For next class: read all intervention chapters: tracking/reframing –tracking/reframing א until restructuring – p.96

Emotional focused therapy (EFT) –has best couples therapy outcomes. Lecturer feels that EFT gave more of a road-map to the “what to do” in the tense emotional moments

-developed in the 1980s by les Greenburg and Sue Johnson. People before EFT used systemic/object relationship theories. There seemed like there was a need for more containment. There are interactional pattern that runs across seemingly different situation. EFT came out of the research question of “what makes the critical difference in the therapeutic process?”. EFT came to the conclusion that it was the emotional corrective experience which made the difference. Therapist is not a mediator or referee but looks in the interactional pattern/self experiences which are behind the interpersonal interactional sequences.

-you want to assess engagement – sometimes, 1 partner is truly not really engaged – less chance for success. You may have to ask client why there are in session and what they want to get out of the sessions.

Marital distress – largely by John Gottman-“7 principles that make marriage work”

These create a self-reinforcing cycle of reactivity, with little accessibility or responsiveness. Safety first becomes the rule.

Includes care-talking, attachment, sexuality, in contrast to adult-child attachment in that in adults, it is reciprocal, representational

Bowlby: attachment is extremely important -the way the newborn in attached –this serves as a template

-emotion is viewed as a high-level information processing system rather than a primitive, irrational response

-emotion is a process involving physiological responses, meaning schemes and action tendencies. Threats to attachment induce attack/defensive behaviors. Emotion is the music of the dance… expanding the emotional repertoire helps change the dance

Men tend to like the comforting place, but the soft element of EFT tends to be liked better by women than men.

Women tend to like the emphasis on grounding that men bring, but men go there too fast, and must learn to attune more to the affect when grounding the solution.

Eft movie – sue Johnson – trying to organize and regulate emotions in the couple become habitual and rigid patterns… when wrong, the emotionally not regulated well, the relationship becomes in distress, and needs reorganization so that patterns will foster trust/accessibility/responsivity of the interactions

Therapist will want to be tracking the interactions, filtering out the underlying emotions and the consequent negative cycles. You may want to not keep the other listening too short [too little info] or too long either [too heard for the other to hear].

Victim has a sense of being owed and have a hard time seeing the circular aspects of systemic patters of the couple partnership.

Step 2: identifying the negative interactional cycle which maintain the couple’s distress and precludes secure conding

Ifthere are problems as the abovementioned, they ill emerge in process of assessment at the therapist follows the goals outlines as:

Clients will tell you facts, feelings, incidents and interactions. There are 1) pivotal relationship incidents, 2) personal interactional sequences, and 3) powerful interactional landmarks

Stage one: de-escalating the negative cycle of interaction – “CCER” mostly first order change

-in a typical session there is a lot of content brought forth – look for interactional markers, landmarks.

EFT can us individual sessions as part of the assessment process, usually after a first/second conjoint session. This is in order to:

-initial conjoint session: tracking the interaction, what got them together, why are they coming now?

Reframing the problem in terms of negative cycles and underlying attachment needs

tracking and reflecting is done in stages 1 and 2, but even more often in step 3-4

stage 3 is really hard because people touch on their vulnerabilities. Secure base of the therapist is extremely important to the exploration of this. 4 underlying fears include:

By the end of stage 4, ideally, clients have formulated a coherent and meaningful picture of the couple patters, and take ownership of it.

In meeting the couple, you can ask how the decision to come to counselling took place, has 1 person “quit” the relationship? [i.e. therapeutic prognosis is poor]

-women seek connection more; if unanswered –sense of abandonment/loneliness. Men tend to seek concrete success/competence. If men’s competence is even latently question, shame is often the primary emotions

STEP 6: validate the difficulty in seeing and trusting the unfamiliar partner emerging in the step 5 – validate that this feels “different”

Sometimes, you may want to be careful about sending a traumatized to individual counseling when the issue is circular – so that s/he won’t be “blamed” again.

-not all couples can / should stay together, but therapists should not play God/give in to transference, but rather trust the clients’ judgments. Often, therapist should help the “obnoxious” partner learn how to express the underlying need and the other partner to deal with it appropriately.

Promoting the Identification with disowned needs and aspects of self. This is the watershed of the EFT – the first 4 stages lead to stage #5 and the next 4 are based on stage #5. Previously avoided or unformulated experience is encountered, claimed and expressed to the partner. Most common themes are connected to each partner’s sense of self, especially the lovableness and worthiness. It is not only the disowned feelings but also the disowned needs. Attachment longings and desires start to be seen/expressed clearly,

Integrating those into the relationship and promoting acceptance of the partner’s experience and new ways of interacting

Step 7 – facilitating the expression of needs and wants, and creating emotional engagement

Withdrawer engagement: deal with owning cut-off emotions and express them to partner.

-usually, the softening of the pursuer happens after the withdrawer re-engagement. Reengagement can be gauged:

-therapists’ activeness is related the level of softening – more activeness = more softening

-therapeutic charge is needed when attacks/anger is shown in session + validate the underlying emotions which lead to the cycle in light of the aforementioned.

Class slides

EMOTIONALLY FOCUSED COUPLE THERAPY

LECTURE # 1

The emergence of EFT

Early 80s

-developed by Les Greenberg and Sue Johnson as a short term (8-20) structured approach to couples therapy

-lack of well delineated and validated marital therapy interventions

-few humanistic interventions-mostly behavioural

Perls + Rogers Meet Minuchin

-called EFT to focus on emotion as a positive agent of change rather than simply as part of the problem of marital distress.

Strengths

1. Clear explicit conceptualizations of relationship distress and adult love that are supported by empirical research on the nature of adult attachment and marital distress.

2. Change strategies and interventions are specified. The change process has been mapped into 9 steps and specific change events using experiential and systemic techniques.

3. EFT is empirically validated.

4. EFT has been applied to many different kinds of problems and populations.

Assumptions

Turn page

Now let’s turn our attention to attachment

John Bowlby said that isolation is ultimately traumatizing.

21century – see many vulnerable couples, must look at contextual variables

Our culture pathologizes dependency

More and more people live alone

Previously could turn to a village if no or unavailable mate

Studies (Kiecolt-Glaser)showing isolation undermines the immune system

Showing higher death rate in men with little or no support

Van der Kolk’s work shows bonds main factor in resilience

Culture teaches us that predictability, accessibility, soothing ok for children only

Schedules and stress erode bonding

Our culture pathologizes dependency

In the early 80s, SJ tried to have an article on emotional bonds published and she was refused at first because it would be fostering emotional immaturity.

According to Johnson, attachment theory offers a map to the landscape of love.

Let’s look a little more closely at attachment theory.

EMOTIONALLY FOCUSED COUPLE THERAPY

BASIC THERAPIST SKILLS IN EFT

Easier to learn EFT if the therapist’s personal style includes:

-the flexibility to hold systemic and experiential perspectives simultaneously

-comfort with emotional experience

-comfort with being active and directing interventions

3 BASIC TASKS IN THE SUCCESSFUL IMPLEMENTATION OF EFT

TASK ONE – THE CREATION AND MAINTENANCE OF A THERAPEUTIC ALLIANCE

In EFT the therapeutic alliance is characterized by the therapist’s being able to be with each partner as that partner encounters his/her emotional experience and enacts his/her position in the relationship.

