Emotion-Focused Therapy: Level 1 Institute

York University

Dr. Les Greenberg, [email protected]

cpeh.ca
ISEFT.org

Please do not duplicate or distribute content of this presentation without written

permission from Dr. Les Greenberg

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Day 1

Theory of Emotion
The Originality of Repetition

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Therapy Combines Two Components.
Following & Leading
1. FOLLOWING:
• Presence & Empathic Attunement
• Communication of relational
attitudes

2. GUIDING/LEADING:
• Facilitation of particular modes
of emotion processing at
particular times
GOAL: Change emotion with emotion
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Therapeutic Presence (Geller & Greenberg, 2011)
▪ Being completely in the moment.
▪ Bringing one’s whole self into the encounter with
the client – physically, emotionally, cognitively and
spiritually
▪ Being grounded in one’s own body
▪ Receptively taking in the verbal and bodily
expression of the client’s moment by moment
emotional experience
▪ Extending to meet the other in an empathic and
congruent manner
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Keeping your finger
on the client’s
emotional pulse ---
moment by moment

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Marker Guided Tasks
TASK INTERVENTION CLIENT END STATE
MARKER PROCESS

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Self-Interruption
Unfinished Split
Self-critical Business
Split

islands of work in
an ocean of empathy

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Reprocessing Tasks
TASK MARKER INTERVENTION PROCESS END STATE
Trauma Trauma Relief,
Narrative Retelling restoration of
(internal pressure to narrative gaps
tell difficult life
stories, eg., trauma)
Meaning Meaning Revision of
Protest Work cherished
(life event violates belief
cherished belief)
Problematic Systematic New view of
?
Reaction Point Evocative the self in-the-
(puzzling over- Unfolding world-
reaction to specific functioning
situation)
 Unfolding Problematic Reactions

Vividly Search for

Re-enters Salience in
Scene Stimulus

Meaning Examine
Problematic Modes of Broadening
Reaction Bridge Functions

Subjective
Emotional Construal
Reaction of the
Stimulus

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Evidence Based Treatment
Depression
• Watson, Gordon, Stermac, Kalogerakos, & Steckley(2003). Journal of
Consulting and Clinical Psychology, 71, 773-781).
• Goldman,Greenberg,Angus,(2006).PsychotherapyResearch,16,536-546.
• Ellison,J., Greenberg, L., Goldman, R.N., & Angus, L. (2009). Journal of
Consulting and Clinical Psychology, 77, 103-112.

Complex Trauma & Anxiety

• Paivio & Nieuwenhuis (2001).Journal of Traumatic Stress,14, 115-133.
• Greenberg, Warwar, & Malcolm, (2008). Journal of Counseling Psychology,55,
456-464.
• Anxiety disorders publications on GAD & SAD
Couple Distress
• Johnson, Hunsley, Greenberg & Schindler, D. (1999). Clinical Psychology:
Science and Practice, 6(1),67-79.
• Johnson, S. & Greenberg, L. (1985). Journal of Consulting and
• Clinical Psychology, 53, 175-184.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Pre-Post means & Effect Sizes
PRE POST EFFECT
CC EFT CC EFT CCSIZE EFT
MEASURE
(N=36) (N=36) (N=36) (N=36) (N=36) (N=36)
BDI M 24.56 26.11 9.53 6.2** 2.29 2.86
SD 6.54 6.96 7.48 5.34
GSI M 1.40 1.48 .70 .47* 1.40 1.98
SD .50 .54 .46 .35
IIP M 1.63 1.54 1.22 .92* .76 1.29
SD .54 .41 .56 .48
RSE M 21.51 20.81 26.50 28.7* .79 1.31
SD 6.3 6.01 6.83 5.81

*p< .05, **p<.01

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Survival Functions to Follow up
1.1•

1.0 • Therapy
Group
.9•
-----
.8• EF
•CC
Survival
Rate .7•

.6• _____
EF
.5• CC

•
.4• • • • • • • •
10 20 30 40 50 60 70 80

Number of Weeks
Survival curves. Time to first relapse by condition.
Means (and Standard Deviations) and F values for each Outcome Measure (Watson et al 2003)

CBT PE F value
n M (SD) n M (SD) Time T X Group

BDI
Pre 33 26.00 33 23.24 14.53 .08
Post 33 (9.03) 33 (7.81) ***
10.27 9.03
(9.62) (8.63)
RSE
Pre 29 31.28 31 33.06 5.32* .23
Post 29 (7.32) 31 (6.64)
36.45 38.74
(7.76) (6.11)
DAS Total
Pre 28 144.04 28 132.57 11.21 .06
Post 28 (27.90) 28 (32.32) **
121.93 112.21
(30.75) (34.18)
IIP Total
Pre 29 1.33 (.51) 30 1.40 (.38) 11.89 5.54*
Post 29 1.18 (.53) 30 1.05 (.54) ***

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Hierarchical Regression: Peak Emotional Experiencing on Outcome
Therapy Predictor Total R R square F
Type Variable Square change change df Beta
EFT Peak EXP
BDI Early .16 .16 4.24* 1,23 -.40*
Working .31 .15 4.83* 1,22 -.51*
Peak EXP
SCL Early .20 .20 5.59* 1,23 -.44*
Working .42 .22 8.46** 1,22 -.44*
CBT Peak EXP
BDI Early .15 .15 4.29* 1,24 -.39*
Working .32 .16 5.47* 1,23 -.47*

* p < .05, ** p < .01; N = 25 in all cells; EXP = Experiencing; BDI = Beck Depression
Inventory; SCL-90R = Symptom Checklist R.
* Note: The regression model was run controlling for early peak EXP on outcome for the
BDI and SCL-90R, the unique contribution of the peak EXP in the working-phase on
both outcome measures was significant for EFT; and significant only on the BDI for CBT.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Process Outcome Research
Moderate to high aroused emotions that
are deeply experienced and reflected on
in order to make narrative sense

in the context of

an empathically attuned relationship

with a good working alliance
with a therapist who is present
predicts therapeutic outcome

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Processes & Sequence
Moderately aroused primary emotions
that are processed productively & that
progress from secondary symptomatic to
primary maladaptive to adaptive emotions

in the context of

an empathically attuned relationship with a

good working alliance with a therapist who
is present predicts outcome

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Global EFT Task: approaching feelings
Pandora’s Box

“I’m afraid if I start

crying I’ll never stop.”

“I’m afraid if I let my

anger out I will lose
control.”

“I’m afraid my feelings

will be so painful I
won’t survive them.”

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
We want clients to be comfortable with
feelings so they can go in and explore...

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 to find valuable life and
what is important to them.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
They are afraid they will drown.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Definition

▪ Emotions are relational action tendencies

that at to establish, maintain or disrupt our
relationship with the environment in the
form of a readiness to act

▪ Basis of social connectedness constantly

giving us signals about our social bonds

▪ Different action tendencies

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotions: fundamentally adaptive
▪ Emotions tell us what is personally important and
whether things are going our way (information)
▪ Emotions help us to survive by providing an
efficient, automatic way of responding rapidly to
important situations
▪ Emotions prepare us for action
▪ Emotions involve wishes/needs, which generate
action
▪ Emotions integrate experience; give us meaning,
value and direction
▪ Basic concepts: Emotion Schemes; Emotion
Assessment; Emotion Change Principles

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Affect System Feeling
words are
confident suspicious the leaves.
Emotions
shame fear are the
sadness anger branches.

smooth
rough Sensory Feelings
are the bark of
the tree

Affect is
calm excited the trunk &
roots.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 What is Emotion?

A. A relational action tendency

B. A process of meaning construction

C. A primary signaling system

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion Generation
Visual Cortex
Pre-frontal Cortex

Gatekeeper
Fight, Flight or Freeze

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion Sets Problems
for Reason to Resolve

Cognition works in the service of affective goals.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion and Reason
▪ Nothing is urgent or important in life unless and
until it is brought to our attention by affect

▪ Each of the 7-9 innate affect may be thought of as

a spotlight that turns on to show us what needs
cognition

▪ Each spotlight motivates us to use our cognition

differently
▪ Stimulus gets a response only if it triggers affect

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Psycho-affective Motor Programs
Children come into the world with the
capacity for basic emotions

We don’t teach them how to be

• Sad
• Ashamed
• Angry
• Afraid
• Disgusted
• Happy
• Interested

But what they feel sad or happy about

is learned from experience
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Development of Emotion Schemes
▪ With development, emotional experience is organised
into complex affective/cognitive networks termed
emotion schemes (Oatley 1992, Greenberg 2002)

▪ These provide primary meaning in that they

automatically evaluate what is significant for our
wellbeing and are carriers of personal meanings.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion Scheme
▪ Scheme is a pattern of mental organization.
▪ Provides implicit higher-order organization for
experiencing.
▪ Experience and action producing,
▪ A plan of action not for action.
▪ Self-organizing processes, not things
▪ Consists of component/elements linked together
in a network.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion Schemes
▪ Emotion schemes provide value appraisals; is
something good or bad for me; I like/dislike it
▪ Cognitive schemes provide truth appraisals; is
something true/false, right/wrong
▪ Action and experience producing structures

