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Discovering the Role of Emotionally Focused Therapy in Gender-
Specific Patterns of Attachment Trauma Leading to Emotional
Dysregulation in Adult Romantic Relationships
Nicole Agneta Akinyi
1
and Nazik Fahmi Jeizan
2
Master of Arts in Marriage and Family Therapy, United States International University, Nairobi, Kenya
DOI:
https://dx.doi.org/10.47772/IJRISS.2025.910000152
Received: 02 October 2025; Accepted: 10 October 2025; Published: 06 November 2025
ABSTRACT
Emotionally Focused Therapy seeks to build attunement and address attachment injuries that affect the quality
of our relationships. This study attempts to explore the gendered perspective of attachment trauma that leads to
emotional dysregulation in adult romantic relationships and the impact that emotionally focused therapy can
have in building relationship satisfaction, where gender plays a role in shaping how we perceive and respond to
these injuries. The findings, therefore, seek to emphasise how understanding the influence of gender can enhance
therapeutic approaches.
Keywords—Emotionally Focused Therapy, Gender, Attachment trauma, Dysregulation.
INTRODUCTION
According to Bowlby (1982), attachment styles significantly shape our perceptions and interactions with the
world. He defines attachment as the lasting psychological connectedness between human beings. Individuals
with a secure attachment style generally exhibit better emotional regulation, find it easier to foster connections,
and exhibit greater resilience and emotional stability. In light of this, we start to see how these different
attachment styles influence one’s ability to regulate their emotions. For instance, securely attached individuals
are generally better equipped to identify their emotions and understand the context behind them. This awareness
enables them to process feelings effectively without becoming overwhelmed.
Tang in 2024 elaborates on this further by hypothesizing that this group of people tends to utilize constructive
coping mechanisms, such as problem-solving and seeking social support, contributing to better emotional
outcomes. Their ability to balance positive and unpleasant emotions enhances resilience when they encounter
stress. In contrast, individuals with insecure attachment styles, including anxious and avoidant, often struggle
with emotional regulation due to their early childhood relational experiences.
This is where issues of low self-esteem, fear of abandonment, and trust issues arise. They may display dependent
behaviours, while those with an avoidant attachment may have difficulties with emotional intimacy, tend to
distance themselves from others, and find it challenging to articulate their needs. Those with an anxious
attachment style often showcase heightened emotional responses. They may experience intense feelings of
anxiety or distress, particularly in relationships, as they fear abandonment or rejection. It is important to note
that they each seek connection; however, their fear can override this need.
This hyperactivation can lead to emotional dysregulation, where emotions become overwhelming and chaotic
(Mikulincer & Shaver, 2018). On the other hand, Marganska et al. (2013) speak on those with avoidant
attachment styles, saying that individuals with an avoidant attachment style often engage in emotional
suppression, distancing themselves from their feelings to avoid discomfort. This suppression can hinder their
ability to express needs or seek partner support. Fujimura and Umemura (2018) support this, noting that those
with this attachment style may struggle with emotional intimacy in relationships, leading to challenges in
connecting with others on a deeper level. Their coping strategies often involve detachment or avoidance, which
can create barriers to effective communication and emotional sharing.
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Synovec (2020) addresses the influence of attachment on help-seeking behaviors in the reprint edition of The
Body Keeps the Score, stating that securely attached children learn the differences between situations they can
control and situations where they need to ask for help, however, children who have experienced abuse and
neglect learn that no one will come to their aid regardless of what they do, they are therefore conditioned to give
up in the face of challenges.
Understanding Social Dynamics
Gender roles and expectations significantly shape interactions within families, workplaces, and communities.
Recognizing these patterns allows for a deeper understanding of how societal norms influence behavior and
relationships. This highlights a correlation between attachment issues and developmental trauma. For instance,
traditional views often depict men as breadwinners and women as caregivers, which can then affect decision-
making processes and power dynamics within relationships. Gender-specific patterns often reveal systemic
inequalities that persist in various facets, including education, healthcare, and employment.
