Emotionally Focused Couple Therapy

Emotionally Focused Couple Therapy (EFT) is based on a simple premise derived from attachment theory: human beings need emotional connection.

We all have a basic need to feel loved, valued, and respected. We long to believe that we’re worthwhile and lovable despite our flaws. We need to believe that we matter to our partners and that they’ll be there for us when we need them.

When couples find themselves ‘stuck’, ‘in a rut,’ or constantly arguing, it’s often the result of a breakdown in emotional safety and connection. When a breakdown occurs, our fundamental psychological needs are not being fully met—which can be extremely painful. As EFT expert Dr. Sue Johnson says, humans beings are wired for connection. Nothing is more toxic than emotional isolation.

When we feel disconnected from our loved ones or feel like our primary attachment relationship is threatened, we panic. When couples are happy and securely attached, both partners feel comfortable asking to have their needs met, and are able to do so in a way that elicits a supportive response from their partner.

When the relationship is rocky, though, we don’t always know how to ask for what we need, and may turn to coping strategies that further alienate us from our partner. For example, we might protest the disconnection, becoming critical and controlling as we try to force our partner to respond. We might withdraw, shut down, and pull away in order to protect ourselves and to avoid further conflict. These instinctive but maladaptive coping methods often lead couples into negative patterns of interaction.

One such pattern is known as ‘pursue-withdraw’. In this scenario, the more one partner pushes, the more the other partner pulls away. The more the second partner pulls away, the more the first partner protests feeling shut out.

This cycle has the potential to continue indefinitely, and couples can get stuck in the cycle without getting to the heart of the matter. Rather than expressing our loneliness and fear that we don’t matter, we nag our partners that they don’t spend enough time at home. Rather than expressing our hurt when our partner is critical, we stay late at work to avoid coming home to an argument.

We say something cruel just to get our partner’s attention, or go silent during a fight because we’re paralyzed with the fear that we will never ‘get it right’ with the person we love.

We live in a world where expressing our emotions is perceived as “weak” and can get us labeled as “oversensitive” or “irrational.”

No wonder a lot of us have trouble connecting with how we truly feel and expressing it to our partners! Furthermore, depending on how emotions were dealt with in our family of origin, we may have learned that it isn’t safe to let down our guard and be vulnerable with those closest to us.

The good news: Even if our early experiences prevented us from learning to truly trust or connect with others, it is never too late.

Our intimate relationships as adults are the perfect avenue through which to learn to dance to a different tune.

When working with couples using EFT, I help partners move out of their negative cycle of interaction and into a positive one that fosters love, safety, and emotional connection.

The first step in this process involves helping the couple identify and become aware of the negative cycle they’ve fallen into. Specifically, partners learn to stop blaming one another and to place blame squarely on the negative cycle of communication.

Next, partners learn to identify their respective roles within the cycle, as well as the strong feelings that drive their moves in the relationship dance. Finally, partners learn to turn to one another, express their deepest fears and longings, and ask one another for what they truly need in order to feel safe, connected, and loved.

As an EFT therapist, I help partners learn to reach for one another in a new and honest way. After moving through these steps, couples find themselves in a new, positive pattern of interaction, in which they feel safe and connected. They are less easily triggered by one another, and are able to recover quickly from blips because they know, deep down, that they can count on one another.

EFT applies to all forms of couples and dyads regardless of sexual orientation or religious beliefs. EFT also applies to relationships between family members or between friends.

For anyone interested in learning more about Emotionally Focused Couple Therapy and the new science of love, I highly recommend Dr. Sue Johnson’s books ‘Hold me Tight‘ and ‘Lovesense’.

Making New Year’s Resolutions Stick

Whether it’s exercising more, improving your diet or reducing alcohol, here’s how to make that resolution stick.
Check out this blog from the Heart and Stroke Foundation, featuring Dr. Flanders’ tips for successful behaviour change. These strategies should help make your new year’s resolutions stick.

A User’s Guide to The History of Psychotherapy

Freud and psychoanalysis

A history of psychotherapy starts with none other than Sigmund Freud, the godfather of talk therapy. Freud created a technique known as psychoanalysis, which dominated the field for the first half of the 20th century. Psychoanalysis is an open-ended exploration of the unconscious.

By discussing whatever comes to mind (free-association), patients uncover the deep emotional and conflicts, forged in childhood, that cause suffering in adulthood. The analyst says very little, except an occasional interpretation to guide the patient to deeper, more penetrating insights about themselves and their relationships with others.

