Emotion-Focused Family Therapy

Rooted in a deep and unwavering belief in the healing power of families, the essence of EFFT is to afford caregivers a significant role in their loved one’s mental health and well-being.  The therapist’s role would then be to empower and support caregivers in mastering the skills, tasks, and, yes, the feelings involved in four main domains:

A. Becoming their loved one’s behavior coach, that is, assisting their loved one – regardless of age – in the interruption of symptoms and maladaptive behaviors (anxiety, depression, an eating disorder, etc.) as well as in the transition from stressful life events (a divorce, diagnosis of a learning disability; placement into foster care, etc.);

B. Becoming their loved one’s emotion coach, that is supporting their loved one to approach, process and manage stress, emotions and emotional pain, making symptoms unnecessary to cope;

​​

C. Facilitating therapeutic apologies in order to help loved ones to let go of the weight of old injuries, and

​​

D. Working through and resolving the fears and obstacles that surface in the caregiver during this challenging and novel journey.

 

This last step is necessary when these fears and obstacles interfere with the parent or caregiver’s ability to be effective in their efforts. For example, some parents are afraid that engaging their child in the tasks of recovery and coping will lead the child to feel depressed or suicidal, leaving the parents paralyzed with fear & thus stuck in an impossible bind. There are many other emotion blocks that can surface throughout the family’s journey. For example, parents may sometimes feel resentful that their child continues to struggle and this resentment can influence their helping behaviors. Other parents may feel helpless and without skills and thus find themselves relying on controlling or punitive techniques to motivate behavior change. For details on each of these steps, click here.

 

Common Fears

Parents can feel immobilized in their efforts if for example they fear that engaging in the tasks of recovery will lead to their child feeling too much distress or cause too much disruption for other family members. These unspoken fears can lead families to become stuck in unhelpful caregiving patterns (walking on eggshells, feeling resentful, etc).  The “usual suspects” include the fears that their child will: 1) run away; 2) become depressed or suicidal and 3) move in with the other custodial parent (in the case of split-families).  Other emotions such as anger, resentment, hopelessness and helplessness can also interfere with caregiver efforts to promote recovery. Support and specific skills training are sometimes necessary to release parents and caregivers from the shackles that keep them from feeling hopeful and secure in their helping roles. EFFT can help parents to process and work through these “emotion blocks” in addition to providing skills training in order to help them to feel capable of handling the challenges ahead.

 

Who is this approach suited for?

Parents and caregivers can learn these skills and take on these roles regardless of their child’s level of motivation or involvement in formal treatment. EFFT is a lifespan approach that can be delivered with individuals only, parents and caregivers only, and with families. Click here to read an article covering EFFT for families of children with mental health difficulties.

 

In some cases,  individuals are not able to have their parents or caregivers involved. It is possible to achieve many of the same goals with individuals using Emotion-Focused Therapy, although family involvement is the goal whenever possible.

Where can I find more information on the approach?

The Emotion-Focused Family Therapy Clinician's manual is finally available for pre-order on Amazon! Published by the American Psychological Association, we are relieved, excited, in disbelief that it's ready: We hope you find it to be useful!

For more information on the EFFT model and related topics, visit our sister site here. If you are interested in working with an EFFT clinician or therapist in your area or via video, visit the International Institute for EFFT and consult their directory of certified practitioners.

Related Research

 

A number of scientific papers examining the processes and outcomes of EFFT and related topics have been written.

Cordeiro, K., Wyers, C., Oliver, M., Foroughe, M., & Muller, R. T. (2022). Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop. Clinical Psychology & Psychotherapy.

This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = −0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.

Sabey, A. K., Stillar, A., & Lafrance, A. (2021). Processes and outcomes of an emotion‐focused family therapy two‐chair intervention for transforming problematic parenting patterns. Journal of Marital and Family Therapy.