For instance, women frequently face barriers to accessing resources and decision-making opportunities, which
limit their potential and societal contributions (Delgado-Herrera et al., 2024). The model of heterosexual
romantic and sexual partnerships, which emphasizes fulfilling each other's needs within a nuclear family
structure, is relatively modern and culturally specific. Gender norms can also impact emotional expression and
regulation. Men may be socialized to suppress emotions, while women may be encouraged to express them
openly. In addition, women may also be viewed as too emotional because of this, and men can be perceived to
only be logical without access to a diversity of emotions. Exploring these differences helps in developing
therapeutic approaches that consider gender-specific emotional needs, ultimately promoting healthier
relationships and emotional regulation. The feminist theory founded by Mary Wollstonecraft considers this
power imbalance when exploring the formation of identity and relational events.
Today, many challenges in relationships can be traced back to the cultural expectation that individuals should
find all their emotional and practical needs met by a single partner, acting as a best friend, co-parent, and
romantic lover concurrently (TED, 2015). Additionally, the economic pressures faced by couples, including long
working hours and financial stress, exacerbate these strains, making it increasingly difficult for them to navigate
the complexities of partnership and parenting without facing the threat of poverty.
Another way this has an impact is also in terms of access to resources and support when it comes to emotional
regulation. Women are encouraged to build community, emote, discuss their feelings and thoughts, and also seek
professional help in moments of crisis, this is the opposite for men to the point where even their friendships,
relationships with family members, and also their romantic partner are affected negatively as they are
conditioned to suppress emotion and therefore have poor help-seeking behavior.
Problem Statement
Attachment trauma, arising from early adverse experiences with caregivers, significantly shapes emotional
regulation and interpersonal dynamics in adulthood. While the general effects of attachment trauma on emotional
dysregulation are well-documented, there is a critical gap in understanding how these patterns manifest
differently across genders, particularly in the context of romantic relationships. Eilert and Buchheim (2023)
conducted research that indicated a growing prevalence of mental disorders correlated with dysregulation and
insecure attachment styles. They utilized the Adult Attachment Interview (AAI) or the Adult Attachment
Projective Picture System (AAP) to establish this. A total of 37 peer-reviewed studies involving 2,006 subjects
were analyzed.
Research indicates that men and women may experience and respond to attachment trauma in distinct ways,
influenced by societal norms and expectations surrounding gender. For instance, studies suggest that women
often exhibit higher levels of attachment anxiety, leading to heightened emotional responses and difficulties in
managing relational conflicts. This idea has been weaponized in history to justify why women did not belong in
corporate spaces or should not be trusted with making decisions, as they were viewed as highly emotional,
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erratic, and even hysterical. It has also had an impact on men, drawing on the idea that men who cry, show
sadness, or express love openly, especially to their female counterparts, are weak-willed.
Inversely, Chaplin (2014) shares that men may display greater attachment avoidance, resulting in emotional
suppression and challenges in forming intimate connections. Historically, men were only encouraged to display
happiness or anger, and their access to other emotions was limited as it was directly linked to their manhood,
therefore encouraging emotional suppression. These gender-specific patterns can exacerbate emotional
dysregulation, leading to maladaptive coping strategies that hinder relationship satisfaction and stability.
Despite the increasing recognition of these differences, existing literature largely overlooks the nuanced
interplay between gender-specific attachment styles and the resulting emotional dysregulation in adult romantic
relationships. This oversight limits the development of tailored therapeutic interventions that address the unique
needs of individuals based on their gendered experiences of attachment trauma.
The present article aims to explore how gender-specific patterns of attachment trauma contribute to emotional
dysregulation in adult romantic relationships and explore what role Emotionally Focused Therapy (EFT) has in
promoting secure attachment bonds. By examining empirical evidence and theoretical frameworks, this work
seeks to illuminate the complexities of these dynamics, ultimately advocating for more informed approaches in
both research and clinical practice that consider gender as a critical factor in understanding attachment-related
challenges.
