The case conceptualization frame- work assumes that the client’s general distress, which shows in the form of undifferentiated painful emotions characterized by hopelessness and helplessness (global distress) or by irritability (rejecting anger), is the response to current and past triggers. Emotion-focused therapy (EFT) views clinical disorders as, at base, emotional disorders. In addition, I introduce them to the strategy of relating to intrusive feelings from a wise perspective. Emotionally Focused Therapy Case Conceptualization. Unfortunately, when infants dissociate, the distressing feelings do not go away but become locked in the central nervous system, ready to be triggered by way of a conditioned response whenever there is a reminder internally (thoughts, feelings, memories) or externally (the environment) of the early trauma. Dave expressed anger in the form of defensiveness and passive-aggressiveness. Date: Clinician: ... Identify significant persons in client’s relational/family life who will be mentioned in case conceptualization: Adults/Parents: An "unavailable caretaker" creates distress in a baby akin to an "unavailable partner" creating distress in an adult. cess of developing a case conceptualization and treatment plan is time-consuming at first, over time it will increase the likelihood you will provide effective and time-efficient treatment. On the influence dimension, Angela thought that she and Dave shared influence fairly equally, but Dave disagreed strongly. Step III: Accessing unacknowledged feelings underlying partners’ positions in the mixed, negative cycle. Dave indicated that he loved her very much and showed his love for her in other ways. In other words, if someone says or does something in relation to me (the stimulus), and I have big feelings about it, it is important that I realize that what comes between the stimulus and my big feelings is myself, how I interpret the stimulus based on my own trauma feelings and history. She had lots of resentment toward Dave – such as his giving more to his employees than to her and playing computer games at night rather than spending time with her. 2) presents a clinical strategy and actions of a therapist working with clients with autistic process.The strategy consists of several aspects within three phases leading to emotion transformation. Step II: Identification of the mixed, negative cycle of interaction. Validating their feelings not only indicated that I was taking both their sides, but also helped them to feel understood. The process reduces couples’ conflict while creating a more secure emotional bond. After validating their secondary emotions, I began to explore tentatively their underlying, intrusive feelings. The impact of behavioral couple therapy on attachment in distressed couples. The position taken by Angela evoked recursively the position taken by Peter and vice versa. The case conceptualization model (see Fig. Typically, Angela assumed the position of being one-up or dominant by defining reality in some way for both of them. Although they perceived that they were having little impact on each other because neither were feeling heard, in actuality they were having enormous impact on each other. How to increase brand awareness through consistency; Dec. 11, 2020. Case conceptualization is a framework used to 1) understand the patient and his/her current problems, 2) inform treatment and intervention techniques and 3) serve as a foundation to assess patient change/progress. I suggested that Angela’s pursuit of Dave on the affiliation dimension in the form of criticism and blame was a protest, a determined effort to reach for Dave in order to avoid anxiety and emotional pain and instead to feel close and loved. I encouraged Angela and Dave to experience their feelings on an emotional level rather than to relate to them on an intellectual level, because it is emotional experiencing rather than intellectual insight that heals. This is typical of distressed partners, who tend to avoid exposing their vulnerable feelings with their anger. I will illustrate each of the steps using the clinical case of a Angela and Dave, a hypothetical distressed couple experiencing a lot of conflict. EFT provides a language for healthy dependency between partners and looks at key moves and moments that define an adult love relationship. For use with individual, couple, or family clients. It argues that other forms of psychotherapy have overemphasized conscious understanding and have underemphasized the roles of emotional change. In his mind, they could argue about anything. This research study aims to create a map of how the case formulation process occurs within an Emotion-Focused therapy couple’s (EFT-C) framework. When I asked what brought them to counselling, Angela commented that she wanted to learn to communicate better. Someone else may experience the same stimulus and feel very different feelings based on how they interpret the stimulus through the lens of their trauma feelings and history. Copyright 2019. This is the reason we are triggered as adults in our romantic relationships, in the same repeating (and unhealthy) patterns from our formative years. All of our distressing feelings are best understood as intrusive feelings; that is, feelings that when triggered, intrude from the past into the present, colouring our experience of the world and causing