▪ Self propelling and have affective expectancies

and affective goals

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Expectancies
▪ When expectancies are violated by experience
(errors of anticipation) a loss of organismic
balance occurs
▪ Produces organismic arousal (affect), motivates
automatic attention to search for and resolve
anomalies and rebalance

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Emotion Scheme (Narrative Structure)
Belief: I am going to fail
an expectation

Visual image of mother’s

???
face in context
FEAR
Action tendency to me Tactile sense
shrink away
mother
Sensation/feeling in
Rapid breathing
my stomach

Heart rate

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Neuroscience
▪ Neurons are interconnected within
complex networks

▪ Most emerge in the first 3 years

▪ Functional units for different tasks –

distinct areas of brain are active during
specific tasks

▪ Located on different hierarchical levels

▪ Networks and pathways can change

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Neurons

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotion Schemes
1. Represent internally our emotional reactions
plus the evoking stimulus situation

2. Later we represent our conceptual learning

and beliefs associated with our emotional
experience

3. Result is a “high level” synthesis which when

evoked provides our sense of things such as
feeling unsure, confident, vulnerable or “on
top of the world”

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
A Picture Theory of Emotional Dysfunction

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotional Memories

Emotional These are They get And

experiences stored in triggered later organize
with the networks the whole
world create in the brain organism
memories (schemes)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Development of Maladaptive Emotion Schemes

Primary
Maladapative
Emotion
Primary NOT Schematic
Emotion & Symbolized, Memories
Needs regulated (Fear, sadness &
(initially shame)
and soothed
adaptive)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Secondary Responses

Primary NOT Secondary

Protection
Maladaptive Processed Symptomatic
(learned
Emotion and ie: Blocked Emotions
benefit,
Needs Need NOT +
Fear, sadness
coping,
met Self &
& shame safety)
Interpersonal
Problems
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Our Job in EFT

Secondary Primary What was Primary New

Emotion Maladpative Needed? Adaptive healthier
(Symptomatic Emotion Self-
state) (Injury/Pain) organization
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Dialectical Constructivist Theory:
two fundamental systems
1. Affective system: Pre-symbolic
▪ affect regulation is a core motive

2. Meaning construction: Symbolic

▪ will to meaning is core motive

Interaction between the two systems

determines experience

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 What is Meaning
Organisms organize
Make sense of their world, others and themselves
Meaning is actively created by people as they experience
new things and integrate new information with current
knowledge.
When they experience something that challenges their way
of negotiating the world they have to go through the
transformative process of evaluating their own processes
of making meaning.
Experience forces individuals to engage in reconstruing
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Will to Meaning
▪ The search for meaning is a drive within all of us.
▪ We are born to create differentiations and
narrative meaning.
▪ Searching for meaning is a form of happiness.
▪ Use language to shape personal experiences into
narratives
▪ Our first narrative is a nonverbal imagistic
narrative of our feeling of what happened.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 First Narratives; Non-verbal Imagistic
▪ Knowing, which is the most fundamental level of
consciousness, springs to life in the feeling of what
happened when changes in the status of the body-self –are
connected to environmental impacts (Damasio, 1999).
▪ First stories were constructed by pre-linguistic primitive
human beings who coded experience into something like
“you throw a stone at me; it hits my body, and it hurts”.
▪ It is through the storying of affect that we come to know
what has happened to our body.
▪ Thus meaning was created long before language -
experience organized into stories that have beginnings,
middles and ends, agents, actions and intentions.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Generation
Emotion results from automatic appraisals of
situations in relation to needs/goals/concerns.
▪ Appraisal of features, i.e., size, speed, not thoughts
▪ Emotion is adaptive, not rational or irrational
▪ Variety of Levels
- neurochemical
- physiological
- muscular
- cognitive
- social
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Components
Situation

Meaning

Emotion Sensation/Feeling

Need

Action tendency

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
The Dialectical Articulated Self-Beliefs + Self-Representations Narrative
Construction
of the Self Explaining Reflection Culture
Language
Dialectical & Myth
Symbolizing
Told Cycle
Story Experiencing
Selective Attention
Lived Operating Self-
Story Organization
(felt referent of experience)
(attractor states)
Other possible
self-organization Emotion Schemes

Basic Elements: neurochemical, limbic, glandular and other physiological phenomena

FACULTY OF HEALTH

ISEFT.ORG Perception PSYCHOLOGY CLINIC

EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Day 1
Theory of Practice

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 EFT Compasses
Systematic work with emotion uses
Four Central Orientation Systems.

Emotion Principles Case Problem

Assessment of Change Formulation Markers
An ongoing Includes Follow the Indicate the
moment-by- Regulate, pain!! ways to activate
moment process Activate, emotion to
Transform resolve issues
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG
55 EMOTIONFOCUSEDCLINIC.ORG
 Assessment
▪ Good alliance
▪ Clients with GAF above 50
▪ No active substance abuse or impulse control
disorder
▪ Self not too fragile (narcissistic borderline PD)
▪ Too much or too little emotion
▪ Sign of distress or of working through distress

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Emotion Assessment
Biologically adaptive
http://th73.photobucket.com/albums/i214/ruthanthonygardner/th_shame.jpg

1. Primary
Maladaptive

2. Secondary
Masks

3. Instrumental To get support To intimidate

To achieve an aim:

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Differential Intervention
Primary Adaptive Access for good information

Primary Maladaptive Access in order to transform

Secondary Explore to get to more

primary emotion

Instrumental Awareness of the aim

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Assessment

Adaptive
1. Primary Productive
Maladaptive
Unproductive
2. Secondary

3. Instrumental

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Manner of Processing

Attending

Differentiation Symbolization

Contactfully
Aware
Regulation Congruence

Agency Acceptance

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Differential Intervention

Primary Adaptive Access for good information

Primary Maladaptive
Productive Access in order to transform
Unproductive Regulate

Secondary Explore to get more primary

emotion

Instrumental Awareness of the aim

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Interruptions/Blocks/Avoidance

Cognitive: Catastrophic expectations

Physiological: Musculature
Breathing

Affective: Fear/anxiety of: loss of self

control, or contempt/
rejection from others
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Types of Feelings
▪ Angry, sad, afraid, disgust,
Primary shame/contempt, joy, interest/surprise
▪ Adaptive action tendency in response
to environment
▪ Broken, shattered, wounded, loss and
Painful grief
▪ Not anticipatory, occurs after damage
▪ Results from trauma/shattered self
▪ Helpless, hopeless, dependent,
Bad worthless
▪ Is a complex secondary response
▪ Results from internal disharmony and
cognitive affective sequences
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Emotional Functioning
Emotion Adaptive Maladaptive
Sadness grieving hopeless despair,
reaching out desperate clinging
Anger empowering destructive
Love caring/freeing addictive/clinging
Anxiety signals danger traumatic
Shame belong to self hate/contempt
group/remorse
Disgust/Contempt healthy outrage self/other abuse

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Characteristics
Adaptive Affects
Fresh & new
In the moment in response to shifting circumstances
Changes when circumstances change
Externally cued; are rapid & action oriented (environment)
Internally generated are slower
Explore until you get yes that’s it!
Feel whole, deep
▪ Feel good even if not happy
▪ Nothing that feels bad is ever the last step
▪ First experienced in the body translated into action
▪ Brings relief/changes
▪ Enhance self and relationships
▪ Cues: complete, full, sureness, calm, integrated, alive,
clarity
Primary Maladaptive (Disorganizing)
▪ Feels bad
▪ Stuck in it
▪ They don’t shift with change in circumstances
▪ Familiar old feeling
▪ Difficult
▪ It is overwhelming
▪ Each time feels as bad as the last time
▪ Often about self
▪ Part of our identity
▪ Destructive voice
▪ Destructive to self and others
▪ Cues: deep, distressing, sobbing, can include tantrums or
ranting
Secondary
▪ Obscures
▪ Reactive
▪ Diffuse
▪ Emotion in response to an emotion
▪ Cues: upset, hopeless, confused, inhibited, low energy,
whining, complaining

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 6 Major Emotional Change Processes
A. ACCESSING EMOTION
1. Increase emotional awareness & symbolization
in the context of salient personal stories
Symbolizing emotional experience in awareness in order
to make sense of one’s experience. What am I feeling?

2. Express Emotion
Expressing changes the self and changes interactions
both by mobilizing and revealing self. Overcome control
and inhibition. Completion of expression. Neuro-
chemical changes.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Putting Emotion into Words
has adaptive value
▪ Information about situation & self’s reaction and
possible courses of action

▪ First step in problem solving by defining problem

▪ Labeled emotions easier to regulate

▪ Facilitate striving or goal attainment

▪ Greater well being by ability to pursue aims

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Spinoza
▪ “An emotion which is a passion, ceases to be a
passion, as soon as we form a clear and distinct idea
of it." (Ethics 1677, Part V: Of the Power of the Understanding, or of Human
Freedom Prop:III)

▪ When the mind knows a painful emotion such as

sadness or grief, its activity of knowing signals an
increase of power, which generates a feeling of joy.

