EMOTIONALLY FOCUSED�COUPLE THERAPY

Structure, Interventions and Techniques

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NJ Collaborative for EFT

Elisabeth W. Brown, PsyD

Alan Groveman, PhD

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EMOTIONALLY FOCUSED THERAPY:�

Goals for Today

Basic Overview of EFT

Develop skills in the application of EFT when working with couples.

Emphasis on attachment.

Emphasis on process, here and now.

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OUTLINE OF TODAY’S WORKSHOP�

• Overview and Theoretical Assumptions
• Three Stages and Nine Steps of the EFT Process

a. Goal of Each Step

b. Video Clip demonstration of the Step

c. Vignette and Live Demonstration

d. Vignette and Role Play

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EMOTIONALLY FOCUSED THERAPY:�OVERVIEW AND THEORETICAL ASSUMPTIONS�PRIMARY ROOTS OF EFT

• Experiential Therapy (Perls)
• Person Centered Therapy (Rogers)
• Systemic Therapy (Minuchin)
• Attachment Theory (Bowlby)

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WINNECOTT – GOOD ENOUGH MOTHERING�

• 30% Attunement and the rest is repair (Bowlby)
• Same is true in couples relationships
• Attachment History influences how or whether repair takes place.
• Despite couples’ attachment styles and history, the new research of neural plasticity tells us that we can repair old patterns with new relationships.

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HIGHLIGHTS OF EFT MODEL

• The major distress evidenced in couples is due to ruptures in connection/attachment. The content can change but the fights/distress look the same. The goal of EFT is to translate the content of distress into attachment yearnings and longings.
• Another goal of EFT is to help couples express their longings in ways that don’t scare their partners.

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Attachment

• If we listen to the attachment related themes, we, as therapists, can be compassionate to both partners.
• EFT is empathy on meth.
• All interactions are slowed down and sliced thinly to milk the most attachment related experiences.

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BASIC OVERVIEW OF EFT

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The primary goals of EFT are to:

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• Access, expand and re-organize key emotional responses between partners.

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• Create a shift in each partner’s interactional positions in their rigid interactions with one another.

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• Foster the creation of a secure bond between partners through the creation of new interactional experiences that redefine the relationship.

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OVERVIEW OF TREATMENT PROCESS

• Develop an alliance, identify cycle, identify and access underlying emotions, and work to de-escalate
• Engage the withdrawer
• Soften the pursuer/blamer
• Create new emotional bonding events and new cycles of interaction
• Consolidate new cycles of trust, connection and safety, and apply them to old problems that may still be relevant

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RESEARCH

• 70 – 73% recovery rate in 10-12 sessions.
• Results stable – even under high stress.
• Depression significantly reduced.
• Variety of populations and settings.

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SOOTHING THE THREATENED BRAIN

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CONTRA-INDICATIONS OF EFT

• Different Agendas
• Separating Couples
• Abusive Relationships
• Substance Abuse
• Depression and Other Psychiatric Illness (Sometimes, other times it can be helpful)

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�3 STAGES AND 9 STEPS OF EFT

• Stage 1

Assessment and Cycle De-Escalation

• Stage 2

Changing Interactional Positions and Creating New Bonds

• Stage 3

Consolidation and Integration

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THE FOUR STEPS OF STAGE 1�ASSESSMENT AND CYCLE DE-ESCALATION�

• Step 1: Alliance and Assessment
• Step 2: Identify EFT cycle
• Step 3: Accessing unacknowledged attachment related primary emotions that support the rigid interaction cycle
• Step 4: Reframe the problem in terms of the negative cycle and underlying fears and needs

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THE THREE STEPS OF STAGE 2�CHANGING INTERACTIONAL POSITIONS AND CREATING NEW BONDS�

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• Step 5: Promote identification with disowned needs and aspects of self
• Step 6: Promoting acceptance of the partner’s experience and being responsive to the partner’s identified primary emotions and attachment needs
• Step 7: Facilitating the deeper expression of attachment emotions and needs creating corrective experiences between the partners

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THE TWO STEPS OF STAGE 3�CONSOLIDATION AND INTEGRATION�

• Step 8: Facilitating the emergence of new solutions to old relationship patterns
• Step 9: Consolidating new positions and new cycles of safe attachment and connection

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The EFT Hand Dance

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NOW LET’S LOOK AT THESE STEPS IN MORE DETAIL ONE BY ONE

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STEP ONE�ALLIANCE AND ASSESSMENT

• Create an alliance and delineate conflict issues in the core attachment struggle.
• What are they fighting about and how is this related to core attachment issues?

