Emotionally%20Focused%20Therapy

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Emotionally Focused Therapy

• Interventions and Techniques

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EFT Assessment

• Tasks
• 1. Create a collaborative therapeutic alliance
• 2. Explore client(s) agendas for
• a. The relationship
• b. Therapy
• 3. Present therapy contract

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• 4. Assess prognostic indicators
• a. Degree of reactivity
• b. Strength of attachment
• c. Openness or response to therapist engagement
  with therapy
• 5. Note trust/faith of female 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 Partners Interactions
• Self-report questionnaires
• Individual sessions

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Identifying Delineating Negative Interactive
Cycle

• Identifying the cycle
• Look for predominant pattern
• Delineating the cycle

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Identifying Delineating Negative Interactive
Cycle

• Basic Negative Cycles Interactive Positions
• Pursue/Withdraw
• Withdraw/Withdraw
• Attack/Attack
• Complex cycles
• Reactive pursue/Withdraw

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Common Underlying Emotions of the Withdrawers
and Pursuers

• Rejected
• Inadequate
• Afraid of failure
• Overwhelmed
• Numb frozen
• Afraid scared
• Not wanted or desired
• Judged, critized

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

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Key Movements in Assessment Process Focus Points

• Clients narrative is interrupted by strong
  affect
• Affect is conspicuous by its absence
• Personal landmark
• Interactional landmark
• Position markers
• Responses to positive contact

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Key Movements in Assessment Process Focus Points

• Clients narrative is interrupted by strong
  affect
• Focus on emotional response
• Give message that it is safe and appropriate to
  share this experience in the session

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Key Movements in Assessment Process Focus Points

• Affect is conspicuous by its absence
• Explore lack of engagement in the personal
  experience being related
• Discover the significance in terms of the
  couples engagement in and definition of their
  relationship

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Key Movements in Assessment Process Focus Points

• Personal landmark
• Focus on and explore story
• Uncover the meaning of the story from clients
  perspective
• Ask if the partner understands the clients
  experience
• Label story as unresolved issue for couple and
  validate associated primary or secondary emotion

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Key Movements in Assessment Process Focus Points

• Interactional landmark
• Observe this interaction
• If alliance is developing well, refer to
  interaction in this session
• Otherwise, simply take note of the interaction

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Key Movements in Assessment Process Focus Points

• Position markers
• Get a clear picture of the position each partner
  takes in response to the other
• Ask how each partner perceives and feels about
  such positions

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Key Movements in Assessment Process Focus Points

• Responses to positive contact
• Explore the exit from the contact
• Acknowledge attempts to comfort and ability to
  receive comfort as a strength of the relationship

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Basic Skills in Assessment

• Creating a therapeutic alliance a safe haven in
  therapy.
• Empathic Attunement
• Acceptance
• Genuineness

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• Therapy skills used in assessment
• Reflection
• Validation
• Reframing catching the bullet

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• Reflection
• Reflecting clients experience
• Reflecting nonverbal communication
• Verbal and nonverbal communication incongruence

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• Validation
• Validating clients experience
• Careful validation

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• Reframing
• Need to understand issues the clients are
  struggling with.
• Shifts focus, validates and redirects.
• Catching the bullet
• Interrupting hurtful comments/negative cycles
  works to create safety

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Remember the 3 Tasks of EFT

1. Create and maintaining a therapeutic alliance.
2. Accessing and reformulating emotion.
3. Restructuring key interactions.

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Core Interventions

• Once alliance is established, there are two basic
  tasks
• Exploration and reformulation of emotional
  experience
• Restructuring of interactions

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Core Interventions

• Exploring Reformulating Emotion
• Reflecting emotional experience
• Validation
• Evocative Responding
• Heightening
• Empathic Conjecture or Interpretation

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Exploring Reformulating Emotion

• Reflecting Emotional Experience
• Focusing the therapy process
• Building maintaining the alliance
• Clarifying emotional responses underlying
  interactional positions

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Exploring Reformulating Emotion

• Validation
• Legitimizing responses and supporting clients to
  continue to explore how they construct their
  experience and their interactions
• Building the alliance

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Exploring Reformulating Emotion

• Evocative Responding
• Expanding, by open questions, the stimulus,
  bodily response, associated desires and meanings
  of action tendency
• Expanding elements of experience to facilitate
  the re-organization of that experience
• Formulating unclear or marginalized elements of
  experience and encouraging exploration and
  engagement

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Exploring Reformulating Emotion

• Heightening
• Using repetition, images, metaphors, enactments
• Highlighting key experiences that organize
  responses to the partner and new formulations of
  experience that will re-organize the interaction

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Exploring Reformulating Emotion

• Empathic Conjecture or Interpretation
• Clarifying and formulating new meanings,
  especially regarding interactional positions and
  definitions of self.