▪ Spinoza is suggesting here that putting emotions

into words makes us agents in our lives and that
understanding is inherently joyful.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 6 Major Emotional Change Processes
B. MODULATING & UNDERSTANDING
3. Enhance Emotion Regulation
Explicit regulation. Use deliberate cerebral capacities to
contain and regulate maladaptive amygdala reactions
(especially fear, rage and shame). Implicit self soothing.
Allowing, tolerating, accepting and soothing.

4. Reflect on Emotion
Making sense of experience. Dis-embedding. Creation of
new meaning. Insight. Seeing patterns, understanding in a
new way. New narrative construction.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Window of Tolerance

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 6 Major Emotional Change Processes
C. TRANSFORMING EMOTION
5. Change Emotion with Emotion
An alternate self-organization, set of emotion schematic
memories or ‘voices’ in the personality based on primary
emotions are accessed by 1) attentional re-allocation or 2)
focus on a new need/goal.

6. Change Emotion with New Interpersonal

Experience
New lived experience with another provides a corrective
emotional experience. Disconfirms pathogenic beliefs.
Provides interpersonal soothing. New success experience
changes emotion.
 Major Premises Guiding Intervention
Change Emotion with Emotion
• Spinoza: “An emotion cannot
be restrained nor removed
unless by an opposed and
stronger emotion” (Ethics IV,
p.195).
• Change fear with anger or
sadness, shame with self-
compassion, or anger, hate with
love or compassion etc.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Transformation by Synthesis
1. Catharsis/Completion/Detachment/Habituation/Extinction
Blocked
Needs to be unblocked
Let it run its course
Arising & passing away
Letting go
Desensitizing/Exposure

2. Changing Emotion with Emotion

Undoing
Generates Novelty
= Synthesis
Development not
learning
 Memory Reconsolidation
FIXED
EVENT ENCODE CONSOLIDATE
MEMORY

REACTIVATION

RECONSOLIDATION
UNFIXED TRANSFORMED
MEMORY MEMORY

NEW/ALTERED EXPERIENCE
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Overall Conclusion

Memories are changeable, but only

under some conditions.
Memory formation and reformation is
strongly influenced by emotion.
Memory formation and reformation is
also strongly influenced by sleep.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Accessing Alternate Emotion
0. The empathic relationship
1. Shift attention to present subdominant emotion
2. Access adaptive need/goal and associated emotion
3. Expressive enactment of alternate emotion
4. Imagery to evoke emotion
5. Evoke emotion memory of alternate emotion
6. Mood induction via music
7. Humour
8. Cognitive creation of new meaning
9. Therapist expresses emotion for client
10.Relationship evokes new emotion
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Basic Change Process
Secondary
Distress

Primary
Maladaptive

NEED

Primary
Adaptive
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 S Model of
LOW
E Global Emotional
C
Distress Processing
Degree of Emotional Processing

O Pascual-Leone &
N Greenberg 2007

D Rejecting Fear, Shame PRIMARY

A Anger Sadness MALADAPTIVE
R
Y
Negative
Need
Evaluation
positive evaluation
Assertive
PRIMARY
Anger, Self- Grief, Hurt ADAPTIVE
Soothing
HIGH
Acceptance
Letting go
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Day 2

Phases of Treatment
&
Two-Chair Work for
Self-Criticism
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Case Formulation

STAGE 1: UNFOLD THE NARRATIVE AND OBSERVE

EMOTIONAL PROCESSING STYLE

STAGE 2: CO-CREATE A FOCUS AND IDENTIFY THE

CORE PAINFUL EMOTION

STAGE 3: FORMULATE ONGOING MARKERS AND

TASKS RELATED TO CORE ISSUES
 Case Formulation
STAGE 1: UNFOLD THE NARRATIVE AND OBSERVE
EMOTIONAL PROCESSING STYLE
1. Listening to the Presenting Problem
(problem deconstruction & therapeutic
relationship building)
2. Listen for poignancy and painful experience
3. Unfolding the life story/narrative
4. Attending to and observing emotional
processing style
5. Assessing too little or too much emotion, ie.,
lack of emotional awareness or emotional
dysregulation
 STAGE 2: CO-CREATE A FOCUS &
IDENTIFY THE CORE PAINFUL EMOTION (MENSIT)
a. identify markers for task work (M)

b. identify
underlying core
d. secondary emotion c. identify needs
emotions (S) schemes either (N)
adaptive or
maladaptive (E)

e. identify interruptions (I)

f. identify themes: self-self relations, self-
other relations, existential issues (T)
AIM: Construct a narrative that connects
presenting problem, emotion scheme & behavioural difficulties
Emotionally Focused Intervention

1. Alliance – bonds, goals, tasks

2. Evoke
3. Access deeper emotion scheme

Adaptive Maladaptive

Guide Transform
4. Narrative reconstruction

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Transformation
Challenge with internal resources
Emotional Self Emotional Self
Organization Organization
Maladaptive Internal Resources
Scheme Adaptive Emotions
(bad, weak, alone self) (essential healthy self)
Worthless, Can’t survive, Lonely Worth, Strengths, Caring
Shame, Fear, Sadness Anger, Sadness, Compassion
Needs for Mastery,
Safety & Connection
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Phases of Treatment

PHASE 1: Bonding & Awareness

PHASE 2: Evocation & Exploration

PHASE 3: Generation of Alternatives

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 PHASE 1: Bonding & Awareness

1. Attend to, empathise with, and validate

clients feelings and current sense of self
2. Provide a rationale
3. Promote awareness of internal experience
and regulation when necessary
4. Establish a collaborative focus

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 PHASE 2: Evocation & Exploration

1. Establish support for contacting emotions

2. Evoke and arousing problematic feelings
3. Undo interruptions
4. Access primary emotions or core
maladaptive emotion schemes

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 PHASE 3: Generation of Alternatives

1. Generate new emotional responses to

transform core maladaptive schemes
2. Reflect to make sense of experience
3. Validate new feelings and support an
emerging sense of self

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Three Levels of Intervention

1. Empathic Symbolization

2. Guiding Attention

3. Stimulating Experience

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Empathic Attunement to Affect
Types of Responses

Empathic Understanding
Empathic Affirmation/Validation
Empathic Evocation
Empathic Exploration
Empathic Conjectures

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Understanding
Checking understanding
CLIENT: I have spent the entire day running
after job interviews. I am so fed up.
THERAPIST: Just running all day for the
interviews and it’s like “I’m tired and I’ve
had enough”?
CLIENT: Oh! Yes. I am quite worn out and
frustrated.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Affirmation
These responses validate the client’s
perspective.
CLIENT: He was so cutting. He treated me
like a fool and after I put so much effort into
it.
THERAPIST: No wonder you felt so put down
after all your effort not being valued but
being diminished.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Evocation
Using connotative, metaphoric language
THERAPIST: Like standing alone in a cavern
calling out for help and all hear is the echo of
your own voice.
THERAPIST: Feeling like a motherless child...

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Exploration
Making implicit explicit
CLIENT: I am continuing to stay with him in
the apartment.
THERAPIST: So somehow staying keeps the
door open?
CLIENT: Yes. I guess I have been reluctant
to move on.... It makes me feel so sad,
but I am beginning to realize there is no
point in hanging around.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Exploratory Question
Stimulate client open-ended self-
exploration
THERAPIST: What comes up inside when you
hear that from the critic?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Fit Question
Encourage client to check representation of
experience with actual experience
THERAPIST: Does that fit your experience?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Conjecture
Tentative guess at immediate, implicit client
experience (usually with a ‘Fit Question’)
CLIENT: My mother cancelled her visit,
something to do with helping my father...
sigh... there is always something more
important. I feel so angry.
THERAPIST: And there was a ‘sigh’ just then.
Am I right in guessing that you feel
disappointed, pushed aside, somehow
abandoned and left alone?
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Conjecture
In another example, a client was chastising
her brother for abusing alcohol.
The therapist became aware that the client
did not appear angry but looked sad. Her
therapist said,
“Your face looks very sad? Does that fit?”
The client nodded and burst into tears.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Exercise: Opening Channels
of Receptivity
➢ Visual (what you can see)
➢ Auditory (what you can hear)
➢ Somatic/affective (what you can feel in your body,
including emotions)
➢ Meaning/context (what you read into/ intuit
between the words/in their context)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 102
 Exercise : Opening
Channels of Receptivity
➢ This exercise involves 4 (or 5) positions and
takes about 90 min
➢ Position A: Speaker (5 mins): Sit in the
middle [or: face the camera so as much of
your body can be seen as possible] and talk
about how you experience yourself now. You
are offering yourself for the benefit of your
observers/listeners, so select something you
can can talk about without getting a
response. (This can feel a bit awkward.)
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 103
 Exercise : Positions
➢ Position B: Visual observer: Sit opposite A [or: face
your computer screen; leave your camera on].
Observe body language, facial expression, eye gaze,
flushing, posture.
➢ Hold A with open, kind regard, but do not offer verbal responses.
➢ (You can nod or smile, or let your empathy show on your face)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 104
 Exercise : Positions
➢ Position C: Listener: Sit back-to-back with A [or: turn
your chair so you are facing away from the
computer screen]. Listen to the quality of the story,
but also to tone/quality of voice, including
intonation, breathing, pace and pauses. Do not offer
verbal responses.
➢ Good position for time-keeping

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 105
 Exercise : Positions
➢ Position D: Embodied empathy: Sit to the side of A
[or: turn your chair so that you can see them out of
the corner of your eye]. Try to mirror A’s position
and to experience your body in relation to A. Notice
changes in your body, your breathing, your
temperature, how you are affected.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 106
 Exercise : Positions
➢ Position E: Meaning Understander: This is an extra (but
important) position if there are 5 people in the group.
➢Sit on the other side of A from D but a back a bit and
at an angle to them [or: move your chair back a bit from the computer and
slightly at an angle].