Because the analyst participated very little in the sessions, he or she acted as a kind of blank slate onto which the patient projected all of his or her intra- and inter-personal conflicts. As a result, much of the change and growth achieved in analysis achieved by working through these conflicts via the patient-analyst relationship, a.k.a the transference relationship. The nice thing about psychoanalysis is that it gives people an opportunity to work through deeper emotional problems in an open and unconstrained context.

There are several downsides however, which are responsible for the decline of psychoanalysis in the later half of the 20th century:

  1. It provided little practical tools to people suffering from well-defined psychological problems like anxiety and depression;
  2. There is very little empirical evidence that it actually works in reducing symptoms or resolving these problems; and
  3. Because it is open-ended and non-structured, it can go on for years with no resolution and can be very costly.

Behaviour Therapy (The First Wave)

The return home of WWII vets in the 1940s placed enormous pressure on the mental health field to develop an effective short-term therapy to help major emotional adjustments the soldiers faced.

At this time, Behaviorist researchers were sketching out the foundations of Learning Theory, including Classical Conditioning (Pavlov), Operant Conditioning (Skinner), and Systematic Desensitization (Wolpe). These ideas explained how contingencies and rewards in our environment shape our behaviour and provided powerful tools to eliminate problem behaviours.

These principles were adopted by clinicians who were turned off by Freud’s elaborate psycho-babble and wanted an approach to psychology that was simpler, more practical, and lent itself better to rigorous, scientific study.

Behaviour Therapy emerged and continues to be practiced to this day. It is very effective for treating certain anxiety, phobias, and addictions.

However, it is limited insofar as it does not address people’s thoughts and feelings. Other therapies soon filled that gap.

Humanistic or Client Centered Therapy

Carl Rogers, for one, was very interested in what his patients were saying! In fact, he put his patients’ experience at the forefront of the process of learning and change.

Like the psychoanalysts, he was convinced that the therapeutic alliance (i.e. the relationship between the patient and therapist) was the key factor in therapy. However, unlike the psychoanalysts, he believed that therapists should actively participate in clients’ self-exploration, rather than commenting occasionally from a position of higher authority.

He even preferred to call his patients ‘clients’ to emphasize the non-hierarchical relationship. For Rogers, the therapists role was to provided unconditional positive regard and follow clients’ lead as they pursue their own path to self-actualization.

By the 1950s, Rogers was beginning to have a profound and lasting impact on the way psychotherapists interact with their clients.

Cognitive Therapy (The Second Wave)

In the 1960s, a new paradigm was shifting into place in psychology.

Inspired by the advances in computing technology, psychologists began to think about the human mind as a complex information-processing organ – with the nervous system as the hardware and the mind as the software. Building on the work of Albert Ellis, Aaron (Tim) Beck began applying this model to the practice of psychotherapy.

He argued that the information being processed in our minds (i.e. cognitions) has an important impact on how we feel in the present. So, our thoughts, interpretations, and perceptions of things in our lives influence our feelings and actions. Beck developed Cognitive Therapy, a series of techniques designed to “search and destroy” distorted, exaggerated, or unhelpful cognitions that drag our mood down or stimulate fear and anxiety.

Many behavioural therapists began incorporating these techniques into their repertoire and Cognitive Behaviour Therapy (CBT) was born.

In CBT, the therapist is like a coach, guiding the client through a structured, goal-directed program aimed at reducing symptoms of psychopathology. CBT is practical, equipping clients with tools and strategies to manage their problems on their own. It is also present-oriented and time-limited, often achieving significant symptoms reduction in 8-12 weeks.

Perhaps most importantly, CBT is an evidence-based treatment, meaning it has an impressive record of rigorous scientific studies demonstrating its effectiveness.

As a result of these advantages, CBT has become the most widely-used approach to psychotherapy in the last 20-30 years.

The Third Wave of CBT

Since the turn of the millennium, a group of more recent innovations have begun to shape the history of psychotherapy.

These new approaches share the basic assumptions of traditional CBT: dedication to scientific testing and focus on behavior and cognition in therapy. As such, they have been collectively described as the “Third Wave” of CBT. However, they have introduced the importance of Mindfulness and Acceptance.

1. Mindfulness-Based Therapies

Mindfulness refers to a state of mind, characterized by careful attention to the present moment, with a non-judgemental attitude.

As has been known for thousands of years in eastern spiritual traditions, cultivating this state of mind through meditation helps reduce anxiety, lift mood, and promote health and well-being. It is only recently – thanks in part to the work of Jon Kabat-Zinn – that the practice of Mindfulness has reached the mainstream of Western psychological and medical best-practices.