Gender-Specific Experiences with Attachment Trauma
Van Polanen et al. (2016) conducted a study examining the influence of child gender and caregiver gender on
child-caregiver interactions and attachment relationships. They highlight two main theories: Gender
Socialization Theory and Gender Schema Theory. Gender Socialization Theory proposes that male and female
caregivers will treat boys and girls depending on cultural norms and expectations. For instance, women are more
likely to be conditioned to be nurturing and sensitive in their approach to caregiving, whilst men may be more
rough. The Gender Schema Theory also has a gendered lens on this and states that interactions between mothers
and daughters and fathers and sons are likely to be more positive than those of mixed genders. It goes further to
suggest that same-sex relationships between the caregiver and the child foster a deeper emotional connection.
Weber et al. (2022) reference research that indicates that men and women have similar levels of psychological
distress, however, their findings disclosed that men seek professional help 30% less than women, and when it
comes to the different diagnoses, this is less explored. Additionally, it is stated that one’s attachment style has a
great influence on their likelihood to seek professional help.
In their book, The Body Keeps the Score, Kolk and Bessel (2014) highlight men without mothers, and they
address their experience of being torn from their mothers to be taken to boarding school which coincided with
the Murray's who were also conducting research on the impact of this detachment. He goes further to elaborate
on Karlen Lyons-Ruth’s focus on the phenomenon of dissociation, characterized by feelings of being lost,
overwhelmed, abandoned, and disconnected from one's surroundings. Individuals experiencing dissociation may
perceive themselves as unloved, empty, helpless, trapped, and burdened. Lyons-Ruth identified a significant and
unexpected correlation between maternal disengagement and misattunement during the first two years of a child's
life and the emergence of dissociative symptoms in early adulthood. She concluded that infants who are not
genuinely seen and understood by their mothers are at a heightened risk of developing into adolescents who
struggle to know and recognize themselves.
Exploring Emotional Dysregulation in Adult Romantic Relationships
As defined by Gross (2014), emotional dysregulation is the inability to modulate emotions and use strategies to
adapt and deal with the feelings that arise. This skill is learned across the lifespan. Those who do not cultivate
the skills to regulate their emotions properly, such as blaming and suppression, are considered to have a
childhood developmental problem. Emotion regulation is a process of trial and error, humans often have the
innate desire to reach out to an attachment figure when experiencing distress. This would lead to a decrease in
distress and offer protection from physical and psychological threats.
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Children who face adversity, such as abuse, neglect, and other forms of dysfunction, are more likely to have
unsupportive caregivers, in turn affecting the level of reassurance and supportive responses they receive when
needed. This leads to a reduced ability to acquire healthy and normal emotional regulation skills, instead, they
learn the negative strategies from others. They may resort to suppressing emotions, which may only lead to short-
term relief (Szepsenwol & Simpson, 2019).
According to Gardner et al, emotion regulation strategies are an extension of internal working models that
influence behavior in children. These models are stable over time and influence how individuals interpret and
evaluate behavior in close interpersonal relationships. These patterns are called attachment orientations, and they
include the behaviors, emotions, and expectations individuals have. (Fraley & Shaver, 2000; Mikulincer &
Shaver, 2016).
There are many forms of emotional regulation processes, distancing strategies, and engagement strategies.
Distancing strategies involve suppressing, reducing, or hiding emotions, such as avoidance of negative stimuli
and inhibiting emotional expression and rumination(Mehta et al., 2020). On the other hand, engagement
strategies involve expressing emotions to others and gaining support, reappraisal, and reframing of an event and
acceptance of one’s emotions nonjudgmentally, allowing for constructive processing.
According to Brandão et al (2019), attachment influences psychological well-being through emotional
regulation. The study involved 119 heterosexual couples who answered self-report questionnaires based on
attachment styles, emotional expression, emotion suppression, and psychological well-being. The findings
showcase a disparity between the psychological well-being of couples with secure attachment and those with
insecure attachment. Securely attached individuals rated higher in psychological well-being in comparison to
their insecurely attached counterparts due to the suppression of emotion. Anxiously attached individuals had an
impact on their partner’s well-being through their emotional expression, while avoidantly attached individuals
had ranked low in well-being due to suppression.