➢ Listen carefully to how A is using language, or saying

“between the lines”, including metaphors/ images, and
what the experience means for the person in their
social/cultural context
➢ Later, during during feedback, offer these observations tentatively,
as your experience (Do not interpret)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 107
Exercise : Processing, Timing
& Structure
➢ When A’s 5 minutes are up, briefly offer A each of your
experiences and observations from your position; try to stay in
“role”
➢ You have 15 minutes for this part of the exercise in a group of
4 or 10 minutes in a group of 5.
➢ Please keep time rigorously! (You’ll run out of time if you
don’t.)
➢ After each of the observers, A can let B, C, D (and E) know
whether or not their observations are useful.
➢ Make sure you don’t go back into your story
➢ After each round of processing, make sure to rotate positions
until you have experienced each position.
➢ A becomes B; B becomes C; etc.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 108
 Exercise : Take home points
➢ The purpose of the exercise is to experience and focus on
each of your channels of receptivity in turn.
➢ You may discover through this exercise that you have a
strength or limitation in a particular channel of receptivity.
➢ Your continuing journey as an EFT therapist may involve
you deepening this strength, or you may wish to develop
the other channels to bring more balance to your capacity
to be more fully receptive.
➢ Be aware of how you are affected when you are being
receptive.
➢ Being self-aware is your best resource to supporting
yourself and to discerning the difference between yourself
and others. FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 109
 Opening up Empathy:
Tracks/Channels/Expressions
Input.
Process
Output

FACULTY OF HEALTH
PSYCHOLOGY CLINIC 110
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Opening up Empathy: Tracks/Channels/Expressions

➢ Complexity of client experience

involves multiple channels or tracks:

Listening for
different tracks
of experience =>
Produces different
ways of listening
Gives rise to =>
different kinds of
empathic
response =>-
Gives our
empathy broader FACULTY OF HEALTH

range/ flexibility
ISEFT.ORG
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG 111
 Markers & Tasks

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Relationship Tasks
TASK MARKER INTERVENTION END STATE

Beginning of Alliance Productive

Therapy Formation Working
Environment
Therapy Alliance Alliance Repair
Complaint or Dialogue (stronger
Withdrawal (each explores therapeutic bond
Difficulty own role in or investment in
(questioning goals difficulty) therapy)
or tasks; avoidance)

Vulnerability Empathic Resilience

Affirmation

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Empathic Affirmation at Vulnerability Marker
VULNERABILITY MARKER (SHAME/STIGMA/DEFECTIVE)
EMPATHIC AFFIRMATION ANXIETY REDUCTION
READINESS FOR MOVING INTO EXPLORATION

1. Focus on Revealing rather than Exploring

2. Therapist not open edge exploratory responses but
confirming and validating
3. It is the person’s intense vulnerability related to the
experience that needs to be addressed in this event.
4. Exploration of the sources of emotion are not the focus.
5. Accepting clients as they are in the their vulnerability
helps differentiate this as an aspect rather than as the
total self. The person feels less overwhelmed and
stronger. The strengthened sense of self makes possible
coping and further change and growth.
ISEFT.ORG
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
Steps of Model: Providing Empathic
Affirmation at Vulnerability Marker
STAGES:
1. Emergence of vulnerability and shame
2. Initial deepening
3. Intense deepening, touching bottom
4. Partial resolution; turning back to
growth and hope
5. Appreciation/Reconnection
6. Full resolution

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Stage 1: Marker
Intense Generalized Vulnerability
CLIENT: THERAPIST:
▪ Intense fragility, ▪ Provides validation,
shame, confusion & safety
hopelessness ▪ Slows process, staying
▪ Intense emotion, with vulnerability,
reluctant exposure, assists self-soothing
overwhelmed ▪ Reflects emptiness,
fragility, shame
▪ Disconnection ▪ Reflects isolation,
▪ Long-term experience disconnection & thus
▪ Feels trapped provides connection
▪ Reach out – pull back ▪ Highlights importance
of staying with this
ISEFT.ORG
difficult state
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
T53: Do you think you could put your sister in the chair
and talk to her?
C54: No [pause]
T54: It’s really hard a one for you. [Pause] What are you
feeling right now?
C55: [small voice:] Scared. [=Vulnerability begins to
emerge]
T55: [gently: ] Scared. [Pause] Uh-huh. Just so scared
about…
C56: What will happen to the little [rueful laugh: ]
relationship that we have.
T56: Uh-huh, scared that if you assert yourself here, you
could lose her.
C57: What change will it bring in her, towards me. I don’t
think I could handle it. (T: mhm)
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
T58: “If I assert my feelings or if I express my true
feelings of jealousy towards her, will it ruin the
shared of a relationship that we do have? (C:
mhm) Will it ruin the little bit of e-mail I do get.” It
might destroy even those little threads, and it’s so
scary to think about not having that relationship.
(C: mhmm mhm)
C59: Yeah. It is such a risk. I don’t know if I can bear the
loss. Without her it’s like I would have nothing.
T59: Just a feeling that, “Without that connection I will
be left totally alone.”
C60: Yes, that’s how I would feel, totally alone, not
anything to anybody.
T60: Uh-huh, without any value to anyone.
C61: Yes, it’s like feeling that I could die without anyone
knowing.
ISEFT.ORG
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
T62: No one would even know.
C62: Yes. I feel tight in my throat. (T mhm) My stomach
hurts.(T Uhhuh….)
C65: Sometimes it’s just like I want to go crawl in my
bed and just stay in there and nobody bother me
[=vulnerability emerges further]
T65: Mhm, mhm. “I just want to shut my eyes and shut
all the pain shut out (C: Mhm, mhm) And shut all
the people out. Yeah. (C: mhm) I just want to
make all the pain go away” [Pause] Yeah, even on
the level that you were talking about last week of
not even wanting to wake up sometimes, (C:mhm)
really just thinking that death would be preferable
(C: mhm) to the pain that you’re living right now.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
C66: Again, just no thought of future. If you ask me
what I think will happen in two years, three
years: Nothing. (T: mhm)
T66: Because you are so hopeless. “Two or three
years from now I may not be here.”
C67: Mhm, or “where will I be?”
T67: Mm, “I can’t see my future, I can’t see any point
to this.”
C68: Right, right.
T68: Really, really hopeless. [Pause] Really, really
hurting. [Pause] Just so full of, hurt, but so
empty at the same time. [C: large sigh] Like all
the wind’s been knocked out of you.
C69: Or like I’m drowning, (T: [whispered:] drowning)
and I keep reaching up, and I’ve been struggling
FACULTY OF HEALTH
since I was a kid.
ISEFT.ORG
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
T69: [whispering:] Like you’re drowning, and a little
piece of you, one hand, one arm just keeps
reaching up, (C: Mhm). (C: mhm) And drowning in
all this pain. And suffocating, can’t breathe, can’t
even move after a while.
C70: Mhm. And my pain, my physical pain [C has a
chronic autoimmune disease]
T70: Mhmm, just surrounded by pain, and sinking,
can’t move my body, can’t breathe. [Pause]
C71: To me one of the scariest things, is, [deep breath]
diving into a pool of water and being under water,
that is so, [Pause] It’s just you, your awareness of
everything else is cut off (T: Mhm) You can’t, you
don’t hear that well, um. (T: mm) Of course you
can’t breathe or smell. You can see sometimes,
but it’s still, I don’t know…
ISEFT.ORG
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
T71: You’re just utterly cut off .
C72: Underwater.
T72: Underwater.
C73: And it’s like, it’s just you, that’s it, that’s all there is.
T73: [Gently:] That’s all that exists. (C: mhm) There’s not a
past. (C: Mhm) There’s not a present. (C: mhm)
There’s not other people. (C: mhm, mhm) It’s just
you. (C: mhm) And in that pool, you’re terrified,
(C: mhm) that just you is going to drown. (C: mhm)
Because just you is there. (C: mhm) And what are
you going to do when you start to sink. (C: Mhm)
[Pause] That’s absolutely terrifying. [Pause]
(C: mhm) [Pause] It’s like not even knowing how to
get, outside the boundaries, (C: right, right) to even
grasp onto what you might need (C: mhm, mhm,FACULTY OF HEALTH

