17. Emotionally Focused Therapy - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
Consultant/Trainer/Author
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Out of the Developmental Chrysalis in Intimacy and Relationship Therapy
Chapter 17: EMOTIONALLY FOCUSED THERAPY
by Ronald Mah





Difficult and diverse relationships dynamics can be extremely challenging for the therapist.  It may be akin to cross-cultural or multi-cultural work with a diversity of psychological experiences as opposed to social/cultural experiences.  Working with a self-referred and committed individual client may involve a transference and counter-transference relationship that involves managing attachment traumas, insecure attachment, and reparative dynamics.  However, the one-to-one relationship of the therapist-client can be quite simple in contrast to the triad of the therapist and two-person couple with its multiple dyads in play: therapist-first partner, therapist-second partner, the partners, prior attachment figures-first partner, prior attachment figures-second partner, and more.  Family therapy with more members is further complicated.  Emotional and relational distress and/or insecure attachment in one, several, or all of these dyads can make the couple or family's relationship, much less the couple or family therapy highly charged and difficult.  Naaman, et al., (2005) describe Emotionally Focused Therapy developed by Johnson and Greenberg (1985) as helping couples work through attachment injuries.  Emotionally Focused Therapy (EFT) "builds on Bowlby's theory that conceptualizes adult love as an attachment bond with an irreplaceable other—the primary caregiver is irreplaceable and is the one who fostered an emotional connection or attachment pattern that is difficult to be replaced by another, namely, the current partner (Johnson, 1996)" (page 56).
  
An attachment injury would come from a critical moment especially when attachment needs are prominent, where one's intimate other person is experienced as inaccessible or unresponsive.  An attachment injury harms the attachment bond creating disconnection and cycles of negative interactions that cause relationship distress to continue and intensify.  The psychic survival of the first person becomes threatened since "…the attachment model of adult intimacy views love as a bond, which is a tripartite mechanism consisting of behavioral, cognitive, and emotional elements that interact in synchrony to optimize survival (Naaman, et al., page 56).  The therapist should be on the lookout for attachment injuries in the relationship as they are indicative of the relationship dysfunction and the difficulty of the therapy as well.  "Relatively recent attachment injuries may prove to be good prognostic indicators of the therapy outcome.  It seems plausible to hypothesize that the longer a couple spends together interacting in a negative style resulting from an attachment injury, the more likely the interactional patterns and emotional experiences become entrenched.  If the injurious incident is potent enough to alter the attachment style and the ways of relating between partners consequently change, therapy may also prove to be more therapeutically challenging.  Conversely, those couples who present with recent attachment injuries may be more responsive to change in a shorter period of time" (Naaman, et al., 2005, page 74)

Similar to caregiver and child dynamics, the adult relationship has a group of behaviors to foster and maintain proximity to the attachment figure.  In the couple, the attachment figure is the intimate partner.  The cognitive component of the adult bond is a working model of oneself and the other person containing information about one's lovability and the other's accessibility.  This defines the person's attachment style.  Emotional accessibility and responsiveness for the couple's relationship are the basic elements as they are for the caregiver and child.  If a partner experiences attachment security threatened when his or her attachment figure as not accessible or non-responsive, he or she seeks to re-establish the bond through as series of attachment seeking behaviors.  If these behaviors are unsuccessful getting the attachment figure to respond as desired, the disappointed partner is likely to respond with angry protest, clinging, despair, and finally detachment.   Whether this is a recently developed condition or one that has endured for years is important diagnostic information for the therapist.  In addition to dealing with separation and re-attaching, attachment styles are behavioral responses to both perceived and actual distress.  Attachment styles are enduring patterns of expectations or strategies developed in response to previous relationships.  They serve as "information-processing mechanisms that filter information from the environment to answer two basic questions: 1) 'Am I worthy of love and care?' and 2) 'Can I count on others in times of distress/need?'  There is a finite number of answer combinations to these two basic questions, thus giving rise to four attachment styles" (Naaman, et al., page 57).

