Introduction to Emotionally Focused Couples Therapy

1. Introduction to Emotionally Focused Couples Therapy by Tracey D. Bauer, M.A. LMFT tbauer@cprgnet.com www.cprgnet.com

3. Agenda Background What is Emotionally Focused Couples Therapy? Its All About Attachment Overview of Emotionally Focused Couples Therapy Video Segment by Sue Johnson How to Become an EFT Therapist Questions?

4. Couples Therapy is Difficult! Consumer Reports Survey "Those who went to marital counselors didn't do quite as well, and gave their counselors lower grades for competence.One reason may be that working with a fractured couple may be difficult.“(Seligman, 1995) Marital Therapy May Be Hazardous to Your Marriage Common Pitfalls (Doherty, 2002) • Therapists working from individually based models • Therapists lacked experience / expertise Best Practices • Therapist active involvement • Structured process • Hope for relationships

5. EFT Authors Dr. Leslie Greenberg Psychologist, York University, Toronto. • Mainly EFT with individuals. • Leading process researcher. • Empirically validated. Dr. Sue Johnson Psychologist, University of Ottawa. Student of Les in early 1980’s. Interested in couples therapy and attachment theory. Leading proponent of EFT use with couples.

6. Primary Sources Also, The Emotionally Focused Couple Therapy Externship May 25-28, 2011 Presented by: Dr. Brent Bradley, Jeff Hickey, Nick Lee & Sarah McConnell Greenberg Johnson 1988 Johnson 2004 Johnson et al. 2005

7. Major Reviews • Empirically Supported Couple Therapy EFT is one of only two empirically supported treatments for couples therapy (Snyder, Castellani, & Whisman, 2005). • Meta-analysis EFT studies demonstrate a 70 – 73% rate of improvement (Johnson, 2003). • Robust Approach EFT applied to a variety of treatment conditions: Depression, Post-partum Depression, Chronic Illness, Eating Disorders, Infidelity / Attachment Injuries, Trauma Exposure.

8. What is Emotionally Focused Couples Therapy? • Formulated in he early 1980s, Johnson & Greenberg. • Based on adult theory of attachment. • Distressed couples do not experience a sense of security and emotional safety with each other. • Looks WITHIN at how partners construct their emotional experience of relatedness. What is your experience of this relationship with your partner? • Looks BETWEEN at how partners engage each other. Determining the current repetitive cycle – The Dance. • Creates change by: • Reprocessing & expanding emotional responses. • Creating NEW kinds of interactions – changing the Dance. • Fostering SECURE bonding between partners.

9. Its All About Attachment Piglet sidled up to Pooh from behind. “Pooh,” he whispered. “Yes, Piglet?” “Nothing,” said Piglet, taking Pooh’s paw. “I just wanted to be sure of you.”

10. Attachment Theory “All of us, from cradle to grave, are happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figure(s).” John Bowlby A Secure Base (1988, p. 62)

11. A Safe Haven & a Secure Base Secure Attachment Offers: • Safe Haven: Buffer against stress, the “arms wrapped around” feeling, coming home at the end of the day and feeling loved and cared for. • Secure Base:Safety to explore &master the environment.

12. Attachment Styles/Strategies SECURE Better able to acknowledge and cope effectively with negative emotions. (“Steady”“Grounded”) INSECURE Avoidant Strategy:Attempts to block out negative emotions; uncomfortable seeking support. (“Cold”) Anxious Strategy:Highly emotionally expressive but often cannot regulate/integrate emotions. (“Clingy”)

13. Attachment Theory for Adults “Attachment theory for adults emphasizes that an adults’ desire for comfort and support in adversity should not be regarded as childish or immature dependence; instead, it should be respected as being an intrinsic part of human nature that contributes to personal health and well-being.” (Feeney & Collins, 2004).

14. Questions so far?

15. Goals of EFT with Couples • To expand and re-organize key emotional responses–the music of the attachment dance. • To create a shift in partners’interactional positions and initiatenew cycles of interaction.Changing the Dance. • To foster the creation of asecurebondbetween partners.

16. The EFT Journey: From alienation, to emotional engagement. From vigilant defense and self-protection, to openness and risk-taking. From a passive helplessness in the face of the inexorable dance of the relationship, to a sense of being able to actively create that dance. From desperate blaming of the other, to a sense of how each partner makes it difficult for the other to be responsive and caring. From a focus on the other’s flaws, to the discovery of one’s own fears and longings. Most of all, from isolation to connectedness.

