Emotion Focused Family Therapy with Children and Caregivers

A Trauma-Informed Approach

Mirisse Foroughe, Mirisse Foroughe

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351664394
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

This book introduces emotion focused family therapy (EFFT) as an evidence-based intervention for children through the integration of parent trauma treatment and emotion-focused techniques. A team of expert authors, including the founders of EFT and EFFT, contribute to the chapters, in which recent findings from longitudinal clinical trials are woven into a rich and deeply presented overview of using EFFT practically with clients. This immensely practical book also provides illustrative case studies, intervention strategies, and do's and don'ts at the end of each chapter.

1 Overview of Emotion-Focused Therapy

Genevieve Vrana and Leslie Greenberg

An Evidence-Based Treatment

Emotion-Focused Therapy (EFT) is recognized as an evidence-based treatment for depression and marital distress (Elliott, Greenberg, & Lietaer, 2004; Johnson, Greenberg, & Schlindler, 1999). It has also demonstrated positive outcomes for trauma (Paivio & Nieuwenhuis, 2001; Paivio & Pascual-Leone, 2010), eating disorders (Robinson, Dolhanty, & Greenberg, 2015; Robinson, Dolhanty, Stillar, Henderson, & Mayman, 2014; Wnuk, Greenberg, & Dolhanty, 2015), anxiety disorders (MacLeod, Elliott, & Rodgers, 2012; Shahar, Bar-Kalifa, & Alon, 2017; Watson & Greenberg, 2017), and interpersonal problems (Greenberg & Malcolm, 2002; Greenberg, Warwar, & Malcolm, 2008; Paivio & Greenberg, 1995). A manualized form of EFT for depression was found to be highly effective in treating depression in three separate clinical trials (Goldman, Greenberg, & Angus, 2006; Greenberg & Watson, 1998, 2006; Watson, Gordon, Stermac, Kalogerakos, & Steckley, 2003). In these trials, EFT was as or more effective than a client-centred (CC) empathic treatment or a cognitive behavioural treatment (CBT). Both CBT and CC were highly successful in reducing depression; however, EFT was more effective in reducing interpersonal problems than either of the two other treatments, along with promoting more improvement in symptoms, compared to the CC treatment. Further, EFT was highly successful in preventing relapse over an 18-month follow-up period (77% non-relapse; Ellison, Greenberg, Goldman, & Angus, 2009).

EFT has generated a lot of research on the process of change—possibly more than any other treatment approach. Several therapy process variables have been found to contribute significantly to therapeutic outcome in EFT, namely: therapist empathy, therapeutic alliance, client depth of experiencing, emotional arousal, making sense of aroused emotion, productive emotional processing, and particular emotion sequences (e.g., Boritz, Angus, Monette, Hollis-Walker, & Warwar, 2011; Choi, Pos, & Magnusson, 2016; Elliott et al., 2004; Goldman, Greenberg, & Pos, 2005; Greenberg, Auszra, & Herrmann, 2007; Malin & Pos, 2015; Missirlian, Toukmanian, Warwar, & Greenberg, 2005; Pascual-Leone & Greenberg, 2007; Pos, Greenberg, Goldman, & Korman, 2003;Tarba, 2015; Wong & Pos, 2014).

Theoretical Underpinnings

EFT is a humanistic-integrative approach that emphasizes the importance of human emotion in psychological functioning and therapeutic change. With early roots in humanistic, Gestalt, and existential therapies (Frankl, 1959; May, 1977; Perls, Hefferline, & Goodman, 1951; Rogers, 1957; Yalom, 1980), as well as family systems theory (Bowen, 1966; Pascual-Leone, 1987), EFT later drew on advances in cognitive neuroscience and emotion research (Damasio, 1999; Frijda, 1986; Izard, 2002; Tamietto & de Gelder, 2010). In this context, EFT theory and practice were developed through several years of research into the process of therapeutic change (Greenberg, 1986, 2002; Greenberg & Johnson, 1988; Greenberg, Rice, & Elliott, 1993; Greenberg & Safran, 1987; Rice & Greenberg, 1984).

Although EFT uses an integrative framework, there is a sustained focus on a person’s emotions. An emphasis on experiential engagement and felt emotions is seen as the primary vehicle of change. In EFT, a person needs to experience their painful feelings in order to change them; in other words, they have to arrive at a place before leaving it (Greenberg, 2012).

Research has shown that emotional experiences are fundamentally adaptive to human functioning. Emotions can and often do occur earlier and more quickly than cognitions, and they make an integral contribution to information processing (LeDoux, 1996; Greenberg, 2011; Forgas, 1995, 2000; Greenberg, 2002; Greenberg & Safran, 1987). Moreover, people rely on emotion as a foundation for many cognitive processes, particularly for making decisions (Bechera, Damasio, Tranel, & Damasio, 1997; Damasio, 1994).

