Two Poems About the World PCE Conference Athens 2024

Note: For me, poetry is a way of speaking truth, sometimes painful truth. In this entry, I offer two poems about my experiences of the World Person-Centred Psychotherapy and Counselling Conference in Athens, September 2024. I thank Gillian Proctor for the diffraction image used in the second poem.  I hope that readers will find something in them that resonates.

 

1  The Honouring of Ornery Elders

 

As the conference opens, I hear:

-- We honour the elders, past and present

 

But I want to protest:

-- I didn’t ask for this.

I want to go back to being

A bright younger,

Full of anxiety and promise.

 

It seems only a second ago, I complain,

-- How did I get here?

 

And answer myself:

-- Like everyone else, I guess:

One year at a time.

 

But time’s forest fire

Has burned through this community

Of the children and grandchildren of Carl Rogers,

And the remaining tall trees

Are rarer every year:

The elders are passing.

 

Those of us who are left

Are more brittle and cranky

Each time we meet.

 

We ask ourselves:

-- Is this the last time?

A final time to be heard?

 

And we reply to ourselves:

-- If few listened before,

Why should they listen now?

 

People look at me, talk about me,

As someone whose kind is in short supply,

Some kind of ghost

Of a lost, brilliant, golden age.

 

And I, newly retired, am aware

Of my own new fragility:

The osteoporosis, the fading vision,

The stiffness to stand;

I take the amphitheatre’s descending steps

Slowly, carefully.

 

Though I hate it, I inhabit the part,

The role into which

I find myself cast, unwilling.

 

 

2  The Sharp Edges of Our Differences

 

The light that shines

Through these approaches

To the healing of souls

Is split into a spectrum of colours:

Person-centred, emotion-focused, focusing-oriented, and more.

 

These make space for many ways of being

With ourselves and our clients.

Like a deep gene pool,

Filled with many waters,

To equip us to meet

The many challenging moments

That lie in front of us.

 

And yet this rich variety

Can be difficult and challenging,

Leading us to wish

For simplicity and an easier life.

 

Holding these tensions can make us tense,

Can hurt and be hurtful to each other.

 

And so, in deep conversations

With my therapeutic siblings

I hear with sadness how some

Feel diminished and pained

By my beloved ways of working,

By focusing and chair work.

 

Perhaps at times I proclaim these things,

Too loudly or too proudly,

So my fellows hear me as belittling them,

Leaving them behind, judging them,

Threatening their beloved ways of working,

 

They tell me that this

Makes them doubt themselves,

Imagining themselves from my point of view,

Imagining me as a critical audience

To their ways of working.

 

I can well understand

How this erodes

The firm ground they need

To be present to their clients:

My active, intense ways of working,

Such a function of who I am,

Are sharp edges for them…

And these sharp edges hurt.

 

Of course, it’s in our nature

To turn hurt to fear,

And thence to anger, contempt, and judgement:

More sharp edges, like broken glass,

That can hurt me and make me feel unwelcome.

 

Because of this, I have

Often tried to make myself smaller;

Hoping I’d be less threatening

If I put away my EFT hat,

And spoke instead of research:

 

Research is a thing I love

For its methods and craft,

Its findings, by turns

Enriching and perplexing.

As I tell myself yet again,

“The facts are friendly”,

I hope that this is true.

 

But for all my love of careful study

I am also an EFT therapist,

Who sometimes doubts his welcome here,

And who sometimes, without meaning to,

Makes others feel unwelcome too.

 

I don’t think this is what any of us want:

To dismiss or to be dismissed;

To hide ourselves, or to make others hide.

 

We know well what it feels like

To be sent way or overlooked

In the wider world of psychotherapy,

When all the while

We could be keeping

Each other company

And shining with all the colours of rainbow.

 

                        -Athens/Pleasanton, September 2024

The Adaptive Functions of Nonadaptive Emotion Responses

Entry for 7 Dec 2017: FEAR Conference on Brain, Behaviour and Society in Aarhus

Sandwiched between my November Scottish work period and my December California work-and-holiday-period, I’ve just been to a fascinating and challenging two-day conference hosted by the University of Aarhus Institute for Advanced Studies (AIAS).  I found this conference fascinating because it was by the far the most multidisciplinary scientific meeting I’ve ever been to.  I also found it challenging, for exactly the same reason:  The scientific disciplines featured ranged from cellular biology and neurophysiology on one end of the spectrum, to political science and even history and theology at the other extreme, with many gradations in between.  Along this spectrum, I would have to put myself somewhere in the middle.  What all these folks had in common was an interest in understanding fear and anxiety at multiple levels and from different angles.

I’m pretty sure that the work that I’m going to find most useful going forward is that of the largest group of folks in the middle of that continuum: A collection of experimental field biologists/ethologists/neuroscientists, who are essentially doing animal psychology on animals ranging from racoons to South African birds to snails.  These folks, most notably Liana Zanette, Mike Clinchy, Dan Blumstein, and Tom Flower, do naturalistic field research on predator-prey interactions in wild animals, which is a natural place to study fear.  They use a range of relatively new methods such as camera traps (think motion-sensitive or sound-activated CCTV for spying on animals), battery-powered portable speakers (for scaring animals with the vocalisations of predators), and robotic pseudo-predators.  Related to them are more lab-based neuroscientists like Ken Lukowiak and Cornelius Gross, who use new, elegant technologies such as optogenetics to turn particular sets of brain neurons on and off at will, in order to study their behavioural effects and to trace neural pathways.