This includes the following the following techniques:

Empathic attunement Empathy has been described by Guerney 1994 as an act of imagination, an ability to inhabit each client’s world for a moment. Rogers believed this ability along with its communication to clients was curative in itself.

Acceptance- A non-judgemental stance is essential in the creation of a powerful alliance.

Genuineness- Being real, present, human(ack. Mistakes). Allow clients to teach about their experience.

Active monitoring- the therapist must take an active role in monitoring, probing, and if necessary, restoring the relationship.

5. Joining the system- the therapist engages the system as well as each spouse. The therapist reflects the sequence and patterns of interactions in a manner respectful to both of them.

TASK TWO – THE ACCESSING OF EMOTION

Emotional experience is focused upon, expanded, reprocessed, and restructured throughout the process of EFT.

e. g. the accessing of loneliness in a critical attacking partner creates a new meaning context for this partner’s hostility. It allows this hostility to be reprocessed as desperation, fostering a new presentation of self to other. It challenges the other’s perception of hi/her partner’s behaviour and fosters new emotional responses.

Focus on emotion important throughout EFT, but particularly steps 3 (ack. feelings underlying interactional positions) & 5(identifying disowned needs).

How emotion is characterized in EFT.

Emotions that EFT focuses on are anger, fear, surprise, hurt/distress, shame, sadness/despair and joy.

Emotion is seen as basically adaptive, providing a response system that is able to rapidly organize a person’s behaviour in the interests of security, survival, or the fulfillment of needs.

A focus on emotion is seen as efficient in that strong, affective responses are able to reorganize responses quickly and create broad changes of perspective. On the other hand, emotion not addressed in therapy can undermine the process.

Emotion can be differentiated into primary, secondary, instrumental and maladaptive responses.

Primary- direct responses to situations

Secondary- reactions to and attempts to cope with primary reactions.

Instrumental- used to manipulate the responses of others. E.g. tears to control

Maladaptive- out of context compelling responses that constrict how present situations are processed. e.g. PTSD symptoms.

Emotional experience is evoked and experienced as vividly as possible that allows for the discovery of new aspects of the partner’s emotional life. However, the indiscriminate ventilation of negative emotion to create catharsis is not a part of EFT. The expression of secondary negative emotions is a part of the couples everyday experience but EFT focuses on the discovery of new or unrecognized emotional experience.

Which emotion to focus on.

The therapist focuses on the most poignant and vivid aspect of experience that arises in the therapy situation. e.g. tear, gesture, image, label etc.

The therapist focuses on the emotion that is salient in terms of attachment needs and fears.

The therapist focuses on the emotion that seems to play a role in organizing negative interactions and accessibility and responsiveness. E. g. the fear behind Marg’s defensiveness.

The process also dictates emotions that need to be worked on.

Early stage of therapy – reflect/validate secondary emotions.

Middle stage- reflect underlying emotions.

These underlying emotions are often implicit but not yet clearly formulated. They have an emerging or “leading-edge” quality to them.

The client’s response also dictates the focus. The EFT therapist stays close to the client’s experience, to where the client is in the here and now.

SKILLS AND INTERVENTIONS: ACCESSING EMOTION

Reflection. Not simply paraphrasing or echoing. Involves an empathic absorption in the client’s experience. It directs the client’s experience to their inner experience and slows down the interpersonal process in the session.

Validation. The EFT therapist conveys to their clients that they are entitled to their experience and emotional responses. The therapist explicitly differentiates one partner’s experience from the other’s intention or character. E.g. Marg’s feeling that T doesn’t love her is differentiated from his feelings. This acceptance acts as an antidote to the self-criticism or anticipated judgement from others. e.g. “You never have a positive thing to say.”

Evocative responding. These responses focus on the tentative, unclear, or emerging aspects of a partner’s experience. These reflections are offered tentatively, for the client to try on. The therapist leads clients to the leading edge of their experience.

Heightening. The therapist chooses to highlight or intensify particular reactions and interactions, often those that play a crucial role in maintaining the negative interactional style. Heightening brings a certain response from the background into the limelight so that it can be used to reorganize experience and interaction. The therapist heightens by repeating a phrase, lowering his/her voice and moving forward, using poignant images and metaphors that crystallize experience, directing partners to enact responses and by maintaining a specific focus to maintain intensity.

Empathic conjecture/interpretation. The therapist infers the client’s current state and experience from non-verbal, interactional, and contextual clues. The goal is to facilitate more intense experiencing, from which new meanings may arise, not to create insight, per se. Inferences are given tentatively. Partners are encouraged to guide and correct the therapist.

Disquisitions. A more elaborate conjecture presented when there is a lot of resistance. A story about another couple or couples woven around the interactional pattern of this particular couple. An indirect and non-threatening way of probing for certain experiences.

Self-disclosure. Not often used in EFT except occasionally to build alliance, intensify validation or help client’s identify elements of their own experience.

TASK THREE – RESTRUCTURING INTERACTIONS

In task three, the therapist does the following:

-Tracks and reflects the patterns and cycles of interaction.

-Reframes problems in terms of context, that is, in terms of cycles.

-Restructures interactions by choreographing new events that modify each partner’s interactional position.

Tracking and reflecting. The therapist tracks and reflects interactional patterns as he tracks and reflects inner experience throughout therapy and the pattern becomes more elaborated as time goes on.

The identification and continuing elaboration of the negative cycle of interaction throughout therapy externalizes the problem in a manner not unlike the narrative approaches to therapy. Antidote to defects in partners beliefs. This formulation allows partners to take some responsibility for the way the relationship has evolved, while framing the destructive cycle, rather than the other partner or their own failings, as the enemy.

Reframing. As a result of tracking the cycle, the therapist is able to reframe each partner’s behaviour in terms of the cycle. the other partner’s behaviour and in the context of intimate attachment. E.g. reframing the critic as wanting closeness or the withdrawer as self-protective in the face of anger.

Restructuring and shaping interactions. The therapist directly choreographs new interactions between couples to create new relationship events that will redefine the relationship.

Examples:

Enacting present positions so they can be directly experienced and expanded. For example, John has held back from commitment for 10 years with periodic breaks. He suggests stopping the sessions for a number of months. The therapist suggests he tell his partner: “Can you tell her: “I’m not going to let you in. I never have. I’ll never let any woman in where she can really hurt me.”

Turning new emotional response into a new response to partner. The EFT therapist helps clients express new experience to their partners in a direct way. Change in EFT comes not from a reprocessing of new experience but from new dialogues that arise as a result of this experience. If the client cannot express his/her feelings to the other then this is focused upon and explored. E.g. “Can you tell her, I fear if I reach for you, you will turn away.”

Heightening new responses. The therapist heightens any response that is outside of the usual negative pattern and has the potential to create a new kind of engagement. Therapist: “What just happened there? That was different. What was that like for you Mike to say what you just said?”

Choreographing change events. As new emotional experience and new aspects of self emege in therapy and attachment issues come to the fore, the therapist is able to facilitate interactions that more and more create the basis of a secure bond.

THERAPEUTIC IMPASSES

Presenting diagnostic pictures and narratives of the couples interactions and positions in a manner that makes the impasse explicit and confronts the couple with the consequences of this impasse for their relatiosnship.

Conducting individual sessions to explore specific blocks in the therapy process.

