Family Therapy paper

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Emotionally Focused Therapy (EFT)

Michelle Washburn-Busk, MS, LMFT

Slides adapted from Austin Beck’s

Music

In-Class Journal

What’s a song that makes you feel happy?

What’s a song that makes you feel sad?

What’s a song that makes you feel cool?

What’s a song that makes you feel stressed out?

What’s a song that relaxes you?

In-class journal

https://www.youtube.com/watch?v=ecYgqLml89c

Write some of your thoughts and feelings down during each song, including the original.

Share in your groups.

https://www.youtube.com/watch?v=ecYgqLml89c

Theoretical Basis

Origins:

Attachment is the emotional bond to a primary caregiver

In couples, attachment style is the way someone bids for intimacy

Based on patterns of emotional response from childhood

The working model of attachment

Stressor event

Fight or flight system triggered

Turn to attachment figure for support/soothing

Figure responds

Outcome = soothing or distress

Baby face video: https://www.youtube.com/watch?v=apzXGEbZht0

Still Face Experiment

https://www.youtube.com/watch?v=apzXGEbZht0

Attachment Theory

Styles of Attachment

1. Secure

Views partner as trustworthy

Knows partner will respond to needs in a healthy way

2. Anxious

Views partner as inconsistent

Not sure if relationship is safe

Clingy

3. Avoidant

Views partner as unavailable/unsafe

Becoming emotionally invested is dangerous, so why bother?

Withdrawn

Based on strange situation, Ainsworth and Bowlby stuff

Styled responses to attachment threats

Anxious – up the ante - “I’ll make you respond”

Avoidant – cool your jets – “I will care less”

Fearful – chaos – “Come here, but don’t touch.” (this is often labeled as borderline)

Therapy Based on Attachment Theory

Focuses on attachment needs and forms of engagement and disengagement

Privileges emotion

Creates the therapy session as a secure base

Shapes new bonding responses, events

Addresses impasses, attachment injuries

Gottman said: “People fight about sex, chores, parenting, money.”

Sue said: “All fights are about attachment. The fights that matter are attachment focused. Don’t get lost in the content of the fight. Rather, think about and focus on the process of attachment.

Sue Johnson on Attachment

“In relationships, feeling understood is like oxygen. If you feel misunderstood, you feel like you are suffocating.”

It’s Not about the Nail clip

www.youtube.com/watch?v=-4EDhdAHrOg

“In relationships, feeling understood is like oxygen. If you feel like your emotions and needs are ignored or misunderstood, you feel like you are suffocating.”

Goals of Therapy

The goals of therapy are to:

Access, expand and reorganize key emotional responses

Enhance the attachment bond

Create a shift in interactional patterns

Foster the creation of a secure bond between partners where vulnerable emotions are safe to be expressed

Focus on the Present

EFT focuses on the here-and-now

Family of origin and past history

Only attended to as they relate to functioning in the present

Change occurs in session

Less of a focus on homework

Although couples often come up with their own homework

Mention the differences to other therapies like bowen

Focus on Emotion

Emotion = prime player

Relationship distress

Changing that distress

“Music of the Dance” metaphor

Clients are not viewed as deficient, delayed, or unskilled. Instead, viewed as:

Having emotional needs

Getting stuck in emotional states

Developing negative cycles

No Duh, right? This is the name of the therapy!!!

Origin of the problem

EFT believes that couples develop harmful cycles because of deprivation, isolation, and loss of secure attachment

Problems originate because of insecure attachments  therefore, treatment is aimed at fostering secure attachments.

Key Emotion Concepts

Primary emotions

Core feelings

Vulnerability

Authentic/genuine

Examples:

Sadness

Fear

Hurt

Shame

Loneliness

Key Emotion Concepts

Secondary emotions

Defenses of the more vulnerable primary emotions

Reactive

Examples

Anger

Jealousy

Resentment

E.g., I may feel hurt (primary) but I then feel angry (secondary) in response to the hurt.

