Fev 2010 Entrevista

Sociedade Portuguesa de Psicoterapias 50MINUTES Construtivistas Robert Elliott Focused Therapy

PROCESS-EXPERIENTIAL/EMOTION FOCUSED THERAPY

Robert Elliott is, with Leslie Greenberg and others, co-originator of Emotion-focused Therapy. He is intervening in the Society’s Specialization, offering EFT training, as Les Greenberg does. This 50 minutes conversation took place the 11th February 2010, at Lisbon. The distinctive features of P-E/EFT were among other topics discussed.

FEATURING EMOTION FOCUSED basis of contemporary emotion client that’s kind of a delicate kind of THERAPY theory and thinking about attachment feeling your way into what’s not and things like that. So is neo- quite clear, that’s on the edge of what humanistic, is also process oriented – the client’s been able to say, and that PART I - On PE/EFT main distinctive the original name of the therapy was exploratory but at the same time features, role of , homework assignments, manuals and creativity .. process-experiential because we empathic response style – which is wanted to capture this sort of intense not non directive but it’s also not A.H.: Thank you so much Robert for look at the therapeutic process and directing the content – it’s a sort of willing to have this conversation. the differentiation of the therapeutic guiding the client deep to a deeper How would you describe Process- process into tasks and responses and process. I think that’s fairly Experiential /Emotion Focused modes of engagement and all the distinctive. Therapy main and distinctive different elements. So there’s quite a features? high degree of process differentiation A.H.: You are following and you are in the therapy. So it is very process leading? R.E: There are a set of characteristics oriented. And it’s also, of course, I think that set Process - Experiential emotion focused. We do see emotion R.E.: We’re both following and Emotion Focused Therapy apart. It’s as this sort of crux of the change leading at the same time. It’s really a no one feature, I think it’s the process for clients, and also as the kind of mutual process. And the combination of those things. First of sort of core of what it means to be therapy is also evidence based. So all this is a neo-humanistic therapy - human so it’s emotion focused. it’s built on a program of research, is a therapy based on humanistic There’s a particular exploratory principles that have been response style that the therapist first into particular therapeutic tasks reformulated and renewed on the provides in the relationship with the – which is how clients resolve

[1] certain issues that they bring into therapist - this therapist needs to be they’re too busy worrying about…, therapy – and then outcome research highly skilled in empathy and I think right? So there’s this beginning phase and more recently randomized that things like chair processes, two- of the therapy, which is the clinical trials and things like that. So chair work, empty-chair work relationship building phase and we have these things. They kind of actually place greater demands on the alliance formation, where you’re not come together in a package in therapist empathy than other kinds of doing chair tasks and then you can’t Process-Experiential Emotion therapeutic work. So empathy is do a chair task every session. It’s Focused Therapy which I think absolutely foundational. I think the very intense, it needs to be worked we’ve believed is distinctive. therapy is potentially dangerous into, it needs to be processed without that solid foundation of afterwards and sometimes you stop A.H.: How is EFT distinct from other empathy. And at the same time… we in the middle and do something else approaches and models of therapy? do see empathy as having two and come back to the chair task. So different roles to play in the change even in a session that’s mostly chair R. E.: Right! I think what I’m saying process. First empathy is a core work or unfolding, or one of the is that it’s actually that combination change process too, so the process of other main active tasks, even in those of things. I mean, there are other being known, the empathic process is sessions at least half of it it’s not emotion focused therapies and there healing to clients and takes clients a chair work. And then you can’t sort are other evidence-based therapies long way in their journey, even of bang on with chair work every and there are other humanistic without the tasks. And secondly single session. The client needs a therapies and there are other process- empathy is the foundation for doing breather, there’s different kinds of oriented therapies, right? But things like chair work or . work that can be done using other somehow to bring all those things All of them need to be based on kinds of… we would say basically together… I think that’s what makes empathy. So empathy is both a means straight empathic exploration. And so it distinctive, yes. So we’re not to an end and an end in itself in the the mix of the straight empathic claiming we’re totally unique in therapy. exploration and different kinds of anyone particular feature but it’s the tasks I think is more effective than package. J.S.: You think it’s healing in it self? simply trying to… and of course the clients don’t present the markers in A.H.: Can we identify clear phases or R.E.: I do think empathy is healing in every session. So, you know, we’re stages in EFT? itself, right, yeah. And if you look at not going to do chair work, two-chair the research literature person- work unless there’s a marker for it. R.E.: I think that therapy in general centered therapy actually holds up has to be stages and that includes pretty well in terms of the outcome A.H.: So you find that Isn’t there an EFT. I think there’s an opening and literature. EFT looks to me like it’s a excessive focus on tasks in EFT relationship building stage of the little bit better. The comparative training manuals therapy, there’s a main working studies, the effect sizes, looks like it phase in which there’s deep does a bit better but person-centered R.E.: Yes, so our books, you know, exploration and restructuring that therapy does quite well also. I think especially the first book, the 1993 happens and there’s a closing phase empathy does get you a long way and book Facilitating Emotional Change, where we help the client to without it you can’t have effective with Greenberg, Rice and Elliott, that consolidate their gains and sort of EFT either. book was criticized - and I think aim themselves out of the therapy rightly – for the lack of emphasis on and beyond the therapy. So that’s true A.H.: Depending on each client’s the relational conditions on empathy whether it is psychodynamic, process, it looks as tasks can take and an almost exclusive focus on the cognitive-behavioral, EFT, right?… less than half the time an EFT chair tasks, focusing systematic process takes. If this is really the evocative unfolding. And people like A.H.: Empathy appears as a core case, what is going on during the Germain Lietaer and others took us feature and skill in EFT. Do you see remaining therapy time? to task for just the very thing, you empathy as a core construct in EFT know, excessively focusing on those or just a mean to achieve a goal? R.E.: What do we do the rest of the tasks. Now, we tried to readdress that time we are not doing chair work? in the Learning Emotion Therapy R.E.: It is a core concept and a core (laugh). First of all you can’t do chair book, the 2004 book, so we put the process. The whole therapy is based work until somewhere around relational work upfront, we have on empathy. You can’t do EFT session four because the client has to extensive coverage to empathy and effectively without this solid have internalized you as an empathic also relationship building processes foundation of empathy, both in terms presence, strongly enough to be able and they come before the active of the immediate therapeutic process to take their eyes off you to look at tasks. I think we get a better balance but of course also the skill of the the other chair, right? So before that