 

Emotion-focused family therapy (EFFT) is a therapy model which includes a two-chair intervention aimed at facilitating awareness and an interruption of problematic patterns of parenting as well as a reconnection to healthy caregiving instincts. The present study employed a task analysis to examine the process of this intervention with parents in a therapeutic setting and report on preliminary outcomes. Four trained EFFT therapists conducted chair work interventions with four parents (total of 16) and parents completed questionnaires directly following the intervention. Results indicated that most parents experienced significant emotional resolution of their love-based fears and an increase in confidence in supporting their children struggling with mental health issues. Use of the intervention in clinical settings is an effective and efficient way to support parents in responding to their children's mental health challenges.

 

Lafrance, A., Strahan, E. J., & Stillar, A. (2021). Treatment-engagement fears in family-oriented interventions: validation of the caregiver traps scale for eating disorders. Eating Disorders, 1-16.

 

As more caregivers of children (of any age) struggling with an eating disorder are recruited as partners in care, it is important to identify potential barriers to such involvement. The Caregiver Traps Scale for Eating Disorders (CTS-ED) was developed as a measure of caregiver fears with respect to treatment-engagement. The purpose of this study was to evaluate its psychometric properties. One hundred and twenty four parents of children with ED participated in the validation of this instrument. Data were analyzed through exploratory factor analysis. The exploratory factor analysis revealed one factor, accounting for 39% of the variance, with a mean of 3.99 (scale from 1 to 7), indicating that caregivers endorsed clinically significant fears relating to their involvement in their child’s treatment. The scale yielded high internal consistency (α = .89). As expected, the CTS-ED was significantly positively correlated with a measure of accommodating and enabling of ED symptoms, and negatively correlated with a measure of parental self-efficacy. This scale shows promise as a measure for clinicians and researchers to identify parental fears that could potentially fuel accommodating, enabling or treatment-interfering behaviors. Suggestions for its utility as a clinical and supervision tool are also provided.

 

Nash, P., Renelli, M., Stillar, A., Streich, B., & Lafrance, A. (2020). Long-Term Outcomes of a Brief Emotion-Focused Family Therapy Intervention for Eating Disorders Across the Lifespan: A Mixed-Methods Study. Canadian Journal of Counselling & Psychotherapy/Revue Canadienne de Counseling et de Psychothérapie, 54(2).

Emotion-focused family therapy (EFFT) empowers caregivers to support their loved one's eating disorder (ED) recovery. Data were collected over time from 74 caregivers who participated in a 2-day EFFT workshop. Results revealed positive outcomes related to self-efficacy, treatment engagement fears, and the accommodation and enabling of behaviours. A thematic analysis of interviews conducted with eight caregivers identified the following themes: (a) increasing self-efficacy with emotion, (b) working through emotion blocks, (c) strengthening interpersonal relationships, (d) experiencing togetherness among participants, and (e) benefiting from experiential practice via role-play. Results suggest this brief intervention is associated with positive caregiver outcomes that can be maintained over time.

 

Wilhelmsen-Langeland, A., Aardal, H., Hjelmseth, V., Fyhn, K. H., & Stige, S. H. (2019). An Emotion Focused Family Therapy workshop for parents with children 6-12 years increased parental self-efficacy. Emotional and Behavioural Difficulties, 1-13.

In this pilot study, we examined whether a 2-day Emotion-Focused Family Therapy workshop strengthened parental self-efficacy, satisfaction and beliefs regarding their ability to help their children regulate emotions and reduce the children’s symptoms of behavioural- or psychological difficulties. Twenty-three caretakers with 17 children (9 boys) aged 6 to 12 years old completed the workshop. Pre, post and 3-month follow-up data on the Parents` Beliefs About Children`s Emotions – Guidance scale and Parenting Sense of Competence scale, as well as pre and 3-month follow-up data on the Child Behaviour Checklist parent form, were used to assess the effects of the intervention. Parental self-efficacy significantly increased, the caretakers` satisfaction in the parenting role significantly increased but faded after 3 months and the caretakers` beliefs that children can guide their emotions on their own were significantly reduced. Finally, oppositional defiant problems in the children significantly declined.

