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Emotionally-focused therapy for couples 

Dr Jenny Fitzgerald



Discipline of Psychiatry University of Queensland Email [email protected]

Suite 335 St Andrew’s Place Spring Hill Phone 07 38316058

Supervision [email protected] Dr Clare Rosoman or Caz Moffat (Newcastle) 0466 797 173 www.eftcouplescounselling.com.au

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Outline •

Des and Irene

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Introduction and overview of EFT for couples ▫

Goals/Assumptions/Contraindications

▫

Summary of Emotion theory

▫

Summary of Attachment theory

•

Stages and steps of EFT

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Intra-psychic and interpersonal interventions

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EFT Change Events

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Exercises and DVDs

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Emotionally-focused couples therapy Developed in the 1980’s



Professor Susan Johnson (University of Ottawa)



Professor Les Greenberg (York University, Toronto)



One of only two marital therapies endorsed by APA



http://www.eft.ca

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EFCT  In

1980s, emotion was seen as a troublesome intra-psychic variable that was not part of an interpersonal systemic perspective (?too dangerous to engage)

 Importance

of emotion in couple’s interaction and therapy increasingly recognised in last two decades…From an EFT perspective now, we see emotion as too

important to ignore

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EFT is congruent with empirical work of Gottman



ESSENTIAL NATURE OF MARITAL DISTRESS IS

ABOUT BEING OVERWHELMED WITH NEGATIVE EMOTION AND TRAPPED IN CONSTRICTING INTERACTIONS

(Gottman, 1994)

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Basic Overview of EFT EFT

views couple distress as being maintained by absorbing states of negative affect. This affect both reflects and primes rigid, constricted patterns of interaction. 

These patterns make the safe emotional engagement necessary for secure bonding impossible. 

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Goals of EFT are to:  access,

expand and re-organize key emotional responses

 create

a shift in partners’ interactional positions

 foster

the creation of a secure bond between partners through the creation of new interactional events that redefine the relationship

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Watching an EFT therapist at work… Therapist  creates

a safe and egalitarian relationship with both partners

 tracks

and explores how emotions direct the couple’s “dance” (cycle/interactional pattern) and how the dance/cycle shapes key emotions

 expands

emotional responses and helps to create a new dance/interactional pattern

 helps

partners disclose deep fears, longings & needs

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How is EFT different from other approaches to couples therapy? 

Therapist does not primarily give coaching, insight or cognitive therapy



Therapist is a PROCESS CONSULTANT and a choreographer of the couples’ relationship dance

Therapist is not the expert…each couple is the expert on their relationship.

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Research on EFT – Outcomes 

Effect size of 1.3- 90% treated couples better than controls

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73-75% of couples recovered from distress at follow-up (trend- improvement continues after therapy).

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Two-year follow up on relationship distress, depression, and parental stress – results stable – 60% continue to improve.

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Positively impacts depression, intimacy, trust.

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Outcomes (cont) 

Studies have been rigorous. Few dropouts. (Clinical Psychology: Science & Practice, 1999, 6, 67-79.)



EFT alone is as effective as EFT + communication training in improving communication and relationship satisfaction



EFT compared with Problem Solving Skills only: EFT couples did just as well

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Used in a variety of populations (eg., gay, low SES, medical pop, survivors of childhood abuse)

+ EFT

– Predictors of Success.



Alliance – especially task aspects – engagement.

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Distress at beginning of treatment only predicted 4% of variance in outcome.

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Traditionality is not predictive.

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EFT worked well for older and “inexpressive” men.

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Best predictor – female’s faith that the partner “cared.”

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Deeper emotional experiencing is related to greater satisfaction with therapy.

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Recent research 

Johnson et al (including Jim Coan) (2013). Soothing the

threatened brain: Leveraging contact comfort with emotionally focused therapy. PLoS ONE 8(11):e79314. 

After completing EFT, neural responses to threat changed when partner was holding hand (strongest results for most distressed couples at start of experiment)

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The power of loving contact to give us safety and comfort

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The power of EFT couple interventions to create and shape a powerful antidote to fear

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How our brains are wired to use connection with others to help us cope with threat and uncertainty.

