A Primer for Emotionally Focused Individual Therapy (EFIT)
Cultivating Fitness and Growth in Every Client - 1st Edition
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A Primer for Emotionally
Focused Individual Therapy
(EFIT)
Cultivating Fitness and Growth in Every
Client
Susan M. Johnson
and T. Leanne Campbell
First published 2022
by Routledge
605 Third Avenue, New York, NY 10158
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2022 Susan M. Johnson and T. Leanne Campbell
The right of Susan M. Johnson and T. Leanne Campbell to be identified as authors of this
work has been asserted 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 utilised 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: 978-0-367-54597-0 (hbk)
ISBN: 978-0-367-54825-4 (pbk)
ISBN: 978-1-003-09074-8 (ebk)
DOI: 10.4324/9781003090748
Typeset in Caslon
by Deanta Global Publishing Services, Chennai, India
To my clients who constantly inspire and teach me, and to my colleagues who
are my loving fellow-travelers in the search to find the secret of healing and
growth in those caught in the web of human vulnerability and despair.
– Susan M. Johnson
To my clients and colleagues who continually inspire me to learn and grow,
and to my family who have provided me the safe haven to do so.
– T. Leanne Campbell
CONTENTS
ABOUT THE AUTHORS XI
Introduction1
Chapter 1 What Is EFIT? Let’s See! 4
Chapter 2 What Is the Guiding Framework for EFIT? 22
Chapter 3 Shaping Safety: How Does the EFIT
Therapist Engage the Client? 38
Chapter 4 How Does Emotion Move the Client into
Change in EFIT? 53
Chapter 5 What Is the Macro-Intervention Sequence,
the EFIT Tango? 72
Chapter 6 What Are the Key Micro-Interventions Used
in EFIT? 93
Chapter 7 How Does the EFIT Therapist Tune In and
Find Focus – Assess the Client? 102
Chapter 8 How Does the Therapist Shape Stabilization
in Stage 1 of EFIT? 123
ix
x Contents
Chapter 9 How Does the Therapist Restructure Self
and System in Stage 2 of EFIT? 140
Chapter 10 How Does the Therapist Guide
Consolidation In Stage 3 of EFIT? 160
Chapter 11 What Do Key Change Events Look Like in
EFIT? 170
Chapter 12 Epilogue 187
APPENDIX 197
RESOURCES 201
REFERENCES 202
INDEX 206
ABOUT THE AUTHORS
Susan M. Johnson
Dr. Sue Johnson is a leading innovator in the fields of couple therapy and
adult attachment. She is the primary developer of Emotionally Focused
Couples and Family Therapy (EFT), which has demonstrated its effec-
tiveness in over 30 years of peer-reviewed clinical research. Sue’s received
numerous awards acknowledging her development of EFT, including the
APA’s “Family Psychologist of the Year” in 2016 and the Order of Canada
in 2017.
Her best-selling book Hold Me Tight (2008) has taught countless couples
how to enhance and repair their love relationships. The book has since been
developed into an interactive relationship enhancement program, Hold Me
Tight Online. Her newest book for clinicians, Attachment Theory in Practice
(2019), delineates the promise of attachment science for understanding and
repairing relationships and her seminal text, Emotionally Focused Couple
Therapy – Creating Connection (2019), is now in its third edition.
As the founding director of the International Centre for Excellence in
Emotionally Focused Therapy (ICEEFT), Sue trains counselors in EFT
worldwide and provides guidance to over 80 affiliated centers. She consults
for the US and Canadian militaries and is a popular presenter and speaker
for the general public. You can find out more about Sue and her work at
www.iceeft.com and www.drsuejohnson.com.
T. Leanne Campbell
Leanne Campbell is co-director of the Vancouver Island Centre for EFT
and Campbell & Fairweather Psychology Group and is an Honorary
Research Associate of Vancouver Island University. Initially trained by Dr.
Sue Johnson, Leanne has continued to work in the EFT model and has
xi
xii About the Authors
worked with hundreds of individuals, couples, and families over the past
three decades.
In addition to maintaining an active and full-time private practice, with
a primary focus in the areas of trauma and grief, Dr. Campbell currently
manages a two-site practice comprising over 20 clinicians and is a site co-
ordinator for an Emotionally Focused Individual Therapy (EFIT) outcome
study. An active ICEEFT Certified EFT Trainer, Leanne has been pro-
viding trainings in EFT for many years and has similarly been involved in
the development of various training materials including DVDs, on-line
and other training programs, books, and workbooks.
Introduction
Introduction to EFIT
We are writing this book to do much more than give you a blueprint for a
model of therapy based on the best scientific understanding we have about
exactly who we are as human beings. We are writing this book to move and
inspire you! We want to turn you on to the power of following the emotional
charge in a therapy session and using it to color and frame a client’s world
differently, and to do this in an organic way that your client’s brain is organ-
ized to respond to. We want you to know how to use the power in emotion
to “move” clients in potent new directions. We are writing this book to chal-
lenge the world of individual therapy to take a new and long look at the mirror
offered to us by attachment science and how that image clarifies human hurts
and longings and gives us a direction and a destination for psychotherapy as
a discipline.
