Couples Week 5 - EFT

The EFT Priorities

1. It is a brief treatment focused on key factors in relationship distress and so it can be used in a managed care environment. 2. It has been systematically described and rigorously tested and found to be effective. 3. Relapse is a significant concern in the couple therapy field. Research with high-risk couples suggest that relapse is not a significant issue with EFT. 4. The need for studies of change occurs and exactly how therapists should intervene at key times in an ongoing issue in this field. Process research exists that supports the clinical wisdom of EFT and elaborates on how change occurs, specific processes, and change events in therapy. 5. EFT fits with recent research on the nature of marital distress and satisfaction within the developing science of personal relationships. 6. There is an increasing focus in couple therapy on issues of diversity. EFT is used with many different kinds of couples, with couples of different social classes, with different kinds of problems. EFT also assumes that there's is a certain universality that tends to cut across differences of culture, race, and class. For example Tomkins (1962) lists what appears to be a small set of universal basic emotions: interest/excitement, joy, surprise, distress/anguish, disgust/contempt, anger/rage, shame, and fear/terror. 7. EFT shares a number of characteristics with gender-oriented and feminist approaches to couple therapy. The EFT attachment perspective on relationships parallels the work of feminist writers who depathologize dependency. EFT and other feminist-informed therapies examine the impact of gender-based constraints and work to increase personal agency and to develop egalitarian relationships where reciprocity, intimacy, and interdependency can flourish. 8. EFT has also followed the move toward integration of interventions across models by combining systemic and experiential perspectives and attachment theory as a theory of love. It also integrates recent research on marital distress with these elements. 9. EFT fits with the present climate of couple and family therapy in that it takes a post- modern stance, promoting a collaborative alliance where clients are the "experts" on their reality, and therapists discover with their clients how inner and outer realities are constructed. 10. Last, but not least, the growth of the EFT model reflects the increasing pressure for clinicians to find empirical support for their conceptualizations of key variables and to document the impact of these variables on relationship problems and repair processes. The attachment theory of adult love used in EFT has a substantial and growing research base.

EFT and Attachment : EFT focuses on 10 tenets of Attachment Theory

1.Attachment is an innate motivation force. Seeking and maintaining contact with significant others is an innate, primary motivating principle in human beings across the life span. 2.Secure dependence complements autonomy. There is no such thing as complete independence from others or overdependency, there is only effective or ineffective dependency. 3.Attachment offers an essential safe haven. Contact with attachment figures is an innate survival mechanism. 4.Attachment offers a secure base. The presence of a secure base encourages exploration and a cognitive openness to new information. 5.Emotional accessibility and responsiveness build bonds. The building blocks of secure bonds are emotional accessibility and responsiveness. 6. Fear and uncertainty activate attachment needs. When the individual is threatened, either by traumatic events, the negative aspects of everyday life such as stress or illness, or by any assault on the security of the attachment bond itself, powerful affect arises and attachment needs for comfort and connection become particularly compelling. 7.The process of separation distress is predictable. If attachment behaviors fail to evoke comforting responsiveness from attachment figures, a prototypical process of angry protest, clinging, depression, and despair occurs, culminating eventually in detachment. 8.A finite number of insecure forms of engagement can be identified.When connection with an irreplaceable other is threatened but not yet severed, the attachment system may become hyperactivated or go into overdrive 9.Attachment involves working models of self and other. We define ourselves in the context of our most intimate relationships. 10.Isolation and loss are inherently traumatizing. Attachment theory, is a theory of trauma. The trauma of deprivation, loss, rejection, and abandonment.