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EFT for Couples assumptions:  Accessibility and responsiveness are the

building blocks of a secure attachment bond.

 Consequently, couples therapy is about

increasing the security of the couples’ attachment bond by increasing the accessibility and responsiveness of the partners to each other.

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Assumptions Change involves new experiences

and new relationships events.

Partners are not sick, personality

disordered or developmentally delayed. They are stuck. Most needs and desires are adaptive.

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Assumptions

Attachment needs are universal,

although their expression is culturally defined. The way we seek and obtain support is defined differently in various cultures and even in different families and must be understood and respected.

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Assumptions

 Rigid

interactions reflect and create negative absorbing emotional states. Negative absorbing emotional states reflect and create rigid interactions (it is circular).

 Insecure

attachment leads to negative interaction cycles and, in return, negative interaction cycles lead to insecure attachment

(it is circular).

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Emotions

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Adaptive function 

Primary emotions provide information about a given situation and organise us for action (Frijda, 1986)



Emotions occur in response to a change in the environment ◦ APPRAISAL ◦ AROUSAL ◦ REAPPRAISAL ◦ ACTION (Arnold, 1960)



Word “emotion” from “immovere”-to move:

Emotions move us toward responses…

(Becoming an emotionally focused therapist: The Workbook, 2005, p47/48)

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Emotion sequence occur in response to a change in the environment:

 Emotions

Des sees frown on Irene’s face  Appraisal  Arousal

(“Something is wrong”)

(↑HR, uneasy feeling in stomach)

 Reappraisal

(“She’s mad at me!”)  Action tendency (escape-turns away to study newspaper)

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Chains of emotion sequences occur in response to a change in the environment

 Emotions

Irene see Des reach for newspaper  Appraisal

(“He’s not interested!”)  Arousal (feels hot and bothered, tightening of muscles around mouth)  Reappraisal (“He never wants to listen!”)  Action tendency (fight back-angry shout)

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Positive sequences also occur in response to a change in the environment

 Emotions

Husband sees broad smile on wife’s face  Appraisal

(“She’s happy!”)  Arousal (↑interest, sense of anticipation)  Reappraisal (“Something good has happened…I wonder what?”)  Action tendency (to discover…moves toward her and asks questions)

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Function of emotions (Greenberg, 2006) 

Emotion is a primary signalling system



Emotions tell us when something is wrong or that our needs are not being met

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Emotion is a primary meaning system and constantly give us information about the state of our intimate bonds

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Emotions provide us with action tendencies

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Emotions thus identify problems for us to solve and rapidly communicate that there are problems.

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 FEAR-prepares

us for escape / ready for flight

 ANGER-overcoming  SADNESS-invites

obstacles / ready for fight

withdrawal and help seeking

 DISGUST-expulsion

of unwanted intrusions

 HAPPINESS

and LOVE-move individuals toward others in gestures of cooperation 1997)

(Greenberg & Paivio,

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Facial expressions Emotions provide information to others through distinctive facial expressions (adaptive function) (Darwin 1872/1955) 

Surprise

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Anger

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Sadness

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Fear

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Disgust

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Happiness

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Types of emotion (Greenberg, 2006)

Emotion Assessment  1.

Primary  Biologically adaptive  Maladaptive

 2.

Secondary

 3.

Instrumental

(In EFT we work differentially with 10 , 20 and instrumental emotions)

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Primary/ secondary

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Primary emotions are original/core/basic emotions experienced in response to change in environment

(eg., fear, sadness, anger, happiness, disgust, hurt, disappointment, loneliness) Mostly adaptive 

Secondary (or reactive) emotions occur in response to other emotions/thoughts (resentment/frustration/anger, helpless withdrawal, hopeless despair, shame, embarrassment) Understandable, but often not adaptive

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Primary emotions can be maladaptive  Some

primary emotions become dysfunctional in certain contexts and at high intensities eg.  blind

panic  violent anger  happiness at another’s suffering

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Secondary emotions  Some

social influences on secondary emotions

 secondary anger

when feeling primarily afraid (sex-stereotypical of men) or  crying when

of women)

primarily angry (sex-stereotypical (Greenberg & Paivio, 1997)

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Secondary emotions (cont) In

trying to connect, distressed couples get caught in negative repetitive sequences of interaction where partners express secondary emotions rather than primary emotions.

