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.
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