mhm) Yeah.
ISEFT.ORG
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
C74: [stronger:] And, and you know, reaching, and just
keep reaching (T: mhm, hm) and I think it was one
of my brothers who [rueful laughter:] realized I
was drowning [laughs], you know, pulled me up,
and uh, um, I don’t even know how old I was, but,
but very traumatized by that.
T74: And right now, it’s like you’re saying, “Is there
anyone that can reach me and pull me up out of
this?” (C: mhm)
C75: I want to say, sort of, [Pause] there is no image of
anyone comforting or preparing (T mhm) to say,
“Don’t worry. It’ll be fine.”
T75: And so you just don’t have any comforting image.
C76: No, I don’t.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
T76: And it’s not just from your childhood, it’s also from
your life, from your present. (C: Mhm) You don’t
have a comforting image. (C: mhm, mhm) So it’s
feeling like you’re supporting yourself the best way
you can, but you’re drowning.
C77: Mhm, And I’m reaching for something, somebody.
(T: mhm, mhm) [large sigh] You know, thinking
back, I think, OK, I did have an unrealistic
expectation of getting married to Dave, and moving
away. And that was just so exciting to me.
T77: So you reached for him, (C: mhm) then, to pull you
out of the childhood drowning (C: mhm) that you
were doing, reaching for someone to pull you out
(C: Mhm) of this lake, (C: mhm mhm) or this ocean.
That’s what you want.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
T77 (cont.): [Long pause] What are you experiencing
right now?
C78: I guess that’s why therapy is so important to me. I
really need someone to help me find my way. And
so it feels good in a way for me to be able to tell
someone about these things.
T78: It’s just nice knowing that I know what it’s like for
you, and how much you want reach out and
connect to other people.
C79: Uh-huh. And I don’t feel so desperately in need of
someone in my family like my brother or sister to
rescue me, or so angry when they’re too tied up in
their own lives. But still I would like to hold onto
my relationships with them. There are moments
when I know I can make it. It’s just sometimes it
feels so overwhelming and I go to that place.
 Reprocessing Tasks
TASK MARKER INTERVENTION END STATE

Trauma Narrative Trauma Relief,

(internal pressure to Retelling restoration of
tell difficult life
stories, narrative gaps
eg., trauma)

Meaning Protest Meaning Work Revision

(life event violates of cherished
cherished belief) belief

Problematic Systemic New view of self

Reaction Point Evocative in-the-world
(puzzling over- Unfolding functioning
reaction to specific
situation)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Unfolding Problematic Reactions

Vividly Search for

Re-enters Salience in
Scene Stimulus

Meaning Examine
Problematic Modes of Broadening
Reaction Bridge Functions

Subjective
Emotional Construal
Reaction of the
Stimulus

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Systematic Evocative Unfolding [SEU]

▪ Access episodic memory

▪ Heighten recall of affect

▪ Processing difficulty
▪ problematic
▪ intense
▪ automatic reactions

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Stages of Model
▪ Problematic reaction

▪ Re-evoke experience

▪ Identify salience

▪ Meaning bridge

▪ Recognize & re-examine personal style

▪ Resolution
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 1
Marker
▪ Client describes puzzling,
unexpected personal reaction

▪ Identify marker

▪ Propose task

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 2
Building the Scene
▪ Client describes the situation vividly &
concretely, almost as if they were playing a
movie of the scene

▪ Therapist helps client to construct the details

so as to bring situation alive in the session

▪ The more vivid the description, the more

likely that clients will access their emotional
response
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Building the Scene
▪ Determine when reaction occurred

▪ Get an impressionistic sense of how things

had been going just prior to reaction

▪ It is important to blow up moment when

reaction occurs in order to identify the
stimulus or trigger

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 3
Identify Salience
▪ Track the feelings

▪ Identify moment when feelings change

▪ Help client identify trigger, eg. thought, tone

of voice, facial expression

▪ Explore meaning of stimulus

▪ Explore clients’ construal of situation

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 4
Meaning Bridge
▪ Identify dominant scheme or way
of being
▪ Provides understanding
▪ Characteristic style
▪ Important value
▪ Organizing schema

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 5
Recognition & Re-examination
of Self-Schemes
▪ Listen for and encourage broadening

▪ Help client explore broader meanings

▪ Help client explore alternative self-

schemes as they emerge

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 5

▪ Explore characteristic style/scheme

▪ Examine origin

▪ Examine its accuracy in light of other

examples

▪ Evaluate its efficacy currently, and work out

new way of being

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 STAGE 6
Consideration of New Options
▪ Listen for and explore emerging new
understand
▪ of self in relation
▪ self-in-the-world

▪ Help client explore implications for

change

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Example of SEU
Client: I had a weird experience this weekend I just
found myself shutting down silenced it was almost as
if I could not talk. I just felt so constrained. I don’t
understand it or what happened I just felt awful

Therapist: So you felt shut down. You sound confused

and puzzled by your reaction. Would you like to
examine it in more depth?

Client: Yes that might be useful – I just felt so awful

and I don’t know why

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Therapist: I would like you to help me get a picture of
what happened – almost as if you were playing me a
movie of the situation. When did this feeling happen?
(Beginning to recreate scene)

Client: It was in the afternoon – we had some people

over and it just got worse and worse

Therapist: O.K. Let me just get a sense of how the rest

of the day had gone up until then. How were you
feeling in the morning?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client: Umm let me think umm good. Yes I felt O.K. in
the morning. I was a little tired and impatient to get
some order. We had moved on the Friday and I was
hoping to unpack some boxes

Therapist: O.K. so you were feeling a little tired and

impatient. Did you get to the unpacking in the
morning?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client: Yes! We were also expecting Mark’s parents to
come over in the afternoon to help as well as some
friends

Therapist: O.K. So at what point did you feel shut

down?
Client: It was when I was working with Mark’s folks in
the kitchen. We were unpacking dishes and loading
the dishwasher. Mark’s mother went to put a teapot
into the dishwasher and I said don’t put that in I’ll
wash it by hand and she got upset.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
and then her husband started to defend her. It was
just very tense and awkward.
Therapist: So you were in the kitchen. Where were
you standing?
Client: I was at the sink and my mother-in-law was
beside me.
Therapist: Where was your father-in-law?
Client: He was at the other end on the step ladder
changing a light bulb.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Therapist: O.K. so there you were at the sink with
your mother-in-law and you notice she is about to
put the teapot in the dishwasher and you say “Don’t
I’ll wash it by hand” and then what happens?

Client: My mother-in-law just said mine always come

out beautifully they are not damaged in any way.

Therapist: So there was just something about the

way she said mine always come out beautifully and
are not damaged that got to you? (searching for
salience)
----------------
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client: No it was her face… the look on her face.
Therapist: So there was something about the look on her
face that somehow choked you up?

Client: Yes...she looked wounded somehow

Therapist: So there was something about seeing her

wounded that somehow makes you shut down?
(Identifying salience or the trigger)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client: Yes! I feel responsible and that I have to
take care of them. (Meaning Bridge)
Therapist: So somehow you are responsible when
others are hurt?
Client: Yes, well that is how it was at home. I
remember always being so conscious of my mother
and trying to read her. When she looked hurt or
sad I tried to take care of her and I think I got lost
in the process.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Experiencing Tasks
TASK MARKER INTERVENTION PROCESS END STATE
Attentional Clearing a Work
Focus Difficulty Space productively
(confused, with experiencing
overwhelmed) (working distance)

Unclear Feeling Experiential Symbolization,

(vague, external or Focusing carrying forward,
abstract) felt shift
Difficulties Allowing & Appropriate
Expressing Expressing expression of
Feelings Emotion emotion to
(avoiding feelings, (also Focusing, therapist &
difficulty answering Unfolding, others
feeling questions) Chairwork)
 Enactment Tasks
TASK MARKER INTERVENTION PROCESS END STATE
Self-Evaluative Two-Chair Self Acceptance
Split Dialogue Integration
(self-criticism,
tornness)
Self- Two-Chair Self-expression
Interruption Enactment Empowerment
Split
(blocked feelings,
resignation)
Unfinished Empty Chair Let go
Business Work of resentments,
unmet needs, affirm
(lingering bad self, understand or
feeling re: hold other
significant other) accountable
 Enactment Tasks
TASK MARKER INTERVENTION PROCESS END STATE
Anguish Self-soothing Resilience
Emotional Dialogue
suffering

Powerless Imaginal Empowerment

Helpless re-entry
Unsupported
Splits and Two Chair Dialogues: Critical

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Splits and Two Chair Dialogues: Control

