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EFFT: An Empowering Way to Work with Families


EFFT: An Empowering Way to Work with Families

by Dr. Ashley Miller, Child and Adolescent Psychiatrist 


As a new graduate, I saw a ten year old girl for the treatment of separation anxiety.  Trained in CBT, I set about seeing the girl for individual sessions with some parent involvement, but week after week, her symptoms persisted.  It turned out that her mother wasn’t supporting home practice and she was getting increasingly frustrated, especially with me.  I knew this ten year old couldn’t turn things around by herself, but how to engage and work effectively with her family?

While therapists may see patients once or twice a week at most, families and caregivers are there 24/7.  Family therapy recognizes the strengths and capacities of families to help their loved ones recover and the importance of healthy family relationships for mental health across the lifespan.  EFFT is a family therapy treatment model developed by Drs. Adele Lafrance Robinson and Johanne Dolhanty from Laurentian University.  Building on the work of Dr. Leslie Greenberg in emotion-focused therapy, the New Maudsley family-based treatment for Eating Disorders and a variety of other therapeutic approaches, EFFT translates concepts from years of family therapy practice and research into a family-friendly treatment approach.

EFFT was originally practiced and studied for patients with a range of eating disorders, but has now developed into a transdiagnostic approach suitable for use with families of children and teens of all ages. Rooted in a deep and unwavering belief in the healing power of parents and caregivers, the essence of EFFT is to afford them a significant role in their loved one’s mental health and well-being while also reducing the frequency of therapy-interfering behaviors. EFFT can also be integrated into existing treatment models for those clients and families who do not respond to standard care.


 Some of  the key components of EFFT include:

1) Recovery coaching: assisting loved ones – regardless of age – in the interruption of symptoms and maladaptive behaviors (anxiety, depression, eating disorders, behavioral problems, etc.).

2) Emotion coaching: supporting loved ones to approach, process and manage stress, emotions and emotional pain.

3) Relationship repair: healing possible wounds from the child or family’s past in order to help loved ones to let go of the weight of old injuries.

4) Caregiver support: working through and resolving the fears and obstacles that surface within the caregiver during this challenging and novel journey

I first learned about EFFT from a parent who had participated in a 2-day EFFT caregiver workshop.  She knew I was teaching family therapy and wanted to make sure I knew about this approach.  After attending the workshop, she tried one of the techniques she learned with her teenage daughter.  She wrote her an apology letter, validating her daughter’s experience with a difficult illness a few years before.  This seemingly simple gesture transformed their relationship, and this parent was extremely grateful for the EFFT approach.

One of the things I really appreciate about EFFT  is the specific attention to therapist factors that can get in the way of effective treatment.  Often, clinicians tell me in frustration that they are on the verge of closing a youth’s file because they haven’t been able to engage the family in treatment.  EFFT gives clinicians tools to keep going and help parents commit to their child’s recovery.  As a new therapist working with that ten year old anxious girl, I’m sure I must have encouraged her mother to “stick with the practice.”  I may have gone through the practical barriers and problem-solved some solutions.  But my own sense of incompetence and my own fear of angering her parents probably stood in my way of looking for the deeper roots of the therapy-interfering behavior.  EFFT supervision and tools would have helped me identify my own emotional blocks and work through them.


This last week, I had a final session with the family of a thirteen year old girl.  When they first came to see me, their daughter had been homebound and refusing to attend school for months.  They were extremely reluctant to follow my advice for a voluntary hospitalization.  Using some of the “chair work” (role play with an empty chair) I had learned in EFFT, we were able to uncover the harrowing reasons for their reluctance.  Once the nature of their fear was out in the open, her parents were able to start moving forwards and acting on what they knew they needed to do for their daughter.   Their courage and perseverance was key to their daughter’s recovery, and the EFFT philosophy and tools helped them get there.

If you are interested in learning more about EFFT, there is an upcoming training in Vancouver:

EFFT Training in Vancouver | Oct 17-19, 2016

Registration via Eventbrite


Dr. Ashley Miller is a Child and Adolescent Psychiatrist at BC Children’s Hospital and Clinical Assistant Professor in the Department of Psychiatry at UBC.  She is also the co-director of Interpersonal Psychotherapy and Family Therapy training for the UBC Psychiatry Residency Program.


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