 

Foroughe, M., Stillar, A., Goldstein, L., Dolhanty, J., Goodcase, E. T., & Lafrance, A. (2018). Brief Emotion Focused Family Therapy: An Intervention for Parents of Children and Adolescents with Mental Health Issues. Journal of Marital and Family Therapy.

This study evaluated the 2-day intensive modality of Emotion Focused Family Therapy (EFFT). The intervention attempts to prepare parents to take a primary role in their child's recovery from a range of mental health issues. One hundred and twenty-four parents completed the intervention and provided data a week prior to intervention, post-intervention and at 4-month follow-up. Results include significantly reduced parent blocks and increased parental self-efficacy in relation to involvement in their child's recovery, as well as significant improvement in child symptomatology. The findings confirm positive results from an earlier pilot study involving eating disorders and demonstrate the potential for EFFT as an intervention for a range of clinical problems in children and youth.

 

Strahan, E. J., Stillar, A., Files, N., Nash, P., Scarborough, J., Connors, L., ... & Orr, E. Lafrance, A. (2017). Increasing parental self-efficacy with Emotion-Focused Family Therapy for eating disorders: a process model. Person-Centered & Experiential Psychotherapies, 16(3), 256-269.  

 

A process model was tested whereby parental fear and self-blame were targeted in order to enhance parental self-efficacy and supportive efforts in the context of emotion-focused family therapy (EFFT) for eating disorders (ED). A 2-day EFFT group intervention was delivered to parents of adolescent and adult children with ED. Data were collected from eight treatment sites (N = 124). Data were analyzed using t-tests, regression analyses and structural equation modeling. The findings supported the proposed process model. Through the processing of parents’ maladaptive fear and self-blame, parents felt more empowered to support their child’s recovery. This increase in self-efficacy led to an increase in parents’ intentions to engage in recovery-focused behaviors. This study is the first to test a method for clinicians to increase supportive efforts by targeting and enhancing caregiver self-efficacy via the processing of emotion.  

Bøyum, H., & Stige, S. H. (2017). «Jeg forstår henne bedre nå» – En kvalitativ studie av foreldres opplevelse av relasjonen til egne barn etter emosjonsfokusert foreldreveiledning [“I understand her better now” – A qualitative study of parents’ experiences of their relationship to their children after Emotion-Focused Family Therapy (EFFT)]. Scandinavian Psychologist, 4, e11.

 

In this article, we report from a qualitative study investigating whether and how parents experience Emotion-Focused Family Therapy’s (EFFT’s) impact on the relationship to their children. Six parents who had attended a two-day course of EFFT were interviewed, with qualitative in-depth interviews taking place two to four months after completion of the course. We used a hermeneutic-phenomenological approach in analyzing these interviews. Analysis resulted in four main themes: Increased understanding of the child; Stronger confidence in their role as parents; Increased focus on emotions improving relationships; and Improved communication with the child. The study shows how the parents experienced becoming more secure in their role as parents and obtaining increased confidence in their own abilities. In addition, they experienced improved contact with, and better understanding of, their children. The parents underscored how these processes were ongoing and demanding and how they entailed considerable effort. Further research will contribute to expanding and nuancing our knowledge on how parents experience receiving EFFT and how such therapy affects parents’ experiences of their relationships with their children. 

Stillar, A., Strahan, E., Nash, P., Files, N., Scarborough, J., Mayman, S., . . . Lafrance Robinson, A. (2016). The influence of carer fear and self-blame when supporting a loved one with an eating disorder. Eating Disorders, 24(2), 173-185.