[2] there in the 2004 book. But of course the empirically-supported. How do you see chair work is, you know, it’s sexy and this trend? exciting and it’s what people always 50MINUTES 2010 want to see and want to talk about. It’s R.E.: A manual is a funny thing, right? I flashy, right? mean you can write a ten page description of the therapy and call it a J.S.: So EFT is also marker guided? manual and people do that. So you can write a little tiny thing and call it a R. E.: Yeah its marker guided, yeah. manual, right? Or you can write a three That was the other distinctive feature hundred page book - like the Learning that I forgot to mention, right? Yes, its Emotion-Focused Therapy book is a marker guided. manual also. It’s a complex one. And Bill Stiles in his review of it said this is A.H.: Do EFT clients have «homework» the most detailed therapy manual that’s assignments between sessions? And if ever been written because we try to get they do, of what kind, with which down to the nitty gritty of the purpose? therapeutic process in a very specific way and all these different processes. So R.E: The most common form of that’s on one end of it and then you’ve homework we give, in fact the only kind got a bunch of gradations in between of of homework I give, as a therapist is more or less detailed manuals. So then, I what we call awareness homework mean, in a way it’s a kind of marketing which is can you pay attention to some thing… process that we’ve been working on the sessions so if the client was working A.H.: Hum hum, they result useful in a with their critic I might say see if you lot of ways for learning, for teaching, for can be aware of when your critic comes training… up and what happens during the week, right? One of my clients is struggling R.E.: That’s right. And trainees love with,… one of my clients with social [manuals]… for selling, for selling the anxiety is working on her sense of therapy, for getting grants… and ugliness. Many clients with social students like them too because they anxiety have this feeling that they’re make them feel more comfortable or ugly. It’s not just a belief in their head safe. So the manuals have their uses. but is a sort of deep embodied feeling The important thing about a manual is… that they’re ugly. So this just came up at a good manual describes the therapist towards the end of the session, I said responsiveness. So, all therapies have to (we talked about it) this sounds like it respond to their clients in a might be pretty important for us to work differentiated way. They can’t just plug on but during the week maybe pay everyone into the same process. All attention to times when you feel ugly manuals have to do that. The good and also what you’re doing to make ones… yourself feel ugly. So that’s awareness homework and that’s going to set up for A. H.: Have to be complex? us to do some more focus work in the Workshop on Process- therapy next time, probably - on this R.E.: That’s right. They have to build experiential emotion-focused ugly making critic process. Or, you that complexity and that responsiveness. therapy - Lisbon 12-13 Feb know, we might say pay attention to If they don’t do that then it’s basically Regular training in EFT principles times during the week when you find not a good manual. and methods is promoted in the yourself feeling really anxious and bring Psychotherapy Specialization the those in and we can work with those and J.S.: What about the therapist creativity Society organizes since 2005. The authors are regularly invited to offer do some kind of unpack and unfold in these treatment manuals? training through supervision, them. So that’s the kind of homework seminars and workshops. we give. R.E.: I think there’s room for creativity within a manual. For example, I mean, A.H.:We have seen a lot of efforts to think about different kinds of art… create manualized treatments, above all