Primary emotions generally strengthen the bond between partners

Secondary emotions tend to push partners away from each other

When you feel overwhelmed with school (primary), what is your secondary reaction?

Vignette

Paul came home from work, slamming the front door and yelled when he accidentally tripped on some of his children’s toys on the living room carpet. Paul’s wife, Sarah, asked him why he was behaving this way. Paul slumped down on the couch, sighed, and said he was let go because the company had some budget problems. Sarah starts asking him several questions about how they were going to pay their bills, and what they should do to prepare for the future. At Sarah’s questions, Paul gets up quickly saying he “had enough” and leaves the room. Sarah quickly follows him, and says, “you always do this!”.

In-class journal: What were each of their secondary emotions?

In-class journal: What were each of their primary emotions?

Divide into groups

Mechanisms of Change

Involve:

Identifying the negative cycles of interaction  vilifying the cycle, not partner

Accessing the emotions that are both a response to and organizers of these cycles

Reprocessing these emotions to create new responses that shape secure bonding events and new cycles of trust and security

“Cleaning the wound vs. applying a Band-Aid”

(Woolley & Johnson, 2005)

EFT posits a unique change mechanism distinct from many of the other models.

Cleaning the wound vs. bandaid

EFT Assumptions

In EFT, it is assumed that:

Once emotional bonding events occur, then 

The attachment with the partner can become secure, then 

The interactional cycle becomes more supportive, and finally 

The couples are believed to be able to have or help each other generate the skills and insights necessary to solve their own unique problems.

Role of the Therapist

EFT therapist is NOT a:

Coach teaching communication skills

Wise creator of insight to the past

Strategist employing paradox and problem prescription

Teacher

EFT Therapist is a:

Process consultant

Choreographer

Collaborator

Interventions in EFT

Some of the interventions EFT therapists use:

reflecting emotional experience

validation

evocative responding

empathic conjecture

“Perhaps you feel like you’re not worthy of love?”

tracking, reflecting, and replaying interactions

reframing

Sue Johnson EFT in Action

1. https://www.youtube.com/watch?v=xaHms5z-yuM

2. https://www.youtube.com/watch?v=xaHms5z-yuM

Interventions

Reframing

Three most commonly used reframes:

Anger is framed as attachment protest

Withdrawal is framed as fear

Cycle is framed as the enemy and the problem, rather than the partner

Enactments

Therapist structures a safe interaction where each partner can talk directly to the other

Each partner expresses attachment needs

Each partner responds to the other person’s expressed needs

Ex: “Can you turn to her and tell her, ‘I feel so helpless and defeated, I just want to run away and hide.’”

Interventions

Heightening New Responses

Use RISSSC

R= Repetition

I = Imagery

S = Slow

S = Soft

S = Simple

C = Client’s words

Role Play

A couple come in to see a therapist because they have been fighting more often. Most of the fights occur because they disagree about how much time they are spending with one partner’s family.

Split into groups of 3-5.

Have two people role play the couple.

Have one person role play the therapist using the RISSSC techniques.

Use RISSSC

R= Repetition

I = Imagery

S = Slow

S = Soft

S = Simple

C = Client’s words

The 3 Stages and 9 Steps of Change

There are three primary stages of the practice of EFT:

(a) cycle de-escalation,

(b) formation of new interactions

There are 9 interactive steps within these phases (Johnson, 2004).

In all of these steps, therapist moves between the following two:

Helping partners uncover and express their emotional experience

Helping partners reorganize the pattern of their interactions

The steps are not rigidly sequential, but flexible guides for the mechanism of change

Steps of EFT

Stage1

Step 1: Exploration of conflict issues and building a strong alliance.

Step 2: Identify the negative interactional cycle fueling couple distress.

Step 3: Access core emotions underlying the interactional cycle.

Step 4: Reframe the problem in terms of the interactional cycle in response to unmet attachment need.

Stage 2

Step 5: Identification with own attachment needs and emotions.

Step 6: Promoting acceptance of partner’s emotional experience.

Step 7: Expression of needs and wants/creation of bonding events.

