Emotionally Focused Therapy for Couples 0898627303, 0898621534

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ILeslie S. Greenberg Susan M. Johnson

Emotionally Focused Therapy for Couples Leslie S. Greenberg, Ph.D. and Susan M. Johnson, Ed.D. "Greenberg and Johnson describe a fascinating and powerful new approach to working with coujr les. The book is rich in clinical detail,, and the transcripts as well as case descriptions really bring the approach to life. I am going to use this book whenever I teach courses on marital therapy." - Neil S. Jacobson, Ph.D. uGreenberg and Johnson have accomplished more than just a wonderfully clear description of their method of couples therapy: They have reintroduced to the field the powerful idea, often forgotten in the last decade, that feelings and emotions must receive the attention of family therapists just as much as observable behavior. Greenberg and Johnson's approach to couples therapy not only achieves an integrated model of treatment, but also fosters the integrati.on ofpeople. This is a book at the frontier ofcontemporary marital and family therapy." - Alan S. Gurman, Ph.D.

This book demonstrates how emotional experi ence in relationships can be used to reconstruct intimate bonds. Covering theory, research, and practice, emotionally focused therapy (EFT) is an integration of experiential and systemic approaches and rests on a conceptualization of adult intimacy as an emotional bond. Focusing on emotion, without ignoring cognition and behavior, its aim is to increase accessibility and responsiveness by integrating new aspects of self into the relationship and rendering positions more flexible and adaptive. EMOTIONALLY FOCUSED THERAPY FOR COUPLES presents the theoretical bases of EFI', summarizes outcome data, traces the process of the initial interview, and covers all elements of practice. Two extensive case examples illustrate the steps of EFT, and specific interventions are described for gaining access to emotional experiences and restructuring interactions. Completing the volume are incontinued on back flap

Emotionally Focused Therapy for Couples

LESLIE S. GREENBERG SUSAN M. JOHNSON York University

The Guilford Press New York London

@

1988 The Guilford Press

A Division of Guilford Publications, Inc.

72 Spring Street, New York, NY 10012 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher. Printed in the United States of America Last digit is print number: 9 8 7 6

Library of Congress Cataloging-in-Publication Data Greenberg, Leslie S. Emotionally focused therapy for couples. Bibliography: p. Includes index. 1. Marital psychotherapy. 2. Emotions. I. Johnson, Susan M. II. Title. RC488.5.G7 1988 616.89'156 88-1441 ISBN 0-89862-730-3 ISBN 0-89862-153-4 (pbk.)

To Brenda.

-L.S.G. To the courage and openness of our clients. -S.M.J. & L.S.G.

Preface

In the last decade the marital therapy field has exploded. Failure to develop a satisfying intimate relationship with one's partner has been reported to be the single most frequently presented problem in therapy. As the demand for this kind of intervention has increased, well-defined approaches and strategies for improving adult intimate relationships have been developed and tested. The approach outlined in this book began with the authors suddenly facing the task of working with couples and seeking an approach which integrated intrapsychic and interpersonal dimensions. Both authors have been trained in individual therapy using the experiential approach and in systemic family therapy. Not finding a model of therapy which really seemed to capture the set of interventions we found ourselves practicing, we decided to write our own manual. The finished product reflects the experiential focus on the process of individual experiencing and the systemic focus on patterns and cycles of interaction. However, it also reflects our focus on the power of emotional experience in relationships and how such power could be used to reconstruct intimate bonds. The aim of therapy is to increase the accessibility and responsiveness which constitute the strength of such a bond, by integrating new aspects of self into the relationship and rendering relationship positions more flexible and adaptive. The name emotionally focused therapy (EFT) does not mean that cognition and behavior are unimportant in this approach. It simply means that the experience and expression of emotion is considered central to the way couples structure their relationships and central in the process of changing such relationships. EFT is not advanced as a panacea but as a therapy which contributes to the field a particular set of interventions which, like all other Vll

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PREFACE

interventions, must be fitted to the client's immediate and long-term goals, distress level, presenting problems, and processing style. The book presents theory, practice, and research because it is our belief ( 1) that in the field of psychotherapy, the clinician- scientist is the pioneer who opens up new frontiers, and (2) that theory without practice or research without theoretical and practical implications is ultimately not useful or worthwhile. The book is organized in the following fashion: Chapter 1 provides background information concerning our view of emotion in general and our conceptualization of therapeutic change. Chapter 2 presents the theoretical bases of EFT and a summary of outcome data. Chapter 3 introduces and deals with general issues concerning the practice of therapy. Chapter 4 focuses upon the process of the initial interview. Chapter 5 presents an overview of the steps of therapy and two extensive case examples. Chapter 6 delineates specific interventions designed to access emotional experiences and restructure interactions. Chapter 7 discusses clinical issues which arise in the practice of EFT. Chapter 8 focuses upon the process of change and research completed on this topic. Chapter 9 focuses on the importance of an integrative perspective. Throughout the book we often will refer to marital therapy as the paradigm case for intimate relationships, because marriage is still the most prevalent form of intimate bonding between adults in our culture. This does not imply that marriage is the only form of intimate relationship that can benefit from couples therapy. All couples in intimate relationships become emotionally and interactionally involved in the ways described in this book. The view taken here is a basically optimistic and positive one: that couples seek positive change, that relatively brief couples therapy can significantly enhance the quality of relationships and individual functioning, and that the effective couples therapist has a powerful contribution to make to his or her clients' lives. We hope that the content of this book may help to expand such therapist's awareness of the powerful tools that they hold in their hands.

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Contents

Part One. Theory and Research

Chapter One. Emotion in Interaction Emotion in Human Functioning 4 Model of Emotion 9 The Self-Organizing Function of Emotion 11 Communication 13 Intimacy and Emotional Bonds 18 The "I-Thou" Dialogue 20 Cognition and the Emotion Process in Interaction Relational Beliefs and Testing 24 Trust 26 Summary 27

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Chapter Two. An Affective Systemic Approach Experiential Theory 29 The Interactional Systemic Perspective 32 Integrating Experiential and Systemic Perspectives 35 The Process of Change 40 The Evaluation of Emotionally Focused Therapy 47 Summary 53

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Part Two. Practice

Chapter Three. General Considerations Conditions for the Use of Emotionally Focused Therapy 59

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Emotionally Focused Therapy versus Other Approaches 62 Overview of the Therapy Process 65 Summary 71 Chapter Four. The Initial Interview Assessing Cycles 72 Establishing a Therapeutic Contract

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Chapter Five. The Process of Therapy Nine Steps of Therapy 82 Case Example: The Porcupine and the Armadillo 104 Case Example: The Wall That Separates: An IntrusionRejection Pattern 121

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Chapter Six. Therapist Interventions Task 1: Accessing Emotional Experience 148 Task 2: Changing Interactional Positions 164 Summary 173

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Chapter Seven. Clinical Issues Issues Arising in the Process of Accessing Emotion 175 Issues Arising in the Structuring of New Interactions 178 Alliance Mending 180 Training Issues 182 Examples of Change Events Used in Training 184 Using Emotionally Focused Therapy to Address Individual Symptomatology 189 Contraindications for Emotionally Focused Therapy 193 Integration in Couples Therapy 195

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Part Three. Effecting Change

Chapter Eight. The Process of Change What Are the Change Processes? 203 Observers' Model of the Process of Conflict Resolution 216

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CONTENTS

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Do Interactions Change? 222 What Processes Relate to Outcome? 223 Summary 225

Chapter Nine. Epilogue: Integration

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References

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Index

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Emotionally Focused Therapy for Couples

PART ONE

Theory and Research

CHAPTER ONE

Emotion in Interaction

Close relationships are possibly the optimal context for investigating and understanding adult human emotional experiences in general and the emotional processes affecting marriage in particular. The marital relationship, representing as it does the primary adult emotional bond, is an area in life in which feelings and their communication play some of their most powerful roles. Because so much is at stake, feelings are evoked in the marital relationship as in perhaps no other. The marital relationship provides the opportunity for interdependence, the chance to have one's feelings and needs respected, and the opportunity to be the most important person to a significant other. This type of relationship between adults promotes trust, intimacy, disclosure, and the expression of intense feelings. Therefore, therapy for couples affords a unique opportunity to observe and study human affective experience and expression in the context of people's most significant affectional relationships. Marriage, we are suggesting, is the home of most people's emotional life. Subtle changes in the experience and expression of emotions related to intimacy and identity occur continuously in marriage. These changes provide the individuals ·in the relationship (and the discriminating observer) with a continuous readout of the current emotional state of each of the individuals and the state of their relationship. When something goes wrong in a relationship, a change in emotional experience and expression is usually the first indicator that there is a problem. Emotions, we will argue, are complex syntheses of all that is being experienced; therefore, they provide the most accurate feedback available on a person's current state. When a situation deteriorates or improves, a change in emotional experience and expression is the index of the situational change. Feelings, because they are less susceptible to distortion and conscious control than thinking, are often the best clue to what is going on within and between people. 3

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The practice of marital therapy thus requires a heightened sensitivity to the emotional conversation that occurs between two people. When a couple come into therapy, they are generally in emotional pain. They have been unable to have their feelings understood and their needs and wants responded to. They feel invalidated by their partner. A therapy that can successfully help partners access this emotional pain and help them communicate it will make a significant difference in the quality of the relationship. Emotions are primary and universal aspects of human experience, yet they have not been emphasized sufficiently in theoretical explanations of change. Although a number of excellent therapists have been highly adept at working with the experience and expression of feelings in therapy (Kempler, 1981; Perls, 1973; Rogers, 1951; Satir, 1972), a clear framework for working with emotion in therapy has not been articulated. In this book, we attempt to lay out an initial framework for working with emotion in couples therapy and describe our general approach to changing distressed relationships.

EMOTION IN HUMAN FUNCTIONING Emotion has long been the cornerstone of psychology and psychotherapy, yet it remains a complex and confusing phenomenon. Nevertheless, advances in the study of emotion have led to a growing consensus of opinion among theorists and researchers on certain aspects of emotional functioning. It is becoming increasingly evident, for instance, that certain primary emotions are biologically adaptive and motivational in nature; also, it has been found that emotion serves an important communicative function in social interaction (Buck, _1984; Greenberg & Safran, 1984a, 1987a; Izard, 1977; Izard, Kagan, & Zajonc, 1980; Plutchik & Kellerman, 1980). Infants provide much evidence as to the biological roots of emotion. For instance, they have been shown to have in-wired emotional responses to specific stimulus configurations. Infants show signs of fear both to looming shadows and to spider-like forms; they show joy in response to human facial configurations and anger at restriction. Contact-comfort has been shown to be a primary need of humans as evidenced by infants' failure to thrive in environments without sufficient human nourishment. Attachment and loss responses also appear to be in-wired; infants show anxiety in response to strangers and distress at separation.

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In addition, study of the development of affect is beginning to show an innate sequence for the onset of different emotions. Distress and smiling appear in the first months of life. These expressions precede signs of anger or fear, which appear only after 4 and 8 months, respectively (Izard, 1979). In addition, certain universal aspects of the facial expression of emotion have been identified from cross-cultural studies of the facial expressions of emotion (Ekman & Friesen, 1975), indicating that these expressive patterns are also in-wired. The center of our argument concerning the role. of emotion in therapy in general (Greenberg & Safran, 1984a, 1987a)-and in couples therapy in particular (Greenberg & Johnson, 1985, 1986)-is that emotions play a potentially adaptive role in human relationships. Emotions provide an important basis for human behavior. They amplify the effects of motives on behavior; they orient us toward or away from different objects in our environment; they constitute a connection between us and our environment. Emotions are not self-centered nor are they independent of others. Rather, they are directed toward others. In this sense, emotions are not simply inside us, but rather they are actions that connect us to the world. To feel is to want to act in relation to the world and to be organized to do it. Emotions are not, however, the same as drives. Instead, they are rapid, direct responses to situations. They organize us for action but do not cause or lead to behavior directly; additional higher level processing of the emotional response leads to motivated action. Emotions thus provide the impetus for action although they do not necessarily lead directly to behavior by themselves. Often feelings are regarded as unimportant and people's experiences are discounted by labeling them as "just emotional" or "irrational." In fact, emotions provide essential information about our reactions to situations, which can be either attended to or ignored. Individuals are complex information-processing systems constantly integrating information from multiple internal and external sources. The affect subsystem provides important biologically adaptive information to the total system (i.e., the person). People function optimally (1) when they utilize all possible available information to guide their actions and (2) when they do not use their resources to block out useful internal or external information. Having clients in therapy pay attention to their biologically based affective responses helps them utilize an important source of adaptive information to aid problem-solving. For example, attending to affective information helps people to identify with the action tendencies associated

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with emotion; furthermore, identification with previously disclaimed action tendencies results in more unified, coherent action and thereby improved interaction. Emotions can be more or less affected by social experiences and can thereby be broken into two broad classes for heuristic purposes-biologically based emotions and socially derived emotions. Those feelings that are automatic direct responses to situations are biological, and other, more derivative emotions are social. The latter are complex derivatives of the former and reflect the influence of learning and culture. They are not inherently biologically adaptive, and they may or may not' be socially adaptive. They depend on personal and societal factors and current conditions for their occurrence, and their forms of expression depend on cultural factors rather than being in-wired. Thus, for example, pride and envy are socially based emotions that depend on what is culturally regarded as valuable whereas primary sadness and anger are biologically based responses to loss or intrusion. The human experience and expression of anger and sadness can, of course, be strongly influenced by learning. The emotion system's susceptibility to social influence, however, does not negate the existence of primary biologically adaptive responses in human beings. When working with emotion in the creation of therapeutic change, it is useful to differentiate clinically between classes of emotional expression (Greenberg & Safran, 1984b, 1987a). Emotions can be divided into four main categories. The biologically based category is called "adaptive primary emotions"; two more culturally based categories are referred to as "secondary emotions" and "instrumental emotions"; and a final category, in which biological and cultural factors interact, is called "maladaptive primary emotions." It is only the experience and expression of adaptive primary emotions that convey biologically adaptive information that aids in problemsolving, unified action, and constructive interaction. Secondary emotional reactions often take the form of defensive coping strategies and are counterproductive in creating change; their expression is, in fact, often problematic. Secondary responses are the emotional reactions that behaviorists and cognitive behaviorists often claim need to be bypassed or curtailed in therapy. These secondary reactions are often readily available to consciousness, and the desire to lessen their intensity is often a motivation for therapy; for example, anger or bitterness toward one,s spouse can lead to a request for help. Potentially dangerous derivative emotions such as hatred, revenge, and rage also belong in this secondary category.

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To access or heighten secondary reactions in therapy is uncalled for and could be highly detrimental. Secondary emotions are, however, important cues for exploring underlying thoughts and feelings. The therapist, then, has to distinguish between secondary reactions and more primary biologically adaptive emotional responses. This is a mattef of clinical judgment; anger, for example, can be a primary affective response_ to being violated or a secondary reaction to underlying hurt .or fear. For example, a woman saying angrily to her husband, "You make me angry when you don't respond to my touch," may be expressing something quite different from the woman who says in an angry tone, "Don't tell me who to be and what to do in my job." In the first case the woman feels hurt and rejected, and the anger may be a secondary response masking the underlying adaptive feeling of sadness and the need for affection and contact. In the second case, the woman, feeling that her boundaries are being violated, is adaptively asserting her rights and signaling with her anger that she will not allow herself to be dominated. Of course, judgments are always dependent on context. Instrumental or functional emotions are emotions that serve a primarily interpersonal function and are often referred to as "roles" or "manipulative feelings"; examples are expressing helplessness to gain sympathy or expressing anger to avoid responsibility. These expressions are used to manipulate the responses of others. Such emotional expressions are relatively easy to interrupt; since the person is in control and can alter his or her focus of attention, it is easy to divert his or her attention away from this state. Therapists who focus on instrumental feelings generally emphasize either understanding why clients do things or the interpersonal effects of what they do. Maladaptive primary emotional responses are direct immediate responses to situations, such as fear of heights, in which the biological response has become maladaptive. These come about through a negative learning history in which certain feelings become conditioned to particular stimuli. In couples therapy, maladaptive emotional responses can be found in certain cases of fear of intimacy in which a person has learned that closeness or touch can be dangerous and therefore reacts with fear or anger. In these cases, the maladaptive primary emotion needs to be accessed and modified. Primary emotions, as opposed to secondary reactive and instrumental emotions, are often not fully in awareness when the client comes to therapy; they are instead unacknowledged, disavowed, or simply not

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being attended to. It is "getting in touch" with these feelings that seems to be helpful to therapeutic change. When a woman is able to fully experience the loneliness or fear underlying her aloofness or a man is able to experience without blame the hurt he feels, the couple will melt into genuine intimate contact. Primary emotions come into awareness by means of a synthesis of sensory and perceptual information and help to form new meanings and to organize internal experience in a new way. Thus, attending in the present to the constant tightening in her jaw and stomach and her feeling of wanting to curl up and hide can help the woman crack through her aloof exterior into an acknowledgment of her fear and need to protect herself. The experience of feeling primary emotions seems to carry its own stamp of authentication; the client does not doubt their veracity but is rather intensely involved and moved by them. Feeling involves bodily felt sensations and is often accompanied by images and evocative language indicating that the feeling is actually experienced and not just talked about. Primary emotions often underlie the stable interactional positions occupied by distressed partners. Thus, anger or fear may underlie a defensive position, or fear may underlie an attacking position. Primary feelings are thus a rich source of information and can be used in therapy to create new perceptions, responses, and interactional patterns. For example, a therapist might work with a client to raise to awareness a primary emotional experience of sadness and loss underlying a secondary response such as anger, which placed the partner in the role of wrongdoer. For the therapist to use emotion as an agent of change, he or she must continue to explore and probe for affect that is currently unavailable and that, when encountered, has a deeply involving or newly discovered quality; for example, the discovery by one partner of a fear of abandonment or a need for love, which is not generally experienced or spoken of and which underlies this partner's secondary or instrumental response of anger, can come as a revelation to both members of a couple. This new synthesis then has the potential to act as a change agent on both intra- and interpersonal levels. Hence, the therapist must be able to identify different classes of emotional experience and adjust his or her interventions to each. The therapist also must have the skills to evoke emotional experience, in the present, and to help the client to engage fully in the experience. This is very different from teaching clients to label physiological cues or rationally restructuring their experience through

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insight. It is the difference between thinking about feeling and feeling itself, between experience remembered and life itself. New experience thus needs to be evoked in the present in order to promote adaptive problem-solving. A therapist working with emotion in couples therapy, therefore, needs continually to be assessing whether a particular emotional response is a primary or secondary reactive emotion. In the latter case, the emotion should be bypassed or probed, to uncover the underlying feeling. Only primary adaptive emotional responses should be heightened, expressed, and explored. Thus, the rationally oriented therapist who advocates suppression of feeling and emotional expression in favor of rational deliberation is, in our view, referring to secondary emotions rather than primary feelings. Of course, it may be appropriate to discuss the underlying reasons for secondary feelings. For instance, when a partner reports feeling disappointed, frustrated, or angry at the actions of a spouse, the therapist needs to delineate the reasons for this response. When, however, it is discovered that the disgruntled spouse feels unworthy and unlovable and has felt this way since childhood, it is important to help him or her acknowledge this experience and express the pain and fear of criticism. This leads ultimately to the owning of disclaimed experience

and to a focus on self rather than on blaming the other. It also simultaneously allows the other, no longer under attack, to be more responsive. Cognitive and behavioral analyses of couples interaction that do not include an analysis of emotional processes always miss describing the whole picture; the refore, they provide less than satisfying accounts of psychotherapeutic change processes. Only when we begin to conceptualize and analyze therapeutic processes in terms of the combined affective, cognitive, and behavioral processes involved will we begin to adequately cover the domain of psychological processes relevant to therapeutic change (Bradbury & Fincham, 1987). An integrative endeavor of this nature, however, first requires an explication of emotional processes in couples therapy.

