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Hi Everyone – hope you’re all enjoying a glorious Summer! I’m writing about some upcoming trainings in the area this Fall that are worthy of special consideration.

Dr. Barry McCarthy is a long time sex therapist and author of numerous clinical and self-help books and journal articles on a wide range of sex-related topics, including Rekindling Desire and Men’s Sexual Health. His Good-Enough model, primarily a cognitive-behavioral approach, also includes a strong relational focus. I’ve attended several of Dr. McCarthy’s presentations and always find him to be a clear, knowledgeable presenter who addresses careful multi-dimensional assessment of sexual difficulties. This is a great opportunity to learns some basics of sex therapy. He’s presenting 1-day workshops in the area on September 11 and 12, presented by PESI. Get more info at pesi.com .

The Family Institute and its Alumni Association are hosting Dr. Donald Baucom on September 12^th. He’ll be speaking on infidelity, one of his many couple therapy research topics. He’s a co-author of one of my favorite books on working with infidelity, Helping Couples Get Past the Affair, and the self-help version, Getting Past the Affair, both of which lay out an empirically investigated cognitive-behavioral 3-stage model for working with marital distress related to infidelity. More info is available at family-institute.org/fallconference .

Dr. Joe Kort will be in the area October 6 through 8 presenting 1-day workshops on working with gay, lesbian, bisexual and transgender clients. Dr. Kort is the author of Gay Affirmative Therapy for the Straight Clinician, a well-respected overview of how to work more effectively with gay clients. He has a practice in Ann Arbor, MI and was one of the featured speakers at the University of Michigan sex therapy training program I completed last year. He’s an informative and engaging speaker. More info is available at pesi.com .

Finally, I’ll be presenting a 1-day Introduction to Emotionally Focused Couple Therapy at Trinity International University’s Fall Counseling Conference in Deerfield on October 31^st. I regularly get inquiries from local therapists asking about introductory talks on EFT; this is an excellent opportunity for therapists only marginally familiar with the model to get an overview of the theory and interventions. Visit divinity.tiu.edu/counseling-conference/ to get more info.

Enjoy your Summer!

Jeff

I recently came across this short excerpt from a video interview conducted by Rich Simon of the Psychotherapy Networker with Dr. Dan Hughes, the creator of Dyadic Developmental Psychotherapy. Hughes developed DDP for working with traumatized children to help them “establish a secure attachment with his/her caregivers”. I’ve seen him present on his work several times; it’s impressive and inspiring. Much of his therapeutic use of self is easily adapted to our work with couples, especially his careful attunement to clients’ emotions.

In this three minute video, Hughes succinctly describes how he uses not only his felt sense of the child’s experience, but also the emotional impact it has on him in the moment to create safety, a shared understanding and co-regulation of affect. The result, says Hughes, is that the negative emotions are ‘experienced in a new way, with new meaning’. Sound familiar from your EFT training? The video is a little grainy, but you’ll get the idea. Let me know what you think.

I’d never heard the word ‘externship’ before starting my own EFT training over 10 years ago and it’s still not a word I hear much outside of EFT circles.  Wikipedia defines it as an ‘experiential learning opportunity’ that gives ‘short, practical experience in a field of study’. I think of it as a relatively brief, but deep immersion in EFT that helps you understand the model both cognitively and experientially so you can practice it in your work.

The Externship is a 4-day intensive training in the theory, treatment process and interventions of Emotionally Focused Therapy with couples. We cover the roots of EFT as a humanistic, experiential and systemic model, the influence of adult attachment theory and treatment techniques that help you work with emotion to help your couples shift from distress to secure engagement. Our goal is to have you finish the training with the knowledge and skills needed to implement EFT in your clinical work. Between us, Lisa and I have done dozens of externships and we’re constantly looking for new ways to bring the ideas and skills alive for participants.

We follow a basic plan of describe – demonstrate – practice to help you get EFT in your head and in your heart. We also teach experientially: we’re speaking to your right brain too. In fact this is often the way therapists get a personalized, intuitive grasp of how attachment and emotions shape relationships.

First the description. The first day is the most didactically oriented as we lay the foundation for understanding couple distress through an attachment lens and give you an overview of the process and key interventions of the model. Over the next three days, we build on this, by providing more details on the course of treatment, how EFT works actively with emotion and the three key change events: Cycle De-escalation, Withdrawer Re-engagement and Pursuer Softening. You can see we cover some content each day and we’ll also take questions regarding the material. After all, most therapists come to EFT after being grounded in other treatment approaches and it’s natural to compare and contrast in learning a new approach.

