There is no one-size-fits-all approach when it comes to couples counseling, as each relationship comprises different challenges and experiences. But some therapeutic strategies have proven to be particularly effective when untangling stressful, tense partner dynamics.  

Emotion-focused therapy, in particular, is one of the most commonly used tactics that relationship counselors use to help couples establish more secure attachments with their partners. One analysis from the New York Center for Emotion-Focused Therapy showed that 90% of couples showed significant improvement after EFT sessions compared to the control group who did not receive such therapy.  

Let’s examine how it differs from other strategies and whether it can benefit your relationship as well. 

What is Emotion-Focused Therapy 

Popularized throughout the 1980s, the therapeutic practice helps clients better identify, explore, accept, and even alter their own emotions. The essence of EFT is rooted in our awareness and relationship to our own emotions, both positive and negative, subsequently boosting emotional intelligence and improving our reactions to events and external behaviors.  

According to an American Psychological Report: 

“Emotions are seen as crucial in motivating behavior. People generally do what they feel like doing rather than what reason or logic dictates. It follows that to achieve behavioral change, people need to change the emotions motivating their behavior.” 

EFT is used in a variety of therapeutic settings, such as individual counseling, and family or group therapy as well.  

How is emotion-focused therapy used in couples therapy 

Benefits of EFT in relationship settings 

Every successful relationship relies on healthy emotional dynamics, wherein each partner is not only aware of their own emotions but has the tools to regulate them and is also comfortable being vulnerable with the other person. 

In the words of Dr. Sue Johnson, one of the founders of emotion-focused therapy:

“To foster connection we need not just to spend time together as companions, but to also risk sharing softer, deeper emotions. We must learn to hold each other’s feelings in a way that calms our nervous systems and gives us a deeply-felt sense of safe connection.” 

That makes EFT a particularly useful approach in couples therapy. Let’s take an example of an exchange where such an approach could be valuable: 

Person A: Would you like to go out somewhere this Friday?
Person B: I don’t know, you probably don’t want to go anywhere anyway. 
Person A: [Shrugs, rolls eyes, walks away] 

In EFT, Person B’s dismissive response to the question would warrant further exploration if re-enacted or described in an EFT session. Upon further examination, it may reveal that they are feeling frustrated that Person A doesn’t take the initiative to make plans to do enjoyable activities together, something that Person B may find important as part of a fulfilling relationship. Conversely, Person B’s emotional response – as evidenced by rolling their eyes and ignoring their partner – may derive from feeling like, no matter how much effort they make, it’s never enough.  

Though brief, these emotional reactions can teach therapists and their clients a lot about not only the root of recurring arguments but what can be done to address them. 

Stages of EFT Couples Counseling  

EFT is typically administered over a finite number of sessions – often ranging from eight to twenty – with a few key phases demarcating the level of progress achieved: 

Stage 1: De-escalation 

Oftentimes, when a couple first begins counseling, there is a common communication cycle, where one person may lob a criticism – intentional or not – at their partner, who subsequently responds defensively (intentional or not). These exchanges often escalate to the point where it’s hard to resolve the original discussion that surfaced, to begin with.  

In the de-escalation phase, each couple should become aware of how they each play a role in perpetuating emotional distress in such exchanges. 

Stage 2: Restructuring 

Once couples have an understanding of how their actions impact the other person, therapists will start introducing guidance on alternative ways of responding, all with the intention that these prompts or questions will help each partner become more curious and empathetic to the other’s feelings.

The main goal of this stage is that each person in the relationship feels more comfortable being emotionally vulnerable and accepting their partner’s emotional and attachment needs.

Stage 3: Consolidation

Once deeper trust is established in the second stage, therapists will help couples navigate ways to more effectively communicate, which includes ways to better express their needs. Some level of conflict will always be a part of every relationship, but enhancing our ways of discussing old problems and disagreeing in the future is the key to reducing tension and building trust.  