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Instrumental emotions 

Emotions used to influence others



One partner may have learnt that expressing certain emotions moves the other to action

Eg. Expressing anger aggressively leads the other partner to back down 

Crocodile tears (observer is not moved)

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Expression of instrumental emotion typically has a superficial tone

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Not typically the focus of EFT

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Clinical implications of an emotion focused approach  Attend

very carefully throughout the entire session to  the faces of your clients  the tone of their voices  their body “language”  all the words and metaphors they use

“Words are handles to open the door to the client's emotional experience”- S.Johnson

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Attend carefully to words and images

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“She shuts me out”

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“I feel so torn”

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“He only gives me the scraps of his time”

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“I feel so trapped”

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“It feels like there are multiple arrows coming for me”

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An attachment perspective

 Romantic

love conceptualized as an attachment process (Hazan & Shaver, 1987)

 Attachment

figure serves function of

SAFE HAVEN and SECURE BASE

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Attachment Seeking

and maintaining contact with a few irreplaceable others is a primary motivating principle in humans (Bowlby, 1988).

Isolation

is traumatising

Separation

distress is normal

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Accessibility and Responsiveness  “Am

I worthy of care?”

 “Can

I count on this person to be there for

me if I need him/her?”

→ “Working models” of self and others

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Attachment styles

 Develop

from ways of regulating distress with attachment figure across thousands of interactons

 Reflect

rules that guide responses to distressing situations (fear, illness, stress, fatigue, loneliness)

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Secure attachment  acknowledge distress

comfort and support

 comfortable

support

 flexible

and turn to others for

with others turning to them for

about dependence vs independence

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Anxious attachment •

Hypervigilance for threat (rejection, abandonment)

•

Difficulty soothing attachment fears and feelings

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Anxious clinging, pursuit, sometimes even aggressive attempts to obtain a response

“She’ll let me down. They always do. Why can’t she just be more attentive and then I wouldn’t get so mad.” Sadly, these individuals are prone to bringing about the thing they fear most.

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Avoidant attachment •

Deactivation of attachment system

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Suppression of attachment needs

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Focus on tasks, uncomfortable with partners who seek “too much” closeness

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Defensiveness and stonewalling

 Cautious

about depending on others; reluctant to have others depend on them

“I’m a bit of an island. I just shut down when things get too much.”

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Fearful avoidant (“Disorganised” in infant lit.) 

Fearful of abandonment and yet fearful of closeness



Associated with traumatic attachments in which the attachment figure was both the source and the solution to fear



Often observed in individuals with a trauma history (CSA, severe physical abuse)



“I want him close. I need him. But then, I don’t trust him so I end up saying, “Come close but no touching.”

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A map for therapy

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Attachment theory provides a clear definition of a positive secure bond and indicates this is the optimal outcome of couple therapy.

 Secure

dependence fosters autonomy and selfconfidence, leading to interdependence

 On

an existential level we are all alone and scared to stand in the dark…if someone is standing beside us, it makes all the difference (S. Johnson)

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Attachment dance

Emotion is the music of the attachment dance.

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Theoretical background cont  EFT

is an integration of humanistic and systemic approaches to therapeutic change. Humanistic: focuses on present emotional experience Systemic: focuses on patterns of interaction with intimate other Attachment: works with fundamental need to seek closeness with other



(Salvatore Minuchin coming to tea with Carl Rogers and John Bowlby)



See The Workbook, p 28-39

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EFT cont  Focuses

on here and now

(sometimes with reference to the past, for the purpose of validating present day feelings and interactions)

Eg., “Irene, I can understand that you long to feel special and close to Des; especially because when you were young and so often felt “on the outer”, you wanted so much for your family to give you support and assurance that you were special to them.”

