Emotionally-Focused Therapy, Sue Johnson
Emotion
Purpose. Emotions offer a compass in life. They color our world and orient us to what matters at any moment. They move us to action, and they communicate to others.
Purpose. Emotions offer a compass in life. They color our world and orient us to what matters at any moment. They move us to action, and they communicate to others.
Health. Emotional health involves having access to our emotions, being able to trust the signals they send, and being able to regulate them. Approach emotions — joy, evoking relaxed engagement and openness; surprise, evoking curiosity; anger, evoking assertion and moving toward goals. Avoidance emotions — shame, evoking withdrawal and hiding; fear, evoking fleeing or freezing; sadness, evoking withdrawal or comfort-seeking.
Six Core Emotions. Approach emotions — joy, evoking relaxed engagement and openness; surprise, evoking curiosity; anger, evoking assertion and moving toward goals. Avoidance emotions — shame, evoking withdrawal and hiding; fear, evoking fleeing or freezing; sadness, evoking withdrawal or comfort-seeking.
Elements of an Emotion. Trigger: “There is a shadow in the darkness.” Fast, Basic Perception: “This is bad, dangerous.” Body Response: Heartbeat rises, pupils dilate, blood goes to feet. Cognitive Meaning-Making Response: The prefrontal cortex notes, “I should not be here alone.” Action Tendency: I speed up and begin to run.
Changing Emotions. To change an emotion, you must first allow yourself to feel it. Then you must tolerate it, unpack it, take hold of its essence (or distill it), and reshape it. The concept of deepening affect captures this process.
Therapeutic Work with Emotions. The therapist is always leading the client to the leading edge of their experiencing, helping the client to discover the unknown. When doing this, the therapist is careful to titrate risk, modulating the client’s engagement with difficult emotions. Moreover, the therapist knows that emotions tend to be fast and overwhelming, and therefore the therapist slows things down.
Specificity. When deepening emotional engagement and expanding awareness into what is implicit or hidden or denied, the therapist strives for specificity. As Laura Feldman Barrett points out, it is important to put emotions into words, constructing one’s experience with a high degree of specificity. This means that we’re searching for when, specifically, do emotional shifts happen — what is the key moment when things change? We ask, “What specifically happens to you in these difficult moments and where do you feel this? How does your perception change or how does your body feel?”
Present Moment. The therapist is constantly attuned to the present moment. The focus on the present moment as a microcosm of the client’s ongoing construction of their life experience is the hallmark of EFIT. Emotion turns the past into the present and discovery and change happen in the present. The therapist often says things like, “And right now what is happening for you” and, “Can we stay here, right now, with this moment?”
Macro Interventions: The EFT Tango
This is the basic set of interventions the therapist uses again and again in all stages of therapy.
Move 1: Reflecting Present Process. Your reflect and clarify cycles of affect regulation and cycles of interactions with others.
Move 2: Affect Assembly and Deepening. You join the client in discovering and piecing together the elements of emotion and placing them in an interpersonal context that renders them coherent and whole, often resulting in an expansion of awareness into deeper elements of emotion. You must make concrete each element and then link them to one another, putting these responses into a clear, concrete, and coherent whole.
Examples. Trigger: “What happened just before you shook your head so vehemently?” “Is there a moment when your sense of his unavailability really hit home — a moment that stands out for you — or an image that came up for you just before you sighed?” Body Response: “Can we just stay for a moment with the ache in your chest? Where is the ache?” Meaning-Making Response: “What do you say to yourself as you feel the ache in the middle of your chest? (Going for the meaning making that is part of the emotion.)”
Move 3: Choreographing Engaged Encounters. As new emotion emerges or is distilled and made poignant, you set up the disclosure of these expanded and deepened inner realities in structured guided encounters with parts of self, significant others, and at times yourself.
Move 4: Process the Encounter. You help the client explore and integrate the new interactional responses and dramas. With the client, you explore what enacting this emotion was like and how the responses of the other were heard and integrated. Example: “So how does it feel to say to Mom, ‘I am not going to creep around and beg for love anymore?’”
(1) Tracking and Reflecting Interactions. You first identify the negative cycle. You then move to interactions within the session. “What just happened there? You said… and then you said…” “How do you react, want to respond, when he talks about this in this way?”
(2) Reframing. You reframe the behavior in terms of attachment. Reframe #1: The cycle is the enemy. Reframe #2: The cycle is the fight for connection. “If you weren’t so important to her, she wouldn’t care...She suffocates you because she doesn’t know how to tell you what she needs.” Reframe for the withdrawer: You point out that withdrawers withdraw to regulate their emotions and protect the relationship from more fighting; withdrawers do not withdraw because they don’t care. Pursuer reframer: pursurers blame as an attempt to draw their partner closer; in attachment terms, any response is better than no response)
(3) Enactments. You invite clients to turn to each other. Don’t prompt an enactment before the client has experienced their primary emotion. Ask client to enact their primary emotion, not their need or desire. You must wait until Step 7 for this.
