Withdrawer Re- engagement: Coming Alongside

Transcription

1 Withdrawer Re- engagement: The Art of Coming Alongside KATHRYN RHEEM, ED.D. & NICK LEE, PH.D. EFT SUMMIT 2017 SAN DIEGO, CA 1 Objectives To recognize maladaptive withdrawing and how it blocks emotional bonding and interdependency. To understand the process of coming alongside withdrawers in an attuned way. To recognize the signs of sufficient depth of emotional experiencing in- session with withdrawers. Video Demonstration of WRE 2

2 BELAR (2000) 3 Appraising the EFT Research Evidence Sexton, Gordon, Gurman, Lebow, Holtzworth- Munroe, and Johnson (2011) Evidence- based and ready for dissemination 1. Absolute and Relative Efficacy 2. Contextual Efficacy 3. Change Mechanisms and Process Research 4

3 Levels of Evidence EFT Research Absolute/Relative Efficacy Contextual Efficacy Process and Predictor Johnson & Greenberg (1985a,b) James (1991) Goldman & Greenberg (1992) Dandeneau & Johnson (1994) Denton et al. (2000) Halchuk et al. (2010) McPhee et al. (1995); Gordon- Walker et al. (1996) Johnson et al. (1998) Clothier et al. (2002) Dessaulles et al. (2003) Naaman et al. (2008) McIntosh & Johnson (2008) Denton et al. (2012) McLean et al. (2013) Johnson et al. (2013, fmri); Lee et al. (2017) Makinen & Johnson (2006) Bradley & Furrow (2004, 2007) Wittenborn (2012) Rheem (2011)** Lee et al. (2017)** Dalgeish et al. (2015) Burgess- Moser et al. (2015) Weibe et al. (2016, 2017) 5 Facilitating Withdrawer Re- engagement: Science into Practice / Practice into Science 6

4 Stage 1 Stage 2 Step 3: Identifying, accessing primary emotion The start of a Reconnaissance Mission Reconnaissance Mission for primary emotions Identify then access (experientially) Emphasis on failure, inadequate, disappointment, discouraged, hurt, pain, fear Depth of Emotional Experiencing in Step 3 In Step 3 an enactment will have less emotional intensity than in Stage 2 when a partner is being asked to take a risk and ask for his/her needs to be met 7 Enactments in EFT Experientially link the intrapsychic with the interpersonal Creates bonding moments (Johnson: the only way to re- structure the bond) Revision View of Self/Other (Bowlby) Change procedural memory (Siegel) 1. Intentional Effort 2. Intensive Repetition 3. Focused Intervention 8

5 Stage 1 Enactments In Stage 1: Engenders hope, reinforces positive interactions, especially at the beginning Helps partners own their positions in the cycle on an emotional, not just intellectual, level. Makes positions EXPLICITLY FELT Helps heighten feeling when looking at partner s face Helps partners make safe (non- escalated) contact 9 Stage 2 Enactments In Stage 2: Used extensively in change events Depth of Emotional Experience important Experiencing Scale (Klein et al, 1969): Level 4+ Corrective Emotional Experience Create bonding events necessary to re- structure the bond Ultimate Goal: Mutual Accessibility & Responsiveness 10

6 A Model of Withdrawer Re- engagement Two task analytic studies exist on the WRE process Rheem (2011); Lee et al. (2017) To discover the in- session processes that lead to successful completion of the WRE change event Steps in task analyzing change events (Bradley & Johnson, 2005; Greenberg, 2007) 1. Specify the task 2. Create a rational model of the task 3. Empirical observation of the task (i.e., coding in- session responses) 4. Synthesize the rational model with empirical observations 11 A Model of Withdrawer Re- engagement 1. Task specification: withdrawer re- engagement defined as the more withdrawn and/or dismissing partner shifting his or her pattern of relating from emotional avoidance and disengagement to connection (Johnson, 2004; Rheem, 2011). 2. Establishing a rational model of WRE: scoured empirical literature, conceptual literature, reviewed commercially available training tapes, and reflected on our own clinical experiences 12

7 Rational Model of WRE 13 A Model of Withdrawer Re- engagement 3. Empirical observation of the task Therapist operations coded using the Emotionally Focused Therapy Coding Scheme (EFT- CS; Bradley, 2001) Client emotional experiencing coded using the Experiencing Scale (EXP; Klein et al., 1969, 1986). 14

8 Experiencing Scale (Klein, Mathieu, Keisler, & Gendlin, 1969) Level Content Characteristics 1 External events; refusal to participate Impersonal, detached 2 External events; behavioral or intellectual self- description 3 Personal reactions to external events; limited self- descriptions; behavioral descriptions of feelings Interested, personal, self- participation Reactive, emotionally involved 4 Descriptions of feelings and personal experiences Self- descriptive, associative 5 Problems of propositions about feelings and personal experiences 6 Synthesis of readily accessible feelings & experiences to resolve personally sig issues 7 Full, easy presentation of experiencing; all elements confidently integrated 15 Exploratory, elaborative, hypothetical Feelings vividly expressed, integrative, conclusive or affirmative Expansive, illuminating, confident, buoyant Commonly Observed Interventions WRE Across both studies the following were the most commonly observed Heightening Evocative Questioning/Responding Empathic Conjecture Tracking/Reflecting Underling Emotions Restructuring Interaction via enactments 16