MODEL OF EMOTION A comprehensive model of emotion, which, similar to Magda Arnold's pioneering view ( 1970), emphasizes the role of intuitive appraisal and the associated adaptive action tendency in emotional experience, seems best

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to capture the role of emotion in therapeutic change. In this view, an emphasis is placed on the fundamental role of the initial, perceptual experience in the construction and organization of reality (Greenberg & Johnson, 1985, 1986; Greenberg & Safran, 1981, 1984a, 1987a; Safran & Greenberg, 1986). Emotional experience generally is seen as having very little to do with conscious, logical, or higher level conceptual processes. The experience of feeling sad or feeling angry is much more similar to "apprehension" or "seeing" than it is to reasoning or solving a logical problem. In some fundamental sense, then, emotional experience is prereflective; it is not explicit and deliberate but rather is immediate and reflexive. This does not mean that emotion is free of cognition. Emotional experience is the product of a preattentive, constructive synthesis of a set of incoming information. This integrative product is experienced as emotion and serves to orient us to the world, strongly influencing our view of ourselves and everything around us. Hence, emotion is essentially information about our current state and processes; it is also the most comprehensive source of feedback we have about what is occurring for us in the moment. This feedback must be attended to in order for it to be informative; ignoring this information not only makes problem-solving less informed but also puts the person at risk since important survivalrelated information is ignored. In a related vein, Leventhal's perceptual motor-processing model of emotion (1979), in which emotion is viewed as a complex integration of a number of different information-processing components, has recently been adapted for use in psychotherapy (Greenberg & Safran, 1984a, 1987a). In this model, cognition and emotion are best viewed as being intertwined or fused complexly rather than linearly related; although conscious rational "thinking" and conscious passionate "feeling" may be experientially distinguishable, both feeling and thinking involve cognitive and affective processes operating at an automatic level, out of awareness. There is thus no thought without feeling and no feeling without thought. In this integrative perspective, emotional processing is seen as involving three distinct automatic mechanisms: an expressive motor system; a schematic or emotional memory; and a conceptual system that stores rules and beliefs about emotional experiences. In this model, expressive motor responses are elaborations of responses that were biologically in-wired in the neonate. Schemata are representations of prior emotional experience that contain stored subjective reactions, stimulus features, and physiological responses to earlier situations. In addition to

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storing earlier experiences, schemata act to guide attention and perception in current information gathering. The conceptual system is concerned with conscious and volitional processing and can analyze and evaluate concrete experience, storing the situational antecedents and consequences of feelings. Experienced emotion results from a preattentive synthesis of expressive motor information, implicit emotional schemata, and conceptual cognition. These components are all aspects of a person's current experience, much of which is out of awareness. All of these components are continually being integrated to form conscious emotional experience. In this model, affect, cognition, physiology, and behavior are all integrated into a comprehensive model of human emotion. Emotion is thus viewed as providing a framework for perception as well as motivating behavioral responses. Network analyses of emotions, such as the one described above, have begun to be advanced by a number of authors in order to explain how emotion is produced (Bower, 1981; Lang 1979, 1984). These authors propose that emotional experience is a construction from physiological and motor responses, emotional memories, and ideas rather than an inference made from behavior and the situation, as proposed by earlier cognitive models of emotion (Schacter & Singer, 1962). In these network analyses, activating any one of the components of the network stimulates the other parts of the network. Thus, the evocation in therapy of particular thoughts, meanings, memories, or expressive motor reactions can be seen as having a priming effect on the other components and on the whole network. Emotion is evoked in therapy by attending to and heightening available components. Attention to the components serves to activate the total network with which the components are associated. (The kinds of techniques that are consistent with this theory of affect and that are used for working with emotion in couples therapy are the subject of this book.)

THE SELF-ORGANIZING FUNCTION OF EMOTION Emotion is best thought of as a disposition to act (Lang 1984). Emotion is thus a relational experience connnecting the individual and the environment; people experience emotion in relation to people or objects in the world that they are angry at, sad about, or afraid of Also, accompanying any feeling is a tendency to act; however, these tendencies or

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action dispositions may or may not be transferred into goal-directed action depending on decisions executed by higher order processing. Different classes of action are inherent in different emotions, and exactly what action is taken is a function of learning. Anger, for example, will lead to aggressive behavior if carried through into action, but the specific behavior chosen, whether verbal or physical, is a function of learning. Fear will lead to self-protective, flight behavior if carried into action. But how that flight is enacted is influenced by experience. Loneliness can lead to affiliative behaviors, which play a strong role in terms of the survival of the species. Love can lead to affiliation and to procreation. There are many examples of the interaction of biology and learning with emotion and action. The infant, for example, has certain innate responses to looming shadows and facial configurations. These responses are integrated over time, with experiential and conceptual learning, into a set of more complex automatic responses, which can be highly adaptive. In a further example, in a situation in which an individual is physically threatened, a neural impulse is centrally generated that leads directly to expressive motor behaviors, promoting fight or flight. Muscle tensions in the body prepare and organize a person for adaptive action, be it to run or to defend. The person is thus automatically organized in a complex fashion with a particular response readiness. Learning interacts with this organization to rapidly generate specific adaptive behavior in response to an event that requires action. Emotions thus help organize people to cope effectively with the environment. In addition, human emotions possess a certain salience that serves to override other cues and to ensure that we attend to emotionally generated information. Thus, what we feel rather than what we think is most likely to determine what we do in situations of stress or relaxation. Our emotions guide our actions unless we deliberately act contrary to the dictates of feeling. In this sense, emotion can be said to serve a selforganizing function; we are organized by our emotions to act sad, vulnerable, deprived, or angry. This self-organizing function of emotion is crucial in couples therapy, in that what partners feel strongly influences what they do, how they act, and how they perceive their loved ones. People are thus active perceivers who construct meaning and organize and are organized by what they see and hear. Conscious meanings and perceptions are constructed from the base of the individual's current emotional state and experiential organization; thus, emotions, thoughts, bodily sensations, and images are all aspects of the ongoing experiential

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process, the organization of which determines the person's behavior (Greenberg & Safran, 1987b). It is also significant that, at any one moment, more is going on than is available to awareness or observation; a person's current organization of experience utilizes only some of the information available to the person and structures this into only one of a number of possible self-organizations. According to this view, people can, depending on their current synthesis of tacit, subsidiary information, be at one point organized as vulnerable and at another time as assertive (Kaplan & Kaplan, 1985), although at any one time, there is a particular organization that dominates while other organizations and aspects of experience are not in focal awareness. In this manner, a person's immediate organization of experience dominates focal awareness and- governs functioning. For instance, a person who organizes experience in terms of feelings of hurt and rejection is inclined to perceive a spouse's actions as directed against him or her, whereas when this same person organizes these experiences as feeling loved, he or she may perceive the spouse's same actions as unrelated to him or her. But if the individual's dominant self-organizations are restricted, his or her response alternatives are limited as well. Hence, an emotionally focused therapy must address each person's current emotionally based self-organization and the factors influencing this organization.

COMMUNICATION The significance of communication in marriage and family therapy was initially highlighted by the Palo Alto group (Bateson, Jackson, Haley, & Weakland, 1956; Jackson, 1967; Watzlawick, Beavin, & Jackson, 1967). Their analyses of communication set the stage for much of what followed in the field. They posited that people are always communicating, that everything done in a relationship is a form of communication, and that it is impossible not to communicate. In addition, they focused on the hierarchical structure of communication. They also pointed out the difference between the report and command aspects of a message, in which the sender both communicates something (report) and gives a message about the communication, such as how to interpret it (command). They found differences between analogic and digital communication also to be of note. Analogic communication refers to its object by a

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representation, usually nonverbal in nature, which has a likeness to the object but is somehwat ambiguous, such as the shaking of a fist or the blowing of a kiss. Digital communication represents its object by an arbitrary name but enables logical precision. The importance of analogic communication in defining the role of each person in a relationship was stressed (Bateson, 1955). However, even though the Palo Alto group recognized the importance of analogic communication, they emphasized the cognitive, informational aspects of the communication process, thereby focusing on the encoding and decoding of messages and failing to pay sufficient attention to the affectional and motivational aspects of emotional communication. Their basic model of the person was that of a cybernetic information-processing machine; feelings did not form a part of this machine. Our model, however, adds emotion to the picture. It involves a more complex human being, a motivated, affective-cognitive, information processor. This view regards both emotion and communication as determinants of behavior and thus can be thought of as offering an affective-systemic approach to couples therapy. A great deal of human communication is analogic, emotional communication, in which small nonverbal signals of emotional states are exchanged. People constantly monitor emotional communication, sending and receiving emotional signals facially, gesturally, and paralinguistically, and this strongly influences ongoing interaction. The nonverbal signaling of one person's emotional state to another and the picking up of this signal is an important part of the work of relating. For example, depending on all of these factors, the words "I love you" can be genuinely caring, or they can be extremely hostile. Thus, in couples therapy, the therapist must observe and listen to the nonverbal emotional conversation occurring between the partners. The notion of emotional expression as a biologically based signal system was first suggested by Darwin ( 1873). In The Expression of Emotion in Man and Animals, Darwin argued that facial expressions and other displays had adaptive value in social animals because these expressions essentially signaled something about the animal's inner state and that this allowed greater prediction of behavior, greater cooperation, and the possibility of avoiding unnecessary lethal conflict. This development required the evolution of both sending and receiving mechanisms in the domain of emotional expression. The function of emotions and their expression, in addition to orienting the organism in the world, is the communication of this orientation to others. The facial expression of

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emotion is known to be cross-culturally consistent (Ekman, 1972) and generally has priority over verbal expression when the two are inconsistent (Mehrabian, 1972). Thus, the facial expression of emotion is a powerful regulator of social interaction. For example, facial expression associated with aggressive emotions communicates an intent of attack and could intimidate the enemy into leaving. Similarly, facial expression associated with fear might signal to another individual to come to the threatened individual's assistance. Voice quality has also been shown to convey different emotional states that influence interaction. Dominance, submission, and sympathy have been shown to be identifiable by vocal characteristics, while emotions such as anger, sadness, indifference, and joy are easily recognizable from vocal cues alone (Scherer, 1986). We suggest that the nonverbal signaling function of emotional expression is of great importance in couples therapy. Emotional expression is spontaneous rather than intentional or deliberate, and it is analogic rather than symbolic. The face, for example, will often display anger, disgust, sadness, or joy before the reaction can be controlled. Smiles are often used to mask certain feelings but the "felt smile" can be discriminated from a smile masking anger by the different facial muscles involved (Ekman & Friesen, 1975). Thus, when one partner criticizes the other, a momentary look of hurt may be seen in the eyes and mouth before the recipient of the criticism organizes him- or herself to rebut in anger. Often, when couples quarrel, they tune out the content and listen only to the tone of voice to evaluate whether the message is hostile or friendly. Nonverbal emotional expression is clearly a visible and observable signal accompanying an emotional state and is generally not under deliberate control. It is therefore influential in people's reading of each other's states, particularly when they do not trust the other person and are searching for valid cues. Thus, facial and vocal expression is trusted more than content, since emotional expression is the externally observable manifestation of an internal experiential state. It is important to note, however, that the relationship between experience and expression is not that of two separate sequentially or causally related processes but rather of two interdependent processes, that is, expression is not the external communication of an internal preexisting state but rather a constitutive aspect of the human emotional experience. Thus, the facial expression of emotion is integrally involved in the experience of emotion

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rather than simply being an external means of conveying what is occurring internally. Communication of emotion is, in addition, a complex interactional process, and it is the reciprocal expression of nonverbal emotional cues that governs much of what occurs in interactions. Intimacy, for example, is highly controlled by reciprocal nonverbal signals. Signals such as eye contact, body lean, and spatial placement are highly interactive. When there is a matching of expectations and desire for involvement between people, nonverbal signals tend to be reciprocal. These signals are also used to compensate and offset the behavior of the partner when expectations and preferences are being violated (Argyle, 1969). The emotional conversation between partners carried on at the gestural level is therefore an extremely important aspect of couples communication and couples therapy. If the therapist is to change the conversation between people in a marriage, it is essential that the emotional communication be restructured as well. Affect is thus a primary signaling system in interpersonal interaction, since emotion in humans serves a communicative function. From birth, infants are equipped with a set of adaptive expressive patterns long before their cognitive capacities are developed. From the start, infants, through certain organized behavior patterns, communicate their needs, wants, and distress. Their ability to communicate through the facial musculature is uniquely developed and serves as a nonverbal system of affective communication. This affective behavior is not a release but a form of communication that is either understood or misunderstood by the parent. Babies do not cry to feel better; they cry to get mommy or daddy to make them feel better. Affective expression, therefore, is a crucial form of communication. The expression of particular emotions has particular significance in human interaction. For example, vulnerability tends to disarm while anger creates distance. The expression of fear and vulnerability, besides evoking compassion, also communicates analogically that "this is not an attack" and often represents a major change in position in the interaction by that person, especially if the prior position was either blaming or withdrawing. Similarly, expressions of sadness and pain communicate a need for support, while newly recognized or expressed anger and resentment can help define differences, delineate individual boundaries in the relationship, and represent major changes in position in an interaction. All are complex means of analogic communication.

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The degree of closeness- distance and dominance- submission, the two indices of greatest importance in assessing interaction in couples, can be changed effectively by appropriate modification of affective expression. Expression of fear or sadness tends to evoke protection and compassion in the partner, and this can result in closeness. On the other hand, anger or disgust produces clear personal and interactional boundaries and can result in greater independence, appropriate separateness, and recognition by the partner of the other's rights. Thus, expression of vulnerability and need draws people close whereas expression of anger drives people away. It is the emergence of emotions in the session as both currently lived experiences and changes in expression that is important in providing new information in the relationship. This information is derived both from the analogic level of communication and from the difference between the new and the earlier expressions. Thus, it is not the oft-repeated litany of stale resentments or the continually expressed sadness or complaining that is sought after in this therapy but rather the previously unexpressed resentment or the buried sadness. Finally, communication also serves to determine and maintain the emotional state of self-organization of one's partner. As previously stated, one's current state or organization dominates awareness and governs functioning. This state of organization is, however, a field event affected by current forces both from within and without the individual (Kaplan & Kaplan, 1985). Thus, communication received from one's partner is highly influential in determining one's own current state. Therefore, communication patterns can maintain current feeling states as much as current feeling states can maintain certain communication patterns. A person's current experiential state or self-organization is thus constructed both from internal and external information. Emotional states organize certain interactional stances and verbal and nonverbal patterns of communication, while interactional stances and communication patterns reciprocally organize certain emotional states and the availability of internal resources and capacities. Thus, a particular state of self-organization, such as vulnerability or confidence, will alter the type of message sent in a communication; however, equivalently and coequally, a communications stance characterized by acceptance or interest by one partner can evoke or maintain this new self-organization in the other partner.