+ Reminder: the goals of EFT are to •

access, expand and re-organize key emotional responses (emotion)

•

create a shift in partner’s interactional positions (cycle)

•

foster the creation of a secure bond between partners through the creation of new interactional events that redefine the relationship (attachment)

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Three stages and nine steps of EFT (Johnson, 2004)

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Stage 1.

GOAL: De-escalation of negative cycles

of interaction (p141-164) Step 1. Create alliance; delineate conflict issues in the attachment struggle Step 2. Identify negative cycle Step 3. Access unacknowledged emotions underlying interactional positions Step 4. Reframe the problem in terms of the negative cycle, underlying emotions and attachment needs

Reframe the cycle as the couple’s common enemy

+ Stage 2: GOAL: Changing interactional patterns to achieve attachment security

Step 5. Promote identification with disowned attachment emotions and needs and integrate into interactions Step 6. Promote acceptance of partner’s experience and new interactional responses Step 7.

Facilitate expression of needs and wants and create emotional engagement and bonding events (make attachment needs clear)

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Consolidation and integration Step 8. Facilitate the emergence of new solutions to old relationship problems

Step 9. Consolidate new positions and new positive cycles of attachment behaviours

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Stages (in summary)

 Stage1:

Awareness

 Stage

2: Bonding

 Stage

3: Consolidation

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Stages and steps Awareness 

Step 1: Assessment

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Step 2: Cycle

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Step 3: Emotions

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Step 4: Reframe

Bonding 

Step 5: Experiencing

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Step 6: Observing

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Step 7: Attachment needs

Consolidation 

Step 8: Solutions

Step 9: Review/Closure

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Assessment-first session  Create

a therapeutic alliance  Safe and accepting atmosphere  Validate /legitimise both partner’s experience within the relationship  Non judgmental language  Be sensitive to where each partner is “at”

 Explore

motivations for therapy (do they both want to be here?)

 Explore

agenda (do both partners desire the same outcome?)

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Assessment cont 

Relationship history

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Other health problems or life crises

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Contraindications

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Is the couple ready for couples therapy? The major issues to consider if couple is ready for EFT: •

Aggression (ongoing)

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Affairs (ongoing)

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Addictions (uncontrolled/unacknowledged)

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Axis 1 dx (untreated)

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Already left Can the therapist ensure safety?

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Assessment Observe Nonverbal

communication

Congruence

between verbal and nonverbal

cues Note Poignant

phrases, images, labels

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Limits  Therapist

does not decide if couple should end or continue the relationship

 Information in

any individual sessions is confidential but if information seems crucial for change process, therapist will advise that partner share it with the spouse

 The

therapist cannot change the relationship only the couple can

 Couple

need to pay attention to their relationship between sessions

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Attachment Hx assessment Childhood  Who

did you go to for comfort?

 Could

you count on this person/s?

Adulthood  Previous

romantic relationships/experience in this relationship

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Assessment -Negative cycle “If

I were a fly on the wall at home when you fight, what would I see…what typically happens..?”

Watch

their interactions in session. Listen for comments pertaining to closeness and distance

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Negative cycle 

PURSUE / WITHDRAW:  



WITHDRAW / WITHDRAW 

   



70-80 % of couples; usually female pursues if male pursues- female withdraws, check for coercion/violence

could be conflict avoiding couple

typically involves a “burnt out” pursuer couple seems friendly (don’t fight) but usually report they don’t feel close; often don’t make love this cycle is more deadly to a relationship need to reflect back on the development of the cycle over years

ATTACK / ATTACK   

basically pursue/withdraw but in fight mode these couples need containment slow down the process by having them talk through the therapist eg., Tell me the story…

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Cycle cont  REACTIVE

CYCLE (with separation)  withdrawer is now kicked into action and looks like a pursuer  need to trace the steps (“How did you get to this point?”)