[3] different… literature, or… you create an clients. So there was a split that of basis of task analysis. So that’s in artistic work within structures. They occurred in the 60’s, and so we had two there, certainly. Is there something else sometimes break through them but branches: what’s called the classic, or I’m leaving out and you’re going to there’s something about structure, which relational person-centered approach and remind me of? is a kind of bed for creativity. And I what came to be called experiential think manuals are like that too, you therapy, which is originally Gendlin and J.S.: ? know? The manual provides the focusing and then Rice and Greenberg structure and the therapist can be and folks like and me and other folks. R.E.: Oh yes! Gestalt! Sorry! Yes, ok. creative within that and the highest level So that’s the big split, between folks That’s in there also. Well, you know, of mastery of the therapy – EFT who focused mostly on the therapist Laura Rice was studying a task from included – is to be able to create new relational conditions and people began client-centered therapy, that she did structures, new tasks. You haven’t really to differentiate… ok, so, influences for encountered in her own clients in mastered EFT or some other therapy EFT: of course we’re powerfully Chicago in the 50’s, called systematic until you actually can begin to create influenced by the relational conditions evocative unfolding and Les decided to new tasks. or the empathy genuineness and then we go get gestalt training to see if they took on board Gendlin’s work and then could find something in that tradition Rice looking at developing task that would be amenable to study and so A.H.: Can we turn into the influences on analysis. Now, task analysis came out of he went to a Gestalt Training Institute EFT? cognitive science, so looking at how and at some point he butted heads with experts solved problems, Newell & them about the importance of the Simon and the fundamental insight was relationship - because he kept saying, FEATURING EMOTION FOCUSED that clients are experts too! Clients have you know, the relationship was really THERAPY expertise, particularly if you catch important and this was the 70’s when clients actually resolving something, you basically you wouldn’t want to then you can study what they did. And encourage client dependency - you PART II - On PE/EFT main influences, so cognitive science was another would want to take clients to be self influencing, and future developments influence. So then we went into the 70’s supporting. So Gestalt folks in that A.H.: What are the major influences in and the 80’s and contemporary work on era… (it’s changed since then but) EFT? And given those influences in emotion started to develop and Gestalt folks in that era were really EFT development, what would you say Greenberg and Safran in particular, allergic to things like therapists being have been the major changes to this picked that up - a modern emotion nice to their clients and being warm and model over time? theory - and started elaborating it and empathic and things. It’s like the dark emotion research, so that became a big side of Fritz Pearls… Anyway, where R.E.: Yes, I think there’s two questions: influence, starting in the mid 80’s, was I’m going with this story is finally they What were the original influences, were that came in. And that eventually led to said to him – the Gestalt trainers at the did it come from and then what the therapy being relabeled as Emotion Institute said to Les – well, if you don’t influences has it picked up along the Focused Therapy. And along the way, of like how we do it why won’t you go start way… like a snowball rolling down in course, we also picked up an interest in your own therapy! (laughs). So the the hill or something… So, of course, in attachment theory. So, that’s in the mix amusing thing, of course, is that today a the person-centered approach in the too although it’s not a big part and we lot of gestalt therapists say that they do 1960’s there was a great divide between don’t write about it that much but that’s EFT, right? I’ve got a gestalt colleague those who would work with in there also. Contemporary in Scotland who’s a wonderful gestalt in the counseling scene in the 1950’s influences… training therapist and she is seeing and who had come to emphasize the clients in my research and she came to therapist offered conditions, so that A.H.: And the Dialectical me in this week and she said I’m so were focused on the therapist Contructivism? afraid I’m messing up the therapy, contribution. And then in the late 50’s because I did this thing where I had the and early 60’s Rogers and Gendlin and R.E.: Yeah, so Piaget… well, actually client enact attacking himself, you others began to look at the client what happened with that was that one of know? And I said you mean you worked process – what does the client do? – Les Greenberg’s teachers and one of with a self interruption split and you Because they haven’t really looked at Laura Rice’s colleagues at York teach her enactment? She said yeah, that before then. And say start looking at University in Toronto was one Pascual- yeah, I said fine, no problem, right… what the client did and they started Leone who was a student of Piaget’s what else? And she gave me something differentiating - the Client Experiencing and so Pascual-Leone sort of extended else… that’s self soothing, right? You Scale came out of that – and then Laura Piaget’s constructivism into a sort of know? So basically there’s a huge Rice came and start talking about the doctrine of what he called Dialectical amount of overlap between what we do evocative function and looking at the Constructivism and that’s the other sort and Gestalt and we look at each other’s