us distress to varying degrees (see the article, Intrusive Feelings). Obegi & E.Berant (Eds. These conceptualizations inform all aspects of treatment, including who should attend sessions, the type of therapeutic relationship, the therapist’s theoretical orientation, and therapeutic interventions. Step IV: Reframing the problem in terms of partners’ underlying feelings and attachment needs. Its formation begins in childhood with a primary caretaker, such as a parent.. Once home, his mother returned to work after about four months and he had been cared for by his maternal grandmother, whom he recalls being cold. EFT offers an emotion‐based case formulation of SAD, in which social anxiety is conceptualized as secondary to primary maladaptive shame. Dave assumed the position of being one-down or subordinate by allowing her to define reality, albeit with protest. “A powerful video, useful for practitioners, educators, and students, especially those studying or working in Couples and Family therapy. Angela expressed anger in the form of criticism and blame. It is also quite useful with various cultural groups throughout the world. Also, she resented that he failed to show expressions of love and interest in her – such as writing her love notes or enquiring about how she was doing at work by text – despite her frequent requests. Also, I suggested that he would have felt bad about himself (shame) when he was dropped off at his grandmother’s each day and experienced her lack of interest in him, feelings that would have been reinforced as a child when his father was intoxicated and angry with him. Read our, Verywell Mind uses cookies to provide you with a great user experience and for our, The 10 Best Marriage Books for Couples of 2020, The Benefits of Couples Therapy While Separated, The Best Online Marriage Counseling Programs, How Constructivism Helps People Make Their Own Life Path, Everything You Need to Know About Relationship Counseling, What You Should Know About Attachment Styles, How John Bowlby Influenced Child Psychology, Find out How Imago Therapy Can Transform Your Relationship, Influential Theories About How Children Grow and Develop, How to Know if You Need Marriage Counseling, Emotional Freedom Technique (EFT) for Panic and Anxiety, What Affectional Bonds Mean in Attachment Theory, Daily Tips for a Healthy Mind to Your Inbox, established patterns carry through to adulthood, The impact of behavioral couple therapy on attachment in distressed couples, Formation and disruption of bonds between caregivers and institutionalized children, Soothing the threatened brain: leveraging contact comfort with emotionally focused therapy, Emotionally focused therapy with couples — the social work connection, Demand-withdraw patterns in marital conflict in the home. The primary goal of the model is to expand and re-organize the emotional responses of the couple. I validated both Angela and Dave for risking being more vulnerable with each other, and for their willingness to experiment with a new way of communicating with each other. Also, I suggested that Dave’s distancing after his initial defensiveness was his attempt to avoid anxiety triggered by conflict and to protect their attachment from the damage of escalating conflict. Angela said that her mother had had difficulty coping while pregnant with her because she already had four children and her dad worked long hours. ), Attachment theory and research in clinical work with adults (pp. As Angela and Dave expressed their feelings and needs more responsibly, they felt less defensive and found it easier to validate each other (see the article, About Feelings). He recalled that he had been born three weeks premature, and had spent about two weeks in the hospital separated from his mother before coming home. In actuality, these steps are mutually overlapping and recursive. He notes that what comes between what a person says or does (the stimulus) and an individual’s feelings is the “self” of the individual. Cultura RM Exclusive-Lost Horizon Images / Getty Images, Emotionally Focused Therapy (EFT) is a short-term (eight to 20 sessions) and structured approach to couples' therapy developed by Drs. After a few days of little contact, Angela would initiate talking again. Emotion-focused therapy (EFT) is a therapeutic approach that aims to help clients to become aware of, viscerally experience, accept, express, utilize, regulate, and transform emotion. Likewise, I explored the intrusive feelings that underlay Dave’s position as distancer. Marni Feuerman is a psychotherapist in private practice who has been helping couples with marital issues for more than 27 years. In this view, although we are entitled fully to whatever we feel (see the article, About Feelings), it is best to own and take responsibility for whatever we feel as belonging to the self rather than blaming others for our feelings. Dave’s experience of intrusive feelings of fear and diminishment (an aspect of shame) informed him of his needs for safety and respect. I point out that trying to change one’s partner is counter productive, merely fueling the negative cycle. As we terminated counselling, I congratulated Angela and Dave for their efforts and changes, suggesting that, because change is uneven, likely they would hit some bumps moving forward. I encouraged Angela and Dave to contain, soothe, and heal the intrusive