Lecture 7. EFT for Couples Stage 1: Steps 1-4 Assessment and Cycle De-escalation

Couple Counselling SkillsKevin Standish

Learning Objectives

Describe theory of Stage 1 Identify the 4 Steps Identify the skills used in each step Understand withdraw engagement

and blamer softening

Principles & Concepts

Looks within at how partners construct their emotional experience of relatedness

Looks between at how partners engage each other.

Focus of EFT: The 4 P’s

Experiential Present Primary Affect

Systemic Process (time) Positions / Patterns

The therapist is a process consultant

4 P’s

Present experience Deal with the past when it comes into the

present to validate client’s responses as it relates to how they coped/survived

When emotion is re-experienced it is now in the present

Focus is on current positions/patterns Don’t ask “why”, focus on what is.

4 P’s Primary emotions

Validating and moving from secondary to primary emotions

Stay with emotions, create safe haven Organize the emotion of a past

experience so that client can engage in the here & now

4 P’s Process patterns

Look individually how each person is processing in the moment

“What happens…then what…then what” Positions

The position each partner is taking in the relationship

Work to create new position & new patterns

3 Tasks of EFT

1. Create and maintaining a therapeutic alliance.

2. Accessing and reformulating emotion.

3. Restructuring key interactions.

Task 1 Interventions

Therapeutic Alliance1. Empathic Attunement2. Acceptance3. Genuineness4. Continuous active alliance

monitoring

Task 2 Interventions

Accessing and Reformulating Emotion

Fostering an emotion focus Primary, and secondary

emotions are key focus

Key Issues when focusing on Emotion1. Involvement: requires direct

engagement and experience of the emotions.

2. Exploration: leads a process of emotional discovery based on personal experiences.

3. New emotion: discover and expand previously unrecognized or unformulated emotional experiences. Support engagement with primary emotions.

Task 3 Interventions

1. Tracking & reflecting patterns & cycles of interactions

2. Framing and reframing problems in terms of negative cycles and attachment responses.

3. Using enactments to shape interactions (choreographing new events to modify, step by step, each partner’s position).

Restructuring Interactions Enactments

Used to shape and restructure interactions.

1. Enacting present positions2. Turning new emotional experiences

into new interactions.3. Highlighting rarely occurring

responses.

Enactments

Phase 1: Making the request to make contact

Phase 2: Maintaining the focus, blocking detours, and containing and framing escalations

Phase 3: Processing each partner’s experience of the enactment

Skills for Emotional Engagement: R-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.

Enactment reflections in action If you watch Johnson doing this kind of therapy, it may seem she

goes on and on at times about the same issues. However, it is the act of saying these things, hearing these things, and afterward finding nothing horrible happened… that helps people tolerate their emotions and feel safe when they express them. Good EFT therapists use techniques like:

Speaking slowly, calmly, and patiently, checking with the client to make sure they are remaining engaged. This sets the tone for the session, and if they communicate that they can tolerate the intimacy, and are not afraid of it, they can help the clients do the same.

Reflective statements (“It seems you are feeling terribly scared by that”). This is a validation of Rogers, but it is also helping the partner listening to understand the key points, the words to describe what they see in the other, and the power of these emotions.

Validation (“And it’s hard to even talk about this kind of fear, especially for you given your past experiences with relationships”). This kind of statement helps the partner listening see the link between the past and the present, and helps the partner speaking see it and accept it too.

Enactment reflections in action Evocative questions (“What’s happening now for you as I

say that… What’s it like to say that out loud, here and now?”). In some sense, this is drawing attention to meta-emotion, or emotions about emotions and expressing feelings. It can help the partner speaking be mindful of the moment, attend to what they feel in their bodies as they talk, and “own” in a very concrete way their feelings.

Heightening (using images like “It feels like a noose around your throat that could strangle you at any time” to evoke imagery that captures their emotional experiences, or asking one person to repeat something to their partner).

The Role of the Therapist in Stage 1

Develop an alliance, identify the negative cycle, identify and access underlying emotions, and work to deescalate the cycle Engage the withdrawer Soften the pursuer/blamer

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.

Stage 1 is the hard part. You have to seek out vulnerable emotions, and very slowly build

the awareness of them. Johnson gives the example of moving from “uncomfortable” to

“upset” to “hurt” eventually. Feminists argue we are surrounded by social and cultural

messages that tell men to not express emotions of dependency and fear for risk of being seen as needy and weak.

These messages tell women to not express assertiveness and anger, or risk being seen as dominating and bitchy.

Thus, you can explain to the couple that some emotions may be especially uncomfortable for them to uncover because society’s gender roles have encouraged them to avoid doing so all their lives.

