Free Therapist Training›EFT Couples Therapy Toolkit›Case Conceptualization
Last updated: November 11, 2026
A case conceptualization for emotionally focused couples therapy (EFCT) is a short written account of why a couple is stuck: the negative cycle they are caught in, the emotions and attachment needs underneath it, and the history that keeps it going. It turns what you learn in the assessment sessions into a working formulation that guides the treatment plan.
The template has eleven sections, from the problem in each partner's words to goals in attachment terms, including a safety and fit screen drawn from the individual sessions. A completed example for an invented couple follows the template.
The template is part of the free EFT Couples Therapy Toolkit from the Sentio MFT program, which teaches EFCT among the therapy models in its curriculum.
These are some items to consider when you write a case conceptualization for a couple. Use what fits the couple and your setting. It is not an official form, just some helpful ideas from the Sentio MFT program.
Download the PDFMake an editable copy
| Section | What to write |
|---|---|
| 1. The problem in each partner's words | Partner A, in a short quote. Partner B, in a short quote. What brought them in now. |
| 2. Relationship history | How they met, the good times, when the distress began, and major events: moves, births, losses, illness, affairs, job changes |
| 3. The negative cycle | The pattern (one pursues and one withdraws, both pursue, or both withdraw); each partner's position, trigger, reactive emotion and underlying emotion; the cycle in one sentence. The negative cycle map holds the detail. |
| 4. Attachment fears and longings | What each partner fears the cycle means about the relationship, and what each most needs from the other |
| 5. Attachment histories | For each partner: family of origin, earlier relationships, losses and trauma, and how that history may shape the position each takes in the cycle |
| 6. Attachment injuries | Specific moments when one partner felt abandoned or betrayed at a time of need, and what each partner says the moment meant |
| 7. Strengths and resources | What still works: shared humor, parenting, rituals, commitment, support from family or friends |
| 8. Safety and fit screen | From the individual sessions: violence or intimidation; fear of the other partner; controlling behavior; an ongoing affair; a partner who has decided to leave; substance use that gets in the way of the work; risk to self or others; individual mental health concerns. Record the result and any action for each. |
| 9. Culture and context | Culture, faith, identities, family expectations, work, money, children and other stressors, and how they bear on the cycle and on the therapy |
| 10. Formulation | Three to five sentences linking the cycle, the emotions underneath it, the attachment needs it leaves unmet, and the history and injuries that keep it going |
| 11. Goals | The couple's goals in their own words, the same goals in attachment terms, and the first target for Stage 1 |
Write the formulation so both partners could hear it read aloud without either one becoming the villain. Revise it when new information comes out, such as an injury neither partner mentioned at first.
What Does a Completed EFT Case Conceptualization Look Like?
Marcus and Lena are an invented couple. Marcus pursues and Lena withdraws, and an unresolved injury from the night his mother had a stroke keeps their cycle going.
| Section | Example entry |
|---|---|
| 1. The problem in each partner's words | Marcus: "We're like roommates. She's on her phone or asleep, and when I try to talk she shuts down." Lena: "Nothing I do is enough. He starts in on me the minute I walk in the door, so I go quiet." Marcus called after a fight in which Lena said she did not know how much longer she could do this. |
| 2. Relationship history | Together 12 years, married 10, two children (Theo, 8; Ruby, 5). Both describe the first years as close and fun. Distance grew after Ruby's birth, when Lena moved to night shifts. Two years ago Marcus's mother had a stroke. |
| 3. The negative cycle | Pursue and withdraw. Marcus pursues: triggered by late replies and Lena's turning to her phone, he feels angry, criticizes and follows her to keep talking; underneath he feels lonely and afraid of losing her. Lena withdraws: triggered by his sharp tone, she goes numb, goes quiet and leaves the room; underneath she feels shame and fear of failing him. The more Marcus pushes to reach Lena, the more she shuts down to keep the peace; the more she shuts down, the harder he pushes. |
| 4. Attachment fears and longings | Marcus fears he is alone and that Lena does not want him; he longs to know he matters to her. Lena fears she will never be enough for him; she longs to know she is enough as she is and that it is safe to come close. |
