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Chapter

Emotionally Focused Family

Therapy: Rebuilding Family Bonds
Katherine Stavrianopoulos

Abstract

Relationships with parents, siblings, and other family members go through tran-
sitions as they move along the life cycle. Resilient families realign their relationships
to respond to the changing demands and stressors within the family system. Those
who are unable, find themselves in repetitive patterns marked by conflict and dis-
tress, often resulting in their need to seek treatment. Based on attachment theory,
Emotionally Focused Family Therapy (EFFT) is a pragmatic short-term treatment
approach designed to alleviate distress in family functioning. This chapter provides
an overview of EFFT process, its theoretical underpinnings and the strategies EFT
family therapists employ to promote positive outcomes. The presentation of a case
study provides a unique lens where the therapist illustrates moment to moment
interventions in an attempt to create new and more favorable family interactions,
ones that enhance family members’ feelings of attachment, empathy, communica-
tion and stability.

Keywords: emotionally focused family therapy, family distress, adolescence,

attachment, negative interactions

1. Introduction

In the last 20 years, research studies have demonstrated the effectiveness of emo-
tionally focused couple therapy (EFT) in helping couples repair their distressed rela-
tionships. The natural extension and broader application of EFT couple’s treatment
can prove especially valuable and effective when working in a family system [1, 2].
The foundational principles of Emotionally Focused Couple’s Therapy is based on
attachment and bonding theories that aim to help individuals gain a greater awareness
of their emotions, to provide them with strategies to effectively cope, regulate, and
transform their emotions[3]. It is a short term, evidence-based approach that allows
the therapist to set goals, target key processes, and chart a destination for couples to
identify and remove those emotional blocks which derail the promotion of healthy
functioning, while providing alternative approaches that serve to increase levels of
attentiveness, empathy and feelings attachment and belonging with one another.
According to Johnson, [4] EFFT is similar to emotionally focused therapy for
couples, except that with families, the goal is “to modify family relationships in
the direction of increased accessibility and responsiveness, thus helping the family
create a secure base for children to grow and leave from.” Working within a larger
family system can be especially daunting as therapists attempt to navigate the vast
landscape of family dynamics encompassing multiple, complex interpersonal pro-
cesses between members, especially the powerful bonds that exist between parent

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Family Therapy - New Intervention Programs and Researches

and child, which when weak and broken—are often the root of familiar distress and
dysfunction. The core of the human experience of a family lies within its ability to
create supportive bonds that sustain it during turbulent and stressful times in its
life cycle. The application of EFT to family treatment offers a practical, useful and
expedient model from which to effectively bolster stronger and more empathic
bonds between parents and their children.
This chapter provides an overview of EFFT process, its theoretical underpin-
nings and the strategies EFT family therapists employ to promote healthy family
functioning. Through a presentation of a case study, beginning therapists are
provided a unique lens from which to view the interactions of both family and
therapist as they attempt to create new family interactions, marked by increased
parental accessibility and responsiveness to children, which ultimately leads to their
enhanced sense of attachment, communication, belongingness and security.

2. Theoretical framework

Emotionally Focused Family Therapy (EFFT) is an integration of humanistic [5]

and systemic therapeutic approaches [6]. The focus of treatment is on the ongoing
construction of a family’s present experience and how patterns of interaction are
organized and expressed between family members. Another significant aspect of
EFFT is its detailed attention to emotions. Identifying emotions is viewed by the
therapist as essential in how family members view themselves and others, or an
event. Emotions are hard wired in our brain and are meant to inform us about our
environment. They also, contain physical impulses, which are designed by nature
to be an immediate and adaptive call to action. In EFFT, emotions are categorized
as primary and secondary. Primary emotions have been identified by researchers as
universal emotions, such as joy, anger, fear, sadness, surprise, and shame. These emo-
tions are frequently outside of people’s awareness. Secondary emotions are defined as
reactions, and they help people cope with their primary emotions. The word “emo-
tion” comes from the Latin word, emovare meaning “to move.” Emotions are openly
identified, shared and often reframed by the EFFT therapist, as a vehicle to help
family members navigate into new and more favorable patterns of interaction, one’s
that are more empathic and capable of building safe and healthier relationships.
EFFT is grounded in attachment theory and based on the work of psycholo-
gist John Bowlby [7]. Bowlby maintains that human beings are biologically and
fundamentally driven to pursue relationships that create security and belonging. He
contends that the most critical attachment relationship is an infant’s sense of pro-
tection created by the primary caregiver (typically the mother) through a series of
reciprocal interactions which promote bonding and love. As Karen [8] in Becoming
Attached says about love, “You don’t need to be rich or smart or talented or funny;
you just have to be there.” A parent’s emotionally engaged presence makes all the
difference between disconnection and security. Throughout the cycle children and
adolescents reach out to their primary attachment figures when they are in distress.
If they experience parents as non- responsive or unavailable, it is natural for them
to feel isolated, frightened and anxious. Feelings of insecurity in children are likely
to heighten expressions that call for parental reassurance. Conversely, children may
engage in behaviors that disengage and avoid their expressions of distress, particu-
larly in moments of need [9–11]. In either scenario the resulting negative relational
experiences foster instability and anxiety in the family system.
In EFFT, one’s sense of a secure attachment is linked to positive mental health.
Children who are securely attached are best able to turn to their attachment figures
for comfort and support [12]. Mikulincer and Shaver [13] capture the distinction

