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.