Case #1

Jan and Matthew are a professional couple in their mid-thirties who have been living together for three years. Both want to start a family but Jan is reluctant to do so before marriage. Matthew stated that he might consider marriage after their first child is born. He felt that his father was at the mercy of his mother in their marriage and he is fearful of marriage. Jan is hurt and feels that she is not important enough to Matt. They keep going in circles with regard to this issue and the fights have become more intense and their positions have become more polarized.

Case # 2

Harold and Maude have been married for 32 years and have three grown children, two of whom are married. Four months ago Maude discovered that Harold had been having an affair with a co-worker. Maude insisted that he leave the home. A month later, Harold ended the affair and began to petition Maude to take him back. Maude agreed on condition that they go for couple counselling. Maude is hurting terribly and her world and sense of safety have been shaken. Harold realizes the impact of his actions but says they were unhappy long before the affair and he is not willing to accept all the blame for the deterioration of their relationship.

EMOTIONALLY FOCUSED COUPLE THERAPY

This chapter describes steps one and two of the EFT treatment process.

The delineation of conflict issues.

The identification of the negative interaction cycle that maintains the couple’s distress and precludes secure bonding.

GENERAL THERAPEUTIC GOALS

The therapist’s general goals in the first session are:

to connect with both partners.

assess the nature of the problem and the relationship, including its suitability for marital therapy in general and EFT in particular.

to assess each partner’s goals and agendas for therapy and to ascertain whether these goals and agendas are feasible and compatible from the point of view of the couple and the therapist.

to create a therapeutic agreement between the couple and the therapist, a consensus as the therapeutic goals and how therapy will be conducted.

Problems with goals and agendas

one partner wants out. Therapist can do a few sessions to clarify.

one partner wants therapist to agree wife is mentally ill. Best intervention is not to engage in therapy.

when there is violence in the relationship.

when one partner is verbally abusive.

PROCESS GOALS

If there are problems such as those just mentioned, they will emerge in the process of the assessment as the therapist follows the process goals outlined below.

To begin to enter into the experience of each partner and sense how each constructs his/her experience of this relationship.

To begin to make hypotheses as to the vulnerabilities and attachment issues underlying each partner’s position in the relationship.

To track and describe the typical recurring sequences of interactions that perpetuate this couple’s distress and to crystallize each partner’s position in that interaction.

To begin to understand how the present relationship evolved and what prompted the couple to seek therapy. To hear the story of their relationship.

To begin to hypothesize as to the blocks to secure attachment and emotional engagement within and between partners and to explore these. Are they both wanting the same kind of relationship? Are they both committed to the relationship?

To sense how this couple responds to interventions and how easy or difficult the process of therapy is going to be. Do they both take some responsibility for the relationship? How open and willing are they to take risks in the session?

THE THERAPY PROCESS

The couple is encouraged to tell their story of marital distress, their strengths, etc., but the EFT therapist also focuses the session on attachment issues, emotional experience, and interactional sequences.

Where to focus:

In a typical session of couple therapy the landscape is crowded with facts, feelings, incidents, and interactions. In first sessions, partners usually describe key pivotal relationship incidents and interactions that define how the relationship is for each of them and contain implications about how the self is defined in relationship to other. They also enact powerful interactional sequences that capture the essential quality of the relationship. These moments are like personal and interactional landmarks in the landscape of the marriage and help to clarify the therapist’s emerging picture of the couple’s predicament.

Personal landmarks/Incidents (Ask for examples)

Such incidents often have attachment significance not understood by the partner.

e. g. A husband relates his anger toward his wife for her seeming insensitivity to a child they are fostering. He was adopted and identifies strongly with the child.

e.g.- A wife remembers how her husband was preoccupied with his work during the birth of their first child.

These incidents can be seen in attachment terms as abandonment and betrayal.

Interactional landmarks

In the first sessions, interactions occur that vividly demonstrate the position of the partners and their negative cycle. These are noted and may be reflected back to the couple. They can also be expanded and elaborated as part of the assessment process.

e.g.- A wife describes how embarrassed she feels when her husband criticizes her in front of her family and in the session he points out how deficient her communication skills are.

e.g.- A husband complains that he is always forced to accommodate to his wife and proceeds to accommodate and withdraw in the session.

Interactions also occur that demonstrate the quality of contact and support in the relationship. One partner will become vulnerable for example and the therapist will note the other’s response or lack of response.

INDIVIDUAL SESSIONS

As part of the assessment process, the EFT therapist often conducts an individual session with each of the partners, usually after the first or second conjoint session. The purpose of these individual sessions is to:

To foster the therapeutic alliance with each partner.

2 To observe and interact with each partner in a different context, one in which the spouse is absent.

To obtain information and check hypotheses that are difficult to explore in front of the spouse. E. g. commitment level, extra-marital affairs, previous personal traumas that affect the relationship. The therapist can also explore how each partner views the spouse.

To allow the therapist to refine his/her impression of the underlying feelings and attachment insecurities that influence each partners interactional position and to begin to articulate these insecurities with individual partners.

Revelation of an affair seen as something to explore in relationship to therapy objectives.

All the nine steps in EFT will be presented in terms of the therapeutic processes and interventions that usually occur. As the first two steps include treatment as well as assessment, they will be presented using the same treatment frame.

This format includes:

The markers (points of intervention) and tasks in the therapy process.

Therapeutic interventions.

Couple change processes and how these processes are understood in EFT as well as the end state of such processes.

THERAPEUTIC PROCESSES

Therapeutic Markers

Markers in EFT are prototypical reactions, both emotional responses to the partner and interactional events that define the relationship experience and structure of the couple’s marriage. They are signals to the therapist to pay attention and intervene. The kinds of markers that occur in the first sessions are usually both intrapsychic and interpersonal.

Intrapsychic Markers

As one partner tells his/her story of the relationship and problems in the relationship, strong emotional responses interrupt the narrative. Often non-verbal signs such as tearing, crying, lowering head etc. that interrupts the flow of the narrative. The task here is to focus on and acknowledge the affect, thereby creating a secure base in the therapy for such experiencing.

As one partner tells his/her story, the lack of emotion is very marked. Dramatic events are told from a detached stance. The therapist notes this incongruity. The task here is to explore the lack of engagement in personal experience and what this signifies concerning the couple's engagement in, and definition of the relationship.

During moments of intense affect, partners articulate beliefs concerning themselves, the other partner or their relationship that appear rigidly organized and/or destructive in the present context. These beliefs are often stated as definitions of identity. The task here is to reflect and elucidate such beliefs and begin to frame them as part of the destructive cycle that controls the couple’s relationship.

Interpersonal Markers

In the first sessions, the therapist particularly notes position markers, that is comments or responses that appear to define power/control and closeness/distance in the relationship.

The therapist also notes negative cycle markers. By far the most common pattern in distressed couples is some form of pursue/criticize- withdraw/avoid. However, withdraw/ withdraw cycles where both partners are relatively disengaged and volatile attack-attack cycles are also seen. Withdraw-withdraw cycles have usually developed from the pursue-withdraw pattern after the pursuer has begun to withdraw. The therapist begins to track and clarify the cycle in a way that is meaningful to the couple.

The therapist attends to if and how the couple make positive contact, and how that contact is blocked. This illustrates how the attachment insecurities of each partner are played out in the interaction. Who reaches, who exits. If one partner reaches and the other responds positively, the therapist acknowledges it as a strength of the relationship.

INTERVENTIONS

Reflection and validation are very important in the early sessions for alliance building.

Evocative reflections and questions are also helpful in the accessing of each person’s experience of the relationship.

