Lecture 6. Overview of Emotionally Focused Therapy for CouplesCouple Counselling SkillsKevin Standish

Learning Objectives

Describe the theoretical underpinnings of Emotionally Focused Therapy

Be familiar with the three stages and nine steps framework of EFT

Understand the concepts of enactments, withdraw engagement and blamer softening

Be conversant with the research supporting EFT

Primary Roots of EFT

Experiential Therapy (Perls) Person Centered Therapy (Rogers)

Systemic Therapy Attachment Theory

EFT Assumptions 1. Accessibility and responsiveness are the building

blocks of a secure attachment bond. Consequently, Couples therapy is about A. the security of the attachment bond, B. accessibility, and C. the responsiveness of the partner.

2. Emotion is a target and agent of change. Emotion is A. Source of information; B. Communicates - organizes social interactions; C. Orients & primes responses; D. Vital element in meaning - colors events; E. Has control precedence

3) Emotion frequently leads to adaptive actions eg Anger often leads to Asserting, defending; or Sadness often leads to Seeking support, withdrawing.

EFT Assumptions 4. Negative emotions occur at two levels: Primary and

Secondary. A. Primary Emotions are the deeper, more vulnerable

emotions such as sadness, hurt, fear, shame, and loneliness.

B. Secondary Emotions are the more reactive emotions such as anger, jealousy, resentment, and frustration. They occur as a reaction to the primary emotions.

Primary emotions generally draw partners closer. Secondary emotions tend to push partners away.

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

EFT Assumptions 6. Insecure attachment leads to negative interaction cycles

and, in return, negative interaction cycles lead to insecure attachment (it is circular).

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

8. Partners are not sick or developmentally delayed. They are stuck. Most needs and desires are adaptive.

9. Attachment needs are universal, although their expression is culturally defined. The way we seek and obtain support is defined different in various cultures and even in different families and must be understood and respected

10. Change involves new experiences and new relationships events. Therapy is about creating these new relational experiences

Comparative Framework. 1. Background of the Approach 2. The Healthy/Well-Functioning versus

Pathological/Dysfunctional Couple/Marriage 3. The Role of the Therapist 4. Assessment and Treatment Planning 5. Goal Setting 6. Process and Technical Aspects of Couple

Therapy 7. Curative Factors/Mechanisms of Change 8. Treatment Applicability and Empirical Support

1. Background of the Approach

1. Background of the Approach

It is a constructivist approach: learning is an active, contextualized process of constructing knowledge rather than acquiring it. Knowledge is constructed based on personal experiences and the context.

focuses on the ongoing construction of present experience (particularly experience that is emotionally charged),

and a systemic approach, in that it also focuses on the construction of patterns of interaction with intimate others based on attachment theory.

Leslie Greenberg Susan Johnson

After watching numerous tapes of therapy sessions, they began to see patterns in how emotions were formulated and regulated, they mapped the steps in the change process and identified interventions the therapist need to make

Experiential Influences EFT shares commonalities with traditional humanistic

approaches. EFT adheres to the following basic premises of experiential therapies:

1. The therapeutic alliance is healing in and of itself 2. The acceptance and validation of the client’s experience is

a key element in therapy 3. There is a belief in the ability of human beings to make

creative, healthy choices. 4. the inner construction of experience evokes interactional

responses that organize the world in a particular way. This is a circular process.

5. we are formed and transformed by our relationships with others

6. new corrective experiences for clients emerge as part of personal encounters in the here and now of the therapy session

Systemic Influences EFT draws Minuchin’s structural systemic approach, with its focus on the

enactment of “new” patterns of interaction. EFT adheres to the following basic premises of family systems theory:

1. Causality is circular 2. Family systems theory tells us that we must consider behavior in context. 3. The elements of a system are predictable and consistent relationship with

each other, represented by homeostasis, and is manifested in couples by the presence of regular, repeating cycles of interaction

4. All behaviour is assumed to have a communicative aspect: you cannot not communicate

5. The task of the family systems therapist is to interrupt stuck, repetitive, negative cycles of interaction, so that new patterns can occur

the experiential– systemic synthesis of EFT, there is a focus on both the circular cycles of interaction between people and the core emotional experiences of each partner during the different steps of the cycle.

2. The Healthy/Well-Functioning versus Pathological/Dysfunctional Couple/MarriageWell-Functioning

Healthy/Well-Functioning A healthy relationship, in EFT terms, is a secure attachment

bond. Such a bond is characterized by mutual emotional accessibility and responsiveness. This bond creates a safe

environment that optimizes partners’ ability to regulate their emotions, process information, solve problems, resolve differences, and communicate clearly. Secure relationships are associated with higher levels of intimacy, trust, and satisfaction.

the research on adult attachment has demonstrated that secure relationships are associated with higher levels of intimacy, trust, and satisfaction.

