Rhonda N. Goldman, Leslie S. Greenberg Argosy University, Schaumburg, American School of Professional Psychology, York University

Transcription

1 European Psychotherapy/Vol. 7 No european Rhonda N. Goldman, Leslie S. Greenberg Argosy University, Schaumburg, American School of Professional Psychology, York University Integrating Love and Power in Emotion-Focused Couple Therapy A BSTRACT Affect regulation is viewed as the core motive that organizes three major motivational systems that are the focus of Emotion-Focused Couples Therapy EFT-C (GREENBERG & GOLDMAN, 2008): attachment, identity and attraction. In this view we seek to feel good, and not to feel bad, and are thus motivated to seek positive and avoid negative affect. This is inherent to survival. We thus form attachments and seek to repair them when broken because it makes us feel good and we seek to validate our identity because it leads to positive feeling. A major tenet of Emotion-focused Couples therapy is that revealing underlying feelings based on adult unmet needs for closeness as well as responsiveness and soothing by an intimate partner is crucial to restructuring the emotional bond (GREENBERG & JOHNSON, 1986, 1988; GOLDMAN & GREENBERG, 2006; GREENBERG, FORD, ALDEN & JOHNSON, 1993; JOHNSON & GREENBERG, 1988). JOHNSON (2004) developed the original Emotion-focused couples therapy model put forward by GREENBERG & JOHNSON (1988) to more fully integrate an attachment theory of love to the theoretical framework. In our recent book, we articulate how affect regulation is a core motive and while fully recognizing the importance of attachment we further expand and develop the dimension of influence, suggesting that in our efforts to regulate affect we seek validation and attempt to influence our partners in addition to seeking comfort and needing connection. Adopting a lens of affect regulation helps us understand couples interactions and provides a framework for working with emotion. In EFT-C emotions are treated differentially depending on which emotion is expressed and how it functions for both the individual and the couple. We have recently outlined ways to help both couples and individuals regulate anger, sadness, fear, shame, love and other positive emotions (GREENBERG & GOLDMAN, 2008). Couples conflict can be seen as resulting from breakdowns in both other and self-regulation of affect. A hallmark of our original model is the strong emphasis on people expressing underlying vulnerable feelings to undo negative interactional cycles and the encouragement of the expression of adult unmet needs and responsiveness to these expressions. We also work on 117

2 european European Psychotherapy/Vol. 7 No self- change and the resolution of pain stemming from unmet childhood needs that affect the couple interaction. We thus explicitly integrate our work in individual therapy (GREENBERG & PAIVIO, 1997a&b; ELLIOTT, WATSON, GOLDMAN & GREENBERG, 2004; GREENBERG, 2002) with our approach to couple therapy to form a more comprehensive approach to treating couples. The Emotion-focused therapeutic view of human functioning (GREENBERG, 2002; ELLIOTT ET AL., 2004; GOLDMAN & GREENBERG, 1997: GREENBERG & JOHNSON, 1986, 1988; GREENBERG & PAIVIO, 1997a; GREENBERG & SAFRAN, 1986) purports that the ability of individuals to access, soothe and transform core maladaptive emotion schemes (emotional wounds) is central to self change. Dealing with each partner s pain of unmet needs from the past and helping them to self-soothe is important in couple therapy in working toward relationship satisfaction and enduring change. The focus on self-soothing, if necessary, helps restructure emotional bonds and ensures more enduring and stable change. This is a finding that has been well borne out in research by GOTTMAN (1999) that has shown us that self-soothing is an important element of successful marriage. We will first discuss how emotion functions in couple conflict and how change in couples emotion systems occurs in EFT-C. A five stage model of the major stages of therapy will be outlined and strategies to promote emotional change in couples will be discussed. Concepts will be illustrated through a transcript of EFT-C. Affect Regulation and the Three Major Motivations We suggest that the three major motivational systems of attachment, identity maintenance and attraction are of central importance in couple therapy. Attention to these relational needs in marital conflict leads to therapeutic work that focuses on three related sets of emotions, that govern these motivations viz: fear/anxiety and sadness in attachment, shame/powerlessness and anger in identity maintenance and joy and interest/excitement in attraction. We work on promoting three associated forms of relational response: proximity, nurture and comfort to promote attachment security, and calm fear, empathy and validation to affirm identity, promote esteem and undo shame, and novelty and expression of positive feelings to promote attraction and provide a store house of positive sentiment. Attachment and connection People need connection and closeness to feel secure (BOWLBY, 1988). In the face of threat the toddler runs and clings to the caretaker. This is done because contact/comfort soothes anxiety. Similarly in the face of threat adults turn to their intimate others for comfort and soothing. BOWLBY (1988) proposed that early emotional relationships were the foundations for later ones. He suggested that if our personal history is one of having received security, we will be able to form secure attachments. If our early relationships were experiences of having been 118