Heightening and empathic conjecture are used much less in beginning sessions.

Tracking and reflecting interactions are important early interventions.

Reframing. The central tasks at the beginning of therapy are to engage the couple and to begin to grasp the intrapsychic and interactional struggles that structure the relationship. However, from the beginning of therapy to the extent that the couple is amenable, the therapist begins to reframe their struggle.

COUPLE PROCESS AND END STATE

The desired outcome of the first sessions in EFT is that both partners feel understood and acknowledged by the therapist. The summary at the end of the first sessions always includes a description of the struggles that they have already been engaged in and won.

If the result of the first sessions is that the therapist does not recommend EFT, then the couple is given a diagnostic picture, which usually includes a description of their interactional cycle and a summary about how each seems to experience this relationship as well as reasons why EFT is not being offered. Other forms of help are discussed and referral sources offered.

EMOTIONALLY FOCUSED COUPLE THERAPY

This chapter describes steps three and four of the EFT treatment process.

Accessing the unacknowledged feelings underlying interactional positions.
Reframing the problem in terms of these interactional positions.

Essentially the task is to access the music in the couple’s dance, that is the primary emotions that are usually excluded from individual awareness.

Movement from step to step

The steps do not occur in a linear fashion; rather each step tends to be integrated into the next step or steps. In addition, partners progress through the steps at different rates. Usually one partner will take the lead and begin in step three to move ahead of the other. This is often the less engaged and more withdrawn partner.

Accessing emotion in step three

Accessing emotion in step three does not include blaming ventilating, labeling etc. It involves the following:

An active engagement in and focus on emotional experience in the hear and now

An expansion of that experience so that experience can be differentiated

A reprocessing of experience that involves a process of discovery and creation, so that new aspects of experience are encountered

A symbolizing of that experience in terms that are relevant for the way this partner responds to his/her spouse.

MARKERS

In step three, the therapist intervenes in the following instances:

When one partner expresses the reactive secondary emotions that make up a large part of the distressed couple’s interactions.

Usually anger or frustration that is expressed as blaming or justifying the self. Validate secondary emotions then try to elicit the emotions that are disowned, discounted, or avoided.

When one partner exhibits nonverbal behaviour in response to the other partner that is noteworthy due to its incongruity, intensity, or effect on the interaction. E.g. as a wife complains and weeps, a husband taps his foot and frowns with apparent impatience. His wife looks at him and lapses into silence.

When a partner begins to explore new emotional experiences in the relationship but then retreats to the negative interactional process. The therapist redirects back to the exploration.

When the couple exhibit the interactional style identified in step 2. The task now is to focus on one person’s position in the interaction and how the person experiences the other partner and his or her own compelling emotions in the interaction.

For the EFT therapist, certain relationship positions can be predictably related with particular underlying emotions, even though how these emotions are symbolized will vary with each client. This predictability is enhanced by attachment theory.

Spouses who take an angry, pursuing, critical stance in the relationship often access panic and insecurity when the therapist directs them to explore their underlying emotions. Attachment fears of abandonment or rejection will surface. On the other hand, the partner in the more withdrawn position is more likely to access a sense of intimidation and incompetence related to being unable to please his or her partner as well as a paralyzing sense of helplessness. This arises from not knowing how to respond to the partner in a way that will elicit positive attachment responses or at least curtail the negative cycle.

INTERVENTIONS

The HOW of interventions is extremely important at this stage of therapy. The nonverbal behaviours of the therapist are an essential part of accessing underlying emotions.

The following behaviours help access underlying emotions:

An open stance toward the partner, often leaning forward

A slower speaking pace than is usual, with longer pauses

A lower, softer voice than is usual

Relatively simple, concrete words, often images, often using the clients own words

In effect, the therapist models an intense focus on a particular aspect of a client’s experience and invites the partner to follow and to emotionally connect with the experience in a new way.

Reflection Used as more of a prelude to validation and evocative reflection than a main intervention.

Validation An extremely important intervention because the primary blocks to engagement with one’s own emotional state is automatic, self-critical cognitions about the unacceptable, inappropriate, and even dangerous nature of particular emotions. Expectations that certain emotions will be unacceptable to others also block such engagement.

e.g. I hear that you question John about his whereabouts, not because you want to monitor his activities but because you are worried that he’d rather be doing other things than be with you.

Evocative Reflections and Questions This intervention invites the client to stay with particular experience and then to process it further. As this occurs, new elements then emerge, which reorganize the experience.

e.g. What is it like for you Mary, to want to be close to John but to always be fearful of saying the wrong thing?

Heightening The therapist intensifies, crystallizes, and encourages the couple to enact key problematic as well as new, reprocessed emotional responses, that organize interactional positions. Maintaining a consistent and persistent focus is also a way of heightening responses or interpersonal interactions.

e.g. You’ve said lots of positive things about your life with Mary, John but I also heard you say that in spite of these things, you have felt that there is a gaping hole at the center of the relationship.

Empathic conjecture In this intervention the therapist encourages one of the partners to process his/her experience one step further by expanding on the present experience, using inferences drawn from the therapist’s experience of this person or his/her relational context, and incorporating the therapist’s perspective on marital distress and intimate attachments. The more in contact the therapist is to the client’s experience, the more poignant and relevant these inferences will be. Inferences that are too far away from the client’s experience will not be adopted and if offered continually will damage the alliance.

Ideally, these inferences are offered in a tentative manner that encourages the client to correct them and are only one short step ahead of the client’s experience. These inferences should be made in a simple, concrete, and evocative way.

e.g. When you told Mary, “it’s so hard to ask you to sit beside me on the sofa,” you held your head down and could not look her in the eye. I wonder if there is shame for you in asking for closeness?

Tracking and Reflecting Patterns and Cycles on Interaction In both steps three and four, the therapist places each partner’s emotional responses, as they are accessed, in the context of the other partner’s behaviour and the couple’s cycle. This tends to validate each person’s responses and begins to create a more process oriented view of the problem.

e.g. So when Mary asks so many questions, you get angry and withdraw, and when John seems distant, you ask a lot of questions in the hope of bringing him closer. Is that how it works?

Reframing the Problem in Terms of Contexts and Cycles This is a general intervention throughout therapy and a specific intervention in step 4. The therapist specifically summarizes the process of steps 2 and 3 and explicitly formulates the problem as the positions the couple take in the pattern of interactions, the negative cycle that has taken over their relationship, and the compelling emotions that organize each person’s responses.

e.g. So this pattern of criticism and withdrawl has taken over your relationship. It gets in the way of all the closeness you used to have and keeps everyone’s emotions churning, so both of you are sensitive and raw. Is that it?

COUPLE PROCESS AND END STATE

Step 3 is particularly anxiety provoking because they have often hidden their vulnerabilities not only from their partners but from themselves as well.

They face at least four fears:

The dragon of self-criticism: I hate this part of me.

The dragon of revealing parts of self they are uncomfortable with or unsure of: “I never felt this way before, maybe I’m going crazy.”

The dragon of facing the anticipated negative reaction of the spouse: “She’ll think I’m pathetic.”

The dragon of unpredictable change in a distressed but predictable relationship: I’ve never heard you talk like that. I feel like I don’t know you.”

The other side of this is they feel tremendous relief in being able to understand and process their own emotions and relationship patterns.