A study by Marcos Domic-Siede et al.(2024) studied 98 Chilean Latin-American adults (41 males, 53 females,
4 non-binary) aged between 18 and 58 years. Through self-report questionnaires, participants were assessed on
attachment style with the Experiences in Close Relationships Scale (ECR); Emotional regulation with the
Emotion Regulation Questionnaire (ERQ) or the Difficulties in Emotion Regulation Scale (DERS); emotional
recognition abilities, such as facial emotion recognition tasks; Cognitive and Emotional empathy with the
Interpersonal Reactivity Index (IRI) and defense mechanisms.
Through correlation and regression analysis, distinct patterns in the relationship between attachment and
emotional regulation were found. Securely attached individuals had effective emotional regulation strategies,
such as expression. Anxious preoccupied had high emotional sensitivity, poorer self-regulation, and relied on
emotional validation from others. Dismissive avoidants were more likely to have higher levels of avoidance,
intellectualization, and denial as regulation strategies, making it difficult for them to connect deeply. Lastly,
fearful avoidantly attached individuals reported higher levels of intense emotion but have heightened fear around
expressing them.
A study by Messina et al., (2023) aimed to assess the influence of attachment orientation on interpersonal
emotional regulation strategies (IER) and their effectiveness on emotional and relational well-being. Two
empirical studies used dyadic ecological momentary assessment (EMA) to capture real-time data on IER. The
two studies included a group of 136 couples who reported their six IER strategies through six prompts for 7 days,
while the next study included 361 couples who reported their IER strategies using a daily diary, one prompt a day
for twelve days. The first group aimed to record the methods they used to offer support to their partners, while
the other group aimed to record the perceived strategies received from the partners.
The first study showed that the use of advice or encouragement to suppress emotions was linked to impaired
emotional well-being in partners. Distraction led to positive affect and increased feelings of closeness in partners.
Reappraisal, acceptance, and ignoring showed no significant impact on momentary well-being. On the other
hand, the second study showed that being ignored was linked to decreased emotional and relational well-being,
and other strategies had no significant impact. This supports the hypothesis that emotional regulation has an
impact on the relational well-being of an individual as well.
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A recent study by Moradi Janati et al.(2024) studied 250 couples between the ages of 18 and 25 years on the
influence of emotional regulation on the relationship between psychological well-being and attachment styles.
The self-report study used the Experiences in Close Relationships Scale (ECR) or Adult Attachment
Questionnaire (AAQ), the Emotion Regulation Questionnaire (ERQ) or Difficulties in Emotion Regulation Scale
(DERS), and the Emotion Regulation Questionnaire (ERQ) or Difficulties in Emotion Regulation Scale (DERS).
The results collected and interpreted with Structural Equation Modelling (SEM) found a correlation between
attachment style and psychological well-being. Secure attachment was positively correlated with well-being, and
anxious/avoidant attachment was negatively correlated. Emotional regulation was determined to be a mediating
factor, with a coefficient of 0.798, impacting psychological well-being. Securely attached individuals reported
higher emotional regulation in comparison to their insecurely attached counterparts. Further supports the
hypothesis that emotional regulation has an influence on psychological well-being, showcasing its importance
in relationships.
Based on numerous factors, gender differences between men and women in preferred emotional regulation
strategies and their effectiveness. Larsson and Engsback (2024) investigated how gender influences emotion
regulation through the lens of late positive potential (LPP), a neural marker associated with emotional processing.
Through a systematic review of studies with inclusion criteria based on their examination of LPP responses
concerning emotional stimuli and gender differences, a comprehensive overview of the topic is provided.
Findings showcased that women have heightened emotional engagement and allocate more cognitive resources
to emotional stimuli, reflecting a deeper emotional processing style. Women used more adaptive strategies, such
as cognitive reappraisal, while men tended to use more avoidance strategies. These findings illustrate that gender
differences in emotion regulation are not merely behavioral but are reflected in neural processing patterns.