17. Couple Conflict Escalating Conflict Withdrawer Pursuer Distress • Response • Pursue • Criticize • Contempt Response - Withdraw - Stonewall - Defend Fixed Pattern “The Dance”

18. EFT Treatment Process Stage 1: Cycle De-escalation (Steps 1-4) Stage 2: Changing Interactional Positions(Steps 5-7) Stage 3: Consolidation of More Secure Patterns (Steps 8 & 9)

19. Emotions in EFT Attachment-related Affect/Primary Emotion • Initial reactions to a given situation. • Need to be accessed to promote adaptive response. • Often Sadness, Fear, or Shame Secondary Emotions • Response to initial reaction (primary emotion). • Response to primary emotion, not to the situation that elicited the initial emotional response. • Often need to be explored in order to access primary emotions that underlie these secondary responses.

20. Secondary Emotions Primary Emotions

21. Primary Emotion: Processing Points Find it: Often go through secondary en route. Focus on it: Reflect process rather than content. Possible Entry Points: - Slightest tone change - Sighs - Bodily reactions - Silence - Eyes and glances - Deep breaths - Giggles, jokes, laughter

22. Typical Underlying Emotions Pursuer • Hurt • Alone • Unwanted Withdrawer • Failure • Inadequate • Judged, criticized

23. Common Phrases Pursuer • He is never there. He’s always distracted by work. • He never looks at me when I talk to him. He just watches TV. • I do it by myself and just take care of things on my own (burned out pursuer). • Other couples seem to have lives that are full, and they enjoy each other. We don’t have anything. Withdrawer • I never get it right or satisfy her. • I don’t bother – what’s the point. • I don’t know whatI feel. I’m lost.

24. Key Interventions • Evocative Responding • Focus on tentative, unclear, or emerging experience. • Focus on “felt sense” in the moment. • Ex: “What happens when you hear your wife talking like this John? When she talks about feeling cornered and confined. How do you fee as you listen to her say this?” • Heightening • Therapist intensifies specific responses, experiences, interactions– “front and center.” • Ex: “Can you say that again Evan? Can you tell her again about how it feels when you can’t find her, she seems so far away?”

25. Key Interventions • Reflecting & Validating • Reflecting the secondary emotion. • Ex: “And you get very angry when this happens.” • Reflecting the underlying emotions. • Ex: “So, it’s like you are feeling this kind of panic when he turns his back.” • Validating present responses. • Ex: “I think I’m beginning to understand, for you, shutting down, as you call it, is your natural way to cope.” • Validating newly experienced underlying emotion. • Ex: “It is very hard for you when you hear your wife say that you’ve disappointed her.”

26. Key Interventions • Empathic Conjecture • Moves client “one step forward” to leading edge of emotional experience. • Ex: “I’m not quite sure I understand. Is it like, if she doesn’t desire me every day, I’ve lost her. That’s the signal I rely on to reassure myself that she’s still here, that she wants me. Is that it?”

27. The How of Interventions • Repeat.It is important to repeat key words and phrases. • Image. Images capture and hold emotion in a way that abstract words cannot. • Simple. Keep words and phrases simple and concise. • Slow. Emotional experience unfolds in a session; a slow pace enables this process. • Soft. A soft voice sooths and encourages deeper experiencing and risk taking. • Client’s Words. The EFT therapist notes and adopts the client’s words and phrases in a collaborative and validating way.

28. The Process of Change Three major shifts are discernable in the process of change in EFT. These are: Negative cycle de-escalation at the end of the first stage of therapy. Withdrawer engagement in Stage Two of therapy. Blamer softening in Stage Two of therapy.

29. Assessment Couple Session • Engage the experience of each partner. • Track and clarify interaction patterns. • Assess level of couple’s reactivity. Individual Session • Build alliance. • Explore: • Commitment level. • Indicators of abuse / related fears. • Extramarital relationships. • Previous attachment traumas.

31. Stage 1: Cycle De-escalation Step 1: Creating an alliance and delineating conflict issues in the core attachment struggle. Step 2: Identify the negative interactional cycle where conflict is expressed. Step 3: Access unacknowledged emotions underlying interactional positions. Step 4: Reframing the problem in terms of the negative cycle, underlying emotions, and attachment needs. The cycle is framed as the common enemy preventing the partners from feeling emotionally safe with each other.

32. Stage 2: Changing Interactional Positions Step 5: Promoting identification with disowned attachment emotions, needs and aspects of self and integrating these into relationship interactions. Step 6: Promoting acceptance of the partner’s experience and new interactional responses. Step 7: Facilitating the expression of needs and wants and creating emotional engagement and bonding events that redefine the attachment between partners.

33. Stage 3: Consolidation Step 8: Facilitating the emergence of new solutions to old issues and problems. Step 9: Consolidating the new positions the partners take with each other and new cycles of attachment behavior.

34. Promoting Consolidation Partners more open to resolving problems. • Therapist facilitates partners efforts to be accessible and responsive engaging a more secure pattern. • Therapist promotes exploration and discussion of issues. Couples describe new patterns. • Therapist highlights new patterns. • Therapist reinforces steps the couple is taking to strengthen security (accessibility & responsiveness).

36. Questions?…and thanks for listening!