Emotions are connected to our most essential needs, rapidly alerting us to situations that are important to our well-being and ensuring that we are prepared for action (Damasio, 2003; Frijda, 1986; Greenberg, 2004; Izard, 2002; Tomkins, 1962). For example, fear can quickly alert us to danger, making sudden escape possible; anger can signal that our boundaries have been violated, promoting an assertive response; sadness or grief can indicate a loss, encouraging us to seek comfort and support from others. More “positive” emotions, such as joy and contentment, tell us that we are safe, that threats to our survival are absent, and that we can let our guard down.

People form associations between lived experiences and the emotions evoked at the time, creating emotional memories. In other words, people react from their emotion systems, not only to biologically inherited cues of danger and safety, but also to learned associations, such as a parent’s impatient voice or the tune of a soothing lullaby (Greenberg, 2011). In EFT, these emotional memories form a part of organizing networks referred to as emotion schemes (Oatley, 1992; Greenberg et al., 1993; Greenberg & Paivio, 1997). Emotion schemes involve several elements: 1) situational-perceptual experiences, including immediate appraisals of current situations and emotionally charged memories, such as noticing that you are alone or isolated from others and remembering an experience of abandonment from childhood; 2) bodily sensations and expressions, such as tightness in the chest or a sinking feeling in the stomach; 3) implicit verbal-symbolic representations, including self-labels (e.g., “unlovable”); and 4) motivation-behavioural elements, including needs and action tendencies like wanting closeness with others or withdrawing from contact (Elliott & Greenberg, 2017). Exposure to any of the above elements of an emotion scheme can quickly and automatically re-activate the entire scheme. For example, a present-day situation that bears resemblance to an earlier experience of rejection can serve as a cue to re-activate old, familiar feelings of sadness and hopelessness. This means that people can re-experience an emotional memory many times long after the original event. These kinds of emotional experiences are the main targets of intervention in EFT.

Distinguishing Between Different Kinds of Emotions

While EFT acknowledges that emotions are adaptive to human survival and well-being, emotional processes can become problematic as a result of past trauma or even ongoing misattunement between a person’s emotional needs and what is available in their environment (McGuinty et al., 2015). Consequently, emotion-focused therapists use a system of in-session process diagnosis to differentiate between types of emotional responses and intervene accordingly (Greenberg & Paivio, 1997; Greenberg & Watson, 2006; Elliott et al., 2004). In this system of sorting out the client’s emotions, an important distinction is made between primary and secondary emotions. Primary emotions are a person’s most fundamental, direct initial reactions to a situation, such as being sad at a loss or angry at a boundary violation. Secondary emotions, on the other hand, are responses to a person’s own thoughts or feelings rather than to the situation. For example, feeling angry in response to feeling hurt by someone, or feeling guilty about feeling angry.

EFT’s emotion diagnostic system also distinguishes between primary states that are adaptive and those that are maladaptive (Greenberg & Goldman, 2007; Greenberg & Watson, 2006). Primary adaptive emotion responses are a person’s first, natural reactions to the current situation that would help them take appropriate action (Greenberg, 2010). For example, if a person is being violated by someone, anger is an adaptive response, because it helps them take assertive action to end the violation. Another example of an adaptive emotional response is sadness over a loss, which motivates the person to seek connection. In contrast, primary maladaptive emotions are less reliable guides for action. They are the old, familiar feelings that occur repeatedly and do not change over time, such as a core sense of loneliness and anxious insecurity or a feeling of worthlessness and inadequacy that plagues a person throughout their life (Greenberg, 2010). These maladaptive feelings do not shift in response to changes in circumstance and they also do not provide adaptive directions for solving problems when they are experienced.

For therapeutic change to occur, primary adaptive emotions need to be accessed for their adaptive information and ability to organize helpful action, whereas maladaptive emotions need to be accessed, regulated, and transformed into more adaptive emotional responses (Greenberg, 2010, 2011). As well, secondary emotions need to be bypassed so that the primary emotions underlying them can be accessed and used in the healing process (Elliott et al., 2004).

A third category of emotions is instrumental emotions. These are strategic displays of emotion for their intended effect on others, such as feigning sadness to receive the comfort of others (Elliott & Greenberg, 2017; Greenberg & Watson, 2006). Common examples include “crocodile tears” (instrumental sadness), “crying wolf...

Table of contents

• Cover
• Title
• Copyright
• Contents
• About the Contributors
• Foreword: A Caregiver-Based Intervention
• 1 Overview of Emotion-Focused Therapy
• 2 Emotion-Focused Therapies for Children and Adolescents
• 3 Development and Core Components of EFFT
• 4 Emotion Focused Family Therapy in Practice
• 5 Processing Parent Blocks
• 6 EFFT and Trauma: Engaging the Parent With a Dismissing Attachment Style
• 7 Practical Resources
• Glossary
• Index