3 European Psychotherapy/Vol. 7 No european separated, let down, or disappointed, we face a harder task in forming trusting relationships with others in adulthood. What Bowlby called maternal deprivation, a lack of a continuous nurturing relationship in the first three years of life would make it difficult, sometimes impossible for a person to form trusting intimate relationships in adulthood. HAZAN & SHAVER (1987) extend infant attachment theory to adult romantic relationships, arguing that adults appear to experience bonds of attachment toward romantic partners that has some of the same characteristics as infant caretaker bonds. They propose that the emotional and behavioral dynamics of infant-caregiver relationships and adult romantic relationships are governed by the same biological system (HAZAN AND SHAVER 1987; 1990; SHAVER & HAZAN, 1988). Partners become distressed when loved ones leave or are unavailable for any length of time. The infant s tendency to monitor the caregiver s proximity, availability and responsiveness is present in adults in close relationships. Adults basic concerns in intimate relationships thus involve the same affect regulation needs: 1) a need for proximity (are you there when I need you?), 2) a need for availability (do you give me the things I need such support, care?), and 3) a need for responsive receptiveness to me (do you respond when I need it?). These all help adults regulate affect and feel secure. For the young child these are mostly automatic responses but adults often (although not always) are able to articulate their felt needs and beliefs in regard to their needs for care. This need for attachment is an adult, not an infantile need, and only becomes unhealthy if a person cannot tolerate need frustration, and flies into a rage or becomes depressed at loss, separation, distance or non-responsiveness. Thus, the emotions and behaviors that characterize romantic relationships and infant-parent relationships share similar activating and terminating conditions and appear to exhibit the same latent dynamics (SHAVER ET AL., 1988). Adults also appear to share the same attachment styles as toddlers. Initially three adult attachment patterns were postulated (AINSWORTH, 1985); a secure pattern and two insecure patterns and these were later expanded to four patterns, secure, anxious-ambivalent, fearful avoidant and dismissive avoidant (MAIN, 1996). These attachment styles have been used in an effort to clarify a person s motives in interpersonal relationships: Does the person want closeness, or does the person prefer distance? Does the person feel in control of the relationship, or does he person feel helplessly vulnerable to rejection and abandonment? Some people routinely avoid closeness in order to protect themselves from rejection. Partners who are avoidant feel uncomfortable being close to others and find it difficult to trust them completely and difficult to depend on them. They get nervous when a partner gets too close, and often feel their partner wants them to be more intimate than they feel comfortable being. Partners who are anxiously attached find that others are reluctant to get as close as they would like. They often worry that their partners don t really love them or won t want to stay with them. They often want to get very close to their partners, and this sometimes scares their partners away. Spouses who are fearfully avoidant adopt an avoidant orientation toward attachment relationships to pre- 119

4 european European Psychotherapy/Vol. 7 No vent being hurt or rejected by partners. Dismissing partners, adopt an avoidant orientation as a way to maintain a defensive sense of self-reliance and independence. It appears however that individual differences in romantic attachment are best organized within a two-dimensional framework rather than by the type of attachment patterns mentioned above (MIKULINCER & GOODMAN 2006). One dimension, is anxiety, and relates to the degree of anxiety and vigilance concerning rejection and abandonment. The other dimension, avoidance, relates to the degree of discomfort with closeness and the dependence or a reluctance to be intimate with others. People are thus seen as monitoring and appraising events for their relevance to attachment-related goals, such as the attachment figure s physical or psychological proximity, availability, and responsiveness and then regulating their attachment behavior. For example, to regulate attachment-related anxiety, people can orient their behavior toward the attachment figure or withdraw and attempt to handle the threat alone. JOHNSON (2004) has written extensively on the role of attachment in EFT-C and we view the attachment bond and the security it provides as a central concern in most couples. It is a key form of affect regulation, governing both emotional arousal and approach and avoidance. We however suggest that we attach because attaching regulates affect and that without fear at separation, joy at connection and sadness at loss we would have no attachment. In our view affect regulation is a core motive that leads to attachment (GREENBERG & GOLDMAN, in press) rather than vice-versa. Motivation is thus seen to work because of affect regulation rather than simply to produce it. People clearly are relational but what they need from connecting with others is more than only security as suggested by attachment theory. Our relational need has to be differentiated into its different aspects. Attachment has come to be seen as the master motive by many theorists and practitioners and in our view now has been over-applied to explain almost all of human functioning, even to explain love itself. Adult love seems to be more than, but include attachment. We also should not assume that all romantic, or couple relationships, always are attachment relationships. In addition in a long-term adult relationship, as opposed to in infant caregiver relationship, the attachment and caregiving roles are interchangeable making adult attachment quite different from infant attachment. Adults also are able to self-soothe and need to develop this ability if they cannot. What is important and unique about attachment figures is that we internalize their functions so we feel their soothing effects without their physical presence. Anticipating their soothing responses thus regulates our emotions. To assume however that adult attachment parallels infant-caregiver bonding is a stretch and to call this love is also a problem. Finally, attachment styles often are multiple and dynamic. People have more than one style and these can change depending on the context and can transform over time (GREENBERG & GOLDMAN, in press). In addition we need relationships for more than soothing separation anxiety and providing security. 120