Stage 3

Step 8: New solutions to old problems.

Step 9: Consolidating new positions and cycles.

At step 4, help couple to unite against the enemy: the cycle

Stage 1

The first stage is cycle de-escalation and includes steps 1-4 in the change process.

The main objectives of Stage 1 are to:

assess the couple’s perceptions of the presenting problem

develop a solid therapeutic alliance

gather relationship history that could be influencing their interaction patterns

uncover the negative cycle of interaction that is leading to the couple distress.

Stage 1

Step 1: Exploration of conflict issues and building a strong alliance.

Gathers relationship history.

Joining by validating

Observation of cycle

Step 2: Identify the negative interactional cycle fueling couple distress.

Step 3: Access core emotions underlying the interactional cycle.

Validation

Empathic reflection

Step 2: For example, a wife could be perceived by her husband as verbally attacking him and he may then withdraw in response to her attack.

She could then respond by increasing the intensity of her verbal attacks because he is withdrawing.

The two have begun the cycle of responding based on their interpretation of the actions of their partner.

Step 3: Let’s assume her verbal attack touched on a deep-seated fear that he is a failure as a husband. In response to this fear, he becomes angry and tells himself that he is not a good husband. He then withdraws from his wife in response to him viewing himself as a failure. In turn, his wife views this withdrawal and has an emotional response of her own that influences her subsequent behavior.

Interaction Cycle (Scott Woolley)

Behavior

Perceptions/Attributions

Secondary Emotion

Primary Emotion

Unmet Attachment Needs

Partner 1

Partner 2

Interaction Cycle (Scott Woolley)

Withdraw

Verbal Attack

“My husband is scary”

“I’m a terrible husband”

Anger

Fear

Abandonment

She wants protection & safety

He wants acceptance & to be loved

Mary

Kevin

https://www.youtube.com/watch?v=nn3I6-DBLJM (The Breakup Clip with couple fighting)

Class will discuss the cycle based on the clip

Pursue withdraw

Most cycles have some element of pursuit and withdraw patterns – where do you see these for Mary & Kevin?

Three Major Shifts clients make in EFT

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.

Stage 1

Step 4: Reframe the problem in terms of the interactional cycle.

Relabeling and reframing to understand emotional needs in the cycle.

Both the individual and the partner can start responding to these main emotions.

Externalize the problem to view the main issue as the negative cycle, not as the uncaring husband or critical wife.

Stage 2

Stage 2 is the formation of new interactions.

Now that the negative cycle has been identified, a healthier cycle can be created that promotes secure attachment.

This is accomplished as the couple moves through steps 5-7.

Stage 2

Step 5: Identification with own attachment needs and emotions.

Each individual takes responsibility for their part in their cycle.

The couple reveals their attachment needs and emotional responses to their partner.

Step 6: Promoting acceptance of partner’s emotional experience.

In this step, the couple is responding to the unseen emotional causes of behavior rather than responding to the behavior that can be seen on the surface.

It’s like addressing the underlying cause instead of treating the observable symptoms (Johnson, 2004).

Step 7: Expression of needs and wants/creation of bonding events.

Safe expression of emotion leads to deepening connection and responsiveness of partner

Step 5: In the example, this would involve the husband discussing his fear that he is a failure as a husband and the subsequent behaviors that result. “I withdraw because I’m afraid that I failed as a husband.”

Step 6: This would involve the wife being able to express that she believes and accepts what her husband is expressing related to his deep seated fear of failure rather than criticizing his behavior.

Stage 3

Stage 3 is Consolidation/Integration.

Changes in session  changes in daily routine

Stage 3

Step 8: New solutions to old problems.

Healthier style has been created

The couple has a more secure bond from which the couple can explore future problems

More effective responses

Step 9: Consolidating new positions and cycles.

Couple can articulate the changes they have made

Chances that they will revert back to old patterns of interaction are decreased

The partners are aware of the new positions they hold in the interaction cycle and how each person has a specific role in maintaining the progress gained through therapy