I found this work, in itself, to be fascinating, and because I read Science News regularly, I felt I was able to follow it pretty well. It also helped in conversations over meals to be able occasionally to ask for translation of the more obscure jargon terms.  So on first approach I loved being drawn into the world of field biology/ethology, which deeply resonated with the young boy I had once been, fascinated by strange animals and the adventure of field work.

However, this work is actually important for Emotion Focused Therapy and our understanding of how human emotion processes function and can go awry, even when they are doing exactly what they are evolved to do. Over the two days, I was able to see many useful connections. This group has identified persuasive analogues for several important clinical/EFT phenomena: 

First, Liana Zanette & Mike Clinchy, from the University of Western Ontario (now rebranded as Western University), have developed an analog for PTSD by subjecting prey animals (eg, chickadees, racoons) to predator stress, created by intermittently playing predator sounds in the immediate vicinity of birds or smaller mammal further down the food chain.  Played repeatedly and predictably over time, this creates chronic stress in the animals, including behaviours that resemble many specific symptoms of PTSD, such as hypervigilance, exaggerated startle response and loss of appetite. Most strikingly, they have shown that these stressed animals have higher mortality rates and fewer offspring; even more strikingly, this increased mortality and lowered reproductive success is passed on their offspring, and also affects species below them in the food chain. 

Yesterday before I left to catch my bus back to Billund Airport, I had one more relatively brief visit with Liana and Mike at breakfast.  They wanted to make sure I got their main message: Trauma-induced chronic fear/anxiety -- which EFT refers to as Primary Maladaptive Fear/Anxiety – is from an evolutionary point of view, not maladaptive but fundamentally adaptive:  By motivating constant vigilance, this reaction to stressful or even traumatic predator exposure increases the probability of not being killed by those predators.  They argued that falling victim to a predator instantly reduces the individual’s chances of survival to zero.  Our emotion system evolved the ability to overgeneralise from single traumatic events because this has survival value, especially in predator-rich environments, which until recently were quite common. As Mike said this morning, this tendency purchases maintenance of life at the cost of quality of life.  Mike and Liana wanted to know if I had heard anything in these two days that was going to affect how I work with clients.  Of course, it’s hard to know exactly with new ideas, but I told them I thought it might.

One thing for sure, however, is that it’s going change how I talk and write about emotion response types: From an EFT point of view, we assume that by and large Primary Adaptive ERs are more adaptive than the others, and that the broad goal of therapy, both within and across sessions, is to help clients reduce Primary Maladaptive, Secondary Reactive, and Instrumental ERs while at the same time increasing Primary Adaptive ERS.  However, it’s now clear to me that all four types of emotion response distinguished in EFT theory evolved because they had useful functions and survival value, especially in social units or groups:

• Primary Adaptive Emotion Response (ER): This is what the emotion evolved for in the first place, eg, danger => fear => flee/freeze.  This is our first, natural and specific emotional response to a particular situation.  Note that in a given situation, our first, most natural response to a situation does not always provide the best way to get our needs met; eg, violation in the form of abuse by a powerful/unsympathetic other => anger => increased danger of further/worse harm.

• Primary Maladaptive ER: Predisposes us to develop quite general, long-lasting learning from single traumatic episodes, “because I can’t afford to wait for a second chance”; increases sensitivity/strength of response to danger, but also anticipation of possible danger => anxiety => pause/orient/prepare.  In fact, “generalised primary emotion response” might be a more accurate term for this kind of emotion response.

• Secondary Reactive ER: Gives us the ability to respond in complex ways (such as inhibition/interruption) to our emotion responses; eg, violation => anger => fear of possible damage to relationships => partial inhibition of anger allowing time to develop more nuanced useful responses

• Instrumental Emotion Display: Gives us the ability to influence others, behave appropriately, or preserve relationships even when we are not feeling the relevant emotion; eg, danger from manageable adversary (eg, mountain lion or bully) => instrumental anger display to intimidate.  Drongo bird (South Africa) example (from Tom Flower): Opportunity to steal food => give danger alarm cry to scare or distract the other.  This works bests where the instrumental emotion display is the expected response or, failing that, where the other lacks the ability to detect the true emotion, or can’t afford to get it wrong.

The implication of this analysis is that the judgement of adaptiveness requires more than just identifying the type of emotion response; some further consideration of two kinds of context is required:  First, the emotional context of our key needs in the situation; second, the interpersonal context of others’ likely responses to our emotion responses.  Taking these further factors into consideration requires a fairly high level of emotional intelligence, both awareness of the range of our important emotions in the situation and reasonably accurate simulation of others’ likely reactions to our emotion responses.

This is why in EFT we don’t talk about maladaptive emotions (except when we are speaking carelessly), but only about maladaptive emotion responses:  This emotion response was useful originally, in the presence of danger, but isn’t here and now, in this particular situation.  Liana and Mike’s research suggests that the tendency to form overgeneralised, automatic fear responses is deeply embedded in us in an evolutionary sense, and research by others (such as Cornelius Gross) indicates that it is very likely to be mediated by the limbic system (especially the amygdala and the hippocampus).