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Emotionally Focused Family Therapy: Rebuilding Family Bonds
DOI: http://dx.doi.org/10.5772/intechopen.84320

between these predictable patterns of attachment behavior as shown in their

research when they describe the issues of secure vs. insecure scripts. The secure
script is: “If I encounter an obstacle and/or become distressed, I can approach a sig-
nificant other for help; he or she is likely to be available and supportive; I will experi-
ence relief and comfort as a result of proximity to this person; I can then return to
other activities [13].” However, when the attachment system remains in an activated
state, there are two different insecure coping responses. The avoidant (dismissive)
approach “includes rapid self-protective responses to danger without examining
one’s emotions, consulting other people or seeking to receive help from them [13].”
The implicit script is, “If I am in distress, I will carry on with other activities.” In
contrast, the anxious approach is described as always being on guard for threat, and
having difficulty receiving comfort. The implicit script is, “If I am in distress, I will
reach for you and reach for you and reach for you, endlessly and to no avail.”
Attachment anxiety and avoidance are natural responses to the lack of confi-
dence in the parents’ emotional availability. Drawing from attachment theory, the
EFFT therapist conceptualizes distress in terms of attachment dilemmas in which
ineffective responses to attachment needs fuel miscommunication, creating parent-
ing dysfunctions and exacerbating symptoms associated with individual psycho-
pathology [14]. The therapist must obtain a clear understanding of symptoms that
generate distress in the family and furthermore, evaluate the parent(s) availability
and their children’s confidence in their availability. These observations will provide
the therapist with information about the attachment quality in the parent–child
relationship. Insecure attachment is evident when the parent’s capacity for empathy
is blocked, giving precedence to feelings of anxiety and anger, thus viewing the
child as difficult, antagonistic or uncooperative. In such instance, parents tend to
blame the adolescent or child as solely the identified patient and remain oblivious to
the underlying emotions, of fear, or sadness that are at play [15]. The EFFT thera-
pist connects the child/adolescent’s symptoms to their perception that the caregiver
is unavailable and detached. This perception increases a child’s anxiety, anger and
defensiveness that contributes to the presenting problem [9, 16]. The goal of the
EFFT therapist is to work through a series of interventions that reframe the fam-
ily problem as one arising out of an attachment crisis, and subsequently works to
normalize family difficulties without blaming anyone [17]. Key to the EFFT process
is understanding and integrating these core theoretical principals.

3. EFFT process: Steps and stages

The process of EFFT is categorized into three stages and nine treatment steps.
In the initial four treatment steps, the therapist carefully focuses on assessing the
interactive styles of the family and judiciously works to deescalate any conflicts
as they emerge. In the middle phases of treatment (steps five, six, and seven), the
therapist and family, work in concert to find new ways to establish more secure
familial relationships. In the final two steps of treatment, the therapist highlights
and validates new patterns of positive interaction. As importantly, the therapist
reinforces family members confidence to handle future conflicts and issues now
that they are armed with greater empathy and understanding for one another. The
stages and steps of EFFT are outlined and discussed below.

3.1 Stage one: Deescalating family distress

Step 1: Forming an alliance and family assessment.

Step 2: Identifying negative interactional patterns that maintain insecure
attachment.