5 European Psychotherapy/Vol. 7 No european Identity maintenance and Dominance and Control In our view, an understanding of the relational and emotional processes in the formation and maintenance of identity and self esteem and the dominance cycle that ensue when identity is threatened is a crucial piece of the puzzle of how to resolve couples conflicts. Our intimate relationships are important in influencing how we see and feel about ourselves. In this paper we thus elaborate an emotion-focused perspective on how to work with threats to identity and with the dominance struggles that result from partners efforts to ensure a sense of a worthwhile identity. Hierarchy and issues of dominance and control and maintenance of self have long been recognized as significant issues in couples and family functioning. Couples struggle over the definition of reality and issues of power and control are often the most difficult interactions to deal with in therapy. When identity is threatened people act and interact to protect their identities. When identities are threatened shame and fear result, as well as anger. People attempt to exert influence and control in order to regulate their affect ie: to not feel shame of diminishment and the fear of loss of control or to feel the pride of recognition and the joy of efficacy. We thus work with revealing and soothing of the emotions of shame and fear that underlie dominance and the anger and control that ensues from threats to identity. We have found that self-soothing, in addition to other-soothing, often is important in helping people deal with identity threats and in resolving influence and dominance cycles. In dominance conflicts it is each partner s concern with how they are perceived (their identity) by the other and whether their needs for agency or recognition are being met, rather than concerns with closeness and connection, that become primary. In these conflicts partners argue, not about being close or needing distance, but about being validated and respected or about not being seen, feeling unimportant or diminished- they argue to maintain their identities. It is important to note that dominance struggles although hinging on identity needs can still exert a strong influence on the attachment bond by producing abandonment anxiety and insecurity as a secondary response captured by phrases such as If you don t value who I am you may leave me or If you cannot validate me I may reject you. In one form of dominance struggle the central concern is whose definition of self and reality is right, and who has the right to define what s right. In another it is whose needs are more important. In struggles about what s right, partners fight to defend their view of reality and they defend themselves against the humiliation of being found wrong or lacking because feeling wrong makes them feel unworthy, inferior, deficient or incompetent. Partners attempt to stave off dreaded feelings of catastrophe and loss of control. They also fight to influence decisions and courses of action in order to feel recognized and to maintain status and a sense of autonomy. They fight to protect their ability to operate by choice under their own volition rather than being coerced. Alternately partners give up their identities and become fused in order to avoid 121

6 european European Psychotherapy/Vol. 7 No conflict but excitement and positive feelings are the victims. When people are seen negatively by their partners, feel over-exposed or powerless they often shrink in shame and want to hide. When they feel seen, accepted and validated they open themselves to the other and express their innermost thoughts and feelings. In order not to feel this primary shame and in an attempt to avoid these powerful uncomfortable experiences people often respond with anger and attempts to dominate. Differences and conflicts related to dominance and control thus often emerge in couple relationships out of threats to identity as aggressive attempts to regulate shame. Fear of loss of control also leads to efforts to dominate and control. Partners then can stimulate positive affect in the other and find this to be a far more satisfying way to receive recognition and identity validation than coercion. This can often be achieved interactionally or by arousing positive feelings of care, concern, attraction and liking that in a sense form a buffer and protects against negative emotions. In addition, helping partners learn to tolerate and regulate their own fear and shame rather than being controlling and/or flying into a rage to regulate self-esteem and maintain identity becomes an important goal of couple therapy. Attraction and Liking Working with emotions in the third motivational system, attraction and liking, also needs to be considered in promoting bonding in couples therapy. The positive feelings that are generated when partners are interested in, like, and feel attracted to each other are important in the maintenance of intimate bonds. Feeling excited by, and enjoying each other helps couples stay together. Being reminded of feelings of attraction and liking, feeling warmth and appreciation and cherishing and valuing the other, as other, leads, in our view, to both pleasure in, and compassion towards, the partner. Developing a store-house of positive feelings also acts to inoculate against future conflict. Without positive feelings a relationship may be functional but it will not flourish and therefore may not last. We thus emphasize this third motivational system, and the related set of feelings of excitement and joy and liking of the other as very important ingredients of what makes relationships work. Emotion in Interaction Emotions organize both the self and interactions with others. Members in a family are highly connected to each other through this emotion system. They read each other s emotional signals with great care and this reading dominates their interactions. The amygdala, at the core of the emotional brain, has been shown to be particularly attentive and reactive to subliminal facial expressions of fear and anger, indicating how automatically and rapidly people react to facial expressions of emotion (SCHUPP, OHMAN, JUNGHOFER, WEIKE, STOCKBURGER, HAMM, 2004). 122