The secure base the therapist provides is extremely important in this process. To maintain a secure base the therapist has to quickly change focus from exploring one partner’s feelings to exploring the impact on the other.

e.g. When an observing spouse expresses criticism about what they hear their partner saying, the therapist can validate that this seems strange for them to hear as it is so different from the way they have experienced their partner all these years.

It is in step three that each partner’s attachment issues begin to be clarified. In step four, these issues and the interaction patterns that block emotional engagement are framed as the problem. This is also a time when attachment betrayals are explored and clarified.

By the end of step 4, the couple has formulated a coherent and meaningful picture of the patterns that define their relationship as well as how they create them. The withdrawn partner is talking about his paralysis in the face of his wife’s criticism, rather than just going numb and silent. His wife is still angry, but not as actively hostile as before and is beginning to talk of her hurt. By the end of step 4, the partners are engaged in a new kind of dialog about emotion and are beginning to be more emotionally engaged with each other during therapy sessions.

EMOTIONALLY FOCUSED COUPLE THERAPY

Steps 5&6

This chapter describes steps five and six of the EFT treatment process: Facing the dragon.

Promoting identification of disowned needs and aspects of self

Integrating these into the relationship and promoting acceptance of the partner’s experience and new ways of interacting.

Johnson sees step 5 as a watershed in the therapy process. The first 4 steps lead up to step 5 and the next 4 build on the processes in step 5 to restructure the partners’ interaction.

In step five, previously avoided or unformulated experience is encountered, claimed and expressed to the partner. The most dramatic emotions that arise in step 5 are connected to each partner’s sense of self, particularly the loveableness and worthiness of self.

In the description of step 5, disowned needs are referred to rather than simply disowned emotions. The implication here is that accessing the emotions underlying interactional positions also accesses the attachment needs that are connected to the emotions. It is in step 5 that attachment longings and desires begin to be clearly articulated.

Step 6 is concerned with helping the partner deal in a constructive way with this new behaviour. Specifically, the therapist contains any effects of the initial discounting of the partner’s new response by the distressed other, supporting the other in his/her confusion at encountering this “new” spouse.

MARKERS

In step five:

-The emotional responses accessed by a partner in step 3 are experienced or referred to by a client in the session. These emotions are now more easily identified and related to the interactional cycle. E.g. a withdrawer says: “I just give up. I’ll never make it with her, I feel small and scared. So then I back off and go away.” The therapist’s job is to validate the emotion and action it evokes, which is to withdraw and protect self, and to help the partner further differentiate this experience and to own it.

-A partner begins to explore his/her underlying feelings but is interrupted by the partner or exits from the process into abstract cognition or descriptive comments. The task for the therapist is to redirect the process.

In step six:

-A partner reaches a sense of closure of his underlying emotion with the therapist and is able to clearly relate this experience to habitual responses to the other partner. The therapist requests that the partner share this new synthesis with the other partner. The therapist’s task in step 6 is to support the other partner to hear, process, and respond to this sharing.

There is no reason the observing spouse should be open to this new way a partner presents him or herself after years of disappointment and negative experience. If the therapist is not present, this lack of responsiveness to such sharing becomes a potentially aversive experience for the partner who is opening up.

This step often begins with the therapist asking the observing partner, “So what is it like for you when your partner talks like this?”

INTERVENTIONS

Reflection and validation constant part of EFT but other interventions more important in steps 5 & 6.

Evocative Responding, Heightening, Empathic Conjecture used a lot. Added in this phase are Disquisition and Restructuring Interactions.

Disquisition: Used in step 6 to try to help a blocked client risk more. You might tell them that some people who have been very hurt in relationships have a hard time taking risks. Some people have a hard time believing their partner’s when they are speaking differently than they usually do.

Restructuring Interactions: The therapist choreographs enactments of present positions that are now more explicitly, consciously, and actively taken.

In step 5, the therapist helps shape new interactions based on the new emotional experience.

e.g. Can you tell him that you are so afraid that you can’t let yourself hope for his love so you act prickly and wait for evidence of his betrayal.

In step 6, the therapist monitors the responses of the other partner to this new experience and if necessary, choreographs less constricting and/or more accepting responses.

e.g. Can you tell her Bill, “I’m too angry to hear you right now. I’m not going to acknowledge the risks you’re taking.”

COUPLE PROCESS AND END STATE

This process is characterized by:

An intensification and heightening of the emotional experience accessed in Step 3.
An owning of that experience as belonging to the self (not created by the other). E.g. “I’m behind a wall. No wonder you can’t find me.”
The accessing of core self-concepts associated with the emotions that arise. “I’m not good at this love stuff so when she yells at me that I’ve disappointed her, I can’t stand it so I start yelling.”

All of the above allow for a reprocessing of primary emotions related to the sense of self in relation to the other; in this process, the experience of the connection with the other develops and changes. Specifially, key wishes and longings in the emotion begin to emerge and be articulated. They can then be worked on in step 7.

From an attachment point of view, attachment behaviours begin to change at this point in therapy as the emotions that organized them are reprocessed. For example, a previously withdrawn spouse becomes more accessible.

In terms of change events, step 5 is crucial. It forms the basis of withdrawer re-engagement for one partner and softening for the other. As one partner becomes engaged in and intense exploration of his or her emotional experience, the other partner begins to perceive him/her in a less rigidly organized way.

He/she sees the partner as different e.g. an emotionally withdrawn partner who cries.

He/she becomes engaged with the partner in a new kind of dialogue.

He/she hears the partner take ownership of his/her part in the development of the negative interactional cycle.

When the second partner reaches step 5, it sets the stage for new bonding events, which usually occur when the second spouse engages in step 7.

The evolution of the increased responsiveness of the withdrawn partner and the increased openness of the usually critical partner are intertwined and reciprocally determining. Most often the withdrawn partner leads the process.

Testing not unusual: “Has my partner really changed?” If really stuck, individual sessions might help.

EMOTIONALLY FOCUSED COUPLE THERAPY

Step 7

Step 7: Facilitating the expression of needs and wants and creating emotional engagement.

The completion of step 7 for the less engaged partner results in the change event, Withdrawer Re-engagement.

The completion of step 7 for the more critical partner is a Softening Event in which this partner is able to ask for contact and comfort from a position of personal vulnerability.

As the second partner reaches step 7, powerful new bonding events occur. These events heighten the emotional engagement between the couple and construct a new positive cycle. This cycle becomes as self-reinforcing as the original negative cycle and fosters a secure attachment between partners.

The partner in step 7 speaks from a position of increased efficacy. It evolves from “I feel small and inept with you and live in fear of you seeing this, so I go numb and placate”, to “I want to feel special to you. I want you to hold off the criticism and quit threatening to leave.” This partner is able to stay connected to his emotional experience and state what he needs in order to feel safe and connected.

When the partner attains this new way of communicating as well, they move into problem solving (step 8) and the consolidation of new positions (step 9).

The process of step 7 is essentially one in which the new emotional experience of step 5, which has been integrated into the relationship in step 6, is now used to restructure the relationship.

MARKERS

A partner reiterates of further expands the emotional experience encountered in step 5 but does not symbolize the needs and wants implicit in the experience. Therapist helps partner formulate and express these needs and wants.

A partner spontaneously begins to express these needs and wants but does not express these to his/her partner or exits from this expression of sharing. The therapist task is to redirect partner to express needs to partner or bring back partner to previous focus.