Kaur et al. (2022) carried out a study on 60 individuals (28 males and 32 females, with a mean age of
36.18±11.917 and 37.97±11.683 years). The Difficulties in Emotion Regulation Scale (DERS) was used to
assess emotional regulation capacities among participants. It evaluates various aspects of emotional regulation,
including emotional clarity, acceptance, and impulse control. The results were analyzed the SPSS. The results
were similar to other studies showing that women use a wider range of emotional regulation strategies compared
to men. Women will most likely use rumination and acceptance strategies, while men use avoidance and
suppression more often. Men showed higher difficulty accepting emotions compared to women (P=0.035).
Conversely, women demonstrated lesser emotional clarity than men (P=0.003).
A study by Ajayi et al. (2022) analyzed 13 studies from 17 different African countries, from a plethora of cultures
and socioeconomic backgrounds. The tools used included standardised questionnaires assessing socio-emotional
skills, emotional regulation, and teamwork abilities
Researchers looked for significant differences in emotional regulation and teamwork skills between male and
female participants. The findings were analyzed by SPSS and showed that men, in comparison to women,
reported more socio-emotional skills. Furthermore, men perceived themselves as more emotionally intelligent.
On the other hand, women had greater emotional regulation as well as teamwork skills. The study also
highlighted the influence of culture on emotional regulation. Collectivistic cultures value harmony and cohesion,
resulting in more adaptive strategies such as seeking support and positive reappraisal. Contrastingly
individualistic
The study found significant differences in emotional regulation strategies based on cultural contexts. Collectivist
cultures emphasized harmony and social cohesion, leading to more adaptive emotion regulation strategies, such
as seeking social support and utilizing positive reappraisal. Contrastingly, individualistic cultures value self-
reliance, often leading to maladaptive strategies such as suppression.
Discovering The Role of Eft in Promoting Secure Attachment Behaviors
EFT was developed in the early 1980s by Dr. Johnson and Dr. Leslie Greenberg as a therapeutic approach for
couples. It focuses on emotional attunement and reprocessing negative interaction patterns. Dr. Johnson and Dr.
Leslie Greenberg strongly believed that the way to solve problems is to recognise and address emotions to help
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restructure relationships by understanding their attachment styles. In episode 194: Dr. Sue Johnson: Attunement,
Attachment and the Development of Emotionally Focused Therapy of the Psychiatry and Psychotherapy podcast
hosted by David Puder, Dr. Johnson emphasizes that emotions are closely tied to attachment needs and that
understanding these connections is crucial for improving adult relationships.
EFT posits that emotional responses play a key role in the formation of relationship dynamics. By addressing
underlying emotional experiences, couples can transition from negative interaction patterns to more positive
connections (Puder, 2024). The concept of "softening events" is introduced, where partners experience empathy
and understanding during therapy sessions, leading to improved emotional responsiveness. For this to occur,
safety has to be established within the therapeutic space for both partners to be able to externalize the problem.
Sue Johnson often referenced the change events that need to occur for the withdrawer-pursuer cycle, where the
change event for the withdrawer is engagement, and that of the pursuer is softening. Tools such as evocative
responding, heightening, and validation become very useful.
Formella and Ugwuanyi (2024) conducted a study to explore the application of attachment theory in clinical
settings by using the Adult Attachment Interview and the Experiences in Close Relationships questionnaire. The
research focuses on adults aged 18 and older diagnosed with various personality disorders, including borderline,
antisocial, and narcissistic personality disorders, with a sample size of 120 participants. After the study, it was
found that integrating attachment theory into clinical assessment allows psychologists to attain deeper insights
into clients' attachment styles and relational histories, which informs personalized treatment approaches,
allowing clinicians to successfully target core issues underlying personality disorders. Formella and Ugwuanyi
(2024) emphasize this further by stating that Emotionally Focused Therapy (EFT) has been demonstrated to
preserve and even strengthen secure attachment behaviors in long-term relationships, effectively counteracting
the tendency for emotional distance to develop over time. As a result, couples reported lasting enhancements in
both communication and emotional closeness.