7 European Psychotherapy/Vol. 7 No european Emotions influence interactions in various ways. They change the interaction by changing the self. In anger, for example, the individual transforms by swelling up, thrusting forward, and is both physiologically and cognitively organized to attack or defend. The action tendency organizes the person to thrust forward or alternately to flee thereby changing the person s relationship with the environment. The emotional organization plus the facial expression of anger in addition signals angry intent to the other. Emotion thus is our primary signaling system and influences interaction by non-verbal communication. Affective expression is a crucial form of communication that regulates self and other. Interaction The emotion-focused approach applied to systems, views interaction and negative interactional cycles, as a major source of dysfunction. Interaction thus becomes a primary focus of therapy. Revealing vulnerable emotions underlying intercational positions is seen as an excellent means of changing negative interactional cycles. Conflict, as we have said is seen as stemming mainly from failures to resolve struggles for both security and identity. Negative interaction cycles arise when core identity and attachment needs are not being met. Fear and shame are the core maladaptive emotions that accompany invalidation of these needs. However, couples in therapy are more likely to express rapid-acting anger and anxiety-based withdrawal so that the work of the therapy is first to access the core underlying emotions. Conflict thus results from escalating interactions that rigidify into negative interactional cycles. Once negative cycles related to threats to security and identity have been identified, the fundamental task of therapy is to engender positive interactional cycles by having partners reveal previously unexpressed primary, adaptive attachment and identity oriented emotions and needs and finding new ways of dealing with these. Types of Emotion in Couple Therapy Given that relational conflict most often results from unexpressed hurt feelings and unmet needs related to security and identity it is important to help partners deal with their own, and their partner s emotions and related needs. Simply helping partners get in touch with any feeling or encouraging the expression of any emotion will not resolve conflict because not all emotions serve the same function. Therefore it is important to distinguish between different types of emotions, and understand which emotions need to be acknowledged and expressed to resolve conflict, which need to be bypassed, contained or soothed, which need to be explored, and which need to be transformed. Our approach to treatment is based on the idea that some emotions are adaptive and some are maladaptive. As other papers have made clear we have found it helpful in understanding emotion to distinguish between different types of emotion: primary, secondary and instrumental as well as between adaptive and maladaptive emotions 123

8 european European Psychotherapy/Vol. 7 No (GOLDMAN & GREENBERG, 2006; GREENBERG & SAFRAN, 1986; GREENBERG, RICE & ELLIOTT 1993, GREENBERG 2002; ELLIOTT ET AL., 2004). These are described below. Maladaptive emotional states are indicated by intense and escalating interactions and these states lead the partners to say and do things that later often are seen as not representative or not real, or as having gone a bit crazy. People will later say that what was felt and what was said in these states was untrue, it was really not them. These not me states seem to have a mind of their own. These not me states, are states of dysregulation that are self reinforcing. Once in them people may begin to yell at each other rather than speak to each other, or they may cut off and not listen. They think they have heard it all before. They probably have repeated these fights before and have resolved them and have sometimes understood and forgiven each other many times. But it just happens all over again. They can even see it coming but once they enter these unhealthy emotional states of threat, violation or humiliation, they are transformed into their other maladaptive selves. For example in one of these dances of maladaptive states a husband, sensing some invalidation may experience it as a discounting of his identity and he may yearn for appreciation and acceptance. He might seek control and attempt to make her do it his way. He may become anxious in the face of her denial of him. The wife on hearing a hint of demand and control may automatically feel a desperate need to protect herself from destruction. She fears becoming overwhelmed by her partner, seeing him as intrusively powerful and closes up, becoming rigid, feeling icy and becomes dismissive. This only further increases the husband s sense of invalidation. In the past, she may have had to take care of others by validating their identity at the expense of her own needs and is therefore sensitive to potential invalidation or annihilation. A Stage Model of Therapy GREENBERG & JOHNSON (1986, 1988) laid out nine steps of treatment of EFT-C that were subsequently organized by JOHNSON (1996) into three stages of, negative cycle de-escalation; restructuring the negative interaction, and consolidation and integration. We present here an expanded fourteen step five stage framework of EFT which in line with our incorporation of more self-focus includes additional steps that focus on each partner s intrapsychic emotional process. The five stages are: Validation and alliance formation; Negative cycle de-escalation; Accessing underlying feelings; Restructuring the negative interaction and the self; and Consolidation and integration. 124