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STEP ONE (CONTINUED)�ALLIANCE AND ASSESSMENT

Tasks

1. Create a collaborative therapeutic alliance

2. Explore client(s) agendas for:

a. The relationship

b. Therapy

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STEP ONE (CONTINUED)�ALLIANCE AND ASSESSMENT

3. Assess prognostic indicators

a. Degree of reactivity

b. Strength of attachment

c. Openness or response to therapist – engagement with therapy

4. Note trust/faith of each partner

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TAKING HISTORY OF THE RELATIONSHIP

• Sample questions:
• How long they have been together?
• What attracted them to each other?
• What was it like when things were good between them?
• When they fight/argue, do they feel they resolve issues? How do they make up?
• What prompted them to come for therapy at this time? What changes would they like to see?

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ASSESSING ATTACHMENT STYLE

• Assessing Attachment History
• Assessing Partner’s Interactions
• Individual sessions – after initial couple session, schedule each partner for individual session.
• Self-report questionnaires

Dyadic Adjustment Scale

When We Are Not Getting Along

Attachment History

Couple Questionnaire

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STEP 1 - ESTABLISHING AN ALLIANCE�THE ESSENTIAL SKILLS

• Reflection
• Validation
• Empathic Attunement

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SKILLS FOR EMOTIONAL ENGAGEMENT

R-I-S-S-S-C

R: The therapist intentionally REPEATS key words and phrases for emphasis.

I: Therapist uses IMAGES or word pictures that evoke emotions more than abstract labels tend to do.

S: Therapist frames responses to clients in SIMPLE and concise phrases.

S: Therapist will SLOW the process of the session and the pace of her speech to enable deepening of emotional experience

S: Therapist will use SOFT and soothing tone of voice to encourage a client to deepen experience.

C: Therapist uses CLIENT words and phrases in a supportive/validating way.

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GOAL FOR STEP 1 ROLE PLAY

1. Alliance Building
2. Validating and Reflecting each Partner
3. Practice Slowing it Down and using RISSSC

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Demonstration Vignette

Partner A: “He doesn’t listen to anything I say

Partner B: “She is so critical, nothing I ever do is right for

her. She just nags me all of the time

ROLE-PLAY

Role-Play Vignette

Partner A: “He doesn’t listen to anything I say

Partner B: “She is so critical, nothing I ever do is right for

her. She just nags me all of the time

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STEP TWO�IDENTIFY THE NEGATIVE INTERACTION CYCLE

• EFT Cycle levels include

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• Action tendencies (behaviors)

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• Perceptions

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• Secondary Emotions

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• Primary Emotions

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• Unmet Attachment Needs

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STEP TWO�IDENTIFY THE NEGATIVE INTERACTION CYCLE

• The goal is for the therapist to:

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• See the cycle in action

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• Identify it

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• Describe it to the couple

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• Work towards stopping it

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BASIC NEGATIVE CYCLES & INTERACTIVE POSITIONS�

• Pursue/Withdraw
• Withdraw/Withdraw
• Attack/Attack
• Complex cycles
• Reactive pursue/Withdraw

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COMMON UNDERLYING EMOTIONS OF

Withdrawers

• Rejected
• Inadequate
• Afraid of failure
• Overwhelmed
• Numb – frozen
• Afraid – scared
• Not wanted or desired
• Judged, criticized
• Shame
• Empty

Pursuers

• Hurt
• Alone
• Not wanted
• Invisible
• Isolated/disconnected
• Not important
• Abandoned
• Desperate
• Deprived
• Emotionally Starved

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EFT EMOTIONS AND REACTIVITY

Emotions occur at two levels: Primary and Secondary (or reactive).

Primary Emotions are the deeper, more vulnerable and tender emotions such as sadness, hurt, fear, shame, and loneliness.

Secondary Emotions are the more reactive emotions such as anger, jealousy, resentment, and frustration. They occur as a reaction to the primary emotions. Anger, Blame,

Primary emotions generally draw partners closer.

Secondary emotions tend to push partners away.

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THE CYCLE�SCOTT R. WOOLLEY PH.D. ©

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Partner

Partner

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STEP 2 – IDENTIFYING THE NEGATIVE CYCLE

• Who is the Pursuer?
• Who is the Withdrawer?
• Describe the Negative Cycle
• What are the Secondary Emotions?
• What are the Primary Emotions?