Makinen and Johnson (2006) carried out a study aimed at validating the attachment injury resolution model by
analyzing 24 couples with attachment injuries who engaged in an average of 13 sessions of emotionally focused
therapy (EFT). At the conclusion of the treatment, 15 couples were classified as resolved. Observations of the
most effective therapy sessions revealed that the resolved couples demonstrated significantly higher levels of
connection and deeper emotional engagement compared to those who remained unresolved. Additionally,
resolved couples reported marked improvements in relationship satisfaction and also in forgiveness. These
findings support the efficacy of the attachment injury resolution model, indicating that achieving resolution
during EFT can be beneficial for couples.
A study by Bazyari et al. studied 12 couples from counselling centres in Ramshir, Khuzestan, Iran. The couples
underwent nine sessions of EFT. Data collection was done using the Gottman Emotional Divorce Scale, the
Emotional Regulation Questionnaire, and the Marital Disturbance Questionnaire. The data was interpreted by
using repeated measures ANOVA. Findings indicated that emotional regulation scores increased from a mean
of 77.25 to 115.50 and later on 125.00. This demonstrated the effectiveness of EFT on emotional regulation.
(2024)
A mixed-methods study by Ramirez and Smith (2024) used a questionnaire assessing attachment style and
relationship satisfaction. In addition to the 200 participants who had filled out the survey, 20 couples were
interviewed using each of the attachment styles. Correlation and regression analysis for the quantitative data and
a thematic analysis for the qualitative data. The findings show that in couples with at least one partner with
secure attachment, there was better communication, successful conflict resolution, and greater relationship
satisfaction. The study illustrates the effectiveness of attachment work using EFT by promoting mindfulness and
emotional regulation among partners. This therapy encourages partners to express their needs without fear of
rejection, thereby enhancing emotional connection. Specific exercises within EFT focus on leveraging the
strengths of securely attached partners to model healthy behaviours for insecure partners.
Similarly, a longitudinal study by Reid and Johnson (2021) looked at the effectiveness of healing attachment
injuries using EFT. The quantitative study involved 446 patients receiving online therapy during the pandemic.
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A subset of 121 participants filled in a questionnaire assessing attachment style, the therapeutic process, and
COVID-related stress. The treatment modality used was EFT, more specifically the Attachment Injury
Resolution Model (AIRM). The findings showcased that individuals with lower levels of attachment anxiety and
avoidance had significantly less distress. Those who had high attachment anxiety and avoidance benefited from
joining and alliance building as well as softening techniques used in EFT i.e., expression of vulnerability.
A study by Petreson et al. (2023) was carried out on 150 to 200 couples experiencing modern-related stressors.
The missed methods study used measures of attachment style, relational satisfaction, and modern stressors. The
intervention used was the 9-step EFT model, with integrated softening events, such as emotional expression
during video calls. And psychoeducation. The quantitative analysis was based on the comparison of pre- and
post-scoring on all measures, The findings suggest further that Anxious Attachment: Partners exhibited reduced
protest behaviors (e.g., excessive texting) and greater self-soothing capacity after accessing unmet attachment
needs 5.
Avoidant Attachment: EFT facilitated increased emotional expression, with 72% of avoidant partners engaging
in vulnerable conversations by the final therapy phase 3.
Long-Term Efficacy:
Post-Therapy Stability: 80% of couples maintained secure attachment patterns at 6-month follow-up, particularly
those who completed "booster" virtual sessions 6.
Resilience to Stressors: EFT-trained couples demonstrated adaptive responses to unforeseen stressors (e.g., job
loss), leveraging secure bonds for mutual support 4.
CONCLUSION
In conclusion, it is essential to recognise the impact of culture on gender norms and how this affects the emotional
stance couples take in their romantic relationships. As elaborated upon in the preceding sections,
psychoeducation on these limitations brought about by gender-specific perspectives can allow for the creation
of safety within interactions between couples that then promotes emotional attunement between them and moves
them from a combative stance to a collaborative one. The EFT model encapsulates this through techniques such
as mapping out the cycle, validation, evocative responding, and reflection. Couples do not have to be stuck in
their negative interaction cycles; the EFT model teaches couples to soften towards each other and fully engage
in their interactions to allow for the individuals within the couple relationship to truly see each other and make
room for attunement beyond their differences. In the end, we can see how this increases relationship satisfaction
but also has an incredible impact on men and women as individuals in their healing journey.
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