FAQS about couple therapy that works
About Emotionally Focused Therapy
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EFT is an approach to therapy that focuses on emotions and attachment–the deep human need to feel securely connected to the people who matter most. It was developed by Dr. Sue Johnson in the 1980s and has become one of the most researched and effective approaches to couples therapy. Rather than teaching communication techniques, EFT helps couples understand and change the patterns that keep them stuck.
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Yes. EFT is one of the most rigorously researched approaches to couples therapy. Studies show that 70-75% of couples move from distress to recovery, and about 90% show significant improvement. It's grounded in attachment science and neurobiology.
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A lot of traditional couples therapy focuses on communication skills, conflict resolution, or helping partners "understand" each other. EFT goes deeper. We're not just changing how you talk, we're changing the emotional patterns underneath the conflict. When those shift, the communication stuff tends to follow.
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The Cycle is the pattern you and your partner get stuck in. It’s the predictable dance that happens when things go sideways. Usually one person pursues (pushes for connection, criticizes, asks "what's wrong?") while the other withdraws (shuts down, goes quiet, pulls away). Or you both pursue and things escalate fast. Or you both withdraw and the silence grows.
None of this is anyone's "fault"–it's how two attachment systems bump up against each other. Once you can see the cycle, you can start to change it.
About Paula Zerfoss
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I'm a licensed psychotherapist with over 25 years of experience. I'm also a Certified EFT Therapist and Supervisor through ICEEFT (the International Centre for Excellence in Emotionally Focused Therapy), which means I've completed advanced training and I also train other therapists in EFT. I'm certified in EFIT (Emotionally Focused Individual Therapy) and EFFT (Emotionally Focused Family Therapy)as well.
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Because I've been there. I went through my own painful marriage and divorce, and that experience drove me to understand why relationships derail and, most importantly, how people who love each other can find their way back. That question has shaped my entire career.
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Yes. I work with married couples, unmarried partners, engaged couples, couples considering separation, LGBTQ+ couples, and couples at every stage of life.
I also work with families with teens or adult children.
Fees & Logistics
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I don't accept insurance directly, but I'm considered an "out-of-network provider." That means your insurance may reimburse you for part of the cost. Before your first session, I'd recommend calling your insurance company and asking:
What are my mental health benefits?
Do I have out-of-network coverage?
What's the reimbursement amount per session?
Do I need to meet a deductible first?
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Contact me regarding fees & costs, that way I can give you the most up to date information.
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A typical session is 75 minutes. This gives us time to do the real work without rushing.
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I work with clients online throughout Massachusetts and North Carolina. Most couples sit together in the same room for our video sessions–same couch, same space–which works beautifully for couples. For families, I can work with family members from different locations. Please contact me for specifics.
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I ask for 48 hours notice if you need to cancel or reschedule. Late cancellations or no-shows are charged the full session fee.
Getting Started with Couples Therapy
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If you're asking the question, that's usually a sign. Some common signals: you keep having the same argument, you feel more like roommates than partners, there's been a betrayal or major rupture, you're considering separation but not sure, or things just feel "off" and you can't figure out why. You don’t have to wait until things feel desperate to get started! Generally, the sooner I can intervene in the Cycle, the quicker therapy will progress. If there is trauma, we may have to work more slowly.
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This is common. Sometimes one partner is more hesitant. Maybe they've had a bad therapy experience before, or they don't think it will help, or they're nervous about what might come up.
I'd suggest sharing a bit about EFT and how it's different. If they're still unsure, I'm happy to do a brief phone call with one or both of you to answer questions before committing.
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I prefer to meet with couples together from the start. But if there are specific circumstances, reach out and we can talk about what makes sense.
About the Process of EFT
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We talk. I ask a lot of questions about your relationship history, what's been happening lately, and what brought you in now. I'll start mapping out your cycle — the pattern you're stuck in. It's not about finding the "bad guy." It's about understanding how you got here.
After I meet with you as a couple, I will then have an individual session with each of you to get an even better understanding of you, your history, and your goals.
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Most couples meet weekly, especially at the beginning. Consistency matters in this work. Once things stabilize, some couples move to every other week, or once a month.
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It depends on what you're working through. Most couples start to feel a shift within the first few sessions. Typical treatment runs 8-20 sessions, though some couples stay longer for deeper work. I'm not trying to keep you in therapy forever. I'm actually trying to help you not need me anymore!
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Let's talk about it. Sometimes there's a stuck point we need to address directly. Sometimes the approach isn't the right fit. I'd rather have an honest conversation than have you quietly disengage.
About Services
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Couples therapy focuses on the two of you–your relationship, your cycle, your connection.
Family therapy brings in other family members, usually to work on parent-child relationships (teen and parents. adult children and their parents, even siblings). The approach is similar–we're still looking at patterns and attachment–but the focus shifts.
I don’t judge anyone, even in no contact situations.
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A Couples Intensive is an extended session– usually a full day or two–where we do the work that would normally happen over several weeks. It's a good option if you're in crisis and can't wait, if your schedules make weekly sessions difficult, or if you just want to go deep and make progress faster. Contact me if you're interested.
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My focus is couples and families, but I am trained in EFIT (Emotionally Focused Individual Therapy). If you're working through relationship patterns on your own–maybe you're not currently partnered, or your partner isn't ready for couples work–we can talk about whether individual sessions make sense.