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INTIMACY AND EMOTIONAL BONDS In understanding the origins of emotional life, the need for attachment is of primal importance. Other needs or drives such as mastery and curiosity are important, but attachment is particularly significant in couples therapy. Attachment needs seen in infancy (Bowlby, 1958, 1969, 1973, 1980), and the primary tendency toward other relatedness, as postulated by object relations theorists (Fairbairn, 1952; Greenberg & Mitchell, 1983; Guntrip, 1969), appear to be crucial human drives. Attachment behavior is aimed at maintaining closeness and contact with other people, particularly with primary caregivers. Harlow (1958) showed that contact-comfort was a primary mediator of attachment in primates. Baby monkeys crave touch as much as they crave food. The attachment system provides infants at birth with a repertoire of inborn expressive motor responses that enable them to interact with their caregivers very early in life (Bowlby, 1980). Marriage, along with other forms of coupling, is a social framework for the attainment of adult intimacy; it is also one of the most acceptable social vehicles for human closeness. Just as baby monkeys and children only feel free to venture forth when they can return to the soothing softness of a caretaker, so do adults fare much better in the wide world when they can return for emotional refueling to the haven of a supportive marriage. The dual psychological processes of connecting and separating, joining and individuating, are central to marriage. The closer people get, the more they are able to be separate; conversely, if people are not able to be separate they cannot be close. In this dialectical process, people move from closeness to distance with love and hate and compassion and anger as the joining and separating emotions. Intimacy and vulnerability are aspects of the communal connecting tendencies, while boundary setting and contracting are aspects of separating tendencies (Bakan, 1967). In our view, interdependence is the goal of healthy attachment. As object relations theorists have pointed out, a basic tendency in human nature is to seek contact and connection with other humans. From birth to old age, human connectedness is an essential need. Interdependence then is the highest form of development, not independence, as is posited by many developmental theorists. Interdependence is characterized by a caring for the other as well as a need for caring, by a concern for the other as well as a need for support. Maturity in the adult thus involves both a

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need for the other and the ability to respond to the needs of the other. Therefore, the mature adult is a person who needs people and who possesses the ability to seek and give support. The ability to make and maintain connections is the true sign of optimal development. Attachment needs are thus an essential aspect of adulthood and form the core of the emotional bond in close relationships. Adults, like children, show a need for easy access to the attachment figure or partner; a desire for closeness to that figure, especially in times of stress; comfort and diminished anxiety when accompanied by their partner; and an increase in distress and anxiety when the partner is inaccessible. If the affectional bond is perceived as threatened, then attachment behavior such as clinging, crying, or angry coercion becomes more extreme. In distressed relationships, where disagreement and distance are perceived as threatening, such behavior is commonplace and every disagreement is viewed as a possible threat. Bowlby (1969) placed attachment in the framework of evolutionary adaptation: In a dangerous world, a close and responsive attachment figure ensured survival. People alone are essentially powerless and vulnerable, while in pairs they can protect and care for each other. Attachment behaviors such as clinging and crying are then adaptive mechanisms rather than a sign of neurosis or developmental failure. When attachment behaviors achieve their aim and the bond is secured, then stress is alleviated; if not, withdrawal and despair will ensue (Bowlby, 1973). Attachment behaviors can be accounted for in terms of goals and information-processing. If a set goal of proximity to an attachment figure is not met, then attachment behaviors will be initiated to create that proximity. From this point of view, the blaming coercive man who continues to blame-even though he understands this drives his partner away-is involved in a desperate need to achieve closeness. Such behaviors, governed as they are by set goals, are difficult to bring under cognitive control; rather, it is the emotional bond that must be restructured to allow for the closeness and responsiveness necessary to satisfy the attachment need (Johnson, 1986). Conflict in couples involves a struggle for separateness and connectedness. In this struggle, each individual searches to satisfy his or her basic needs for identity and security. Failure to resolve the inevitable conflict around intimacy leads eventually to feelings of alienation and deprivation. It is in the context of an innate human need for close contact with others, a context in which emotional attachment to a few significant

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others is a requirement for psychological well-being, that distress in relationships needs to be seen. Thus, relationships are a natural arena for the gratification of basic human needs, and their problems emerge far more from unmet adult needs than from the neurotic expression of infantile needs (Wile, 1981). Partners need to be able to reveal their essential selves to each other and be accepted as they are. They need to be able to say what they feel most deeply and what they think most profoundly without fear of rejection or fear of hurting the other. Buber has described this form of relating as the attainment of an I-thou dialogue. THE "I-THOU" DIALOGUE ..'Marriage will never be given new life except by that out of which true marriage always rises, the revealing by two people of the Thou to one another" (Buber, 1958, p. 51). Over a long period of time, the quality of close relationships depends on their trustable core-the genuine dialogue. This dialogue is characterized by Buber as possessing qualities of "pres­ ence," in which people make themselves present to each other, "inclusion," which is the process of letting another in on one's inner thoughts and feelings, and "mutuality," in which the above processes are engaged in by both parties. The genuine dialogue is nonexploitive, and it is a great resource in relationships, leading to reciprocal giving and mutual benefit. Buber's notion of the healing that occurs from the "meeting" in the I-thou dialogue points to the human need for connectedness and the importance of the emotional bond. In this type of meeting, presence, directness, and immediacy characterize the moment in which two people genuinely care about each other's side of the dialogue. Dialogue thus involves responsible position-taking by both people. In contrast, a manipulative response fo­ cuses only one person's expectations and definitions. In an I-thou dialogue, partners do not impose themselves on each other, nor do they attempt to have their partner see the world in their manner. The imposer or manipula­ tor is interested in another person's qualities only in terms of how they can be exploited for personal gain. This is not dialogue; dialogue is simultane­ ously self-delineating and self-validating for both partners. Buber refers to the sphere of the interhuman as being of great importance; this is the sphere between partners in which reality is created.

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As Buber proclaims, "the inter-human opens out what otherwise remains unopened." Couples in dialogue break through the alienation of "seeming" to the communication of "being." They also break through the inadequacy of their restricted perception of the other and engage in what Buber calls a person-making present, to see the other as a whole, not to view him or her analytically or reductionistically. In this process, an attempt is made to make present to oneself the real person who confronts one in his or her entirety, wholeness, unity, and uniqueness. This is a process of forever creating self anew. Where there is genuine dialogue between partners there is thus brought into being, between partners who express themselves without reserve and free of semblance, a fruitful partnership that can be found in no other way. I-thou dialogue is thus in and of itself healing and generative. Achieving this kind of contact between parties in therapy is both the process and the goal of therapeutic change.

COGNITION AND THE EMOTION PROCESS IN INTERACTION An important purpose of thinking is the creation of meaning. Emotion is also involved in providing meaning (Solomon, 1977). Meaning is thus the overarching concept that integrates emotion and cognition in therapy. The human being is a constructive information processor who continually creates meaning based on cognitive and affective processing; meaning then determines much inner experience and overt behavior. Ultimately it is complex constructions or views of reality that govern interactions in couples and need to be changed in order to change these interactions. In cognitive psychology, the notion of schemata has come to represent the individual's internal representation of reality. It is these schemata, particularly the more affectively based ones, that are the ultimate target of change in emotionally focused therapy. Perceptions of one's partner's intentions and behaviors is dependent on a complex blend of selective attending that results in certain constructions of the other as having particular motives and intentions. These constructions are based on past learning with significant others and with the partner. They are stored in the schematic emotional memory and may lead to distorted perceptions of one's partner or hypersensitivity to minor

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manifestations of particular attributes in one's partner. It is these schemata that ultimately require change if the couples are to enjoy lasting hange. As mentioned earlier, emotional life and cognitive life are practically inseparable although theoretically distinct. All interactions with the environment involve affect and cognition. There is no affective behavior without cognitive behavior; hence, since affect and cognition are two aspects of behavior, it makes no sense to discuss which one causes or precedes the other. Emotion and cognition are more complementary aspects of human functioning, not separable entities. Yet, although we favor the theoretical position that emotion, cognition, and action are more fused than separate, it is helpful when talking about clinical practice to distinguish among processes that are predominantly emotional or predominantly rational or predominantly behavioral. A repertoire of therapeutic interventions already exists that focuses on changing what individuals feel, think, or do, or how people interact. Interventions such as prescribing interactional cycles, setting homework, challenging beliefs, or reflecting feelings are thought of, respectively, as interactional, behavioral, cognitive, or affective. These distinctions are useful at the level of practice. It is important when using these distinctions, however, to bear in mind that affect, cognition, behavior, and interaction are ultimately inseparable. Hence, focusing on ways in which cognitive processes are important in an emotionally focused therapy, we are referring to these processes at an applied level rather than seeing cognition as distinct from emotion, action, and interaction. Three particularly important cognitive processes are described below. These are attribution of meaning, accessing, and modifying dysfunctional cognitions. In the process of couples therapy, the therapist is continually working with people's views of each other, asking them repeatedly what they observe in their partner, how they interpret what they observe, and what this leads them to feel and do. In human interaction, it is not simply one partner's behavior that determines the other's reaction; the meaning attributed to the partner's behavior is also important. This attribution process is an important aspect of the emotional conversation in any couple. Meaning involves both cognition and affect; in fact, emotion is often regarded as containing tacit meaning and has been spoken of as involving intuitive appraisal (Arnold, 1970) and evaluation (Solomon, 1977). The point here is that the meaning of a partner's behavior is a

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crucial component of interaction in couples and that meaning is intrinsically both cognitive and affective. Evidence has recently been mounting demonstrating the effects of affect on cognition. It appears that mood may determine memory and cognition as well as cognition and memory determining mood (Bower, 1981). Although the experimental study of these links unfortunately involves a somewhat linear causal conceptualization of the relationship between affect and cognition, it highlights that cognitions interact with and are influenced by emotions. This is in sharp contrast to the previous emphasis in psychological studies on the primacy of cognition in determining meaning and feeling. Thus, what people "think" or "say to themselves" is somewhat influenced by their feeling states. This is of great importance in therapy where emotion is very intertwined with cognition. In therapy, if the therapist wants to access certain dysfunctional cognitions, he or she may first have to evoke the feelings with which these thoughts are associated. Certain crucial, interaction-governing cognitions, such as thoughts that one is unlovable or perceptions that it is impossible to get what one needs, often only come into operation when the person is in a particular affective state. Evoking an emotional experience in the present thus helps access many kinds of dysfunctional "hot cognitions" (Greenberg & Safran, 1981, 1984a, 1984b, 1987a; Safran & Greenberg, 1982, 1986) that influence couples' interactions. Thus key cognitions, as to the nature of the self in relation to the other, are most accessible in couples therapy when the emotions themselves are aroused. These are cognitions about the self in relation to the other and are central aspects of the schematic network, which is involved in emotional processing. When the network is evoked, that is, when the person is experiencing the emotion, the different aspects of the network became available to awareness. In addition, modification of internal processes such as thoughts, beliefs, and self statements is greatly enhanced by evoking these processes in a live and currently felt fashion, that is, in the context of the schematic network to which they belong. Challenging a belief by provision of inconsistent evidence or by disputation is much more effective when that belief is currently operating and determining experience and behavior. Thus, in couples therapy, it is helpful to challenge dysfunctional relationship beliefs such as the belief that disagreements are destructive or that mind-reading is possible (Eidelson & Epstein, 1982) when they are actually operating in the moment.

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RELATIONAL BELIEFS AND TESTING At the center of people's self schemata are certain core beliefs about themselves and their relationships with others that, if they are dysfunctional in nature, cause interpersonal problems and distress in relationships. Certain core dysfunctional beliefs related to important relationship issues such as attachment- abandonment or dependenceindependence are found in statements such as, "No one is interested in me," "No one will be there for me," "I have to be strong; no one is interested in my struggles," "Don't get close, you only get hurt," etc. Other core beliefs related to self-worth, assertion, or autonomy are found in statements such as, "I'm inferior," "Standing up for myself only leads to disaster," "I'm unlovable," "Anybody who loves me couldn't be worthy," "I will never allow myself to be disappointed" etc. People continually act so as to protect themselves from the possible disasters they believe they may encounter; hence, their behavior is often governed by certain catastrophic expectations about the consequences of particular actions. As Weiss and Sampson (1986) pointed out, however, people are also always struggling toward adaptation by testing to see if their beliefs are true. They repeatedly collect evidence to disprove their pathogenic beliefs when they perceive it is safe to do so. As Weiss and Sampson pointed out, patients in individual therapy continually test out their unconscious pathogenic beliefs in the relationship with their analysts. If the therapist passes key tests, that is, provides disconfirming evidence, the therapy deepens, exploration becomes bolder, and the patient makes noticeable progress in therapy (Weiss & Sampson, 1986). A similar process occurs in relationships, as shown in the following example. A man believes that no one will be there for him, but he continually tests this out on his partner by slightly disclosing something of importance or hinting at a need. He does this to see if his partner will "be therefor him." If he gets evidence to disconfirm his pathogenic belief, that is, if she responds to his need, she passes the test and deeper connection, trust, and intimacy will follow. However, couples who come to therapy have often failed each other's tests, and their interaction has become structured around these failures . When they enter therapy they are fighting to get what they need. Their attempted solutions have become the problem, or they have given up trying to get what they need because the partner has

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repeatedly failed their test. Their core beliefs therefore guide people into self-protective behavior, although there is still continual microtesting of the partner which may be highly imperceptible to both individuals but still present. The task of couples therapy is to subject the core dysfunctional belief or catastrophic expectation to experiential disconfirmation, that is, to have the partner pass the test. At the same time, the belief is also brought out into the open for inspection and exploration. This inspection of the belief helps access new evidence arising from the partner's new response. In emotionally focused therapy, it is the partner's new behavior in therapy that acts to disconfirm the pathogenic belief of the other partner. Following our example, if the man's belief is that no one will be there for him, he acts in terms of that belief, on the one hand, not to express his need openly because he fears it will not be met. On the other hand, however, he still continually tests his partner, essentially to see if he can trust her to be there for him. The core pathogenic belief needs to be activated in therapy in order for it to be subjected to disconfirrnation; however, it needs to be activated not as an abstract intellectualized belief for therapeutic discussion but rather as a lively felt operating principle so that it is the currently governing perception and action. Once it is operating, then the partner needs to respond in a way that will disconfirm the belief. The woman who believes "men are not interested in my struggles, they require me to be strong" is thus brought to the point of trying to express some inner struggle to test her partner's ability to respond. The therapist then works to have him respond to her. The therapist may have the woman disclose her core pathogenic belief by having her say, for instance, "But what's in it for you to respond to me when I am feeling vulnerable?" When the man is able to say, "It feels very intimate to me that you're really letting me in and I feel very close to you," the woman might cry in pain and in joy. Essentially, she is, at this moment, simultaneously experiencing that she never believed that anybody wanted to be close to her and that her partner really does want to be close to her. Relational beliefs of this type are a particularly important type of hot cognition and need to be activated in a currently felt manner to be subjected to new experiential learning in couples therapy. Couples therapy therefore works toward the experiential disconfirmation of core dysfunctional relationship beliefs.

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TRUST Trust is another important component of intimate relationships. Trust strongly influences interaction. If individuals trust their partners, the meanings attributed to their partners behaviors are more likely to be positive than if the individuals are mistrustful of their partners. Trust involves a complex blend of cognitive and emotional elements. The aspects of trust based on learning involve the person's expectations about their partner's reliability and dependability while the aspects of trust based on affective factors involve hope, a feeling of basic security, and the strength of the bond (Rempel, Holmes, & Zanna, 1985). The breaking of and reestablishing of trust are often important issues in couples therapy. These issues need to be worked with, using both cognitive and affective interventions. The beliefs and expectations that promote wariness need to be brought to awareness and explored, while new emotional bonding needs to be established. Disappointment, that is, the failure to have expectations satisfied, is a related cognitive-affective issue that requires therapeutic focus in couples therapy. In intimate relationships, disappointment tends to be attributed to behavioral events mainly when the partner's actions have personal relevance. Berscheid ( 1983) suggests that events in relationships are personally relevant if they interrupt or facilitate an individual's plans or goals. Goals in turn are determined by the individual's needs and desires and by his or her expectations and beliefs about the possibility of having such needs and desires met. What one does in a relationship therefore depends greatly on what one wants and one's expectations that it is worth trying to get. This presents an important area of intervention. If partners are not attempting to have their needs met, because, based on prior learning histories in this or other relationships, they have low expectations of success, they will end up feeling deprived. Accessing and modifying the expectations, plus making the needs and desires known and communicated, are important therapeutic strategies involving an emphasis on cognitive expectations and emotional needs and desires. We can thus see that in couples therapy, cognition and emotion need to be worked with in a fashion that reflects their complex interdependence. At a theoretical level, affect involves cognition and cognition is not affect-free. Ultimately, the two are inseparable. Cognitive factors such as attribution, expectations, beliefs, and thoughts thus all play an important part in an emotionally focused therapy.

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SUMMARY

We have attempted in this chapter to briefly outline the components of an adequate theoretical framework for the consideration of emotion in interactional therapy. First, the biologically adaptive role of emotion in human interaction was noted, next, the role of emotion in organizing people for action was emphasized. Different classes of emotion were then differentiated for the purpose of clinical assessment, and primary adaptive emotion was identified as an ally in the process of change. A comprehensive model of emotion was presented in which emotion is viewed as resulting from the preattentive integration of a number of different levels of information-processing. Emotion thus provides the organism with important ongoing feedback about its reactions to situations based on this complex synthesis of information. It also provides a continuous readout of a person's responses to situations; it organizes the person for action. Individuals are thus continually organizing themselves for. contact with the world through the medium of their emotional responses to it. Their reactions, as we have shown, depend on how they integrate information at a tacit level. A person's current organization of experience thereby governs his or her functioning; emotionally focused therapy addresses this emotionally based self-organization. Emotion, as well as affecting a person's self-organization, is also crucial in defining interaction patterns and thus in determining the other partner's self-organization and thus his or her responsiveness. Emotion is a biologically based primary signaling system and is therefore highly influential in communication in couples. Particular emotions have particular significance in interaction; expression of the softer, more vulnerable emotions brings people closer whereas the harder more aggressive emotions create distance. Intimacy and attachment appear to be primary human needs; the expression of these needs helps reestablish the emotional bond on which marriage is based and leads to a mutually enhancing noncoercive I- thou dialogue. In addition to the importance of emotion in self-organization and in changing interactions, emotion in therapy is closely connected to cognition. Accessing emotion helps people become aware of dysfunctional cognitions, facilitates the modification of problematic relational beliefs, and helps in the reestablishment of trust. The experience and expression of emotion in therapy is, for all of the above reasons, a potentially powerful agent in the process of therapeutic

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change. Sartre ( 1948) described emotion as a transformation of the world; it is an orientation to the world and thus intricately involved in the definition of self. Expressed emotion also has the power to define or redefine a relationship to the most crucial aspects of our world-intimate others. Emotion has too long been overlooked as an important vehicle of change in couples therapy. The remainder of this book focuses on how to work with emotion to achieve change in couples therapy. In the next chapter, the theory of emotionally focused therapy is presented, followed in later chapters by principles and examples of practice.

CHAPTER TWO

An Affective Systemic Approach

Emotionally focused couples therapy is an affective systemic approach in which the emphasis is on changing interactional cycles and changing each person's intrapsychic experience, which maintains, and is maintained by, the cycle. In this treatment, the emphasis is first on identifying the negative interactional cycle early in treatment and then on accessing each partner's unexpressed underlying emotions, which serve to organize his or her views of self and partner. The problem cycle, the individuals' interactional positions, and their behaviors are then redefined in terms of the newly experienced underlying emotions. Thus, for example, the blaming of one partner may come to be seen as an expression of an underlying fear of abandonment, vulnerability, or loneliness, while the withdrawal or rejection of the other partner may come to be seen as an attempt at self-protection or fear of engulfment. This approach is based on an integration of experiential and systemic approaches, as outlined below.