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Model of Resolution of Self Criticism
Self Set
Critical Boundary
Marker

Role Play Harsh Specific Values

Softening
Critic Criticism Criticisms Standards

Role Play Affective Wants

Differentiated Emerging and Negotiation
Experiencer Reaction feelings Experiences Needs

Secondary Maladaptive Adaptive Integration

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Harsh Criticism: The first time he hit you, you
should have walked away.
Specific Criticism: You are stupid.
Affective Reaction: I feel I am stupid.
Differentiated Feelings: It really hurts.
Core Maladaptive: Shame
Wants and Needs: I need understanding.
Emerging Experience: Anger
Values and Standards: I need reassurance that
you won’t do it again.
Softening (Initial) “I love you.” Compassion.
I forgive you BUT → MICRO-MARKER
Two Chair Dialogue for Self Criticism
STEP 1: Identify the marker
STEP 2: Enact the critic
STEP 3: Selfs secondary and primary emotional
reaction to the critic
STEP 4: Self Expresses need to critic
STEP 5: Critic responds to the need
STEP 6: Self responds to the critic’s response

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Two Chair Task-Steps in Chairs
Experiencing chair Other chair
STEP 1: Identify the marker STEP 2:Enact Critic

STEP 3:Self Secondary

& primary response
STEP 5: Critics
STEP 4: Express the need response

STEP 6: Self’s response

to the critic

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Client Therapist
1 . I’m really a bad mother. I am so critical of Step 1. Identify the Marker & Enact
myself the Critic
“So it sounds like there are two
2. You’re a failure as a mother. You just never parts. Lets try something . Come
get anything right. over here and criticize her”
Step 2. Get self’s reaction to the critic
“Come back here. What happens inside
3. I feel bad,hopeless, sort of flawed & kind of when you get that?”
worthless. (Deepened to shame.)
Step 3. Express the Need
“What do you need when you feel
4. I need you to give me a break.Im angry this?
I’m not going to let you push me around
anymore.Recognisse what I do offer Step 4. Critic Responds to Self Come
: back to this side. What happens when
you hear her?” “What do you feel
when you hear her feelings”
5. I don’t want to cause you pain. I feel
compassion for you Step 5. Self Reaction to the Critic
“Lets go back. What happens inside
6. It’s a relief. It feels good. when she says this?”
 Coach Critic
“You shouldn’t be so
depressed/anxious/
insecure” “You should be
more confident” hopeless/anxious/insecure

“How do you make

yourself...?” hopeless/anxious/insecure,
“You are too stupid, fat, I feel like a failure,
ugly, selfish needy.” others reject me.

Make him feel like a

failure. Be others, and
reject him. “You’re I feel ashamed,
useless. You’re so quiet.” unlovable
 Coach Critic
C: it’s that I always see the negative in things, because then I can be prepared if the
positive is not coming true (…) Then afterwards I can say: -There you see, it didn’t
work out (…). I think it’s kind of a defence mechanism for myself. So it’s so easy for
me to say that I feel like weak person, because I can’t manage to achieve the things
that I want, because I don’t dare to do it. And that tells me that I’m a wimp…. that
don’t even dare to try…
T: Come over here (pointing to chair). -You are a wimp that doesn’t even dare to
try…
C: yes, you are a wimp that doesn’t even dare to try. For example when it comes to
applying for a new job, you don’t have the courage to do that. You don’t know how
to do it. Everyone else manage to do that…
T: Everyone else can do it…
C: why can’t you do it?
T: You don’t manage to do anything on your own…or?
C: You gotten stuck… in a place you supposed to be…when it comes to you job. And
that also I feel is a sign of weakness (…)
T: So it’s something like: …-You are helpless? Or what are you saying to yourself ?
C: Yes… I feel that you are helpless. You can’t expect everyone else to help you. It’s
easier for you to escape into that little bubble (…).
T: You are a coward?
C: Yes… that’s right … a coward and afraid FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 In a Relationship for Years:
A Need to Make a Commitment
I should take the risk,
be more confident in the I feel panic.
relationship. Commit.

Coach Chair The Fear

We don’t follow the

coach voice. You have to be careful.
Rather, this becomes You will be abandoned I feel shaky.
Frighten yourself inside. again.

Catastrophizing
The Fear
Chair
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Therapist Operations
Predialogue Stage
1. Establish collaboration
2. Structure the experiment
Opposition Stage
3. Identify the 2 aspects of self
4. Separate and create contact between
the 2 sides
5. Promote taking responsibility for each
side’s position
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Contact Stage
6. Promote client’s awareness of
automatic self-criticisms & injunctions
7. Increase the specificity of the client’s
self-criticisms & injunctions
8. Identify core self-evaluations &
injunctions
9. Access & express underlying feelings in
the experiencer
10. Encourage recognition of and affirm
wants & needs of experiencer
11. Increase awareness of values and
standards
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Integration Stage
12. Focus critic on inner experience when
softening appears and promote
expression
13. Facilitate negotiation or integration
Post-dialogue Stage
14. Create meaning perspective

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Day 3: Empty-Chair Dialogue for
Resolving Unfinished Business

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 162
 What is Unfinished Business?
▪ When important needs from significant others have not
been met:
➢The normal cycle of experience cannot be completed
➢Unresolved or “stuck” emotion schemes connected to
these needs and the significant “other” are present in us.

▪ Unfinished Business makes us vulnerable to:

1. Others triggering these emotion schemes
2. Chronically re-experiencing these unresolved emotions
FACULTY OF HEALTH
PSYCHOLOGY CLINIC 163
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Types of Emotional Injuries
Identity-Related
▪ Damage to one’s sense of healthy identity
▪ Not being able to be who I am or accepted for who I am
▪ Not being supported in developmental tasks
(eg. mastery, independence, individuation)

Attachment
▪ Support and love is conditional
▪ Neglect or abandonment, absence of warmth or caring
▪ Other makes unreasonable demands
▪ Other is frightening

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 164
 Markers for UFB
▪ Chronic lingering bad feelings such as hurt, resentment,
resignation, complaint, blaming, longing.
▪ These feelings are connected to another person who has
played a significant attachment role in the client’s life.
▪ These feelings are currently being experienced often.
▪ The experienced feelings are being blocked or interrupted
in some way and remain undifferentiated.
▪ Client is stuck in the cycle of lingering bad feelings about
the other that will not go away.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 165
 Resolution of Unfinished Business
Change in
Specific View of/
Negative
Negative feelings about
Other
Aspects other RESOLUTION
- self-affirmation
- self-assertion
Client - holds other accountable
experiences Dysfunctional - boundary setting
unresolved Belief - new view of others
feelings - understands other
- forgive other
Global
Distress Differentiation Intense
Blame/ of feelings expression Expression/
Complain/ Adaptive/ of primary entitlement
Hurt Maladaptive emotions need to do

Episodic memories
“can you think of a time?”
Self Interruption/ Optional: Letting go of trying
Conflict to get unmet need met by SO
UFB: In-Depth Summary of Therapist Operations

STAGE 1: Predialogue Stage

1. Establish collaboration and reflect/confirm marker; rationale.
2. Structure the experiment.
STAGE 2: Arousal Stage
3. Evoke the sensed presence of the significant other, “Can you see
your mother there?”
4. Establish contact between self and sig. other, “What`s her
expression towards you? How is she sitting/looking at you?”
5.Access client’s initial feelings in response to other. “How do you
feel as you see her there?” (use “I” statements)
6. Express to the other
FACULTY OF HEALTH
PSYCHOLOGY CLINIC 167
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
UFB: In-Depth Summary of Therapist Operations

STAGE 2 Continued: Arousal Stage

7. If needed, facilitate enactment of the sig.other.
(SWITCH to other chair) and intensify the stimulus
value of the sig. other.
8. Evoke a specifically recalled event or episodic
memory. “Can you remember how old you were?
What did you look like at 8yrs? Go back to that
time, and tell her what it was like for you.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC 168
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 UFB: In-Depth Summary of Therapist Operations
STAGE 3: Expression
9. Differentiate feelings toward significant other.
➢ The therapist uses empathic reflection followed by a
direction to get the client to access and express feelings
to the other. “It sounds like you felt…. Tell her”
10. Promote full expression to significant other of
differentiated primary, adaptive emotion. Listen for sadness
under anger, etc.
➢ Help the client differentiate fused anger and sadness. “I
resent you for…” “I felt so unloved…”
11. Help maintain a balance between expression and contact
with inner experiencing.
➢ “What’s it like inside? What’s happening inside as you
say this?” 169
UFB: In-Depth Summary of Therapist Operations
(Stage 3: Expression cont.)
12. Facilitate expression to significant other of unfulfilled
needs and expectations in regard to significant other.
➢ What did you need that you didn’t get? What was it like
for you that you didn’t get this? What did you miss?
13. SWITCH to SIGNIFICANT OTHER to get other to
respond to client’s heartfelt feelings and needs
➢ “How do you respond?”
➢ “What happens when you hear her saying she felt…
And that she needed…
14. Promote Softening
➢ Tell her what you’re sorry for… That you do love her…
FACULTY OF HEALTH
PSYCHOLOGY CLINIC 170
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
UFB: In-Depth Summary of Therapist Operations

