Sue Johnson, a British-born Canadian clinical psychologist and best-selling author who developed a novel method of couples therapy based on emotional attachment, challenging what had been the dominant behavioral approach — the idea that behaviors are learned and thus can be changed — died on April 23 in Victoria, British Columbia. She was 76.
Her death, in a hospital, was caused by a rare form of melanoma, said her husband, John Douglas.
When divorce rates rose in the 1970s, couples therapy blossomed. Drawing from traditional psychotherapy practices, therapists focused mostly on helping distressed couples communicate more effectively, delve into their upbringings and “negotiate and bargain,” as Dr. Johnson put it, over divisive issues like parenting, sex and household chores.
In her own practice, however, she became frustrated at how her couples seemed to be stalling out.
“My couples didn’t care about insight into their childhood relationships,” she wrote in her book “Hold Me Tight: Seven Conversations for a Lifetime of Love” (2008), which has sold more than a million copies and been translated into 30 languages. “They didn’t want to be reasonable and learn to negotiate. They certainly didn’t want to be taught rules for fighting effectively. Love, it seemed, was all about nonnegotiables. You can’t bargain for compassion, for connection. These are not intellectual reactions; they are emotional responses.”
In conventional therapy that sought to modify behavior, emotions had long been dismissed as problematic in dealing with marital issues — something to be tamed — and dependence on a loved one was seen as a sign of dysfunction.
Dr. Johnson thought otherwise. She knew of the attachment studies of John Bowlby, the British psychiatrist who studied children who had been traumatized by being orphaned or separated from their parents during World War II. Later researchers began to focus on adult attachments and noted how secure connections among couples helped them weather the inevitable storms of relationships.
Dr. Johnson began to see a couple’s mutual emotional dependence not as a weakness but as a strength, and thus developed techniques to help couples enhance those bonds. While working toward a Ph.D. at the University of British Columbia, she videotaped her therapy sessions and analyzed couples’ behaviors, from which she shaped a model of treatment with the help of her thesis adviser, Leslie Greenberg. They called it Emotionally Focused Therapy, or E.F.T.
They then tested their method by giving some couples behavioral therapy, some E.F.T., and others no therapy at all. The couples who had undergone E.F.T. fared the best: They fought less, felt closer to each other, and “their overall satisfaction with their relationships soared,” Dr. Johnson wrote.
She honed her method using the paradigm of attachment theory, which notes that pair bonding — the term for selective associations between two individuals of the same species — is a survival technique developed over millions of years of evolution. Her thesis was a scientific view of love.
But when she published her work, colleagues cried foul. They argued, she wrote, that “healthy adults are self-sufficient. Only dysfunctional people need or depend on others. We had names for these people: they were enmeshed, codependent, merged, fused. In other words, they were messed up.”
Decades of E.F.T. studies proved her colleagues wrong, she said. Nearly 75 percent of couples who went through the therapy, she wrote, reported being happier in their relationships, even those at high risk for divorce. E.F.T. has been recognized by the American Psychological Association as an evidence-based approach and is now taught in graduate schools and internship programs.
“By focusing on creating the security of the attachment between couples,” said Dr. John Gottman, co-founder of the Gottman Institute in Seattle, which seeks to strengthen relationships, “Sue focused on the idea of trust, and how couples can build trust with one another in the moment, and it changed everything in the field of couples therapy.”
Dr. Julie Gottman, his wife and co-founder, added, “In some ways we all remain children, and when we reach out for a lifelong love with our partners, we really have to know we’re fully accepted and embraced in the same way a parent embraces a child, and with that kind of acceptance people can really blossom.”
Studies have shown that consistent emotional support and strong partner bonds lower blood pressure, strengthen the immune system and reduce the death rate from cancer and the incidence of heart disease.
“In terms of mental health,” Dr. Johnson wrote in “Love Sense: The Revolutionary New Science of Romantic Relationships” (2013), “close connection is the strongest predictor of happiness, much more than making masses of money or winning the lottery. It also significantly lessens susceptibility to anxiety and makes us more resilient against stress and trauma.”
In 2007, Dr. Johnson set out to show how E.F.T. affected the brain. She worked with Dr. James Coan, a neuroscientist at the University of Virginia, who had shown, by scanning areas of the brain that register fear, how hand-holding would relieve stress in couples.
First, Dr. Johnson recruited heterosexual couples who reported being unhappy in their relationships. Researchers then subjected the women to electric shocks while their partners held their hands. For these couples, the hand-holding had no effect. Then, Dr. Johnson treated the same couples with a course of E.F.T. — about 20 sessions — and repeated the test. On the second try, the area of the women’s brains that would respond to threats stayed quiet.
“It was amazing, because this is what Sue had predicted as far back in 1989 without knowing anything about the brain,” Dr. Coan said. “She was a model for doggedly subjecting her therapeutic intuitions to scientific testing. You have to be a scholar of clinical psychology to understand how rare this is.”
“Love is a basic survival code,” Dr. Johnson wrote in “Love Sense.”
Susan Maureen Driver was born on Dec. 19, 1947, in Gillingham, England, the only child of Arthur and Winifred Driver. The Drivers ran a pub called the Royal Marine, and Sue grew up in its boisterous environment. “I spent a lot of time watching people meeting, talking, drinking, brawling, dancing, flirting,” she wrote. Her parents’ relationship was chaotic and contentious, and they divorced when she was 10.
She earned a degree in English literature at the University of Hull in East Yorkshire before moving to Canada, where she earned a master’s degree in literature and history at the University of British Columbia and worked as a counselor at a residential center for troubled teenagers. After beginning training as a therapist, she enrolled in a doctoral program in psychology and earned her Ph.D. in 1984. Her dissertation was about her work with E.F.T., and she was hired by University of Ottawa to teach in its department of psychology.
Dr. Johnson was married briefly in the 1970s and kept her first husband’s surname. She met Mr. Douglas, who was managing an engineering firm, in 1987, and they married a year later. In addition to Mr. Douglas, she is survived by their children, Sarah Nakatsuka and Tim and Emma Douglas.
In 1998, with Mr. Douglas and others, Dr. Johnson co-founded the International Center for Excellence in Emotionally Focused Therapy. It trains and certifies therapists around the world in E.F.T. and conducts clinical studies in the method. Both the Canadian and American military have offered E.F.T. programs to service members, and E.F.T. has been used to reduce stress among couples coping with a partner’s heart disease, diabetes or Parkinson’s disease.
“Underneath all the distress,” Dr. Johnson said, “partners are asking each other: Can I count on you? Are you there for me?”
