Once again, they were having significant impact on each other without realizing it. I suggested that both of their intrusive feelings were being triggered in the relationship and that these intense feelings underlay their mixed, negative cycle. The position taken by Angela evoked recursively the position taken by Peter and vice versa. Therapist (to Dave): I’d like you to tell her, “Let me see if I got you” and then paraphrase what you heard her say. Emotionally Focused Therapy, also known as EFT, entails a variety of therapeutic approaches that can be used for individuals, families and couples, and centers around the understanding and regulation of emotions as the foundation for positive change in interpersonal relationships, communication and emotional management. Angela was unaware largely that beneath the criticism and blame of her position as pursuer, she was feeling anxious, neglected, and unloved. It means a lot to me when I hear from you.” Rather than saying, “Why are you bossing me again”, Dave learned to say, “I’m not blaming you for my feeling, and I want you to know that I feel diminished when you tell me how to drive. Rather than perceiving Angela as aggressive and controlling, Dave began to see her as attempting to reduce her anxiety and pain, to feel close to him, and to maintain their attachment. He recalled that he had been born three weeks premature, and had spent about two weeks in the hospital separated from his mother before coming home. Step IV: Reframing the problem in terms of partners’ underlying feelings and attachment needs. Angela replied that if she didn’t take charge the house would be a mess and nothing would get done. Both Angela and Dave recalled experiencing distressing feelings growing up. On the affiliation dimension, Angela’s way of avoiding anxiety (blaming about lack of contact) triggered Dave’s anxiety about conflict, and Dave’s way of avoiding his anxiety (defensiveness followed by shutting down) triggered her anxiety and pain about loss of contact. The more we allow and feel the feelings with an attitude of wisdom and compassion for ourselves rather than escape them, the more they diminish and resolve. Obegi & E.Berant (Eds. Clinical Case: Emotionally Focused Therapy Angela, a part-time teacher in her late 20s, requested an appointment for her and her husband, Dave, who was in his mid 30s. Partners begin to view undesirable behaviors (i.e., shutting down or angry escalations) as “protests of disconnection.” Couples learn to be emotionally available, empathetic and engaged with each other, strengthening the attachment bond and safe haven between them. EFT has many strengths as a therapeutic model. What is interesting is that as Dave made these changes, he liked the increased contact with Angela and the appreciation that she showed for his efforts. She had lots of resentment toward Dave – such as his giving more to his employees than to her and playing computer games at night rather than spending time with her. It pleased her to know that she was contributing to his happiness. I explained how Vancouver psychologist Dr. Geoffrey Carr’s book, Making Happiness, presents research showing infants are much more sensitive and aware of their environments than previously thought, and that all infants to some extent experience intense trauma feelings. The infant’s experience of mild distress quickly escalates into overwhelming feelings of helplessness and pain if the infant isn’t responded to in a timely and sensitive manner. When Angela noticed herself feeling neglected or unloved (anxiety and emotional pain triggered on the affiliation dimension), or noticed herself feeling a loss of control (anxiety triggered on the influence dimension), I suggested that she allow herself to feel these feelings as fully as possible; for example, by telling herself, “I feel so anxious and in so much pain.” When Dave noticed himself feeling tense and defensive (anxiety triggered on the affiliation dimension), or noticed himself feeling controlled and diminished (anxiety and shame triggered on the influence dimension), I suggested that he allow himself to feel these feelings as fully as possible; for example by telling himself, “I feel so scared and bad about myself”. I am safe now”. For example, rather than saying, “Why didn’t you text me at work today?”, Angela learned to say, “I’m not blaming you for my feeling, and I want you to know that I feel uncared for when I don’t receive a text from you asking me how my day is going. Dr. Paul James is a registered psychologist in Vancouver, BC. In other words, the distressing feelings are echoes from the past. I suggested that their pattern on the influence dimension was as follows. Both said that they not only felt more heard and understood, but also felt some relief about understanding their feelings and relationship patterns more fully. The close, temporal relationship between what people say or do and the feelings that they experience has given rise to the popular notion that people or events cause our feelings. The distressed couples who may benefit from EFT include those where one or both partners suffer from depression, addiction, post-traumatic stress disorders, and chronic