Saturday, March 13, 2010

Questions about EFT, Part 1 (Groningen, March 2010)

Entry from 6 March 2010:

I’ve been doing a lot of EFT training lately, and recently began asking participants to generate questions from skill practice sessions. On the last day of EFT Level 1b (= days 3 & 4 of Level 1) in Groningen last weekend, Jeanne Watson and I ran a long “Open Marker” skill practice session, in which participants were asked to first locate the client task and then to work with whatever it was. Afterwards, we asked them, “What questions do you have from the Open Marker Work Practice?” On this occasion, the participants came up with a particularly rich set of questions, which Anja typed into my computer so that everyone could see them. Finally, Jeanne and I tried to answer the questions, to the best of our ability, while Anja again recorded our answers. The following is an edited and elaborated version of those notes. (Many thanks to Jeanne Watson and Anja Rutten for their help in formulating and recording this material.)

A. On Two Chair Work:

1. How do you know when to suggest that my client switch chairs in 2 chair work?

(a) In general, when a request/demand/ultimatum is made, a place where in a regular two-person conversation you would naturally expect the other person to respond. You may feel this in your body.

(b) Jeanne points out an important time to change: When the client has expressed a primary adaptive feeling and the associated need, particularly when this is directed back to the other part. Then it’s important to see how the Critic responds to this, to see whether they are able to soften and begin negotiation. If not, then the client can go back to the Experiencer chair and talk about the experience of the critic not softening.

(c) It’s also useful to look at what the Critic (or Other in Empty Chair work) is doing, not just their content/words, thus move a bit beyond content in process. For example, acting dismissively, showing scorn in face, or sitting in a particular way, etc. The therapist can formulate this back to the client and help them heighten it (“Are you aware of look of scorn on your face? Can you do that some more?”).

(d) It’s also important to pay attention to the fact that clients sometimes change parts but not chairs, which can confuse things a lot. Pay attention to the manner and content of each part, so that you can hear if this happens then suggest that the client go over to the other chair and say it from that part.

(e) Finally, Jeanne notes that in 2 Chair Work, the two parts can sometimes get stuck in a pattern of ‘fight-fight’ that goes in circles and stays on the surface. Then, stopping the usual back and forward and helping the client to deepen one or the other part can be useful.

2. When you are working with 2 chairs and heightening Critic, how do you know when there is enough heightening?

(a) Remember that the Critic is your friend in the process, so often what we are doing is helping the client heighten their Critic until something “pops”. You can test this: Have the client try out a critical statement or repeat it, then switch and see what comes up in the Experiencer. If there is no response from Experiencing chair, then it is not enough. Also, you can use your own felt response as a test.

3. In Two chair work, when the client hesitates to switch chairs, when is it a good idea to address it and explore it with the client?

(a) It’s natural for clients to be hesitant about chair work, given that it is

so different from ordinary everyday processes. They generally think it’s crazy until they’ve tried it.

(b) At the same time, it’s always a good idea to pay attention to client hesitation in changing chairs, although once understood it is often OK to proceed anyway.

(b) Nevertheless, any serious hesitation requires therapeutic attention and exploration, and possibly alliance repair work.

4. What do I do with a collapsed Experiencer?

(a) Don’t panic! This is common and expectable part of working with conflict splits in depression, social anxiety etc.

(b) See Learning for a description of the Two Routes, via the critic or via the experiencer (sometimes both).

(c) Via the Critic: Ask: “What happened there? It looks like you were starting to do/say X, and then it just collapsed. That’s really interesting! Is that what happens?” Change chair task and look at how critic makes experiencer crumble by heightening the critic. Heightening critic can intensify the experience; for example, it may make the experiencer angry, so that they protest. It also is important to help the Critic see what s/he is doing to the experiencer.

(d) Via Experiencer: Client will be in a ‘collapsed experiencer’ state. Ask, “What is it like to experience that, what happens, can you stay with that?” Help the client deepen the Experiencer by responding empathically to the pain, then listen to experiencer in order to find their growth tendency and help them come up again, usually by asking them what they need/want, which helps them move toward action/self assertion. Clients with severe social anxiety may not have a strong enough sense of self, they may need help to build this.

5. A related question: What do you when the client in the chair of the harsh Critic displays tears/vulnerability? Do you stay with the strong criticism or the first sign of softening?

(a) It’s important to hear both things, to hear the critical message but also to ask what the tears are saying.

(b) It’s also important to find out if softening is in the Experiencer or Critic part.

(c) Remember to stay with the process and the client: The client is more important than the model.

B. Other Practice-oriented questions:

6. Can you change from one task to another and if so when?

(a) See Principle 5 in the Learning book for more on this issue. If a new, more central task emerges, it’s generally a good idea to switch to the more central task, e.g., from 2 chair to empty chair or vice versa.