 COMPLEX

CYCLE  Come here-go away  Seen with trauma survivors (not a typical presentation)  The Workbook, p 128-133

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Cycle •

•

•

Each partner's position in the negative cycle is thought of as his/her best attempt to get attachment needs met (closeness/connection; autonomy/safety) For some couples, the cycle is very easy to identify; for others it is more complex (eg., some withdrawers fight back some of the time; some pursuers become overwhelmed and withdraw some of the time) No position is absolute

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Interventions

 Intra-psychic

(working within)

 Interactional

(working between)

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R-I-S-S-S-C manner (p53-54)  REPEAT

key words

 IMAGES  SIMPLE  SLOW  SOFT

WORDS

PACE

VOICE

 CLIENT’S

WORDS

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RISSSC CONT

“So you pull back Des, you feel so scared…so scared to let her know just how much her criticism hurts you…yes?”

(Tx repeats client’s own words using simple terms, soft voice and slow pace)

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RISSSC CONT

RISSSC manner helps client to access and process emotional experience.

Depth of emotional processing in session is a predictor of successful outcome.

EFT involves work with emotions rather than just an intellectual discussion about emotions.

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Empathic Reflection 

Empathy is the basis of EFT



Reflect (“If in doubt, reflect”)

-empathic reflections of each partner’s experience and feelings “Honour your client’s construct of reality” (Rogers) “A good reflection is not repetition but revelation” (Rogers) “One first has to make sure one finds where the other is and start there.” (Kierkegaard, 1948)

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Empathy



“Empathy is a leap of the imagination to inhabit the client’s world for just a moment” (Guerney, 1994)

Sometimes it is a great struggle for us to take this leap of imagination

“The more you don’t like a client, the more you need to empathise with him/her.” (SJ) (What would it be like to be this man/woman, living in this relationship?)

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Rogers, from Kitchen table wisdom (Remen,1996, p218)

"Before every session I take a moment to remember my humanity. There is no experience that this man has that I cannot share with him, no fear I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable. And because of this, I am enough. Whatever his story, he no longer needs to be alone with it. This is what will allow his healing to begin."

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Empathic reflection 

“Des, your face tells me you are feeling very sad. It is hard to know she feels this way?”



“It’s confusing to hear him say that? It doesn’t make sense to you?”

“Irene, it’s frustrating for you when Des turns away and goes silent, yes? You feel angry.”

(p 62, 95, 105, 116-117, 281)

+ Validation (p61-64)



Therapist conveys the message that emotions and responses are legitimate and understandable (Bowlby- behaviour is “perfectly reasonable”)



Validation supports natural tendency to grow (Rogers)



Acknowledge and validate 20 emotions



Validate…. without invalidating the other

“I think I understand Des…you feel so criticized and put down by Irene’s remarks that you want to withdraw to protect your self, to feel safe. But Irene, you see Des’s withdrawal and silence, and feel, ‘Oh no, he’s a stranger….we can’t talk about anything that matters!’ This is hard for you both.”

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Evocative reflections and questions (p64-67)  Process

enquiries… Every question except “why”

 How

do you feel when..?  How do you do that?  What happened just then?  When you go behind that wall, what’s it like for you?  How do you numb out?

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REV (Yolanda von Hockauf)  Reflect

I see your tears/sadness

 Evoke

Can you tell me about what is happening for you right now?

 Validate

(attachment-related)

It’s understandable that you feel very sad hearing her say that she no longer feels close to you.

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Empathic conjecture, interpretation (p72-78)



Making the implicit explicit



Don’t jump too far ahead of the person….just one step

“You look uncomfortable…is it scary for you?” “Tell me if I am wrong, but it’s my guess that it’s hard for you to hear that she has felt lonely all these years?”

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Empathic conjecture cont (draw on attachment theory and individual’s history) To a withdrawer: “Even though you keep your distance, my sense is that part of you longs to feel close.” (tapping into adaptive attachment longings) To a critical pursuer: “Under all your frustration and anger, I sense there is this great well of sadness that you and Des do not feel close?” To a confused partner: “It must be disorienting to hear your husband speak of his softer feelings. It’s like he’s a different person?”

+ Heightening (p68-71)  Expands

attachment related fears and longings

(both +ve and –ve emotions are heightened)  REPEAT

(“You feel so torn”)

 RE-ENACT

(“ Can you just say that again?”)

 REFOCUS

(“Can I get you to come back to what you just told me…?)