STAGE 4: Completion Stage

15. Identify with other and support emerging new
representation of other.
➢ “How does it feel to hear that from her?” “What do you
want to say to her?”
16. Support emerging new understanding of other and of
relationship with other.
17. Empower the client.
18. Close contact with the other appropriately.
STAGE 5: Post-dialogue Stage
19. Create meaning/perspective
FACULTY OF HEALTH
PSYCHOLOGY CLINIC 171
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Current Interpersonal Conflict or Issues:
Different from UFB

▪ If the conflict is not from the past but

it is current and ongoing
▪ Especially if there are not longstanding issues of UFB
▪ If the issues of past UFB are different enough from the
current ongoing issues
▪ Note that there is a strong risk of re-injury as it’s
ongoing
▪ There is an immediacy to clarifying one’s need given the
current situation, i.e. I need to know what to do to cope,
what I need, in the face of this difficult situation,
Eg. Fight with husband, friend
FACULTY OF HEALTH
PSYCHOLOGY CLINIC 172
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 How working with Current Interpersonal Issues
▪ Issue with other is ongoing:
different feelings
from UFBare not about the past
▪ No change in view of the other
▪ Episodic memories are current/recent
▪ Primary feelings are usually adaptive and lead to clarity
about current needs
▪ Need is current, not a past unmet need
Resolution in Ongoing Interpersonal Issues
▪ Need from self is more important: How do you support?
What do you need from yourself given the situation?
▪ Self-affirmation, Self-assertion, Hold other accountable,
▪ Boundary Setting

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG 173
• What is underlined is different than UFB
Current Interpersonal Issues/Conflict: Amended Dialogue
Specific Change in
Negative
Negative View of
Other - Clarity about current
Aspects Other feelings/needs from self & other
-self-affirmation
Client - self-assertion
experiences - holds other accountable
unresolved Dysfunctional - boundary setting
feelings that Belief - new view of others
are current - understands other
- forgive other

Global Intense Expression/

Distress or Differentiation expression entitlement
Feeling of feelings of primary of current
Upset emotions unmet need

Current Memory/Situation Optional: Letting go of

Self interruption, self-
Episodic memories criticism, anxiety unmet current need
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Accessing Episodic
Memories Using
Childhood Age
Regression
Serine Warwar

• Work with the client’s past childhood (or earlier age-

related) memories, emotional experiences, reactions, and
survival behaviors from their past.
• Guide them to re-experience childhood situation and
feelings by means of childhood regression.
• Invite client to go back and “be the child” and to enter
episodic memories as a way of accessing the dreaded
painful feelings, in order to rework them in the present.
Video: Childhood Age-Regression Episodic Memory

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Guidelines for Age Regression Work
1. Elaborate an experience of concern such as
childhood neglect: Eg. My parents just left me to
myself. They were too involved in their own stuff
to even know what I was doing, never mind
feeling.
2. Empathize, ask them to pay attention to a
feeling in the present, Just left so alone, feeling
I’m not important? Let’s stay with that feeling,
“can you feel any of that in your body right now.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
3. Seek permission and guide clients to go back to an
earlier time when they felt this before. Get them
to imagine vividly a memory of a younger self at a
specific time. Eg. If it’s ok with you, let’s go back to
an earlier age. Do you remember a specific age or
time when you were aware of feeling that? Take
your time. Eg. Can you imagine going back to that
time when you were 6 years old. What does that
little girl look like? What is she wearing?

4. Focus the client on event/feelings as a child. So

you are six years old. What’s happening and what
are you feeling?
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
5. Guide the client to re-experience the feelings in
the present by having the client talk as the child in
the present. As your 6-year-old, what are you
feeling in your body? There is your mother talking
to her friend. What’s it like for you? What do you
feel?
6. Help clients stay with and accept the painful
feeling and validate them. Just stay with those
feelings, Yeah, it was so painful, and must have
been so lonely.
7. Focus on the unmet need asking, What did you
need?
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
8. Validate the deservingness of the need: Of
course you needed attention and support. All
children need this, and you deserved it. Tell them
again, I deserve some of your attention.
9. Access a new feeling that arises in response to
the need having not been met. (Usually
assertive anger, or grief at the loss, or
compassion.) What happens inside now as you
say that?
10. Finish the session by bringing the client back to
the present and debrief the client’s experience
of the work. How are you feeling now? What do
make of this? Are you ready to go back into the
world? Anything you need right now? FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Two-Chair
Dialogue for
Self-Soothing
Serine Warwar

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Self-Soothing

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Synthesized
I don’t like Model of Self-Soothing
this!
Fear of Emotion, Interruption I will be
there for
I can see you you.
crying.
Seeing hurt Caring/Compassion
(evocation of “I’m here” CARE
I can’t
compassion) “You are ok” GIVER
take it! Dad
sometime
Emotional played with Resilience,
Suffering/ Positive Episodic
me. Memory
(loving connection) Understand own
Anguish I’m so I need you to suffering
lonely. take care of I feel
me. strength
Primary Sad inside.
and Lonely Need Grieving

I used to be I needed it, but I

like this. Negative Episodic Memory just could not
(absence of support) have that.

CARED
FOR SELF FACULTY OF HEALTH

ISEFT.ORG
All events were observed inEMOTIONFOCUSEDCLINIC.ORG
the context
PSYCHOLOGYof CHAIR WORK.
CLINIC
 Refined Model of Self-Soothing (Goldman)
Protest, Fear of Emotion, Interruption

Seeing hurt Caring

(Evocation of Support
Compassion) Compassion
Marker
Anguish/ Resilience,
Positive Episodic Understand own
Emotional Memory
Suffering/ suffering
(Loving Connection)
Familiar Primary Sad
Despair & Lonely Need Grieving

Negative Episodic Memory

(Absence of support)

Existential
Confrontation

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Day 4

Focusing and Self

Interruption

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 FOCUSING
A Micro-Intervention for Deepening Emotional Process

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Experiencing Tasks
TASK MARKER INTERVENTION END STATE

Attentional Focus Clearing a Space Work productively

Difficulty with experiencing
(confused, (working distance)
overwhelmed)
Unclear Feeling Experiential Symbolization of felt
(vague, external or Focusing sense, carrying
abstract) forward, felt shift
Difficulties Allowing & Appropriate
Expressing Feelings Expressing expression of emotion
(avoiding feelings, Emotion to therapist and
difficulty answering (also Focusing, others
feeling questions) Unfolding, Chairwork)

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Prototypical Focusing Marker
Unclear Feeling: (Absent, Global, External, Stuck)
▪ Prototypical marker: unclear feeling signaling that
something is “not right” or “off” in some way and
one is not sure why.
▪ Clients are having difficulty describing their
experience.
➢ Clients are talking about something clearly important,
but does not seem like they are experiencing it.
▪ When a client says, “I’m not sure how I feel” or “I
feel something, but I don’t know what it is.”
▪ For external clients: “I don’t have anything to talk
about”.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Felt Sense VS Emotion
▪ The felt sense has a concrete physical somatic sensation,
different than“I feel angry.”
▪ In contrast, an emotion is usually recognizable, “I feel
sad.”
▪ A person can feel the physical quality of a felt sense but
often does not know what it is.
▪ Felt sense is implicit higher level meaning: includes many
thoughts, emotions, meanings, perceptions, and context.
➢ Eg. not just “feeling hurt”, but the feeling you get in your
stomach when you run into someone you have unfinished
business with.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Felt Sense: SHIFT
SHIFT IN SUCCESSFUL FOCUSING
▪ When our attempts to symbolize the felt sense
are on the right track.
▪ There is a distinct physical sensation of change
called a shift.
▪ A relief is felt inside
➢this signals that the symbols we have chosen “fit”
the felt sense adequately
▪ Check with the client if the felt sense has
changed

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Focusing Attitude - Receptivity
▪ Quietly and inwardly waiting and remaining present with the
not-yet-speakable, being receptive to the not-yet-formed.
▪ With curiosity and interest.
▪ With care and acceptance.
1)Encourage Accepting and Caring Attitude
T: “Can you be caring, and accepting towards the sensation even
though it is uncomfortable, recognizing that it is a part of you
that has important information for you.”
When this is not possible...
2)Encourage Curiousity and Interest
T:“Can you be curious and interested...”

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Focusing Prototypical Marker:
Unclear Feeling; stuck, blank, global, external
Focusing Micro-process/
Task Resolution Therapist Response

1. Marker: Unclear feeling: Identify, reflect marker to

vague, stuck, absent, global, client; propose task.
external.