| 5. Attachment histories | Marcus: his parents divorced when he was 10, and his father called less and less after moving away; he learned that "you have to fight to be noticed," which fits his protest when Lena seems far away. Lena: her mother was exacting and quick to criticize; she learned that staying quiet and getting things right kept the peace, which fits her freezing when Marcus's tone turns sharp. |
| 6. Attachment injuries | The night of his mother's stroke, Marcus waited at the hospital alone while Lena stayed home with Ruby, who had a fever, and texted that she thought he would want space. Marcus: "That night I learned I can't count on her." Lena: she did not know he wanted her there and felt she could not get anything right that night either. Marcus raises it in most fights. |
| 7. Strengths and resources | They still laugh together, especially on trips; they co-parent well; both want the marriage and came to every session; Lena stays calm in crises; Marcus says what he feels; the Sunday pancake breakfast is a ritual they share. |
| 8. Safety and fit screen | Seen alone (Lena, session 3; Marcus, session 4). No pushing, hitting, threats, forced sexual contact or monitoring reported by either partner; Lena is not afraid of Marcus and speaks freely in joint sessions; Marcus once slammed a door last spring; no weapons in the home. No affair reported. Neither has decided to leave. Alcohol: Marcus two or three beers on weekends; no drug use. No suicidal thoughts reported; Lena sleeps poorly in night-shift weeks. Action: proceed with joint EFCT; safety question at the start of every session; agreed 20-minute pause when a fight escalates. |
| 9. Culture and context | Lena's night shifts leave them few evenings together; both work in jobs that ask a lot of them; parenting two young children. Ask both partners what their families and cultures taught them about conflict and closeness. |
| 10. Formulation | Marcus and Lena are caught in a pursue-withdraw cycle that leaves both feeling alone. Marcus's anger is a protest against disconnection, rooted in an old fear of being left; Lena's silence protects her from the shame of failing, rooted in a childhood where staying quiet kept the peace. Each partner's move confirms the other's fear. The night of the stroke is an unresolved injury that Marcus brings up when he feels most alone, which pushes Lena further into withdrawal. |
| 11. Goals | Couple: "Feel like we're on the same team again" (Marcus); "Stop dreading coming home" and say what is going on without a fight (Lena); fewer escalating fights; repair the night of the stroke; two evenings a week together. In attachment terms: de-escalate the cycle so both feel safe enough to show what is underneath; help Lena step in and Marcus ask for comfort from his fear rather than his anger; heal the injury. First Stage 1 target: both partners describe the cycle as the shared problem. |
What Is an EFT Case Conceptualization?
An EFT case conceptualization is a working explanation of a couple's distress in the terms of the model: the negative cycle, the emotions that drive it and the attachment needs it leaves unmet. EFT here means emotionally focused couple therapy, the attachment-based model of couple therapy whose primary developer was Susan Johnson (Johnson, 2020; Wiebe & Johnson, 2016).
In the first step of EFCT, the therapist builds an alliance with both partners and lays out the core issues in their conflict from an attachment perspective (Johnson et al., 1999). The conceptualization is the written result of that work. It also prepares the reframe of step 4, which casts the problem in terms of the cycle, the underlying emotions and attachment needs (Johnson et al., 1999).
The negative cycle map holds the detail of the cycle; the conceptualization sums it up and adds the histories, injuries, strengths and safety screen. For case formulation and treatment planning more broadly, see the free Case Formulation and Treatment Planning webinar with Alexandre Vaz.
What Goes into It?
The core is the cycle and what drives it: each partner's position, the reactive emotion on the surface, the underlying emotion beneath it, and the attachment fear and longing each partner carries. Around that core sit the couple's own account of the problem, their relationship history, each partner's attachment history, any attachment injuries, their strengths, the safety and fit screen, culture and context, and the goals.
Name the pattern first. In a pursue-withdraw cycle one partner blames or pursues and the other defends or withdraws (MacIntosh & Johnson, 2008); in a withdraw-withdraw cycle both partners pull back (Johnson & Whiffen, 1999). Then separate the two layers of emotion: MacIntosh and Johnson (2008) give the example of expressing primary fear instead of reactive anger.