Security in key relationships helps us regulate our emotions, process information effectively, and communicate clearly

Security involves inner realities, cognitive models and ways of regulating emotion, and patterns of interaction

View of distress in EFT

EFT looks at distress in relationships through the lens of attachment insecurity and separation distress

Relationship distress is maintained by absorbing negative affect.

Affect reflects and primes rigid, constricted patterns of interaction.

Patterns make safe emotional engagement difficult and create insecure bonding.

View of Distress

Rigid repetitive interactional patterns: No exits – no detours/ repair impossible Rigid narrow positions – fight/flight/freeze Most common patterns

Criticize, complain, express contempt Defend, distance, stonewall

Results: self reinforcing cycles or reactivity/self protective strategies

View of Distress

Partners cannot attune to one another because they are so absorbed in their own negative affect

Cannot communicate because of their own state.

Gottman 1979 – absorbing states of negative affect: everything leads in, nothing leads out.

Key Principles of EFT

Key Principles 1. A collaborative alliance offers a couple a secure base from

which to explore their relationship. The therapist is best seen as a process consultant to the couple’s relationship.

2. Emotion is primary in organizing attachment behaviors and how self and other are experienced in intimate relationships. The EFT therapist privileges emotional responses and deconstructs reactive, negative emotions, such as anger, by expanding them to include marginalized elements, such as fear and helplessness. The therapist also uses newly formulated and articulated emotions, such as fear and longing or assertive anger, to evoke new steps in the relationship dance

3. The attachment needs and desires of partners are essentially healthy and adaptive. It is the way such needs are enacted in a context of perceived insecurity that creates problems.

Key Principles 4. Problems are maintained by the ways in which interactions

are organized and by the dominant emotional experience of each partner in the relationship. Affect and interaction form a reciprocally determining, self-reinforcing feedback loop.

5. Change occurs not through insight into the past, catharsis, or negotiation, but through new emotional experience in the present context of attachment-salient interactions.

6. In couple therapy, the “client” is the relationship between partners. Problems are viewed in terms of adult insecurity and separation distress. The ultimate goal of therapy is the creation of new cycles of secure bonding that offer an antidote to negative cycles and redefine the nature of the relationship.

3. The Role of the Therapist

3. The Role of the Therapist

Develop an alliance, identify cycle, identify and access underlying emotions, and work to deescalate

Engage the withdrawer Soften the pursuer/blamer Create new emotional bonding events and new

cycles of interaction Consolidate new cycles of trust, connection and

safety, and apply them to old problems that may still be relevant

What Makes EFT, -- Its Look and Feel1. Relentless Empathy2. Attachment Frame and Language3. De-pathologizing Model4. RISSSC5. Enactments

Skills forR-I-S-S-S-C Emotional Engagement

R: The therapist intentionally REPEATS key words and phrases for emphasis.

I: Therapist uses IMAGES or word pictures that evoke emotions more than abstract labels tend to do.

S: Therapist frames responses to clients in SIMPLE and concise phrases.

S: Therapist will SLOW the process of the session and the pace of her speech to enable deepening of emotional experience

S: Therapist will use SOFT and soothing tone of voice to encourage a client to deepen experience.

C: Therapist uses CLIENT words and phrases in a supportive/validating way.

4. Assessment and Treatment Planning

Key Movements in Assessment Process – Focus Points

1. 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

2. 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 3. 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 4. 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

5. 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 6. 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

Attachment History - (View of Self and View of Other)

“When you were young (ages 6 – 10) who did you turn to for care and comfort in a time of need? Can you tell me what that was like?”

Secure: A person is better able to acknowledge and cope effectively with negative emotions. Adults are self-confident, socially skilled, interested in close, romantic relationships, and more likely to form stable and satisfying long-term relationships.

Avoidant: A person often attempts to block out negative emotions, and are uncomfortable seeking support. Adults lack self-confidence, are worried about rejection and abandonment. They are prone to bouts of jealousy and anger. They see partners as untrustworthy. Seek romantic relationships, but may choose ill-advised partners.

Anxious: A person is highly emotionally expressive but often cannot regulate their emotions. Adults are uncomfortable with closeness, self-disclosure, dependence on others, and are more socially unskilled.

5. Goal Setting

5. Goal Setting: primary focus

• To expand and re-organize key emotional responses between partners–the music of the attachment dance.

• Create a shift in each partner’s interactional positions in their rigid interactions with one another and develop new cycles of interaction.

• Foster the creation of a secure bond between partners through the creation of new interactional experiences that redefine the relationship.