[4] therapy and we say well it looks like my in emotion-focused way and… therapy. The main difference with Gestalt is the theory, the use of emotion A.H.: Recognizing it? theory and there’s process differentiation 50MINUTES 2010 laying out the task. So I can tell my R.E.: Yes! Yes. In different ways and, colleague what she’s doing better than you know, Hanna Levenson, for she can because we’ve got this language example, has stopped using for it and… interpretations and has replaced that with chair work. That’s a really A.H.: So what would you say have been interesting thing, right! And I think the major changes to this model over that’s fascinating, so my group in time? To the EFT? Strathclyde and I we’ve started getting these videos of these contemporary R.E.: Yeah… let’s see… we start psychodynamic therapists and looking at developing the therapy in 1985 - it was their work and actually we were really really before when the Emotion Theory impressed with them. Like Diana Fosha, was differentiated. So that got added she’s a wonderful therapist! with Greenberg and Safran and then during the 90’s that got sort of clarified A.H.: You could look inside. What a and added. Emotion Theory got put in privilege! there and that really helped clarify our theoretical base. And the other thing R.E.: Yeah, yeah! So that’s a place that’s we’ve done was we added tasks. So been recognized. Now there’s overlaps when we started in 1985 we didn’t have with CBT on schema therapy and… you empty-chair work formulated. We knew know, there’s various kinds of CBT that there was an empty-chair task but it are actually fairly close and it’s a little hadn’t been mapped yet. So that got hard to tell whether, you know, where done in the late 80’s and then we added Jeff Young got - his use of chair work in narrative work and we added meaning schema focused therapy. It’s little hard creation, but the most recent one we’ve to tell, but… I mean Aaron Beck now added is self soothing. So we’ve just says that he never said that the mapped the self soothing task. All of us relationship between cognition and have been doing it for years but we’ve emotion was only one way. He says he never had a map for it. Now we’ve got a always said it was two ways, right? So, formulation – the markers and the stages is that influence? It’s not recognition and things like that. So, basically… part but… of what happens is that we keep adding tasks, right? We’re up to I think fourteen A.H.: It’s a strange way of recognition. now. R.E.: There’s an interesting story that A.H.: How much is contemporary Les tells about Laura Rice and that’s that psychotherapy evolution somehow Aaron Beck approached Laura Rice and being influenced by EFT practices and – I think approximately in early 70’s – theorizing? And if it is, into what extent and asked if she wanted to work with Workshop on Process- is this recognized? him and she said no thank you, right? experiential emotion-focused But that’s just interesting, right? therapy - Lisbon 12-13 Feb R.E.: yeah… I mean, that’s interesting. It could be an occasion for me to A.H.: So, looking into this evolution Regular training in EFT principles and methods is promoted in the complain about how people don’t what would you like to see in EFT in the Psychotherapy Specialization the recognize our work more (laugh)… but coming years as an evolution, how is the Society organizes since 2005. The what’s really got me, capture my interest future? authors are regularly invited to offer training through supervision, in the last months or so is the influence seminars and workshops. of EFT on psychodynamic therapy. So R.E.: Well I’d like to see us… of course the work of Diana Fosha, Leigh humm … doing more training with more McCullough, and Hanna Levenson, therapists, I’d like to see us developing and these are three contemporary ways of working with new client groups. psychodynamic therapists who practiced You know, right now we got pretty good