illness, among other disorders. In other words, if someone says or does something in relation to me (the stimulus), and I have big feelings about it, it is important that I realize that what comes between the stimulus and my big feelings is myself, how I interpret the stimulus based on my own trauma feelings and history. It made sense that Angela was feeling resentful because she wanted more closeness and contact with Dave. If you are looking for help with a distressed relationship, an EFT trained therapist would be a wise choice. In Step II, I identify the negative cycle of interaction that maintains the couple’s distress and undermines a secure attachment. In J.H. Also, I suggested that Dave’s distancing after his initial defensiveness was his attempt to avoid anxiety triggered by conflict and to protect their attachment from the damage of escalating conflict. Emotion-focused therapy case formulation focuses on the client’s narrative content (the stories they tell) as well as emotional processing (how the client feels). It argues that other forms of psychotherapy have overemphasized conscious understanding and have underemphasized the roles of emotional change. In Making Happiness, Vancouver Psychologist Dr. Geoffrey Carr discusses the notion of responsibility for feelings and says that people are the stimulus but not the cause of our feelings. Step VI: Expressing intrusive feelings and associated needs responsibly. Sue Johnson and Les Greenberg in the 1980s. Angela stated that Dave, the owner of a small company, thought they should be able to resolve their problems on their own but had agreed reluctantly at her insistence to attend couple’s counselling. When humans dissociate, they detach from their experience and feel numb. In Step IV, I reframe the relationship problem in terms of partners’ underlying feelings and attachment needs, and the negative cycle as partners’ misguided attempt to reestablish their attachment. When incoming information is familiar, the amygdala is calm. However, when I told them that we learn a lot in the first year of life that we don’t remember – such as how to walk, talk, and recognize our parents, they were more open to accepting that the source of the intrusive feelings underlying their mixed, negative cycle was early trauma. Case formulation in EFT is a relatively new concept and useful tool that helps therapists to both conceptualize cases as well as follow markers across therapy in order to initiate tasks that promote change in emotional processing. 2018;71(suppl 6):2650-2658. doi:10.1590/0034-7167-2017-0844, Johnson SM, Burgess Moser M, Beckes L, et al. EFT approaches include elements of experiential therapy (such as person-centered therapy and Gestalt therapy), systemic therapy, and attachment theory. I suggested that that likely she would have experienced overwhelming feelings of pain and helplessness as an infant as the result of being separated from her mother during this critical period of development, feelings that would have been reinforced as a child when her mother was ill and the home disorganized. What is interesting is that as Angela made these changes, she liked the increased support he offered resulting in her over functioning less. These conceptualizations inform all aspects of treatment, including who should attend sessions, the type of therapeutic relationship, the therapist’s theoretical orientation, and therapeutic interventions. Then, I directed Angela to respond by reflecting back what she had heard Dave say using the new way of communicating I had just introduced. She noted that they had always had a lot of conflict, nearly separating a few times. The four-step case con - ceptualization and treatment planning process will now be discussed in detailusingthecaseofPat. Rev Bras Enferm. As we terminated counselling, I congratulated Angela and Dave for their efforts and changes, suggesting that, because change is uneven, likely they would hit some bumps moving forward. Both were tired of the conflict, and wondering if they were compatible or not. EFT offers an emotion‐based case formulation of SAD, in which social anxiety is conceptualized as secondary to primary maladaptive shame. Dave expressed anger in the form of defensiveness and passive-aggressiveness. cess of developing a case conceptualization and treatment plan is time-consuming at first, over time it will increase the likelihood you will provide effective and time-efficient treatment. It is grounded in research while focusing on negative communication patterns and love as an attachment bond. Also, I suggested that they assumed predictable positions in this negative cycle on the influence dimension. Dave’s greater assertion of influence was evident in how he expressed his feelings and need to be respected as an equal in a clear, responsible manner. They had been married for three years and did not have children. Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved, Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Emotionally Focused Therapy Case Conceptualization. Johnson, S. M. (2009). The former refers to how partners relate to each other in terms of emotional closeness; the latter refers to how partners share influence with each other. The relationship becomes a haven and a healing environment for both partners. Cultura RM Exclusive-Lost Horizon Images / Getty Images, Emotionally Focused Therapy (EFT) is a short-term (eight to 20 sessions) and structured approach to couples' therapy developed by Drs. Emotionally focused therapy and emotion-focused therapy (EFT) are a family of related approaches to psychotherapy with individuals, couples, or families. They had been married for three years and did not have children. Dissociating provides relief from overwhelming, intense feelings of fear, shame, and pain. The position taken by Angela recursively evoked the position taken by Peter and vice versa. This freezing response, in which the animal looks dead from the outside but is highly activated internally, is adaptive biologically because the animal has a greater likelihood of survival by appearing dead. First, it is supported by extensive research. Second, it is collaborative and respectful of clients. According to Dr. Carr, in order to understand how an infant is traumatized, it is important to recognize that it is the infant’s experience of the event rather than the event itself that is traumatizing. "Primal fear" ensues and sets off an alarm in part of our brain called the amygdala, also known as the fear center. He complained that this was the only relationship in which he was bossed, that he didn’t like feeling like a subordinate, and that he was frustrated because she persisted in being bossy despite his complaints. Papp LM, Kouros CD, Cummings EM. Typically, Angela assumed the position of being one-up or dominant by defining reality in some way for both of them. I said to Dave, “I wonder if you don’t feel anxious when you feel blamed by Angela for not spending time with her,” Dave stated, “I guess so, because I feel tense and on edge.” When asked if this was a familiar feeling, he stated that he often felt tense growing up when his mother was critical of his dad for coming home late which led to conflict between his parents. For example, Angela refrained from being a back seat driver and insisting that he clean the kitchen in her way. EFT is collaborative and respectful of clients, combining experiential Rogerian techniques with structural systemic interventions. Grounded with thirty years of process and outcome research, Emotionally Focused Therapy takes the attachment perspective out of the research lab and into therapy sessions with individuals, couples, and families. I then asked if it would be okay if I introduced them to a new way of communicating, and with their consent, the following dialogue ensued: Therapist (to Angela): I’d like you to tell him directly, “I find it so painful when at the end of a long day apart I want to spend some time with you and you seem to prefer computer games rather than being with me.” I, Angela (to Dave): “I find it painful when you seem to prefer computer games over time with me at night.”. She noted that they had always had a … Sue Johnson and Les Greenberg in the 1980s. Angela, the fifth in a sib line of six children, recalled feeling anxious and neglected as a child, particularly when her mother, who experienced recurring bouts of depression, was ill. Dave, the middle child in a sib line of three, recalled feeling afraid and ashamed, particularly when his dad was drinking and angry. Emotion-focused therapy (EFT) views clinical disorders as, at base, emotional disorders. Jones, L. K. Emotionally focused therapy with couples — the social work connection. I will illustrate each of the steps using the clinical case of a Angela and Dave, a hypothetical distressed couple experiencing a lot of conflict. Strengths of Emotionally Focused Therapy EFT is based on clear, explicit research-based conceptualizations of individual growth, health and dysfunction and of relationship distress and adult love. Includes online forum access with select EFT trainers and a free e-book copy of Attachment Theory in Practice Angela, a part-time teacher in her late 20s, requested an appointment for her and her husband, Dave, who was in his mid 30s. Changes were now evident in Angela and Dave’s mixed, negative cycle. Neuroscience also intersects attachment theory and EFT. “A powerful video, useful for practitioners, educators, and students, especially those studying or working in Couples and Family therapy. I want to feel respected.”. More recently produced MRI studies demonstrate the significance of secure attachment. Our attachments are potent, and our brains code them as “safety.”. The process of EFT Vancouver involves seven steps, which for didactic purposes are presented as discreet steps. Dave said that his mother worked while pregnant with him because his parents struggled financially. Finally, I suggested that these feelings were triggered in the marriage whenever he experienced Angela being blaming and controlling, resulting in his initial defensiveness and subsequent passive-aggressive resistance. As I explored their conflict from both their points of view, I began by validating their secondary emotions. 