9 European Psychotherapy/Vol. 7 No european The Five Stage Framework Stage 1: Validation and Alliance formation The first stage emphasizes the creation of safety and the development of a collaborative alliance. It involves the following steps. 1. Empathize with and validate each partner s position and underlying pain. 2. Delineate conflict issues. Assess how these issues reflect core problems in the areas of connectedness and identity. The most important initial goal of the first stage is establishing safety and a collaborative alliance. This stage involves the therapist developing empathy, genuineness and positive regard for the couple and forming a bond with each partner, without alienating the other. This allows clients to feel safe enough later to reveal their vulnerabilities and their position/role in the cycle. Validation of feelings and needs by the therapist helps calm each partner s anxiety and the empathic understanding by the therapist of each partner s emotional pain, to some degree, soothes the hurt of not being heard by the partner. Stage 2: Negative Cycle De-escalation The second stage emphasizes reducing the emotional reactivity between the partners and involves the following steps. 3. Identify the negative interaction cycle, and each partner s position in that cycle and externalize the problem as the cycle. 4. Identify the unacknowledged attachment/identity related emotions underlying the interactional positions. 5. Identify each partner s sensitivities and vulnerabilities and their historical origins to help broaden the understanding of the negative interactional cycle. 6. Reframe the problem in terms of underlying vulnerable feelings related to unmet attachment and identity needs. The therapist in this stage relationalizes the couples presenting problems in terms of the cycle thereby identifying the cycle as the problem rather than partners. Once the cycle is identified the therapist begins to focus on helping partners label their underlying emotions and most importantly to identify and explore the underlying core sensitivities that are being activated in the cycle. The therapist at this time also explores to see if there are some important psychogenetic origins of the wound. Getting a sense of partners families of origin stories helps to identify interacting sensitivities or vulnerabilities. If the sensitivity is not from family of origin it may come from previous relationships or life experiences. These sensitivities are not viewed as pathological but as understandable vulnerabilities and are still seen as current adult unmet needs. Once a picture of the cycle and underlying feelings and sensitivities has been formed, the therapist emphasizes how the sensitivities interact. For example one partner s sensitivity to 125

10 european European Psychotherapy/Vol. 7 No abandonment based on an earlier loss which leads to aggressive pursuit interacts with the others fear of being unworthy based on a history of criticism which leads to withdrawal. Stage 3: Accessing underlying feelings This stage emphasizes the actual experiencing and revealing of the underlying emotions. It is important to note that it is the display of emotion that is so important in changing interaction. Seeing the face of each other evokes experience. We are impacted by the ways others face us. How we imagine the face of the other also is important in how we feel and what we do even without the other present. The face however is an ambiguous text open to interpretation and so how we react to others also is subject to our interpretation of the other. In therapy we also want each partner to express in words what they feel in such a way that there is no doubt about what is being felt, so that it is not misinterpreted. In this stage the steps below embody the core of the emotion-focused work. 7. Access unacknowledged feelings/needs underlying interactional positions and revealing them to the partner. Generally blamers need to express fear, sadness or loneliness, while distancers need to expresses anxiety or anger. Generally dominants need to express underlying shame, fear or anger while submitters need to express anger, shame or fear. 8. Identify and overcome intrapsychic blocks to accessing and revealing emotions. 9. Promote identification with disowned needs/aspects of self, integrating these into relationship interactions. An important skill that an EFT-C therapist must learn, in order to help partners access underlying emotions, is how to identify blocks to, and interruptions of, underlying feelings and how to help partners overcome these blocks. If the couple is ever to move beyond, talking about their feelings to true revealing, they have to feel safe enough with both the partner and therapist to overcome their usual avoidance of their core feelings and their fear of revealing them. One of the main methods for dealing with interruptions and avoidances is to treat them as needed protection and to understand their protective function. Using the metaphor of a wall of protection to do this is often useful. Therapist operations that are helpful in overcoming blocks to revealing, especially when an injury or betrayal has occurred, or when there is a lot of distrust and vulnerability in one partner, are Reaching in and speaking for, and Focusing on the fear of opening. Here the therapist needs to make explicit what is being protected and what is not being said, and say it for the partner. The therapist needs to reach in and pull out the underlying vulnerability (this is reminiscent of Virginia Satir s sculpting method of teaching where she would have someone act as the vulnerable child part of the person and she would pull it out through the person s legs). It is important to identify the nature of the fear that is organizing the protection. The therapist needs to focus on the fear of reaching out or of letting the other in. The fear may be either of i) what the other may say or do (i.e.: reject, criticize etc.) or, ii) the self may feel worthless, 126