Mindfulness-based therapies help clients bring greater awareness and clarity to their day-to-day lives, which typically result in more effective coping and problem-solving for the challenges they face. The most common Mindfulness-Based therapies include Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR), Zindel Seigal’s Mindfulness-Based Cognitive Therapy for Depression (MBCT).

These therapies are structured, group-based programs and have taken root in most medical centers in North America and Europe. Mindfulness has exploded in popular discourse in recent years, due in part to the rapidly expanding clinical and neuroscience evidence for the benefits of meditation and the increasing media coverage of these findings.

2. Acceptance and Commitment Therapy (ACT)

ACT (pronounced as the work ‘act’) is a relatively new set of innovations to CBT, developed by Dr. Stephen Hayes.

As the name implies, the techniques in ACT are designed to help clients learn to use acceptance-based (as apposed to control-based) strategies for coping with difficult experiences. Many of the problems people face in life stem from difficulty tolerating negative emotions (such as anxiety, fear, or sadness) and tend to avoid, repress, or attempt control them.

A series of impressive studies has shown that these reactions actually amplify the negative emotion, thereby making the initial problem worse!

So ACT therapists help clients develop skills to better accept their experience and work toward more effective ways of coping with and solving problems.

Ultimately, the goal of ACT is to help clients move past preoccupations about mental health toward a focus on living by their most cherished values.

One of the biggest advantages of ACT is the strength of the evidence supporting it.

Before presenting ACT to the public, Hayes dedicated many years to building a broad theoretical framework (Relational Frame Theory) and solid empirical foundation for the approach (Contextual Behavior Science). More recently, he and his team have conducted numerous randomized-controlled trials demonstrating the effectiveness of ACT techniques for a variety of psychological problems.

ACT has really caught on recent years and is now widely considered at the cutting edge of Cognitive Behaviour Therapy.

Emotion Focused Therapy

The basic tenets of Emotion-Focused Therapy are very simple. Emotions such as sadness, anger, surprise, fear and happiness are adaptive and, without them, humans would have not survived.

For instance, fear told us to run (or fight) when facing danger or threat (e.g., to self or to our family). In essence, our emotions tell us what we need and they help us to connect with others. Unfortunately, we all have difficulty dealing with emotion sometimes and Emotion-Focused Therapy was developed to help people to become more aware of their emotions so that they can be used adaptively.

Despite the adaptive nature of our basic emotions, they are often misunderstood. There are a number of misunderstandings or negative thoughts about emotions in popular media, society, etc.

For example, the word “emotional” is often associated with being sad (or emotionally unstable), which is perceived to be bad or undesirable. In addition, many people are taught to act like Superman (or woman), in total control of their feelings.

We tend to shy away from expressing emotion, as it is often perceived as a sign of weakness or impending breakdown. These beliefs are problematic because they limit our ability to fully connect with others via our emotions.

In therapy, clients discover how they tend to inhibit or suppress their emotions and learn to be with them more comfortably.

People often report feeling “lighter” after experiencing their emotions in a validating therapeutic environment. Clients are also taught to contain their emotions to minimize feeling overwhelmed and to work through secondary emotions such as anger that shutdown more primary emotions such as sadness and fear.

How does EFT work?

Our emotions reside in our bodies, most typically in the chest or stomach. A main task in Emotion-Focused Therapy is to explore bodily sensations and to find words that correctly label our emotional experience.

The body will know what words fit. Having such awareness fosters direction and meaning. Other EFT tasks include processing unmet needs related to key life experiences so that closure and acceptance are reached.

Finally, clients can reach a sense of completeness by minimizing problematic behaviours such as self-criticism via dialogue tasks. These tasks help clients to explore parts of the self (e.g., fear underlying self-criticism or laws of behaving that are imposed by others) in order to give voice to adaptive behaviour.

An impressive body of scientific research has shown that EFT can help reduce depression and interpersonal problems and increase self-compassion, assertiveness, self-esteem, and problem-solving in social and work settings.

In addition, clients report improvements in symptoms related to traumatic experiences such as avoidance of reminders. Last, research also shows that EFT helps couples reduce distress and, more importantly, begin to rely on each other for comfort and support. It works, and more research is currently being done on the process of change.

That is, what specific therapist and client behaviours occurring in a session lead to the most change?

Anyone who is depressed has problems in relationships and who generally feels unwell regarding who they are and what they do will benefit from Emotion-Focused Therapy. In the words of many clients: “It’s like I just went to the spa.”