The EFT Approach

EFT is integrative; it looks within and between. It integrates an intrapsychic focus on how individuals process their experience, particularly their key attachment-oriented emotional responses, with an interpersonal focus on how partners organize their interactions into patterns and cycles. It considers how systemic pattern and inner experience and sense of self evoke and create each other. The process of experiencing and the process of interaction are touchtstones for the therapist as he or she attempts to guide the distressed couple away from negative and rigidly structured internal and external responses, toward the flexibility and sensitive responsiveness. The interactional positions adopted by the partners are assumed to be maintained by both the individual emotional experience of the partners and the way interactions are organized. That is, by intrapsychic realities and the couple's habitual moves in their interactional dance. These realities and moves are reciprocally determining and constantly recreate one another. Both have to be processed and reorganized if the couple is to attain a positive emotional bond. The creation of such a secure bond is the ultimate goal of EFT. EFT expands experience and interactions The first goal of therapy is to access and reprocess the emotional responses underlying each partner's often narrow and rigidly held interactional position. This is done by facilitating a shift in these positions toward accessibility and responsiveness, the building blocks of secure bonds. The second goal of therapy is is to create new interactional events that redefine the relationship as a source of security and comfort for each of the partners. The reprocessing of inner experience is used to expand the interpersonal context (as when a spouse discovers that his wife is desperate rather than malicious). In turn, the structuring of new interactional events expands and redefines each partner's inner experience (as when a spouse expresses his need for his wife, and she then experiences her own fear of responding, rather than staying focused on his unavailability). When EFT is successfully implemented, each partner becomes a source of security, protection, and contact comfort for the other. Each partner can then assist the other in regulating negative affect and constructing a positive and potent sense of self. The EFT therapist choreographs bonding events in the session, which then powerfully redefine the relationship.

Introduction to EFT

Emotionally Focused Therapy is a short term, systematic, and tested intervention to reduce distress in adult love relationships and create more secure attachment bonds. The title reflects the priority given to emotions as a key organizer of inner experiences and key interactions in love relationships. A focus on emotion is seen as the essential transforming element in effective couple therapy. The word "emotion" comes from the Latin word "to move". EFT uses the power of emotion to "move" partners and evoke new responses in recurring key interactions that make up a couple's relationship "dance". When we speak of being emotionally "moved" we are usually talking of being touched, stirred up, compelled to respond to a powerful cue that evokes action in us. Emotion pulls for and organizes key responses in close relationships.

The Journey of EFT

From alienation, to emotional engagement. •From vigilant defense and self-protection, to openness and risk taking. •From a passive helplessness in the face of the inevitable dance of the relationship, to a sense of being able to actively create that dance. •From desperate blaming of the other, to a sense of how each partner makes it difficult for the other to be responsive and caring. •From a focus on the other's flaws, to the discovery of one's own fears and longings. •But most of all, from isolation to connectedness. •This is not an easy journey for most couples, even with guidance of a seasoned therapist.

What does EFT look like?

The therapist creating a safe, egalitarian relationship with the partners. The therapist is tracking and exploring how emotions direct the couple's dance and how the dance then shapes key emotions. The therapist is expanding emotional responses to include basic fears and needs and helping to create a new dance based on these expanded emotions. The therapist shifts from questions like "what happens to you when your partner moves away, as he did just now?" to formulations such as "Your desperate anger scares your partner and it is so hard for you to show the loneliness and longing underneath," to requests such a "Can you tell him 'Please, I need you to hold and reassure me."

Adult Attachment

•Adult attachments tend to be different from parent-child attachment in three important ways: 1.Adult love relationships are more representational. Adults find it easier to carry their loved ones around in their minds and use this representation for comfort. The smaller the child, the more there is need for physical contact. 2.Adult relationships are more sexual. Sexuality can be seen as an attachment behavior as well as a seeking after orgasm or reproduction. Oxytocin is released during nursing and at sexual climax. 3.Adult relationships are more reciprocal in nature. A parent is expected to take the lead and frame the attachment relationship with a child. Adult partners expect this to be a reciprocal process.

The Significance of Attachment Theory for Couple Therapy Cont.

