Tuesday, August 26, 2014

Questions & Answers about Emotion-Focused Therapy (EFT) and Social Anxiety

Entry for  26 Aug 2014:
 This was written some time ago for a mental health organisation website, but unfortunately never saw the light of day.

1. Can you say a few words about how you became interested in researching social anxiety and about your therapeutic approach?

Emotion-Focused Therapy (EFT) -- not to be confused with the “Emotional Freedom Technique” – is a humanistic approach to psychotherapy or counseling that is similar to Person-Centred Counselling but is more structured and combines a genuine, caring, empathic relationship with specialized techniques to help clients deal with specific issues that they bring to sessions.  These issues, referred to as “tasks”, include internal conflicts, unresolved relationship issues such as emotional injuries, puzzling personal overreactions to situations, and problems finding the most useful level of emotions.

EFT was originally developed as a treatment for depression in the late 1980’s, before being extended to trauma in the 1990’s.  However, there is a large overlap between depression and anxiety, so EFT therapists have always had to work with anxiety alongside other presenting problems.  Furthermore, many clients who present with traumas such as childhood mistreatment suffer from PTSD, which is usually regarded as a type of anxiety problem.  Building on this earlier work, in the past 10 years EFT therapist-researchers in the Canada, Ireland, Israel and Scotland have begun turning their attention to anxiety as a main presenting problem.

2. How is EFT different from other approaches in working with social anxiety?

Social anxiety is fear of other people, most commonly fear of speaking or doing things in public and fear of close relationships with others.  The main other approach to social anxiety is cognitive-behaviour therapy (CBT).  CBT focuses on the dysfunctional thoughts or beliefs that generate social anxiety, as well as the avoidance or safety behaviours that maintain it.  EFT sees dysfunctional thoughts and avoidance behaviours as the result of underlying emotion processes, such as “anxiety splits” in which one part of the person tries to induce fear in order to prevent perceived social dangers.

3. What is the evidence that EFT is effective in working with social anxiety?

We’ve just completed a reasonably large study with socially anxious clients, comparing EFT to person-centred counseling.  Clients in both treatments showed substantial pre-post improvements, but clients in EFT improved more, especially on measures of social phobia and the particular issues they wanted to work on.  Our results also suggest that we got better at working with social anxiety as the study progressed, as we developed and refined our approach, especially in the EFT arm of the study.  We are currently writing this study up for publication but a preliminary report was published last year in the journal Person-Centered and Experiential Psychotherapies.

We’ve found that some socially anxious clients benefit from an unstructured nondirective approach; however, we’ve also found that many others have trouble coping with unstructured social situations and therefore seem to do better with more structure and focus in their treatment.

4.What can a client expect to happen when they engage in Emotion-Focused Psychotherapy?

The first few sessions of EFT are fairly similar to Person-Centred Counselling (from which EFT is a development):  The therapist begins by trying to establish a genuine, caring and empathic relationship.  However, for clients with social anxiety who are afraid of unstructured one-to-one situations EFT therapists try to offer more structure at the beginning, until they feel safe with the therapist.  Also, EFT therapists tend to provide more information about the nature of therapy and social anxiety.  As therapy progresses, EFT therapists listen very carefully for what the client is bringing into each session to work on, such as being puzzled about why they get so anxious around other people, or self-criticism, or unresolved feelings from having been bullied when younger.  These are examples of EFT “tasks”, specific pieces of the social anxiety that can be worked on bit by bit, using specific techniques such as “replaying” a social anxiety episode like it was a movie to recapture triggers; or having an imaginary conversation with your internal critic or even with the people who bullied you.  The therapist never imposes these ways of working on the client, but does offer them as things that EFT therapists have found to be helpful with clients.  The therapist also tries to leave time at the end of each session for helping the client set aside any painful emotions that they might have gotten in touch with, and also for reviewing what has been accomplished in the session and what might be next in therapy.  In the end, however, the therapeutic relationship comes first, both because it is healing in itself and because it provides a safe situation for the client to work productively on the difficult or painful experiences that are at the heart of social anxiety.

5. How long is a course of treatment?

The version of EFT that we’ve developed for social anxiety at the University of Strathclyde lasts up to 20 X 50-min sessions.  Although some clients require fewer sessions or more sessions, most are able to make productive use of the available sessions.

6. Do you have a few helpful strategies or tips for someone suffering from social anxiety?

First, the thing about social anxiety is that everybody from Freud to your gran knows that the only way to get over being afraid of other people is to spend time hanging out with them until you stop being so afraid.  The problem, is how do you get yourself to do that, when you’re so scared? 

