Stepping into Emotionally Focused Couple Therapy, by Lorrie L. Brubacher

Posted on Oct 16, 2017

Key Ingredients of Change

Stepping into Emotionally Focused Couple Therapy: Key Ingredients of Change provides an accessible introduction to Emotionally Focused Therapy (EFT) as articulated by Dr. Sue Johnson. It introduces therapists unfamiliar with the model the theory and practice of EFT from the clients’ and therapist’s points of view. It also gives practitioners already familiar with the model a practical overview to augment their facility and engagement with the model. Process and outcome research testifies that EFT is arguably the most effective model of couple therapy available. We know not only that EFT works but we know how it works.

The book adds to the main text of EFT (Johnson, 2004) by integrating recent developments and research. The book is designed to be is theoretically crisp and therapeutically relevant, fully consonant with Dr. Johnson’s approach. It is infused with Johnson’s spirit and scientific knowledge through many pithy quotes from her writings as well as quotes from and references to the work of Bowlby, Coan, Mikulincer and Shaver, to name a few, all leaders in the field of attachment and/or EFT research.

In presenting the EFT model, the book does the following:

It initiates therapists, one step at a time, into EFT. A concise introduction to the model is complemented with practical handles, relevant for seasoned therapists, for new clinicians or graduate students, wanting to integrate EFT into their practices, and for couple therapists of other modalities who are curious to dip a toe into EFT waters.

It gives therapists an experience of EFT, by including many of the reflections and intentions of new EFT therapist “Emily” as she works primarily with three particular couples. Each of the couples represent a common ineffective interaction patterns couples present in therapy: Tara and Kyle have a classic demand/withdraw pattern; Phil and Julie, have a withdraw/withdraw pattern and Sophie and Ella, have highly escalated attack/attack sequences.

EFT’s nine-step, three-stage model for reshaping distressed relationships into secure bonds, are conveyed in a practical and accessible manner. At the same time theoretical clarity reveals how the model is based in attachment science.

Practical examples and images clarify how attachment theory, as integrated in EFT, provides a reliable map for transforming a system dominated by unexpressed attachment emotions and needs. Attachment theory is shown to provide a guide for couple therapists otherwise lost in a jungle of conflict, distance, distress and despair. Therapists are shown how to move from a paradigm of problem solving to one of de-escalating negative interaction patterns so as to reshape the attachment bond.

Therapists overwhelmed or discouraged about with working with couples, are given hope and encouragement. The case examples of three couples help readers to experience the change events of EFT and to see how an EFT clinician uses an attachment lens to frame and normalise some of the most difficult and daunting couple interactions.

The book has several unique qualities:

  • Each of the chapters delineating the EFT steps and stages explores what an EFT therapist SEES and HEARS, what the therapist and clients actually DO, and finally HOW (the manner in which) an EFT therapist intervenes for each step of the model.
  • Key ingredients of change are summarized at the end of each of the chapters delineating the 9 steps of EFT.
  • A chapter synthesising the entire model summarises “markers” (or guideposts) for following the EFT map, for working with emotion, and for going through each step of change. This chapter also guides a therapist to use “felt sensing” to follow these markers.
  • EFT in special circumstances – working with addictive behaviors, resolving relationship-specific attachment injuries, and extending the model to working with individuals – is discussed in subsequent chapters.
  • The book closes with a summary of the pearls of wisdom of EFT, a look at the future of EFT and suggestions for you to design your own next steps with EFT.
  • Reference is made in the book to video therapy sessions, that complement the writing, available for mental health practitioners to purchase, at www.steppingintoeft.com. The videos include first, a session with a gay couple, illustrating elements of the first change event of EFT – de-escalation, to complement chapters 4 and 5, which describe “Assessment and alliance: The attachment experience of steps 1 and 2” and “The tyranny of unheeded attachment fears: Unpacking emotion in the de-escalation change event: (Steps 3 and 4)”. Second is a Stage 2 session, with a more withdrawn female partner and a more pursuing male partner, demonstrating consolidation of the second change event of EFT withdrawer re-engagement, and the third change event of EFT – known as blamer softening. This complements Chapters 6 and 7 – Working with emotion to shape the withdrawer re-engagement and blamer softening change events. Finally, to augment Chapter 12, “Extending attachment-based EFT to individual therapy” is a video of an EFT session with an individual, demonstrating the five moves of the “EFT Tango”.