6. Process and Technical Aspects of EFT Couple Therapy

Overview of EFT Treatment Process• Develop an alliance, identify cycle, identify and

access underlying emotions, and work to de-escalate

• Help couple see the negative cycle as the enemy, not each other

• Engage the withdrawer • Soften the pursuer/blamer• Create new emotional bonding events and new

cycles of interaction• Consolidate new cycles of trust, connection and

safety, and apply them to old problems that may still be relevant

Attachment Withdrawer “I never get it right or make her happy.” “I don’t bother anymore what’s the point.” (Feelings: Rejected, inadequate, fears

failure, overwhelmed, judged, shame, empty,

alone) Pursuer “He’s never around and whenever he is he’s always distracted.” “She doesn’t see me. No matter what I do I

don’t count in her world.” (Feelings: Hurt, unwanted, invisible,

abandoned, desperate, deprived, not important)

Common Underlying Emotions of Withdrawers and Pursuers

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

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

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EFT: 3 stages and 9 steps

Stage 1 Assessment and Cycle De-escalation

Steps 8-9

Steps 1-4

•Stage 2Changing Interactional Positions and Creating New Bonds

•Stage 3Consolidation and Integration

Steps 5-7

EFT: 3 Stages

• Stage 1 Assessment and Cycle De-Escalation• Stage 2Changing Interactional Positions and

Creating New Bonds• Stage 3Consolidation and Integration

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and 9 Steps Step 1: Identify the relational conflict issues between the partners. Step 2: Identify the negative interaction cycle where these issues are

expressed. Step 3: Access the unacknowledged, attachment oriented emotions

underlying the interactional position each partner takes in this cycle. Step 4: Reframe the problem in terms of the cycle, underlying emotions

that accompany it, and attachment needs. Step 5: Promote identification with disowned attachment needs and

aspects of self. Step 6: Promote each partner’s acceptance of the other experience. Step 7: Facilitate the expression of needs and wants to restructure the

interaction based on new understandings and create bonding events Step 8: Facilitate the emergence of new solutions to old problems. Step 9: Consolidate new positions and cycles of attachment behavior.

Stage 1 Assessment and Cycle De-Escalation

Step 1: Identify the relational conflict issues between the partners.Step 2: Identify the negative interaction cycle where these issues are expressed.Step 3: Access the unacknowledged, attachment oriented emotions underlying the interactional position each partner takes in this cycle.Step 4: Reframe the problem in terms of the cycle, underlying emotions that accompany it, and attachment needs.

The Nine Steps of EmotionallyFocused Couples Therapy

Step 1-4• Alliance and assessment: Creating an

alliance and delineating conflict issues in the core attachment struggle.

What are they fighting about and how are they related to core attachment issues?

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Step 1: Identify the relational conflict issues between the partners.

Alliance & assessment: Creating an alliance and delineating conflict issues in the core attachment struggle.

What are they fighting about and how are they related to core attachment issues.

Establishing AN ALLIANCE• Reflection• Validation• Empathic Attunement

Step 2: Identify the negative interaction cycle where these issues are expressed.

Identify the negative interaction cycle EFT Cycle levels include

• Action tendencies (behaviors) • Perceptions• Secondary Emotions• Primary Emotions• Unmet Attachment Needs

The goal is for the therapist to see the cycle in action and identify and describe it to the couple and work toward stopping it.

Identifying & Delineating Negative Interactive Cycle

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

EFT Emotions and Reactivity

Emotions occur at two levels: Primary and Secondary (or reactive).Primary Emotions are the deeper, more

vulnerable and tender emotions such as sadness, hurt, fear, shame, and loneliness.

Secondary Emotions are the more reactive emotions such as anger, jealousy, resentment, and frustration. They occur as a reaction to the primary emotions. Anger, Blame,

Primary emotions generally draw partners closer.

Secondary emotions tend to push partners away.

Pursuer/Withdrawer : primary and secondary emotions

STEP 2 – IDENTIFYING THE NEGATIVE CYCLE• Who is the Pursuer?• Who is the Withdrawer?• Describe the Negative Cycle• What are the Secondary

Emotions?• What are the Primary

Emotions?

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Step 3: Access the unacknowledged, attachment oriented emotions underlying the interactional position each partner takes in this cycle.

The goal is to help each member of the couple to access and accept their unacknowledged feelings that are influencing their behavior in the relationship.

Both partners are to "reprocess and crystallize their own experience in the relationship" so that they can become emotionally open to the other person.

Step 4: Reframe the problem in terms of the cycle, underlying emotions that accompany it, and attachment needs.

The cycle is framed as the common enemy and the source of the partners’ emotional deprivation and distress.

The goal, by the end of Step 4, is for the partners to have a meta-perspective on their interactions.

