Psychodynamic Models for Couples - EFT book - Chapter 3

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Johnson, S.M. (2004). The Practice of Emotionally Focused Couple Therapy: Creating Connection. New York: Bruner / Routledge. - Second Edition of 1996 book.

The Practice of Emotionally Focused Couple Therapy: Creating Connection

Chapter 3

Johnson, S.M. (2004). The Practice of Emotionally Focused Couple Therapy: Creating Connection. New York: Bruner / Routledge. - Second Edition of 1996 book

Chapter 3 –expanding experiences and shaping dances: basic therapist skills in EFT

-therapist has to create a safe context [secure attachment base]. This means validating. Therapist also needs to go back and forth between processing inner experiences and choreographing interactions between partners ài.e. relating to both the experiential and the systemic.

àtherefore, therapist5 must be comfortable with emotional content as well as in directing interactions. [active/engaged/flexible]

Three tasks of EFT therapist:

  1. The creation and maintenance of a consistent positive therapeutic alliance with both partners
  2. Accessing and re-processing of emotional experience
  3. Restructuring of interactions.


Task 1: The creation and maintenance of a consistent positive therapeutic alliance with both partners

-therapist is a process consultant – not an expert . Therefore the EFT therapist is supposed to facilitate the emotional reprocessing of the EFT.
-therapeutic alliance of EFT: client sees therapist as appropriately warm and supportive, the tasks and goals that the therapist gives need to be seen as relevant. Client has the confidence that therapist will be accepting in light of painful or destructive cycles of the marital distress. Therapist must validate each side of couple in order to build a therapeutic alliance with both.

For the therapist to build a therapeutic alliance, there must be stance that includes:

  1. Empathic attunement: “the ability to inhabit the client’s world for a moment”. This reduces anxiety and allows for more complete engagement of the client. There is judgments in this stance, but rather an understanding and consideration of the person’s positionàmaking contact with the client’s world
  2. Acceptance: non-judgmental stance must be taken in thinking of the client and communicating with the client
  3. Genuineness: genuineness of therapist – i.e. not necessarily self-disclosing, but rather open to be able to “learn from each of the clients about their experiences.” In other words, make the therapeutic encounter a human encounter
  4. Active monitoring: monitoring the alliance and restoring it if necessary, if there is a rupture in the alliance. i.e. at the end of an intense session, ask the couple about their reactions
  5. Joining the system – therapist addresses the relationship system: i.e. reflecting to the couple on what the therapist observes [+validate without invalidating the other person in the couple. This means that the therapist has to gauge with the other about how the other sees that therapist-partner interaction which just took place]

Task 2: accessing of emotion

This stage includes accessing and processing of the emotions behind the interactions -i.e. accessing the loneliness behind the attacking partner. This could include, for example:

  1. Creating a new meaning for context of the partner’s hostility
  2. Reprocess the hostility as desperate, fostering a new presentation of the self
  3. Challenges the other’s perception of the hostile partner.

Emotion in EFT
-emotions have a small number of basic universal emotions:
  • Anger
  • Fear
  • Hurt/distress
  • Shame
  • Sadness/despair
  • Joy

Emotional processing is seen in an information-processing lens: physiological responses, meaning schemes and action tendencies as well as self-reflexive awareness of this experience. Emotion gives us feedback on how the environment is influencing us. They orient us to the world, tell us of the personal significance of events as well as what we want/need. Emotions are the response system to quickly reorganize a person’s behaviours in the interest of survival/safety/fulfillment of needs. In intimate relationships, affect does the following:

  1. Focus attention and orient partners to their needs and particular environmental cues
  2. Colours perceptions and meaning construction
  3. Prime and organize responses, particularly attachment behaviours
  4. Activate core cognitions concerning self, other and the nature of the relationships
  5. Communicate with others – i.e. tries to invoke certain responses in others

EFT claims that no change could happen without focusing on the emotions: at best, no therapeutic change would occur. At worse, the clinically-untapped emotions will do harm to the clinical process.

EFT: correct a thought with an alternative though; correct an emotion with an alternate emotion.