To conclude, when a client with PTSD presents with a stuck feeling of constant fear of being revictimised that is causing them a lot of emotional pain and ruining their ability to get on with important life projects (as in the video I showed at the conference), it is clearly not true that their fear has always been maladaptive. It’s also the case that their continuing hypervigilance and strong response might very well be adaptive in some situations in their current life, more adaptive than a more relaxed view. Thus, it is only in particular situations, in which the person finds themselves unreasonably afraid when they and others’ carefully assess that this is not the case, that we would be justified in concluding that the person’s emotion response of fear is maladaptive, because it doesn’t fit the current situation. However, the fact that they have this response is completely natural, understandable and in the broad evolutionary sense adaptive. 

iSEFT Toronto 2017 Conference Call for Submissions

The second conference of the International Society for Emotion-Focused Therapy (iSEFT) will be held in Toronto, Canada, June 15-18, 2017. This is a conference where anyone interested in EFT can attend to learn about recent developments in Emotion-Focused Therapy and to hear about the latest research.

Jan Stiegler, from the Norwegian Institute for Emotion-Focused Therapy, is the head of the program committee for the conference, has issued a call for submissions for presentations.  He writes: 

"We are especially interested in recent developments in EFT: theoretical developments, clinical developments, research and/or experiences with EFT applied to specific populations. Also, experiences with integrating EFT with other approaches will be welcomed.

There are three types of presentations at the conference; plenary panels, plenary talks, and parallel workshops.

Depending on the submitted abstracts, panels will be set up with a few presenters focused on a common theme, or various facets of a research project. Panels will be 90 minutes in duration with a minimum of 15 minutes for open discussion with audience members. Each panel will have a moderator. In some cases individual plenary talks might be preferred format for presenting. The length of these will normally be 45 minutes.

Workshops are intended to provide exposure or training in specific areas of EFT methods, populations or problems. Workshops could also have clinical presentation of assessment or treatment that is followed by discussion on how to apply the clinical procedures described.

Submissions should include: 

• Name of presenter(s)

• Title of talk, plenary or workshop

• Amount of time requested

• Abstract describing the subject to be presented. 

Please send submissions to me at stiegler@ipr.com or jan.stiegler@gmail.com.

Deadline for submissions is 31^st of October, 2016. 

PCE Conference in Buenos Aires

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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.

Person-Centered/Experiential Psychotherapy for Anxiety Difficulties: Theory, Research and Practice

Entry for 17 May 2013:

Last July, about a week after my return from California after the two months I spent helping care for my mother, I gave my first keynote presentation to a conference of the World Association for Person-Centered and Experiential Psychotherapies.  The talk, given in Antwerp, Belgium, was the basis for an article just published in Person-Centered and Experiential Psychotherapies.  It combines selected results from two studies: the 2008 humanistic-experiential psychotherapy outcome meta-analysis that Beth  Freire and I carried out with support from British Association for the Person-Centre Approach; and the First Strathclyde Social Anxiety Project, largely funded by grants from the New Professors Fund by the University of Strathclyde and by Counselling Unit internal funds. 

I am deeply appreciative of the help I received in carrying out the research on which this article is based, including the clients, volunteer therapists, students, research associates, and members of the Social Anxiety Study Group, University of Strathclyde, 2006-2012, especially my colleagues Brian Rodgers, Beth Freire, Susan Stephen, Lorna Carrick, Lucia Berdondini, and Mick Cooper.   In addition, Les Greenberg and Ann Weiser Cornell made helpful contributions to the theory sections of this article.  Finally, I have dedicated this article to the memory of my mother, Ann Helena Kearney Elliott, 7 April 1929 – 22 June 2012.

Although the article has been available on the publisher’s website since March, it was very nice to receive the hard copy of it the other day.

Reference:

Elliott, R. (2013). Person-Centered-Experiential Psychotherapy for Anxiety Difficulties: Theory, Research and Practice.  Person-Centered and Experiential Psychotherapies, 12, 14-30. DOI:10.1080/14779757.2013.767750

Abstract: Anxiety difficulties are an increasingly important focus for person-centered-experiential (PCE) psychotherapies.  I begin by reviewing person-centered, focusing-oriented, and emotion-focused therapy (EFT) theories of anxiety.  Next, I summarize a meta-analysis of 19 outcome studies of PCE therapies for adults with anxiety, most commonly supportive or person-centered therapies (PCT) carried out by cognitive behavior therapy (CBT) researchers.  The results indicate large pre-post change but a clear inferiority to CBT.  I then summarize promising early results from an ongoing study of PCT and EFT for social anxiety, which show large amounts of pre-post change for both forms of PCE therapy but substantially more change for clients in the EFT condition.  I conclude with a discussion of the implications for PCE therapy practice, including the value of process differentiation and the possibility of developing more effective PCE approaches for anxiety.

Update for September-October: Adventures and European-UK SPR

Entry for 20 October 2012:

Over the past 6 weeks I’ve been extremely busy dealing with the move from Jordanhill and various work crises, on top of the usual things, and also being behind from all the time I missed between May and August.  I’ve never really caught up, and things keep piling up.  All of us are feeling overwhelmed and that includes me.  Meanwhile, I’m doing my best to keep sane and healthy, which means that a lot of things aren’t getting done when they should.  At times it really does feel like a crazy life, and it’s been hard to keep up with things like blogs.

One thing that hasn’t been sacrificed is our Saturday Adventures, of which we’ve had quite a few since early September.  Glasgow Open Doors day in mid-September was great for scoping out interesting churches and places in the Blytheswood area in the west side of Glasgow city centre.  In late September, we visited Crichton Castle, south of Edinburgh, and then Inverarary Castle, in Argyle, both of them getting ready to close for the season.