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DEMONSTRATION VIGNETTE

The goal of this role play is to:

Unpack the cycle

• Behaviors
• Perceptions
• Secondary Emotions
• If possible work toward tagging the underlying Primary Emotions and the unmet attachment longings and needs.

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• Partner A “I asked you to bring home a dozen lemons and you brought home three. How come you never listen to what I say. I feel like I’m not important to you.”
• Partner B “Everything I do is wrong, I can’t get it right with you. I can’t sit down and take a break without you telling me that I screwed up”

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�STEP THREE��ACCESS UNACKNOWLEDGED EMOTIONS UNDERLYING INTERACTIONAL POSITIONS

• The goal is to help each member of the couple access and accept their unacknowledged feelings that are influencing their behavior in the relationship. Both partners are to "reprocess and crystallize their own experience in the relationship" so that they can become emotionally open to the other person.

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DEMONSTRATION VIGNETTE

GOAL OF VIGNETTE

1. What are underlying Emotions
2. Positions - Who is the Withdrawer, who is Pursuer

Presenting problem:

• Partner A “Here, I go to the Michigan game with you, that’s how I show up, what do you do for me?”
• Partner B “I get up every morning to be the best tour guide I can be. So, maybe you don’t have to work anymore. That’s how I show up for you.”

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STEP FOUR�REFRAME PROBLEM IN THE CYCLE IN TERMS OF UNDERLYING FEELINGS, ATTACHMENT NEEDS, YEARNINGS AND LONGINGS.

The cycle is framed as the common enemy and the source of the partners’emotional deprivation and distress.

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EFT REFRAMES IN STEP 4

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For example:

Angry Criticism is viewed in EFT as:

• an attempt to modify the other partner’s inaccessibility or manage the disconnect
• a protest response to emotional isolation and abandonment not being “crazy or irrational”.

Avoidant is seen as:

• an attempt to contain the interaction and regulate fears of rejection or not burden the other partner
• an attempt to avoid confrontation or working models that define the self as unlovable .

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STEP 4��REFRAME THE PROBLEM IN TERMS OF UNDERLYING FEELINGS, AND REFRAME THE NEGATIVE CYCLE IN TERMS OF ATTACHMENT NEEDS, FEARS, YEARNINGS AND LONGINGS. ��

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ACCESSING UNDERLYING FEELINGS�ENACTMENTS

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Set up the enactment.

• Identify the primary attachment need or fear.
• Ask if he/she has ever told him/her that before
• Explore what he/she imagined would happen if he/she did share
• Explore what it would mean to be able to share
• Float a trial balloon e.g. Do you want to try
• Explore how it feels to share
• Turn to the partner and ask him/her if he/she is surprised by the feelings of his/her partner
• If surprised or disbelieving, be sure to catch the bullet…reframe the surprise
• Ask receiving partner how they feel hearing their partner’s feeling
• Where does it hit them.
• If they could take in or believe what the disclosing partner says, how would it feel to them (e.g.. slicing it thinner).
• What would it mean to the receiving partner if they could believe the other partner…
• (And if therapist is comfortable with the receiving partner’s response – e.g. it is softened to the point of receiving it, then complete the enactment and have the partner respond.

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Role Play: Enactments

1. SET THE STAGE�Therapist: Have you ever told Vince how you feel not seen, or not valued when he forgets what you requested.

Jennifer: He knows. We’ve been together long enough

Therapist: What do you imagine would happen if you turned to him right now and told him how bad it feels when you feel that you don’t matter to him, this guy that means so much to you.

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2. DIRECTING ONE PARTNER TO MAKE CONTACT WITH THE OTHER

Therapist: Can you turn to him right now and tell him how painful it is when

you feel you don’t matter to him, this guy you care so much about

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3. PROCESS EACH PARTNERS EXPERIENCE OF THE ENACTMENT

Therapist: What happens to you Jennifer when you turn to him and share

these tender feelings?

Therapist turns to Vince: Are you surprised that Jennifer feels so much pain

when she feels she does not matter to you? That you mean so much to her.

Therapist continue with Vince: What happens inside, Vince, when you hear

her tell you how much you matter to her and the pain she is in when she

feels that she doesn’t matter to you.

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Role Play: Enactments – cont’d

If Vince can’t take in the vulnerability of Jennifer, slice it thinner.