We demonstrate the model by showing and discussing videos showing various expert EFT practitioners so you have the chance to see how we all bring ourselves as therapists and use the model differently. We’ll also conduct two live demonstration sessions that will bring the model to life in the moment. Along the way we’ll likely do brief, impromptu role-plays that model specific interventions.

Finally, the practice. During break out role-play sessions, facilitated by an advanced practitioner, you’ll practice basic EFT skills. Even experienced therapists often find it challenging, but tremendously useful, to try out the interventions in this structured, guided, supportive environment. This is often a key element in helping therapists truly grasp the power of the model; not surprisingly, we find that participants learn in their roles as both therapist and client.

Or course it’s not all work! We’ll have some fun along the way and provide an opportunity for folks to meet and network outside the training. Hope you can join us.

A few comments on recent externships:

“Great trainers and additional support from EFT practitioners in the area. Wonderful group of supportive role play leaders that really help to advance your skills.”

 “I am extremely grateful & pleased at the breadth and depth of knowledge of both couples therapy and EFT. Both facilitators were very accessible and provided safety for the work. There honestly isn’t anything that I found lacking or frustrating.”

“Excellent. Loved the roleplay, real, interactive style of both presenters.”

“My individual goal was to translate this model from head knowledge to embodied knowledge. The role plays were extremely helpful for me to know what it looks like and feels like to practice this model. Thanks!”

“I really enjoyed you both. It was very safe, supportive and enriching, professionally and personally. Thank you!”

1.  EFT is a research-validated approach to couple therapy: Emotionally Focused Couple Therapy was developed in the mid-1980’s by Dr. Les Greenberg and Dr. Sue Johnson. Since that time, dozens of outcome and process studies have demonstrated its effectiveness with a wide variety of populations and presenting problems. For more info on research: www.iceeft.com/images/PDFs/EFTResearch.pdf

2.  A clearly delineated treatment model: The stages of treatment are clearly specified, beginning with De-escalation through Re-structuring to Consolidation, giving you a clear map for intervening with couples to facilitate lasting change.

3.  An attachment view of couple distress: Couples high in conflict or disengagement can be challenging for any therapist. Attachment theory provides a powerful organizing lens that will help you understand the most common ways couples express relational distress.

4.  Skills to work deeply with emotion: In EFT, emotion is both target and agent of change. A skilled EFT therapist evokes core emotions to create powerful enactments and unleash in-the-moment change events that help transform relationships.

5.  Specialized training in couple therapy: Many mental health professionals receive scant training in couple therapy. And yet relationship distress is one of the most common reasons for entering therapy and increasingly, couples are seeking therapists trained in EFT.

6.  Improvement in general psychotherapy skills: EFT’s humanistic orientation will likely enhance your ability to create a strong alliance that engages clients in the change process.

7.  A meaningful, competence-driven certification process: ICEEFT has laid out a training process and requirements for the demonstration of competence that insure certified EFT therapists have met a high standard of EFT practice.

8.  Eligibility for membership in ICEEFT: The International Centre for Excellence in EFT includes members from around the world and maintains a directory of practitioners who have begun formal EFT training and those who are certified. ICEEFT also publishes a quarterly newsletter and maintains an active member listserve.

9.  A growing therapeutic community: Join almost 300 therapists who have participated in CCEFT Externships over the past 4 years and thousands more who have taken part at trainings around the country and across the world. Locally, EFT therapists support each other through peer consultation, a mutually supportive learning atmosphere and client referrals.

 10.  28 ceu’s: The training virtually fulfills the biennial continuing education requirement for license renewal for social workers, licensed counselors, psychologists and marriage and family therapists in Illinois. By the way, this is about the equivalent of a 2 credit-hour college course – especially if you do the recommended preparatory and follow-up reading.

Let’s face it; it’s easy to get lost while doing couple therapy. And there are so many ways to get lost that it’s surprising it doesn’t happen more often. To give a few examples: A couple gets into an intense debate over a content issue, such as whether their teenage daughter needs more structure or more freedom to make mistakes, and you find yourself losing track of their process and getting sucked into a debate about the merits of different parenting styles, giving advice and quoting parenting experts. Or, a couple you believe has de-escalated and moved into stage two suddenly returns to their historic conflict pattern and it’s as reactive and consuming as ever; and worse yet, you’re not clear what precipitated the shift.

These moments happen to us all; key to finding our way through them is checking in with ourselves to track the couple’s process and at least as important, our own internal reactions in the moment.