More formally speaking, we might say that the purpose of this book is
to share the wisdom gleaned in over 35 years of clinical experience using
Emotionally Focused Therapy (EFT) with individuals, couples, and families
as it applies specifically to shaping individual change. This experience has
been enriched by our many research studies where we have pinpointed the
process of individual and relational change, as well as many kinds of positive
outcomes. The training of thousands of mental health professionals across
the globe and the creation of a professional network for those professionals,
DOI: 10.4324/9781003090748-101 1
2 Introduction
the International Centre for Excellence in Emotionally Focused Therapy
(ICEEFT, www.iceeft.com) has also enhanced this model, bringing wisdom
from many cultures, ethnic groups, and ways of seeing the world.
Emotionally Focused Therapy is mostly known as a cutting edge, empiri-
cally validated couple intervention, though from its inception, has always been
used with individuals, especially those facing depression, anxiety, and the
effects of trauma. EFT has contributed much to the world of couple therapy
but this book focuses on the use of this model with individuals. As EFT
developed, it has become clear that the positive and lasting results found in
EFT are mainly the result of two factors: the clear map to human misery
and motivation provided to us by the developmental theory of personality
we call attachment theory; and the focus on systematically reconstructing
emotional experience as it occurs in session. The first author’s most recent
book, Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with
Individuals, Couples, and Families (Johnson, 2019), has outlined how these
two factors offer the promise of real integration and coherence to the field of
psychotherapy as a whole (Johnson 2019).
Having stated the formal rationale for this book, it is not, in fact, intended
to be a formal text. The world of psychotherapy has become a bit of a circus. So
many labels, disorders, models, and interventions, it is hard to know how to find
our way. Attachment science tells us who we are and shows us how to befriend
our client’s emotions and use the power of corrective emotional experience to
enable clients to find a new sense of self – a sense of competence and worth.
This book is full of stories, images, and information that will make it possible
for you to create moments of transformation in every session. It is written to be
accessible, easy to read, even fun! A clear map shapes a sense of confidence and
competence in a therapist that translates into more on-target interventions, bet-
ter outcomes and less therapist burn-out. We hope to offer you a clear way home
with each and every client. We would like you to feel as affirmed as we do when
clients like Mary and James tell us, “You get me; you go to the heart of the mat-
ter,” and, “I can’t believe what a difference that last session is making in my life.”
It is worth noting that the EFIT model fits well with the major concerns
of the present societal context in terms of its stance on diversity and inclusion,
and in the fact that it seems to translate very well to an online format. In fact,
most of the sessions outlined here took place online. In terms of diversity,
the core concepts and values of the general EFT model, of which EFIT is a
part, are grounded in the humanistic experiential perspective of Carl Rogers,
who insisted that respect for every individual and a full valuing of the per-
son of the client was the foundation of good clinical practice. EFT is also
founded on attachment theory, which views core emotions, vulnerabilities,
protective strategies, and the need for safe connection with others to be uni-
versal. Belonging and becoming are two sides of the same coin and, in a truly
Introduction 3
civilized society, all must belong. The EFT model, and EFIT in particular, is
used in many different countries and contexts around the world with almost
every possible cultural, racial, and diverse group of therapists and clients.
Practicing in different contexts challenges us to renew our curiosity and learn
to adapt our interventions in a more refined way to fit particular cultures and
particular clients. The EFT stance on diversity and position statement can be
found on the website, www.iceeft.com.
In terms of online practice, EFIT interventions appear to be suited to the
very factors that clinicians worry will be hard to achieve in digital sessions,
namely safety, full engagement and absorption in the tasks, and experience of
therapy in a way that shapes effective change. As will be apparent throughout
this book, the EFIT model has always focused on creating safe haven sessions
and teaching therapists to exhibit authentic, real engagement with clients, the
kind of engagement that crosses the barrier from live to on-screen sessions.
The focus on emotion and on-target attuned intervention also lends itself to
the shaping of engagement with a client’s core emotions and significant exis-
tential dramas – the dramas that continuously define a client’s sense of self.
The first large study of EFIT referred to in this volume was also conducted
online. Suffice to say here that there seems to be no problem using this up
close and personal model of intervention in an online mode.
This text is designed as a primer – a way to orient you and get you started
in EFIT. However, we hope that even if you are already an experienced EFT
therapist who is using EFIT in everyday practice, this volume will deepen
your understanding and expand your repertoire of EFIT interventions. We
have deliberately included many transcripts of actual therapy sessions and
have repeated key concepts throughout the book to enable you to take in this
model and make it your own. There are Play and Practice sections at the end
of every chapter to help you integrate what you learn and immediately trans-
late it into practice. DVDs of EFIT in action are available from our institute,
www.iceeft.com. As a general model of individual, couple, and family ther-
apy, EFT offers you membership in a supportive professional organization.