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Core Interventions

• Restructuring Interventions
• Tracking, reflecting, replaying interactions
• Reframing in the context of the cycle and
  attachment processes
• Restructuring and shaping interactions

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Restructuring Interventions

• Tracking, reflecting, and replaying interactions
• Slows down and clarifies steps in the
  interactional dance
• Replays key interactional sequences

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Restructuring Interventions

• Reframing in the context of the cycle and
  attachment processes
• Shifts the meaning of specific responses
• Fosters more positive perceptions of partner

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Restructuring Interventions

• Restructuring and shaping interactions
• Enacting present positions, enacting new
  behaviors based upon new emotional responses and
  choreographing specific change events.
• Clarifies and expands negative interactional
  patterns
• Creates new kinds of dialogue and new
  interactional positions leads to positive
  cycles of accessibility and responsiveness

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Interventions are Experiential

• It is all about emotional engagement
• We slice it thinner until we find a level where
  they feel secure to engage.
• Once they engage we can then move to other
  levels.
• Insight is not enough to change emotions/patterns

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Expanding Emotional Experience

• Client statement I feel numb/empty.
• Therapist
• Can we just stay there a moment? (focus on
  process)
• You feel numb. (reflection)
• When Mary says you feel numb. (repeat in
  context of cycle/interaction)

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Expanding Emotional Experience

• And they you stay silent, say nothing? (action
  primed by numb withdrawal)
• Whats that like for you, to go numb, stay numb?
• How do you feel as you talk about this right now
• Whats happening for you as you talk about this?
  About going numb?

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Expanding Emotional Experience

• How do you do that? (frames client as agent in
  creation of experience)
• Thats how you protect yourself? (conjecture
  about function/attachment behavior)
• If you didnt do that what would happen?
• As you say that, you clench your fist tight, like
  holding on.
• That must be hard, to feel you have to numb out
  all the time.

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Expanding Emotional Experience

• Thats the way you have of protecting yourself
  here.
• You shut down, shut off, go somewhere else, go
  away, hide, chill out.
• Its like, I dont want to feel, is that it?
  You cant get me?
• And you feel like hes not there with you?
  (speaking to other partner)
• You cant stay and here her say , you have to
  go away?

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Expanding Emotional Experience

• Can you tell here I shut you out? (enactment)
• For you its like you feel so battered, so
  criticized that you are numb.

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Key Change Events

• Softening
• Re-engagement

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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 counselor 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 here 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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Change Events

• There is a relentless focus, while helping client
  feel safe/supported
• May be more directive
• After a change event validate every aspect of
  what they did be specific on what they did that
  worked.

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Contraindications of EFT

• Different Agendas
• Separating Couples
• Abusive Relationships
• Substance Abuse
• Depression and Other Psychiatric Illness

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Impasses and other clinical issues Attachment
Injuries

• A betrayal of trust or abandonment at crucial
  moment in need.
• A form of relationship trauma defines
  relationship as insecure.
• An impasse in repair process
• Attachment significance is key not content.
• Indelible imprint only way out is through.

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Resolution of Attachment Injuries

• Articulate injury and impact.
• The other acknowledges hurt partners pain and
  elaborates on the evolution of the event.
• The hurt partner integrates narrative and
  emotion.
• He/She accesses attachment fears and longings.
• The other owns responsibility, expresses regret,
  while staying attuned and engaged.
• Relationship is redefined as a safe haven.
• New narrative is constructed.

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Therapist Checklist Beginning an EFT Session

• 1. What is the cycle that characterizes this
  relationship?
• 2. What are the hypothesized or acknowledged
  primary emotions embedded in this cycle?
• 3. What are the attachment issues/fears/needs?
• 4 Where are they in the process of change in the
  9 steps? The next step/task is?
• 5. Are there pivotal incidents that crystallize
  issues, in relationship history, in session?
• 6. Are there key images, definitions of self
  that partners use?
• 7. What are the current blocks to engagement
  with emotions, engagement with other?
• 8. Is the alliance with the therapist in tact?
• 9. What happened in the last session (process)?
• 10. What are this couples strengths?

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Beginning an EFT Session

• Check the alliance, Is it intact with both
  partners? How do you know?
• What is the main negative cycle? Who does what?
• What are the primary emotions underlying the
  cycle?
• What are the linked attachment fears and issues
  related to the cycle?

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Beginning an EFT Session

• Where is the couple in the EFT steps?
• What are the pivotal incidents in the
  relationship which have defined the relationship
  as safe or unsafe?
• What are the key images/definitions of self and
  each partner?
• How is the cycle playing a role in blocking
  emotional engagement within relationship?

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Beginning an EFT Session

• Review the highlights and processes of the last
  session.
• What are the strengths in this relationship? What
  are the strengths of each partner?
• Review the focus and direction of the session.
• Review steps and make a tangible therapeutic goal
  for the session.

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