In Chapter 1, Introduction to emotionally focused therapy (EFT), we meet Emily, a therapist newly learning EFT and three of her couples who reappear throughout the book as we walk through the steps and stages of EFT. The chapter presents a brief history of the development of EFT, presents the steps and stages of the EFT map for change, and outlines the research validating EFT as an evidence-based approach.

In Chapter 2, Key Ingredients of Change on the EFT Roadmap, I expand on three client factors – task alliance, emotional depth and affiliative interactions. I explore the empirically validated EFT therapist interventions that are needed to follow the EFT map for change.

Chapter 3, The Revolutionary New Science of Love as an Attachment Bond, offers an experiential felt sense of adult romantic love as an attachment bond, similar to the bond that exists between infant and parent. Threats to an attachment bond are viewed as the element that casts romantic love in peril. I answer the questions, “How is romantic love an attachment process?” and “How does attachment theory provide a clearly articulated theory and science of adult love?”

I immerse the reader in an attachment view of adult love that helps him/her to discover how attachment theory serves EFT clinicians as a reliable and active guide from the first session with a couple through the entire change process. I end the chapter by examining roadblocks commonly encountered by therapists seeking to internalize attachment theory as a guiding paradigm for couple therapy.

In Chapter 4, Assessment and alliance: The attachment experience of steps 1 and 2, I hold up an attachment lens for the reader to see and experience how attachment sculpts and forms the alliance building and assessment process in Steps 1 and 2. The main aspects of Step 1 are described as: 1) Creating safety in sessions; 2) Assessing for compatible agendas between partners; 3) Making a therapeutic contract; 4) Privileging process over content; 5) Having individual sessions. Clients and therapists collaborate in Step 2 to name the dominant attachment dance – including the moves each partner makes, the threatening cues that trigger these moves and the meanings each partner makes of the other’s moves. Positions of pursuit and withdrawal are identified. Clients make contact with each other through simple enactments, acknowledging the self-protective moves they make in the negative cycle.

Drawings of the typical negative cycles of Kyle and Tara (pursue/withdraw) and Phil and Julie (the frozen lake withdraw/withdraw) are presented. These visualizations illustrate how the action tendencies of one partner cue the attachment fears and meanings of the other partner, triggering self-protective action tendencies in reaction, and creating repetitive cycles of unsatisfactory strategies for connection. To help the reader differentiate who is the pursuer and who is the withdrawer in a negative cycle, I explore in this chapter, the emotional experiences that are connected to particular positions of withdrawal and pursuit.

Chapter 5, The Tyranny of Unheeded Attachment Fears: Unpacking Emotion in the De-escalation Change Event (Steps 3 and 4), sets the stage for understanding emotion as a dynamic process, and describes the various paths into primary emotion that remains outside of immediate awareness. The theory of emotion upon which EFT is built is laid out in the chapter – to enhance readers’ capacity to work with emotion as the target and agent of change. I describe Emily’s discovery of what it means that emotion is a multi-faceted process (perceiving safety or danger, sensing bodily arousal, making meaning, being motivated to act). I delineate how to unpack the process of emotion with couples – validating and respecting the cues which signal danger, until each partner is able to find words for their nuanced version of attachment panic.

Chapter 6, Working with Emotion to Shape the Withdrawer Re-engagement Change Event (Steps 5 – 7), begins with the seismic shift of the Stage 2 change events – withdrawer re-engagement and blamer softening. The signs of de-escalation and a growing tone of safety are described, helping a therapist know when a couple is ready to begin Stage 2. The reader is presented with the rationale for the change event of withdrawer re-engagement needing to precede the blamer softening change event. In Stage 2, the withdrawer takes the lead into Stage 2, “diving more deeply into his or her emotional processes”, distilling and disclosing newly accessed experience to the other partner.