Things to Consider 

While this applies to various therapeutic approaches, couples therapy can bring negative emotions to the forefront, particularly those that individuals have suppressed or been loath to confront for a long period of time.  

Emotion-focused therapy, especially during relationship counseling, requires us to address difficult feelings, behaviors, and thought patterns head on. While this may feel vulnerable and at times even painful, it’s also best to do so in the presence of a trained mental health professional who can help process raw, emotional wounds in a healthy way.  

If you and your partner have been trying to get pregnant for a year or longer but haven’t yet conceived, it’s possible you are facing fertility issues. You might already have started talking with your doctor about these challenges and your options for getting pregnant.

Most likely, your doctor is monitoring all aspects of your physical health. But it’s important to take care of your emotional well-being too. People who want to have a child but struggle to get pregnant may face a range of emotions, including anger, frustration, grief, and shame. If these emotions aren’t dealt with productively, they can fester and contribute to pain, resentment, or mental health issues such as depression.

Infertility not only affects you and your partner individually, but also your relationship. Here, we’ll discuss problems you may face as a couple if you’re dealing with infertility and ways you can address them. When difficulties are managed in healthy ways, you’re more likely to grow stronger as partners than grow apart.

Social Stigma Around Infertility

Discovering how common infertility is surprises many people. According to the Centers for Disease Control and Prevention, 12% of American women between the ages of 15 and 44 have trouble getting pregnant or struggle to carry pregnancies to term when they do conceive.

Once a couple marries, it’s often assumed they’ll begin trying to have a child. Certainly, this assumption is flawed in more ways than one, but one main issue is the stigma that often results. Your parents and friends might ask prying questions. Social situations may become uncomfortable if your friends don’t seem to understand what you’re going through. People may avoid inviting you to events like birthday parties or baby showers. Even if they do so out of good intentions, you may still end up feeling excluded.

It’s important to experience your feelings as they come, but it’s also important to avoid blaming yourself or your partner. Blame, self-directed or otherwise, can trap you in a painful cycle that leads to more distress.In the past, women took much of the blame for infertility. While it’s known today that infertility can result from male or female factors, women may still struggle with feelings of failure or shame. Men may deal with similar pain but find it harder to talk about. In society as a whole, there can be a general feeling that couples without children are somehow incomplete, a judgment that can make the distress of infertility even more painful.

In recent years, many celebrity couples have shared their experiences with infertility, including Michelle and Barack Obama. Maybe you’ve talked about your infertility with a loved one and felt empowered and supported by their reaction.

Infertility issues often feel like a private struggle. But reducing the stigma could help more people feel comfortable talking about their own difficulties becoming pregnant. People who don’t feel ready to open up may still draw support from knowing they aren’t alone. No matter which factors contributed to infertility, neither you nor your partner should feel shame.

Avoiding Blame and Shame

Letting yourself experience grief is an important part of coping with infertility. Even if you’re pursuing fertility treatments, facing the reality that becoming pregnant may not be possible can have a heavy emotional impact. Grief and sadness may be your first reaction.

Sometimes the cause of infertility can’t be determined. But finding out infertility issues stem from you can lead to decreased self-esteem, depression, and anxiety. If your partner is the one who is infertile, you may might feel frustrated. You may struggle to keep from blurting out that it’s their fault, not yours.

It’s important to experience your feelings as they come, but it’s also important to avoid blaming yourself or your partner. Blame, self-directed or otherwise, can trap you in a painful cycle that leads to more distress.

Counselors who work with couples dealing with infertility recommend talking to your partner about how you feel, openly and honestly. This might be difficult when you’re angry, but remember: You and your partner are a team, and communication is essential in a good team. Even if you’re angry, hurt, or ashamed, it’s usually better to talk about your emotions calmly, rather than waiting until they burst out during an argument or stressful moment. You may decide not to share your struggles with family and friends, but commit to being honest with each other.