A high point was a trip to Falkland Palace in Fife the first Saturday in October.  This was another of the favourite haunts of the Stewart royalty in the 16^th century, really a hunting lodge, restored in the 19^th century and still inhabited by the current Keeper.  The little village of Falkland is lovely and I was particularly taken by the lovely Catholic chapel in the Palace and the larger than life-size wicker figure of Mary Queen of Scots with her favourite falcon, near a tree labyrinth in the orchard below the palace.  However, the most amazing thing was discovering on the grounds of the palace the oldest extant Real (or Royal) Tennis court, the original form of tennis, with lots of wacky rules, like having to serve the ball so that it bounces off the roof of the observer stand!  Apparently, this was all the rage with the nobility in 16^th century Europe.

Last weekend, we went to the European-UK SPR meeting in Porto, Portugal.  This was my make-up SPR conference, since I’d missed the international SPR in Virginia Beach in late June, so I was very glad to go.  It was very well-organized and in a great site, the Portuguese College of Physicians; and Diane and I had a very good time, and ate a lot of fish while we were there.  The European-UK conferences are smaller than the big international SPR meetings, but have quite a lot of diversity.  This year I heard quite a few presentations by different groups of Psychodrama researchers, who have taken up various of the suggestions I gave them when I met with them Edinburgh several years ago.  They bring a lot of creativity and energy to their research, and are doing very interesting research, including a couple of new randomized controlled trials. 

This week I’ve been trying to recover form the Portugal trip while managing a very heavy teaching load.  Exhausting!  Nevertheless, we managed a drive out to Kilwinning (= St. Finnian, the teacher or St. Columba) today, where we visited the ruins of Kilwinning Abbey, dating back to the 13^th century.  The village of Kilwinning is a bit depressing, but the ruins are lovely.  After that we went to Eglinton Country Park, which contains the ruins the Eglinton Castle, the site of the last major medieval tournament in the UK, which took place in 1839.  Like Kilwinning Abbey and its village, the Eglinton castle and its estate fell on hard times and only a few bits have been restored.  The theme of the day seems to have been an autumnal one: faded glory, decay and deterioration, but we’ve had plenty of chances to see signs of life over the past 6 weeks!

Tenth World PCE Conference in Antwerp

Entry for 16 July 2012:

I’d not been back in Scotland for more than 10 days before I was off again, this time to the Netherlands, Belgium and Italy.  First I went to Veldhoven for another EFT Level 3 supervision day, then it was back to Antwerp for the Tenth Conference of the World Association for Person-Centered and Experiential Psychotherapy and Counselling.  This was like a return to the beginning, because the very first of the these conferences was also in Belgium (1988, Leuven), and many of the same players were present: Among them were: Greet Vanaerschot (who gave the plenary lecture on the first night), Mia Leijssen (who made several brief appearances), Germain Lietaer (who was in charge of the first conference), Paul Dierick (a PhD student at the time) among others.

My keynote address was at midday the next day.  I had found myself unable to work on it while I was in California helping care for my mother, so I didn’t start working on my slides until I returned to Scotland.  I finished it two days before we left, but started coming down with a cold after I arrived in Belgium and was not feeling too well by the time I gave it.  We spent the two hours before my talk fighting with the equipment, so I was quite nervous by the time I started.  I’d never been a World PCE conference keynote speaker before, and these talks are often of historical importance, or controversial, or both.  And of course I had way too much material and didn’t have a clear strategy for dealing with this.  I’d also been struggling with the need to somehow integrate what I’d been through with my mother for 7 weeks with my work as a researcher and therapist.  So the night before I added sections of the Conversations Journal Poem Sequence to the beginning and end of my talk.  In the event this was both personally satisfying and also fit well with my talk, underscoring the fundamentally Person-centred nature of the work I do as an EFT therapist.  The abstract for my talk is given at the end of this entry, and I’ll soon do an entry here on the Conversations piece.

Then Brian Rodgers and I did a thematically-linked panel of outcome results and case studies in the late afternoon on the same day as my keynote.  After that, first thing the next morning Graham Westwell, Beth Friere and I did a panel on our person-centred-experiential therapy competence scale, which turned out to be a lot of fun. 

By this time, however, I was pretty wiped out from my cold and lack of sleep.   I dragged myself through the rest of the conference.  I had to miss the last half day of the conference of the final plenary panel in order to fly to Italy to make up training I’d had to cancel last May in Florence and Rome.  However, I did catch interesting and stimulating EFT presentations by Jeanne Watson, Rhonda Goldman, and Laco Timulak, including Jeanne and Laco’s new work developing EFT for Generalised Anxiety Difficulties, which I found very promising.  And Rhonda reported further details on the Self-soothing task. 

The conference banquet was one of the best I’ve even attended, in “Horta House”, an art noveaux event space near Rubens’ House in Antwerp.  I let myself relax in the company of Germain and Greet sitting on either side of me, while the jazz washed over us as we talked and ate an excellent conference meal.  For the occasion, Nele Stinckins wrote a song parody of Funicula, Funiculi, satirising the keynote speeches (including mine) and minor conference glitches; this was performed by a chorus of conference organisers, while Nele and some of the other Belgian women did the can-can.  Amazing!

Here is the Abstract of my keynote talk: Working with anxiety difficulties in Person-Centered-Experiential psychotherapies: Theory, research and practice

Anxiety difficulties are common in clinical and nonclinical populations and are a clinically and theoretically important recent focus for Person-Centered-Experiential (PCE) psychotherapies.  In this presentation I summarize current and emerging theory, research and practice with clinical anxiety, focusing particularly on social anxiety and emotion-focused therapy (EFT, also known as process-experiential therapy).