“Emotional handles” of a withdrawer’s primary emotional experience are delineated as markers of “the withdrawer’s hidden misery or despair” and as places to begin the expansion and deepening of his or her core attachment fears and needs. I illustrate the “overly determined sense of independence and self-reliance” of more withdrawing partners and the survival strategy that more avoidant partners use “to avoid any emotional state that would interfere with their main goal of keeping the attachment system deactivated.” Withdrawers also seek to avoid experiencing “emotions that are associated with a sense of threat and vulnerability (such as fear, anxiety, anger, sadness, shame, and guilt.”

In withdrawer re-engagement, a therapist invites the partner to take the ultimate risk of “stepping into the relationship, towards an intimate partner, with vulnerability and assertiveness, taking a stand to give voice to his or her wants and needs.”

In Chapter 7, Working with Emotion to Shape the Blamer Softening Change Event (Steps 5 – 7,) I explore the blamer softening change event (BLS). This second round of Steps 5–7 are focused on the more pursuing partner softening and taking a new position in the relationship. Recent research is presented, showing that BLS is found to be crucial to success in shaping secure bonds between partners. The change event of BLS is clearly defined. Key ingredients of change in BLS are explored from the perspectives of what is seen, what is done, and how the steps are done. The couple, Sophie and Ella are shown walking through the themes of Blamer Softening.

In Chapter 8, Consolidating Secure Bonds in Stage 3 of EFT (Steps 8-9), I give an overview of Stage 3 consolidation, where the therapist guides couples through integrating and consolidating the changes they have made so that they can continue to shape and grow their love relationship. Stage 3 is a time of celebration, satisfaction, and happiness. I describe how in Step 8, EFT therapists support partners to collaborate in solving pragmatic problems, now that differences are no longer triggers of attachment threat, and in Step 9, encourage partners to create ways to keep their secure bond of love alive.

In chapter 9, Integrating and Consolidating the Map of EFT, I integrate and consolidate the process of EFT as a scientific and artistic endeavor. I illustrate signals or micro-markers of emotional experiencing. I present guideposts through the steps of change and give descriptions of the EFT tasks to do at each of these steps. Finally, to help you to refine your creative competency as an EFT therapist and to integrate EFT into what Carl Rogers called a “way of being”, I end the chapter with a discussion of therapist felt sensing. I argue that a therapist’s ability to get a felt sense of the attachment drama playing out between partners is the link between knowledge and competency.

In Part IV, Chapters 10 and 11, I discuss two specific issues that frequently create complications and can block relationship repair in EFT therapy: Addictive processes and relationship-specific injuries, defined as attachment injuries. Both create relationship trauma and pose a serious threat to the security of the attachment bond. They can also make de-escalation very challenging. I seek to increase readers’ comfort with assessing for and working explicitly, first with addictive behaviors as faux attachments (Flores, 2004) in Chapter 10 and, second, with relationship-specific attachment injuries in Chapter 11.

In Chapter ten, Addictive Processes as Substitute Sources of Comfort, I explore a changing view of addictive processes. Initially considered a contraindication for couple therapy, addictive processes are now approached as an attachment-related problem that, if acknowledged, can be worked with in EFT.

I present the positive incentive theory of addiction – the view that addictive processes are motivated by a search for reward. This view, rather than the older physical dependence model, fits with EFT, as it is consonant with attachment theory. The positive incentive theory holds that it is the preoccupation with anticipating the reward of the addictive substance or behaviour that becomes the problem. EFT therapists track negative cycles of this web of expectation. I describe how effective dependency or secure connection is the antidote to reliance on addictive processes, with the case example of Emily working with Jess and John.

One of the challenges for therapists seeking to work with an attachment frame, discussed in Chapter 3, is that of tacitly seeing one partner as largely responsible for the relational distress. This challenge presents itself very boldly when addictive processes are present. The positive incentive model of addiction and attachment theory can support an EFT therapist to keep from being sucked into a “find the bad guy” mentality, working instead through times of darkness and ambiguity with patience and open-mindedness.