The safety and fit screen comes from the individual sessions. Stith et al. (2012) summarize general guidelines as screening every couple through individual interviews with both partners, using written questionnaires as well as interviews. EFCT is not recommended where abuse is ongoing (Johnson et al., 1999). More generally, individual treatment should precede or replace joint treatment when a partner is afraid of the other (McCollum & Stith, 2008), and the partner who used violence needs to take responsibility for it before couple treatment starts (Bograd & Mederos, 1999, as cited in Vall et al., 2018). One EFCT practitioner lists ongoing affairs and serious substance abuse among signs of potential contraindications (Simakhodskaya, 2018); treat either as a possible reason to delay or adapt joint work.
Record the result for each item and the action you will take. If the screen finds danger, joint sessions do not begin, and safety planning and referral come first; the intake form and safety screen covers this step in detail.
How Do Attachment Histories Fit In?
Use each partner's history to understand the position that partner takes in the cycle. EFCT is based in attachment theory (Wiebe & Johnson, 2016), and Johnson and Whiffen (1999) describe how the therapy is adapted to each partner's attachment style.
Ask about family of origin, earlier relationships, losses and trauma, then write a sentence or two linking that history to the partner's move in the cycle. In the example, Marcus's lesson that "you have to fight to be noticed" fits his protest when Lena seems far away, and Lena's lesson that staying quiet kept the peace fits her freezing when his tone turns sharp.
Keep the histories short and fair to both partners. Johnson (2019) applies attachment theory to emotionally focused therapy with individuals, couples and families.
What Is an Attachment Injury?
An attachment injury is a moment when one partner felt abandoned or betrayed by the other at a time of need. Johnson et al. (2001) define it this way: "An attachment injury is characterized by an abandonment or by a betrayal of trust during a critical moment of need." They present such injuries as a source of impasses in couple therapy.
Record the moment itself and what each partner says it meant. In the example, the night of the stroke means to Marcus that he cannot count on Lena; to Lena it was one more night she could not get right. Both meanings belong in the conceptualization, because the injury feeds the cycle each time Marcus raises it.
Resolving an injury moves back and forth between the two partners: the hurt partner describes the injury and what it meant, the other partner takes in the hurt and responds with care, and the couple builds a new account of what happened (Johnson et al., 2001). Makinen and Johnson (2006) studied this resolution in EFT as steps toward forgiveness and reconciliation. The toolkit's treatment plan template places the repair among the Stage 2 goals, alongside the two Stage 2 change events, withdrawer re-engagement and blamer softening (Wiebe & Johnson, 2016).
Practice next
Rehearse drawing out and reflecting each partner's attachment fears and needs, the material the formulation is built from. Two exercises in the APA book Deliberate Practice in Emotionally Focused Couple Therapy (Levenson et al., 2025) fit this step: Exercise 1, "Evocative Inquiry: Identifying Patterns and Eliciting Attachment Fears and Needs," and Exercise 4, "Attachment-Reframed Validation." Watch Sam Jinich and Hanna Levenson demonstrate exercises from the book in the free Deliberate Practice in EFCT webinar, and review the attachment frame in the free EFCT crash course.
Keep reading
EFT Negative Cycle Worksheet, a map of each partner's side of the cycle, joined into one loop, with a completed example
EFT Treatment Plan Example, goals, objectives, interventions and measures for each stage, built from the conceptualization
EFT Couples Therapy Intake Form, joint and individual assessment sessions with a safety screen for each partner
Case Formulation and Treatment Planning, a free webinar with Alexandre Vaz
Frequently Asked Questions
How is an EFT case conceptualization for couples different from an individual case formulation?
An individual case formulation explains one person's difficulties. An EFCT case conceptualization explains a pattern between two people: the negative cycle, what each partner feels and needs inside it, and how each partner's history and any attachment injuries keep it going. Write it so it is fair to both partners, since both will hear it.
When should the case conceptualization be written?
Draft it after the assessment sessions and before the feedback session in which you describe the cycle back to the couple and agree on goals. In the example, the couple came together for two sessions, each partner came alone once, and the feedback session was the fifth. Revise it whenever new information changes the picture.
Should the couple see the case conceptualization?
Yes, in plain words: describe the formulation to both partners in the feedback session, framed around the cycle so neither partner is cast as the problem. Write the document itself in words you would be comfortable having either partner read. If either partner does not recognize the cycle as you describe it, revise the formulation.