One conceptualization defines that there are four adult attachment styles: secure, preoccupied, dismissive, and fearful avoidant.  Securely attached individuals hold themselves as worthy of love and care for the most part, and generally find that others can be counted on in times of distress and need.  They also tend to successfully establish relationships with individuals who can be counted on.  

Securely attached individuals have better adjustment and higher levels of satisfaction in their adult relationships.  With experiences of greater intimacy and trust, securely attached individuals tend to be less hypervigilant, jealous, and fearful of being abandoned.  

Individuals with preoccupied attachment style largely feel unworthy as a result of their life experiences.  They tend to cling to partners and require constant reassurance because of their sense of deficiency.

Dismissive individuals view others negatively, while holding a positive sense of self.  They try to protect themselves from possible disappointment by others, who they see as beneath them through avoiding intimacy.  This creates an illusion of invulnerability.

Fearful avoidant individuals have both a negative self-perception and think poorly of others.  They also avoid interpersonal intimacy as they anticipate rejection or betrayal by the negative others.

The therapist may find that attachment needs, fears, longings, and individual's adaptive and maladaptive attempts to meet needs for contact and proximity to the adult attachment figure are effective concepts to assess a relationship.  The significance of attachment injuries, loss of connection and trust in the relationship can then direct therapy.  EFT draws upon attachment theory to address the role of affect in intimate relationships.  "Dialectically, this therapeutic approach is a synthesis of experiential and systemic approaches to psychotherapy.  In support of its therapeutic efficacy, research by Gottman (1994) has found that marital distress is a result of partners being stuck in certain absorbing states of negative emotion that give rise to rigid interactional cycles, which in turn leads to maintaining aversive emotional states.  Consistently, research by Johnson (1996) suggests that distressed couples are readily identifiable both by their rigidly structured interactional patterns and their intense negative affect.  Understandings of this nature indicate that the essence of EFT is geared towards helping distressed couples reprocess their emotional responses and, in doing so, adopt productive and healthier interactional positions.  This is achieved by allowing couples to elicit and expand—work through—their core emotional experiences that give rise to their interactional positions and then to effectuate a shift in these interactional positions.  Germane to this process is that emotional responses and interactional positions are reciprocally determined—that is, they are both equally addressed in therapy (Johnson, 1996).  Consequently, the salient goal of the therapeutic process is to foster a secure emotional bond between partners, which has been shown to be powerfully associated with physical and psychoemotional well-being, with resilience in the face of stress and trauma, and with optimal personality development (Burman and Margolin, 1992)"(Naaman, et al., 2005, page 58).

EFT identifies three discernible process shifts: cycle de–escalation, withdrawer re–engagement, and blamer softening.  Cycle de–escalation seeks to reduce the negative intensity of the couple's interactions without changing the couple's interactional cycle.  Withdrawer re–engagement in couple's therapy occurs with the withdrawn partner becoming willing again to risk engagement with the pursuing partner.  He or she becomes more active and engaged instead of staying withdrawn.  The therapist facilitates redefinition of perceptions of contact, accessibility, and responsiveness seeking to change the interactions and stances so the couple can engage differently.  The therapist validates and helps the partner express underlying feelings of helplessness and needs that prompted withdrawal.  As a result, the pursuer can be less critical, gain a different experience of the other, and take a new more positive stance in the relationship.  With successful cycle de-escalation and withdrawer re-engagement, the therapist then guides the pursuer through a softening.  "Johnson and Greenberg (1995) described the softening process as 'a watershed for the relationship and a powerful attachment event that initiates a new sense safety, trust and contact in the relationship' (p. 139).  This softening process represents a shift in the direction of increased accessibility and responsiveness such that, essentially, both partners become able to respond to the other in an accepting manner in the context of a high level of experiencing.  According to Greenberg and Johnson (1988), softening is the most critical and difficult task to accomplish within EFT, especially for a novice therapist" (Naaman, et al., 2005, page 59).