First, I summarize three current theories of anxiety: (a) person-centered, which emphasizes conditions of worth and incongruence; (b) focusing-oriented, which points to difficulties accessing immediate experiencing and maintaining working distance; and (c) EFT, which locates the source of anxiety difficulties in early experiences of rejection, neglect, abuse or bullying by significant others, resulting in a harsh internal critic.  This generates primary maladaptive shame and fear, which turn motivates behavioral and emotional avoidance or self-interruption. 

Second, I report the results of a meta-analysis of 19 outcome studies of PCE therapies for range of anxiety difficulties, most commonly supportive or person-centered therapies carried out by CBT researchers.  Results indicate large amounts of pre-post change (d = .94), medium-sized controlled effects (d = .5), but a medium-sized negative comparative effect vs. CBT (d = -.39).  I then summarize highly promising results from an ongoing study of PCE for social anxiety, which points to the possibility of developing more effective PCE approaches for anxiety.

Finally, using the results of this study, I describe a general therapeutic approach for working with this client group, including: (a) establishing a genuine, empathic, caring relationship; (b) explicating anxiety-generating processing by careful unfolding or re-experiencing of anxiety-provoking situations coupled with work on the client’s internal critic and self-interruption processes; (c) focusing, empathic affirmation and emotion regulation work to strengthen the sense of self; (d) work to transform core emotions that generate anxiety into new, more adaptive emotional responses; and (e) consolidation of client change.

8 July 2011: Reflections on route to the US: June-July Update

The last few weeks, since the end of May, have been very busy:

1. Courses end. The counseling diploma courses ended, amid the usual drama, tears and last minute marking of assignments. I continue to enjoy my work with the student groups here, counseling diploma & MSc students, counseling psychology professional doctorate students, and research PhDs. They are passionate and committed, which they have to be, because there is so little financial support for them.

2. EFT Training. Also in June, Anja Rutten and I delivered the third and final installment of a very successful EFT Level 2 in Veldhoven, Netherlands, and began planning Level 3 to start in the Autumn. The Strathclyde EFT Level 1 for the end of August is already almost full, thanks in part to the various one-day taster workshops I’ve been do around the UK. Over the past year or so, it has become clear that Emotion-Focused Therapy is gathering critical mass in Europe. The International Society for Emotion-Focused Therapy (ISEFT) is being formed to promote the approach and to develop standards and accreditation procedures for EFT therapists, supervisors, trainers, and training centers.

3. Settlement. After a month of intensive study, Diane and I took and passed our UK citizenship test, entitling us to apply for what is called Settlement, or Permanent Leave to Remain in the UK, equivalent to a Green Card in the US. The test consisted of 24 multiple choice questions divided evenly between blindingly easy questions (“What is Valentine’s Day?”) and mind-numbingly picky ones (“How many representatives to the European Parliament does the UK have?”). We had 45 minutes for the test; Diane was the first of our group of 15 to finish, at 7 minutes. When we return from the US at the end of July, finishing our application will be our top priority; we can’t submit more than 28 days before our visa runs out at the end of August. However, the process requires us to send in our US passports. Once we’ve turned our application in, we’re stuck in the UK until we hear back on our case. That could take anywhere from a month or two, to 6 months or more. I’ve already cancelled or rescheduled most of the travel plans for the period. We will have to be patient and flexible, just like when I was recovering from surgery during the same time period last year.

4. The Summer Solstice, with 17.5 hours of daylight, came, but it was rainy and gray in Glasgow. We’ve a couple of days of nice weather since mid-May, but that’s about it.

5. SPR-Bern. The highlight of my scientific year is generally the annual international conference of the Society for Psychotherapy Research (SPR), and this year’s conference in the beautiful, historical Swiss city of Bern was no exception. There were many EFT panels on the program, and a group of us did the “EFT Tour” going from session to session, learning about the latest EFT developments, such as applications of Antonio Pascual-Leone’s recently developed model of the emotional change process in EFT, and a new task model of hopelessness (which turns out to be a form of self-interruption). I took Rachel McLeod’s HSCED study of my first social anxiety client (about to appear in Psychotherapy Research) and converted it into a change process study, which worked surprisingly well. Diane gave her first SPR presentation, on clients from the Research Clinic who dropped out after only one or two sessions, and by all reports was informative and entertaining. (I missed her presentation because I was scheduled to present at the same time in a parallel session.) We got together with old friends, like David Orlinsky and the Collaborative Research Network; Bill & Sue Stiles; Art Bohart & Karen Tallman; Chris Barker & Nancy Pistrang; and many others. All in all, Franz Caspar and his team, along with Guillermo de la Parra, the program chair, did an excellent job of organizing the conference, one of the best in years, in my view.

Now, it’s time for a vacation!

Emotion-Focused Therapy and the Person-Centred Approach: Past, Present & Future

Reference: Elliott, R. (May, 2011). Emotion-Focused Therapy and the Person-Centred Approach: Past, Present, Future. Paper presented at Counselling Unit Twentieth Anniversary Conference, University of Strathclyde, Glasgow, Scotland.