Getting Lost in Content

When I follow a couple into content – often an exit from more vulnerable emotions in the moment – I start to see myself less as a therapist and more as a teacher or referee. I notice that the conversation seems somewhat shallow and find myself sitting back in my chair and disengaging. I feel like a bystander in the therapy and momentarily inadequate. When I catch it, I reorient myself to the process, lean forward in my chair and attune more carefully to the emotions in the room – both theirs and mine – and begin to note the impact they’re having on each other as they discuss parenting styles.

In other words, if one or both becomes dismissive, blaming or retreats, I want to reflect that process, ask evocative questions about their experience in the moment and help them each expand on it. I also want to notice if there’s something about their interaction with each other or with me that makes me want to stay in my head rather than use my empathy and attune to them in the moment. Do they sound detached? Am I feeling overwhelmed by the conflict?  Do I feel hopeless about change? All are excellent questions for a quick self-check.

By the way, it’s not that the parenting concerns are unimportant, but rather that the couple’s conflict cycle – often fueled by attachment-related distress – leads to familiar patterns of critical pursuit and defensive withdrawal that interfere discussing those concerns productively. My overriding task is to help them shift that pattern.

Unexpected Relapse

In the second example above, it’s not just that the couple relapsed to old patterns; couples often do, and tracking relapses can help them recognize the precipitants and the related vulnerability. It can turn a temporary regression into a renewed focus on their attachment bond and the blocks to maintaining it. This is more of a challenge though when I’m at a loss about what created the shift back into a negative cycle. I just can’t see the links and neither can they. I often start by reflecting and validating that staying open and accessible isn’t easy when partners have gotten accustomed to protecting themselves with negative patterns of pursuit and distance. Next, I’d likely look for entry points to primary emotion as they relate their experience in the moment. If needed, I’d probably ask them to return to the interactions that accompanied the shift back to the cycle and focus on the context and attachment meaning of those interactions. Silently or aloud, I begin to wonder what necessitated the familiar, reactive responses such as distancing or blaming that create temporary protection while adding to the sense if isolation. I might also ask them what they noticed in reaction to recent expressions of vulnerability and what sort of blocks to trust and openness they were noticing. In short, I want to get curious about the process, bring it into the moment, heighten the experience in the moment and hopefully create enactments built upon re-accessed primary emotion.

So it’s really not so significant that we get lost – we all do. The keys are noticing it, checking in with our internal, affective experience in the moment and getting very curious with our clients. After all, even the best of guides have to learn the terrain.

Next time: How to help your transparency work for you.

Till then…

Jeff

The Chicago 2014 Externship is in June! For more info, visit chicagoeft.com/events/.

We always appreciate your help in getting the word out!

Are you looking for ways to be more effective in your couple work?

Join EFT trainers Jeff Hickey LCSW and Lisa Palmer-Olsen PsyD for this intensive training in the theory, interventions and treatment process of EFT. Our goal is nothing less than to transform your work with couples. The training will:

• Sharpen how you conceptualize and intervene with highly distressed and disengaged couples,
• Deepen your work to evoke key relationship-changing attachment emotions.
• Equip you with skills to implement the in-session change events that help create enduring bonds.

Emotionally Focused Couple Therapy, with it’s fast-growing and respected body of outcome and process research, provides the couple therapist a clear model of change – even with high conflict couples.

This ICEEFT-approved Externship includes:

• Thorough readings and handouts that will ground you in the basics of the model.
• Review and discussion of session video clips conducted by Sue Johnson and other EFT experts.
• Observation of live demonstration sessions conducted by your trainers, Jeff Hickey and Lisa Palmer-Olsen.
• Extensive facilitated role-play sessions to help you learn key interventions.

June 4 – 7, 2014 at Loyola’s Watertower Campus

Special Early Bird rate through April 30th!  (This event not affiliated with Loyola University)

28 CEU’s are available to social workers, counselors, psychologists and marriage and family therapists for $15. 

Externship Registration  (Special rate available to groups of 3 or more.)

For more info on:

• EFT Externships
• ICEEFT
• EFT Certification

In early December of last year I had the good fortune to be joined by two of my favorite trainer colleagues, Lisa Palmer-Olsen from San Diego and Jim Furrow from Los Angeles, for an advanced EFT training here in Chicago. About half of the 28 participants were from the Chicago area, the remainder from around the country or beyond, and I knew all but a small handful from previous trainings I’ve done here and there. Lisa created the training format – she calls it a Dig-In – to maximize experiential learning of EFT. In smallish groups, participants well versed in EFT have an opportunity to identify and work on specific challenges in learning the model, often framed as ‘self of therapist’ concerns, in a supportive atmosphere. The idea is that tuning into and working with our own experience in the process of learning and practicing EFT are key to our competence and effectiveness. This is hugely important for us all: after all, no humanistic/experiential approach to therapy can be reduced to mere lists of interventions or steps and stages. I always learn something new from Lisa and Jim – both are very experienced and creative leaders – and this time was no exception.