11 European Psychotherapy/Vol. 7 No european ashamed or afraid. Whatever the fear is the therapist may need to formulate the partners unformulated experience and say this for the partner. If one partner is having particular difficulty opening up and reavealing vulnerability, the therapist may even have that partner say this to the other partner. For example, the therapist might say can you tell him this now. I feel vulnerable and I need to protect myself. I just can t let you in right now. I am too afraid. Partners interruptions of emotion, their avoidances or defenses, thus are validated as protective and the need for them is empathized with and explored until such time as the readiness for change emerges. In more general instances in working with characterological blocks to emotion in highly defended or avoidant partners, where for example one person is super-rational or is highly deflecting, therapists need to help the individuals first become aware that they are avoiding emotion. Then the therapists helps them become aware of how they are doing this, be it by intellectualizing, changing the topic, making jokes or squeezing their muscles. Only when people are aware of their blocks to emotion and begin to own this process can the therapist help them access and reveal what feelings they are blocking. How to work with individuals self-interruptive process in an emotion-focused way has been elaborated more extensively in books on individual emotion-focused work (GREENBERG, 2002; GREENBERG & PAIVIO, 1997a; ELLIOTT ET AL., 2004; GREEN- BERG & WATSON 2006). Stage 4: Restructuring the negative interaction and the self This stage emphasizes the enactment of new ways of being with each other with steps ten and eleven embodying the core of the interaction-focused work and step 12 emphasizing selftransformation. 10. Promote acceptance of the other partner s experience/aspects of self. 11. Facilitate the expression of feelings, and needs and wants, to create genuine emotional engagement, and restructure the interaction. The main goals here are to promote blamer softening and distancer-reengagement in pursue-distance cycles and to support the dominant partner to go one down by revealing vulnerability and having the submitter assert in influence cycles. 12. Promote self-soothing and transformation of maladaptive emotion schemes in each partner, to facilitate self change and more enduring couple change. In restructuring the interaction, it is the partners acceptance of the expressed vulnerable underlying feelings that is paramount and it is this that sets up a new interaction. When one partner has non-blamingly revealed a primary feeling about an identity vulnerability or an attachment insecurity and the listening partner is unable to respond with validation or caring, attention needs to be turned to what is blocking more bonding and validating responses from the listening partner. This is usually a 2-step process. Working with the blocked partner, the therapist helps the client identify and acknowledge that there is a block which in turn allows the thera- 127

12 european European Psychotherapy/Vol. 7 No pist to hold and contain the vulnerable partner while exploring what may be blocking the blocked partner from responding more acceptingly and compassionately to a revealed vulnerability. Once acceptance has been achieved, the expression of, and response to heartfelt needs is promoted. This is often expressed in an enactment in which the partners turn towards each other and express and respond to each other s feelings and needs. These expressions result in a change in interaction. This also is one of the points at which the promotion of positive interaction to promote positive feelings and the expression of positive feelings to promote closeness and validation is emphasized. Once partners are more accessible and responsive and interactions have changed, to ensure enduring change, individuals also may need to work on developing their own capacities to self-soothe and to transform their maladaptive emotional responses, which often are responses to unmet childhood needs or past trauma, rather than to the partners lack of responsiveness. The capacity to self- soothe also is important for times when the partner is not emotionally available or responsive. Often with less dysregulated couples, restructuring the interaction involves first developing more responsiveness to each other. With more dysregulated couples, the work of restructuring will often first require helping partners in the couples therapy, learn to self-soothe when they become highly dysregulated in response to the others non responsiveness or unavailability. Then helping partners transform their own responses, which often are based more on unmet childhood needs than on the current context, is also helpful. The focus on self regulation of emotion, be it an early step for more extreme behaviors, or a later step to facilitate self-change and more enduring interactional change, by focusing on transforming emotional responses based on childhood unmet needs, involves helping people to tolerate their own painful emotions, soothe them, make sense of their emotions, and utilize them for constructive action and interaction rather than hold their partner responsible for their feelings. Stage 5: Consolidation and Integration In this final stage both interactional change and new narratives are supported and the steps below embody the behavioral and narrative focused work in EFT-C. 13. Facilitate the emergence of new interactions and solutions to problematic interactions/issues. 14. Consolidate new positions and new narratives. In the final stage of couples therapy partners are asked to reflect on what is different now. The therapist encourages the articulation of a new narrative of the relationship and of each partners self by eliciting examples of their personal and relational growth. This is another point in therapy at which positive feelings are focused on and their expression is encouraged. The discussion focuses on couples developed strategies for undoing negative cycles by expression of underlying feeling and needs. The couple also is asked to practice new behaviors involved in 128

13 European Psychotherapy/Vol. 7 No european their positive cycles and also to identify what they could each choose to do to precipitate the negative cycle if they wanted to return to a more dysfunctional way of relating. This gives them a sense of their own role and responsibility in, and control of, their negative interactions. In addition the new ability to take a self focus rather than an other focus is emphasized and practiced. Ella and Tim: An Illustration of Emotion-Focused Couple Therapy The example that follows is taken from the ninth session of a short-term EFT-C focused on healing from a betrayal by one member of the couple, Tim, having had an affair over 2 years prior to therapy. Earlier sessions have focused on the identification of the couples negative interactional cycle and reframed it in terms of underlying attachment/identity related emotions. An understanding of some of the historical origins of their underlying sensitivities in their respective earlier lives has been formed. In their typical cycle Ella tends to blame and criticize when she feels rejected by Tim. In response Tim tends to withdraw and wall off. Ella s core underlying vulnerable feelings of anxiety that drive her attacks and Tim s core underlying fear that drives his withdrawal have been identified. Based on having identified and developed an awareness of their cycle in a previous session the couple is talking about how to remain aware of it and ultimately change it. In the following excerpt the couple is working toward expression of underlying feelings and needs (Stage 7). Here the therapist is encouraging Ella to express the hurt, pain and fear that she previously has been too scared to expose due to past abuse in her life. It becomes clear, however, that the affair and her past abuse by her father are intertwined and that the affair served to confirm her deepest fears that nobody, not even her closest partner, is trustworthy. The therapist is encouraging her to seek what she needs from Tim: protection and closeness. First, the therapist is working with Ella to identify the intrapsychic blocks she puts up (Stage 8) that prevent her from revealing primary adaptive emotions and getting her needs met. T: can you tell us about the pain and what it would mean to say I m hurting right now. and I m frightened of it. it scares me. E: I think for me it s kind of ah, my whole life has proven to me so far that, nobody looks after that part of me, I have been very alone in terms of protecting that part of me, (T: mm-hm) so the idea of having that part re-threatened with something that s going on and not, put up any kind of protection, it s almost in a way me betraying me, you know if Tim for some reason can t do what I would need him to do which is his right being a separate person not always being able to know what I need, that would be devastating (inhales) that would scare me T: because you ve always needed to protect that little girl who got abused because nobody else would listen, nobody else would be there for her 129

