Updated: Dec 2, 2021
When it comes to choosing any model for any therapy, whether individual, couples, or family, my first concern is that the model or models are evidence-based. Two couples models, the Gottman method and emotionally focused therapy (EFT), are both evidence-based and appeal to my personal style. While not knowing it prior to my research, Dr. Gottman explains that his method is an existential method at its core, which is my individual orientation. And, hmmm, a mathematical-driven theory with existentialism at its core—there’s nothing more beautiful than to take something like primitive emotions and use mathematics to describe them.
Dr. John Gottman
Sue Johnson, one of the originators of emotionally focused couple’s therapy, was heavily influenced by Dr. John Gottman, director of the Relationship Research Institute. It’s no surprise that their models complement each other as a result. In an interview in The Family Journal (2005), Dr. Johnson had this to say about Dr. Gottman’s influence on EFT, “what I loved about it was that it stayed close to the data. It stayed close to the reality, to the real reality. It wasn’t labeling with all kinds of huge abstract labels that didn’t make much sense to me. It wasn’t going into all these theories. It was staying close. It was saying: This is what happens; this is what this picture looks like. I just found it such a relief.” Even though I’m early in my studies, I had a similar reaction when I discovered Dr. Gottman’s approach. And as Sue Johnson herself said, we need data to go along with our models, “intuition is just misleading without real empirical data.” I can’t agree more.
Gottman’s important research provides the data that informs us using data about why some relationships work and why some fail. Gottman discovered a “magic” ration concerning the quality of interactions that are important to reach if a relationship will succeed. He writes in Gottman, J., & Silver, N. (1994) “The magic ratio is 5 to 1. As long as there is five times as much positive feeling and interaction between husband and wife as there is negative, the marriage was likely to be stable over time. In contrast, those couples who were heading for divorce were doing far too little on the positive side to compensate for the growing negativity between them.” And Gottman also provides us with what types of specific negative emotions are most destructive. They are criticism, contempt, defensiveness, and stonewalling, with contempt being the most damaging.
Dr. Sue Johnson
But therapy requires much more than data, it requires dealing with emotions. This is where Dr. Johnson’s work comes in. In the same interview, Dr. Gottman said this about Dr. Johnson’s work with emotion.
“To look at how very primitive people’s emotions are when they are in an intimate relationship that is not working. How desperate they are. And what [Dr. Johnson] taught was where to go. How to create a structure that not only liberated emotion but gave it a direction. And that built something, constructed something, which was this reframing of an attachment bond that had really failed, and a new chance for connection, an emotional connection. It was so consistent with everything that I was seeing in the laboratory… It was so fundamental and primitive. It was very powerful. And it was exactly what we needed in marital therapy, an understanding of what was so basic and so human about the failure of relationships and what people were striving for.”
Dr. Johnson in Johnson, S. (2005) describes emotional focused therapy as “the creation of a technology for in-session change that is informed by the basic research on the nature of marital distress and by the attachment theory of love. The forward movement in this area could be seen as exemplified by the development of EFT. This approach, first tested in the early 1980s, is accepted by the American Psychological Association as empirically validated and obtains the most positive results in the couple therapy field. In metaanalyses of several studies, 70-73 per cent of couples were found to have recovered from distress in 10 to 12 sessions of EFT, as measured by the Dyadic Adjustment Scale (Spanier, 1976), and 90 per cent were significantly improved (Johnson et al, 1999). EFT has also been used in many diverse populations, across different social classes and ethnic groups and with clients who also suffer from depression and anxiety (including post-traumatic stress disorder), or who have physical health problems, such as breast cancer and aphasia.”
As I write this, I’m not surprised that each of these innovators discovered what apparently some of us in class are feeling intuitively—these two approaches really complement one other. When one of my colleagues talked about using both approaches after I had narrowed down my models to the same, and then conducted research that found each to be so helpful in informing the other, I knew I was on to something.
So how can they be effectively integrated? First we can talk about how the two approaches are similar. They are both existential-humanist approaches. For those in this camp, such as myself, this makes integrating both much more natural. They are both short-term, empirically supported, focus on the present and emotional engagement, highly systemic, and emphasize emotional accessibility for improving partner intimacy as explained by David, P. (2015).
In addition, the two models are complementary by being strong where the other has weaknesses. While both have neurobiological foundations, Gottman’s is broader, while Johnson’s focuses more on attachment. Having both lenses available, the therapist can take a zoomed out approach to issues relating to anger, but also look at a simpler attachment view of the anger and decide which is more appropriate considering the circumstances. Another complementary dynamic when integrating the two approaches relates to attitude of the therapist. The Johnson approach allows the therapist to evoke the couple’s deepest emotions in contrast to the Gottman approach where the therapist can take on a coaching role to achieve similar goals.