Second, self-acceptance is a very important part of recovery from social anxiety.  EFT is an acceptance-based therapy, like mindfulness. We say, “You have to arrive at a feeling before you can leave it.” It’s important to accept the fact that you are afraid of other people; this is the starting point.

Third, it’s useful to try to change emotion with emotion, to begin to move past simply focusing on being afraid of the horrible things that might happen with other people.  So it’s very useful to discover other feelings you might have:
·      Self-reflective curiosity about what your underlying feelings are and how this social anxiety stuff works for you
·      Connecting sadness at missing out on human connection
·      Protective anger at past unfair treatment or violations of your boundaries
·      Self-compassion for all the difficult things you’ve been through and the sad and lonely parts of you.

These are a few suggestions for beginning the journey of recovering from social anxiety.  However, because social anxiety comes from and involves relationships with other people, it is best treated within a safe, empathic, genuine relationship, whether that’s a counsellor/psychotherapist, parent or partner.

Thursday, July 24, 2014

PCE Conference in Buenos Aires

Entry for 24 July 2013:

Wonderful PCE conference in Buenos Aires!  I was overwhelmed by friendliness and care of our Argentine hosts. The weather turned cold (3C this morning), but that did not take away from the warmth of our Latin American colleagues.  High points:
• Unstructured large group (150 - 200 people) that inevitably ended up focusing on intercultural issues, some tragic, like the Malvinas-Falkland War and the Fukushima accident, other charming like the young American grad student who said she was going to tell her father how nice all the people she met were.
• The charming conference site (a private primary school with small desks that made me feel like I was 10 again).
• Keynote talks by the likes of Charlie O'Leary (who charmed everyone's socks off) and Shoji Murayama (who reviewed 50 years of building a person-centred community near Kyoto).
• A varied and interesting program that included sessions by Margaret Warner's session on fragile process and fragile relationships (including a very personal and moving account of her own journey) and Sylvia Lombardi's very helpful sessions on doing PCE therapy via Skype (just to pick two idiosyncratic choices)
• Oh, and my two presentations went very well, also:  The Counselling for Depression Workshop was popular enough that many people were very disappointed when they had to be turned away (they asked me to repeat the session on Thursday morning but unfortunately I had to miss the final half day of the conference), while the session on the Personal Questionnaire content analysis study was also well attended and successful, in spite of research not really being the South American PCE therapists’ thing.
I’ve heard many wonderful stories over the past few days, and hope I will be able to remember some of them, because many were very much worth retelling.  The sequential translation in large group and break out sessions provided me with a Spanish crash course, so that by the end of the conference both my receptive and expressive Spanish had greatly improved.  This should be very helpful as we move on to Ecuador today for several days of EFT training in Quito.  I’m looking forward to coming back to South America again before too many more years have passed.

Sunday, June 01, 2014

Prospects for the Next Year: An I Ching Reading on Turning 64

Entry for 1 June 2014:

My brother Willy reminded me that 64 is the number of hexagrams in the I Ching, the ancient Chinese book of divination. His email gave me the idea of consulting it about the prospects for the next year: Unfortunately, I left my yarrow stalk oracle (actually they are chicken skewers but they work just fine) in Ohio. However, it's all on line now, and I found a yarrow stalk oracle site I kind of liked, although I'm not completely sure of the readings (as usual). 

Any way, I got hexagram 37, Jia Ren/The Family, moving to 33, Dun/Strategic Retreat/Save your bacon. I don't remember ever seeing either of these hexagrams before back in my I Ching consulting days in the late 1960's/early 1970's. 


Hexagram 37:  Wind over Fire: The Family: There is a lot here about first protecting one's family, however that may be defined, by perseverance even in hard times.


Hexagram 33: Heaven over Mountain: Strategic Retreat: This then moves to making sure to hang onto the valuable essential things that sustain one's life. 

 Together, these seem like really good advice!

Saturday, May 31, 2014

Dundrennnan Abbey Adventure on my Birthday

Entry for 31 May 2014:

Many, many warm thanks to all my friends and family who have wished me happy birthday in various way. We had lovely Adventure near Kirkcudbright visiting Dundrennnan Abbey, a ruined 12th century Cistercian abbey with wonderful stonework.  As is so often the case for us, the high point was our interaction with the Historic Scotland docent/caretaker.  Glyn, an enthusiastic retired stone mason from Yorkshire, kept dragging us around the site to show one wonderful piece of stone work or architectural feature after another.  
 Right before we left, he took us to an iron gate in the south side of the cloister, which he said had been the door to the kitchen at some point:  "Do you seen that bottom stone on the right side of the door frame?, " he asked, pointing to a lovely carving of flower that stands out against the straight vertical groove carved through the stack of stones there.  "That were just some guy who decided one day to cut t' stone that way.  He didn't get paid for it, he just did it to say he were here.  And here he still is, you can read him in t' stone, all these hundreds of years later!"  The big smile on Glyn's face showed his vicarious pride, empathically resonating with his fellow craftsman across more than 800 years.