 Use

imagery (from past or current session)

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Heightening  “This

voice inside you says,

“Do - I - really - matter - to - her?” (Stage 1: soft voice, slow pace, simple words)

“

You do want to feel close…you’re saying to her, Give- me- a- chance!” (Stage 2: firm voice, slow pace, simple words)

+ Practise RISSSC and R-E-V Work in pairs, with Des or Irene as the client. The Tx task is to find out more about the client’s emotional experience of this relationship. Take 10 minutes each, so both have a turn as Tx.  Empathic

reflection (verbal and non verbal)  Evocative questioning  Validation  Empathic conjecture  Heightening  Use RISSSC manner throughout

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Track and reflect interactions  The

cycle is the issue, not the content.

Eg., Couple start to fight about when he comes home from work.

Tx interrupts to say, “How you balance up work and family time is important, but what is even more important for us at the moment is what happens between you both when you try to talk about time together. Let’s have a look at what happens. ”  Steps

of the cycle are carefully tracked

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Track the cycle “So it seems like a lot of your relationship is taken up with you Irene feeling lonely and afraid that Des is not really close to you, and so you reach for him but in a critical way that makes you (Des) feel criticized and put down. When you (D) feel criticised, you shut down and try to “damp down” the conflict. The more you (I) criticise, the more that you (D) shut down; the more you shut down, the more lonely you (I) feel. This is distressing for you both.”

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Track the cycle_ chains of emotion sequences. “So you (D) hear that tone in Irene’s voice (appraisal) and you feel on edge/uneasy (arousal). You start to think, “Oh no, she’s mad with me again!” (reappraisal); so you shut down and go quiet (action). But then Irene you notice Des go quiet (appraisal) and you feel frustrated (arousal) that he won’t stay and talk to you. You’re thinking, “He just doesn’t want me! We’re not close any more.”(reappraisal) So you get angry and go after him with complaints and criticism. (action) “You are both trying to get your needs met, but it is not working. Our job is to interrupt this cycle and create new ways of interacting”.

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DVD

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Enactments (p90-102)  Therapist

asks one partner to turn to other and express something important (rather than just talking through the therapist)

 Encourage

 Don’t

to express in context of attachment need

enact secondary emotion

 Enactments often

follow a heightening (and are timed when therapist is fairly confident that the receiving partner is open to hearing the message constructively)

 This

is where change happens

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Enactments (example) “So Irene, can you turn to Des now, and tell him how lonely you feel …how hard it is for you to feel that he shuts you out” or or “Des, can you turn to Irene now and tell her how you feel…how hurt you feel by her criticism” (NB: Enact hurt {vulnerable, primary emotion}, not the secondary anger that was expressed initially)

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Enactments have three steps 

Making the request (Can you turn to him and tell him…)



Maintaining the focus (may need to guide, re-direct)

(Irene’s voice starts to sound angry) Tx intervenes and says, “Can you stay with the feeling of loneliness. Can you help Des to know what that feels like for you.” 

Process responses with speaker and listener



“So Irene, how is that to tell Des about your loneliness?”

“So Des, what’s happening as you listen to Irene tell you how she feels?”

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Reframes Criticism and pursuing-fighting for connection

In attachment terms, critical pursuing is framed as attachment protest, a reaction to the unavailability of the other, an attempt to pull the other close by fighting for the relationship.

“You are desperate to get him to listen. Even an angry response is better than being ignored.”

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Reframes Withdrawal and stonewalling (Gottman) 

Stonewalling is not a passive state, but usually a response to distress



From an attachment perspective, stonewalling can be viewed as an attempt to regulate intense attachment fears and to protect the relationship from further negative escalation.

“ Des, you withdraw because it is hard to bear the feeling that you have let her down. You know that fighting back will only makes things worse, so you often shut down to protect your self but also to protect Irene and the relationship as well.”

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Fundamental reframe This hurts so much because she matters so much to you. You get so angry because your relationship means so much to you.

The feelings are so big for you because he is so important to you.