The other partner responds either positively or negatively to this new communication. In either case, the therapist invites the experiencing spouse to continue to respond in an emotionally engaged manner and to state his/her own preferences and needs. The therapist may also need to validate the difficulties the other observing spouse is having in responding to the changes in his/her partner and in the interaction. If the other partner responds positively, the therapist acknowledges, heightens and fosters this response.

INTERVENTIONS

As clients enter step 7, they begin to take more initiative and the therapist can become less active.

The main task is to restructure interactions by heightening and tracking interactions, reframing interactions, and especially fostering the creation of new interactions based on new emotional experience.

More intrapsychic interventions such as evocative responding and empathic conjecture are used when blocks appear.

Evocative Responding:

The therapist focuses upon the client’s emerging experience to help clarify wishes and longings, or to clarify difficulties expressing these to their partner.

Tim: I close down but it’s not what I want to do.

Therapist: What you want is….?

Empathic Conjecture:

It is sometimes necessary to help clients symbolize their longings.

Marion: This relationship has been so hard. I think I’ve buried any hope very deep.

Therapist: Help me understand. It’s almost like, “I won’t long again. I won’t dream and be disappointed.”

Tracking and Reflecting the Cycle

At this point in therapy, tracking and reflecting the cycle usually involves reflecting changes to the negative cycle and the beginnings of a new more positive cycle.

Johnson suggests paying attention to miniseqences. For example, a wife expresses her longings ambiquously (to play it safe) and the husband responds minimally (to play it safe).

Reframing

The difficulties the partners experience in stating their needs are placed in the frame of their experience in the negative cycle and the expectations and vulnerabilities that arise as a result of that cycle.

Therapist: I understand that for you it’s like a death-defying risk to ask Steve this, after such a long time of feeling unimportant to him.

Restructuring Interactions:

The most common intervention at this point in therapy and sometimes the only intervention necessary is the choreographing of a request and the heightening of a response.

Therapist:

So can you ask her please, “I want you to start to take your walls down. I want to be close.”

The therapist then heightens this event and the possibility it holds for a secure bond between the couple.

CHANGE EVENTS

Couple process and end state is discussed in this chapter in terms of change events.

Withdrawer engagement: The completion of step 7 for a withdrawn partner is synonymous with the change event: withdrawer engagement.

Softening: The completion of step 7 for a critical partner is synonymous with the change event called a softening.

After they have completed step 7, both partners are more accessible and able to communicate about attachment issues.

Withdrawer engagement

The shift begins in step 5 with the owning of emotions underlying the interactional position, This sequence has been simplified to show how the process evolves.

e.g.

A usually withdrawn spouse fully experiences his real fear of

contact, “She’ll finally see how pathetic and inadequate I am.”

He then processes this fear with the therapist, who directs him to share it with his partner.
He then accesses a more specific hurt that he is able to express directly to his spouse as in, “I am not and can never be your exciting first lover.”
His spouse responds with disbelief and cold detachment but when validated by the therapist, she begins to struggle with her partner’s message.
Supported by the therapist, the husband stays engaged with his emotional experience and begins to feel entitled to his emotions. He begins to verbalize where he is and what he wants.
The therapist supports the partner to hear this and helps her deal with her anxiety.
The therapist encourages the husband to tell his wife his needs and wants. This includes what he can and cannot, will and will not do in the relationship.

Softening

The shift begins in step 5 and is often stimulated by the movement of the other to a more accessible position as in the re-engagement event.

Partners (often female) now begin to focus more on the self and in particular on powerful attachment fears or experiences. Often expressed are comments such as “I promised myself never to count on anyone again.”

The therapist helps her to share her experience with her spouse and helps him respond in a caring manner. Her needs and longings come to the fore and the therapist helps her formulate them and share them with her partner.

As this partner addresses her attachment needs with her partner from a softer, more vulnerable stance, the contact between them is intense and authentic.

Transcript of a softening event – Johnson and Greenberg,1995

EMOTIONALLY FOCUSED COUPLE THERAPY

Steps 8&9

This chapter describes the termination phase of EFT:

Step 8 Facilitating the emergence of new solutions to old issues and problems.

Step 9 Consolidating the new positions the partners take with each other.

The relationship now becomes a secure base from which to explore the world and a safe haven that provides shelter and protection.

Step 8 New solutions

Couples solve pragmatic issues far more easily when their emotional struggles have been removed from the equation.

Research on EFT found that adding a communication/problem-solving component did not improve EFT effectiveness.

Another study showed that couples improved their problem solving after EFT despite the fact that it did not include teaching in this area.

In EFT, the therapist models new ways to speak and reach each partner.

Also the process of therapy shows what partners can do and who they can be when they feel safe and validated.

MARKERS

In step 8 the therapist intervenes when:

In the latter part of the process of re-engagement, a partner begins to focus on pragmatic issues in the relationship. e.g. a husband says that he will run his business without his wife’s interference but he will deposit a sum of money in her account each month.

When both members of the couple have completed step 7, they begin to deal with some of the concrete issues that have been facing them.

The therapist’s task is to facilitate discussion and exploration while allowing the couple to find their own solutions.

Step 9

The therapist’s task here is to support healthy, constructive patterns of interaction. The therapist also helps the couple to construct a coherent and satisfying narrative that captures their experience of the therapy process and their new understanding of the relationship.

Termination issues are also addressed in this phase of therapy. The goal is for the couple to leave therapy non-distressed and able to maintain an emotional engagement that will allow them to strengthen the bond between them.

MARKERS

The therapist intervenes when:

the couple enact positive cycles in the session or report on positive cycles outside the session.

the couple suggests that they no longer need the therapy sessions and/or worry about not having the safety net of the therapy sessions.

Therapist’s task is to heighten the changes the couple has made. The therapist stresses that these changes belong to the couple and discourages any attribution to his knowledge or skill.

The possibility of booster sessions in the future is mentioned but is framed as probably being unnecessary.

INTERVENTIONS, Steps 8 & 9

Throughout the final sessions, the therapist comments on the process from the metaperspective of attachment.

Reflection and validation of new patterns and responses

Therapist: I noticed Mike that you were able to identify your impulse to run and hide but you kept on sharing and reaching for Mary.

Evocative responding

Therapist: Things seemed to be going well there Jim, then something happened to change the dance. Did you notice?

Reframing

Therapist: So now when Martha expresses her fear that you will leave rather than yells, you can hold her and stay connected.

Restructuring Interactions

This involves noting restructuring that has already occurred:

Therapist: When you discussed the incident with your relatives, it struck me how differently you manage difficult situations now.

Or encourages the couple to summarize their own changes:

Therapist: How are you different Susan. What has changed for you?

COUPLE PROCESS AND END STATE

What do the couple look like at the end of therapy?

It is difficult or impossible to identify rigid positions.

- Both can get angry and critical

But both take risks in the relationship
And both are able to reveal their own vulnerabilities and respond to their partners in a caring way.

Positive interactions are more apparent. The quality of contact has shifted toward safety, closeness and trust. Change in tone, more compassion.

Marital therapy does not always end in the creation of more positive relationships. Sometimes clarifying the interaction results in separation or a decision to live more parallel lives.

In Summary, the following changes usually noticeable:

Emotional

- Decrease in negative affect and an increase in positive affect.

The partners are more engaged in their own emotional experience and can express these emotions in a way that their partner can respond to them.

Behavioural

Partners can now ask for what they need in a way that helps their partner respond. Neg cycles have largely become positive.

Cognitive

The partners perceive each other differently. They have a different metaframework for relationships in general since they have experienced the relationship through the therapist’s attachment perspective.

