EMOTIONALLY FOCUSED THERAPY
Structure, Interventions and Techniques
Elisabeth Brown, Psy.D.
Alan Groveman, Ph.D.
Karen Skean, Psy.D.
Joan Wolkin, Ph.D.
EMOTIONALLY FOCUSED THERAPY
EMOTIONALLY FOCUSED THERAPY:
PRIMARY ROOTS OF EFT
Learning Objective
•Describe the theoretical underpinnings of Emotionally Focused
Therapy
•Be familiar with the three stages and nine steps framework of
EFT
•Understand the concepts of enactments, withdraw engagement
and blamer softening
•Be conversant with the research supporting EFT
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EMOTIONALLY FOCUSED THERAPY:
OVERVIEW AND THEORETICAL ASSUMPTIONS
PRIMARY ROOTS OF EFT
• Experiential Therapy (Perls)
• Person Centered Therapy (Rogers)
• Systemic Therapy (Minuchin)
• Attachment Theory (Bowlby)
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BASIC OVERVIEW OF EFT
The primary goals of EFT are to:
• Access, expand and re-organize key emotional responses
between partners.
• Create a shift in each partner’s interactional positions in their
rigid interactions with one another.
• Foster the creation of a secure bond between partners
through the creation of new interactional experiences that
redefine the relationship.
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What Makes EFT, EFT – Its Look and Feel
1. Relentless Empathy
2. Attachment Frame and Language
3. De-pathologizing Model
4. RISSSC
5. Enactments
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SKILLS FOR EMOTIONAL ENGAGEMENT
R-I-S-S-S-C
R: The therapist intentionally REPEATS key words and phrases for
emphasis.
I: Therapist uses IMAGES or word pictures that evoke emotions
more than abstract labels tend to do.
S: Therapist frames responses to clients in SIMPLE and concise
phrases.
S: Therapist will SLOW the process of the session and the pace of
her speech to enable deepening of emotional experience
S: Therapist will use SOFT and soothing tone of voice to encourage
a client to deepen experience.
C: Therapist uses CLIENT words and phrases in a
supportive/validating way.
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ENACTMENTS
Types of EFT Enactments
1. Diagnostic enactments
2. Highlighting rarely occurring positive interaction
3. Enacting present positions
4. Turning new emotional experience into new responses
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ENACTMENTS
A Model for Creating Effective Enactments
1. Setting the Stage
2. Directing One Partner to Make Contact with the Other
3. Processing Each Partner’s Experience of the Enactment
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Role Play
OVERVIEW OF EFT TREATMENT
PROCESS
• Develop an alliance, identify cycle, identify and access underlying
emotions, and work to de-escalate
• Help couple see the negative cycle as the enemy, not each other
• Engage the withdrawer
• Soften the pursuer/blamer
• Create new emotional bonding events and new cycles of
interaction
• Consolidate new cycles of trust, connection and safety, and apply
them to old problems that may still be relevant
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ATTACHMENT
•
Withdrawer
•
“I never get it right or make her happy.”
•
“I don’t bother anymore what’s the point.”
•
(Feelings: Rejected, inadequate, fears failure,
•
overwhelmed, judged, shame, empty, alone)
•
Pursuer
•
“He’s never around and whenever he is he’s
•
always distracted.”
•
“She doesn’t see me. No matter what I do I don’t
•
count in her world.”
•
(Feelings: Hurt, unwanted, invisible, abandoned,
•
desperate, deprived, not important
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COMMON UNDERLYING EMOTIONS OF
WITHDRAWERS AND PURSUERS
• Rejected
• Hurt
• Inadequate
• Alone
• Afraid of failure
• Not wanted
• Overwhelmed
• Invisible
• Numb – frozen
• Isolated/disconnected
• Afraid – scared
• Not important
• Not wanted or desired
• Abandoned
• Judged, critized
• Desperate
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EFT
3 STAGES AND 9 STEPS
• Stage 1
Assessment and Cycle De-Escalation
• Stage 2
Changing Interactional Positions and Creating New Bonds
• Stage 3
Consolidation and Integratio n
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 1-4
• Alliance and assessment: Creating an alliance and
delineating conflict issues in the core attachment
struggle.
 What are they fighting about and how are they
related to core attachment issues?
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STEP 1 - ESTABLISHING AN ALLIANCE
• Reflection
• Validation
• Empathic Attunement
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 2
Identify the negative interaction cycle
 EFT Cycle levels include
•
•
•
•
•
Action tendencies (behaviors)
Perceptions
Secondary Emotions
Primary Emotions
Unmet Attachment Needs
 The goal is for the therapist to see the cycle in action and
identify and describe it to the couple and work toward
stopping it.
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IDENTIFYING & DELINEATING
NEGATIVE INTERACTIVE CYCLE
• Basic Negative Cycles & Interactive Positions
• Pursue/Withdraw
• Withdraw/Withdraw
• Attack/Attack
• Complex cycles
• Reactive pursue/Withdraw
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EFT EMOTIONS AND REACTIVITY
Emotions occur at two levels: Primary and Secondary (or reactive).
Primary Emotions are the deeper, more vulnerable and tender
emotions such as sadness, hurt, fear, shame, and loneliness.