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Family Therapy - New Intervention Programs and Researches

Step 3: Accessing underlying emotions informing interactional positions/rela-

tional blocks.
Step 4: Reframing the problem in light of relational blocks and negative interac-
tion patterns.
The primary focus in stage one is for the therapist to identify and track behav-
iors and secondary emotions that fuel attachment insecurities. The therapist
guides the family away from focusing on the content of their presenting conflicts,
to developing a more attentive awareness about what underlies their expressed dif-
ficulties. The therapist accomplishes this task by tracking familial behaviors driven
by intense emotion. As therapists understand, in times of distress, family members
commonly deal with their feelings and interpersonal behaviors in unproductive
ways. Some may withdraw, argue, submit, explain, or engage in other behaviors
designed to minimize and distract from their emotional pain. In this stage, the
therapist pays close attention to the interactive behaviors of the family and
reframes maladaptive or secondary emotional responses in efforts to bring into
awareness their negative cycle of interactions. A negative cycle is defined as a pre-
dictable interactional pattern that gets repeated and organizes the family around
insecurity, rather than vulnerability. Negative cycles are fatiguing and destructive
for family functioning. Tracking the cycle interrupts the behavior and reveals for
the first time to the family their true underlying emotions and how their current
behaviors serve as protective mechanisms to avoid discomfort and pain. Accessing
primary emotions such as fear, hurt, and sadness creates empathy among family
members, facilitates responsiveness, and helps the family deescalate [18]. During
this phase of treatment, the therapist often returns to utilizing tracking interven-
tions to reemphasize to the family the importance of understanding and dealing
with the underlying issues of their discontent in order to enhance family stability
and healthy functioning.

3.2 Stage two: Restructuring family interactions

Step 5: Accessing and deepening a child’s disowned aspects of self and attach-
ment needs.
Step 6: Fostering acceptance of child’s new experience and attachment related
needs.
Step 7: Restructuring family interactions focusing on sharing attachment needs
and supportive caregiving responses.
In stage two, the focus is on deepening and expanding primary emotions
and unmet attachment needs, in order to reshape attachment bonds between
family members that are more secure and connected. The change event in stage
two involves the therapist accessing the needs embedded in the newly expanded
primary emotions that drive the negative family cycle; and helping family mem-
bers learn to identify and request that previously unexpressed core attachment
needs be addressed. The therapist intentionally structures interventions known
as enactments that function to restructure attachment bonds between family
members [14]. Typically, these requests are for direct care, contact, or comfort
and the shift is premised on the parent(s) ability to respond to their children’s
vulnerability. It is very common in this stage to observe parents having the desire
to respond in a more emotionally connected way to their child, but their empa-
thy may be restricted. In such instances, the EFFT therapist will work with the
parents to develop their capacity and ability to respond in a way that shifts family
relationships toward more secure bonds, replacing negative and harmful cycles
of interactions.

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Emotionally Focused Family Therapy: Rebuilding Family Bonds
DOI: http://dx.doi.org/10.5772/intechopen.84320

3.3. Stage three: Consolidation

Step 8: Exploring new solutions to past problems from more secure positions.
Step 9: Consolidating new positions and strengthening positive patterns.
Finally, in stage three of EFFT, positive cycles of bonding are consolidated and
integrated into the life of the family. At the end of this stage, the family is best able
to integrate new ways of engaging in discussions and investing in greater security
[18]. Discussions are characterized by more openness, responsiveness, and engage-
ment among family members. It is imperative for the family to learn how to repair
failed attempts to connect outside of sessions. Before termination, the therapist
affirms that the family is now able to handle its issues and conflicts by examining
and resolving them in new and more effective ways. The therapist also focuses
on amplifying the family’s vision to include more mindfulness of positive affect,
vulnerable reaching, and connection.

4. Core interventions

There are two primary sets of interventions utilized by EFFT clinicians to help
families navigate through the various stages of the treatment process. These core
interventions are designed to direct families toward developing relational bonds
that enhance their security, communication and strength. The first set are inter-
ventions for accessing, expanding and reprocessing of emotional experience. The
second set are interventions for restructuring the family interactions.
The EFFT techniques used within these categories are described below,
followed by an example of a therapist’s response to highlight and reinforce a more
concrete understanding of the techniques deployed. For a more detailed explana-
tion the reader is referred to the EFT manual [3].