EXPERIENTIAL THEORY Gestalt therapy, one of the major experiential therapies, although developed and usually applied in the context of individual therapy, particularly lends itself to thinking about organism- environment interactions in the couple (Greenberg, 1982; Kaplan & Kaplan, 1982; Kempler, 1981; Perls, 1973). Gestalt is holistic; it attempts to overcome both organismenvironment and mind- body dualities by adopting a field conception of human functioning that leads to focusing on what occurs between the 29

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organism and the environment at the contact boundary. The self is viewed as an ongoing process that comes into existence at the contact boundary between the organism and the environment to negotiate organism-environment interactions. Perls's concept of field, drawn from Lewin (1935), emphasizes that at every moment the individual is a part of a larger context (or field) and that it is the nature of the relationship between the individual and the environment that determines behavior. Neither creates the other; rather, each stands in a relationship of mutuality to the other. In this view, both perception and environment are important determinants of human behavior, and the self is the organization reflecting these influences. Gestalt formation, the forming of a figure against a background, is that process by which the self comes into existence in the moment. The gestalt is formed by the integration of aspects of ourselves and aspects of the environment to form an organized whole response that satisfies our needs and fulfills the requirements of the present environment. Gestalt therapy has focused primarily on working with individuals and in so doing has emphasized awareness and choice as major change processes. Although recognizing that the self comes into existence at the organism-environment contact boundary, gestalt has not placed equal emphasis on the role of context, that is, the environmental demand, in determining behavior. With its emphasis on the individual, gestalt therapy has focused on individual awareness, the person's current perceptual organization of the world, and the figure-background formation process. The manner in which people interrupt or interfere with their emerging awareness and experiencing has been seen as central to understanding individual dysfunction. Although the individual's behavior is seen as being equally dependent on environmental opportunity as on internal need, an analysis of environmental influence on the individual has not been emphasized in this essentially individually oriented therapy. In an experiential view of human functioning (Perls, Hefferline, & Goodman, 1951; Rogers, 1951), the individual's internal experiencing is regarded as the primary referent of therapy. According to this view, people are neither purely rational nor purely emotional but rather respond holistically to situations in adaptive ways. People are regarded as wiser than their intellects alone and as functioning more effectively when they pay attention to all of their internal experiences. In addition, people are seen as active organizers of their perceptual world, and it is these perceptions that determine their behavior. The therapist in this approach

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attempts to enter the person's frame or reference to explore the reality of the world as it appears to that person. Acceptance of "what is," by both therapist and client, is a cornerstone of this phenomenological approach. As blocks to experiencing and restrictions of awareness are encountered, the client is helped to identify with and integrate these aspects of functioning, thereby expanding the scope of experience and making available potentially adaptive organismic feelings and needs. People are viewed as having an inherent tendency to grow and thrive. All behavior, therefore, begins with individuals' quests to actualize themselves. As such, it can be assumed that at any moment, people's behaviors are their optimal means of actualizing themselves in their current contexts, as they perceive them, and as such are legitimate and valid. For example, a woman in therapy for her ongoing depressive malaise and dissatisfaction with her marriage may be feeling very hurt and in need of support, but in her life experience a person who expressed hurt was regarded as weak and was either depreciated or ignored. Therefore, when she is hurt, she believes it is important to be strong and organizes herself accordingly. As a result, when her husband criticizes her, she defends by attacking verbally, by blaming him, and by telling him he does not appreciate her. These behaviors bring her neither the comfort nor the support she needs; rather, they serve to distance her husband. Her underlying need for support and comfort is an organismically important one; however, her method of communicating this need is dysfunctional and is based both on her perceptions and on the contextual conditions that seem to support these perceptions. She blames her spouse, and he, in turn, having learned that it is important to be right, defends his actions, which she then experiences as his lack of support. This interaction is organized in a reciprocally determined way in which the wife and husband each act according to his or her perceptions of the situation and mutually alienate one another. In this way, expressions of basically adaptive human needs for support and self-esteem can result in negative interactional cycles. Kaplan and Kaplan ( 1982), writing about gestalt family therapy, suggest that by focusing on processes between the individual and the environment, field processes that determine experience can be identified in the here-and-now of the interactional field. Just as a person may be viewed as disowning aspects of the experience, such as sadness or anger, because of internal blocks or splits, so too can these experiences be

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viewed as discordant with, or disallowed by, particular relationship rules or contexts. Also, the experience and expression of certain emotions may be disallowed because they are a threat to a definition of the self in the relationship. What people attend to in themselves and their partners is determined by a set of internal categories or schemas that have their origins in the relationship itself. Each interaction is a current reminder of these categories, implying as it does such rules as, "Don't get angry. " In addition, people's concepts of themselves in a relationship are influenced by the manner in which they are treated by their partners. The current functioning of an individual can therefore be viewed as being reflexively organized by both internal and external field forces. A person's experience is always organized so that some processes are relatively dominant and more focally in awareness. This concept is basic to a gestalt view of human functioning. If individual or contextual factors act to interfere with the individual's most dominant experience rising to awareness, dysfunction occurs and restricted awareness results. The person begins selectively to attend to a restricted subset of experience and blocks off other experiences. The result is that some aspects of experience fail to be integrated and are disowned or disclaimed. People, therefore, relate within a limited set of possibilities. In therapy, expanding the range of experience may open up conflict, but with it comes the possibility of a fuller, richer relationship. Change can occur in therapy by changing the conditions that organize a particular form of contact between people, be it by changing one person's experience and perception, by changing the context (i.e., the other partner's position and pattern of responses), or, most likely, by changing both simultaneously and in a reciprocally determining fashion.

THE INTERACTIONAL SYSTEMIC PERSPECTIVE Although the interactional perspective articulated by theorists from the Mental Research Institute in Palo Alto (Fisch, Weakland, & Segal, 1983; Jackson, 1965; Sluzki, 1983; Watzlawick, 1978; Watzlawick et al., 1967) is not strictly based on systems theory, it falls within a group of theories that belong to a base paradigm referred to as "family systems theory" (Sluzki, 1983). The word system has in fact become a kind of cliche that has lost most of its meaning. Although systems theory has been a cornerstone of a group of approaches that are similar in their difference from

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intrapsychic approaches, the many systems approaches suggest a number of different ways of understanding dysfunction and of intervening. What is referred to as "family systems theory" is a loosely knit set of concepts rooted in general systems theory and cybernetics. (Only those concepts relevant to couples therapy will be mentioned here, and then only briefly, to set the stage for integration rather than to explain systems theory.) The first key systems concept is that "the whole" is organized. This organization determines how the system functions. In order to understand events we must study them, not in isolation, but in the context in which they occur. Relationships between participants and patterns of interactions between them therefore become the focus of attention rather than the characteristics of the individuals themselves. Parts can only be understood in the context of the whole, and changes in parts affect every other part and the whole. A second key concept, from cybernetics, suggests that the whole regulates itself through feedback in order to maintain stability. This is the idea of homeostasis, in which feedback produces system alteration in order to keep the system in a state of balance. This concept explains stability but not change, and it is currently subject to extensive debate and possible expansion or revision (Dell, 1982; Hoffman, 1981). Regardless of one's view of the relevance of homeostasis in describing the functioning of couples, the concepts of interactional patterning and circular causality, as opposed to individual dynamics and linear causality, are crucial in understanding how couples function. The concept of circular causality suggests that no behavior simply causes another behavior but rather that each is linked in a circular chain to other behaviors and events. Thus, partner A nags because partner B withdraws while partner B withdraws because partner A nags. These circular interactions form consistent recurring patterns over time. These patterns are established and maintained by the . partners' actions, and the therapist is concerned with the effects of what each partner does and how these behaviors function to maintain the cycle. Individuals are viewed not as having motives or intentions to act in certain ways but rather as manifesting particular behaviors in response to contextual determinants. This approach is behavioral in nature; however, the systematic view of behavior is a complex one. Behaviors are not seen as automatic responses to simple stimuli but rather as parts of reciprocally determined interactional cycles. In addition to the emphasis on behaviors as part of

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an interactional sequence, behaviors are also seen as occurring in the context of meaning and as being perceived differently and having different effects, depending on the meaning contexts in which they occur. Thu~ "scolding," for example, is not a simple unambiguous stimulus but either a rewarding, approaching behavior or a punishing, rejecting behaviOT, depending on the meaning in which it is embedded. Similarly, an insult from a friend within an episode of play is regarded as humor rather than hostility. Context determines meaning. In this view, behavior is seen essentially as communication, and all behavior is analyzed in terms of its communicative significance. Thus in this tradition, the therapist does not view a member of a couple as possessing a particular attribute such as "being" selfish, angry, or depressed but he or she rather focuses on the communicative function of the behavior by referring to the person as "showing" certain behaviors. The concept of interactional positioning is of crucial importance in understanding cycles and each person's behaviors in the cycle. In interaction, a person's actions and speech acts are seen as being proposals and counterproposals about reciprocal role definitions. A man, in giving advice, proposes that he adopt a dominant role and his partner a submissive role; depending on her response, she accepts or declines his offer-. Interaction is like a set of moves and countermoves in a game; therefore, it is analyzed not in terms of internal experience, but in terms of the positions people take in relation to each other. The report and command aspects of messages were noted earlier as two important aspects of communication. The "report" is the content of the message, while the "command~, defines the roles of speaker and listener. For example, if a man asks his partner, "Why did you do that?" this is a content request for information, although it also contains a command about the relationship definition. The questioner assumes the superior role of inquisitor and relegates the responder to the inferior position of the accused. The partner, if she answers by justifying her action, in effect accepts the position proposed by the questioner and thereby acts to confirm a reciprocal role relationship definition of superior-inferior or leader-follower. From a systemic point of view, proposing change to a family is seen as posing a dilemma to the system. Change in the presenting problem cannot be brought about without other changes in the system occurring. Usually, the presenting complaint has in effect emerged as the be st possible solution to the problem and can be seen as an attempt not to

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change something else regarded as more difficult to change. Understanding what is preventing other changes or solutions and why and how it is important for people to adopt the current solution is seen as crucial to help the therapist not push for change too rapidly. The therapeutic task in treating conflict in relationships with the systems approaches is to alter the negative interactional cycle. The therapist can work directly to change the conflict by instructing the couple to change their interactional positions. To do this, the therapist uses him- or herself to influence change in behavior directly (Minuchin & Fishman, 1981). Alternately, the therapist can achieve change indirectly by reframing and prescribing what is occurring in the interaction, so that the behaviors take on new meanings (Sluzki, 1978). A new view of the interactional cycle makes alternative behaviors possible.

INTEGRATING EXPERIENTIAL AND SYSTEMIC PERSPECTIVES Although some approaches do integrate experiential and systematic traditions in practice (Duhl & Duhl, 1981; Kempler, 1981; Satir, 1964: Whitaker & Keith, 1981 ), they do so without much attempt to achieve a theoretical integration. The two traditions thus have not been very closely linked in the theoretical literature. We believe, however, that certain basic assumptions in each approach make them good partners for a productive theoretical synthesis in emotionally focused therapy (EFf). For instance, both view the person as a fluid system constantly in process of change rather than as possessing a fixed core or a rigid character based on psychogenetic determinants. Both approaches also focus on current functioning rather than on historical determinants as important causes of specific behaviors. The potential benefits of integrating these two approaches comes from devising a new approach that simultaneously focuses on both intrapsychic and interactional factors. Systemic perspectives focus on how context influences moment-by-moment behavior, and experiential therapy focuses on how current intrapsychic states and perception determine behavior; neither approach posits a core personality or rigid intrapsychic structure that needs to be changed. Gestalt therapy, for example, rather than describing enduring characteristics of people or attempting to explain behavior in terms of causal antecedents, describes ongoing pro-

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cesses of experiential organization by which people interact with their environment. In both experiential and systemic approaches. patholo gy is seen not as residing in a fixed personality structure, but as arising fr om attempted solutions that actually maintain the problem or from faulty views of the situation that lead to inappropriate solutions. Systemic approaches see the individual in terms of a type of role theory of self in which the situational demands define the type of role a person plays in a particular situation. Different social contexts then bring forth, different "partial selves" (Minuchin, 1974). Experiential therapy suggests a type of modular self theory in which multiple partial aspects or potentials of self are organized in a particular way at any time in terms of dominant current needs (Perls, 1970) and the organism's attempts to actualize the self. The two theories intersect in allowing the self to be seen in interaction as a continuous process of context-depe ndent self-organiw zation striving toward healthy adaptation. The self is thus not something fixed inside a person's head; rather, the self is an unending process turning experience into conscious awareness. Two basic ideas underlie our integrative view. The first is a theoretiw cal commitment that couples therapy needs to address both (1) the relationship of the inner psychological world of both partners to their interaction and (2) the relationship of the interactional, contextual deterw minants of the partners' behavior to their internal experience. The second idea, a clinical one, relevant at a more practical level, suggests that the timing of an intervention is crucial and should be based on process diagnoses of opportunities for intervention (Greenberg, 1986). Our view is · that therapy is a complex interactional process in which different opportunities for intervention present themselves at different times and that a skilled therapist has a tacit and sometimes explicit idea of what to do at particular times (Rice & Greenberg, 1984). The therapist is therew fore constantly making process diagnoses of what is occurring and when it is opportune to intervene. When good opportunities for intervention present themselves, the therapist intervenes. In this fashion, interventions from different sch9ols of thought are integrated for use at different times to produce change in different targets. For example, when a negative interactional cycle presents itselC it is identified and elaborated; when an emotional experience or expression emerges in one partner, it is focused on and developed; and when a core belief is accessed, it is inspected. Thus, the therapist intervenes responsively to what is emerging in the process in the present. Certain theoretical notions, however, guide the

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process of what is selected by the therapist as a target for intervention and how best to intervene at specific moments. Our view rests on four main principles that guide our process diagnosis and intervention. The first is that the self is organized in particular ways at any moment by emotional experience. The second is that interpersonal perception serves to maintain self-organization and interactional positions. The third is that certain core beliefs related to persons' views of themselves in a relationship are continually affecting their behavior. The fourth is that interactional patterns in distressed couples are self-perpetuating and serve to maintain the problem and the inner world experience of the partners. Emotion, perception, cognition, and interaction are all aspects of the problem and therefore are all targets of change. In addition, all processes are highly interdependent, at many differing levels. For instance, emotion and perception involve cognition; thus, feeling anger at being betrayed involves the perception of betrayal, the beliefs around loyalty, and physiological arousal of adrenalin and the subjective experience of anger. Similarly, cognition is not independent of emotion; all thought involves feeling, and behavior is determined by, and determines, emotion and cognition. Hence, taking new actions can lead to feeling new feelings. Thus, EFT does not focus on emotional experience alone but rather focuses on multiple levels of experience. Any intervention may focus on a particular clinical target for a particular purpose, such as accessing an emotion to change communication, becoming aware of a belief in order to subject it to new evidence, or identifying a cycle to increase the sense of mutual causation and thereby reduce blame. Interventions may be clinically thought of as focusing at the emotional, cognitive, or interactional level, but all interventions essentially involve an integration of all these levels. In the affective systemic approach presented here, the focus of treatment is thus changing both the interactional cycle and each person's experience of the relationship. Dysfunctional interaction cycles in couples have been observed repeatedly to evolve in dealing with issues concerning closeness and distance and dominance and submission. Once a negative interaction cycle is in place, it seems to take on a life of its own. The focus in an integrated approach is, first, on clearly identifying repetitive interactional sequences of behavior around various issues and assessing the positions that people adopt in these interactions, and, second, on reframing their positions and redefining the problem in terms

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of their underlying feelings. In this view of marital interaction, communication is seen as an attempt at establishing a relationship definition that maintains a particular self-definition. In an integrated experiential- systemic view, organization of the individual subsystems and of the whole, that is, the couple system, can be seen as interdependent and as varying simultaneously and reflexively. For example, when the interaction is organized in a complementary fashion, such as "pursue- distance" or "attack- withdraw," the individuals can be seen as organized so that pursuit and attack, or distancing and withdrawal, are the dominant aspects of their individual organization. This organization is maintained simultaneously and is supported by both (1) the negative interaction cycle (i.e., the couple system functioning) and (2) certain individual processes being more dominant in focal awareness (i.e., individual subsystem functioning). Change in interaction is brought about by reframing negative interactional cycles in terms of underlying emotional experiences in each partner. This approach to therapy with couples involves attention to the current interaction and the current experiential process within the individual. Change occurs both by change in people's views of themselves and by change in their context (i.e., in the partner's communication). Insight in this approach is not enough to bring about change in people's views of themselves. Rather, clients must experience, on an emotionally meaningful level, new aspects of themselves and new aspects of their partner, thereby creating new interactions. Partners must encounter each other in the session in a new way and participate in the corrective emotional experience of an /-thou relationship. This reestablishes the possibility of them having a positive human relationship with each other. This approach is predicated on the assumption that the members of the couple have healthy feelings, needs, and wants that will emerge with the help of the therapist. A major hypothesis of this approach is that accessing and expressing primary feelings, needs, and wants by the partners can aid adaptive problem-solving and produce intimacy. It is not people's feelings and wants that cause problems in relationships (Wile, 1981) but the disowning or disallowing of these feelings and wants that leads to ineffective communication and escalating interactional cycles. A grouchy man, for example, may be avoiding his need for comfort; likewise, a nagging woman may be sharing anger but feeling loneliness. Some of the major needs in couples are needs for closeness, contactcomfort, and intimacy. In addition to needs for connectedness are needs

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for separateness, autonomy, and self-definition. Fears of closeness or separateness and interactional patterns that prevent closeness or autonomy are therefore major targets of change. Our approach involves encouraging people to make explicit statements to their partners of currently experienced feelings and needs. Emotion in this approach is considered to be both a target and an agent of change. Emotional experience provides an organizing framework for the creation of meaning and relationship definition; in particular, it provides a framework for the perception of the partner. Emotion is also a source of motivation for new responses. A strong distinction must be made between "talking about" feelings versus involvement in the current moment and congruent expression of experience. Experience and communication of currently experienced feeling are far more likely to produce change than intellectual insight or discussion about feelings. Insight is not the key to change in this model; rather, the active reprocessing of a current powerful emotion in the presence of the partner and the enacting of a new sequence of responses based on that emotion are the key elements in therapy. As a result, the use of good communication is seen as emerging from change than as bringing about change. Affectively oriented encounters create change in communication styles as partners experience themselves and one another differently. For example, the perception of the partner as more accessible and responsive motivates and facilitates open communication. Poor communication skills often reflect a relationship definition that disallows congruent disclosures and open dialogue; hence, when partners witness the disclosure of fears, for example, rather than defensive reactions, such as aloofness, new responses are often elicited by their new perceptions of their partners' vulnerability. This sets a new interactional cycle in process. EFT is thus experiential in that it focuses on the client's experience; it is also constructivist in that it focuses on how that experience is created and processed. In the experiential tradition, people are viewed as active perceivers constructing meanings and organizing experience on the basis of their current emotional state; experience is accepted as legitimate and valid in the context in which it occurs. EFT is experiential in that it focuses on present experience, particularly the emotional responses underlying each partner's stance toward the other, and on the reprocessing of these responses in such a way as to change interactional positions. In this approach, the clients' needs and wants are cQnsidered legitimate and

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healthy in themselves and are therefore validated by the therapist and expanded on in the present. It is disowning emotional responses, restricting awareness, and defensive automatic emotional reactions that are seen as problematic. EFT is systemic in that it focuses on the process of interaction, particularly negative interactional cycles, frames responses within the context of the other partner's behavior, and enacts previously avoided interactions in the therapy session. It has been suggested (Stanton, 1979) that the reenactment of problematic interactions and the enactment of new interactions choreographed by the therapist are the distinguishing. features of the structural approach to therapy. The structuring of proximity and distance is the main concern (Minuchin & Fishman, 1981). The focus is on the process of interaction, rather than the content, and on the positions taken by the partners in that interaction. Each partner habitually responds to the other in ways that evoke negative reactions, which then reinforce negative emotional responses. The task of therapy is the interruption of this cycle and the creation of a more positive cycle. Since each partner's behavior is viewed as an adjustment to the behavior of the other, the negative cycle is often framed both as an attempted solution constructed by the partners out of their need to protect themselves and as a pattern that turns them both into distressed victims who, in their attempt to create a safer, less threatening relationship, become more and more alienated from each other.

