Sue Johnson: the therapy that put attachment back at the heart of couples

Who is Sue Johnson?

Sue Johnson was born in 1947 in Chatham, in Kent, England. She liked to say she grew up in her parents’ pub, watching people fall in love, fight, and make up at the bar. After moving to Canada, she earned a doctorate in counseling psychology from the University of British Columbia in 1984. It was there, working with psychologist Les Greenberg, that she developed Emotionally Focused Therapy (EFT) in the 1980s, first designed for couples.

A professor at the University of Ottawa, then professor emerita, she founded the ICEEFT in Ottawa, the international center that now trains EFT therapists around the world. She was named a Member of the Order of Canada in 2016. She died on April 23, 2024, in Victoria, British Columbia, at the age of 76.

Why does her work matter for your relationship? Because she was among the first to take a simple idea seriously: an adult needs a secure bond as much as a child does. When that bond wobbles, you don’t “communicate badly,” you panic. Her whole method follows from there, and that is what makes it easy to follow even without a therapist.

The core idea

For Sue Johnson, most couple fights are not about the dishes, money, or the in-laws. They are about one question that never gets asked out loud: “Do I matter to you? Will you be there if I need you?” She borrows this reading from John Bowlby and attachment theory, which she applies to adult couples: your partner is your secure base, and the fear of losing them sets off survival reactions, attacking or shutting down.

The practical consequence is huge. If the problem is emotional disconnection, the solution is not to learn negotiation techniques. It is to make the deeper emotions possible to say out loud, and to learn how to respond to them. A relationship is going well when each of you can reach out and find the other there. Everything else, she argued, follows from that.

The key concepts

The negative cycle, or “the dance”

Every couple in distress repeats the same choreography. One protests, criticizes, pushes; the other shuts down, plays it down, pulls away. The more one pushes, the more the other retreats, and the more the other retreats, the more the first one pushes. Sue Johnson calls this the negative cycle and describes three versions of it in Hold Me Tight, the “demon dialogues”: Find the Bad Guy, the Protest Polka, and Freeze and Flee. The first step in therapy is to name the dance as the common enemy, rather than pointing the finger at each other.

Primary emotions under secondary emotions

The anger, the irritation, the coldness you show are secondary emotions. Underneath, there is almost always a more vulnerable primary emotion: the fear of being abandoned, the shame of not measuring up, the sadness of being alone together. EFT slows the exchange down to reach that level, because it is the only one that moves the other person. A reproach makes someone back away; a fear that’s admitted makes them come closer.

A.R.E.: accessible, responsive, engaged

Sue Johnson sums up the security of a bond in three questions. Are you accessible (can I reach you when I need you)? Are you responsive (do you respond to what I feel, not just to what I say)? Are you engaged (do I sense that you care about me and that you’re staying)? Together they spell A.R.E., which reads like the question “Are you there for me?” For her, that is the real measure of a couple.

The seven conversations of Hold Me Tight

The 2008 book for the general public turns the therapy into seven conversations to have at home: recognizing the dance, finding the raw spots, revisiting a rocky moment, the “hold me tight” conversation itself, forgiving attachment injuries, bonding through touch and sex, and keeping the bond alive day to day. The central conversation is about saying, without blame, what you fear and what you need, and letting the other person respond.

Softening

The turning point of a successful EFT has a technical name, blamer softening: the moment the accusing partner softens. It is the instant when the critical partner stops attacking and asks, from a place of vulnerability, to be reassured, and the withdrawn partner turns toward them instead of protecting themselves. Process studies show that this specific event goes with the best outcomes.

What the research says

EFT is one of the most studied couples approaches. As early as 1985, Sue Johnson and Les Greenberg published a first trial comparing EFT with a problem-solving therapy. Studies then piled up, often run by the Ottawa team itself, and several reviews have taken stock.

• The 1999 meta-analysis (Johnson, Hunsley, Greenberg, and Schindler) pools the four most rigorous trials of the time and calculates an effect size of 1.3, one of the highest ever measured for a couples therapy.
• The 2013 MRI study (with neuroscientist James Coan) followed 23 couples over about twenty sessions: after therapy, women’s brains reacted less to the threat of an electric shock when they held their partner’s hand. The bond had become regulating.
• The two-year follow-up (Wiebe et al., 2017) shows that gains in satisfaction hold long after the sessions end, and attachment to the partner becomes more secure over the course of therapy (Burgess Moser et al., 2016, 32 couples).
• The 2024 meta-analysis (Spengler et al.), the most comprehensive to date, finds medium to large effects, lasting up to two years, and just as clear in couples who were highly distressed at the start.