4.1 Accessing, expanding and reprocessing emotional experience

4.1.1 Empathic reflection

Reflect (name, order, or distill) emotional processing as it occurs. Slows down

the process, directs and focuses attention inward, helps the therapist attune to the
client experience, thus conveying understanding and helps in creating alliance.
Empathic reflections need to be specific and vivid in order to move the client into a
deeper awareness of their emotional experiencing.
Therapist: “I think I hear you say that you become so anxious about his future
that you find yourself wanting to control, wanting to know what he has in mind
because not knowing or not having ‘a say’ is so overwhelming. Is that it? And then
you become very critical with your son. Is that right?”

4.1.2 Validation

Conveys that the client is entitled to their experience. Such statements func-
tion to affirm, and legitimize, the client’s experience as understandable, given the
attachment relationship context. Validating statements start with, “it makes sense
that you would feel this way, given (state specific context)”.
Therapist: “That makes sense to me, that when you feel that things are about to
escalate between you and your mom, you go away, and you avoid any conversation.
Is that right?”

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Family Therapy - New Intervention Programs and Researches

4.1.3 Evocative responding

Through the use of questions, evocative language, and metaphors the therapist
opens up the client’s experience and encourages them to take another step toward it
Therapist: “What’s happening right now as you hear him say that?” “What’s it
like for you when she follows you around the house, pushing for your attention?”

4.1.4 Heightening

This intervention intensifies, clarifies, and deepens an emotion through persis-

tent focus, reflection or enactments. Thus, allowing the client to identify and accept
their emotional experience. The therapist’s pacing, tone and timing are significant.
The acronym RISSSC, implying emotional risk [3], represents how this intervention
is done: with repetition, images, speaking simply, softly, slowly, and using client’s
words. The soft tone heightens vulnerability and sooths the dysregulated brain, so
the client can process clearly.
Therapist: “ This sounds really important, can we stay here for a bit, I think I
hear you say that deep down you really go to a bad place, a place where you get the
message that you are nothing but a failure in their eyes. A real disappointment for a
son, and that makes you feel so sad, so hurt inside.”

4.1.5 Empathic conjecture

Therapist offers an interpretation of client’s experience, or a hunch seen through

the attachment lens. This facilitates a more intense experiencing from which new
meanings may arise and an expanded awareness. It is important to convey tentative-
ness when offering a conjecture and to check if what is communicated matches the
client’s experience.
Therapist: “As I listen to you, I hear you saying that you are angry about her lack
of concern for you, but I see the tears in your eyes and I wonder if you are also say-
ing that you are hurt by her lack of concern. Does that seem to fit?”

4.2 Restructuring interventions

The following interventions are used in EFFT to address the restructuring task:

4.2.1 Tracking, and reflecting interactions

Reflections that track family members behaviors slow down and clarify the
interactional process.
Therapist: “So, when Alex gets frustrated and walks away ignoring what you say,
you get angry too and follow him. You need him to listen to you. And, when your
mom follows you around wanting your attention it makes you shut down even more.”

4.2.2 Reframing

Reframing interactions in the context of the negative cycle, and attachment

needs. An attachment reframe functions to access a positive meaning or inten-
tion for a seemingly negative response. It shifts the view of the member to a
positive portrayal.
Therapist: “You don’t experience that the louder she gets, the more desperately
she is trying to find you. It sounds as if she is upset with you, but she is doing
everything she can to get close to you.”

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Emotionally Focused Family Therapy: Rebuilding Family Bonds
DOI: http://dx.doi.org/10.5772/intechopen.84320

4.2.3 Creating enactments

The therapist requests direct sharing of a clearly distilled message from one fam-
ily member to another. Enactments, the most powerful intervention in EFFT, their
function is to heighten emotional experience and reshape new interactions among
family members which lead to positive cycles of accessibility and responsiveness.
Therapist: “Can you tell her, ‘I go away because I don’t want things to get worse
between the two of us.’ Can you tell her this?”