•Attachment Theory offers the Couple Therapist: •A clear conceptualization of the health in close relationships and pivotal moments that define health or dysfunction. •A clear depathologizing perspective on the essential nature of distress that offers the therapist a language for client's hurts and dilemmas and so makes a safe haven of the therapy session and accelerates learning. •A way to grasp, articulate, and so hone in on the leading elements in relationship dramas: attachment emotions, fears and longings, and the ways patterns of interaction maintain separation distress. •New ways to understand and so effectively address impasses and wounds in relationships.

The Significance of Attachment Theory for Couple Therapy

•Attachment theory offers answers to some of the most fundamental questions about human relationships: •How do we become caught in futile strategies that rob us of the love we desire from our partners and family members? •Why does distancing so often fail to cool down conflictual interactions with attachment figures? •Why do certain events define the nature of relationships more than others? •How can we best focus our repair attempts and foster the valuable bonds with those we love?

Changes in Attachment

•Changes in attachment can be considered on the level of changes in behavioral responses, changes in ways of regulating emotions, or changes in relationship-specific and general models of self and other and ways of organizing information in attachment relationships. •Changes can occur, then, on different levels, but generally the couple therapist wants to foster new attachment responses that restructure a couple's relationship into a more secure bond. •Therapists focus on compelling new emotional experiences in specific ongoing attachment relationships as the main route to change in attachment responses and models. •These new emotional experiences can disconfirm past fears and biases, allowing models to be elaborated and expanded and new behaviors to be constructed and integrated.

Taking People As They Are

•Distressed partners are not seen as primarily deficient, developmentally delayed, or unskilled. •Partner's needs, desires, and primary emotional responses are seen here as generally healthy and adaptive. •It is how these needs and desires are enacted in a context of vulnerability and perceived danger that creates problems. •As Freud noted, "We are never so defenseless against suffering as when we love." •It is how emotional responses, such as fear, are inhibited, disowned, and distorted that leads to dysfunction. The therapist validates partners' experience and responses, rather than teaching them to be different.

The EFT Process

•EFT is designed to be implemented in 8 to 20 sessions. •A positive therapeutic alliance with both partners is considered to be a prerequisite of successful treatment. •It is not meant to be used with violent couples or separating couples, but is most successful with couples who wish to restructure their relationship in terms of a close bond, but have become alienated by negative interaction cycles, often of a blame-withdraw nature. •The therapist tracks and reflects emotional moments and interactional moves. •The therapist helps partners crystallize their emotional experience and sets interactional processes in motion with specific tasks (for instance, Can you tell him____?) •The therapist moves between helping the client unfold emotional experience and enact new responses.

Stage 1-Descalation : Step 3 - Clarify underlying emotions that are hidden or unacknowledged

•Emotions are often seen as negative, unacceptable, and embarrassing. •Clients often have auxiliary emotional reactions that need to be addressed •Sadness is seen as weak •Anger as sinful •This step is particularly vulnerable because it exposes the deep emotions surrounding the pattern •The goal is to help each partner crystallize their experience as to be more able to open up to the others perspective.

Stage 3 - Consolidation : Step 9 - Consolidating new positions and new cycles of attachment behaviors

•Help couple clearly see and articulate the old and new ways of interacting to help the couple avoid falling back into the old interactional style

Stage 2 - ReEngagement : Step 5—Promote identification with disowned attachment emotions, needs and aspects of self, and integrate these into relationship interactions

•Help redefine their distress in terms of unacknowledged emotional needs. •"I nag because I feel abandoned" •"I want to be loved" •"I withdraw because I feel invaded and rejected and I need to feel safe and loved" •Most intra-psychic step •Research says the couples who involve themselves the most emotionally in this step change the most •Disowned refers both to emotions and needs •The completion of step 5 is when both partners can clearly articulate their underlying emotions in an engaged way, i.e. "I just give up. I'll never make it with her, I feel small and scared. So then I back off, and go away."

Stage 2 - ReEngagement : Step 7 - Facilitate the expression of needs and wants and create emotional engagement and bonding events that redefine the attachments between the partners.