Integrated Couples Therapy
David, P. (2015) posits that an Integrated Couples Therapy (ICT) model “consists of 16–22 sessions that are carried out over the following five stages of treatment: (1) alliance/assessment, (2) stabilization, (3) enhancement, (4) conflict management, and (5) integration. Drawing on the Gottman and Johnson approaches, the delineation and sequencing of these five stages are based on the following treatment principles:
1. The beginning of therapy concentrates on establishing a solid alliance with the couple and conducting a thorough assessment of their relationship.
2. The initial stages of treatment focus on stabilizing the conflict in the couple’s relationship so they can have greater access to one another’s emotional needs.
3. Once emotional access is accomplished, the emphasis in treatment is on enhancing closeness in the relationship so the partners can become more secure and responsive to one another.
4. Building on the couple’s enhanced closeness, treatment shifts to their unresolvable and resolvable differences so that the partners can more effectively manage their conflict with one another.
5. The ending of therapy concentrates on reinforcing the positive changes the partners have made in themselves and in their relationship.”
This model isn’t fixed and can be used to context-switch depending upon the therapist’s assessment of what the couple needs at that time. After an assessment in stage one, the therapist can proceed to any stage depending upon the severity of the couple’s distress. In stage one, the Johnson method is used to form an alliance by using acceptance, respect, empathy, and genuineness, while being complemented with Gottman's approach of obtaining data by sending packets with the couple that include a series of questionnaires to be completed before the following session.
In subsequent stages, an ICT model draws upon techniques used by both Johnson and Gottman to help the couple. In phase two this can mean using a Johnson approach of “assisting each partner in redefining the couple’s problems in terms of attachment needs, frustrated emotions, and negative interaction cycles,” David, P. (2015). And it can include a Gottman approach of “educating the couple about the primary role that active expression of caring plays in intimate relationships,” David, P. (2015).
In phase three, these techniques can include creating “love maps” to help each person in the relationship understand the psychological orientation of their partners. And it can include Johnson’s approach of “discussing their disconnection, helping the partners express their primary emotions (e.g., needs for affection) and modulate their secondary emotions (e.g., anxieties about being rejected),” David, P. (2015).
In the fourth phase, couples work on conflict management. This stage is where much of Gottman’s work is utilized. As a result, this stage can involve a lot more coaching and cognitive techniques. Gottman suggests that the couples work on solvable, rather than unsolvable problems. This phase can be exited and entered several times as couples work on solving as many problems as they feel necessary.
In the fifth phase of integration, much of Johnson’s work can be leveraged. Johnson’s work helps clients in this phase process their emotional experiences by doing things such as “having each partner present an affirming account of the change process they have undertaken and helping each partner discuss his or her own expectations for continued self-development,” David, P. (2015).
The techniques described above are not exhaustive of Gottman and Johnson’s repertoire. Many, many more strategies are available to be employed in the course of treatment. The practitioner, by learning the approaches of both, will have a more robust set of tools to draw upon.
In summary, the work of Dr. Gottman provided us with important research to allow us to quantify how healthy relationships function and how they are destroyed. The work of Dr. Johnson helped to balance the research of Dr. Gottman with an approach that allows couples to access their truest and deepest emotions and develop the strong attachments required to heal. By using an integrated model that draws upon the best of both, we may better be able to help our clients heal their relationship and understand why their relationship might succeed or fail. While an ICT model of couple’s therapy makes intuitive sense, since both models are evidenced-based and complementary, it must be noted that an ICT method doesn’t have any of the empirical data to support it as each model individually is supported. Even without the support of research it certainly makes sense to learn both EFT and Gottman’s approaches as both have discovered and publicly proclaimed the value of each other’s work in informing the other. While the practitioner may emphasize EMT over Gottman or vice-versa, having a solid understanding of both can only help expand the worldview of the practitioner which could certainly lead to better outcomes for their clients.
David, P. (2015). Wedding the Gottman and Johnson approaches into an integrated model of couple therapy. The Family Journal, 23(4), 336-345. doi:10.1177/1066480715601675
Gottman, J., & Silver, N. (1994). What makes marriage work? (cover story). Psychology Today, 27(2), 38.
Johnson, S.M., Hunsley.J., Greenberg, I. & Schindler, D. ( 1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6, 67-79.
Johnson, S. (2005). The evolution of couple therapy. The Psychologist, 18(9), 538-540.
Spanier, G. (1976). Measuring dyadic adjustment. Journal of Marriage and the Family, 38, 15-28.
Young, M. A. (2005). Creating a Confluence: An Interview With Susan Johnson and John Gottman. The Family Journal, 13(2), 219-225. doi:10.1177/1066480704272597