5. Case illustration

To help illustrate EFFT treatment in action, a case study of a family recently seen
by the author is provided below:
The Aldo Family: Presenting Concern and Relevant History
The family is composed of James and Penny (names and identifying information
have been altered), a professional couple in their early 50s, married for 28 years.
They have two children; Ellie (23) and Alex (19). The couple has been on and off in
couple therapy for a year. The presenting problem described by the parents focused
on their son Alex, who had told them at the end of his third semester in college that
he wanted to drop out because “this kind of education” was not for him, and he
did not see how it would help him get a job. Both parents were very upset and after
much discussion, hesitantly agreed to allow him to take a “gap year.” It was their
understanding that after the year break, Alex was to resume his studies. During
that time Alex worked as a waiter, earning spending money while living at home.
His work hours provided him with the flexibility to develop an online business that
in the long run became a source of income. Alex enjoyed being independent and
learning about the world through travel, reading and much You Tube video viewing.
A year later, his goal was to be an entrepreneur and not re-enroll in university. Both
parents were extremely upset with Alex and had tried to talk “some sense” into him,
but to no avail. It was at this point that Penny- the mom requested a family session.
During the first two sessions the therapist met once with the entire family in order
to assess they viewed the problem; and once individually with Alex, in order to develop
an alliance and get to know him better. Alex, was a slender young man with short
blond hair, and green eyes. He appeared younger than his years and was soft spoken as
he stated that he was eager to start the process. Alex perceived his mother as critical,
with strong opinions about a college education and persistent about him returning
to school. This made him angry and he said that he frequently avoided conversations
with her because they always ended up on the topic of his future. Mom viewed her son
as unreasonable, and disrespectful because he ignored her questions and refused to
engage with her. She experienced him as spoiled, entitled and selfish; this made her feel
frustrated. James agreed with his wife and said that the tension between Alex and his
mother stressed him, but he did not know what to do to resolve the issue.
Right from the start the EFFT therapist aims to understand the ways family
members react to each other and tracks their interaction pattern. As family mem-
bers discuss how they each perceive their concerns, reactive emotional responses are
expressed or suppressed, thus allowing the therapist to witness the negative interac-
tion pattern firsthand. The therapist tracks and reflects the behaviors that elicit the
negative response and begins to identify the family pattern that is associated with
the problem [3, 4]. It was obvious that this family was caught in a reactive pattern of
defensiveness, which escalated with increasing anger and frustration. The family’s
escalation included mom trying to advise Alex and Alex avoiding the conversation.

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Family Therapy - New Intervention Programs and Researches

The more mom insisted in engaging him the more Alex ignored her and she would
get so upset that she would turn to her husband for help. James, not knowing what
to do would try to calm her by promising he would talk to Alex. However, his
approach was not successful either. The more they tried to talk to him or present
him with consequences for his actions, the more Alex pulled away. The more he
pulled away, the less valued they felt. It appeared to be a hopeless situation.

5.1 EFFT therapeutic interventions

5.1.1 Stage one: Family De-escalation

What follows is an actual dialog from the initial sessions with the family. This
excerpt highlights the goal of stage one treatment to track the cycle between Alex
and his mom and attempt to deescalate the tensions between family members.
ALEX: Well, yes… she is unbelievable. She asks me questions, a lot of questions
about what I am going to do with my life and I do answer her but a few days later she
is asking me the same questions!
THERAPIST: all these questions coming your way, regarding your future and
you answer them, and then she asks again. Is that right?
ALEX: Yes, it’s so frustrating because it’s like, does she not remember? What’s
going on?
THERAPIST: I can understand your frustration- because, you wonder ‘isn’t what
I say important enough to remember’ Is that right?
ALEX: yes, that’s exactly right.
THERAPIST: When your mom asks the same question, what happens inside
you? What do you say to yourself?
ALEX: I hear myself saying, what is the point? I get frustrated.
THERAPIST: Are you feeling frustrated right now?
ALEX: Yes!
THERAPIST: Would you be willing to stay curious with me for a moment about
this part that feels frustrated? Do you notice it somewhere in your body? (staying
with emotion in his body slows him down and intensifies the feeling).
ALEX: I feel tightening in my chest and my shoulders.
THERAPIST: you hear your mom asking another question about your plans, you
get frustrated, which you notice as a tightening in your chest and shoulders, is that
right?
ALEX: yes.
THERAPIST: And then what does this frustrated part want to do or say to mom?
ALEX: It wants to avoid her.
THERAPIST: How do you do that?
ALEX: By ignoring her and eventually leaving the room.
THERAPIST: What would happen if you did not ignore her and did not leave; if
you stayed and talked with her?
ALEX: Nothing good would come out of that. I will only disappoint her again.
There is no point.
THERAPIST: So, if talking makes it worse and you worry that you will disap-
point her, then it makes sense that you do not want to engage. It sounds like when
these fights happen there is nothing more to do but leave. Is that right?
ALEX: That seems to be the best option, right then and there.
THERAPIST: It makes sense to me that you leave the conversation to avoid
making things worse between the two of you and, not disappoint your mom. Do you