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Characteristics of the relationship at the end of Step 4 

 



Each partner’s experience of self and other is less constricted Each partner knows what s/he does to trigger the cycle There is greater awareness of how their interactions/cycle block engagement and leave them feeling powerless First order change (Watzlawick et al., 1967) that is, more fluidity in the system but the organisation of the interactions has not changed

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Change events in EFT  De-escalation

 Withdrawer

 Blamer

of the negative cycle

re-engagement (p 193-217; 314)

softening (p217-236)

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Stage 2: Withdrawer re-engagement and blamer softening 

Here is where we ask questions like,

“How could your partner help you right now?” “What do you need from your partner at the moment?” 

Asking these questions too early (Stage 1) typically flares the negative cycle, whereas when asking in Stage 2 (cycle is deescalated) partners are more likely to be able to drop down from distilled primary emotion and talk about attachment needs and fears.

Des: “I need her to reassure me that I am valued by her.” Irene: “I need to know that he does care and that he will be there for me when I need his support.”

EFT INFINITY LOOP TO MAP CYCLE Position/Behaviour

Perception/Attributions

Position/Behaviour

Perception/Attributions

Secondary

Secondary

Emotion

Emotion

Primary Emotion Attachment Needs & Fears

Primary Emotion

Attachment Needs & Fears

+

Attachment fears and needs Common attach fears

Common att needs



Being rejected



Acceptance



Being abandoned



Closeness



Understanding



To feel important



To feel loved



 

Not measuring up, being a failure Being unlovable Being controlled





For your partner to reflect good things about you For appreciation

+

Stage 2 (cont) In Stage 2 we go slowly (Lots of RISSC manner)  Access  Order

and process primary emotion

and distill primary emotion

 Ask

experiencing partner to turn and tell (enact/disclose).



Help listening partner to respond and reach back.

+

Stage 2 In

Stage 2 we work with the withdrawer first. This is strategic to create sufficient safety for the pursuer to soften. Step 5 with the withdrawer typically blends into Step 7 (expressing attachment needs and fears)

+ Withdrawer re-engagement 

Therapist uses empathy to help withdrawer to come out from behind his/her protective wall/shell



“Des, the accusations are just so painful for you. You protect yourself by withdrawing….can you tell me some more about what it is like for you behind that wall?”



A previously more withdrawn partner shares attachment needs and wants from a now-engaged relational position. Des says to Irene 

“Irene, I am exhausted from all this defending and withdrawing-I want to feel special to you and appreciated by you.”

+

Withdrawer re-engagement (cont)

 Engaged

withdrawer is able to hold on to new stance and doesn’t need to resort to earlier behaviour:  “I’m working hard at our relationship. I am really trying to understand what is important for you.”

+

Withdrawer engagement As more withdrawn partner “steps forward” into the relationship, the pursuer feels less afraid and more willing to take some risks to connect with his/her partner. Once engaged, the previously withdrawn spouse helps to lead the process toward secure bonding…. “Yes, I want you to trust me…give me a chance….I want to get it right with you” 

More

openness and decrease in hostility (cycle de-escalation) from the pursuer invites the withdrawer’s approach. They

help each other to create a new positions

+

Blamer softening Pre-requisites: 

De-escalation of cycle



Withdrawer reengagement



A previously hostile, critical spouse accesses “softer” emotions and risks reaching out to her/his partner who is engaged and responsive. In this vulnerable state, the previously hostile partner asks for attachment needs to be met.



A bonding event occurs that redefines the relationship as a safe haven and a secure bond.

+

Softening (cont)  Criticism

She says: “You’re never home. I sit watching TV night after night on my own while you stay back at work. It’s so unfair!!” Becomes--- “I

want you home in the evening, because I miss you. I know you are trying to develop the business… but I feel lonely just looking after the baby all day. Please, spend some time with me.”

He sees her differently, as vulnerable rather than dangerous. A new interaction is initiated.