Here are three takeaways from the training that in some way relate to the therapist’s use of self. They all stuck out for me in some way, and judging from the evaluations, for many of the participants as well.

• An important distinction between empathy and attunement
• Checking our internal experience re-orients us when we get lost in the content or process
• Transparency in the moment helps us get unstuck and clients feel joined with

Each is fertile ground for reflection and discussion so starting with this entry I’m doing a three-part mini-series addressing each subject in some detail. Today’s entry:

How are empathy and attunement alike and different?

We all know how vital empathy is. Helping clients feel understood is essential to feeling the safety to be open and vulnerable and to take risks to ask for attachment needs to be met. One of the best descriptions of empathy I’ve seen comes from David G. Martin’s Counseling and Psychotherapy Skills, 3^rd ed. (2010). It’s written for grad students in psychotherapy courses. I like it because it’s simple and focuses on the ‘intended’ and ‘implicit’ elements of communication. He writes,

“Empathy is “communicated understanding of the other person’s intended message, especially the experiential/emotional part.” (Quotation original). Every word counts in this definition. It is not enough to understand what the person said; you must hear what he or she meant to say, the intended message. (italics original) It is not enough to understand, even deeply; you must communicate that understanding somehow. It is absolutely essential that the other person feel understood – that the understanding be perceived…”. And later, “You will be listening for what your client is trying to say, and one way you will be doing this is to hear the feelings implicit in his or her message.” (p.4).

 Of course we all do this by paying careful attention not only to their words, but also to the rich nonverbal and paraverbal communication.  I once heard EFT originator and researcher, Dr. Les Greenberg, say at a training that ‘85% of what come out of people’s mouths is noise’. It was his rather direct way of saying that we need to pay attention to many routes and levels of communication. Others have estimated that three-fourths or more of communication is non-verbal, and all therapy approaches recognize nonverbal communication as a cornerstone of understanding and empathizing with our clients.

So how does attunement differ? To begin with, it involves how to use empathy. Having a very clear sense of the implicit message of, in Martin’s words, “what your client is trying to say” is essential, but knowing how and when to work with this is just as important and often requires a deft touch. It’s a very good thing to know that underneath a client’s angry expression lays uncertainty and fear, but the benefit gets lost if I bring it up before he’s ready to have it known. Attunement means being in step with where clients are in the process of letting themselves be known – both by us and their partners. In watching session videos and role-play practice I’ve seen many therapists be spot-on in recognizing the client’s experience in the moment and yet be too far ahead of what the client can tolerate in the moment. The result? The client steps back or resists, trying to keep from feeling over-exposed.

Here’s a suggestion that often helps clients feel both our empathy and attunement. Let’s say my client is talking in a couple session about being reluctant to engage with his partner and share the insecurity he feels in the relationship, so instead he keeps his distance rather than risk being rejected. It’s clear to me that he feels a general fear of rejection by her, that he may not be so important to her. He says a little tentatively, “I know it’s a little silly, but I just wonder if she would even be with me if it weren’t for the kids, and then I feel like I need to be careful about what I ask of her.” It’s clear he’s on the very edge of what he’s ready to say, especially in her presence, but it’s important that he be able to convey that his careful distance – that she sees as a sign of disinterest – is an attempt to protect himself. So I reflect what he’s said and add just a tiny bit and give him a chance to catch up, to verify or differ. “It’s a big question to carry around – unresolved; no wonder you’re careful about engaging with her. So you look carefully for the signs that say she still cares about you, that she wants to be with you.” If he says, “Yes, exactly, it feels like I’m always on the lookout…”, I know we’re well attuned and he’s ready to be nudged slightly in disclosing his fears. If on the other hand, he says, “I try not to get to caught up in the vagaries of what every little comment means”, then it’s clear I’ve pushed a bit too much for the moment and I need to time it more carefully.

The nice thing is that therapeutic attunement has a built in trial and error process with most folks. While it’s hard on the alliance if we’re constantly a little off or way off on occasion, most clients are willing to guide us a bit when we need it. After all, they want to be understood and often we’re the first step in helping them feel understood by their partner.

Warm regards,

Jeff

The Chicago 2014 Externship is in June! For more info, visit chicagoeft.com/events/.

We always appreciate your help in getting the word out!