1. A Personal Journey…
1.1. Five years ago: Invited to join the Counselling Unit
1.1.1. Walked into a place with a deep sense of culture and history built up over many years; but also, deeply counter-cultural
1.1.2. Complex web of: Courses and projects; relationships and traditions; large team of talented trainers and counselors; highly committed students, past and present
1.1.3. Fear & trembling: Questions raised:
• Will I be able to do meaningful work in this new setting?
• Will I be accepted?
• Is there space for my way of working with clients here?
• Will I change it?
• Will it change me?

1.2. Crucial Issue: What is the relationship between Process-Experiential/Emotion-Focused Therapy and the Person-Centred Approach?
1.2.1. In the early 1990’s, Barbara Brodley and John Shlien had both said to me: (Process)-Experiential therapy, Focusing, Emotion-Focused Therapy is not Person-centred
1.2.2. But Laura Rice, Les Greenberg & I had all started from a Person-Centred base, and felt we were Person-Centred
1.2.3. So, coming here, I began a five-year Evolving Dialogue with colleagues: •Classical/nondirective Person-Centred Therapy (PCT)
• Broadly relational PCT
• Pluralistic
1.2.4. My position has varied: Curiosity & puzzlement; awe & skepticism; frustration & excitement
1.2.5. Will present what I’ve learned so far from this dialogue: Past, Present & Future

2. The Past: A Brief History of Person-Centred-Experiential (PCE) Therapy
2.1. PCE Time-line:
• Roots/Sources: Humanism (The Renaissance, The Enlightenment, existentialism, Third force Humanistic psychology)
• 1940’s: Nondirective therapy: Rogers
• 1950’s: Classical approach: Chicago: Relationship conditions: unconditional positive regard, empathy, genuineness
• 1960’s: Focus on client process: Wisconsin; Late Rogers, Gendlin. The dialogue begins…
• 1970’s: Experiential therapy: Gendlin: Focusing; Rice, Greenberg: task analysis
• 1980’s: Partial eclipse period: Dismissed in North America; Further development of PCA in Europe
• 1990’s: Beginning of PCE revival; Training centres established: Counselling Unit; Process-Experiential (PE)/Emotion-Focused Therapy (EFT); explosion of research
• 2000’s: World Association founded; Journal: Person-Centered and Experiential Psychotherapies; Struggles for recognition; Research continues rapid development; EFT books & training emerge

2.2. Legacy of this Past: The Great Divide:
2.2.1. Continuing dialogue between different parts of the tradition, especially from 1970 on
• One end: “Classical” approaches: Emphasize Nondirectivity, Unconditional Positive Regard, the centrality of the relationship
• Other end: Emotion-Focused Therapy: Emphasize client process, process guiding, the work of therapy
2.2.2. “Pluralistic Approach” fits in there somewhere… perhaps at a 90 degree to the Great Divide

2.3. Examining the Legacy: Dialoging Across the Great Divide
2.3.1. Counselling Unit: One of few places in the world where it would have been possible to carry out this dialogue: Over an extended period of time; and with reference to actual practice
2.3.2. Most importantly, this has allowed exploration of the deeper issues of personal and professional identity:
•Need to hang onto what is essential vs. need to escape oppressive restrictions
•Need to establish self vs. feeling threatened or excluded
2.3.2. Which takes us to …

3. The Present: Have PCT vs EFT differences been exaggerated?
•As a result of recent history of dialogue over our differences, can now ask this question.
Two recent efforts to look at this…

3.1. The EFT Translation Project
3.1.1. EFT jargon can put PCT therapists off: Makes it sound like EFT therapists are pulling levers and controlling clients
• Have been trying to translate into PCT Friendly language; many discussions with Beth Freire, Brian Rodgers, Graham Westwell, and others
• Example: The Six EFT Therapy Principles
3.1.2. PCT-Friendly EFT Principles
• Research Clinic therapists examined the 6 EFT principles; decided the following 3 need no translation:
3.1.2.1. Empathic Attunement: Always start by entering, attending to & tracking the client’s immediate experiencing
3.1.2.2. Therapeutic Bond: Offer genuine, empathic, caring presence to client
3.1.2.3. Self-development: Foster client growth, empowerment & choice
•Three EFT Principles Need Translation into PCT Language; involve different kinds of therapeutic work (=“tasks”)
3.1.2.4. “Task Collaboration”:
•EFT: Offer and facilitate involvement in therapeutic work
•PCT Translation:
(a) Listen for and engage with what client wants to work on
(b) Offer orienting information about nature of therapy and particular ways of working in the session, particularly when the client asks or is puzzled
3.1.2.5. “Task Completion/Emotional Change”:
• EFT: Facilitate reorganization of core maladaptive emotion schemes by helping client resolve key therapeutic tasks
• PCT Translation:
(a) Listen for and engage with key issues clearly or repeatedly presented by client
(b) Help client contact, explore and clarify core, growth-oriented emotions and views of self/others
(c) Keep helping client work on their key issues until they feel they have resolved these or decide they want to stop
(d) … and the client decides what is key, core, or resolved
3.1.2.6. “Process Guiding”:
• EFT: Help client work in different ways at different times; foster relevant client micro-processes/ modes of engagement (e.g., experiential search, active expression)
• PCT Translation:
(a) Be aware of and respond helpfully to common kinds of client experiences and process
(b) E.g, Empathic Refocusing response: allow C to step back from difficult emotions before offering opportunity to return to them
(c) Respond to client-presented issues by offering opportunities for potentially useful kinds of therapeutic work
(d) Always accept client’s decision about whether or not to accept a process offer