(b) In addition, many different relationships can exist between different tasks, and markers often overlap. You can have tasks nested within tasks, such as doing a bit of Empty chair work within a Two Chair dialogue, or vice versa. Also, some tasks go nicely with others; for example, after the Meaning Bridge in Unfolding, it can make a lot of sense to switch to Two Chair Work to work on the broader issues, which typically involve a conflict between old and new ways of seeing things.

7. What do you do when you think the client is leaving something out/there is something missing?

There are really two different situations here:

(a) It’s easy if you think client knows it but isn’t saying it: Use empathic conjecture.

(b) However, it’s trickier if client really seems to be unaware of what you are seeing. Here there is a risk of ‘therapist cleverness’ disempowering the client, so you have to be very careful. Here are some suggestions for handling this situation:

•First, pay attention to your emotional attachment to your interpretation. Where is it coming from? Does it come from a need to feel clever? Does it come from a desire to help the client by giving them insight into their problems? Do I believe that insight is an important change process?

•Second, consider the advice that Laura Rice once gave me: Remind yourself that no matter how clever my interpretation is, the client’s own idiosyncratic self-understanding of what is going on will fit them better. The main problem with most therapist interpretations is that they are too simplistic.

•Third, take your interpretation and ask yourself: If I’m right about this, what would be in the client’s experience? Then offer an empathic conjecture about this experience. For example, with a transference link between the client’s experience of you and their parent, is there something about relating to me that feels familiar and old to them?

8. How do I help my client internalise/represent the work we have done with language or symbols?

(a) In general, make time to process the work at the end of the session, talking about what happened; eg, how harsh the critic is.

(b) It can be important for the client to remember/conceptualise some key words (like ‘handles’ in Focusing), to give sense of process they have come through. This often means distilling the key message, eg, with abused clients, ‘it wasn’t my fault’. Jeanne tells about a client who dreamed of a special creative place, which she came to understand as representing taking more care of self

(c) Offering awareness homework is also helpful here, suggesting that the client pay attention to a key feeling outside session. For example, Jeanne suggested at the end of the session to the client who had dreamed of the creative place, that her client try to ‘hold on to the memory of the place and the feeling she had experienced in there’.

(d) Jeanne points out that if there is real resolution, there is often no need to work at helping the client remember it, because work is done and they are already seeing and experiencing in a new way, which will establish itself.

(e) So internalizing work is probably most useful and common in work that is half way, where the client can see ‘light at the end of the tunnel’ but isn’t there yet. Helping the client symbolize what is and isn’t clear at this point makes a ‘placeholder’ for future work.

9. How do I learn more about all the different markers in the different tasks?

(a) Read Learning Emotion-Focused Therapy; (b) do EFT Level 2; (c) Practice, practice, practice!

10. Anything else you want to tell us?

The main roads by which we can help clients access their emotion schemes: (a) Paying attention to their body (Focusing); (b) accessing episodic memories (Unfolding; Empty Chair Work); (c) actively expressing the action tendency/need linked to the emotion scheme.

C. General Questions:

11. Does doing EFT change the way my body feels?

Yes, by becoming more self-aware of it. It may (a) hurt more, if pain has been ignored; (b) or there may be physical relief or a sense of space or a feeling of easing from resolving a problem.

12. How do I get more professionals around me to support my EFT work?

Network! Building your skill at EFT takes time and a network of fellow practitioners to support your developing practice. Set up an EFT study/intervision group in your area. Find an EFT-friendly supervisor. Take part in research on EFT, either on your own or as a part of a practitioner research network (PRN) or larger study.

13. What is the difference between EFT for couples and EFT for individuals, for example, regarding attachment?

(a) Attachment processes are vital to EFT-I (EFT for individuals), just as it is in EFT-C (EFT for couples). However, like Les Greenberg, we don’t see attachment as the only interpersonal process; there are also power and autonomy needs that need to be balanced and integrated in working with couples.

(b) Jeanne and I don’t do couples therapy training so we feel unable to fully answer this. However, we note that Les’ version of couples’ EFT work allows more space for work with individuals within the couple, especially once it’s become clear how each individual’s own issues help generate the couple’s problems. I can remember times in work with a couple when witnessing the other partner’s distress can genuinely touch the observer couple member. However, it’s also the case that the person who is working can feel guilty or exposed; and sometimes it is too painful or not safe to reveal deeply painful experiences to the other.

(c) I speculate that in EFT-C there is really one main task: To help the couple repair the attachment injury in the relationship; it just happens to be a very large task.

(d) Of course, healing the attachment injury will typically mean helping the couple address their individual injuries and the associated emotion schemes from their past that are involved in their recent partner injuries. This may require EFT-I.

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