[5] solid empirical evidence based for J.S.: In January learn to move around in their internal working with depression, with post world and get access. And then the trauma and with couples. Those are R.E.: In January, right… so I’m waiting therapy can start, right? So if you really solid. But what we haven’t done eagerly to see that. But I’ve been spend 10 or 15 sessions helping the much with so far is anxiety, so I’d like to following the work of Sandra Paivio client to learn how to focus see us, and we’re starting to do the work on working with trauma - child sexual essentially… Now we’ve got, there’s now - I’m working with social anxiety abuse most, is what she works with. the social anxiety and we work with and, that folks, people in Ireland and I’ve been following that work for that we go to another level, get to the Toronto, are working with generalized years, I think is fascinating and trauma work, you know? So it can anxiety disorder, with difficulties. So important. And it’s part of what lead easily take much much longer, right? moving into anxiety (and that will stretch us to the establish this evidence base It just depends on the client group us and help us grow as EFT therapists). for the effectiveness of EFT with post- you’re working with and the nature of Eating disorders - Les’s group in Toronto trauma, right? Unfortunately not that client particular issues and is working with eating disorders now, and PTSD. In these studies they don’t problems. Yeah? So it’s like asking that’s a really interesting and important diagnose PTSD, they just work with how long is a piece of string, it area to develop. So I’d like to see us people that have got difficulties with depends upon… right? expanding in other client groups and having been traumatized as kids. populations and as we do that we’ll both A.H.: Yeah, right, of course. Besides A.H.: So this turns us into effectiveness, learn how to work better, more effectively depression you have already talk on can we turn into effectiveness? with those client groups but we will also other populations, the effectiveness develop the therapy further, it will push studies with other populations are us, so that’s certain. And that will lead to there relevant results you want to talk developing more tasks. One of the FEATURING EMOTION FOCUSED some, a little bit about results? reasons why we’ve formulated self- THERAPY R.E.: Certainly with depression the soothing now is because we are working therapy is highly effective. You know, with these clients with social anxiety who I think we’ve got a sense that is that in live in this collapsed state, you know? PART III - on PE/EFT effectiveness, and emotion as a common factor working with that critic process, a lot A.H.: They regulate… of what EFT’s has got in depression is really helping the person see the inner R: Their critic is so severe that they just A.H.: Given your clinical experience, critic process and bring it out - there’s get into to this collapsed state and how many sessions are needed for something really powerful about that. they can’t somehow recover from it. EFT to improve client’s life quality or So, so we’ve got now a body of And then the self-soothing process to solve the main clinical problems of evidence, where recognizes as an turns out to be really important in the a client? therapy. So the client group has lead evidence based therapy by the us to develop the therapy more. I’d R.E.: Yeah, I mean, it really depends on American Psychological . also like to see the humanistic the client group, right? You know? Unfortunately in the UK the center of therapies to be recognized more. The And even with something like social review bodies are ignoring the humanistic therapies in general have anxiety we’ve got a protocol which is evidence, they just kind of pretend it really strong evidence base that’s not 16 to 20 sessions and that seems to doesn’t exist. But, you know, certainly really recognized in the field and I’d work for most clients, but some of our depression, and post trauma, I just like to see us doing more research and clients get done in 7 sessions or 12 said there’s a line of research mostly be more political, actually, about how sessions, and they’re done, right? by Paivio, but also by other people, we use our research evidence so that Other clients it turns out they need that does meet the criteria for being we can be recognized for what we do more than 20 sessions and then we evidenced based therapy to use the do, so. have to figure out how to work with American Psychological Association that, because underneath the social criteria. But that’s not PTSD, that’s J.S.: The last book from Sandra Pavio and anxiety is trauma, often deep trauma, people having difficulties with trauma, Pascual-Leone - EFT for Complex and the trauma is what’s driving the having been traumatized, right? And Trauma - is a new development… social anxiety so you have to go work the couples, you know? The Sue with that and sometimes that’s quite Johnson’s group and Leslie Greenberg R.E.: It is work that’s going back into the complicated. And particularly when have done some research on couples early nineties actually, but they were the client comes in without good therapy too. EFT for couples is a able to put it together I think, finally. I access to the inner world so that they really really effective therapy; it has haven’t even got my copy of it yet, it then need to spend some period of got some of the best results in the was just published this month, I don’t time in therapy learning to develop field, that’s very powerful therapy. So even know… that access, and that can take 10 or 15 that’s, those are the areas where EFT sessions before a client can actually is strongest in.