Interpersonal

Negative cycles are contained and new positive cycles are enacted.

EFT

Attachment Injuries

THE RESOLUTION OF ATTACHMENT INJURIES

1. A marker denotes the beginning of the event. The therapist encourages the injured spouse to risk connecting with his/her now accessible partner. Partner often discounts, denies or minimizes the incident.

2. Therapist encourages injured partner to stay in touch with the injury and begins to articulate its impact and attachment significance. Anger often evolves into clear expressions of hurt, fear, and shame.

3. The partner, aided by the therapist, begins to unders

tand the significance of the event in attachment terms and as a function of his/her importance to her partner rather than as a reflection of their inadequacy or insensitivity.

4. The injured partner tentatively moves to a more integrated and complete articulation of the injury and expresses the grief involved in it and fear concerning the loss of the attachment bond.

5. The other spouse becomes more emotionally engaged and acknowledges responsibility for his/her part and expresses remorse.

6. The injured spouse then risks asking for the comfort that was previously unavailable.

7. The other spouse responds in a caring manner that acts as an antidote to the traumatic event. The partners construct a new narrative of the event that includes why the partner acted in such a distressing manner.

8. Once the attachment injury is resolved, the therapist can more effectively foster the growth of trust and the beginning of positive cycles of bonding and connection.

Bowlby –born 1907-1990, lived in London. Father was a surgeon. Parents were in 40s when Bowlby was born, had older and younger than older brother, Toni, who was the mother’s favorite. 13 months y – Bowlby lived when Freudian ideas dominated the psychotherapy world – Bowlby shifts away from drives theory. Growing up was in a boarding school, which may have been the source of separation part of the attachment

-internal working model – the internal compass as to how the individual will or will not be helped when needed. This has components of a view of self and view of other and the interaction

Attachment system and therapies are based on emotions. Emotions are immediate appraisal of the situation. Emotions are brief rapid global and compelling. They have action potentials. Speed rather than accuracy is emphasized and it occurs in the limbic system within the brain. Physiological reaction happens with the emotion, and is survival based. A cognitive reappraisal of the situation [neo-cortex] adds meaning to the situation. Unpacking the emotions lets people understand where the person is coming from.

When couples come in for couple counseling, looking of how safe they each feel is important. What are the components of adult’s relational safety? i.e.

Parent-child attachment is unidirectional. The couple attachment is bi-directional.

Depression/anxiety plays into the attachment/EFT cycle, and could also be influenced by the cycle.

Attachment emotions moves the person – perhaps into pursuit or withdrawal. Anger usually moves into fight mode. Shame/fear moves one into withdrawal.

“what’s going on in there” talks about sensory development and relationships from ages 0-5 years old.

Shore: Common factor of therapeutic success if the therapist; i.e. know the mode/able to relate

Article: Minds in the making: attachment, the self-organizing brain and the developmentally-oriented psychoanalytic psychotherapy.

-neurological + biological + psychological intersections at work in the unconscious, as well as in attachment system

-affect synchronicity: parent’s rhythm/temperament attunement to the child – reciprocal facial signaling – mother regulates the child’s arousal/emotion. This is also referred to as mirroring. The good enough mother will repair ruptures in this relationship. There are cortical and subcortical elements to this. Winnicott mentioned “there is no baby without a mother” – babies develop in relationship!

Kohut: basis of development of self, who will not collapse in face of normal adversity. Often, parents are in a context, where they are unable to give the mirroring to the child.

The working models of relationship is right-hemisphere. Limbic system is also involved in ego functioning.

Right brain-to-right brain communication through the limbic systems. Transmission and recipients of info! Transference and counter-transference. Fleeting flashing eye movements are of essence to such communication. That + pheromes are important and therefore face-to-face counseling may be key!

-therapy has 2 levels: the words and the understanding the dys-regulation –client must have a vivid emotional experience of the therapist. Freud: you cannot think through a session – you will miss the client.

As a therapeutic approach, you do not break defenses, but build strengths until the defenses are not needed.

Countertransference helps regulate/modulate ourselves of the affects brought to us from the client/clinical situation.

Tasman-f – 32, salesman trainer, business growth person – does not like her job. Finds it hard to take a uniaxial stance when selling – mba, met in uni of Toronto

T likes how m is bright and not arrogant, well read, could relate to Kenya finds him ‘nice’, honest, seductivness. She shows him warms, looks up to him.

Why came to counseling: find that relation is in dead end – do not understand each other.

-M does not want to get married: is ambivalent about it –wants and does not want

-t does not want children but wants this resolved with m – i.e. not sitting on the sidelines, as this causes stress with t’s family of origin. Wants to resolve this in order not to be stressed.

M proposed last year – t said yes, but said no a day later: t is surprised in her own reaction because she expected it to be easier to say yes. T felt that proposal was to please her, like pulling a gun to her head, being forced, and is therefore asking for failure: felt that this is a decision out of pressure and not out of thinking about it. T getting calls from parents, pressuring them to either marry or separate. She felt aggravated about marriage.

Other issues were dealt with and now the aforementioned was brought to the fore.

Mom of m seemed depressed.Tensions between m’s parents separated at age 17. Dad had a lot of mistresses [friends saw dad kissing another woman]. M tries to put this out of his mind, does not get being together for life. Mom took family to Kramer vs. Kramer b/f divorce, divorce took 10 years [legal battle]. Mission in life is to protect mom – took mom’s side. Mom furious at dad. M forced mom to leave near dad so he can be in touch with both. Mom – if you love me, you do not love him. Staying in touch with dad, as he wanted to live with dad. Dad is a surgeon of vascular disease in qc. Father did not badmouth mom. Now, relationship w/ dad is good – respectful of people’s choices. Mother played the victim role in the courts, client realized this at age 21.

Dad was perceived to be hard to get along with because he wanted to be accepted. Brother less enthusiastic than m about the client. Younger brother wished he would “give them” more…

Mom –supportive, dad: pushing forward – yet probably easier to love someone who is only supportive. Dad ended up living with, but not marrying a woman he had an affair with. Marriage is only a legal contract, which could be broken.

T – parents were normal – but fought a lot. Seen as typical to where she comes from – upermiddle class asian in Kenya, as women does not have her own life. T’s mom was a teacher, and the most a woman can do at that context, but could not survive by herself – tried to leave 3 times. 5-10 years, t and mom got closer. Mom shared more of mom’s past- t feels that there was no romance. Marriage would alleviate pressure, but not change anything, i.e. her title or identity, or difference in lifestyle. Mother-in-law = aunt אmom and dad = 1^st cousins. Tried to support mom in working when t was 2-3 years old, as dad’s family did not let her work. T + mom moved out to grandmother’s home, and soon after, hey moved, and then the grandmother died אage 7. Made everyone closer. T was sad at this period. T saw the grandmother’s home as fun. Then t moved into a nicer neighborhood.

One of the reasons why t does not want children is because she doesn’t think that she could: she does not want to sit at home and watch them, nor have a nanny. When mom was there, giving up her career. Can’t be like grandmother, doesn’t want to be like mom

M= hard to remove core of unhappiness in t – it worries m/makes him sad. he “is at the happiest when she is happy” – feels that he cannot do something about it

-later: finds out that t was victim of incest by grandfather. Underlying the not wanting have kids.

Discussion of the couples’ problem and goals essential in the process of engaging the client couple

“Gathering, synthesizing and evaluating pertinent information to design an appropriate and effective intervention strategy.”