•Help them express their emotional needs directly and not through the old pattern •Feeling vulnerable and insecure rather than rejecting •"I am tired of numbing out. I want to feel special to you. I want you to hold off on the criticism and quit threatening to leave. I'm not going to feel small in this relationship anymore." •"Yes, I did what I have done before. I'm so used to reacting that way. But I don't want you to decide now that I'm not trying and get so mad that I can't get anywhere near you. I'm going to work on me and us so that doesn't happen, and I want you to believe me." •Softening occurs with the blamer criticizer •Engagement happens with the withdrawer

Stage 1-Descalation : Step 2 - Discover the negative interactional pattern and each partner's role

•Patterns include: •What are the secondary emotions? •What are the primary emotions? •What are the attachment emotions? •Behaviors they choose within the pattern. •Perceptions they hold of each other. •Enactment •The goal is to give feedback to the couple regarding the pattern you are observing. •Communicate to the couple that the goal is to change this pattern •De-personalize the couple's distress by expressing to them that the pattern is the problem and not each other.

Taking People as They Are Cont.

•People are seen then as being stuck in particular absorbing emotional states and in self-reinforcing interaction cycles, rather than being generally deficient. •Partners are stuck in certain ways of processing, organizing, and regulating emotional experience. •They are also stuck in set ways of relating to each other.•It is assumed that, given their experiences, individuals have coherent and valid reasons for constricting emotional processing and interactions with the spouse. •It is the therapist's task to grasp the "hidden rationality" behind seemingly destructive or irrational responses.

The Three Stages & Nine Steps of EFT

•Stage 1: The De-escalation of Negative Cycles of Interaction•Step 1: Creating an alliance and delineating conflict issues in the core attachment struggle. •Step 2: Identifying the negative interactional cycle where these issues are expressed. •Step 3: Accessing the unacknowledged emotions underlying interactional positions. •Step 4: Reframing the problem in terms of negative cycle, underlying emotions, and attachment needs. The cycle is framed as the common enemy and the source of the partner's emotional deprivation and distress.

The Three Stages & Nine Steps of EFT

•Stage 2: Changing Interaction Positions •Step 5: Promoting identification with disowned attachment emotions, needs, and aspects of self and integrating these into relationship interactions. •Step 6: Promoting acceptance of the partner's experience and new interactional responses. •Step 7: Facilitating the expression of needs and wants and creating emotional engagement and bonding events that redefine the attachment between partners.

The Three Stages & Nine Steps of EFT

•Stage 3: Consolidation and Integration •Step 8: Facilitating the emergence of new solutions to old relationship problems. •Step 9: consolidating new positions and new cycles of attachment behaviors.

How is EFT Different?

•The EFT therapist is not a coach teaching communication skills or more effective ways to negotiate with each other. •They are not a wise creator of insight into the past and how patterns from one's family of origin might influence the marriage. •They are not a strategist employing paradox and problem prescription. •They are not primarily a teacher, who focuses on helping couples modify irrational expectations and beliefs about marriage and relationships. •The EFT therapist is rather a process consultant, helping partners preprocess their experience, particularly their emotional experience of the relationship, and a choreographer, helping couples to restructure their relationship dance. •The EFT therapist is a collaborator who must sometimes follow and sometimes lead, rather than an expert who tells the partners how their relationship should be.

Stage 1-Descalation : Step 4 - Reframe the problem as a cycle tied to attachment needs and underlying feelings

•The cycle is the common enemy •Female partners more often identify with lack of connection and deprivation of contact. •Men more often identify feelings of inadequacy and incompetence. •A great resource is "Love and Respect" by Emerson Eggerichs for Christian couples.