What this work really shows: a structured therapy focused on attachment emotions helps a majority of couples get out of distress, and the changes last. What it does not show: that it works for everyone, or that it is better than every other approach.

Limits and criticisms

The first limit is the closeness between the researchers and the method. A large share of the studies were run by Sue Johnson, her students, or therapists trained by the ICEEFT. That is not fraud, it is a known bias: teams that believe in an approach find more often that it works. Independent trials are fewer.

The second limit is sample size. The 1999 meta-analysis rests on four studies; the MRI study on 23 couples; the two-year follow-up on about thirty. Participants are mostly heterosexual North American couples, fairly well off, and volunteers. Other approaches, like behavioral couples therapy, also get good results, and EFT’s superiority has not been firmly established.

Finally, EFT is not meant for every situation. Sue Johnson herself ruled it out when there is ongoing violence, and she asks that both partners still want the bond. Her attachment lens can also, when misread, make any need for autonomy look like avoidance. The model describes distress very well; it doesn’t tell the whole story of happiness.

How MyLoveLab uses it

Sue Johnson is the backbone of the Attachment and security dimension of the test and the program: the negative cycle, the protest that hides a fear, the three A.R.E. questions, and the secure base are worked on there level by level. She also shows up in the Communication and listening dimension, to learn to say the primary emotion under the reproach, and in the Intimacy and desire dimension, because fading desire often hides a bond that no longer feels reassuring.

We don’t claim to replace EFT therapy. The program keeps what can be passed on in writing and between two people: spotting the dance, naming it, slowing down, asking differently. For everything else, we tell you where to find a therapist.

Further reading

• Hold Me Tight: Seven Conversations for a Lifetime of Love (in French: Serre-moi fort ! Sept conversations pour une vie entière d’amour) · Book, 2008The book to read first, written for couples: the seven conversations.
• Love Sense: The Revolutionary New Science of Romantic Relationships · Book, 2013The science behind EFT, explained for a general audience: adult attachment, the brain, sexuality.
• The Practice of Emotionally Focused Couple Therapy: Creating Connection · Book, 1996The reference manual for therapists, reissued several times since.
• Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families · Book, 2019Her late synthesis: attachment as the framework for all therapy.

Frequently asked questions

References

1. Johnson, S. M. & Greenberg, L. S. (1985). Differential effects of experiential and problem-solving interventions in resolving marital conflict. Journal of Consulting and Clinical Psychology, 53(2), 175-184.
2. Johnson, S. M., Hunsley, J., Greenberg, L. & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67-79.
3. Johnson, S. M. (2008). Hold Me Tight: Seven Conversations for a Lifetime of Love. Little, Brown.
4. Johnson, S. M., Burgess Moser, M., Beckes, L., Smith, A., Dalgleish, T., Halchuk, R., Hasselmo, K., Greenman, P. S., Merali, Z. & Coan, J. A. (2013). Soothing the threatened brain: Leveraging contact comfort with emotionally focused therapy. PLOS ONE, 8(11), e79314.
5. Burgess Moser, M., Johnson, S. M., Dalgleish, T. L., Lafontaine, M.-F., Wiebe, S. A. & Tasca, G. A. (2016). Changes in relationship-specific attachment in emotionally focused couple therapy. Journal of Marital and Family Therapy, 42(2), 231-245.
6. Wiebe, S. A. & Johnson, S. M. (2016). A review of the research in emotionally focused therapy for couples. Family Process, 55(3), 390-407.
7. Wiebe, S. A., Johnson, S. M., Burgess Moser, M., Dalgleish, T. L., Lafontaine, M.-F. & Tasca, G. A. (2017). Two-year follow-up outcomes in emotionally focused couple therapy: An investigation of relationship satisfaction and attachment trajectories. Journal of Marital and Family Therapy, 43(2), 227-244.
8. Spengler, P. M., Lee, N. A., Wiebe, S. A. & Wittenborn, A. K. (2024). A comprehensive meta-analysis on the efficacy of emotionally focused couple therapy. Couple and Family Psychology: Research and Practice, 13(2), 81-99.

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