Categories of emotion:

  1. primary emotions: responses to the here-and now of the situation
  2. secondary emotions: responses to the direct emotion: i.e. obscuring primary responses – i.e. anger is expressed in marital discord rather than the underlying hurt
  3. instrumental emotions: responses meant to manipulate the responses of others
  4. maladaptive responses: out of context, completing responses that constrict how the present situation is handled

àinitially, therapist should relate to the secondary emotions, but focus on the primary responses as the core of the EFT interventions. The aim of focusing on primary emotions is to establish a marital system which be supportive of each other’s primary responses instead of the problematic interactional cycles.

àmaladaptive responses should also be processed so that they do not enter the marital system – so that current marital relationship is a place where those emotional structures are restructured.

Emotional levels in EFT:

  • involvement – therapist must speak concretely and not abstractly in order to connect to the emotions conveyed
  • exploration – the point of EFT is not to re-label them but rather explore them and expand the person’s experience of self in relation to the other àtherefore, therapist may have to unpack a label on an emotion or focus on background description (i.e. the visceral feelings in the event)
  • new emotion – indiscriminate ventilation of emotion/catharsis is not part of EFT and could be detrimental to marital therapy – they anyways do so to each other and this is the thing that contributes to the marital distress. Instead, you need to help couple discover new emotions.

Which emotion to focus on?

  1. The most vivid/poignant emotion which comes up in session àlook for the non-verbals too!
  2. Most salient emotion in terms of attachment needs/fears
  3. The emotion which seems to play a role in organizing the negative interactions – i.e. see the fear right before the withdrawal.

àat first, validate the secondary, but find the primary emotions

-therapist must also stay with the intensity level brought forth by the client

Skills and interventions: accessing emotion:

  1. Reflection: attending/focus on the poignant emotion ài.e. not only echoing and paraphrasing but intense concentration/absorption of client’s experience. This gives focus to the therapy, builds therapeutic alliance and slows down the interpersonal interaction in the session.
  2. Validation: conveying (to both partners) that they are entitled to their experience and emotional responses. If necessary, the therapist explicitly differentiates one partner’s experience from the other’s intention/character [i.e. partner feels hated without the other being hateful] – the stance is that there is nothing wrong or shameful with their responses. Empathic reflection may do this, but sometimes therapist has to explicitly validate. Validation is the antidote to climate of defensiveness/anxiety/disqualification/constriction experiencing/presentation of the self.
  3. Evocative responding: reflections and questions: query responses that focus on the tentative/unclear/emerging aspects of the partner’s experiences àtrying to seek the implicit àthis is meant to help the client construct the experience in a more tentative way. The constructs/reflections are offered on a tentative basis for the client to try/correct/reshape or take on, not as an expert. The reflections focus on emotional cues and how they are perceived processed. The therapist invites the client to the leading edge of the client experience and invites them to take another step in formulating and symbolizing their experience
  4. Heightening: therapist’s highlighting and intensifying certain responses/interactions while tracking the interactions between the couple. This is meant to further the process of the partner respond to the highlighted element. The idea is to move something from the background to the limelight. Several techniques include:
    1. Repeating a phrase
    2. How things are said (i.e. therapist leaning forward, lowering/slowing the therapist’s speak
    3. Using slow poignant images and metaphors that crystallize the experiences
    4. Directing partners to enact their responses so that the intrapsychic becomes interpersonal
    5. Maintaining a specific focus – i.e. blocking distractions
  5. Empathic conjecture/interpretation: inferring the client’s current state of mind in order to let the client take his experiences one step further – not to get the client to reinterpret his experiences but rather understand them ànot insight per se, but rather spontaneous new meanings to the experience [informed by attachment ideas]. Inferences are tentative and could be corrected by guide/correct those inferences. Therapist may help client verbalize them. Disquisition is when a client is very resistant to exploring their experiences: a general story is told that is reminiscent/parallel to the presenting marital issue. It elaborates on responses and underlying emotion. Narrative shoukd be reflective of therapist’s understanding of the clinical situation. Story should be non-threatening and more elaborate than the story that the couple is presenting (experientially speaking). Links should be made in the story about the connection between experience and responses to it. The goal of this approach is to have the partners identify with some part of this story à”and take it from there…” – you can also fix the story to be aimed at the other partner and not directly to the partner who is resistive.
  6. Self-disclosure: usually limited in EFT – can be used to build alliance/validation/joining

-the abovementioned tools are meant to build acceptance as well as promote exploration/elaboration. EFT validates instead of “tossing out” the old skills and bringing in new ones. The process of “self-discovery” of one’s emotional components is key in EFT.