THE PROCESS OF CHANGE The goal of the EFT approach is the restructuring of the emotional bond. This goal, along with the different change processes involved in attaining it, is discussed below.

Restructuring the Emotional Bond In EFT, an individual's experience and behavior are seen as being simul• taneously determined from within and without. Context, perception, and choice all determine behavior. Awareness develops at the organismenvironment contact boundary in order to negotiate dealings between the organism and the environment. The interaction between the organism

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and the environment is viewed holistically, as a system, and the self is seen as being formed in the moment at the boundary in reference to all current influences. The interactional system needs to be viewed not only in terms of the ongoing sequential interactions between participants, but also as being a field event in which all performances are simultaneously affecting and being affected by all other performances in the field. At any moment, all parties in an interaction are under the influence of multifaceted, multidimensional influences. The system is thus more of a complex field of forces than a set of discrete, albeit circularly related, interactions. This field is continually organized by all the changing com­ ponent influences, and whatever occurs at any moment represents the resultant direction of all the constituent forces. A field conception more accurately captures the bond of interconnectedness between people in which the participants, in an ever-changing interaction, are constantly and simultaneously reflecting and defining the other and the self. The influence process between a couple is thus more like that be­ tween two magnets than like that in a homeostatic system. In a magnetic field, the properties of the magnets together interact to constitute the field. In a homeostatic self-regulatory system, such as a thermostat, it is the feedback from the comparator that leads to self-regulation. The notion of feedback as a means of control is quite different from the idea of mutual influence in a field. The homeostatic feedback conception of cybernetics, although at some level helpful in describing the functioning of couples, is still too discrete and simple in its view of the couple system, and it does not truly describe or explain what actually occurs in an interactional system. The notion of a field is more descriptive of the mutual influence process in human interaction. In a field, interactions and individuals become organized in particular ways as a function of the multidimen­ sional influences acting at any moment. Although the magnet analogy is initially useful in describing a field, it breaks down when applied to human interactional fields because magnets themselves are static, struc­ turally stable entities, while individuals are constantly in a process of change. It is imperative to think of individuals as flexible and kaleido­ scopic, as continuously forming organizations that mutually determine and are determined by the field in which they are placed. Within this field view, the purpose of EFT can be described as attempting to change the interactional and emotional field so that indi­ viduals and interactions are reorganized to result in more functional

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relationships. A major goal of EFT is restructuring the emotional bond so as to promote a continually regenerative I- thou dialogue between partners. Family, marital, and couples problems emerge because of the dysfunctional emotional involvement between people. The goal of therapy is to alter the nature of this involvement. For instance, when a child begins as or becomes "the patient," the first step of therapy is breaking the triangular involvement between parents and child and promoting contact between the parents so that they can talk to and listen to each other in a new way. This, then, can become the beginning of couples therapy; that is, the task of couples therapy is the restructuring of the emotional bond between the couple toward more accessibility and responsiveness (Johnson, 1986). If the couple is the presenting problem, rather than a symptomatic child or one partner, the couple is more able to recognize that their emotional involvement is unsatisfying, and work on the relationship can begin directly. The healing possibilities of the I-thou relationship, which probably once operated in the relationship, have long been forgotten, and the emotional bond is in need of repair. The relationship has generally become organized as either too distant or too involved, or there is an imbalance in the dominance hierarchy-one person is up and the other is down. While the individuals are engaged in a struggle for self-definition, the couple needs to be moved to a new level of transaction and mutual dialogue. To do this, certain aspects of self, those internal capacities and resources that are not currently being used in the interaction, need to be accessed and activated, thereby modifying the field. New self-organization will lead to new interaction, and new interaction will reciprocally lead to new self-organizations. Three perspectives on achieving these kinds of change are presented below.

Changing Self Contexts

Often, the best way to access new aspects of self is to change the context of the self. Many people believe if they feel unhappy or weak that they should change themselves to become happier, stronger people. This highly prevalent view leads people to underestimate the power of the family or relationship environment and the need for environmental support. More self-support is sometimes needed, but often more environ-

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mental support, in the form of a network of loving and supportive relationships, is most enhancing. Environmental support often allows new aspects of self or new self-organizations to emerge. The most important element of the context in a couple is the partner.Thus, if the therapist wishes to access a new aspect of self in partner A, this often can be most easily done by changing, in an appropriate fashion, partner B's expression or engagement in the interaction. This, in turn, is done by changing the field that governs partner B's experience. The therapist has two avenues of intervention for changing B's experience: interactional and intrapsychic. The therapist is part of B's field, in the therapy, and can use him- or herself to evoke and support new parts of the self in B in order to change A's view of B and ultimately A's self-organization. The therapist can also work to provide both partners with a new self experience. In an intrapsychic approach, changing A involves the skills of working with the individual's inner world to achieve self change, whereas in an interactional approach, changing A involves an understanding of and working with the reciprocity in the relationship; that is, one achieves change in A by changing the context that supports A's behavior and experience. Understanding how context determines behavior and how patterns such as dominance and submission are reciprocally determining is thus of major significance in making interactional interventions.

Supporting Fluctuations

One of the major problems of family systems theory has been its inability to explain the generation of newness and how change, growth, and creativity take place. Although concepts such as positive feedback and morphogenesis (changing of the form) exist, they have never been used to explain how change takes place in a family. New perspectives on system functioning have, however, emphasized the idea that systems are composed of ongoing processes rather than fixed stable entities and that a given system at any time is actually a current configuration of processes (Kaplan & Kaplan, 1982, 1987). Within any current organization, however, there are always fluctuations that are kept within certain bounds. Change comes about by amplification of some of the fluctuations (Hoffman, 1981; Prigogine, 1976; Prigogine & Stengers, 1984). In a couple locked into a vicious interactional cycle, there are multiple sources of momentary fluctuations of experience in each partner that are

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dampened and curtailed by repeated patterns of behavior. It is this restric­ tion of newness that produces the stability of the negative cycle (Kaplan &, Kaplan, 1987). The momentary fluctuations are, however, potential sources of change. In any complex interaction, subprocesses of potential emerging experiences and expressions are continually not being brought to fruition. There is always more going on within a person, at any moment, than that person or his or her partner can accurately symbolize. A particular feeling of sadness may emerge in a brief sigh by one partner but may be over­ looked by either or both of the partners. This potential self-experience represents a fluctuation in the ongoing self process that is lost. In other instances, a caring glance from one partner to the other is lost in a rapid interchange or an offer of concern or understanding, or a flicker of resent­ ment or anger is swamped by the predominant customary way of relating. Yet emerging moments, held in check by dominant self and interactional organizations, represent the possibility for change. While the systems per­ spective that helps us identify patterns such as the negative interactional cycle tells us about what people keep doing, the process and field perspec­ tives focus on how change occurs. Current functioning always provides clues of alternative organizations and alerts us to look for ways in which fluctuations are dampened by the interaction. As the Kaplans ( 1985) point out, certain patterns develop because, even though they may be painful, they are predictable and reliable. Chang­ ing these patterns involves risk and facing the unknown. To venture beyond established predictable forms of interaction involves a particularly large risk in a hostile or nonsupportive environment. Thus, the task of the therapist is to provide sufficient safety to help people become more flexibly organized and then to help them focus on and develop the emerging fluctuations in their experiences and interactions. If the previously unsym­ bolized sadness or caring glance is brought into awareness and into the interaction, it will change the course of the subsequent interaction; if developed sufficiently, it will help to change the rigid pattern of interaction. The therapist thus focuses on supporting perceived fluctuations. The crucial feature of a self-organizing system is found not so much in the preservation of a homeostatic equilibrium but rather in the mainte­ nance of coherence of organizing processes by means of continuous equilibrium restructuring (Dell, 1982). Thus, the aim of the system or self is not to remain the same but to maintain a coherence that fits best within the field. A self-organizing system is a growing system, proceeding to­ ward more integrated levels of functioning and higher levels of structural

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complexity. It is this thrust toward incorporating newness while maintaining coherence that Prigogine and Stengers (1984) have captured in their formulation of order through fluctuation. It is this process we are emphasizing here in suggesting that the therapist support fluctuations to promote new organizations.

Evoking Emotion The experience and expression of emotion is important in bringing about change in a couple's interaction in this approach. Emotional expression is involved in change on at least two levels in this therapy, for emotion is both a crucial means of communication and an important self-organizer and motivator of individual action. As we have discussed in the previous chapter, emotional expression in humans is a primary signaling system that serves a communicative function right from birth. Affective expression, therefore, is a crucial form of communication, and expression of particular emotions has particular significance in human interaction. Although expressions of love and intimacy can be inherently reparative in intimate relationships, these expressions are often more the result of an affectively oriented couples therapy than the means whereby the therapy takes place. The primary emotions expressed most often as part of an affective therapy are fear, vulnerability, sadness, pain, anger, and resentment. Major changes in interactional sequences can be brought about by reframing a negative interactional cycle in terms of the unexpressed aspect of the person's feeling and restructuring the interaction based on the need or motivation amplified by the emotional experience. A "pursue-distance" interaction can therefore be reframed in terms of the pursuer's underlying caring or fear of isolation and the distancer's fear or unexpressed resentment. The reframe is much more likely to be experienced as valid when these previously unacknowledged feelings are experienced and expressed during therapy. The deeper the experience and expression of these feelings, the stronger the reframe and the change in meaning of the interaction. The new expressions are also themselves changes in the interactional sequence, thereby promoting further changes in the interaction in a mutually causal circular process. Thus, evoked loneliness intensifies the need for connection and motivates more affiliative behavior. Evoked anger in the previously passive partner amplifies

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the person's need for autonomy and motivates more self-defining actions. These new behaviors evoke new responses to them. Thus, emotion moti­ vates new behaviors, which change interactions. In addition to the effect of emotion on interaction, the experience of emotion is the end product of a set of automatic or unconscious informa­ tion-processing activities. Emotion, as we discussed, is a construction from expressive-motor reactions, emotional schemata or memories, and ideas related in an emotional network rather than the result of an inference or thought. Activation of any one of the components of the network or the priming of a number of components can activate the whole network or other parts of the network. Emotional experience is therefore as much a function of the inf or­ mation-processing that takes place at preconceptual, expressive-motor, and schematic memory levels as it is a function of conceptual cognition (Greenberg & Safran, 1984a, 1987a). Purely conscious conceptual change involving a change in people's reasoning or attributions does not neces­ sarily produce a change at an emotional level. This is why emotion needs to be evoked. Emotional change cannot occur without the evocation of the network and its restructuring. Affect is very important in changing attitudes because affectively laden internal information appears to be closely linked to people's self­ schemata and tends to override other cues and dominate the formation of meaning. Affect plays an important role in three individual change processes (Greenberg & Safran, 1984a, 1987a) that are highly relevant to couples therapy. The first is the process of acknowledging previously unacknowledged, biologically adaptive primary emotions that aid prob­ lem-solving. The second is the restructuring of emotion schemata that contain representations of the self, the other, and the situation. The third is the modification of core cognitions that emerge for therapeutic consid­ eration only when the person is in the aroused affective state. These processes occur in each individual during the process of successful cou­ ples therapy. Accessing biologically adaptive primary emotions, pre­ viously not dominant in individuals' organization of their experience, provides information that helps people define themselves better, in­ creases motivation for and enhances problem-solving, and helps partners communicate their needs more clearly. In emotional restructuring, affec­ tively charged emotion schemata are also aroused in order to make them amenable to change. Using a computer analogy, the underlying response program needs to be run in order to assess where the problem lies and to

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have the program links available for change. As Lang (1983) has pointed out, the more the stimulus configuration matches the internal structure or schemata, the more likely the whole structure will be evoked and will then govern experience. The presence of the emotional experience embedded in the network of associations is necessary before the experience can be restructured. Thus, fear of intrusion or self-disgust, for instance, needs to be evoked in therapy in order to change them. Restructuring is achieved by allowing certain incomplete expressions to run their course and by admitting new information to the schemata, thereby altering its organization. Inspection of a number of change episodes (Greenberg & Safran, 1987a) reveals that it is usually a combination of the relief and recovery after the completed expression of an emotion, such as grief or anger, and the cognitive reorganization involved in expressing the emotion that lead to change. Thus, the experience of the anger at, and loss in relation to, a distant and rejecting parent and its being worked through to completion allows the person to incorporate a new understanding of the parent's difficulties and to let go of the need for attention or love from him or her. In addition to affect leading to change by altering self-organization or restructuring schemata, it has become clear that arousal of currently experienced emotions can provide access to certain state-dependent learnings. Certain core cognitions, cognitive-affective sequences, and complex meanings learned originally in particular affective states are much more accessible when that state is revived. Accessing these "hot cognitions" (Greenberg & Safran, 1984b, 1987a) can be particularly important in clarifying couples' interactions because key construals that induce certain behaviors in the interaction are often not readily available for recall when the problem is being discussed coolly, after the fact, in therapy. Helping couples re-create the situation and relive the emotions in therapy often makes the cognitions governing these behaviors more available for inspection, clarification, and modification.

THE EVALUATION OF EMOTIONALLY FOCUSED THERAPY Research on the outcome of EFT is reviewed briefly below in order to present the existing evidence on the efficacy of the approach. Research illuminating the process of change is presented in Chapter 8.

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THEORY AND RESEARCH

A preliminary point of some interest is that a brief manual describing EFT was found to be useful for the purposes of training and research . Presented in the next section, the manual outlines a nine-step procedure in an attempt to capture the major treatment strategies. From this manual, an adherence measure was developed for use as an implementation check in the research studies. Generally, it was found that EFT could be accurately described and successfully identified by trained raters using the adherence measure. The raters were able to discriminate EFT from both a behavioral approach using problem-solving and communication training (Johnson & Greenberg, 1985a) and a systemic, interactional approach using paradoxical reframing and prescription (Goldman, 1987).

Results at Termination Three studies of the effects of manual-guided EFT on moderately to more severely distressed couples have been conducted. The first study (Johnson & Greenberg, 1985a) compared the relative effectiveness of EFT and a cognitive behavioral problem-solving (PS) approach that involved problem-solving and communication training. Forty-five moderately distressed couples were randomly assigned to one of these two treatments or to a waiting list control group. Eight sessions of each treatment were implemented by six experienced therapists who were committed to the particular approach they were using. Adherence to treatment manuals was monitored and maintained with a high degree of consistency. The perceived quality of the therapeutic alliance was also measured and was found to be equivalently high across treatment groups. Results in this study indicated that both treatment groups made significant gains ovt:_r untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. The effects at termination of EFT were in addition superior to those of the PS intervention on martial adjustment level (see Table 1), as measured by the Dyadic Adjustment Scale (DAS; Spanier, 1976), on intellectual intimacy, as measured by the Personal Assesment of Intimacy in Relationships (PAIR) (Schaefer & Olson, 1981), and on the target complaint level. It has been recently suggested that there are more meaningful ways of summarizing the effects of treatment than simply reporting group

AN AFFECTIVE SYSTEMIC APPROACH

49

Table J. Dyadic Adjustment Scale Scores Study I Pre

Post

2-month follow-up

EFT

92.8

PS

91.7 91.9

112.7 102.4 91.5

112.4 101.1

C

Study III

EFT IS C

Pre

Post

86.27 83.86 82.50

100.14 96.75 80.86

Note. EFT= emotionally focused IS = interactional systemic.

4-month follow-up

I-year follow-up

92.05 101.0

99.47 100.72

therapy; PS = problem solving;

C = control;

means (Jacobson & Follette, 1984; Jacobson, Follette, & Revenstorf, 1984). If couples' posttreatment DAS scores are assessed in terms of effect size (Smith & Glass, 1977), the obtained effect size for the EFT group was 2.19 and for the PS group was 1.12. That is, the mean effect of EFT was more than two standard deviations from the postwait mean of the control group. Another way to view the results is to compare the treated couples' marital adjustment to that of nondistressed happy couples. The posttreatment and follow-up mean DAS score for EFT couples was within two points of Spanier's norm (1976) for married couples (M = 114.8), and 47% of the EFT couples scored above this norm. This study was one of the first controlled comparative studies of an experiential and behavioral treatment for marital distress and indeed one of the few controlled studies of a more dynamically oriented (as opposed to behaviorally oriented) marital therapy. The EFT approach has thus been shown to have a positive effect on couples' ability to achieve goals and change specific complaints, as well as on variables such as marital satisfaction, which were more directly addressed by the treatment interventions and are viewed by marital partners as being highly related to positive emotions (Broderick, 1981 ). The main limitations of the study were that all measures were self-reported, and the results can only be generalized to the population of moderately distressed couples.