3.2. Comparing PCT & EFT: The PCEPS study (Freire, Elliott & Westwell, 2011)
3.2.1. Developed quantitative process rating measure of PCE therapist adherence/competence: Person-Centred and Experiential Psychotherapy Scale (PCEPS)
3.2.1.1. Two subscales:
• Person-Centred (PC): 10 items (Eg Client frame of reference; content nondirectiveness)
• Experiential Process (Exp): 5 items (Eg Experiential specificity, emotion focus
1 – 6 descriptively-anchored scales)
3.2.1.2 Passing = 3.5+
3.2.2. The PCEPS study – Method: Just finished test of measure on 120 segments:
• Research Clinic data
• 10-15 min segments
• 60 sessions, 20 clients, 10 therapists
• 5 student therapists (general client sample)
•5 post-training therapists (clients with social anxiety): 2 PCT, 3 EFT (2 fully trained)
3.2.3. The PCEPS study: Summary
3.2.3.1. PCEPS is reliable (across items and raters)
3.2.3.2. In general, PC and Exp items correlate very highly with each other
3.2.3.3. We also found a Nondirectiveness factor: Empowering Presence, Content Nondirectiveness, Clarity/brevity
3.2.3.4. Student therapists scored lower on all items
3.2.3.5. No difference between fully trained PCT and EFT therapists on: PC, Exp, and nondirectiveness subscales
3.2.3.6. Conclusion: Therapist and training effects much more important than PCT vs EFT differences

4. The Future: Some concluding thoughts about avenues for continuing the dialogue & an agenda for the future
•Where does this leave us?
4.1. Beyond ideology, Or: Back to the Process Itself
• Is it worth continuing to argue at an ideological level over nondirectivity and process guiding?
• Like Psychology, we have been neglecting study of concrete behavior in favor of the ease of self-report data: Both quantitative questionnaires & qualitative interviews
• PCEPS study illustrates value of following the example of early Carl Rogers and colleagues: We need to return to the study of therapy process

4.2. A Pluralistic community of practice: Using our different strengths as therapists to complement each other
4.2.1. Most of us are never going to be effective therapists across a range of different therapy approaches
4.2.2. But: We can do a better job of listening to and learning from each other within the PCE tradition:
• Classical, nondirective therapists
• Broadly relational person-centred therapists
• Focusers and EFT therapists
• Person-centred-based pluralistic experimenters in other approaches
• Near neighbors in 4th generation CBT (eg Schema therapy) and contemporary relational psychodynamic therapy

4.3. Toward a deeper understanding of nondirectivity via Task Analysis
•Here in the Counselling Unit, I have found myself fascinated by rigorous nondirectivity in therapy
•Personally, I could never adopt a sustained, rigorously nondirective stance
• Nevertheless, it is clear to me that there are clients and moments when this is absolutely the best thing to do
• I want to know:
(a) What are these moments? (=client markers)
(b) How can I maintain nondirectivity at these moments? (=therapist processes)
(c) What are the immediate and ongoing effects of these moments? (=micro-outcomes)

4.4. Conclusion: Living with the creative tension between nondirectivity and process guiding
4.4.1. It’s so difficult to live in the middle: Between dichotomies/unresolved differences/ ambiguity/ complexity (David Rennie’s “rocky middle road”)
4.4.2. However, I strongly suspect: Nondirectivity and Process Guiding might actually need each other: Can be a source of moderation and creativity for each other
4.4.3. My dream for the next 20 years of the CU: That as a community, we learn how to effectively live with and grow from from the creative tension between Nondirectivity and Process Guiding

5. Coda: And by the way…
• Those questions I asked five years when I walked into this place…
• About doing meaningful work, being accepted, finding space, changing things, and being changed…
• The Answer is … Yes

SPR Asilomar 2010

Entry for 28 June 2010:

In 1980, The Society for Psychotherapy Research’s annual international meeting was held at Asilomar, a retreat and conference center in Pacific Grove, California. This was familiar territory for me, because I had been there many times before as a child and teenager. The first time I was 10 or 12 when my grandmother brought me there to hear an author speak.

In 1980, Mardi Horowitz, as president-elect, was program chair (I talked to his son, who was very proud of his dad). Ed Bordin gave the presidential address, “Of human bonds that bind and free”, laying out his now-famous universal model of therapeutic relationship as comprised of three components: bond, goal agreement, and task agreement. I presented an early version of Elliott, Barker, Pistrang & Caskey (1982), on the helpfulness of different therapist response modes.

This year’s international SPR meeting returned to Asilomar, 30 years later. Like SPR itself, the place has grown over the years, to a large, rambling complex of dormitories and meeting rooms. It took a while for me to connect my memories to the present site, but the dining hall (now expanded with an additional dining room), the social hall, and the chapel eventually clicked into place, on three sides of the meadow of sand and beach scrub vegetation.

Louis Castonguay led off with a stimulating presidential address on different kinds of theoretical and research-practice integration, and the conference itself was a rich mix of sessions on the diverse aspects of psychotherapy research in different theoretical orientations and research methods. I was especially struck by the new generation of committed and talented psychotherapy researchers that has emerged. I find this reassuring and heartening.

I came to the conference exhausted from an intense two weeks of work that had followed after Diane flew to Seattle to see our new granddaughter. I’d been hard at work revising the chapter on empathy for the second edition of Norcross, Psychotherapy Relationship that Work; Bruce Wampold had taken exception to the primitive statistics (ANOVA) that I’d used in the empathy-outcome meta-analysis, and so I had had to learn newer statistics (Cochrane’s Q in particular) and concepts. This entailed completely rewriting the methods and results sections and occupied me all across the Atlantic and up until the day before SPR started.