An Emotional Focus

•The essence of any short-term therapy is focus. •In EFT, emotion is seen as the prime player in the drama of relationship distress and in changing that distress. •It is emotion that organizes attachment behaviors, that orients and motivates us to respond to other and communicates our needs and longings to them. •In EFT emotion, rather than being minimized or controlled, or simply labeled, is developed and differentiated. •This is described as unfolding a client's emotional reality. •Emotional experiences and expression are viewed as targets and agents of change to a much greater extent than in other nonexperiential models of therapy. •The expansion and articulation of new or marginalized aspects of emotional experience are primary therapeutic tasks here, and a new corrective emotional experience of engagement with one's partner is the essence of change in EFT. •Unfolding key emotions and using them to prime new responses to one's partner in therapeutic enactments in the heart of change in EFT. (Identifying the presenting emotion and getting to the underlying emotion. )

The EFT Treatment Goals

•The goal of EFT is to reprocess experience and reorganize interactions to create a secure bond between the partners, a sense of secure connectedness. •The focus here is always on attachment concerns; on safety, trust, and contact; and on the obstacles to the above. •There is then no attempt to teach a distressed couple communication skills per se, since from the EFT perspective it is unlikely that couples will use such skills when they are most relevant, that is, when each becomes distressed and vulnerable. •Since partner's problems are not generally viewed as resulting fro personality flaws, there is little emphasis on insight into unconscious intrapsychic conflicts. •Since the relationship is considered primarily as a bond rather than a relational bargain, there is no attempt to help the couple renegotiate new deals, or resolve pragmatic issues by drawing up new agreements or contracts. •Once a couple has created a more secure bond, we find that their partners can then use the negotiation skills they have; issues become clearer and less onerous when they are not infused with attachment conflicts and insecurities.

Stage 3 - Consolidation : Step 8 - Facilitating the emergence of new solutions to old relationship problems.

•The reduction of negative pattern enables new solutions to old problems •Secure attachment leads to feelings of safety, security, and flexibility

How is EFT Different? Cont.

•The therapist focuses on the here-and-now responses of the partners, tracking and expanding both internal experiences and interactional moves and countermoves. •Change occurs in the session as the couple experiences themselves differently and interact in a new way. Attention is paid to family-of-origin issues only as they are played out in a present sensitivities and the here and now of the interaction. (When they come up, Identify them) •There is also less use of future-oriented interventions such as the assigning of future tasks and homework.

The Process of Change

•Three major shifts are discernible in the process of change in EFT. These are: •Negative cycle de-escalation at the end of the first stage of therapy. •Withdrawn partners begin to risk more engagement and hostile partners are less reactive and angry. •The couple may begin to initiate some close contact such as lovemaking, seem to find their engagement in therapy reassuring, and begin to be hopeful for their relationship. •Withdrawer engagement in Stage two of therapy. •This occurs when the more withdrawn partner begins to become more active and engaged in the relationship. •This shift involves a change in interactional position, in terms of control and accessibility for contact. •The withdrawn partner asserts his or her needs and wants, rather than stonewalling or avoiding the spouse, becoming more emotionally engaged. •Blamer softening in Stage two of therapy. •When the previously hostile and more active spouse risks expressing his or her own attachment needs and vulnerabilities, allowing for interactions that challenge the trust level in the relationship.

Stage 1-Descalation : Step 1-Build an alliance and identify core pattern

•What are the fights about? •What is each partner's story? •Manage interruptions •Minimize cross talk •Reassure each partner that their story makes sense to you. •Inform them that every partner's story is different •Encourage listening by the partner •Focus on the unfolding of the story to deeper emotions•Help to organize their story and experience •Comfort and Reassure them when confronting difficult emotions

Stage 2 - ReEngagement : Step 6 - Promote acceptance of the other partner's experiences and new interactional responses

•Work to build trust that what the other is sharing is truthful •Catching the bullet as a therapist •"This is hard for you to listen to. It doesn't fit with how you see him. So you interpret his actions in a negative way. You get in your tank and fire, so as not to be taken in—is that it? It's hard for you to see that he is risking and reaching for you when he says..." •"So what is it like, what happens for you, when your partner talks like this and says. . ."