2. Attending with Accepting Encourage focusing attitude:

and Curious Attitude to the Invite client to turn attention
unclear feeling, including whole inward to what is troubling or
felt sense. unclear, encourage attitude of
receptive waiting; encourage
attention to whole feeling.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Focusing Micro-process/
Therapist Response
Task Resolution
3. Symbolizing: Finding Label Ask client to find word or image
Finding and confirming for unclear feeling; reflect
accuracy of description exactly what client says; avoid
(symbolic representation). interpretation; encourage client
(without feeling shift). to check label with unclear
feeling until “fit” is found.

4. Feeling shift -Go back to Step 2 (what is X

(a feeling of AHA, it fits!) about?) Or use exploratory shift
questions: What else is there?
What is at the core/bottom
line? What does it want/need
ISEFT.ORG
to change/shift?FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
 Focusing Micro-process/
Therapist Response
Task Resolution
5.Receiving: appreciating, and Encourage client to stay with
consolidating emerging meaning feeling that has shifted; help
from feeling shift, without self- client to temporarily set aside
criticism. critical or opposing feelings.
Help client process and
consolidate new meaning.

6. Carrying forward outside Listen for, facilitate carrying

therapy; or new in-session task forward if appropriate (What is
next? Where does it lead?)
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Focusing Instructions
from Focusing, Gendlin (1981)

1. Clear a space
How are you? What’s between you and feeling
fine?
Don’t answer from your head. Let what comes in
your body do the answering.
Don’t go into anything.
Greet each concern that comes. Put each aside for
a while, next to you.
Except for that, are you fine?
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
2. Felt sense
Pick one problem to focus on.
Don’t go into the problem analytically. What do
you sense in your body when you recall the whole
of that problem?
Sense all of that, the sense of the whole thing, the
murky discomfort or the unclear body-sense of it.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
3. Get a handle
What is the quality of the felt sense?
What quality-word would fit best?

What one word, phrase or image comes out of

this felt sense?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
4. Resonate
Go back and forth between the word (or image)
and the felt sense. Is that word or image right?
If they match, have the sensation of matching
several times.
If the felt sense changes, follow it with your
attention.
When you get a perfect match, the words (or
images) being just right for this feeling, let
yourself feel that for a minute.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
5. Ask
What is it about the whole problem that makes
me so ________ ?
What is the worst of this feeling?
What’s really so bad about this?
What does it need?
What should happen?
What would if feel like if it was all okay?
Let the body answer: What is in the way of that?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
6. Receive
Welcome what came. Be glad it spoke.
It is only one step on this problem, not the last.
Now that you know where it is, you can leave it
and come back to it later.
Does your body want another round of focusing,
or is this a good stopping place?

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Self-Interruption

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Fear of Dangerous Emotion

Weston (2018), in a qualitative study, found that the

core category of the experience of blocking was
“Fear of Dangerous Emotion”.
ISEFT.ORG
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
 Falling Apart
This highlighted the self-protective function of blocking
and self-interruptions (avoidance and defenses) as coping
strategies to prevent disintegrating or falling apart.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Overwhelmed
It is not that clients are avoiding the pain of the emotion;
rather, it is the fear that they will be overwhelmed, will
fall apart or drown
They are protecting against no longer being able to
function that.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Example of SIE Marker: Sadness

C: Ooh, very sad.

T: Very! Sad, uh-uh.
C: (sigh)
T: Can you let yourself feel the sadness?
C: Silence (6 seconds)
T: Let the tears flow if you need to?
C: Silence (6 seconds) Oh a part of me is fighting it too.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Another client interrupts anger
T: What’s happening inside now?
C: Ooh! I’m just (sigh), I’m oh! I want to scream at him so
badly.
T: What do you want to scream at him?
C: Ooh! He just, oh I can’t even express it I’m just so!
Furious with him (big sigh). I can’t tell him that. I can feel
my, I am just sucking it all in.
Here is an example of the blocking of tears
T: So what’s happening for you now as you speak?
C: Um (pause). I’m feeling kind of tearful.
T: Can you stay with that what words come? Tearful? Sad?
C: I don’t want to feel tearful. FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Intervening Using Two-Chair Enactment

Therapists have clients enact the process of interruption

in a dialogue between two sides of the self.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Intervening Using Two-Chair Enactment
• Clients are encouraged to act out how they stop
themselves from feeling, verbalize particular
injunctions, & exaggerate the muscular constrictions
involved in the interruption.
• This provokes a response from the suppressed
aspect - often a rebellion against the suppression.
• Then, the suppressed emotion bursts through
the constrictions, thus undoing the block.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Two Chair enactment of Self-Interruption
Role play Specify Enact Recognition
agent interrupters interruptions of agency

Role play Affective Differentiate Emerging

object reactions feeling experience

Expression of
need

Contact with
environment

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Three Essential Steps
1. Bring the client’s attention to the fact that they are
interrupting (i.e., by noting that the client looks away
when they mention certain things, change the topic, or
smile).
2. Turn the passive to active and the automatic to
deliberate by inquiring and ascribing personal agency to
the client in the interruptive process (i.e., “How do you
stop yourself or interrupt yourself?”).
This is an awareness task that the therapist can use to
elaborate conscious experience and specify what the
interrupters are ( “What do you say to yourself?” “What
do you do muscularly?” “How would you do it to me?”).
3. Access what is being suppressed and integrate the two
sides of the struggle.
ISEFT.ORG
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
EMOTIONFOCUSEDCLINIC.ORG
 Unblocking Emotion
A task analytic study (Vrana 2021) of the unblocking
of emotion found the following components of
resolution:
▪ How (actions) of interruption
▪ The purpose of the interruption
▪ Realization of the negative impact of the
interruption
▪ Reduction of fear of emotion
▪ Desire to, allow the emotion
▪ Support and encouragement by therapists
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Resolution of Self Interruption/Aversion to Emotion
Therapist Coaching and Support*

Desire to
Allow (with
Marker of Awareness Awareness Agency) Resolution:
Realization Allow and
Self- of Self- of of Negative
Interruption Interruption Protective Approaching Express
Impact of Emotion in
/Aversion to Function Interruption
Emotion Session
Aware that Reduce*
self- Fear of
Fear of Emotion
interrupting
consequences
Fear of Optional: Additional
Internalize components of resolution for
being
Validation clients who interrupted the
Aware of overwhelmed
how expression of the emotion
Damage to outside of therapy
interrupting identity/
attachment Resolution of the conflict
Internalize
(integration of both parts)
Safety

Allow/express the emotion

outside of the session
*Relationship with fear. See it as part; be present to it.
• The factors that appeared most important in
unblocking the interruption were
a) clients’ experience/realization of the
negative effects of their self-protective acts
of interrupting combined with,
b) support and encouragement by the
therapist to allow their emotions.
• Together, these factors motivated clients to cross
the bridge, face their fears of disintegration, and
allow their emotion.
• It seemed that when clients came to experience
that the harm of the interruptions outweighed the
benefit, they were ready to face the difficult
emotion. FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 How of Interruption, Blind Gets Drawn, Window in Hell, I am Protecting You

SIE 31:24-35:22

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Purpose of the Interruption

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Desire to Allow, Realization of the Negative Impact

SIE 35:29-36:59

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client Process Measures

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Experiencing Scale
1. Objective and intellectual, giving no evidence of
the personal significance of events they describe.

2. Personal but detached; no explicit reference to

feelings, reactions or internal states.

3. Reactions to external events begin to appear.

4. Marked shift inward with a focus on exploration of

feelings and internal experiences. At Level 4, clients
are in direct contact with their fluid experience and
speak ‘from’ it as opposed to ‘about’ it.
FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
5. Questions about experience and the self are raised
and explored from an internal perspective.

6. Newly realized feelings and experiences are

integrated and explored to produce personally
meaningful constructions and resolve issues.

7. Shifts and new understandings in one particular

area of experience are broadened to a wider range
of experiences giving clarity and meaning.

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
 Narrative Processes Model
& Coding System (NPCS)
(Angus et al 1999; 1996)

External Narrative Mode: what happened?

Personal storytelling/information

Internal Narrative Mode: what did I feel?

Emotional differentiation

Reflexive Narrative Mode: what does it mean?

Meaning exploration in relation to stories &
emotions

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG
Client Emotional Arousal Scale (Warwar & Greenberg 2003)

1. Person does not express emotions.

Voice or gestures do not disclose any emotional arousal.
2. Acknowledgement but very little arousal in voice or body.
Almost completely restricted
3. Person acknowledges emotions.
Arousal is mild in voice and body
4. Arousal is moderate in voice and body.
Emotional voice is present, arousal still somewhat restricted.
5. Arousal is fairly intense in voice and body.
Speech patterns deviate markedly from the client’s baseline
6. Arousal is very intense and extremely full.
Freely expressing emotion, with voice and body.
7. Arousal is extremely intense and full.
Complete disruption of speech, uncontrollable.
 Vocal Quality

External voice

Focused voice

Limited voice

Emotional voice

FACULTY OF HEALTH
PSYCHOLOGY CLINIC
ISEFT.ORG EMOTIONFOCUSEDCLINIC.ORG