Choosing Other Fertility Options

Assisted Reproductive Technology (ART) helps many couples treat fertility issues. When considering your options, it’s important for you and your partner to agree on how long you’ll pursue treatment, how much money you can spend, and what treatments you’ll try.

Have an honest discussion with your partner about treatments you’re uncomfortable with before planning on any procedures.Your insurance may not cover all (or any) of the cost of fertility treatments. Beginning treatment with a financial limit can help you avoid putting yourself in financial difficulty by continuing indefinitely.

It’s also helpful to decide on a length of time you’ll try treatment for. ART can give you hope, but treatments don’t always work right away. Sometimes they don’t work at all. The uncertainty and stress associated with treatment can have a negative effect on your relationship. Though you may feel renewed grief if you approach the end of the time period and still haven’t conceived, having a limit in place can help relieve some of the uncertainty and emotional distress.

Depending on your specific fertility issue, a range of treatments may be available. Options include medication, in vitro fertilization, and intrauterine (also called artificial) insemination. You might also choose to use donor eggs or sperm or have a surrogate carry a fertilized egg to term.

Some of these options may not work for you due to religious, ethical, or personal beliefs. For example, some people consider freezing embryos to be unethical. Have an honest discussion with your partner about treatments you’re uncomfortable with before planning on any procedures.

Addressing Infertility in Couples Counseling

Though it’s possible to maintain a strong, committed partnership while navigating infertility issues, taking preventative steps can help keep your relationship healthy. Research suggests infertility is a highly stressful and upsetting experience, and any type of stress can affect a relationship negatively. Couples therapists recommend seeking help early on instead of waiting until the crisis you’re facing starts to significantly affect your relationship.

A 2017 study found evidence to suggest couples with compatible coping methods had better communication and were more likely to develop a stronger relationship despite infertility. In other words, it is often better to deal with the issue as a team, even when your instinct may be to deal with your pain alone. Therapy can help you and your partner develop strong coping strategies and quit maladaptive behaviors such as avoidance.

Therapy also provides a safe space for you to talk about your feelings regarding infertility and mental health symptoms you’re experiencing. (Talking about these in individual therapy may also be recommended). Your therapist can support you and your partner through finding helpful ways to cope, relate, and connect during infertility challenges.

If you aren’t already working with a couples therapist, it can help to begin seeing one, even if fertility issues aren’t affecting your relationship at the moment. Some couples therapists may even have specialized training in infertility counseling. You can begin your search for a couples counselor in GoodTherapy’s directory.

References:

1. Fertility treatments. (n.d.). Planned Parenthood. Retrieved from https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments
2. Glenn, L. M. (2002). Loss of frozen embryos. AMA Journal of Ethics. Retrieved from https://journalofethics.ama-assn.org/article/loss-frozen-embryos/2002-12
3. Infertility FAQs. (2019, January 16). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/reproductivehealth/infertility/index.htm
4. Infertility. (2018, March 8). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317
5. Itkowitz, C. (2018, November 9). Michelle Obama is one of millions who struggled with infertility. Here’s why her broken silence could matter. Washington Post. Retrieved from https://www.washingtonpost.com/politics/2018/11/09/michelle-obama-is-one-millions-who-silently-struggled-with-infertility-heres-why-her-broken-silence-could-matter/?noredirect=on&utm_term=.8d2645a61c30
6. Pasch, L. A., & Sullivan, K. T. (2017). Stress and coping in couples facing infertility. Current Opinion in Psychology, 13, 131-135. Retrieved from https://www.sciencedirect.com/science/article/pii/S2352250X16300902
7. The psychological impact of infertility and its treatment. (2009). Harvard Mental Health Letter. Retrieved from https://www.health.harvard.edu/newsletter_article/The-psychological-impact-of-infertility-and-its-treatment
8. Volmer, L., Rösner, S., Toth, B., Strowitzki, T., & Wischmann, T. (2017). Infertile partners’ coping strategies are interrelated – implications for targeted psychological counseling. Geburtshilfe Frauenheilkd, 77(1), 52-58. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5283173