In Chapter 11, Repairing Broken Bonds: Forgiveness and Reconciliation with EFT’s Attachment Injury Resolution Model, I describe attachment injuries ranging from infidelity to physical or emotional absence during a time of critical emotional need. An attachment injury is defined as a specific relational incident, where one partner is inaccessible or unresponsive to offer comfort and caring in a particular moment of need, shattering the bond of trust between intimates. I describe different ways an attachment injury can emerge in therapy.

Since such injuries cannot be ignored nor be resolved in the negative climate of Stage 1, I begin with describing how to work in Stage 1 when an attachment wound is present, and then describe the attachment injury resolution model (AIRM) for reconciliation and rebuilding trust in Stage 2. With the case of Gail and Paul, I show Emily working in Stage 1 with the mistrust of a shattering attachment injury. I present the specific steps of the AIRM and studies validating the model to resolve an attachment injury in Stage 2 and illustrate with Emily following the AIRM to resolve an attachment injury with Deshawn and Tanisha.

In Chapter 12, Extending Attachment-based EFT to Individual Therapy, I respond to one of the inevitable next steps for a therapist embracing EFT: A search for how to extend this model across all of one’s therapy clients and in particular, how to extend attachment-based EFT to individual therapy. I describe Emily’s quest to apply EFT smoothly to individual therapy. She thinks of the elements of EFT that she has come to rely on and value so deeply: shaping secure bonds by (a) focusing on attachment, (b) following emotion, and (c) priming new responses, and she reflects on how she can extend the elements she values in EFT with couples to individuals.

In this context, I discuss how these elements are applicable to individual therapy: (a) Dyadic co- regulation and secure attachment is not a dynamic restricted to romantic relationships, but is more efficient and more effective than conscious self-soothing to regulate emotions; (b) Tracking repetitive and automatic patterns of emotional behaviors during times of stress, is as relevant an initial step for individual therapy as it is for couple therapy; (c) The transformative aspect of EFT couple therapy can be applied to shaping new responses in individual therapy as well.

I discuss Emily’s quest to extend EFT to individuals by noting that the attachment perspective focuses upon dyadic relationships and that there are three basic relational contexts in therapy with individuals: the client’s relationship with the therapist; the relationships the client has with others in his/her life, and the client’s mental representations of relationships with attachment figures from the past that often blend with conflictual inner relationships with parts of self.

I provide several case examples and delineate the EFT interventions and the five moves of the EFT Tango in EFIT. I seek to give the reader practical guidelines and a map to follow as well as an experience of how emotionally focused individual therapy can be an experience of love and transformational change.

In Chapter 13, Future Steps: You and EFT, I encourage readers is specific ways to use Emily’s integration of EFT as a model to trust their capacities to develop their own style of EFT, one step at a time. I encourage participation in the international EFT community (www.iceeft.com) as well as in local peer support groups. I review Johnson’s three pearls of EFT: following emotion, focusing on attachment, and creating therapeutic enactments. I suggest ways of growing by experiencing the EFT model and take a brief glimpse at the future of EFT.

I end the book by expressing my hope that you now feel “ready to accelerate your exploration of EFT’s art and science of creating secure bonds. You’ve picked a winning route for your journey. Go for it!”

Lorrie L. Brubacher, MEd, LMFT, is the Founding Director of the Carolina Center for EFT (Emotionally Focused Therapy). A certified trainer with the International Centre for Excellence in EFT (ICEEFT), she is an individual, couple and family therapist since 1989. She is also an adjunct at University of North Carolina, Greensboro, and has previously taught at several Canadian universities. She trains internationally and publishes frequently on the topic of EFT, often with its originator, Dr Sue Johnson. She co-developed EFT’s first interactive video training program.

        Her book, Stepping into Emotionally Focused Couple Therapy: Key Ingredients of Change has recently been published by Karnac.

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