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 • 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 • Assessing Attachment History • Assessing Partners’ Interactions • Self-report questionnaires • Individual sessions
Identifying & Delineating Negative Interactive Cycle • Identifying the cycle • Look for predominant pattern • Delineating the cycle
Identifying & Delineating Negative Interactive Cycle • Basic Negative Cycles & Interactive Positions • Pursue/Withdraw • Withdraw/Withdraw • Attack/Attack • Complex cycles • Reactive pursue/Withdraw
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
Key Movements in Assessment Process – Focus Points • 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 • 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 • 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 • 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 • 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 • 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 • 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 • Create and maintaining a therapeutic alliance. • Accessing and reformulating emotion. • Restructuring key interactions.
Core Interventions • Once alliance is established, there are two basic tasks • Exploration and reformulation of emotional experience • Restructuring of interactions
Core Interventions • Exploring & Reformulating Emotion • Reflecting emotional experience • Validation • Evocative Responding • Heightening • Empathic Conjecture or Interpretation
Exploring & Reformulating Emotion • Reflecting Emotional Experience • Focusing the therapy process • Building & maintaining the alliance • Clarifying emotional responses underlying interactional positions
Exploring & Reformulating Emotion • Validation • Legitimizing responses and supporting clients to continue to explore how they construct their experience and their interactions • Building the alliance
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
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
Exploring & Reformulating Emotion • Empathic Conjecture or Interpretation • Clarifying and formulating new meanings, especially regarding interactional positions and definitions of self.
Core Interventions • Restructuring Interventions • Tracking, reflecting, replaying interactions • Reframing in the context of the cycle and attachment processes • Restructuring and shaping interactions
Restructuring Interventions • Tracking, reflecting, and replaying interactions • Slows down and clarifies steps in the interactional dance • Replays key interactional sequences
Restructuring Interventions • Reframing in the context of the cycle and attachment processes • Shifts the meaning of specific responses • Fosters more positive perceptions of partner
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
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
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 • Softening • Re-engagement
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.
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.
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)
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
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.
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 partner’s sense of self. Both can comfort and be comforted. • Both are defined as “lovable”
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.
Contraindications of EFT • Different Agendas • Separating Couples • Abusive Relationships • Substance Abuse • Depression and Other Psychiatric Illness
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.
Resolution of Attachment Injuries • 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. • 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 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 couple’s strengths?