Stage #1: Setting the stage. Ask one partner to anticipate sharing directly her primary fear. “Can you imagine turning to Kyle just now and telling him about how afraid you are of him slipping away, and how, when you get that fear, it comes out in your, what you call your torrent of words?”
Stage #2: Directing the enactment. First confirm that the expressing partner is engaged in their experience and that the receiving partner is open to receiving. Then ask the partner to turn and share their experience. “Can you turn to him right now? Can you look at him and tell him about this fear?” If the client isn’t ready, you can slice the request/risk thinner. “Can you tell him, ‘It’s too difficult to tell you about this fear I have’?”
Stage #3: Processing the experience with the discloser. “What was it like to tell him about your big fear of him slipping away from you that bursts out in these massive rages?”
Stage #4: Processing the experience with the recipient. “What was it like for you, Kyle, to hear Tara share with you that under her outpourings of anger is this deep fear you could slip away from her and that she would be without you?” If Kyle diverts with, “She doesn’t need to be afraid of that,” the therapist validates and refocuses him. “.
Stage #5: Summarizing and integrating the experience.
Macro Interventions: The EFT Tango
This is the basic set of interventions the therapist uses again and again in all stages of therapy.
Move 1: Reflecting Present Process. Your reflect and clarify cycles of affect regulation and cycles of interactions with others.
Move 2: Affect Assembly and Deepening. You join the client in discovering and piecing together the elements of emotion and placing them in an interpersonal context that renders them coherent and whole, often resulting in an expansion of awareness into deeper elements of emotion. You must make concrete each element and then link them to one another, putting these responses into a clear, concrete, and coherent whole.
Examples. Trigger: “What happened just before you shook your head so vehemently?” “Is there a moment when your sense of his unavailability really hit home — a moment that stands out for you — or an image that came up for you just before you sighed?” Body Response: “Can we just stay for a moment with the ache in your chest? Where is the ache?” Meaning-Making Response: “What do you say to yourself as you feel the ache in the middle of your chest? (Going for the meaning making that is part of the emotion.)”
Move 3: Choreographing Engaged Encounters. As new emotion emerges or is distilled and made poignant, you set up the disclosure of these expanded and deepened inner realities in structured guided encounters with parts of self, significant others, and at times yourself.
Move 4: Process the Encounter. You help the client explore and integrate the new interactional responses and dramas. With the client, you explore what enacting this emotion was like and how the responses of the other were heard and integrated. Example: “So how does it feel to say to Mom, ‘I am not going to creep around and beg for love anymore?’”
Move 5: Integrating and Validating. New discoveries and new positive interactional responses are highlighted and reflected and validation is offered to build competence and confidence. Example: “This is amazing Carol, you have just taken all your ‘weakness,’ as you call it — all your pain — and faced it, stating clearly to your mom and now you are beaming at me!. Example: “Wow, Henny, you amaze me.”
Mirco Interventions
These are interventions for accessing, deepening, and reprocessing emotions.
(1) Empathic Reflections. Empathic reflections involve communicating the client’s core message back to him. Example: “I get so annoyed that my husband spends so much time gaming on his computer. Non-reflective response: “What would happen if you’d tell him to stop?” Reflective response: “So angry that this most important person in the entire world is turning away from you!”
Reflections serve several purposes. First, they allow the client to feel seen and acknowledged. Second, they order and distill experience. By repeating the client’s core emotional experience, emotional processing becomes increasingly orderly and meaningful. Rogers said that reflection is not a repetition but a revelation. Third, they make the leading edge of experience explicit. We are always listening on the leading edge for what the client seems to be saying but is not putting words. Fourth, they slow the processing and encourage present moment engagement. To do this, reflections need to be CVS — concrete, vivid, specific.
Sometimes we might want to reflect secondary emotion first, and then move to primary emotion.
(2) Validation. Validation affirms the client’s experience as legitimate and understandable given the attachment relationship context. Validating statements usually begin with “It makes sense that you would feel that way, given…” or “It makes sense that you would take that to mean…”
(3) Evocative Questions. These are questions that ask about the different elements of emotion. We ask these questions to evoke more emotion and exploration. Asking about triggers: “What do you see that tells you he is not listening?” “When do you get the message that he is ignoring you?” Asking about body response: “What sensations do you feel in your body when this happens?” Asking about meaning: “What does it tell you when he does not listen?” Asking about action tendency: “What do you feel like doing when…?”
(4) Heightening. What: Intensify certain emotions and interactions. How: RISSSC — Repeat key words for emphasis, Images to evoke emotion, Simple language, Slow your words, Soft voice, use Client’s words.
(5) Conjectures. These are tentatively offered reflections which go slightly beyond the leading edge of what a client expressed or conveyed. They could be called hunches seen through an attachment lens. But these are not hunches about why someone acts or feels as they do, as we are not searching for reasons or explanations; rather, we are seeking to expand experience. Conjectures are tentative and they allow room for clients to disagree or clarify.