They are framed as unwittingly creating, but also being victimized by, the cycle of interaction that characterizes their relationship

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EFT Reframes Step 4For example:Angry Criticism is viewed in EFT as: an attempt to modify the other partner’s inaccessibility or manage the disconnect a protest response to emotional isolation and abandonment not being “crazy or irrational”.Avoidance is seen as: an attempt to contain the interaction and regulate fears of rejection or not burden the other partner an attempt to avoid confrontation or working models that define the self as unlovable .

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The CycleScott R. Woolley Ph.D. ©

Partner

Partner

Primary Emotion

Primary Emotion

Perceptions/AttributionsPerceptions/Attributions

Secondary Emotion

Secondary Emotion

BehaviorBehavior

Unmet Attachment Needs

Unmet Attachment Needs

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Stage 2Changing Interactional Positions and Creating New Bonds

Step 5: Promote identification with disowned attachment needs and aspects of self. Such attachment needs may include the need for reassurance and comfort. Aspects of self that are not identified with may include a sense of shame or unworthiness.Step 6: Promote each partner’s acceptance of the other experience. Step 7: Facilitate the expression of needs and wants to restructure the interaction based on new understandings and create bonding events

The Nine Steps of EFT STAGE 2Steps 5-7

Step 5- Withdrawer Re-Engagement and Pursuer Softening

Promote identification with disowned attachment emotions, needs and aspects of self, and integrate these into relationship interactions.

Help the couple redefine their experiences in terms of their unacknowledged emotional needs. "I nag because I feel abandoned and I want to be loved." "I withdraw because I feel invaded and rejected and I need to feel safe and loved."

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The Nine Steps of EmotionallyFocused Couples TherapyStep 6 Promote acceptance of the other partner’s

experiences and new interactional responses . Work to get each partner to accept, believe, and

trust that what the other partner is describing in terms of underlying emotional needs is accurate.

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The Nine Steps of EmotionallyFocused Couples Therapy

Step 7 Facilitate the expression of needs and wants and

create emotional engagement and bonding events that redefine the attachment between the partners.

Help them learn to express their emotional needs and wants directly rather than through the old patterns and create emotional engagement. This will help each person see the other person in a more benign manner. (Feeling vulnerable and insecure rather than rejecting.)

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Stage 3 – Consolidation Step 8 – Facilitating the emergence of new solutions to old relationship patternsStep 9 – Consolidating new positions and new cycle of safe attachment and connections

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.

Step 8 & 9 The goal here is to consolidate new responses and cycles of

interaction, for example, by reviewing the accomplishments of the partners in therapy and helping the couple create a coherent narrative of their journey into and out of distress.

The therapist also supports the couple to solve concrete problems that have been destructive to the relationship.

this is often relatively easy given that dialogues about these problems are no longer infused with overwhelming negative affect and issues of relationship definition.

Without the old negative interaction style and with the new emotional connection and attachment, it is easier to develop new solutions to old problems.

7. Curative Factors/Mechanisms of Change

Curative Factors/Mechanisms of Change Once the alliance is established, there

are two basic therapeutic tasks in EFT: (1) the exploration and reformulation of

emotional experience, and (2) the restructuring of interactions.

1.Exploring and Reformulating Emotion 1. Reflecting emotional experience 2. Validation. 3. Evocative responding 4. Heightening: Using repetition, images,

metaphors, or enactments. 5. Empathic conjecture or interpretation

2. Restructuring Interventions

1. Tracking, reflecting, and replaying interactions 2. Reframing in the context of the cycle and

attachment processes 3. Restructuring and shaping interactions:

Enacting present positions, enacting new behaviors based upon new emotional responses, and choreographing specific change events

8. Treatment Applicability and Empirical Support

Contraindications of EFT Different Agendas Separating Couples Abusive Relationships Substance Abuse Depression and Other Psychiatric Illness

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Research 70 – 73% recovery rate in 10-12 sessions. Results stable – even under high stress. Depression significantly reduced. Variety of populations and settings. Best predictor of success – female faith in

partner’s caring (Not initial distress level).

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Readings

Core reading: 1. Gurman (2008) Chapter 4. Emotionally Focused Couple Therapy by

Susan M. Johnson 2. Bradley & Johnson (2012) EFT Integrative approach 3. Crawley & Grant (2005) EFT for couples and attachment theory 4. Johnson (2003) Attachment-Theory and couple therapy. MUST READAdvanced readings: 5. Greenberg (2010) EFT a clinical synthesis 6. Greenman & Johnson (2012) EFT and PTSD 7. Brumbaugh (2006) transference and attachment: how do attachment

patterns carry forward from one relationship to the next.