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Emotionally Focused Family Therapy: Rebuilding Family Bonds
DOI: http://dx.doi.org/10.5772/intechopen.84320

think your mom knows this? Can you tell her that you leave in order to not escalate
things between the two of you?
ALEX: (turning to mom) I do not get into it with you and I walk away because I
do not want us to fight and I do not want to disappoint you.
MOM: I had no idea.
THERAPIST: Yes (nodding). This is something new you are learning about Alex.
The therapist also works with mom to identify her behaviors, thoughts and feel-
ings as they relate to the negative cycle.
THERAPIST: And when he walks away what happens to you?
MOM: I get fired up and I follow him, and I ask again. I insist that he listens to
me and not ignore me.
THERAPIST: Would you be willing to stay curious with me for a moment about
this part that gets all fired up? Do you notice it somewhere in your body?
MOM: I feel tense all over.
THERAPIST: you see Alex walk away, you get very angry, which you notice as a
tension all over your body, is that right?
MOM: Yes.
THERAPIST: And then what does this angry part do or say to Alex?
ALEX: It gets very focused, very energized, and follows him relentlessly to get
his attention.
THERAPIST: What would happen if you did not do that?
ALEX: I would not know what he is up to and I would not be able to help him. I
have good advice- I have been where Alex is now, and I can possibly spare him the
heartache if he would talk with me. I worry that he will make a mistake, but he does
not value my input.
THERAPIST: You want Alex to value your advice. So, you get angry and you
insist on engaging in a conversation in the hopes that you can help him see the value
in what you say. Is that right?
MOM: That’s right.
THERAPIST: What does it feel like when you think that Alex does not value you?
MOM: (deep sigh) It feels sad.
THERAPIST: You want him to value you and your input and when he does not
that makes you feel sad. Is that right?
MOM: (in soft voice) yes.
THERAPIST: Do you think Alex knows that? What would it be like to share a
little bit of that with him? That underneath your anger you feel sad because you
think that he does not value you? Can you tell him that?

5.1.1.1 Treatment focus and progress in stage one

In the above excerpt the therapist looks at the pattern as it unfolds in the room
between Alex and his mom. Family de-escalation occurs as Alex and his mom
begin to understand their part in the negative interaction pattern and how their
attachment-driven behaviors trigger predictable responses in each other. In this
case every time mom needed to be assured that Alex was on the right path regard-
ing his future, she asked questions which in turn triggered Alex and made him
feel that an argument was imminent and he would disappoint his mother. He then
pulled away to avoid the argument, leaving mom to feel sad and not valued and
fearful that she was failing as a mother. This triggered mom and she then followed
Alex around the house insisting that he engage with her. Alex would get more
frustrated and eventually would leave the room thus confirming mom’s fear of not

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Family Therapy - New Intervention Programs and Researches

being valued. The therapist helps both uncover these deeper emotions and then
invites them to do an enactment. In other words, to turn toward each other and
engage in a different conversation. Until now, neither was aware how they pro-
tected themselves in their relationship nor had they been able to talk about their
underlying feelings. The enactment is successful, and both Alex and mom have a
new understanding about each other’s behavior. He expresses that he values her
and wants to be able to talk with her without arguing because it does not feel good
to either of them. They both share in the new experience of staying engaged. This
awareness shifts the focus from blaming each other to owing their contribution in
the negative cycle. In turn, this begins to alter their experience; they feel calmer
and more open. A level of safety is created that will allow us to go deeper into
vulnerabilities in the next stage.