My main activity for this conference was acting as discussant for three different panels. Over the past couple of years, I have been increasingly called upon to do this, and I have been honing my skills as discussant. In general, I seem to do best if I don’t over-prepare, which is good because it is usually difficult to find time to read through long presentations beforehand, on top of everything else. I take acting as discussant as a kind of extreme sport calling for quick integration of information. It reminds me of the extemporaneous speech event in the speech tournaments that I competed in high school. In a couple of panels that I was discussant for, I think I managed to nail the essence of what the researchers were trying to do, balancing praise with stimulating but constructive critique. It’s a really nice feeling to see the faces of these younger psychotherapy researchers, knotted in thought and at the same time pleased to have their work engaged with seriously and in depth. In the process, I came up with the following:

Robert’s Recipe for a Successful SPR Panel

1. New data

2. Interesting phenomena

3. Multiple methods

4. Videos!

As always, the high point of this year’s SPR was reconnecting with old friends and making new friends. For example, this year Mardi Horowitz and Bill Pinsof returned to SPR after many years’ absence, and it was good to catch up a bit with them, along with regulars Karla Moras, Les Greenberg, Adam Horvath, Irene Elkin, Lynne Angus, Sandra Paivio, Jesse Geller, Barry Farber, and many others. The conversations were far-ranging, from statistics, to qualitative research, to colleagues, to health, to the World Cup, to EFT training. For me, the spirit of Ed Bordin hovered over the conference, but also Lester Luborsky, who died this past year, as well as others who were here in 1980, the last time we met in this place: Ken Howard, Hans Strupp, Sol Garfield, Laura Rice, and Enrico Jones; all of their spirits hovered over the meeting, a host of ghosts, their voices in the wind and fog that blew in from the sea.

Reference:

Elliott, R., Barker, C.B., Caskey, N., & Pistrang, N. (1982). Differential helpfulness of counselor verbal response modes. Journal of Counseling Psychology, 29, 379-387.

Elliott (2010). Psychotherapy Change Process Research: Realizing the Promise

Entry for 31 March 2010:

When I received the Distinguished Research Career Award from the Society for Psychotherapy Research in June 2008, it came with a catch: I had to produce a paper for SPR’s journal, Psychotherapy Research. Paulo Machado asked me in Barcelona shortly after I got the award, giving me what felt at the time like a generous deadline: Aug 1, 2009. I spent months wondering what I should write about; I even sounded Paulo and Clara out about using my long-neglected Adjudicated HSCED paper (Elliott et al., 2009) for this purpose, but was gently reminded that it had to be single-authored.

Somewhere around February or March 2009 I finally realized that the only logical thing was for me to write about Change Process Research (CPR), a topic close to my heart and one that has spanned my research career. By a strange piece of synchronicity, Madison, Wisconsin, provided a 30-year time loop encircling my interest in CPR: At the front end of the time loop, my scientific interest in CPR dates back to a fateful conversation that I had with Les Greenberg in 1977, as we drove to O’Hare Airport after that year’s SPR meeting in Madison, Wisconsin. At the other end of the time loop, I had given a plenary paper on CPR at the 2007 SPR meeting, which was once again in Madison. The Madison 2007 paper became the starting point for my senior career award paper.

Because my writing schedule is generally restricted these days to 20 minutes each morning, work on the paper proceed slowly, as the pressure from Paulo increased to produce the paper, as it turned out, earlier than the original deadline. April and May passed, with the paper being repeatedly pushed aside for other pressing writing projects, including final work on the adjudicated HSCED paper. I had promised Paulo something by the end of June; however, I arrived in Santiago de Chile in late June with only a fraction of the paper drafted.

Then I came down with the H1N1 or Swine Flu, which was pretty awful in itself, but turned out to be gift from heaven as far as my senior career CPR paper was concerned. First, I was quarantined in my hotel room for a week, so I had plenty of time to lay in bed with minimal distractions. Second, the doctor had given a timely dose of Tamiflu, which reduced the flu symptoms enough so that I actually had enough energy to work on the paper. As a result, I wrote most of the paper during the week after the Santiago SPR meeting.

The paper turned out to be a tour de force, a survey of the major approaches to CPR, featuring lots of references and examples. It felt big, and was an odd contrast to my situation at the time, living in the enforced role of an invalid while putting together a grand survey of the key approaches at the core of the most central focus of the psychotherapy research field. Nevertheless, thanks to the H1N1 virus, Tamiflu, and especially to Diane’s patient help, the paper got written and was submitted on the 3^rd of July.

See also January 18, 2010 entry on this blog for a previous excerpt from this article: Change Process Research on Relational Depth: The Added Paragraph

Reference:

Elliott, R. (2010). Psychotherapy Change Process Research: Realizing the Promise. Psychotherapy Research, 20, 123-135.

Abstract: Change process research (CPR) is the study of the processes by which change occurs in psychotherapy, and is a necessary complement to randomized clinical trials and other forms of efficacy research. In this article I describe and evaluate of four types of CPR. The first three are basic designs and include quantitative Process-Outcome, qualitative Helpful Factors, and micro-analytic Sequential Process; the fourth, the Significant Events approach, refers to methods such as Task Analysis and Comprehensive Process Analysis that integrate the first three. The strengths and weaknesses of each design are described and summarized using both causal and practical criteria, as part of an overall argument for systematic methodological pluralism.

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.