50

THEORY AND RESEARCH

The second outcome study (Johnson & Greenberg, 1985b) involved a within-subjects' design in which control subjects placed on the waiting list in the first study were treated, and postwait, posttreatment, and follow-up outcomes were assessed. The therapists in this second study, however, were novice marital therapists who received 12 hours of training in EFT plus ongoing weekly supervision. No significant changes on dependent measures (the same as used in the first study) were found at the end of the 3-month postwait period. This finding of no change after waiting adds to the evidence that marital distress is not a phenomenon prone to spontaneous remission. After an 8-week EFT treatment, the couples showed change on all outcome measures. The results were generally consistent with the previous study; however, the effect size (0.94) was smaller. The most likely explanation for the smaller effect size would seem to be the inexperience of the therapists, who were learning how to practice marital therapy in this project. One of the additional positive findings of this study is that EFT was delineated with sufficient specificity that it was able to be successfully taught to novice therapists. In the third outcome study (Goldman, 1987) EFT was compared with an interactional systemic (IS) treatment that involved the use of a team behind a mirror suggesting tasks to restructure the interaction and sending paradoxical messages (Weeks & L'Abate, 1982) to reframe and prescribe the negative interaction cycle (Greenberg & Goldman, 1985). In this study, 42 couples were randomly assigned to EFT, to the IS treatment, or to a waiting list control group. The selection criteria for this study were set to select couples with lower DAS scores than in the previous studies in order to test a differential treatment hypothesis that an IS approach would be superior to EFT for more distressed couples. The couples in this study were the refore somewhat more distressed than the couples in the first two studies, with a mean DAS score of 84 as opposed to a mean DAS score of 92 in the earlier treatments. In this study, 10 sessions of each treatment were implemented by seven experienced therapists committed to the approach they were using. Of the seven therapists using EFT, only one had been a therapist in the first study, so this represented a new group of therapists. Adherence to the treatment manuals was monitored, and the core of the EFT treatment was administered, although the later steps of the manual, involving the

AN AFFECTIVE SYSTEMIC APPROACH

51

provision of an overview of the couples' functioning, were not as rigor­ ously maintained as in the first study. The perceived quality- of the therapeutic alliance between the couple and the therapist was measured after the third and final session. The alliance was found to be equivalent in both groups after the third session. Results indicate that, at termination, both treatments significantly improved the quality of the marital relationships when compared with the waiting condition. Outcome measures included marital adjustment, goal attainment, target complaints, and conflict resolution. Contrary to our expectations, no differential outcome effects between the two ap­ proaches were found at termination. DAS scores are shown in Table I. The proportion of couples who had improved their marital adjustment -as measured by the dyadic adjustment scale (Spanier, 1976) at termi­ nation, according to the stringent condition of improvement criterion suggested by Jacobson et al. (1984)-was 71%, or 10 out of the 14 couples. Follow-up In the first study, both the PS and the EFT groups were found to have maintained their gains at a two-month follow-up. The EFT group was in fact found to score higher than the PS group at follow-up on two of the four outcome measures. This was a promising indicator that the effects of EFT lasted at least until 2 months following therapy. No follow-up was completed in the second study. In the third study, couples were followed up after 4 months and I year with a complex pattern of findings. Although there was no statisti­ cally significant difference at the 4-month follow-up between the EFT and the IS groups when compared with each other, there was a signifi­ cant interaction effect. This showed that the EFT group, although main­ taining some change, had dropped significantly on three of the four measures between termination and the 4-month follow-up, whereas the IS group had remained stable over this period. At a I-year follow-up, however, the two groups were again indistinguishable, and the EFT group appeared to have improved from the 4-month follow-up to levels comparable with its scores at termination. DAS scores are shown in Table I.

52

THEORY AND RESEARCH

What appears to have happened is that the couples in EFT, having improved over therapy, lost some of their gains after 4 months, but regained them after 1 year. Couples in both groups were interviewed intensively at the 4-month follow-up, and the couples in the EFT spoke more frequently of the need for check-up sessions foil owing termination or for more practice to maintain the levels attained at termination. Both sets of couples , also reported that they would have liked a few more sessions added to the treatment package of 10 sessions. One possible interpretation of this data is that EFT provides the couple with a self-generating set of conditions for maintaining satisfaction, if couples reach normative levels of marital satisfaction (DAS = 114 ± 10) by termination, as they did in the first study. When, however, therapy terminates and the couple has not reached a functional level of satisfaction and intimacy, as occurred with some couples in this study, although they have experienced some improvement and experienced some intimacy during therapy, the change is not sufficient to sustain the improvement, and the couples deteriorate to a degree. Thus, the findings with the more distressed sample used in this study suggest that more than 10 sessions of EFT might be beneficial in order to increase the level of couple satisfaction at termination. In the IS group, couples, although they terminated at similarly low levels of satisfaction, did not deteriorate but rather maintained their gains. This suggests that a selfsustaining process of change has been created. After I year, however, the EFT group was indistinguishable from the IS group. It is as though, having had a glimpse of intimacy and greater satisfaction and then lost some of it, the couples in the EFT treatment found their own way back to previously achieved levels of satisfaction. These findings are interesting in light of the attitudes of systemic therapists toward emotionally oriented treatments. The creation of intimacy and expression of feeling are often seen as making people feel good but not as necessarily producing change. The truth maybe lies somewhere in between, that unless the emotional system reaches a sufficiently high level of trust and satisfaction, it does not automatically produce permanent or second-order change. Initially, change may occur by a circular process whereby good feelings increase motivation to change behavior, and this change in behavior modifies interaction cycles, which in turn help to increase good feelings. This needs to occur repeatedly until such time as trust is developed and the bond is restructured- that is, until such time the change process is reversible.

AN AFFECTIVE SYSTEMIC APPROACH

53

SUMMARY

EFT integrates experiential and systemic perspectives. People are viewed as constructive, self-organizing beings having inherent tendencies to survive and grow. This process of self-formation is totally context-dependent in that the organism is in dynamic equilibrium with the environment. Thus, interaction is understood in terms of circular causality or reciprocal determinism, rather than linear cause and effect. In viewing the person as a self-organizing system in a continual process of becoming, in a field constituted both by internal intrapsychic influences and external interactional influences, change can be brought about both by changes in self and changes in context. Thus, therapy focuses on changing both the interactional cycle and each person's inner experience of self and the relationship. The process of change is directed toward a restructuring of the emotional bond. This is brought about by changing the context in order to promote new responses and by supporting emerging new aspects of self. Evoking and expressing the emotional experience underlying interactional positions allows the restructuring of intrapsychic and interpersonal processes. Research has demonstrated that the approach conceptualized above led to positive change in three studies of the effects of EFT. Significant effects were found at termination and follow-up on a variety of measures. Treatment that did not bring couples to a functional level of adjustment by termination appeared to lose some of its impact over time.

PART TWO

Practice

CHAPTER THREE

General Considerations

'

In emotionally focused couples therapy, intrapsychic and interpersonal perspectives are combined; interactional positions are assumed to be maintained both by strong, primary, emotional responses and by the way interactions are structured and organized-that is, by intrapsychic realities and the rules of the relationship. Hence, the goal of emotionally focused therapy (EFT) is to enable a couple to change the habitual positions they assume in relation to each other and to change the way each partner experiences the relationship. The direction of this change is toward genuine dialogue and the fostering of accessibility and responsiveness. The emotional experience underlying relationship positions is then explored and expressed in order to enable couples to reorganize their relationship-specifically, to take more flexible positions with each other. These new positions involve new, more differentiated perceptions of the self and the other and an expanded range of behaviors in response to the partner. EFT is based on the concept of intimate relationships as emotional bonds. The needs of the partners in such relationships are viewed in terms of the provisions supplied by intimate bonds, such as the affirmation of worth and identity, the creation of a shared reality, and the provision of nurturance, security, and intimacy. The general principles of EFT are as follows: 1. The therapist focuses on the present experience of each partner in the relationship. Individual past experience is evoked only in the event that such experience seems to be blocking one partner's ability to respond to the other in the present relationship. More recent relationship experiences-for example, the fight the couple had on the weekend-are evoked in the present by the therapist. Partners then do not 57

PRACTICE

~imply discuss events; they also reexpenence whatever remains unres h~ . 2. The focus is particularly on accessing primary emotional experirnces, especially each partner's experience of vulnerability and / or fear , and having partners communicate these underlying experiences to each ther; reyealing themselves and their needs for contact and comfort helps t create a genuine dialogue. Primary emotional responses not fully attended to, and therefore not available to conscious awareness, nevertheless create an orientation to the partner and to the relationship; therefore, they override other cues that are inconsistent with this orientation. As a result, it is essential to bring these primary emotional responses into awareness and explicitly into the interaction. 3. The focus is on the interactive process rather than the problematic issues. Since the same interactional patterns emerge in numerous different content issues, the focus is on these patterns; that is, how the couple fight is more important than what they fight about. The pragmatic issues presented in therapy are the arena in which the structure of the relationship and the underlying emotional responses of each partner are played out. The therapist must view the relation.,ship from this niet~level and not become enmeshed in trying to solve particular issues for a couple. As part of this focus on the interactive process, all individual responses are viewed in terms of the context in which they are evoked, that is, the context of the other partner's behavior. 4. The focus is on restructuring the interaction using the newly accessed primary emotions to motivate new behavior. Once the underlying primary emotion is experienced, the partners are encouraged to express the needs and wants associated with these emotions to each other. Different emotions dispose individuals to different actions, which may then be enacted with the partners, changing the interaction. Certain emotions promote contact and attachment behavior while others promote distancing or the assertion of control. Thus, fear, vulnerability, or t4idneu will evoke flight or nurturance-seeking behavior. Anger and dttiU8t wiJJ evoke assertion and boundary setting. These emotions and th~ u1ociated action tendencies may then be used to restructure interact-Jon, in term» of uffiliation and autonomy. In 1ummury, then, EFT concentrat.es on the present, primary, emotional e¼pc,,1 nee ond the restructuring of tJ1e process of interaction in which this ~, rl 11 ltt evoked ond expressed.

GENERAL CONSIDERATIONS

59

CONDITIONS FOR THE USE OF EMOTIONALLY FOCUSED THERAPY The first prerequisite for conducting EFT is that the couple do wish to reorganize their relationship in terms of an intimate partnership. This does not imply that from the beginning of therapy the couple have to feel totally committed to the relationship; some relationships may be redefined as distant friendships as a result of therapy, and doubts about commitment are nearly always present in a distressed couple. However, if one partner is clearly choosing to dissolve the relationship and the other partner is resisting this decision, then EFT does not seem to be appropriate. Some of the problems couples exhibit also preclude the use of EFT; for example, this approach is not recommended for physically abusive couples. The second requirement for EFT, apart from a general consensus as to the agenda for therapy, is a good working alliance with the therapist. In EFT, the therapeutic allia~ce is a prerequisite for treatment rather than being considered as a mechanism of change in and of itself. This alliance must involve an agreement between the therapist and both clients as to the goal of therapy and the perceived relevance of the tasks involved in the therapy process (Bordin, 1979). An appropriate bond between the therapist and each client, evoking a sense of safety and trust, is the final element of such a working alliance. This sense of safety is essential in a therapy that focuses on the exploration of emotional experience. However, this bond is not as intense as may be expected in individual therapy since the other partner, the main object of each client's emotional life, is present; also, one of the goals of the therapy is the attainment of a close caring bond between the partners. The quality of the bond aspect of the alliance would seem to be more crucial in EFT than in behavioral or cognitively oriented couples therapy. The practice of skills, for example, would seem to require less personal trust in the therapist than the experiencing of previously unacknowledged and potentially threatening emotional states. The creation of a safe environment is also essential in that EFT involves each client taking considerable personal risks with the other. The reality of this risk becomes apparent when, even after emotional responses have been explored with the therapist in front of the partner, a client has great difficulty actually stating these same feelings to the partner when asked to do so. The building of an alliance is also an integral part of EFT in that the beginning stages of EFT particularly involve the therapist validating each

60

PRACTICE

partner's present experience of, and responses in, the relationship. Such validation builds an alliance and also constitutes the first step in treatment; importantly, it legitimizes clients' responses and encourages them to explore these responses further. The therapist must be able to join with both clients in their intrapsychic and interpersonal experiences even though they may present opposing antithetical views of reality. To join each client without alienating the other involves the therapist validating each one's experience without attributing intentionality or blame to the other. The use of descriptive rather than evaluative language is essential here. It is consistent with this approach to view the partners as feeling legitimately deprived of such basic satisfactions as closeness, contact, comfort, and recognition. In a relationship that is not working well, both partners are usually withholding affection and caring and are realistically feeling unloved and untrusting. The therapist initially attempts to capture the pain that each partner feels and to describe how each expresses this pain in the relationship. As discussed in the previous chapter, the needs for closeness and contact are considered here in a context of basic healthy functioning rather than in a context of developmental failure or psychopathology. Hence, the therapist presents a picture of the couple's problem as stemming from adult unmet needs and perceptions of the partner and the relationship that result in self-defeating cycles of interaction. Both partners are at o:ice the creators of the relationship dance and the victims of it. The problem is thus framed in terms of mutual responsibility and mutual deprivation. This frame, which always views one partner's behavior in terms of the evoking stimuli presented by the other, also helps the therapist to maintain the neutrality necessary for effective intervention.

Rationale The rationale for therapy is stated in terms of the fact that couples often have strong emotional responses to each other that make it difficult for them to accept the partner and respond in a loving way. As the relationship becomes less and less safe on an emotional level, it then becomes more and more difficult to be clear about what each person feels and needs from the other and to express these feelings and needs. Each person begins to protect him- or herself and enters a relationship of appearance rather than authenticity. This then leads to less and less willingness to

GENERAL CONSIDERATIONS

61

reveal oneself to one's spouse and more and more distance in the relationship. Ideally, therapy sessions are a safe place for partners to explore each other's experiences of the relationship and clarify their responses to each other. The therapist also places the relationship in the context of bonds and bonding, suggesting, for example, that the accessibility and responsiveness of the partner is a source of security and comfort for most people and is crucial in terms of how individuals view themselves and their world. This rationale does not involve a didactic statement to the client but emerges in the first few sessions as the therapist comments on interactions, validates responses, and presents his or her perspective on relationships and relationship problems.

The Process The therapist must be sensitively attuned to each partner's internal frame of reference and experience and to the impact of this experience on the relationship. One of the basic skills of EFT is, in fact, the therapist's ability to change focus rapidly from an individual intrapsychic experience to the facilitation of interaction between the partners. The therapist often takes the part of a director or choreographer. He or she guides the movement of the interactions in a particular direction, talking to partners about their experiences, crystalizing such experiences and facilitating the expression of them. The therapist may develop and expand particular experiences and conflict themes by blocking or heightening one of the partner's responses, by talking to one partner about the other, or by asking one partner to comment on the other's experience; the possible transactions are numerous. The process resembles that of a play with different subplots eventually coming together to form a deeper and more comprehensive meaning than was initially evident. Even though the emotional climate a therapist creates is supportive and empathic, the therapist must be active and directive both in terms of directing the process of therapy and in terms of ascribing meaning to certain interactional phenomena and the intrapsychic experience underlying individuals' positions in the interaction. The two main tasks of the therapist in EFT after the creation of a strong therapeutic alliance are to evoke and work with emotional experience and to help the couple to frame that experience in terms that allow

62

PRACTICE

them to redefine their relationship. (These tasks are discussed in more detail in Chapter 6.) EFT is presented to the couple as a brief therapy, lasting anywhere from 8 to I 5 sessions. It is presented as a therapy that is designed to help them orient to each other in a different and more satisfying way. Emotional experience in this case is viewed as an orienting response. The format of therapy is conjoint except that each partner is usually seen alone for one session near the beginning of therapy. These individual sessions can help build a working alliance between the therapist and client and also provide an opportunity for partners to share openly with the therapist concerning sensitive issues. Such issues may involve their level of commitment, information about past relationships, or frank evaluations of their partners and the relationship that they may not be willing to share with their partner present. Later in therapy, each partner may again be seen individually to address specific blocks in the change process, such as one partner's inability to respond to the other's expressed needs, but this is often unnecessary. In general, whenever possible, the couple are seen together. Whenever one partner is seen alone as part of the assessment procedure or to resolve a problem later in therapy, the other partner is also given an individual session since to see only one partner tends to unbalance the therapeutic alliance; also, a solo session may seem to label this partner as a problem or as particularly needing the therapist's attention. The therapist begins by listening to the story of each partner and fostering open communication between him- or herself and each client before redirecting the clients to interact with each other. In general, at the beginning of therapy, each partner will interact with the therapist for the major part of the session. As therapy progresses, however, the sessions become more and more involved with the interaction between the spouses, with the therapist directing the clients' attention to their emotional responses and when necessary, making suggestions or commenting on the relationship as he or she observes the interaction.