5.1.2 Stage two: Restructuring family interactions

What follows below is an example of actual dialog used to illustrate the process
of restructuring family dynamics:
THERAPIST: A few sessions ago you talked about feeling sad because you see
yourself as a disappointment for your parents. Do you remember?
ALEX: Mhmm.
THERAPIST: I guess, I am curious to know, more about this place that you go to…
when you feel that… you are a disappointment. Is it okay for us to go to that place?
ALEX: Sure. (pause) It’s pretty bad. I try not to think about it. Instead, I just try
to focus and work harder.
THERAPIST: It’s so bad that you try to not think about it? Right now as we are
thinking about it, talking about, notice what happens in your body.
ALEX: I feel flushed and I feel tightness in my throat. It’s a bad feeling. That’s
why I do not like to think about it.
THERAPIST: Sure, it makes sense. And… who sees you in that place? Who
knows about that?
ALEX: Nobody knows. Nobody sees how much I try to make them proud of me.
Instead I am told that everything I do is wrong. My whole approach is wrong, I am
all wrong! (eyes closed).
THERAPIST: That’s really painful—it’s hard for you.
(Long Pause)
ALEX: Sometimes it feels that I might be running out of time… you know… my
dad had problems with his heart last year. (At this point Alex, with his eyes closed
and tears running down his cheeks, can hardly speak. After a long pause he contin-
ues). I am afraid that I might not have the chance to prove myself and it will be too
late. And that maybe I should give up on my ideas and listen to theirs because it will
be faster, but then I get conflicted and I think that, it’s not right to do something
that I do not believe in. And I really believe in this. I do not want to disappoint them
but I do not want to disappoint myself either.
THERAPIST: Wow! It feels like you are running against time and you have to
choose - your parents or yourself. Neither is a good option; and so you go here and
you struggle, and you are confused and scared and alone trying to figure things out.
Alex is sobbing, and his dad reaches over and hugs him. His mom moves over
and she too, sits beside him and hugs him.
THERAPIST: Alex, your parents are right beside you. They want to understand.
Can you let them in to that place where you are alone and sad?
ALEX: I am scared when I think that something suddenly might happen to dad
or to you (mom) like last year- and then you would not have the chance to see what I
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accomplished and be proud of me. Then you will never know that I am capable and
that it’s ok to do it my way.
THERAPIST: That is scary, to think that something might happen to either of
your parents and trying to prove yourself, trying to get it right and not disappoint
while you still have time.
DAD: I am so sorry that you are so hurt. I am, we are not disappointed in you and
we do not want to “fix you” or “change you”. We love you no matter what you do and
now that I know I will do anything to be there for you. I am sorry that our pushing-
our way of trying to help you caused you so much pain. We love you and want to
support you, in a way that is best for you.
ALEX: I could leave the house, but I really want to work on our relationship,
because it is important that I, have both of your “blessings” as I move on. It is
important, that I leave “the nest” as you say, knowing that you are proud of me
and you love me, even if I failed. It’s like, the baby bird trying to fly out of the
nest. The parents have to trust that he can do it- although they may not know for
sure. If the baby bird falls, he needs his parents to lovingly encourage him to try
again. Sometimes, he flops around for a little bit before the parents rush in to help,
and that is ok. The little bird is learning even if he falls, even if he breaks a wing.
Keeping the bird in the nest or constantly giving him directions how to fly is con-
straining—he will not find his way. I guess what I am asking is… do you think you
can be there as I try to figure things out? I want to find my way and can you trust
that I will be okay–without flying in to help me or try to change my path?
DAD: “I had no idea that you felt this way; that you have been trying to fly out of
the nest. I didn’t see all this as your attempt in figuring things out. What I thought I
saw, was a little bird taking advantage of the safety provided by our nest and unless
we pushed, you were not going to fly. I see now how that hurt you and how it made
you feel that we didn’t trust you. I love you and want to support you and it’s pretty
incredible to hear what has been going on for you.”
At this point Alex is weeping in his father’s arms. Mom joins in the hug and after
a small pause, with tears in her eyes says:
MOM: “I am so sorry I hurt you. I get scared and I rush in to help you, to save
you, to show you and that makes you feel that I don’t believe in you. I want to be
there for you. I don’t want you to feel this way.”