feelings that were triggered in the relationship by relating to them from a wise perspective (see the article, Listening to Our Feelings from a Wise Perspective). I suggested that likely he too would have experienced overwhelming feelings of pain and helplessness while separated from his mother as a preemie in the hospital. Emotionally Focused Therapy (EFT - Emotionally Focused Therapy) is a structured approach to couples therapy formulated in 1980 and developed through the science of adult attachment and emotional ties to expand the understanding of what happens in relationships and to guide therapists. Feelings are like a compass in that they orient us to what we need, to what matters to us (see the article, About Feelings). In this case study, we will look at one young lady who is beginning to explore the role of anger in her life, and how it could be addressed in couples therapy through the use of assessment tools and Emotionally Focused Therapy. Formation and disruption of bonds between caregivers and institutionalized children. Case conceptualization also aids in establishing rapport and a sense of hope for patients. As Angela and Dave made a conscious effort to allow their intrusive feelings and to relate to them from a wise perspective rather than avoid them by trying to change each other, the intensity of their feelings began to diminish, they experienced less conflict, and they began to feel more securely attached to each other. For example, I suggested it was understandable that Angela felt resentful of Dave when she perceived he was more attentive to his employees than to her. Rev Bras Enferm. Angela’s increased openness to influence was apparent in how she modified her controlling behavior and expressed the need for practical support in a responsible manner. In Step II, I identify the negative cycle of interaction that maintains the couple’s distress and undermines a secure attachment. Therapists who provide emotionally focused couples therapy (as the approach is also known) typically work with couples and families to help facilitate the … EFT can help couples understand themselves and their partner better, which makes it easier to interact positively with one another. Angela, a part-time teacher in her late 20s, requested an appointment for her and her husband, Dave, who was in his mid 30s. The change process has been mapped into a clearly defined process consisting of nine steps and three change events that help guide the therapist and track progress. According to Dr. Carr, in order to understand how an infant is traumatized, it is important to recognize that it is the infant’s experience of the event rather than the event itself that is traumatizing. When I asked if this was a familiar feeling, she commented that she had often felt neglected as a child, particularly when she got home from school a few hours before her parents returned from work. PLoS ONE. According to the website dedicated to EFT, a substantial body of research outlining the effectiveness of this treatment exists. It is now considered one of the most (if not the most) empirically validated forms of couples therapy. In Step I, I develop a clear understanding of whether the couple’s conflict is primarily on the affiliation dimension of interaction, the influence dimension of interaction, or both. Emotion‐focused therapy (EFT), which is an efficacious treatment for depression, complex trauma, and couples' distress may also be efficacious for SAD. On the affiliation dimension, Angela’s way of avoiding anxiety (blaming about lack of contact) triggered Dave’s anxiety about conflict, and Dave’s way of avoiding his anxiety (defensiveness followed by shutting down) triggered her anxiety and pain about loss of contact. What they found interesting was how much impact they had on each other in this fight cycle. Top 10 blogs in 2020 for remote teaching and learning; Dec. 11, 2020 For example, Angela refrained from being a back seat driver and insisting that he clean the kitchen in her way. Johnson, S. M. (2009). I pointed out to Angela and Dave that there was a pattern to their conflict on both dimensions of interaction, which is called a mixed, negative cycle. She noted that they had always had a … Emotion-Focused Family Therapy . First, it is supported by extensive research. Second, it is collaborative and respectful of clients. I am safe now”. It is grounded in research while focusing on negative communication patterns and love as an attachment bond. Social Work Today. Rather than perceiving Angela as aggressive and controlling, Dave began to see her as attempting to reduce her anxiety and pain, to feel close to him, and to maintain their attachment. It pleased him to know that he was contributing to her happiness. Also, I suggested that they assumed predictable positions in this negative cycle on the affiliation dimension. She noted that they had always had a lot of conflict, nearly separating a few times. Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved, Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. The more we allow and feel the feelings with an attitude of wisdom and compassion for ourselves rather than escape them, the more they diminish and resolve. Attachment also offers a secure base, allowing you to feel safe while you explore the world and learn new information. They had been married for three years and did not have children. Dave agreed, and also expressed a concern about how they fought a lot about trivial matters. Both said that they not only felt more heard and understood, but also felt some relief about understanding their feelings and relationship patterns more fully. They had been married for three years and did not have children. Therapist (to Dave): I’d like you to tell her, “Let me see if I got you” and then paraphrase what you heard her say. Benson LA, Sevier M, Christensen A. EFT can help to unwind these automatic, counter-productive reactions. Dave would respond defensively. As an experiential therapy, EFT requires a careful balance between following and guiding clients, helping them work at the leading edge of their attachment emotions and needs. As I explored their conflict from both their points of view, I began by validating their secondary emotions. Once again, they were having significant impact on each other without realizing it. Angela stated that Dave, the owner of a small company, thought they should be able to resolve their problems on their own but had agreed reluctantly at her insistence to attend couple’s counselling. It shifts blame for the couples' problems to the negative patterns between them, instead of the couples themselves (or the partners). She began to tear and said, “It’s painful “. Changes were now evident in Angela and Dave’s mixed, negative cycle. I validated both Angela and Dave by suggesting that their feelings were understandable in the present situation. Both realized that they were insecurely attached as infants, and that they didn’t deserve to have the intense, intrusive feelings that caused them to be insecurely attached to each other. When this occurred, I encouraged each of them to validate the partner’s experience without feeling responsible for it. For example, Angela’s experience of intrusive feelings of helplessness and anxiety informed her of her needs for contact and a sense of control. The only protection that an infant has against experiencing intense trauma feelings, therefore, is a highly attuned caregiver who responds sensitively to the infants’ needs before they reach high levels of distress and fall into the freezing response. Although we are so accustomed to trauma feelings that intrude at a low level chronically in the form of mild tension and dullness that we accept this as normal, it is when these feelings are triggered – such as during conflict with our partner – and intrude at high levels of fear, shame, and pain that we feel distressed. Angela and Dave showed a lot of negative emotion in their marriage. Selecting a Theoretical Perspective Sue Johnson and Les Greenberg in the 1980s. The purpose of this paper is to explore the assumptions, the goals, and the process of emotionally focused therapy (EFT) for couples and families through a cultural lens. Research studies have found that 70-75% of couples undergoing EFT successfully move from distress to recovery, and approximately 90% show significant improvements. However, as soon as the amygdala encounters threatening or unfamiliar information, it increases the brain’s anxiety level and focuses the mind’s attention on the immediate situation. According to an article on EFT in Social Work Today, any perceived distance or separation in our close relationships is interpreted as danger. Losing the connection to a loved one threatens our sense of security. Step V: Feeling the intrusive feelings that underlie the mixed, negative cycle. Dr. Paul S. JamesRegistered Psychologist #975, Dr. Paul S. James, Ed.D.Email: info@pauljames.caKing Edward/Oak St. Office.Phone: (604) 873-0222, Vancouver Anxiety Disorder Counselling & Therapy, Early Trauma Feelings: What We Don’t Remember Can Hurt Us, Listening to Our Feelings from a Wise Perspective. For example, I said to Angela, “I’m wondering if you don’t feel neglected and unloved when Dave plays computer games rather than spending time with you at night.” When she answered affirmatively, I asked her what it was like to feel neglected and unloved. EFT has proven to be a powerful approach for couples dealing with infidelity or other more traumatic incidents, both current and past. In his mind, he was easy going and she was bossy, constantly telling him what to do and criticizing how he did things. This freezing response, in which the animal looks dead from the outside but is highly activated internally, is adaptive biologically because the animal has a greater likelihood of survival by appearing dead. I don’t deserve to feel so scared, bad, and in so much pain. I suggested that both of their intrusive feelings were being triggered in the relationship and that these intense feelings underlay their mixed, negative cycle. Emotion focused therapy for couples consequently emphasizes the interpersonal experience, expression, and processing of emotion within a relational dyad (Greenberg & Johnson, 1988; Johnson et al., 1999). Case conceptualization refers to how a therapist thinks about, or conceptualizes, the client’s concerns. Emotionally Focused Therapy, also known as EFT, entails a variety of therapeutic approaches that can be used for individuals, families and couples, and centers around the understanding and regulation of emotions as the foundation for positive change in interpersonal relationships, communication and emotional management. I then asked if it would be okay if I introduced them to a new way of communicating, and with their consent, the following dialogue ensued: Therapist (to Angela): I’d like you to tell him directly, “I find it so painful when at the end of a long day apart I want to spend some time with you and you seem to prefer computer games rather than being with me.” I, Angela (to Dave): “I find it painful when you seem to prefer computer games over time with me at night.”