EMOTIONALLY FOCUSED THERAPY VERSUS OTHER APPROACHES To further clarify EFT, it seems useful to compare the change strategies used in EFT with those typical of other approaches to couples therapy. All couples therapists deal with the same problems; all attempt to reduce

GENERAL CONSIDERATIONS

63

blaming, coercion, and conflict escalation, and all attempt to encourage trust and goodwill. Most approaches attempt to clarify partners' desires, encourage mutual responsibility for problems, and modify communication patterns in general (Gurman, 1978). However, various approaches focus on different relationship paradigms which are then reflected in general treatment strategies and in specific interventions. If the troubled relationship is viewed mainly in terms of being a conclusive unconscious contract between conflicting individuals who are projecting past conflicts onto the present, then the treatment strategy is one of promoting insight into generic causes (Sager, 1981). A possible intervention here might be an interpretation of present events in terms of past problems. If the relationship, on the other hand, is viewed in terms of family systems theory, that is, in terms of symptom-maintaining transactions, the treatment strategy is to change the pattern of transactions without referring to individual motivations or experience. This may be achieved by reframing and prescriptions, by the use of therapeutic paradox (Fisch et al., 1983; Haley, 1976), or by directing people to interact differently (Minuchin & Fishman, 1981; Sluzki, 1978). If the relationship is viewed in terms of a bargain in which the participants do not have the skill to negotiate effectively, as in the case of social exchange theory, then the treatment strategy might be to substitute skillful behaviors for unproductive responses by teaching people to control their communication patterns. In this case, the interventions might focus on teaching and rehearsing specific skill sequences or making rational contracts for the exchange of desired behaviors (Jacobson & HoltzworthMunroe, 1985; Jacobson & Margolin, 1979; Stuart 1980). If, however, the relationship is viewed in terms of an emotional bond that has become threatened or insecure and in terms of trust that has been shattered, then the treatment strategy, as in EFT, is to heal the bond and to reestablish trust, by promoting the experience and expression of emotions underlying interactional positions. This is done by exploring the emotional experiences of the couple in such a way as to help each of them to evoke acceptance and contact from their partner. Partners reveal themselves to each other as they really are and acknowledge and accept each other. In this case, the interventions involve reflecting and heightening authentic emotional responses and needs underlying the structure of the bond, such as the distress at being abandoned and the need for security. The art lies in being able to help people access these emotions and overcome blocks to expressing and listening to such experiences.

64

PRACTICE

To take a pragmatic example, if one spouse turns to the other and states, "I can't bear it when you talk so coolly about this,:' how would therapists from other approaches conceptualize and respond to this statement? A psychodynamic therapist, searching for underlying dynamic motivations and perceptual distortions, might say, "You spoke of your father always being "cool" in the last session. Does this response seem familiar to you?" In the strategic systems paradigm, the therapist might reframe the interaction as one based on the cool partner's caring or concern for the other. In the behavioral approach, the therapist, focusing on negotiating new behaviors, might suggest that the speaker pinpoint exactly what the partner does that evokes this response and that she state specifically how she would like his behavior to change. In the emotionally focused approach, the therapist might direct the client's attention to a current aspect of their experience that would help restructure the interaction. The therapist might say, "How are you feeling right now? There seems to be a kind of desperateness in your voice." Each therapist is attempting to change the communication process; however, the EFT approach differs from the psychodynamic in that the focus is on the immediate emotional experience rather than on a more abstract understanding of generic origins; also, EFT views context as helping construct inner experience. EFT differs from the systemic and behavioral approaches in that the exploration of inner experience is a priority. The other three approaches to a certain extent all use a more rational conceptual model, although the conceptual processes involved in the different approaches may vary from complex insights about patterns of responses to a skill-building process involving negotiation or problemsolving skills. The EFT approach, in contrast, assumes that emotional responses are the most relevant source of information likely to lead to an adaptive response in the situation; on the other hand, in the systems and behavioral approaches, the exploration of emotional experience is generally considered to be detrimental or irrelevant. If emotion is addressed, for example, in the behavioral approaches, the expression of alreadyformulated emotion is seen as simply one step in the rational problemsolving process. In psychodynamic approaches, emotional responses are often seen as infantile responses requiring socialization. Negative, reactive emotional expressions such as blaming the partner have been considered generally problematic in all approaches to couples therapy. Thus, if a husband says to his wife, "You've never loved me and you only care about yourself," therapists from the behavioral approaches

GENERAL CONSIDERATIONS

65

might attempt to suggest that this kind of blaming is dysfunctional and substitute other statements or help the client to pinpoint his grievance more specifically. However, these interventions tend to bypass or ignore the client's immediate experience and his feelings of rage and rejection; instead, the client is encouraged to detach himself and control his emotions. The more analytic therapist might make an interpretation as to the intrapsychic origins of this type of remark and explore the blamer's relationship with a rejecting parent; this, then, disregards the ongoing interaction patterns between partners. The EFT therapist, in contrast, would attempt to focus on the present felt experience, validate this experience, and then begin to unfold what it is that this client feels and ultimately wants from his partner. In the EFT approach, the negative reactive emotional experience is validated; this is the first step on the path toward accessing the more primary and adaptive underlying emotional responses. These are legitimate reservations concerning the expression of such negative feelings in couples therapy. For instance, some therapists feel that this expression tends to solidify the status quo and create more distance between the couple. However, this reservation is valid only if emotion is simply ventilated rather than acknowledged or used as a stepping stone to the exploration of authentic underlying feelings. It is the exploration that then leads to new response patterns and a restructuring of the relationship. The different relationship paradigms and approaches imply then a different focus for the change process. Interactional patterns can either be understood from an intrapsychic point of view, reframed in order to change their meaning, structured differently by the use of rules and positive control techniques, or, in the case of EFT, restructured by reconstructing -underlying emotional states. Redefinition of the interaction in terms of underlying emotions influences the current emotional states and experiential organizations of the partners, predisposing them to become more open and responsive to each other. In EFT, new aspects of the self and the other are brought into focal awareness, revealed, and then integrated into the couple's interactions in order to restructure the emotional bond.

OVER VIEW OF THE THERAPY PROCESS In this section, an overview of therapy is presented followed by a case example describing the therapy process and then an example of the process in one session of EFT. The steps of therapy are presented in a

66

PRACTICE

brief, linear manner. (A further delineation of these steps, together with a description of therapist interventions and an exposition of techniques, is given in Chapters 5 and 6.) This overview is designed to orient the reader to the following chapters. Although the steps are presented in a linear fashion, progress through them is often circular; the therapist often goes back and retraces various steps at varying levels of awareness as unacknowledged emotional responses slowly become clear. Each step is also described more fully in Chapter 5. The nine steps of therapy are as follows: l. Delineate the issues presented by the couple and assess how these issues express core conflicts in the areas of separateness-connectedness and dependence-independence. 2. Identify the negative interaction cycle. 3. Access unacknowledged feelings underlying interactional positions. 4. Redefine the problem(s) in terms of the underlying feelings. 5. Promote identification with disowned needs and aspects of self. 6. Promote acceptance by each partner of the other partner's experience. 7. Facilitate the expression of needs and wants to restructure the interaction. 8. Establish the emergence of new solutions. 9. Consolidate new positions.

Case Example: The Steps of Therapy John and Tess, a couple in their early 20s, came into therapy having been married for 2 years. The presenting problem was stated in terms of sexual dysfunction, in this case, vaginismus on the part of the wife. The couple had attended a sexual dysfunction clinic and had been told there was no physical cause for their problem. The problem had resulted in a short separation and a brief affair on the part of the wife. The couple•s perception of the problem was as follows: Tess believed that there was "something wrong with her," and John was frustrated that his marriage seemed to be on the rocks when, as he saw it, he was doing everything he could to maintain the relationship. The sexual problem was not apparent in courtship but appeared directly after the marriage.

GENERAL CONSIDERATIONS

67

In terms of basic issues of affiliation and dependence, John was at once very dominating in his manner, speaking loudly and frequently, and very desirous of physical and emotional closeness. Tess, on the other hand, seemed very passive, presenting herself in a very submissive and withdrawn manner, speaking very quietly, not making eye contact, and allowing her husband to direct the session. Both stated that they wanted the relationship to continue. Identifying the negative interactional cycle was a simple matter in that the couple enacted it constantly in front of the therapist. They also described a sequence in their everyday life in which John initiated contact, and when Tess did not respond as he wished, he became critical and then attempted to push her into being with him or into making love. The pattern here was very clear: The more he pushed the more she withdrew. John would finally withdraw in a huff until the sequence began again. The therapist identified the negative cycle and pointed out that the pattern seemed to hold no matter what topic was discussed or where the couple were, in a session or at home. This pattern of pursue-distance is one of the most typical in couples' attempts to achieve intimacy and security and is particularly common in distressed couples entering therapy. Two other cycles, mutual distance and mutual blaming, are often attempted solutions to unresolved basic pursue-distance cycles. In therapy, the two "solution" cycles, if probed, often reveal themselves to be variants of the basic cycle of the pursue-distance form. A second fundamental pattern is that of dominance-submission in which the partners become involved in a complementary one up-one down pattern that becomes part of each partner's self-definition. The elements of separateness-connectedness (affiliation) and dependence-independence (power) are always present in any interactional position and in any cycle; however, the way a particular couple interact often leads the therapist to focus more on one aspect than the other. In this case, Tess, as well as withdrawing, adopted a submissive position, using her sexual symptom to avoid domination. John, as well as pursuing Tess for closeness, adopted a dominant position. The cycle here thus could be viewed from both power and affiliation perspectives; that is, it can be seen as a submissive distancing response evoking and resulting from a dominant pursuing response. In an optimally functioning relationship, responses are flexible but centered around a basic level of equality and interdependence which then facilitates the resolution of affiliation issues. Security, arising from a sense of having some control in

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the relationship, would seem to be a prerequisite to intimacy and the accessibility and responsiveness necessary to the maintenance of close, satisfying bonds. The therapist, having identified for the couple the basic cycle as a pursue-distance cycle, began to explore the unacknowledged feelings implicit in the positions that this couple took with each other. The main focus of therapy became John's anger and frustration and the basic sense of helplessness underlying his initial dominant style. John also began to talk about how afraid he was of losing his wife and his anxieties about being alone. For Tess, therapy began to center on her sense of being overwhelmed and invaded by John. The therapist then began to reframe the problem in terms of Tess's sense of intimidation and fear and John's sense of helplessness and dependency on his wife; that is, the therapist framed the problem in terms of their underlying emotional responses to each other and to the pattern of their interactions. Tess began to explore her fears of being taken over and engulfed not only in sexual areas but in other areas such as finances, decision-making, etc. She also examined her almost physical fear in the face of her spouse's aggressive manner. The therapist used reflection, evocative imagery, and other experiential techniques to facilitate the accessing of the couple's experiences. For instance, the therapist began by exploring John's experience of Tess's withdrawal. This involved John's sense of rejection (which was at first denied), his very strong sense of inadequacy as a lover and a partner, and panic at being isolated from his spouse. His previously disclaimed tendency to dominate his partner was placed in the context of his anxiety and his fear of losing his wife. At first, John was not receptive to Tess's expression of feelings of intimidation and fear. He intellectually discounted them and pointed out how inaccurate and mistaken they were; she then became confused and withdrawn. A vivid evocation and reprocessing of her fear in the session were necessary before Tess was able to own this fear and communicate it to John in such a manner that they could both see that her response to the fear was to shut him out and retreat inside herself. John was encouraged at this time to experience and express the feelings of loneliness and failure that he experienced in the relationship. Tess was surprised but responsive to John's expressions of anxiety and his fears of inadequacy. The therapeutic task at this point was to help John hear how Tess experienced his approaches to her. Each partner now began to see how their responses evoked certain emotions and reactions in the other.

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The therapist now could help the couple restructure the interaction using newly accessed emotion to motivate new behavior. Having ex­ pressed her fear and having had it validated and accepted, Tess was able to assert her needs for safety and comfort rather than withdraw. New, more contactful and assertive behavior on her part now became possible. She began to express her desire for some autonomy and control in sexual areas as well as in others. John began to ask for reassurance a'i to his wife's caring and positive regard for him and to talk of his need for closeness. New emotional syntheses led them to new action tendencies. As the couple began to take new positions with each other, Tess started to talk clearly and assert herself more, requesting certain kinds of approaches to sexuality and to closeness in general. John became much less demanding and aggressive and in fact presented himself to his wife as vulnerable and needing to be wooed back into a sexual relationship with her. Tess began to take more control, initiating sexual contact, running her own finances, and responding to John's need for reassurance. At the end of therapy, the couple were more balanced and flexible in their positions with each other. They had started to make love and were able to reassure each other about their commitment. They engaged in genuine dialogues with each other in therapy and were thereby able to tap resources in the relationship and to create again the unique sense of caring and commitment that constitutes the life force of an intimate relationship. Therapy ended with the couple role-playing each other as they were at the beginning of the change process. She was able to play at being forceful and intimidating and he at being passive and withdrawn. The couple had found new solutions to their sexual problem and had also restructured their interactions to include more equality and closeness. The link between the presenting symptom of vaginismus and the struc­ ture of the relationship was very clear in this case, and once the relation­ ship was reorganized the symptom disappeared. In this therapy process, John, a critical pursuer, accessed his vulner­ ability and communicated his fear of being unaccepted to his wife. Tess, a passive withdrawer, also accessed and expressed her fears in the relation­ ship and was able to respond to John's vulnerability. Both partners redefined their positions in the relationship so that they felt more person­ ally secure and were more accessible and responsive to each other's needs. This kind of process is not viewed in terms of a structural personality change but rather within an experiential and systemic framework. A couple's dysfunctional ways of processing experience and contextual

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constraints result in the utilization of only a limited amount of the information available in a particular situation; this information is structured into only one of a number of possible self-organizations. When partners resynthesize their emotional responses, they are able to construct experience in new ways-in this case example, in terms of either vulnerability or assertiveness. New aspects of self are thus accessed and revealed and are then supported by the partner's new positive responses. A new context results in new aspects of self being activated and revealed. Finally, an authentic dialogue begins in which loving and commitment to the other's well being is reestablished.

The Therapy Process in a Single Session Presented next is a description of a session in which a couple complete a treatment sequence. This session was a microcosm of the whole treatment process. It was the eighth session with a sophisticated older couple who had had a long but very stormy relationship. The session began with the partners, Sylvia and James, having a fight abo11t his reluctance to take her fishing with him. The fight followed the already-identified pattern of their interactions, in which Sylvia became angry and accusatory and James became cool, justifying his actions logically and calmly. As Sylvia became more and more demanding, James threw up his hands and suggested that her demands were boundless and that the relationship was hopeless. The therapist intervened to focus Sylvia on her feelings of panic at James's perceived distance and indifference to her need for contact and closeness. Sylvia focused on her inner experience, which had been explored in a previous session, and was able to express her vulnerability to James in an authentic manner without implying criticism of him. James, however, did not respond to her in a symmetrical fashion; instead, he implied that she was in fact "too needy." At this point, the therapist intervened. If the therapist had not moved quickly, the newly experienced vulnerability would have become costly to Sylvia, and the interaction would have escalated again into an argument. Instead, the therapist worked with James to explore his response to Sylvia by expanding, heightening, and replaying the sequence of interactions. Sylvia reiterated in a vivid, immediate, and authentic way her fears that James did not want the kind of closeness that she desired. Eventually, James revealed

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that he had become terrified while listening to Sylvia's need for reassurance and preoccupied with his own sense of always having been a failure in intimate relationships. He also acknowledged that his usual way of protecting himself was to become logical and accusatory. He further revealed that many labels had been placed on him by a past wife concerning his deficiencies, and that he had never communicated to Sylvia his sadness and hopelessness in the face of these labels. Finally, James experienced a great sadness and expressed his sense that he would never be accepted and would never be able to make anybody happy. This was at once a core belief concerning his own identity and a key appraisal contributing to his position in the relationship with Sylvia. At this point, the therapist encouraged Sylvia to respond to James and comfort him, which James then reciprocated in kind. The therapist ended the session by suggesting that the couple ask each other for help; Sylvia, with her fear of vulnerability in the relationship, and James, ·with his sense of personal deficiency. This couple had made good progress previous to this session, going through the steps of therapy in a more measured way. This session seemed to be a critical enactment of their negative cycle; however, this time the experience was reprocessed and resynthesized. New aspects of the self were acknowledged by each partner, followed by new responses in the other. As the relationship had been, it was structured to reinforce Sylvia's sense of insecurity and James's sense of inadequacy, resulting in them constantly protecting themselves from each other and thus endangering the bond between them.

SUMMARY As this chapter has outlined, the essential elements of EFT are considered to be the reprocessing, the acknowledgment, and the expression in the present of authentic emotional responses, which then lead to new interactional patterns. Prerequisites for the use of EFT were outlined, together with a rationale for therapy and the main tasks of the therapist. A comparison with the practice of other approaches was also made, and an overview of the therapy process and case examples were given. The following chapters will consider the process of therapy in more detail.

CHAPTER FOUR

The Initial Interview

In the first interview, the EFT therapist has three main tasks: ( 1) to build a therapeutic relationship with each of the two partners; (2) to assess the relationship from a clinical standpoint, particularly in terms of the cycles of interaction and the positions that each partner takes in these cycles; and (3) to begin to establish a contract for therapy with the couple, that is, an agreement concerning the purpose of therapy and the overall structure. The building of an alliance was discussed in the previous chapter; this chapter deals with the second and third of these three tasks.

ASSESSING CYCLES The therapist begins by discussing each partner's perception of the problem and expectations of the therapy process. The focus here is on how each partner experiences the relationship and views the self in relation to the other. The therapist also observes how each partner elicits responses from the other that confirm his or her intrapsychic reality; for example, when confronted a husband withdraws, evoking attacking behavior from his wife, confirming his sense of helplessness and his desire to protect himself. The therapist attempts to gain a sense of the way each partner experiences the relationship and how this experience is translated into the positions each takes with the other. Generally, the position each partner takes and the experiences underlying that position are validated by the therapist whenever possible. The therapist in accepting each partner's experience creates an atmosphere of safety and encourages a lack of defensiveness and further exploration. Thus, the responses of a partner who has been harassing his wife in an extremely dominating way, insisting on knowing every detail of her life, might be validated or made 72

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legitimate by a therapist framing these responses in terms of the husband's sense of exclusion from his wife's life and his fears of losing her. This legitimizing of where people are when they enter therapy is a natural consequence of the experiential view that it is not people's impulses or desires that are the problem, but rather, the discounting or disallowing of these desires; therapy attempts to change people into what they are rather than what they are not. Accurate empathic reflections are the main vehicle for validations. Each partners' responses are legitimized in terms of his or her experience in the relationship and perceptions of the pattern of responses offered by the partner that cue these experiences. Thus, the therapist might say, "I understand that when you don't know where she is, you become angry and you feel deserted. Then when she does come home, her reluctance to talk to you, since she sees that you are angry, is even more upsetting." This validation of an individual partner's experience must be done in such a way as to be acceptable to the other partner as well-that is, in a way that this does not discount the other partner's experience. This kind of validation also tends to diffuse negative emotional responses such as anger, while encouraging self-exploration rather than a focus on blaming the other partner. The therapist next begins to delineate patterns in the process of interactions. This begins by the therapist observing a behavioral sequence as the couple enact the sequence in the session or as they narrate recent episodes of conflict. The therapist begins to see how the partners attempt to make contact or maintain distance, influence the other, and/ or protect themselves in the relationship. Distressed couples exhibit extremely rigid, repetitive patterns of interaction that can be easily identified most of the time. These patterns or "cycles," so called since the actions of each spouse are at once a stimulus for and a response to the actions of the other, are automatic, immediate, and self-perpetuating, with the couple taking habitual positions in each interaction. Thus, the therapist might observe that as the husband begins to describe the relationship in a slow, quiet voice, the wife interrupts, discounts his description, and criticizes his perspective. The husband then smiles nervously at his wife and tries to reason with her in a placating tone; when this produces no response, he withdraws into silence with a shrug of his shoulders. The wife then attacks him for his lack of participation, and he agrees with her. Finally, the wife ends the sequence by addressing the therapist, commenting on her husband's passivity. This couple might then describe a typical recent distressing incident in their marriage, which will follow the same pattern.