Task 3 - restructuring the interactions

Therapist must do the following three steps in the restructuring of the interactions

  1. Tracks and reflects the patterns and cycles of interaction
  2. Reframes problems in terms of context/cycles
  3. Restructures interactions by choreographing new events that modify each partner’s interactional position

Tracking and reflecting

Tracking means tracking and reflecting on the interactions, just like one would track the inner experiences of the individuals. This may include identifying the negative cycle of interactions: i.e. talk the couple thorough how they respond to each other, and their emotive motive (play on words is mine) behind it. Therapist helps the couple clarify [reflect] what they are going through – i.e. through their interactions: blame-defend, pursue-withdraw. Therapist can externalize the problem, similar to the narrative approaches, and is an antidote for seeing one of the couple members as “defective”. The problem is seen as having a life of its own and which gets in the way of the couple attempts at contact and caring. The EFT therapist will look at prototypical interactions as observed in sessions.

Reframing

As a result of the tracking, identification and elaboration of the cycles of interaction, in the context of the reacting to each other – i.e. reframe one’s responses to indeed be seen as a cycle of responses to the other’s behavior. It is not a random reframing (i.e. “nice externalization”). Those reframing help partners see 1) their own and their partners need for connection [i.e. EFT is talking about here-and-now, not based on family of origin and not seeing connection as a deficit] , 2) how they unwittingly help create the other’s distress and resulting negative responses. Distancing behaviours might be reframed as self-protective, rather than assumed “indifference”.

Since EFT is based on Attachment Theory, anger is framed a response to the perceived unavailability or separation of the partner, and distancing is also a attachment-regulating attempt.

Those reframed are most effective when client comes up with them, and not simply exterior labels (graciously) given by the therapist.

Restructures and shaping interactions

  1. Crystallize and enact present positions so that they may be expanded – i.e. highlight and enact those interactions which maintain the structure of the relationship
  2. Turn new emotional experience into a specific new response to the partner that challenges old patterns of relating
  3. Heighten new or rarely occurring responses, which have the potential to modify partner’s position
  4. Choreograph specific change events

Techniques specific to difficult therapeutic impasses:

  1. Diagnostic pictures or narratives – i.e. putting the diagnostic picture of narratives and couple’s interactions in a manner which makes the impasse explicit and confronts the couple with the consequences of this impasse for their relationship. This has to be concrete and specific. Phrasing it graphically heightens the clients’ sense of impasse. This focuses their positions and often makes the couple take a new risk or response to break the impasse. i.e. when partner complained about the other withdrawing and now cannot trust the engaged partner. Therapist is to recount the counseling under the partner’s turnaround and paint a picture of the present interactional pattern, and how they place the interaction in neutral.
  2. Individual sessions – to explore specific blocks in therapy

Summary (i.e. happy ending)

EFT therapist tries to be a guide/process consultant to reprocess and reorganize emotional experiences, i.e. by changing habitual responses, in order to engage in the other’s and one own’s emotional/interactional experience. An emotional and interactional corrective experience is sought through EFT. EFT therapist may:

  1. Monitor the alliance
  2. Reflect secondary emotion
  3. Reflect underlying emotions
  4. Validating present responses
  5. Validating newly experiences underlying emotions
  6. Evocative responding
  7. Heightening
  8. Engaging in empathic conjure
  9. Tracking/reflecting interactions
  10. Reframing each partner’s behavior in the context of the cycle
  11. Reframing each partner’s behavior in the context of attachment needs
  12. Restructuring interactions

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