For Example: Therapist – Vince, if you could entertain the notion that Jennifer really feels what she is saying right now, what do you imagine you would feel.

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Role Play an Enactment – Your Turn

1. SET THE STAGE
2. DIRECTING ONE PARTNER TO MAKE CONTACT WITH THE OTHER
3. PROCESS EACH PARTNERS EXPERIENCE OF THE ENACTMENT

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STEP 5�WITHDRAWER RE-ENGAGEMENT �AND PURSUER SOFTENING

Promote identification with disowned attachment emotions, needs and aspects of self, and integrate these into relationship interactions

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• Help the couple redefine their experiences in terms of their unacknowledged emotional needs. "I nag because I feel abandoned and I want to be loved." "I withdraw because I feel invaded and rejected and I need to feel safe and loved."

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STEP SIX�PROMOTE ACCEPTANCE OF THE OTHER PARTNER’S EXPERIENCES �AND NEW INTERACTIONAL RESPONSES

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• Work to get each partner to accept, believe, and trust that what the other partner is describing in terms of underlying emotional needs is accurate.

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STEP SEVEN�FACILITATE THE EXPRESSION OF NEEDS AND WANTS AND CREATE EMOTIONAL ENGAGEMENT AND BONDING EVENTS

• Help them learn to express their emotional needs and wants directly rather than through the old patterns and create emotional engagement. This will help each person see the other person in a more benign manner. (Feeling vulnerable and insecure rather than rejecting.)

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STEPS 5,6,7 PURSUER SOFTENING

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SOFTENING

Pre-requisites:

• De-escalation of negative cycle (Stage 1)
• Withdrawer re-engagement (Stage 2 change event)
• A previously hostile, critical partner accesses “softer “ emotions and risks reaching out to his/her partner who is engaged and responsive.
• In this vulnerable state, the previously hostile partner asks for attachment needs to be met.

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SOFTENING

• At this point, both partners are attuned, engaged and responsive (accessibility & responsiveness)
• A bonding event then occurs which redefines the relationship as a safe haven and a secure base.

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WHAT THERAPIST DOES IN SOFTENING

• Heightening emotions
• Evoking responding
• Creating a new dialogue
• Model a secure attachment (helps take a short cut for the couple)

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LEVELS OF CHANGE IN SOFTENING

• She expands her experience and accesses attachment fears. Emotions tell us what we need.
• She engages her partner in a different way.
• She articulates emotional needs and changes her stance (position) in the dance.
• New emotions prime new responses

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LEVELS OF CHANGE IN SOFTENING

• He sees her differently (afraid rather than dangerous) and is pulled towards her by her expression of vulnerability
• She reaches and he comforts. She sees him differently.
• A new compelling cycle is initiated – an antidote to previous negative cycle – a redefinition of the relationship as a secure.

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LEVELS OF CHANGE IN SOFTENING

• They exhibit more open communication, flexible problem solving and resilient coping.
• Couple resolves issues/ problems (stage 3)
• There are shifts in both partners’ sense of self. Both can comfort and be comforted.
• Both are defined as“lovable”

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INTERVENTIONS IN EFT�

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Emotion Interventions

1. Empathic Reflection
2. Validation of Client Realities and Emotional Responses
3. Evocative Responding – Question and Reflections of the Leading Edge
4. Heighten, Expand Awareness – Repeat, Re-Enact, Refocus and use imagery
5. Empathic Conjecture, Interpretation and Inferences, Disquisitions

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Interaction Interventions

1. Track and Reflect Process of Interaction, Make Positions and Cycles Explicit
2. Reframe experience/Interaction in Terms of Attachment Context and Interactional Cycles
3. Restructuring and Shaping Interactions Using Enactments

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ROLE PLAY

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Vince’s Attachment History: An angry, distant father. Perfectionistic mother. He could never get it right, so he withdrew and took care of himself. Early on learned that expression of emotion was dangerous.

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Jennifer’s Attachment History: Jennifer’s father left when she was in grade school after having an affair. Mother, worked a lot to provide for her and her three sisters. As the oldest, Jennifer was the parentified child.

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Help one or the other unpack the unmet attachment needs and assist the other partner to hear in a softened and accepting way.

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THANK YOU�CONTACT INFORMATION:�DOCEWB@GMAIL.COM�NJPSYCH@GMAIL.COM�WWW.NJCEFT.ORG