitude of studies on adult attachment tell us that the essence of love is not a negotiated exchange of resources, a friendship, Nature’s trick to get you to mate and pass on your genes, or a time-limited episode of delusional addiction.
Love is a very special kind of emotional bond, the need for which is wired into our brain by millions of years of evolution. It is a survival imperative. The human brain codes isolation and abandonment as danger and the touch and emotional responsiveness of loved ones as safety, a safety that promotes optimal flexibility and continual learning. Jaak Panksepp11, in his neurobiological studies, finds that loss of connection from attachment figures triggers “primal panic,” a special set of fear responses. As Bowlby notes, the words “anxiety” and “anger” come from the same etymological root and both arise at moments of disconnection, when attachment figures are non-responsive. This need for emotional connection is not a sentimental notion. The basic image of who we are and what our most basic needs are, namely that we are social animals who seek such connection, is reflected in health studies. For example, it is now clear that emotional isolation is more dangerous for your health than smoking, and that it doubles the likelihood of heart attack and stroke.
Attachment theory states that we need a safe haven relationship to turn to when life is too much for us and that offers us a secure base from which to go confidently out into the world. This is effective dependency. Many psychotherapy clients learn that their problem is that they are too close or undifferentiated from loved ones. The evidence, however, is that secure, close connection is a source of strength and personality integration rather than weakness. Studies show that the securely connected have a more articulated and positive sense of self. Eighteen months after 9/11, researcher Chris Fraley2 found that securely connected survivors, who could turn to others for emotional support, were able to deal with this trauma and grow from it, whereas insecurely attached survivors were experiencing significant mental health problems. Secure connection is shaped by mutual emotional accessibility and responsiveness. This is the heart of the drama that plays out in couple therapy. The fights that matter in a relationship are only superficially about the kids or money. Partners and therapists can spend many hours talking about these content issues instead of focusing on how the couple talk and more specifically, on the key attachment questions that drive a couple’s negative dance. The key questions are: “Are you there for me?” “Do I matter to you?” “Will you turn towards me and respond to me?” Partners often do not know how to ask these questions, and therapists often miss them or even see them as a sign of immature dependency.
If you look through the attachment lens, the negative spirals that distressed couples create and are victimized by are all about separation distress—the deprivation and emotional starvation that comes from emotional disconnection. When we cannot get an attachment figure to respond to us, we step into a wired-in sequence of protest, first hopeful and then angry, desperate, and coercive. We seek contact any way we can. Clients often say, “I poke him and poke him—anything to get a response from him, to know I matter to him.” If we cannot get a response, despair and depression come to claim us. This way of understanding the usual demand-withdraw cycle in a distressed relationship allows the therapist to help partners to see the game instead of the ball, and to come together against the common enemy of the isolation and the negative dance that is consuming their relationship. It also implies that unless the underlying attachment issues and primal panic is addressed, other approaches, such as insight or learning skill sequences, are unlikely to be effective.
Shaping a sense of safe connection
If we cannot find a way to turn towards our partner and shape a sense of safe connection, there are only two other secondary strategies open to us and they map onto two emotional realities with exquisite logic. Strategy one is to become caught in fear of abandonment and demand responsiveness by blaming; unfortunately, this often threatens the other and pushes this person further away, especially if this strategy becomes habitual and automatic. Strategy two is to numb out attachment needs and feelings and avoid engagement (and conflict), that is, to shut down and withdraw. Unfortunately, this too shuts the other person out. Both these secondary strategies are ways of trying to hang onto an attachment relationship and deal with difficult feelings, but they often backfire. Over the course of EFT studies and practice, we have been able to chart the emotional realities of partners as they use these strategies. Once they can order and name their feelings, blamers speak of being alone, left, unimportant, abandoned, and feeling insignificant to their partner. Underneath their anger they are extremely vulnerable. Withdrawers speak of feeling ashamed and afraid of hearing that they are failures. They believe that they can never please their partner and so feel helpless and paralyzed.
Attachment-oriented couples therapy
When couples can reconnect in this way, immensely positive bonding events take place. Partners begin to see each other more fully and are more authentic and compassionate with each other. Their connection empowers each of them and opens the door to all the benefits that research tells us comes with secure attachment. Their way of engaging with their own emotions, their loved one and the world, which now contains a safe haven, shifts. The research on bonding suggests that as they make this kind of connection, lovers are likely flooded with the cuddle hormone, oxytocin. This is released during orgasm, breast-feeding or simply when attachment figures come close to us. Oxytocin is also linked to the release of dopamine, a natural opiate linked to pleasure, and down-regulates cortisol, the stress hormone. The neurochemical basis of bonding—the physical source of the calm euphoric feeling associated with love—is no longer a mystery. Once a couple can create these kinds of interactions, they can move into the final consolidation phase of EFT.
Dr. Sue Johnson is one of the originators and the main proponent of Emotionally Focused Couples Therapy (EFT). She is a Professor of Clinical Psychology at the University of Ottawa, Canada, Director of the Ottawa Couple and Family Institute and the International Center for Excellence in Emotionally Focused Therapy and a Distinguished Research Professor in the Marital and Family Therapy Program at Alliant University in San Diego, California.