14 european European Psychotherapy/Vol. 7 No Here the therapist validates that her difficulty being vulnerable with her partner is related to earlier abuse in her life (stages). She continues, helping Ella to explore it. E: (crying) T: Can you tell us what that s like. can you do that? E: (crying) I just feel that s the part that it just, can cry forever (T: mm-hm) there s no end to that (crying) T: can you tell us what you need from Tim when you re feeling like that? Here the therapist is helping her to identify with unmet needs (Stage 9) E: I mean it s everything that he always does, I mean T: mm-hm, can you tell him what it is. tell him what he does. E: (crying) he comforts me and makes me feel like he cares about me T: Uh huh, can you tell him I m frightened, I need to be taken care of. Can you tell him that? and it scares me to even trust you with that part of me E: (crying) it s scary because part of what was so painful about the affair (crying) was that, in a way does that mean that I can t trust Tim either, do you know what I mean? (T: mm-hm) every single person who s ever been important in my life has betrayed that (T: little girl) yeah, so it s really scary / It s scary, it s just so scary to put myself out there like I feel that could destroy me, like I don t know what there would be left. T: It would almost be like putting a baby out in the snow, that a piece of you would be at risk. Here the therapist stays with Ella s intense fear related to earlier experiences and validates her need to protect herself. The therapist focuses on her fear of reaching out and letting Tim in (Stage 8 and 9). E: Yeah I need to protect myself but it feels better putting it into words. T: It makes a difference because you re trusting and he s right there holding your hand. and seeing that he cares about all of you. can you tell her some of that Tim? Tim: You can trust me, I m going to be here. don t be scared. T: may I make a suggestion Tim, can you tell her that it s okay to be scared and that you ll be there to help protect the scared part of her. Tim: it s okay to be scared. This is the beginning of stage 10, where the therapist is encouraging Tim s acceptance of Ella s expressed vulnerability and is thereby beginning to set up a new interaction. Notice here that Ella has softened and Tim has reengaged (Stage 11). The therapist encourages direct expres- 130

15 European Psychotherapy/Vol. 7 No european sion on Tim s part and Tim has no difficulty. This is only a start, however, as Ella has had many negative experiences. As one might expect, she finds it difficult to immediately accept this shift. The therapist follows Ella, once again through an exploration of intrapsychic blocks (Stage 8) and her maladaptive fears (once adaptive presumably) of allowing Tim to comfort her. The therapist continues to help Ella symbolize her experience. T: and your response to that he will protect that part of you. there s some doubt, some hesitation? E: (sniffles) I just feel like that never happened, you know? T: I want to but it would be totally unchartered territory, it would be so so different. And I guess you re saying that gives him a lot of power. Here, Ella actually identifies how Tim s wall (his own self-protection) has helped her protect herself where she has felt too vulnerable to let him in. E: I mean now he has this wall. (T: right) and I know that if that wall goes up he like sees it and then I can kind of stop if he s going too far or if he s going too far away I can (makes hand motion of pushing him away with explosive sound) and he says oh well, fine and stomps the other way. That way I can kind of stop the onslaught. I mean it just doesn t feel right to leave yourself so exposed, like ultimately I need to take care of myself (sigh). Once again, the therapist in her response below understands her fear in terms of her earlier experiences of abuse and validates Ella s need for self-protection. She also continues to encourage Ella to identify with disowned needs (Stage 9) and allow Time to soothe her (stage 10). T: you ah, tried to get people to share that with you and they betrayed you. of course you d be foolish not to have some protection, some wall that you could put in place and and I think it s really important that you know that it s okay to keep that wall when you need it. but also to entertain the possibility that Tim could come behind the wall with you, and reinforce your sense of safety. it s like don t get rid of the wall but go behind it together. It s a big risk and I think it s really important Tim for you to hear how much control that would give you and how much you hold in your hands then. Tim: It s so foreign you know, I mean it s understandable when she gets like that, it s the little girl trying to, you know. But when you don t see it you know you don t know it. but I see it now and it s very awkward for me to have, for our arguments to be based on what happened to her so many years ago. It s hard for me to accept it but I feel I just need to understand it what it does in our relationship because I couldn t, I can t picture her and that happening, they re two different people. So it is almost easier to deal with the anger 131