This takes some of the blame off of them, and provides another example of how they can be victims of something larger, but not slaves to it.

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 1: Identify the relational conflict issues between the partners. Johnson advocates an assessment phase to guide all this, seeing

them together and separate. However, this kind of is Step 1, rather than being a separate

assessment phase followed by an official beginning to therapy. Background is important only as it impacts the current life

dynamics; this is not an insight into the family history kind of therapy.

Ask them what they hope to gain from therapy to focus them. Weave their separate complaints into one, and tie this to a plan

for treatment and a contract for therapy. Sometimes you may see them together, but sometimes apart to

help them be together when you do the next conjoint session

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.

EFT Emotions and Reactivity When uncovering the “primary” or underlying

emotions, notice the language the partners use. You’ll hear partner’s say things like “I feel like I’m

drowning” or “I’m dying and you can’t hear me screaming for help.” It seems dramatic, but it captures an intense, painful, and powerful emotional experience and use these words and analogies to weave together a story that both members could accept.

The “secondary” emotions of anger and resentment are far easier to show and talk about when you think about it this way.

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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Pursuer/Withdrawer : primary and secondary emotions

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.

Blamer softening: Access the unacknowledged, attachment needs https://www.youtube.com/watch?v=xaHms5z-yuM

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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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.

Furrow; Edwards; Choi and Bradley (2012) Therapist Presence in Emotionally Focused Couple Therapy Blamer Softening Events: Promoting Change Through Emotional Experience Journal of Marital and Family Therapy Volume 38, Issue Supplement s1, pages 39–49, June 2012 The blamer softening event has been associated with successful

treatment outcomes in emotionally focused couple therapy. Previous research has highlighted the critical role of softening events

and heightened emotional experience in best sessions of emotionally focused couple therapy (EFT).

This study examined the effects of a therapist’s emotional presence in predicting heightened levels of client emotional experience in blamer softening events.

Findings from a detailed analysis of successful and unsuccessful EFT softening attempts demonstrated that a therapist’s emotional presence and corresponding evocative vocal quality were more likely to predict heightened levels of client emotional experience in successful softening attempts.

ANALYZING THE WITHDRAWER RE-ENGAGEMENT CHANGE EVENT IN EMOTIONALLY FOCUSED COUPLE THERAPY: A PRELIMINARY TASK ANALYSIS Rheem (2011)

The process of successful withdrawer re-engagement was mapped in order to describe the change process for the EFT clinician. This change process closely paralleled the Idealized Model already put forth in the literature by Johnson (2004). A facet of describing this change process was measuring and naming the most commonly used EFT interventions throughout the change process which this study did. The Stage Two interventions already named by Johnson (2004) and Bradley and Furrow (2004) were found to be the most commonly used interventions in the withdrawer re-engagement change event.

two important process variables already named in the EFT literature: the depth of emotional experiencing and the quality of affiliative interactions between partners and see if these variables are related to successful treatment outcomes.

these two process variables showed to be significant for successful treatment outcomes in EFT.

You know a couple has de-escalated when…

Couple views cycle as the problem Couple can look beyond their own Partner sees role in cycle and impact on

other Couple can begin to exit their cycle

Andrea K. WittenbornExploring the Influence of the Attachment Organizations of Novice Therapists on their Delivery of Emotionally Focused Therapy for CouplesJournal of Marital and Family Therapy Volume 38, Issue Supplement s1, pages 50–62, June 2012

Clinicians’ own attachment organizations—have been found to influence the process and outcome of treatment.

Findings indicated that secure therapists, when compared to their insecure peers, were more competent at working with attachment needs, as well as the overt and underlying emotions of their clients.

Secure therapists perceived themselves as being more skilled in emotion regulation, which may have contributed to their abilities to remain attuned to their clients’ attachment needs and emotional expression, even in the face of emotional arousal in session.

Couples of insecure therapists also reported greater alliance splits.

Readings

1. Johnson (2004) chapter 4 the basics of EFT: tasks and interventions chapter 5 assessment: defining the dance and listening to music: EF key steps one

and two chapter 6. Changing the music: towards the escalation. EFT steps three and four Advanced reading: 2.Greenman et al (2009) EFT intercultural couple therapy 3. Bradley & Furrow (2007) Inside blamer softening maps and missteps 4. Rheem (2011) ANALYZING THE WITHDRAWER RE-ENGAGEMENT CHANGE EVENT IN

EMOTIONALLY FOCUSED COUPLE THERAPY: A PRELIMINARY TASK ANALYSIS . Found here

http://www.rebeccajorgensen.com/wp-content/uploads/2011/12/DISS-Rheem_Kathryn-Final.pdf