Transcript Emotionally Focused Therapy

EMOTIONALLY FOCUSED
THERAPY
Interventions and Techniques
EFT Assessment
Tasks
1. Create a collaborative therapeutic alliance
2. Explore client(s) agendas for:
a. The relationship
b. Therapy
3. Present therapy contract
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
Taking History of the Relationship
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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?
Assessing Attachment Style
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Assessing Attachment History
Assessing Partners’ Interactions
Self-report questionnaires
Individual sessions
Identifying & Delineating
Negative Interactive Cycle
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Identifying the cycle
Look for predominant pattern
Delineating the cycle
Identifying & Delineating
Negative Interactive Cycle
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Basic Negative Cycles & Interactive Positions
 Pursue/Withdraw
 Withdraw/Withdraw
 Attack/Attack
 Complex
cycles
 Reactive pursue/Withdraw
Common Underlying Emotions of the
Withdrawers and Pursuers
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Rejected
Inadequate
Afraid of failure
Overwhelmed
Numb – frozen
Afraid – scared
Not wanted or desired
Judged, critized
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Hurt
Alone
Not wanted
Invisible
Isolated/disconnected
Not important
Abandoned
Desperate
Key Movements in Assessment Process –
Focus Points
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Client’s narrative is interrupted by strong affect
Affect is conspicuous by its absence
Personal landmark
Interactional landmark
Position markers
Responses to positive contact
Key Movements in Assessment Process –
Focus Points
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Client’s 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
Key Movements in Assessment Process –
Focus Points
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Affect is conspicuous by its absence
 Explore
lack of engagement in the personal experience
being related
 Discover the significance in terms of the couple’s
engagement in and definition of their relationship
Key Movements in Assessment Process –
Focus Points
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Personal landmark
 Focus
on and explore story
 Uncover the meaning of the story from client’s
perspective
 Ask if the partner understands the client’s experience
 Label story as unresolved issue for couple and validate
associated primary or secondary emotion
Key Movements in Assessment Process –
Focus Points
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Interactional landmark
 Observe
this interaction
 If alliance is developing well, refer to interaction in this
session
 Otherwise, simply take note of the interaction
Key Movements in Assessment Process –
Focus Points
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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
Key Movements in Assessment Process –
Focus Points
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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
Basic Skills in Assessment
Creating a therapeutic alliance – a safe haven in
therapy.
 Empathic Attunement
 Acceptance
 Genuineness
Therapy skills used in assessment
 Reflection
 Validation
 Reframing & catching the bullet
Reflection
 Reflecting client’s experience
 Reflecting nonverbal communication
 Verbal
and nonverbal communication incongruence
Validation
 Validating client’s experience
 Careful validation
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
Remember the 3 Tasks of EFT
1.
2.
3.
Create and maintaining a therapeutic alliance.
Accessing and reformulating emotion.
Restructuring key interactions.
Core Interventions
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Once alliance is established, there are two basic
tasks
 Exploration
and reformulation of emotional experience
 Restructuring of interactions
Core Interventions
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Exploring & Reformulating Emotion
 Reflecting
emotional experience
 Validation
 Evocative
Responding
 Heightening
 Empathic Conjecture or Interpretation
Exploring & Reformulating Emotion
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Reflecting Emotional Experience
 Focusing
the therapy process
 Building & maintaining the alliance
 Clarifying emotional responses underlying interactional
positions
Exploring & Reformulating Emotion
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Validation
 Legitimizing
responses and supporting clients to
continue to explore how they construct their experience
and their interactions
 Building the alliance
Exploring & Reformulating Emotion
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Evocative Responding
 Expanding,
by open questions, the stimulus, bodily
response, associated desires and meanings of action
tendency
 Expanding elements of experience to facilitate the reorganization of that experience
 Formulating unclear or marginalized elements of
experience and encouraging exploration and
engagement
Exploring & Reformulating Emotion
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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
Exploring & Reformulating Emotion
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Empathic Conjecture or Interpretation
 Clarifying
and formulating new meanings, especially
regarding interactional positions and definitions of self.
Core Interventions
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Restructuring Interventions
 Tracking,
reflecting, replaying interactions
 Reframing in the context of the cycle and attachment
processes
 Restructuring and shaping interactions
Restructuring Interventions
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Tracking, reflecting, and replaying interactions
 Slows
down and clarifies steps in the interactional
dance
 Replays key interactional sequences
Restructuring Interventions
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Reframing in the context of the cycle and
attachment processes
 Shifts
the meaning of specific responses
 Fosters more positive perceptions of partner
Restructuring Interventions
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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
Interventions are Experiential
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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.
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Insight is not enough to change emotions/patterns
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)
Expanding Emotional Experience
 And
they you stay silent, say nothing? (action primed by
‘numb’ withdrawal)
 What’s that like for you, to go numb, stay numb?
 How do you feel as you talk about this right now
 What’s happening for you as you talk about this? About
going numb?
Expanding Emotional Experience
 How
do you do that? (frames client as agent in creation
of experience)
 That’s how you protect yourself? (conjecture about
function/attachment behavior)
 If you didn’t 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.
Expanding Emotional Experience
 That’s
the way you have of protecting yourself here.
 You shut down, shut off, go somewhere else, go away,
hide, chill out.
 It’s like, ‘I don’t want to feel,’ is that it? You cant get me?
 And you feel like he’s not there with you? (speaking to
other partner)
 You can’t stay and here her say “…,” you have to go
away?
Expanding Emotional Experience
 Can
you tell here “I shut you out?” (enactment)
 For you it’s like you feel so battered, so criticized that
you are numb.
Key Change Events
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Softening
Re-engagement
Softening
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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.
Softening
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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.
What counselor does in softening
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Heightening emotions
Evoking responding
Creating a new dialogue
Model a secure attachment (helps take a short cut
for the couple)
Levels of change in Softening
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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
Levels of change in Softening
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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.
Levels of change in Softening
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They exhibit more open communication, flexible
problem solving and resilient coping.
Couple resolves issues/ problems (stage 3)
There are shifts in both partner’s sense of self. Both
can comfort and be comforted.
Both are defined as “lovable”
Change Events
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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.
Contraindications of EFT
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Different Agendas
Separating Couples
Abusive Relationships
Substance Abuse
Depression and Other Psychiatric Illness
Impasses and other clinical issues:
Attachment Injuries
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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.
Resolution of Attachment Injuries
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Articulate injury and impact.
The other acknowledges hurt partner’s pain and
elaborates on the evolution of the event.
The hurt partner integrates narrative and emotion.
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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.
Therapist Checklist: Beginning an EFT
Session
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10.
What is the cycle that characterizes this relationship?
What are the hypothesized or acknowledged primary emotions
embedded in this cycle?
What are the attachment issues/fears/needs?
Where are they in the process of change in the 9 steps? The next
step/task is?
Are there pivotal incidents that crystallize issues, in relationship history, in
session?
Are there key images, definitions of self that partners use?
What are the current blocks to engagement with emotions, engagement
with other?
Is the alliance with the therapist in tact?
What happened in the last session (process)?
What are this couple’s strengths?
Beginning an EFT Session
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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?
Beginning an EFT Session
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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?
Beginning an EFT Session
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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
session.
steps and make a tangible therapeutic goal for the
EFT.CA