Monday, April 28, 2014

Spring 2014 EFT Network Meeting

The Spring 2014 EFT Network meeting will take place
Saturday, 3 May 2014: Video: Rhonda Goldman: EFT Case Formulation
Time: Saturday noon - 5pm

If you are interested in attending please contact me for more details.

Agenda/Approximate Timings:
1. Check-in/update on your practice, including EFT News Update (1 hr)
2. Video (1 hr)
3. Break: Please bring a wee snack to share; we will provide tea/coffee/juice (.5 hr)
4. Skill practice: open marker work; unless otherwise agreed (1 hr)
5. Group supervision (1 hr)
6. Processing (.5 hr)

You don't have to tell me if you're coming; but it would be helpful to know numbers.

We've also scheduled the next two EFT Glasgow Quarterly Network Meetings:

Summer: Saturday, 30 Aug 2014: Video: EFT for Depression, part 1
Autumn: Saturday, 29 Nov 2014: Video: EFT for Depression, part 2

All EFT Network Meetings are free and open to everyone who has completed at least one level of EFT training and is interested in developing their EFT practice.

Wednesday, April 16, 2014

Emotion-Focused Therapy Masterclass: Emotion Focused Therapy for Anxiety

Friday, 2 May 2014 9:30-17.30
University of Strathclyde, Glasgow

Openings remain for the next EFT masterclass.

In general, the results of using humanistic experiential psychotherapies with anxiety difficulties have been generally disappointing.  However, this is beginning to change, with the emergence of Emotion-Focused Therapy for social anxiety and generalized anxiety. In this session I provide an overview of experiential processes in anxiety and key EFT tasks in anxiety, including a recently developed integrated task model that incorporates problematic reaction points, anxiety splits, self-criticism splits, unfinished business and self-soothing. 

In this session I provide an overview of anxiety difficulties, a review of different person-centred-experiential theories of anxiety difficulties, and the EFT approach to working with anxiety, emphasizing anxiety split work and self-soothing.

Individual sessions of the new Emotion-Focused Therapy Masterclass Series are open to counsellors and psychotherapists (Diploma level or above) who have completed Level Two or Level Three training in EFT.  If it’s been a while since you did EFT training, the masterclasses can serve as a refresher course and enable you to catch up on more recent developments in EFT theory, practice and training.

This session will include videos or live demonstration, supervision of client work, and small group skill practice.  Participants are encouraged to bring in material from their anxious clients.

·      Enrolment is set for a minimum of 10 and a maximum of 15.  The balance between supervision and skill practice will depend of number of participants.
·      Course fee: £120.
·      The course could be taken for continuing professional education credit.

Contact: jan.bissett@strath.ac.uk or 0141-444 8415 for further information on this training, the facilitator, ways of applying for this course or other APT events.

Al Mahrer, Eccentric Humanistic Psychologist, RIP

--> Entry for 16 April 2014:

Word reached me today that Al Mahrer has died.  I can’t find any record of a birthdate, so I don’t even know how old he was, probably in his late 80’s, given that he got is PhD  1954.  Al was a wild & crazy guy.  Also quite annoying at times.  I suppose lots of people have Al Mahrer stories.  In one of his books, he claimed his therapy could cure cancer.  Some of my Al Mahrer stories I don’t feel are appropriate to record here, so I will just say that I was pretty outraged at the time.   

At the same time, tonight, as I reflect on his passing, I find myself wondering how it was in 1980 that he thought to invite Clara Hill, Bill Stiles and me to be part of an APA symposium on the future of psychotherapy research.  For some reason, he saw us as promising young psychotherapy researchers who might have something useful to say to the rest of the field. I don't think too many other people were paying attention to us then.  I didn't even know that about myself, until he slapped a grandiose title ("Fitting Process Research to Practicing Therapist"!) onto my untitled APA submission, a title that I then felt I had to live up to.

So, in spite of the nonsense, I also think he was brilliant -- and not just for "discovering" Bill, Clara and me.  He certainly changed the way I think about and do therapy and therapy research.  And I'm sure that his method of bodily resonation is one of the main sources of how I think about empathy as an embodied process in which it is possible at certain times to deeply enter the client's experiential process.  That means that every time one of my clients and I are able to do this, there is a wee bit of Al Mahrer there with us, in the room.  He was certainly one of a kind.