The therapist can often help an individual, the couple, or the family identify a specific critical past event when one person experienced another to be not accessible or non-responsive resulting in a strong sense of betrayal.  During challenging times and situation such as moving, migration, or immigration, retirement, serious illness, childbirth, miscarriage, loss, or other transition events, failures to provide desired attachment care and support can cause one to feel abandoned.  Sometimes, unaddressed or not discussed, such feelings can corrode relationship trust and security.  This can lead to further abandonment and betrayal at times of intensified attachment needs, as well as leading to infidelity (Naaman, et al., page 60).  An attachment injury results from the betrayal of a golden rule of intimate relationships- "If you love, care, respect, and are committed to me, you will always step up for me in any moment or circumstance of need- much less a crisis (whether or not it is obvious to you… but then, it should be obvious!) affecting me.  If you don't, then you are a lying despicable betrayer who has deceived me!!"  The injury is held dormant or actively to either gradually deteriorate the relationship or to erupt volcanically when triggered at some later point.  Attachment injuries may be distinct from the level of general trust between two people or among members.  Failure to meet the demand and the resultant attachment injury becomes indicative of the overall dependability of the other person and are often presented in therapy as a recurring theme of the relationship.  Beyond creating doubt about their attachment viability, attachment injuries can break down emotional bonds, and create chronic dilemmas.  They can become impede and bar positive resolution of injuries.  

An attachment injury can be comparable to trauma.  A traumatic experience creates existential anxiety by tearing asunder the basic assumptions that ones committed intimate will be available and respond in situations of actual or imagined threat, danger, loss, or uncertainty.  When the intimate other person is not reassuring and comforting, one feels doubt about the relationship and ones significance to the other.  Individuals recall such failures with great emotional intensity, including symptoms of hyper-vigilance and avoidance similar to posttraumatic stress disorder.  Hyper-vigilance and avoidance are normal responses to protect oneself from further injury, but also can preclude intimate interactions, which further deepens relationship distress (Naaman, et al., page 59-60).
Various clinical theories reflect EFT's delineation of the couple's problems and needs and also have comparable therapeutic processes to address them.  As a therapist, I relate to and recognize many aspects of EFT that reflect other theoretical and therapeutic guidance that I incorporate into my work, especially with couples.  EFT offers very clinical useful conceptualization for the therapist of three therapeutic phases that facilitate the couple's required three process shifts.

The first therapeutic phase is Cycle De–escalation.  Step one includes assessment, which involves the creation of an alliance between couple and therapist.  The core issues are uncovered and explained in attachment terms.  Step two involves the negative interactional cycle, in its entirety, and is identified with the couple.  Attachment insecurity and the maintenance of relational distress are accounted for by the negative interactional cycle.  Step three includes the denied or unacknowledged emotions giving rise to interactional positions.  In Step four, the presenting problem is reframed in terms of the interactional cycle, underlying emotions, and attachment needs.

The second therapeutic phase is Changing Interactional Positions.  Step five suggests that previously disowned needs and aspects of self are identified and integrated into relationship interactions.  Step six involves acceptance of each partner's experience and new more flexible interactional patterns are promoted.  In Step seven, expression of attachment needs and wants are facilitated, thus creating emotional engagement.

The third therapeutic phase is Consolidation and Integration.  Step eight addresses previous relational problems via new solutions at which the couple have arrived through the therapeutic journey.  Step nine considers the couple's new positions and healthier cycles of attachment behavior. (Naaman, et al., 2005, page 63-64)

The therapist may be a purist in applying EFT to couples or find his or her own style and orientation adapting EFT and other therapies to fit the needs of the clients in the session.  EFT offers a reiteration of the first seven steps as they pertain to the resolution process in other terms that the therapist may recognize:

1. Injured partner expressed violation of trust.

2. Injured partner articulated meaning of experience at an emotionally deepened level.

3. Offending partner became less defensive.

4. Grief was expressed by the injured partner, from a position of vulnerability.

5. The offending partner moved forward and acknowledged responsibility for her share in the injury.

6. The injured partner risked asking for the reassurance that was unexpressed at the time of the injury.

7. The offending partner responded in a caring and protective way. (Naaman, et al., 2005, page 73)
ADDRESS:
433 Estudillo Ave., #305
San Leandro, CA 94577-4915
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
CONTACT INFORMATION:
phone: (510) 614-5641
fax: (510) 889-6553
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