5.1.2.1 Treatment focus and progress in stage two

In the above excerpt, Alex begins to talk about how scary it is to feel that he
disappoints his parents and how he wants to make them proud before he loses either
of them. His parents remain open hearted and open minded as he engages with
them from a vulnerable place. They see his pain, hurt and fear. Dad not only sees
from afar this terrible place that his son struggles in but can stand side by side with
him there. His presence is felt, and his apology makes a huge difference to Alex.
For the first time, Alex feels seen and feels understood at a much deeper level and
therefore, this allows Alex to clearly articulate his attachment needs. Mom and dad
worked together to respond to Alex. Often parents cannot empathize because they
get caught up in their own secondary responses of fear. Staying present with Alex in
his vulnerability allowed both parents to experience how Alex’s problematic behav-
ior was related to the family’s negative cycle of interaction. In a later session, both
parents were able to articulate their fear of failure and Alex was able to hear this
and understand much of their stress as parents. He then reassured them, “you have
been great parents, given me so much. I hope to be able to offer my kids what you
have offered me. I love you both and I don’t want you to feel that you have failed as
parents.” Additionally, he expressed regret for his past behavior toward his mother.
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Alex began to ask for contact, and this continued in following sessions which helped
to bring them closer together.

5.1.3 Stage three: Consolidation

What follows below is an example of actual dialog used to illustrate the process
of consolidation:
MOM: Things are good. Alex initiated a conversation earlier this week where he
confided in me and asked for my advice. He was telling me about an incident that
happened at work and how he handled it. And then asked for my opinion–how I
would have handled it.
ALEX: (smiling) “That was nice, and different than times in the past. She did
not do anything, other than just listen.
(Turning toward his mom) You did not try to fix or problem solve with me the
way you used to with all the questions. You listened to me for a long time and then I
remember that I asked you for advice. You said that you agreed with how I handled
the matter and you would have done the same. It really felt good to talk to you like
an adult without running away or avoiding you. I want to say, thank you for that
because I feel less tense and more relaxed.
THERAPIST: That’s really great Alex that you felt good to approach your mom
and discuss something that was important to you and ask for her input. And it
sounds that you both had this conversation in a different way than before. In a way
that even feels different in your body.
ALEX: Yes. Growing up and doing things differently than the way your parents
expect is hard and can be kind of scary. Knowing that they are open and that my
mom is there without judging me feels great.
MOM: I am so glad that we turned a corner. I am always here for you, no matter
what and I want to be the mom you want me to be.

5.1.3.1 Treatment focus and progress in stage three

In the above excerpt mom discovers during treatment that she could help her
son by her attentive presence. She understands that she did not have to solve Alex’s
problems or go “undercover” to find out what he was doing and, as a result, this
helped her stay more connected with him. The relationship became safer, closer,
and more equal. Both were able to confide in and support each other which is the
desired outcome for stage three treatment.

6. Conclusions

Treating families in distress is extremely challenging for family therapists.

Professionals working with families, especially neophytes, commonly feel uncertain
and discouraged as they attempt to navigate the vast landscape of family dynam-
ics encompassing multiple, complex interpersonal processes between members.
As a result, family therapists find themselves negotiating or offering solutions to
presenting problems, rather than focus on the underlying issues that are at the root
cause of the dysfunction. Unfortunately, they soon realize the techniques used are
not effective, and before long the family members cycle back where they started
from. This makes the therapists feel inefficient and ineffective and therefore may
shy away from doing family work.
Having access to a practical, organized and effective model for working with
families is pivotal if practitioners are to make meaningful differences in the lives of

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DOI: http://dx.doi.org/10.5772/intechopen.84320

people they serve. EFFT arose from the realization that the change principles used
in EFT could be applied to family relationships thus changing the cycles of interac-
tion [3]. EFFT is a powerful and efficient way to assess and create positive change
within the family system. At its core, EFFT views family distress as a result of attach-
ment insecurity where family members fail to get their attachment needs met. Such
families do not possess the skills necessary in expressing their attachment needs and
protect themselves by becoming defensive, beginning a negative cycle of interac-
tion which prevents healthy family functioning and stability. Accessing underlying
attachment-related emotions and the needs associated with these emotions opens
the family to address needs in new ways [3]. Corrective emotional experiences create
safety that change family relationships and most likely impact future generations.
Tapping into parents’ unconditional love is powerful; it offers families great hope
and holds tremendous promise in revitalizing the field of family therapy.

Author details

Katherine Stavrianopoulos
John Jay College of Criminal Justice, The City University of New York, New York,
USA

*Address all correspondence to: [email protected]

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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Family Therapy - New Intervention Programs and Researches

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