 

Carers often feel disempowered and engage in behaviours that inadvertently enable their loved one’s ED symptoms and yet little is known regarding these processes. This study examined the relationships among fear, self-blame, self-efficacy, and accommodating and enabling behaviours in 137 carers of adolescents and adults with ED. The results revealed that fear and self-blame predicted low carer self-efficacy in supporting their loved one’s recovery as well as the extent to which carers reported engaging in recovery-interfering behaviours. The relevance of these findings are discussed in the context of family-oriented ED therapies and highlight the importance for clinicians to attend to and help to process strong emotions in carers, in order to improve their supportive efforts and, ultimately, ED outcomes.  

Lafrance Robinson, A., & Kosmerly, S. (2015). The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others. Eating disorders, 23(2), 163-176.

 

Eating disorder clinicians from various disciplines participated in one of two surveys: the “self” group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the “other” group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent.  

Lafrance Robinson, A. L., Dolhanty, J., & Greenberg, L. (2015). Emotion‐focused family therapy for eating disorders in children and adolescents. Clinical psychology & psychotherapy, 22(1), 75-82.  

 

Family‐based therapy (FBT) is regarded as best practice for the treatment of eating disorders in children and adolescents. In FBT, parents play a vital role in bringing their child or adolescent to health; however, a significant minority of families do not respond to this treatment. This paper introduces a new model whereby FBT is enhanced by integrating emotion‐focused therapy (EFT) principles and techniques with the aims of helping parents to support their child's refeeding and interruption of symptoms. Parents are also supported to become their child's ‘emotion coach’; and to process any emotional ‘blocks’ that may interfere with their ability to take charge of recovery. A parent testimonial is presented to illustrate the integration of the theory and techniques of EFT in the FBT model. EFFT (Emotion‐Focused Family Therapy) is a promising model of therapy for those families who require a more intense treatment to bring about recovery of an eating disorder. 

Lafrance Robinson, A., & Kosmerly, S. (2015). The influence of clinician emotion on decisions in child and adolescent eating disorder treatment: a survey of self and others. Eating disorders, 23(2), 163-176.

 

Eating disorder clinicians from various disciplines participated in one of two surveys: the “self” group (n = 143) completed a survey assessing the negative influence of emotions on their own clinical decisions, while the “other” group (n = 145) completed a parallel version of the survey that assessed their perceptions of the negative influence of emotion in their colleagues. Both groups endorsed this phenomenon to some degree, although differences in reporting were noted between groups. The perceived negative influence of emotion with regards to specific treatment decisions fell within three categories: decisions regarding food and weight, decisions regarding the involvement of the family in treatment, and decisions related to autonomy and control. Decisions regarding the involvement of the family were perceived to be the most emotionally charged, in particular the involvement of a critical or dismissive parent.

Lafrance Robinson, A., Dolhanty, J., Stillar, A., Henderson, K., & Mayman, S. (2014). Emotion-Focused Family Therapy for Eating Disorders Across the Lifespan: A Pilot Study of a 2-Day Transdiagnostic Intervention for Parents. Clinical Psychology & Psychotherapy, 23(1), 14-23.  

 

Emotion‐focused family therapy is a transdiagnostic approach that affords parents and caregivers a significant role in their loved one's recovery from an eating disorder. A 2‐day intervention was developed on the basis of emotion‐focused family therapy principles and delivered to 33 parents of adolescent and adult children. Data were collected pre‐ and post‐intervention. Through education and skills practice, parents were taught strategies with respect to meal support and symptom interruption as well as emotion coaching. Parents were also supported to identify and work through their own emotional blocks that could interfere with their supportive efforts. Analyses revealed a significant increase in parental self‐efficacy, a positive shift in parents' attitudes regarding their role as emotion coach and a reduction in the fears associated with their involvement in treatment, including a decrease in self‐blame. Overall, this broad‐based, low‐cost intervention shows promise, and future research is warranted. Copyright © 2014 John Wiley & Sons, Ltd.