[6] A.H.: Ok, that’s clear. From the point of they’re offered and they run it view of someone who believes in through their own processes. I work affect primacy, who believes that with a team of research who is WORKSHOP 2010 only can change emotions, studying dynamic, psychodynamic how do you understand or explain and in the the so called success of cognitive nineteen-eighties in the UK - David and behavioral focused techniques, Shapiro’s team - and no matter what still dominant today? the therapy was, if it was psychodynamic therapy the clients R.E.: Well, CBT folks are really good at would be trying cognitive therapy marketing with what they do. And and if it was cognitive therapy they they are really good at would be trying to look at their disseminating, you know? Aaron childhoods. So the clients were Beck once said that if it works it’s doing their own thing and they were CBT, so… by definition it must be just using what was offered to them CBT if it works, right? So, I mean, in their own change process, you there’s a process of sort of Borg like know? So they’re accessing their assimilation - if I can make a Star emotions, I mean, and they’re using Trek analogy - and, so that’s that. their emotions to change their But there are other questions, how is cognitions and they’re using their it that clients in all kinds of therapies emotions to change emotions and are able to use those therapies to they’re following the action change themselves, no matter if tendency to behavior change… those are behavioral therapies or cognitive therapies or family A.H.: There’s a common factor? systemic therapies or constructivist therapies or person-centered R.E.: I think emotion is the common therapies or whatever. Clients use, in factor, personally. But that’s my general, are able to use most view. practically any kind of therapy to A.H.: How do EFT [therapists] copes change themselves and that’s with difficult clients, such as the because… severe personality issues, avoidant or J: Although the therapists… borderline? Is there room in EFT for this kind of problems? A.H.: In spite of the therapist. R.E.: Yes, yes I think so. It has to be R.E.: Yeah, that’s right, in spite of the room, we make room for it. And in therapist, often in spite of the the Learning book, for example, we therapist. So that’s because the client have a section were we talk about is the active change agent in the working with borderline processes, therapy, you know. We, like as because inevitably as a therapist you therapists we like to believe that end up having to work with clients we’re doing the heavy lifting, but with borderline processes. Now, actually it’s our clients that are the when you work with this sort of Workshop on Process- active change agents and we are to more difficult or fragile client experiential emotion-focused facilitate their process. We are really processes, it takes more time and you therapy - Lisbon 12-13 Feb there for them to use us to change spend more time in the relationship, themselves. And but, of course, we you know, because there are more Regular training in EFT principles and methods is promoted in the feel as we were the center of the relational ruptures and… so Psychotherapy Specialization the universe, because each person is the relational rupture work becomes a Society organizes since 2005. The center of their universe anyway, so. more central part of the therapy, but authors are regularly invited to offer If I’m a therapist I’m going to feel as relational rupture work is a task also. training through supervision, I’m the center of my universe but the Right? So it’s pretty good kind of seminars and workshops. client is also the center of their task. I do do empty chair and two universe too and they’re the person chair work with my clients with who came in to change, so. Anyway, borderline processes and they can so, I think clients take whatever handle that, they don’t have a