2013;8(11):e79314. As Angela and Dave made a conscious effort to allow their intrusive feelings and to relate to them from a wise perspective rather than avoid them by trying to change each other, the intensity of their feelings began to diminish, they experienced less conflict, and they began to feel more securely attached to each other. Step III: Accessing unacknowledged feelings underlying partners’ positions in the mixed, negative cycle. After validating their secondary emotions, I began to explore tentatively their underlying, intrusive feelings. It includes a valuable chapter dealing with the topic of case formulation in Emotion-Focused Therapy (Greenberg, Goldman, 2007), which is embedded within client-centered and Gestalt therapy… Emotion-focused therapy (EFT) is designed to target and change unhealthy emotional processes that underlie the problems people bring to therapy with the goal of co-constructing new, healthier emotional … The only protection that an infant has against experiencing intense trauma feelings, therefore, is a highly attuned caregiver who responds sensitively to the infants’ needs before they reach high levels of distress and fall into the freezing response. Both began to feel a sense of hopefulness about change, particularly because they noticed that they were fighting much less. For example, Angela’s experience of intrusive feelings of helplessness and anxiety informed her of her needs for contact and a sense of control. In other words, her control (defining reality) evoked his passive resistance in the form of under functioning, and his under functioning evoked her assuming more control in the form of over functioning. EFT can help couples understand themselves and their partner better, which makes it easier to interact positively with one another. Demand-withdraw patterns in marital conflict in the home. I validated both Angela and Dave by suggesting that their feelings were understandable in the present situation. Blog. In his mind, he was easy going and she was bossy, constantly telling him what to do and criticizing how he did things. As an experiential therapy, EFT requires a careful balance between following and guiding clients, helping them work at the leading edge of their attachment emotions and needs. Top 10 blogs in 2020 for remote teaching and learning; Dec. 11, 2020 Expressing feelings responsibly also includes revealing responsibly the needs associated with our feelings. In Step I, I develop a clear understanding of whether the couple’s conflict is primarily on the affiliation dimension of interaction, the influence dimension of interaction, or both. Emotion Focused Therapy for Couples As described earlier, EFT has been applied with great success to couples struggling with problems in their relationship. Exploration indicated that they were having conflict on both of the two dimensions of interaction: the affiliation dimension of interaction and the influence dimension of interaction (called a mixed, negative cycle). Its formation begins in childhood with a primary caretaker, such as a parent.. In actuality, these steps are mutually overlapping and recursive. Dave (to Angela): “Let me see if I got you. Both seemed surprised when I suggested that these distressing feelings reinforced earlier trauma feelings that they couldn’t remember (see the article, Early Trauma Feelings: What We Don’t Remember Can Hurt Us). This reframe of the problem, in which both were viewed as trying to avoid intrusive feelings such as anxiety, pain, and shame, in order to meet legitimate needs and to protect their attachment, made intuitive sense to them. Any time Dave perceived Angela to be defining reality for him in some way – such as by telling him what to do, insisting she knows best, making the decisions and criticizing how he does things – he would resist her control directly by arguing and later indirectly by acting passive-aggressively (e.g., forgetting what he had agreed to do). Both felt increasingly comfortable, safe, and accepted by the other. Emotionally Focused Therapy (EFT - Emotionally Focused Therapy) is a structured approach to couples therapy formulated in 1980 and developed through the science of adult attachment and emotional ties to expand the understanding of what happens in relationships and to guide therapists. There are also several books that might be of interest. Feelings are like a compass in that they orient us to what we need, to what matters to us (see the article, About Feelings). As Dr. Geoffrey Carr articulates in Making Happiness, it is important to remind ourselves that although the strong feelings we experience are being triggered in the present by way of a conditioned response, the intensity of these feelings comes from the distant past. It shifts blame for the couples' problems to the negative patterns between them, instead of the couples themselves (or the partners). With this awareness came the realization that if they were both the creators and victims of their negative cycle, perhaps they could change it. Soothing the threatened brain: leveraging contact comfort with emotionally focused therapy. Attachment theory provides the emotionally-focused therapist with a "road map" to the drama of distress, emotions, and needs between partners. 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