. Emotionally Focused Couple Therapy For Dummies by Brent Bradley and Jamies Furrow,  Hold Me Tight: Seven Conversations for a Lifetime of Love by Sue Johnson, or An Emotionally Focused Workbook for Couples: The Two of Us by Veronica Kallos-Lilly and Jennifer Fitzgeralds are all good places to start. I said to Dave, “I wonder if you don’t feel anxious when you feel blamed by Angela for not spending time with her,” Dave stated, “I guess so, because I feel tense and on edge.” When asked if this was a familiar feeling, he stated that he often felt tense growing up when his mother was critical of his dad for coming home late which led to conflict between his parents. In other words, her pursuit evoked his distancing, and his distancing evoked her pursuit. "Primal fear" ensues and sets off an alarm in part of our brain called the amygdala, also known as the fear center. On the influence dimension, I suggested that Angela’s controlling behavior was a way of avoiding anxiety by being in control, and that Dave’s passive-aggressiveness after his initial protest was his way of avoiding anxiety and feeling diminished (shame). (2010) Emotion-Focused Therapy for Complex Trauma: an integrative approach. More recently produced MRI studies demonstrate the significance of secure attachment. Our attachments are potent, and our brains code them as “safety.”. In addition, I indicated there is evidence that the fetus is affected by the mother’s level of stress and anxiety, and that the birth experience can be highly traumatic if there are complications and unnecessary medical interventions. Emotion-focused therapy (EFT) is designed to target and change unhealthy emotional processes that underlie the problems people bring to therapy with the goal of co-constructing new, healthier emotional … 2013;8(11):e79314. Those early, established patterns carry through to adulthood. New York: Guilford. doi:10.1371/journal.pone.0079314. Attachment theory and emotionally focused therapy for individuals and couples. I suggested that their pattern on the influence dimension was as follows. In Step III, I help partners acknowledge feelings that typically underlie their positions in the negative cycle and are largely not in their awareness. EFT approaches include elements of experiential therapy (such as person-centered therapy and Gestalt therapy), systemic therapy, and attachment theory. Attachment theory provides the emotionally-focused therapist with a "road map" to the drama of distress, emotions, and needs between partners. Case formulation in EFT represents an organizing framework and a map to help therapists specifically address these emotional problems. Even when either of them expressed themselves less responsibly by blaming or becoming defensive, realizing that one’s partner is responsible for his or her feelings helped the other to remain present and calm. Although the theory and working model are easy to understand, application of the model can be quite challenging. Also, I suggested it was understandable that Dave felt defensive when he perceived that she was being bossy in some way. Emotion-focused therapy case formulation focuses on the client’s narrative content (the stories they tell) as well as emotional processing (how the client feels). When humans dissociate, they detach from their experience and feel numb. He also started to text her daily at work enquiring about how her day was going. Doing so helped them to contain, soothe, and heal the feelings. The relationship becomes a haven and a healing environment for both partners. In EFT, the angry, defensive feelings that partners use in the negative fight cycle to avoid either feeling and/or revealing their underlying feelings are called secondary feelings (see the article, Avoiding Feelings with Anger). The infant’s experience of mild distress quickly escalates into overwhelming feelings of helplessness and pain if the infant isn’t responded to in a timely and sensitive manner. Sue Johnson and Les Greenberg in the 1980s. What they found most interesting was how much impact they had on each other in this fight cycle. Both seemed puzzled about this because they saw themselves as intelligent people. In Making Happiness, Vancouver Psychologist Dr. Geoffrey Carr discusses the notion of responsibility for feelings and says that people are the stimulus but not the cause of our feelings. As Angela and Peter allowed themselves to feel their intrusive feelings more fully, I encouraged them to express these feelings and associated needs responsibly (see the article, Responsibility for Feelings). In other words, her control (defining reality) evoked his passive resistance in the form of under functioning, and his under functioning evoked her assuming more control in the form of over functioning. What is interesting is that as Dave made these changes, he liked the increased contact with Angela and the appreciation that she showed for his efforts. 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