The most engaging and emotionally alive conjectures are those where the therapist speaks in a proxy voice: “Under all this anger, Tara, I’m wondering if I am also hearing a lot of fear. ‘I’m terrified that Kyle is going to just slip away from me and find he prefers his gaming over being with me…’ Am I close?” More examples: “I wonder if some kind of fear came up…” “What I maybe hear you saying…” “My sense is…” “I’m guessing it gets really scary…”
These are interventions for accessing, deepening, and reprocessing emotions.
(1) Empathic Reflections. Empathic reflections involve communicating the client’s core message back to him. Example: “I get so annoyed that my husband spends so much time gaming on his computer. Non-reflective response: “What would happen if you’d tell him to stop?” Reflective response: “So angry that this most important person in the entire world is turning away from you!”
Reflections serve several purposes. First, they allow the client to feel seen and acknowledged. Second, they order and distill experience. By repeating the client’s core emotional experience, emotional processing becomes increasingly orderly and meaningful. Rogers said that reflection is not a repetition but a revelation. Third, they make the leading edge of experience explicit. We are always listening on the leading edge for what the client seems to be saying but is not putting words. Fourth, they slow the processing and encourage present moment engagement. To do this, reflections need to be CVS — concrete, vivid, specific.
Sometimes we might want to reflect secondary emotion first, and then move to primary emotion.
(2) Validation. Validation affirms the client’s experience as legitimate and understandable given the attachment relationship context. Validating statements usually begin with “It makes sense that you would feel that way, given…” or “It makes sense that you would take that to mean…”
(3) Evocative Questions. These are questions that ask about the different elements of emotion. We ask these questions to evoke more emotion and exploration. Asking about triggers: “What do you see that tells you he is not listening?” “When do you get the message that he is ignoring you?” Asking about body response: “What sensations do you feel in your body when this happens?” Asking about meaning: “What does it tell you when he does not listen?” Asking about action tendency: “What do you feel like doing when…?”
(4) Heightening. What: Intensify certain emotions and interactions. How: RISSSC — Repeat key words for emphasis, Images to evoke emotion, Simple language, Slow your words, Soft voice, use Client’s words.
(5) Conjectures. These are tentatively offered reflections which go slightly beyond the leading edge of what a client expressed or conveyed. They could be called hunches seen through an attachment lens. But these are not hunches about why someone acts or feels as they do, as we are not searching for reasons or explanations; rather, we are seeking to expand experience. Conjectures are tentative and they allow room for clients to disagree or clarify.
The most engaging and emotionally alive conjectures are those where the therapist speaks in a proxy voice: “Under all this anger, Tara, I’m wondering if I am also hearing a lot of fear. ‘I’m terrified that Kyle is going to just slip away from me and find he prefers his gaming over being with me…’ Am I close?” More examples: “I wonder if some kind of fear came up…” “What I maybe hear you saying…” “My sense is…” “I’m guessing it gets really scary…”
Interventions for Tracking Cycles of Interaction and Creating New Interactions
(1) Tracking and Reflecting Interactions. You first identify the negative cycle. You then move to interactions within the session. “What just happened there? You said… and then you said…” “How do you react, want to respond, when he talks about this in this way?”
(2) Reframing. You reframe the behavior in terms of attachment. Reframe #1: The cycle is the enemy. Reframe #2: The cycle is the fight for connection. “If you weren’t so important to her, she wouldn’t care...She suffocates you because she doesn’t know how to tell you what she needs.” Reframe for the withdrawer: You point out that withdrawers withdraw to regulate their emotions and protect the relationship from more fighting; withdrawers do not withdraw because they don’t care. Pursuer reframer: pursurers blame as an attempt to draw their partner closer; in attachment terms, any response is better than no response)
(3) Enactments. You invite clients to turn to each other. Don’t prompt an enactment before the client has experienced their primary emotion. Ask client to enact their primary emotion, not their need or desire. You must wait until Step 7 for this.
Stage #1: Setting the stage. Ask one partner to anticipate sharing directly her primary fear. “Can you imagine turning to Kyle just now and telling him about how afraid you are of him slipping away, and how, when you get that fear, it comes out in your, what you call your torrent of words?”
Stage #2: Directing the enactment. First confirm that the expressing partner is engaged in their experience and that the receiving partner is open to receiving. Then ask the partner to turn and share their experience. “Can you turn to him right now? Can you look at him and tell him about this fear?” If the client isn’t ready, you can slice the request/risk thinner. “Can you tell him, ‘It’s too difficult to tell you about this fear I have’?”
Stage #3: Processing the experience with the discloser. “What was it like to tell him about your big fear of him slipping away from you that bursts out in these massive rages?”
Stage #4: Processing the experience with the recipient. “What was it like for you, Kyle, to hear Tara share with you that under her outpourings of anger is this deep fear you could slip away from her and that she would be without you?” If Kyle diverts with, “She doesn’t need to be afraid of that,” the therapist validates and refocuses him. “.
Stage #5: Summarizing and integrating the experience.
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