[7] problem with that. I mean often, sessions for a client to develop a A.H.: Can we turn into training? clients with borderline processes often, better relationship with their inner are often so incredible split over world and ability to look inside, then R.E.: Sure. themselves already that the conflict splits they’re going to have trouble fitting just jump out at you and the self-criticism into a 16 to 20 sessions treatment splits… protocol, right? Almost need… I think FEATURING EMOTION FOCUSED it was Reiner Sachse the German THERAPY A.H.: Can they get in touch with their person-centered therapist who emotions? proposed that (he’s working with clients with psychosomatic difficulties PART IV - on PE/EFT training, empathy R.E.: Yeah, I mean the issue with or alexithymia) he proposed that we again, experiencing, researching and practicing borderline, with some of the fragile or actually had a protocol for that, you the borderline processes is not can know? That the first 15 sessions of the A.H.: Empathy, again, it used to be part they get in touch with their emotions, therapy was about just teaching them of the clinical training programs, but it’s are they going to get overwhelmed focusing and then you go on and do not so much since the dominance of by their emotions and go to a flooded the work with the other problems. So CBT as an empirically-supported overwhelmed state? Will they lose that’s a big thing. But also difficult treatment. And rapport is what is their emotion regulation? That’s the life circumstances, you know, the talked about in CBT. How do you see issue and that’s what you got to be clients got hostile others or is very this turn? really careful with. And so, when I socially isolated, there’s things in their work with borderline processes I lives that are eating away at them, R.E.: Well as I said at the beginning make sure early in the therapy that we undermining their change process, empathy I see as foundational for, not work with the task called clearing a undermining things that might start to just for EFT, but actually for all space - which is an emotion regulation happen, and that makes it really therapies and Arthur Bohart and task - and I’m going to use more of difficult. We all know clients with Leslie Greenberg and Jeanne Watson balance, and now I’m using self- such difficult lives that all we can do and I did a meta-analyses of the soothing. I think self-soothing it’s is accompany them and keep them literature on the relationship of the really really important task for from deteriorating, I think. empathy and the outcome several working with clients with borderline years ago and, you know, empathy is processes. So basically it’s the same A.H.: Is there an ideal client for EFT? one of the strongest predictors of thing I was saying before, you know? outcome, there is… Is even stronger R.E.: I mean… with YAVIS clients, you It’s really important for us to work than therapeutic alliance. And, you know young, attractive, verbal, with these various client populations know, so, yeah, I think that it’s a intelligent, successful? Right, yes? because… Well it’s important for us to shame that empathy isn’t emphasized Remember that? I mean… folks like be able to meet these clients and it as much. If you look at really really us… I don’t know… Yes, so these are stretches the therapy and helps it skillful CBT therapists, people like clients that we find more easier to develop. Robert DeRubeis or Steve Hollon, the work with… big names, they all have person- A.H.: These leads us maybe to the centered training, they got taught therapeutic failures or unsuccess in A.H.: More emotional conscious? empathy in the seventies in their EFT. Which are in your opinion the R.E.: Yeah, I mean more emotional graduate training and underneath the main reasons for an occasional intelligence, but of course, those CBT there’s solid empathic skill, therapeutic failure? clients need us less, right? I mean a lot right? So, I think it’s a shame that it’s R.E.: You mean when the therapy doesn’t of those clients basically just need a not emphasized as much as it used to work how do we understand why it little bit of… you know?... or they can be. My friend Carmen Mateu in Spain didn’t work. Well in the book that, I do it themselves with a little bit of in the University of Valencia is think it’s Watson, Greenberg and help or something. So is there an ideal developing an empathy training Goldman, the 6 cases - cases in client… so… I’d like to say that the curriculum. This is a CBT course she Emotion Focused Therapy - they have ideal client is the one in front of me, teaches in but she’s developing an 3 success cases and 3 less success right? Because every client is a Empathy training. She came and spent cases, and basically their feeling is challenge and it’s my job try to figure a year with us in Glasgow to see how that the clients who were not as how to help them help themselves, we taught our students empathy and I successful ran out of time, they need what is it that going to be the that’s… think there’s place for that. more therapy. That 16 to 20 sessions A.H.: The one that is there to be helped… A.H.: A variety of Empathy and listening was too short for some of these folks skills, of emotional attunement and and I think a lot of this stuff I was R.E.: Yeah, exactly… listening, appears as main abilities of saying before, if it takes 10 or 15