16 european European Psychotherapy/Vol. 7 No that she has against me than believe that that went on with her when she was younger, you know so I don t put the two together. Here Tim identifies his difficulty seeing Ella s pain and some of the difficult feelings that it touches in him likely fear and vulnerability. He recognizes, however, that her earlier experiences have made it more difficult for her to express underlying emotions (stage 10), and perhaps only for the first time, experientially understands the origins of her blame and criticism. The therapist reframes Tim s experience in terms of his reengagement (stage 11) and encourages the couples restructuring of the interactional cycle by again encouraging Tim to soothe Ella and Ella to accept Tim s soothing (stage 10). T: I think that what you re saying is that I want to come behind the wall with you but it is hard for me to see you like this but if that is what you need, I can come behind that wall with you so, help me Tim: and I know it is the biggest thing you could ever do E: I don t even know if I can to be quite honest. I don t even know because I don t know how (crying) T: Ella, you re doing it right now. you are doing it right now by talking about it and showing how you feel, that s how you do it. you re being vulnerable right now. Here the therapist points out that in spite of Ella s maladaptive fear she is actually taking a major risk and facing a very important fear. This is a major piece of the transformation of her maladaptive emotion scheme. She is opening herself to a corrective emotional experience. Affect as a key marker. In engaging in intervention within the general framework above it is important to recognize that emotions are at the very core of partners communication with one another and are the ultimate target of intervention. Affective tone through non-verbal expression is thus one of the most important markers of what is occurring between partners. Intervention then is not just about a set of therapeutic procedures that will promote the steps, based on the content of interaction, but is about picking up on the subtlety of the affective tone of partner s communication to each other so as to get at its real meaning in the interaction, and to use this information to intervene. Affective communication because it is so determining of interaction must be the focus of the therapist attention and intervention. To guide intervention therapists must pay more attention to how something is said than to what is said. 132

17 European Psychotherapy/Vol. 7 No european Conclusion Affect regulation is a key motivator that drives couples to connect and seek identity validation. Attraction and liking and building positive emotions are important in inoculating couples against conflict that can cause pain and suffering and in the worst case breakdown in their relationships. In this paper we have identified different types of couples emotional processing problems related to negative interactional cycles driven by secondary and maladaptive emotional responses and outlined an expanded stage model of emotion-focused couples therapy. We emphasize the importance of both other and self-soothing. An excerpt from a therapy session has illustrated how the stage model of EFT-C is applied in session. References Ainsworth, M.D. S., (1985). I. Patterns of infant-mother attachment: antecedents and effects on development and II. Attachment across the life-span, Bulletin of New York Academy of Medicine, 61: and , Benjamin, L.S. (1974).Structural analysis of social behavior. Psychological Review, 81, Bowlby, J.(1988). A secure base. Clinical applications of attachment theory. London, Routledge. Damasio, A. (1999). The feeling of what happens. NY: Harcourt-Brace. Elliott, R., Watson, J., Goldman, R., Greenberg, L.S. (2004). Learning emotion-focused therapy: The Process-experiential approach to change, Washington: APA Books. Ellison, J. & Greenberg, L.S. (2006) Homework in experiential emotion-focused therapy. In N. Kazantzis, & L'Abate. (eds.), Handbook of Homework Assignments in Psychotherapy: Research, Practice, and Prevention. New York: Springer Publishers. Frijda N. (1986) The emotions. Cambridge: Cambridge University Press. Goldman, R.N. & Greenberg, L.S. (2006). Promoting Emotional Expresion and Emotional Regulation in Couples, In D.K. Snyder, J.A. Simpson, & J.A. Hughes (eds.), Emotion Regulation In Couples and Families: Pathways to Dysfunction and Health, Washington, DC: APA. Goldman, R. & Greenberg, L. (1997). Case formulation in experiential therapy. In T. Ells Handbook of Psychotherapy Case Formulation. (pp ). New York: Guilford Gottman, J. M. (1999). The marriage clinic: A scientifically based marital therapy. New York: Norton. Gottman, J. M., Coan, J., Carrère, S. & Swanson, C. (1998). Predicting marital happiness and stability from newlywed interactions. Journal of Marriage and the Family, 60, Greenberg, L.S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, DC: American Psychological Association. Greenberg, L, Ford, C. Alden, L. & Johnson, S. (1993). In-session Change Processes in Emotionally Focused Therapy for Couples. Journal of Consulting and Clinical Psychology, 61, Greenberg, L. & Johnson, S. (1986a). Emotionally focused couples treatment: An integrated affective systemic approach. In N. Jacobson, & A. Gurman, (Eds.), Clinical handbook of marital therapy. New York: Guilford Press. 133