A weekend based on emotions
On the 29th and 30th of May, SIMHA had the privilege of having Dr. Ting Liu give a Workshop on Emotionally Focused Couples Therapy. For those of you who are not familiar with her, she teaches in the Psychology Department at Kean University in New Jersey, is a Pennsylvania licensed Marriage and Family Therapist and an Approved Supervisor with the American Association of Marriage & Family Therapy. She is also a certified EFT (Emotionally Focused Therapy) trainer and supervisor and provides training and supervision in the EFT model of couples and family therapy. She has been working as an EFT Therapist for over 10 years and had a lot to contribute to us in those two days.
Dr. Liu started off by telling us how Leslie Greenberg and Sue Johnson started EFT after taping couples and watching how people change, the factors involved in change and detecting the underlying priorities.
She proceeded by letting us know why EFT has been considered one of the most effective approaches in clinic when it comes to working with couples. She backed it up by giving us statistics, such as 70-75% recovery rate in 10-12 sessions, 86-90% of significant improvement, stable results (even under high stress), significant reducing of depression, and applicability to variety of populations and settings.
According to Dr. Liu, EFT has shown to be an effective treatment for couples and families facing depression, grief, management of chronic illness, sexual abuse histories, and eating disorders, among others. It is brief work (approximately 12-16 sessions) and leads to as good or better rates of improvement (less distress after therapy) and recovery (adjustment and satisfaction scores in the non-distressed range) as other therapies.
Dr. Liu informed us that the essence of EFT is the Emphatic Responsiveness shown when the therapist empathetically responds to his clients. This not only creates safety for the couple (or clients), it guides them into this responsiveness with each other. The most basic EFT intervention is considered to be the emphatic reflection.
Emotionally Focused Couples Therapy, according to Dr. Liu, looks within at how partners construct their emotional experience of relatedness through the Rogerian Intervention. When looking between at how partners engage each other, systemic interventions and tasks are used. The goal is to expand emotional responses from both partners, create new kinds of interaction and promote secure bonding between them.
It is easier to understand EFT’s focus when going into what Dr. Liu called the 4 P’s. Under the Experiential umbrella, the first one is the Present Moment; this stands for assisting the clients to bring the past to life through emotions. The emotion that is re-experienced is used to validate present blocks, styles, and fears. The second would be the Primary Affect, which is validating and moving from secondary to primary (underlying) emotions. This enables the clients to organize their emotion of a past experience so that they can engage in the “here and now”.
The third P, now under the Systemic approach, is the Process that corresponds to the time each individual takes to manage and deal. The final P stands for Positions and Patterns that represents the couples’ structure, the position each partner is taking in the relationship and the work it will take to create new patterns and structures.
According to Dr. Liu, the EFT Therapist must first be a collaborator promoting a secure alliance within therapeutical space. Secondly he must be a process consultant, to facilitate the identification, expression, and restructuring of emotional responses. Finally he must be a choreographer, restructuring the interactions and creating new relationship events.
Dr. Liu went on by telling us about the theoretical fundaments EFT is based on, such as Bowlby’s Attachment Theory. Attachment originates as a survival mechanism to maintain the proximity with a caregiver, especially in a stressful situation. This gives us the main parameters to understand the underlying emotions at stake. The goal the therapist has with his clients is to reduce arousal and reinstate a sense of felt security allowing for exploration.
She gave us an overview of the different Attachment Styles according to Mary Ainsworth (1965), who is best known for her elaboration on the work of John Bowlby’s attachment theory. The attachment styles basically fall within two main categories of secure and insecure attachments. Every individual has a valid longing for a secure attachment to a significant partner.
A secure attachment could be described as a close, trusting relationship in which each person experiences fulfillment of true dependency needs for contact/comfort and acceptance/safety. In a secure attachment, both people experience the relationship as a source of security and provision rather than distress; expressing feelings, articulating needs, and allowing their own vulnerability to show. In unclear relationships, they give clear emotional signals, are engaged, resourceful and flexible (Johnson & Sims, 2000).
An insecure relationship can be described as either ambivalent/anxious (1), avoidant (2), or disorganized/fearful-avoidant (3). Adults that present the first model (1) can be understood, according to Johnson & Sims (2000), as individuals that often feel reluctant about becoming close to others and worry that their partners don’t reciprocate their feelings. They seek high levels of intimacy, approval and responsiveness from their partners, but tend to doubt their worth and blame themselves for their partners’ lack of responsiveness.
In the second model (2), intimacy is generally avoided, their need for attachment is not fully acknowledged, and there is a difficulty when it comes to sharing feelings, thoughts, and emotions with partners. They can be described as people who are psychologically reactive, demand reassurance in an aggressive way and tend to use blame strategies (such as emotional blackmail) in order to get a response and involve their partner.
Individuals within model (3) can be described as having mixed feelings about close relationships. They vacillate between attachment and hostility; although they desire emotional closeness, it makes them uncomfortable to have such. They commonly feel themselves unworthy and do not trust their partners’ intentions. Tend to seek less intimacy and often suppress and hide their feelings from their partners.
To summarize, the basic phases of EFT are: 1) Assessing and De-escalating, 2) Change of events and 3) Consolidation of Change. According to Johnson (2000) all of these can be seen together and separate. In phase 1, the P’s (as previously explained) come in action and it is necessary to remember that the background is important only as it impacts the current life dynamics.
Phase 2 really involves creating corrective emotional experiences. Teaching the partner to identify their needs for themselves, helping their mate to accept and maybe meet these needs, and guiding them both on how to effectively compromise on this.
Phase 3 entails resolving old problems, which are now easier and more naturally solved because the emotional "toxin" originating from attachment conflicts is gone. Some problems are still managed, but they are not so difficult and demanding anymore. The therapist becomes much less directive, and permits the couple direct therapy until they are ready to leave. Future relapses are discussed as inevitable, but easier to handle.
From the EFT perspective change occurs by means of awareness, regulation, reflection, and transformation of emotion taking place within the context of an empathetically attuned relationship. The negative cycles, where one partner pursues while the other withdraws, is worked through when the therapist helps the couples go to the underlying emotions that keep them stuck in those rigid positions and negative interaction cycles. The aim is to create a new relationship event to act as a kind of transformer and thereby change reactive emotion with positive emotions of attachment.
After giving us the general outline, Dr. Liu led us to role playing amongst ourselves. We were divided into two groups, in which we got a very small feel of what it means to be an EFT therapist, speaking slowly and calmly, bringing the past alive and laughing at how we felt like new therapists all over again for working in a way not familiar to us. We also watched a couple of sessions of Sue Johnson’s therapy sessions and were enlightened at how EFT is used with couples.
At the end of the weekend we all felt the taste for more and expressed that to Dr. Liu. Hopefully we’ll be able to hear more of her about this subject and deepen into EFT and its practical clinical techniques.
For those of you who would like to read more about EFT and know how further your study, please visit the website: www.iceeft.com
References used:
EFT Workshop Hand-out by Dr. Tong Liu (29, 30/05/2010) Shanghai, China.
Johnson, S.M. (2002). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. New York: Guilford Press.
Greenberg, L.S.; Johnson, S.M. (1988). Emotionally Focused Therapy for Couples. New York: Guilford Press.
Johnson, S.M. (2004). The practice of emotionally focused marital therapy: Creating Connection. New York : Bruner / Routledge.
Johnson, S.M.; Sims, A. (2000). Attachment theory: A map for couple’s therapy. In T.M. Levy (Ed.), Handbook of attachment interventions, San Diego, CA: Academic Press.