You are invited to look on the website for an EFT community near you or look
for resources in your own language, whether it is Farsi, Romanian, Finnish,
Dutch, English, or German.
There is much to do in terms of finally integrating research and practice in
psychotherapy, finding ever more effective interventions for emotional disor-
ders and training professionals for life-long creative practice. We know that
you will find EFIT an exciting and effective way to reach even your most dif-
ficult clients. We hope you enjoy this primer!
©2021 All materials presented here in this EFIT Primer are copyrighted
to Dr. Susan Johnson and Dr. Leanne Campbell.
1
What Is EFIT? Let’s See!
This chapter will lead you through snapshots of the change process with an
EFIT client suffering from very high levels of post-traumatic stress disorder
due to extreme childhood sexual and physical abuse. In fact, Henny fits all the
criteria for complex developmental post-traumatic stress disorder (PTSD).
Therapist interventions will be outlined to give the reader a picture of what
EFIT looks like in practice. The goal here is to give you a visceral sense of
what EFIT is about before explaining theory and practice in more abstract
terms.
The portrait of change with Henny will focus first on beginning sessions,
then on transcripts from the end of Stage 1 of EFIT – Stabilization, and
one point in Stage 2 – Restructuring, Expanding Models of Self and Other,
where Henny makes significant changes in ordering her emotional world, and
shifting her sense of self. In EFIT we think of our ultimate goal as expanding
the self. This is in contrast to the constriction of the sense of self and engage-
ment with others that is typical in chronic mental and emotional distress. The
moment-to-moment attunement of the EFIT therapist is guided by the map
to basic human vulnerabilities and needs set out by attachment theory and
science (Johnson, 2019).
The macro-intervention sequence we call the EFT Tango is used in every
session of EFIT, in the EFT model for distressed couples and in EFFT with
distressed families. It will be briefly pinpointed and referred to in this chapter.
4 DOI: 10.4324/9781003090748-1
What Is EFIT? 5
These interventions and more micro-interventions will be clarified in detail in
the rest of the book. There follows a case description. Specifically, examples of
key sessions with a client conducted by the first author, Sue Johnson.
Henny bounces into my room, all blonde curls, big hiking boots, and gig-
gles. She talks very fast and immediately engages with me. She tells me she is
50 years old, has had a varied career as a specialized editor and as a teacher of
gymnastics, and has two adolescent children, Vinnie and Veronica, who now
live with her since the breakup of her marriage 9 months before coming for
therapy. She asked her husband, Tom, a dentist whom she met when she was
18, to leave because of his complete withdrawal into his addiction to alcohol,
cocaine, and gambling. This was the third time she had left him. Twice before
this had involved “running away” to new cities but this time was “final.” She
confides that she came for therapy because, “I have always lived in survival
mode, just focusing on taking the next breath,” but now she was, “tired out.”
She states, “I just shut down and sleep for a whole day now.”
In a breathless rush, she then tells me that she was diagnosed with PTSD
after the birth of her second child when Tom turned up high at the hospital
and her parents, who live on the other side of the country, paid her a surprise
visit to see the new baby. She reports that she went into a “trance” and was
“catatonic” for a week in the hospital. Indeed, at the beginning of therapy,
her scores on Briere’s Trauma Symptom Inventory (TSI-2, Briere, 2011) were
elevated and in the clinical range on all but one (i.e., suicidality) of the key
factors on this test. After this catatonic episode she was heavily medicated but
currently was taking a moderate dose of anti-anxiety medication only. She
tells me that her symptoms had abated for a while but, since asking Tom to
leave, she has suffered from nightmares and feelings of hopelessness, panic
attacks, and intense flashbacks of her past trauma with her father, who would
drug his two girls and repeatedly rape them until they reached puberty. He
would always arrange where the girls slept and if you were the one in the most
isolated room, then you were “hunted.” Her mother witnessed many of these
incidents but would then deny they had occurred.
In spite of this traumatic history, Henny immediately comes across as hon-
est, vivacious, highly intelligent, and eager to grow. She is resourceful, tell-
ing me, “I can fix anything. I can rebuild a house if I have to.” She describes
holding down three jobs at a time and teaching gymnastics, stating that her
skill at gymnastics was an ongoing joy for her. She shares that, as a child, she
remembers moving a dresser in front of her bedroom door to keep her father
out and other “victories.” She says, “I want a life that feels safe, I want to break
the pattern. But now it’s hard – Tom was the only person who ever loved me.
Seemed to love me. I don’t trust anyone.”
The goal of Stage 1 of EFIT, Stabilization, is to build a positive alli-
ance and stabilize the client, pinpointing sources of strength and resilience,