Secondary Emotions are the more reactive emotions such as
anger, jealousy, resentment, and frustration. They occur as a
reaction to the primary emotions. Anger, Blame,
Primary emotions generally draw partners closer.
Secondary emotions tend to push partners away.
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STEP 2 – IDENTIFYING THE NEGATIVE CYCLE
• Who is the Pursuer?
• Who is the Withdrawer?
• Describe the Negative
Cycle
• What are the Secondary
Emotions?
• What are the Primary
Emotions?
Sue Negative Cycle Clip
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 3
Access unacknowledged emotions underlying interactional
positions.
 The goal is to help each member of the couple to access and
accept their unacknowledged feelings that are influencing their
behavior in the relationship. Both partners are to "reprocess and
crystallize their own experience in the relationship" so that they
can become emotionally open to the other person.
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STEP 3
ACCESS UNACKNOWLEDGED EMOTIONS
UNDERLYING INTERACTIONAL POSITIONS.
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 4
Reframe the problem in terms of underlying feelings, attachment
needs, and negative cycles.
 The cycle is framed as the common enemy and the source of the
partners’ emotional deprivation and distress.
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EFT REFRAMES STEP 4
For example:
Angry Criticism is viewed in EFT as:
• an attempt to modify the other partner’s inaccessibility or
manage the disconnect
• a protest response to emotional isolation and abandonment
not being “crazy or irrational”.
Avoidance is seen as:
• an attempt to contain the interaction and regulate fears of
rejection or not burden the other partner
• an attempt to avoid confrontation or working models that
define the self as unlovable .
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STEP 4
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The Cycle
Scott R. Woolley Ph.D. ©
Partner
Behavior
Perceptions/Attributions
Secondary Emotion
Partner
Behavior
Perceptions/Attributions
Secondary Emotion
--------------------------------------------------------------------------------------------------------------
Primary Emotion
Unmet Attachment Needs
Primary Emotion
Unmet Attachment Needs
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THE NINE STEPS OF EFT
STAGE 2
STEPS 5-7
Step 5- Withdrawer Re-Engagement and
Pursuer Softening
Promote identification with disowned attachment emotions, needs
and aspects of self, and integrate these into relationship
interactions.
 Help the couple redefine their experiences in terms of their
unacknowledged emotional needs. "I nag because I feel
abandoned and I want to be loved." "I withdraw because I feel
invaded and rejected and I need to feel safe and loved."
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 6
Promote acceptance of the other partner’s experiences and new
interactional responses .

Work to get each partner to accept, believe, and trust that what
the other partner is describing in terms of underlying emotional
needs is accurate.
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THE NINE STEPS OF EMOTIONALLY
FOCUSED COUPLES THERAPY
Step 7
Facilitate the expression of needs and wants and create emotional
engagement and bonding events that redefine the attachment
between the partners.

Help them learn to express their emotional needs and wants directly
rather than through the old patterns and create emotional
engagement. This will help each person see the other person in a
more benign manner. (Feeling vulnerable and insecure rather than
rejecting.)
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STEPS 5,6,7
Stage 3 – Consolidation
• Step 8 – Facilitating the emergence of new solutions to
old relationship patterns
• Step 9 – Consolidating new positions and new cycle of
safe attachment and connections
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SOFTENING
• Pre-requisites:
• De-escalation of negative cycle (Stage 1)
• Withdrawer re-engagement (Stage 2 change event)
• A previously hostile, critical partner accesses “softer”
emotions and risks reaching out to his/her partner who
is engaged and responsive.
• In this vulnerable state, the previously hostile partner
asks for attachment needs to be met.
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SOFTENING
• At this point, both partners are attuned, engaged and
responsive (accessibility & responsiveness)
• A bonding event then occurs which redefines the
relationship as a safe haven and a secure base.
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CONTRAINDICATIONS OF EFT
• Different Agendas
• Separating Couples
• Abusive Relationships
• Substance Abuse
• Depression and Other Psychiatric Illness
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RESEARCH
• 70 – 73% recovery rate in 10-12 sessions.
• Results stable – even under high stress.
• Depression significantly reduced.
• Variety of populations and settings.
• Best predictor of success – female faith in partner’s
caring (Not initial distress level).
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QUESTIONS
ATTACHMENT
• Attachment History - (View of Self and View of Other)
•
“When you were young (ages 6 – 10) who did you turn to for care and comfort in a
time of need? Can you tell me what that was like?”
•
Secure: A person is better able to acknowledge and cope effectively with negative
emotions.
Adults are self-confident, socially skilled, interested in close, romantic relationships,
an
more likely to form stable and satisfying long-term relationships.
Avoidant: A person often attempts to block out negative emotions, and are
Uncomfortable seeking support. Adults lack self-confidence, are worried about
rejection and abandonment.
They are prone to bouts of jealousy and anger. They see partners as untrustworthy.
Seek romantic relationships, but may choose ill-advised partners.
•
•
•
•
Anxious: A person is highly emotionally expressive but often cannot regulate their
emotions. Adults are uncomfortable with closeness, self-disclosure, dependence on
others, and are more socially unskilled.
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