9 A Model of Withdrawer Re- engagement The empirical observations made via the coding process are then compared to the original rational model This is done in a recursive fashion until a synthesized model is established. 17 Synthesized Model of WRE 18

10 Possible Disclosure of Core Affect Level of EXP ranged from 2-3 Interventions Evocative Questions Empathic Conjecture Evocative Q Heightening Evocative Q ( Evoc Sandwich ) Core Theme Does not open up about vulnerability with partner Hesitancy and doubt 19 Distilling Core Affect Shame en- route to fear Level of EXP ranged from 3 to 4 Interventions Heightening (RISSSC); parts language Empathic Conjecture Evocative Questions Reframing Core Themes Shame associated with being incompetent or not getting it right ; fear of being rejected 20

11 Increase Depth of Experiencing: 1. Limbic Resonance: steadies a person whose emotions are tumbling; therapist takes up temporary residence in client s emotion. 2. Limbic Regulation: Balance thru relatedness! Emotional regulation is learned implicitly. 3. Limbic Revision: Knowing your clients limbically is the 1 st goal of therapy. Required to revise the neural code/procedural memory that directs their emotional lives. 21 Role of Emotions Our emotions are a compass - they communicate what matters, what we need, who we are. They are wired in - take precedence in our brains. Hard to hide them - they seep out of every pore. Not illogical - perfectly reasonable if you get the context. Emotions are the attachment language

12 Importance of Emotion The absence of an emotional signal is the ultimate threat in attachment relationships. Suppressing emotion is hard to do. Emotion seeps out of every pore. Suppression strategies should be used with care. Shutting down doesn t calm us down! Expressing & Reading Emotion Expressions are more than just signals; expressions are an extension of the emotion itself When we feel something, the face and body muscles contract in characteristic ways Because we are highly interdependent, very useful to read each other s emotion in order to predict behavior 24 24

13 Facial Expressions (Ekman, 2003) Our faces are emotional truth- telling billboards. The face in one of the few places where the muscles connect directly to the skin. Sophisticated communication system. Macro Expressions Micro Expressions (1/15 1/25 of a second) Importance of Noticing Micros Improve your attunement Visual cues that something is stirring on the inside. Stay closer to your client s unfolding experience Clarify emotion signals being sent Increase your empathy Recognize and manage your own emotions 26 26

14 The Present Moment Empathic Responsiveness: Foundation of all EFT interventions Prosodic Presence of Clinician required to create safety Clinician as a Temporary Attachment Figure Listening without interpreting; listening is reciprocity. Bottom up processing (through the emotions and the body the only way to change procedural memory) See our clients physiology on their faces and in their voices. Clinician has to leverage neurophysiologic data to make the most of it! 27 WRE Enactment Expression of shame and fear with partner Level of EXP ranged from 3 to 4 (sufficient enough?) Interventions Restructuring Interaction (i.e., enactment) RSI Heightening RSI (e.g., setting the table ) Core Themes Difficult to open and share vulnerability; feels scary to let partner in NOTE: level of EXP often needs to be raised with additional distilling of core affect and mini- enactments (Rheem, 2011; Lee et al., 2017) 28

15 Increasing EXP/Additional WRE Enactments Level of EXP at 5 Interventions Enlisting support of partner (hidden gem in both studies!) Additional heightening Validation Evocative Questions Serve up more EVOC sandwiches! Core Themes Fear of being inadequate and/or deficient as a partner; not good enough as a partner 29 Tips for Successful WRE Multiple & shorter enactments; iterative Enactments needed to be expanded and repeated in order to become more fully developed Dripping faucet metaphor Therapists aided process by summarizing & encapsulating so Withdrawer could integrate 30

16 The Cycle of Video Couple Wife: Withdrawer Behaviors: Feels/believes she s incapable of being there for him emotionally. Tidies her corner; avoids contact with him & herself Perceptions/Attributions: I m inadequate; I ll never be enough for him; He s too much; Self-sufficiency is best. Secondary Emotions: Frustrated, Disrespected, Numb, Overwhelmed Husband: Pursuer (mostly) Behaviors: Makes emotionally loaded demands; gets intense; vocal about a lot! Perceptions/Attributions I m too much; too many needs; I m from corrupt stock. She s incapable. Secondary Emotions: Angry, Frustrated, Overwhelmed Primary Emotions: Scared, Hurt, Sad Unmet Attachment Needs: Longing to feel that something more, to feel she is enough for him. Primary Emotions: Scared, Sad, Hurt Unmet Attachment Needs: Longing to connect emotionally, to share emotions together, to be a soft place for her. 31