+

Blamer softening  Shore

up withdrawer engagement

 Explore

possibility of reaching

 Explore

fears of reaching

 Work

with negative model of self/other

 Support

 Help

reach

partner to reach back

+

Blamer softening Typically the most difficult change event to effect. Takes time and repetition/support, especially with traumatised couples Work

in small steps; empathy, conjecture about adaptive longings, heighten, evoke, enact in small steps “Yes

Irene, I understand, you feel so afraid to let him see how small and alone you feel. Any yet, I think you also long to have him draw you close to him, you want so much to feel safe and held by Des.” Ensure

previously withdrawn partner is supported to maintain engagement; help him/her to reach back at each step “Des, what happens for you as you hear Irene tell you how afraid she is (he responds)…can you tell her that please”

+

Stage 2 and Stage 3 

Attachment needs and wants are expressed directly with a sense of empowerment and legitimacy (withdrawer) and from a position of vulnerability (pursuer)



Powerful new boding events occur which lay the foundation for a positive new cycle. Therapist tracks the new cycle of positive interaction to consolidate progress.



Talking about old problems in Stage 3 is different now because the attachment significance has changed.

+

Role Play: Aim to set up and process enactment



Group of 3. Therapist, Irene and Des



This couple have de-escalated somewhat and are not so reactive in session now. They can listen to each other patiently.



Work with Des or Irene, working slowly and going deeper into primary emotion (with one of them). Ask him/her to turn and tell the partner. Process with speaker and listener.

(What is it like to tell? What is it like to hear?)

+

Reminder: EFT in summary



CYCLE



EMOTIONS



ATTACHMENT

Throughout therapy (beginning to end), the therapist is always attending to either the cycle, either partner’s emotions or the couple’s attachment needs (all three are inter-related).

+

Sue Johnson’s phrases 

If you are at the heart of the matter, walk around in it.



Mine the moment

(slow down, expand primary emotions and attachment significance) Slice it thinner (Slow down and work with small “pieces”)  

Catch the bullet (reframe negatives/criticisms) Block the exits (encourage/support engagement with primary emotion)

+

“Felt security”(Sroufe) is linked to  Better

affect regulation (less reactivity, hyper /under arousal )

 Better

information processing (more flexible, curious, tolerant of ambiguity)

 Better

communication (collaboration, meta communication, disclosure, assertion, empathy)

 Sense

of self is more coherent, elaborated, articulated, positive.

+

Certification as an EFT therapist 4 days Fundamentals of EFT 8 days Core Skills of EFT (offered in 2 blocks of 4 days)

(Participants bring a recording of their work to present to the group) Minimum of 8 hours of individual supervision

Reading+ Presentation of materials to ICEEFT

+

References 

Arnold, M. (1960). Emotion and personality. New York: Columbia Press.



Bowlby, J. (1973). Attachment and loss: Vol 2. Separation: Anxiety and anger. New York. Basic Books.



Bowlby, J. (1979). The making and breaking of affectional bonds. London: Tavistock/Routledge



Dalton et al. (2013). Nurturing connections in the aftermath of childhood trauma: A randomised controlled trial of emotionally focused couple therapy for female survivors of childhood abuse. Couple and Family Psychology: Research and Practice, 2, 209-221.

+

References cont 

Gottman, J. (1994). What predicts divorce? Hillsdale NJ:Erlbaum



Greenberg, L. and Paivio, S. (1997). Working with emotions in psychotherapy. NY: The Guilford Press





Hazan, C. and Shaver, P. (1987). Romantic love conceptualised as an attachment process. Journal of Personality and Social Psychology, 52, 511-524.

Johnson, S. et al.(2013). Soothing the threatened brain: leveraging contact comfort with emotionally focused therapy. PloS ONE 8(11): e79314. doi:10.1371/journal.pone.0079314

+

Recommended texts  Johnson, S. et

al. (2005). Becoming an Emotionally Focused Couples Therapist: The Workbook. New York: Routledge

 The

Emotionally Focused Casebook: New directions in treating couples (2011). J.Furrow, S.Johnson & B. Bradley (Eds.) New York: Routledge

+ New books Love

Sense (2013) Sue Johnson

Little, Brown

Attachment-based

Psychotherapy: Helping patients develop adaptive capacities (2013) Peter Costello APA

An

emotionally focused workbook for couples: The Two of Us (in press, Routledge). Veronica Kallos- Lilly and Jennifer Fitzgerald (to be released in August)