[8] EFT therapist (in EFT terms). Which are some of the ones, there are other ones the major difficulties that a beginning too but… psychotherapist will find when learning how to be empathic, how to listen for A.H.: Ok. So what makes a good EFT WORKSHOP 2010 emotions? therapist? What kind of skills or profile would you say he or she needs R.E.: Right, this is the kind of thing, in order to be a Good Therapist? right, that what gets in the way on our R.E.: Right, let’s see… It helps to be ability to be empathic, you know. And curious about people, it helps to be in in the training we do in Glasgow we touch with your own emotional life. I use a lot of processes. I mean the once said at a conference “it helps to students are in active and professional be somewhat insecurely attached - development groups, we have large you know if I’m too securely attached, group processes, we have… but in other words I trust that you like me anyway the point of all this is that and I trust that our relationship with there is lots of places where we get each other, I’m not going to be stuck. And one of the places we get curious, I’m not going to be, you stuck is, for example, we’re afraid of know, I’m not going to be that strong emotions or particular curious. I’m just going to assume that emotions – we’re afraid of our anger, you are who I think you are and I can or we’re afraid of any kind of intense rely on that and that’s going to make feeling or fear, something like that. me actually not as good as a therapist. J.S.: Or our sadness… So I think that a little of insecure attachment actually goes a long way R.E.: Or our sadness, absolutely, right for to driving us as therapists to be a man and men don’t cry… and then curious about other people. I don’t that becomes a block to our empathy know if that makes sense but… because when our client becomes sad then we get scared of their sadness A.H.: That makes sense, yes. Would you and, then we can’t connect with it, we recommend personal therapy as an can’t empathically attune to it. So important part of training? that’s a huge one. I think the other R.E.: Yeah, I think so, yeah… thing, the other place where people get stuck is when they’re attacked A.H.: No doubt on that. and, you know, when the client is unhappy with us or is challenging us R.E.: Yeah, for me it’s a question of when or is making demands of us that we’re is the personal therapy and what other afraid we can’t meet, then lots of things are equivalent to a personal therapists get, really get their empathy therapy, but you know, personal blocked and some of those therapists growth work of some kind is essential. turn on those clients and attack them At some point it’s essential the person and harm them, right? And so, that’s experiences therapy as the client. We really really important in training have a sort of ongoing discussion in courses to address that, otherwise we the course I teach on about whether to Workshop on Process- turn out harmful therapists. Right. So make personal therapy mandatory part experiential emotion-focused for me that’s a core aspect of Empathy of the training. Right now it’s not, it’s therapy - Lisbon 12-13 Feb training - is teaching therapists how to not mandatory and the argument is Regular training in EFT principles hear a potential attack and criticism that if you force people as part of their and methods is promoted in the and how to bear strong emotions. But training to go into therapy, they’re Psychotherapy Specialization the Society organizes since 2005. The that requires personal development maybe unwilling and it’s kind of… It authors are regularly invited to offer work. kind of undermines the therapy, right? training through supervision, So the question is whether it actually seminars and workshops. A.H.: To them to regulate themselves. makes sense requiring it but absolutely I think it’s essential for a R.E.: Exactly, their own emotion therapist to be competent … and even regulation, own self-exploration in something like 2 chair work, you terms of where those emotion phobias know? have come from. yeah, Those are

[9] PROCESS-EXPERIENTIAL/EMOTION FOCUSED THERAPY 50 minutes conversation | Lisbon Feb 2010

J.S.: What kind of And I thought back to my own recommendation would you experience as a graduate student make for beginning therapists for where I persuaded a bunch of my example… friends to let me tape sessions they did with clients and I learned huge R.E.: You mean a person who’s amount from doing that research, beginning to study therapy and is studying what my friends did, interest in EFT. studying how clients experienced that, reading tapes, all those things. So, J.S.: Hum hum. basically, and practice, supervised R.E.: I would say first to get practice. You have to learn by doing, yourself some really good you can’t,… like everything… empathy training, basically, first A.H.: Wonderful, thank you so much. You can’t really facilitate a 2 chair get some solid background in being work process unless you’ve been a present with the other person in an R.E.: It was a pleasure. client and experience it from the empathic and caring way. Then look inside, because you don’t really know at your own issues and then start an what it feels like, you don’t know EFT training and work your way what you’re asking the person to do, through the training in both therapist you don’t know how embarrassing it and client roll. Get involved in is, you don’t know how scary it can be research on EFT. Several years ago when all of a sudden you access we did focus groups with our students something you didn’t know it was and we asked them what did help there. You have to, you know. Part of, them learning EFT and we developed an essential aspect of being competent a kind of a stage model, a stage in 2 chair work is having experience students go through the learning EFT, as the client. Now, we do that in skill and one of which is feeling totally practice because clients take turns, the overwhelmed and lost. But one of the clients and therapists role each other. things they told us was that taking part But you know, within the therapy it’s in research was invaluable to them. also important.

A.H.: So we are close to the end, do you want to add something of your own on this issues.

R.E.: Well, let’s see, what could I say…

Robert Elliott is, with Leslie Greenberg and others, co-originator of Emotion- Regular training in EFT principles and 50 MINUTES focused Therapy. He is intervening in the methods is promoted in the Society’s Psychotherapy Specialization, Psychotherapy Specialization the CONVERSATION offering EFT training, as Les Greenberg Society organizes since 2005. The does. This 50 minutes conversation took authors are regularly invited to offer Sociedade Portuguesa de place the 11th February 2010, at Lisbon. training through supervision, seminars Psicoterapias The distinctive features of P-E/EFT were and workshops. Construtivistas among other topics discussed. . www.sppc.org.pt

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