Do you struggle with finding ways to help couples differentiate the secondary emotions and reactions – the ones we want to accept, reflect and validate – from the primary emotions – the ones we want to heighten, expand and encourage them to share? If so, read on…

The well-known graphic of a figure and ground known as Rubin’s vase is an apt metaphor for the juxtaposition of primary and secondary emotion: what we see depends on where we focus – and it’s all the more true for couples in the midst of conflict. The therapist’s task is knowing where to focus and helping the couple learn to do that in presence of strong emotion.

An essential early task in EFT is tracking the interactional cycle that maintains conflict and/or distance for couples. Partners are often largely unaware that when they experience painful primary emotions and affect states like hurt or loneliness, they often show their partner more critical or defensive reactions. In fact some clients are largely unaware themselves that under their secondary reactions of anger, criticism, etc. they are feeling more vulnerable primary emotions. It often helps therapists to conceptualize the secondary emotions and reactions as efforts to deal with primary emotions that seem too risky to share. It helps us develop and maintain empathy. But the partners also need to be able to distinguish secondary and primary emotions if they are to be successful in interrupting patterns and sharing the core emotions that point to healthy relational needs for security and acceptance.

Here are two ways the therapist can help partners gain an experiential awareness of the distinction and help them recognize how secondary emotions are often an attempt to cope with vulnerability inherent in sharing their primary emotions. Both examples relate to a fictitious couple, Janice and Al, who are four sessions into Emotionally Focused Couple therapy.

Al has just described how overwhelmed and inadequate he felt a few days ago when Janice expressed disappointment that he’d been so withdrawn lately. He acknowledges that his immediate impulse was to retreat physically or emotionally. The therapist carefully tracks the cycle with him, how it began and progressed: the trigger (her tone of voice), his perception (she’s disappointed in or angry with him), his behavioral response (to distance), his secondary reaction, (frustration, shutting down) and his underlying primary emotions (hurt and shame). The therapist reflects the process, taking special care to contrast the secondary and primary emotions:

“Let me see if I understand what’s happening, Al. You heard the edge in her voice and it signaled danger, so you retreated to the basement in an effort to feel safer for the moment. On the way you even told her she needed to work on managing her anger, just like her mother. What you didn’t tell Janice was how overwhelmed and inadequate you felt at the prospect of hearing once again how you’d failed her. You tucked those feelings away and she didn’t have a chance to see your hurt, just your angry distancing. I wonder if you could stay with that hurt and self doubt here for a moment and let her see what’s happening under your retreat.”

You can see the therapist isn’t judging or even teaching Al to react differently, but rather tracking the process carefully, reflecting it to Al (and of course indirectly to Janice), connecting / contrasting the secondary and primary emotions and noting the attachment impact of the cycle.

Later in the same session, in response to Al acknowledging his self-doubt and anxiety, Janice accesses and labels her own primary emotion – her sadness about feeling so cut off from him. She then begins to express it to Al through an enactment, but in the process exits to secondary emotion, the anger she often expresses. She starts, “When I see you burdened and stressed out, I feel really concerned about you and how you’re feeling (softly). And I want you to let me in – I could help (a little more plaintively). It just gets so frustrating (voice rising and gaining an edge) that you feel you always have to go it alone. I don’t deserve to be so shut out of your life – it effects me too!”

The therapist notes the shift, reflecting first Janice’s sadness then noting the shift into anger. He might say, “Your eyes began to moisten and you sounded so sad as you described the gulf between you and Al, at the very time you’d like to be at his side and lend support, and then you shifted to anger. Did you notice it? Could you feel the shift as your indignation crowded out your hurt?”

This is an intervention that requires a strong therapeutic alliance and Janice’s trust that she isn’t being singled out for criticism. The in-the-moment recognition of how she deals with sadness by becoming angry is often a revelation to both partners. It also gives the couple and the therapist a sort of touchstone that can be returned to in future sessions when the cycle resurfaces or either partner struggles to stay with their more vulnerable emotions.

Until next time…

Jeff

If you’re looking for some support to keep growing in your EFT work you have several options available to you. Here’s the who, when and where:

West Suburban Peer Consultation Group

Meets the 3rd Tuesday of the month from 9am till 11:30 at the Carol Stream Police Station.  Open to anyone who has completed an externship. No charge to attend. Contact Mindi Thomas at 630.871-6281 for more info.

Evanston Peer Consultation Group

Meets the 3rd Friday of the month from 10am till noon at 820 Davis St., Suite 211 in Evanston. Also open to anyone who has completed an externship. No charge to attend. Contact Tom Hammerman at 847.424-1924 for more info.

Evanston Clinical Consultation Group

Meets, generally, the 2nd Friday of the month from 9am till 11:30 at 1227 Maple in Evanston.  Go to the clinical supervision page or contact Jeff Hickey at 847.491-0351 for more info.