What contraindicates joint EFCT?
EFCT is not recommended where abuse is ongoing. More generally, individual treatment should come before or replace joint treatment when a partner is afraid of the other, and the partner who used violence needs to take responsibility for it before couple treatment starts. An ongoing affair, or substance use serious enough to get in the way of the work, may be a reason to delay or adapt joint work. When the screen finds danger, joint sessions do not begin, and safety planning and referral come first.
How is a case conceptualization different from a treatment plan?
The case conceptualization explains why the couple is stuck. The treatment plan sets out what therapy will do about it: goals for each stage, objectives you can observe or count, the interventions you will use and how you will measure progress. Write the conceptualization first and build the plan from its goals.
References
Johnson, S. M. (2019). Attachment theory in practice: Emotionally focused therapy (EFT) with individuals, couples, and families. Guilford Press. ISBN 978-1-4625-3824-9 (hardback), 978-1-4625-3825-6 (e-book). https://www.guilford.com/books/Attachment-Theory-in-Practice/Susan-Johnson/9781462538249
Johnson, S. M. (2020). The practice of emotionally focused couple therapy: Creating connection (3rd ed.). Routledge. https://doi.org/10.4324/9781351168366 ISBN 978-0-8153-4801-6 (paperback), 978-0-8153-4800-9 (hardback). Publisher page: https://www.routledge.com/The-Practice-of-Emotionally-Focused-Couple-Therapy-Creating-Connection/Johnson/p/book/9780815348016
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. https://doi.org/10.1093/clipsy.6.1.67
Johnson, S. M., Makinen, J. A., & Millikin, J. W. (2001). Attachment injuries in couple relationships: A new perspective on impasses in couples therapy. Journal of Marital and Family Therapy, 27(2), 145–155. https://doi.org/10.1111/j.1752-0606.2001.tb01152.x
Johnson, S. M., & Whiffen, V. E. (1999). Made to measure: Adapting emotionally focused couple therapy to partners' attachment styles. Clinical Psychology: Science and Practice, 6(4), 366–381. https://doi.org/10.1093/clipsy.6.4.366
Levenson, H., Jinich, S., Vaz, A., & Rousmaniere, T. (2025). Deliberate practice in emotionally focused couple therapy. American Psychological Association. https://doi.org/10.1037/0000436-000 ISBN 978-1-4338-4296-2 (paperback). Book page: https://www.apa.org/pubs/books/deliberate-practice-emotionally-focused-couple-therapy
MacIntosh, H. B., & Johnson, S. (2008). Emotionally focused therapy for couples and childhood sexual abuse survivors. Journal of Marital and Family Therapy, 34(3), 298–315. https://doi.org/10.1111/j.1752-0606.2008.00074.x
Makinen, J. A., & Johnson, S. M. (2006). Resolving attachment injuries in couples using emotionally focused therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74(6), 1055–1064. https://doi.org/10.1037/0022-006X.74.6.1055
McCollum, E. E., & Stith, S. M. (2008). Couples treatment for interpersonal violence: A review of outcome research literature and current clinical practices. Violence and Victims, 23(2), 187–201. https://doi.org/10.1891/0886-6708.23.2.187
Simakhodskaya, Z. (2018). The moment of meeting: First EFT session. The EFT Community News (Special Issue 2018), 4–5. International Centre for Excellence in Emotionally Focused Therapy. https://iceeft.com/wp-content/uploads/2018/11/SpecialIssue2018.pdf
Stith, S. M., McCollum, E. E., Amanor-Boadu, Y., & Smith, D. (2012). Systemic perspectives on intimate partner violence treatment. Journal of Marital and Family Therapy, 38(1), 220–240. https://doi.org/10.1111/j.1752-0606.2011.00245.x
Vall, B., Päivinen, H., & Holma, J. (2018). Results of the Jyväskylä research project on couple therapy for intimate partner violence: Topics and strategies in successful therapy processes. Journal of Family Therapy, 40(1), 63–82. https://doi.org/10.1111/1467-6427.12170
Wiebe, S. A., & Johnson, S. M. (2016). A review of the research in emotionally focused therapy for couples. Family Process, 55(3), 390–407. https://doi.org/10.1111/famp.12229