Process of gathering, analysing and synthesising salient data into a formulation encompassing the following dimensions

Eg. Wife who remembered her father having left the family for a year to return to North Africa to work. Corrected by husband who was her brother’s best friend

e.g. probably necessary if the couple has been referred to you by the courts or Youth Protection

Note: Again - you will develop a relationship with a client if you connect with him/her EMOTIONALLY

Description of the problem and/or needs from the perspective of each mate, in their own words

A measure of the frequency of the problem and its duration from perspective of each mate. May use the following scale:

Any current factors that contribute to the perpetuation of problem; cultural, environmental, life cycle, discrimination or systemic variables related to the problem

The motivation to solve the problem(s) according to each member of the couple. Includes reason for consultation now.

A description of the quality of the couples current relationships with families of origin, extended family, neighbours and friends including those with the therapist

Includes any significant others in the extended family or community who are the source of affective or instrumental support for the couple.

Concrete resources, formal and informal, needed to resolve couple problem(s) and obstacles to their access.

Includes initial attraction from the perspective of each mate, courtship and marriage, sexual history, history of violence/abuse, history of addictions (alcoholism/substance abuse/gambling), attachment injuries.

Includes a description of each mate’s childhood and adolescence, family of origin (parents, siblings and significant others), family attachment styles and issues, any significant psychiatric and medical history, any significant or traumatic events in the life of each mate.

Tasman is a 32 year old female, trained as a sales trainer. She is of Indian-African background. She is single, in a relationship with Martin. Martin is 32 years old and is working in the financial services, selling mutual bonds. He is of French-Canadian background. They have been dating for 6 years and living together for 4 years.

The couple was referred for couples-counselling by the family doctor, due to couple tension.

-sometimes, problem definition is the only thing needed for couple to solve the rest of the problem.

Freud concepts of psychosocial and topographic models. The idea is that the sexual is a more generic bodily gratification thing. Freud was the first to point out that things can be sexual, and not everything is conscious.

New developments in neuroscience show Bowlby and Freud are important, and that development is relational. Development happens in stages and influence subsequent development Freud did retroactive research but not observation of early life. Right brain dominates early life.

Energies of the id impulses can get displaced” if needed” – they have one aim = GET DISCHARGED

-id can be sublimated with the growth to the ego. Id could be accessed through dreams

The brain’s capacity to regulate arousal and modulate instinct behavior, and connects with other brain structures through the orbital pre-frontal cortex. Limbic system – motivation/emotions, which matures at 18 months. Defense mechanism are coping mechanisms and are in right hemisphere, as shown with the MRIs

-identification[with others] helps with the demands of the id as it introduces introjects

anxiety is the driving force behind ego-development, as it pushes the ego to adapt.

-anecdotal evidence -early trauma makes a person more prone to PTSD in subsequent traumas

-when the ego opposes the emergence of impulses, it does it as it fears that it will lead it to danger ->therefore anxiety [and underlying fear] come up as a signal of danger. The pleasure principle gets into play here as this avoids “unpleasure” אsometimes, the signals are mismatches with reality as the ego’s rules of thumb around dangers worked in the past but not in current situation.

-objects – living things external to the individual but psychologically important to the person

-infant development: first relationship is tactile, auditory, smell. Later also visual.

Only at age 3 is there an integration between good and bad object – the neonate does not understand the “bad mother’ – i.e. the one who says no. borderlines have a hard time integrating them.

-identification with important objects is important in early object relations. We still identify with highly cathected objects, as an adult. Kids whose one parent is away for long idealize the gone parents… some disappointment may occur once the parents returns. Soon after, the peers begin to be cathected.

Some look for repeated relationships due to lack of object constancy… this means that the person’s self and identity always shifted the “as if” character always changes, and the mask always changes. This poverty of ego comes from lack of reciprocity and validation, and constant object changes, in early life

Various Object Relations look at different elements that are “missing” from the person’s internal life. Therapist will look at re-enactments of the client, and may challenge parts of it.

Cycle: I am spiteful because of her authoritarian, while the other thinks that I am authoritarian because he is spiteful.

-choice of partner amplifies or mitigates childhood patters.. if the anal phase is intense, then relationship becomes about power.

-competitive couples; dominating [fear of being rules/identification with the ruler]. Active ruler: disowned dependency needs and is very critical of the dependency which he disowned. Demands absolute obedience to mask insecurity of abandonment. Religious movements or other means are sometimes used to legitimize control. “religion” helps the ruler be “right”. Control is seen as security… but you can never be sure you have full security. The passive aggressive – regressive – does not have to think for herself. Affairs are great ways to undermine the dominating partner.

Master-slave: one wants independence and one gives in to demands in order to maintain relationship. Here, it is not control but autonomy. One assumes the disowned parts of the other [mastery vs. lack of direction]. I am omnipotent because you are dependent, while the other says: I am dependent because you are omnipotence. i.e. when husband gets jailed for domestic violence, the wife gets depressed because her super-ego now does what the husband did. Masochist disowns aggression/guilt and elicit it in the sadist. He may feel guilt afterwards. Oppressed know more about the aggressor than vice-versa.

Kohut: narcissism developmental line parallel through oral=anal=phallic. Oneness with mother is the beginning of the development of the self. . Idealization of parents compensates for loss of grandiose self. Empathy of the parents [to soften the blows], but not shadowing. Mirroring it back, makes healthy narcissism. Lack of mirroring could be because of things like parental depression. Kid will then take on “the burden of badness” – when mother is no longer there for him, when she initially was. Then child may serve a function – i.e. soothe the mother. The child may also “unload” things on the child. Alice miller: some parents may feel the need to live through the child. Self will develop along the mirroring you got. Self could be more coherent or more fragmented. Chaotic to harmonious. Vigor of personality.

Bolas: mother is a transforming experience. There is a presence which changes hunger into satisfaction. Later, music does the same thing.

People who enter a relationship with a fragile sense of self, bring in the opposite pole of the same axis

Some narcissists look for overt acknowledgement while complimentary narcissist bump off others/ideals.

DSM and the Family - class notes

EMOTIONALLY FOCUSED COUPLE THERAPY

The emergence of EFT

Early 80s

Strengths

Assumptions

Van der Kolk’s work shows bonds main factor in resilience

EMOTIONALLY FOCUSED COUPLE THERAPY

Case #1

Case # 2

EMOTIONALLY FOCUSED COUPLE THERAPY

GENERAL THERAPEUTIC GOALS

PROCESS GOALS

THE THERAPY PROCESS

Personal landmarks/Incidents (Ask for examples)

EMOTIONALLY FOCUSED COUPLE THERAPY

Movement from step to step

Accessing emotion in step three

MARKERS

EMOTIONALLY FOCUSED COUPLE THERAPY

MARKERS

COUPLE PROCESS AND END STATE

EMOTIONALLY FOCUSED COUPLE THERAPY

MARKERS

INTERVENTIONS

Tracking and Reflecting the Cycle

Reframing

CHANGE EVENTS

Withdrawer engagement

Softening

EMOTIONALLY FOCUSED COUPLE THERAPY

Step 8 New solutions

MARKERS

Step 9

MARKERS

Evocative responding

Reframing

Restructuring Interactions

COUPLE PROCESS AND END STATE

What do the couple look like at the end of therapy?

Behavioural

Cognitive

Interpersonal