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The processes of these negative cycles of interaction can be delineated on many levels, verbal or nonverbal, overt or covert, often it is very interesting just to note the nonverbal communication in a couple. For example, the husband may talk fast, twisting his hands and glancing at his wife; meanwhile, the wife purses her lips, points her finger at him, and leans forward; then, his eyes become wider, he holds his hands tighter, and he leans back in his chair. As the sessions continue, the therapist will describe the cycle in terms of internal cognitive and emotional responses and finally in terms of underlying primary emotional responses; at first, however, it is important to observe the sequence of interactions at a behavioral level before probing deeper to levels out of awareness. Two basic generic cycles or interactional patterns regularly emerge in our work with distressed couples and have been identified by other observers as well. The first, in the domain of affiliation, has been referred to as pursue-distance, intrude-reject, or accuse-withdraw. Variants of the pursue-distance cycle are, first, mutual withdrawal, where both parties take symmetrical positions and distance as a response to conflict or anxiety, and, second, mutual attack, where each partner blames the other in an attempt to change the other. The other generic cycle, in the domain of autonomy, is dominance-submission, blame-placate, or up-down. Symmetrical variants of the dominance- submission cycle are mutual helplessness, in which both partners behave in a more and more dependent and helpless fashion in response to stress, or mutual competitiveness, in which each tries to outdo the other. The pursue-distance pattern is one in which complementary behaviors (dissimilar but fitted)· evoke each other, rather than one in which reciprocal symmetrical behaviors occur (Watzlawick et al., 1967). Reciprocity often does not seem to apply for acts of rejection, which tend rather to elicit complementary behaviors such as emotional appeals or coercive tactics. Each partner's attempt to reduce his or her anxiety then contributes to the other's distress. The abandoned, pursuing partner clasps more tightly, thereby eliciting even more withdrawal from the other partner. As the pursuer strives more and more for closeness, the withdrawer, threatened by demands for contact, strives more and more for a sense of autonomy. This kind of response cycle is consistent with the predictions of bonding theory (Bowlby, 1969; Johnson, 1986), in which perceived insecurity as to the bond between partners elicits protest and proximity-seeking behavior. The more the pursuing partner attempts to suppress unresolved feelings of dependency, the more these feelings will

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then emerge in exaggerated forms such as tantrums, whining, nagging, and complaining. Such behaviors increase the negative impact on the withdrawing partner and help to maintain that pattern of behavior. The couple are then in a bind, as whatever they do increases their distress. It is not hard to see from this description why marital distress is not a phenomenon that is subject to spontaneous remission. In the mutual withdrawal pattern, conflictual communication is limited to hints, allusions, or brief rational discussion. This pattern constitutes a symmetrical interaction in which each partner mirrors the behavior of the other, in a form of negative reciprocity. Here withdrawal is seen by the couple as a safer alternative to active communication, which may become punishing and unmanageable. This kind of relationship pattern is based on the avoidance of conflict and is likely to be related to the partners' schemata or structures for organizing experience, which influence each partner's actual and fantasied interpersonal interactions. Such schemata link confrontations with extreme anxiety and lead to a denial or distortion of conflictual situations. When, occasionally, mutual withdrawers flip into mutual accusation, this then tends to reinforce their fears of open expression. The mutual accusation pattern is closely aligned with descriptions in the literature of aversive control strategies, escalating conflict patterns, and cross-complaining. This cycle is one that couples find exceedingly difficult to exit from, since each feels provoked and frustrated. As the conflict continues, each partner becomes more and more sensitive and overreactive, leading to intense hostility, a need for revenge, and an inability to empathize with the other partner. Feeling understood and acknowledged enables people to exit from this cycle. A rigid dominance-submission cycle precludes secure interdependence and is always associated with difficulties in the affiliative domain. The central issue here is not the attainment of contact, however, but the question of control. Often, submissive partners are also distancers, since both roles are associated with a certain passive stance in the relationship; however, when control is the issue, the conflict is usually framed by the couple in terms of competence and inadequacy. All relationship positions include affiliative and control elements. The element that is operationalized most clearly in the interaction becomes the focus of therapy. The clients' underlying experiences tend to differ according to which element is most prominent in the interaction. A distancer, for example, may typically access fears of being engulfed by the pursuer,

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whereas a submissive spouse will access fears of rejection, worthlessness, and inadequacy. The meshing of control and affiliative issues can be seen in the responses of the most active partner, that is, the dominant or pursuing partner, who often sends interpersonal messages that link these two aspects, such as, "You are not there for me [affiliation] and therefore there must be something wrong with you [control]." In any case, whether control or affiliation is the focal problem, the therapist supports the underlying aspects of self not operating in the relationship in order to shift interactional positions and facilitate secure interdependence. The therapist then supports the potential for responsible self-assertion and boundary marking in the submissive partner and the vulnerability of the dominant partner. Whether the couple's interaction is most prominently centered around control or affiliation, both elements are always present. The dominant partner attempts to coerce the other into fulfilling his or her affiliative needs, whether these needs are concerned with levels of closeness and distance or with becoming the kind of person that the other can rely on and feel secure with. The struggle is always about how the relationship will be defined and by whom it will be defined. These patterns of interaction, while present in all relationships to some degree, are particularly characteristic of and rigid in distressed couples' interactions. They revolve around core issues in marital conflict, particularly those of closeness-separateness and dependence-independence. The attack-withdraw or pursue-distance pattern seems to be most common in couples coming for therapy with intimacy problems. It is possible that most couples in mutual withdrawal do not come for therapy since the relationship may be functionally at an end. Often, when a couple presents in therapy with mutual withdrawal, it becomes apparent that one member has already left the relationship and the therapeutic task is to help the other accept this fact. The attack-attack pattern is a little more frequent, but it is difficult to sustain and usually evolves into attack- withdrawal. The submit-dominate pattern presents more clearly as a power struggle in which affiliative concerns are secondary. Couples involved in cycles where control-autonomy is the main issue often seem to exhibit more physical symptoms and more explicit struggles about how and by whom the self is to be defined. The therapist attending to the process of interaction in the session identifies the pattern and the positions each partner takes. The therapist also invites the couple to narrate how they usually relate to each other in times of conflict or stress, in order to identify patterns and positions.

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Origins of the Cycle

The etiology of each couple's dance is a matter for speculation. It may be partly a result of each partner's general style or personality, predisposing partners to perceive the responses of their spouses in a particular manner and to react to threat in a particular fashion . Experiential approaches, which view people as active creators of their world and the way they perceive that world, are consistent with the concept of such predispositions. These predispositions may be viewed in information-processing terms as schemata that direct attention and influence the interpretation of new stimuli. Thus, withdrawers may have had past experiences that predispose them to believe that exposing their feelings to intimate others is a dangerous activity to be avoided, or they may believe that they are so unworthy that if they reveal themselves, they will be rejected. The way partners habitually and automatically process information and organize experiences will, of course, influence their perceptions of and responses to each other. However, couples have many other self-organizations available to them, and the task of therapy is to activate new aspects of self by changing both the intrapsychic experience and the interpersonal context. In the beginning stages of marital therapy, it seems more useful, rather than focusing on innate predispositions, to focus on each partner's position as it is evoked and maintained by the immediate emotional experiences in the relationship and the responses of the partner. The behavior of the partners is then viewed as a function of the relationship rather than in terms of personality traits or psychopathology. It is useful in this context to take a relationship history. The telling of this history helps to clarify what each partner expected and wanted from the relationship and how their particular cycle, of which they are the creators and the victims, evolved. It is noteworthy, for example, that a husband taking a passive, withdrawn position in relation to a dominating, intrusive wife first met her when he was a patient coming to her as a nurse to learn to manage his diabetes. Key events in the evolution of the relationship should be noted and explored, particularly in relation to the positions the partners now take with each other. The therapist can also ascertain what the norms are in this relationship as to closeness and distance and the issues of influence and control. The developmental stage of the relationship is also noted, since it implies particular priorities and tasks that influence how the couple relate to each other.

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Having explored and validated the clients_' reactions to each other and their perceptions of the relationship, and having ascertained the nature of the negative interactional cycle, the therapist goes on to enquire into each partner's present life status and life history. This is not in terms of extensive information gathering or focusing on past events, such as those that may have occurred in the family of origin. Instead, the therapist needs data with which to hypothesize about each partner's vulnerabilities and the sources of anxiety stemming from past life experiences that may be reflected in present interactions. The self-concept and selfesteem of each partner are noted since how we see and evaluate ourselves is intimately connected with the feedback we receive from our most significant other. As the therapist obtains a sense of how the clients define themselves, the positions they take in relation to each other become clearer and clearer. For example, a woman who is the oldest of four children and who as a child played a parental role to her siblings and her own parents, may believe that self-control and self-reliance are the highest virtues. She therefore would have particular difficulty accepting her partner when he adopts a passive position and expresses his anxieties about his competence or ability to cope. She does not allow any such expression of frailty in herself and reacts in a blaming, critical way to her partner. He, in turn, sees her as super-competent, super-capable, and, thus, not in need of his love and protection. Particular immediate life stresses, such as certain occupational priorities, also affect a relationship and influence partners' abilities to respond to each other. For example, one partner in an older couple may suddenly begin to experience great rage at her spouse to the point where this began to threaten the relationship. In the first session of therapy, this partner may relate how her daughter had suddenly died a year before. It would then become apparent that the rage the client experienced was primarily the result of her husband's inability, as she saw it, to comfort her in her grief and to take the place of the lost daughter in terms of closeness and companionship. After gathering the relationship and personal histories, the therapist then attempts to enter each partner's phenomenological world in order to draw hypotheses as to the insecurities, vulnerabilities, and/ or resentments underlying the position each client takes in the negative interactional cycle. The therapist observes how particular experiences elicit particular interactional responses, and how these responses elicit reactions from the other partner that then tend to confirm each partner's inner experience.

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Assessment in this approach to therapy then consists of the following: 1. Entering the phenomenological world of the client as he or she engages with the partner while hypothesizing as to the vulnerabilities and / or resentments of each client and observing how each attempts to protect himself or herself from the revelation of such vulnerability or resentments. 2. Identifying the negative interactional cycle. 3. Identifying the positions each partner takes in the sequence of interactions. 4. Gauging the clients' openness and flexibility in terms of how likely they are to respond to the therapist's attempts to access underlying feelings and to respond to open communication from each other.

ESTABLISHING A THERAPEUTIC CONTRACT The third main task of the therapist in EFT is to reach a consensus with the couple about the goals and nature of therapy. This task may take up to three sessions to complete. The greatest issue facing the therapist here is the varying agendas that some partners bring to therapy in regard to the relationship and the process of therapy itself. The therapist has to ascertain each partner's level of commitment to the relationship. Some partners come to therapy to avoid ending a relationship that is, in fact, implicitly at an end for one of the partners. These clients usually come to therapy out of feelings of guilt or as a response to pressure from their partner. Often, these partners present with a mutual withdrawal cycle. It may become clear to the therapist that there is a calculated lack of involvement and emotional attachment on the part of at least one partner, and that the task for this partner appears to be the dissolution rather than the re-creation of a bond. The therapist then may choose to explore this area in a separate session with each partner. If one partner has, in fact, already emotionally left the relationship, the best intervention appears to be the presentation of this assessment to the couple, followed by the facilitation of a decision as to the future nature of the relationship. In this case, the therapist may be in the position of helping one member state explicitly that he or she

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wishes to dissolve the bond and helping the other to begin to accept th is as a fact. However, EFT is not designed for couples who are in the intentional process of relationship dissolution since the process of therapy is oriented toward the reorganization of intimate bonds. Separating couples may benefit from individual therapy, from divorce mediation, or from some kind of short-term, problem-solving intervention aimed at helping them to reach reasonable decisions as to how best to separate. The therapist can often gauge the level of commitment and motivation of partners for therapy by focusing on the strength of the relationship and the positive involvement that they may still have with each other. If individual partners cannot identify any relationship strengths, do not express dissatisfaction with distance or conflict, and show themselves as generally not invested in the relationship or unwilling to consider any of the possible alternatives to their cycle, then their commitment is questionable. In couples who are still committed to the relationship and feel emotionally attached to each other, an exploration of the good times they experienced in their relationship is useful in terms of creating hope and gauging the level of possible movement in the relationship. In the course of discussing the relationship's strengths, it may also become clear that the couple have, in fact, much to offer each other and can, under particular circumstances, respond to each other's needs. Partners may also have differing levels of commitment to therapy even if both still wish to be involved in the relationship. The therapist has to acknowledge and explore any reluctance to engage in therapy on the part of either of the partners. Usually, this is dealt with, as are other types of resistance in this model, by exploration and validation of that partner's feelings. Generally, all the therapist can do is to address the client's concerns and to create as safe and as positive an atmosphere as possible while accepting the couple's reservations and anxieties. The therapist can encourage and reassure but cannot persuade or coerce. In general, the therapist must attempt to assess the capacity for change and movement that each client exhibits. The therapist also observes the relative flexibility- rigidity of the interactive negative cycle, the intensity of the cycle, and the willingness of the partners to take some responsibility for their part in this cycle. In this context, the therapist notices how clients respond to probes and reflections and how they react to each other. Generally, by the end of the second session, the therapist has a clear concept of each partner's position as well as some specific hypotheses as

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to the emotional experience underlying this position. The therapist may also have a sense of how each partner's position is part of a selfreinforcing negative interactional cycle. Furthermore, the therapist also has begun to understand the level of commitment in the relationship and the present state of the relationship in terms of the distress- satisfaction it affords to both partners. If the picture is clear in terms of the cycle and the direction for therapy, and a good alliance has been formed with each partner, then there may be no necessity for individual sessions at this point. Later the individual sessions can be used as one method of working through blocks in the therapy process as they arise, although it is preferable to meet conjointly throughout.

CHAPTER FIVE

The Process of Therapy

This chapter is concerned with the elaboration of the nine steps of therapy presented in Chapter 3. The focus here is on the general strate­ gies of therapy and the change process engaged in by the partners. NINE STEPS OF THERAPY Step 1: Delineate Conflict Issues in the Struggle Between the Partners The first step in therapy is to delineate core issues in the conflict between the partners. The partners are encouraged to make as complete a state­ ment as they can of their perceptions of the relationship and their experiences of the problems in the relationship. The therapist deals with opposing reality claims by validating the partners' experiences in the relationship and viewing the positions they take with each other as a natural consequence of these experiences. Although the first sessions are concerned with assessment, they are also inevitably part of the treatment intervention. The questions the therapist asks should elicit information, but they should also challenge the client. For example, the therapist may ask a dominant, withdrawn male, who portrays himself as a tower of strength, whom he goes to for support when he needs it. During the questioning, the therapist focuses on the process of the interaction rather than the content of the couple's complaints and begins to identify themes in the struggle between the partners. These themes, usually concerning affiliation and autonomy, emerge as the therapist asks questions, watches the couple interact, takes the history of the relationship, and asks the partners about their personal 82

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priorities and expectations. It may become apparent from the couple's interaction that one partner, for example, defines the struggle as one in which he resists domination by his wife, while his wife defines the struggle as an attempt to create a reliable, secure relationship. The particular approach of the therapist will, of course, color the information he or she requests, pays attention to, and processes during the assessment. Unlike psychodynamic therapists, EFT therapists assume that if there are any past experiences relevant to the present relationship, they will be enacted in the present and can, therefore, be dealt with by focusing on current interactions. Behavioral therapists would be more likely to focus on specific behaviors exhibited by the partners, such as pleasing and displeasing behaviors and the reinforcement patterns that maintain these behaviors. Behaviorists also focus more on the evaluation of skill deficiencies. However, EFT therapists focus on the partners' experience of the relationship, particularly on their emotional responses to each other and how these responses mediate the closeness or separateness of the bond between them and the process of self-definition. At this stage in therapy, psychoanalytic, behavioral, and EFT therapists might ask similar questions- for example "How do you feel when he shouts at you? "-but they will develop the intervention in very different directions. The analyst probes for past response patterns projected onto the present relationship; the behaviorist might seek to specify the effect of a behavior on the partner from a rational, problem-solving point of view; the EFT therapist will focus on underlying felt experience. The EFT therapist, as he or she identifies and clarifies the positions each partner takes with the other, frames the problem in terms of emotional pain, deprivation of emotional needs, and insecure attachment. The therapist responds to the partners with the assumption that they are doing the best they can in the situation as they see it. The focus is particularly on the fears and vulnerabilities experienced by the partners in the relationship and how their attempts to get each other to respond, while protecting themselves, influence the interaction. The therapist initiates a balanced alliance with both partners by focusing on the relationship rather than on individual traits, history, etc. Since distressed couples are particularly likely to make characterological attributions ("He's lazy like his father"), the therapist, in contrast, begins right from the beginning to relate the behavior and experience of each partner to the other's responses and perceptions. The therapist then links context, experience, and response in statements such

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as, "When you see him looking at you that way, you feel small and then attack him." An example of the kind of summary statement an EFT therapist might make of a couple's problem cycle at this stage is, "So the problem here is that you, Ann, feel very uncomfortable with the distance you perceive between yourself and Al, but when you attempt to talk with him about this, you end up getting angry, you feel misunderstood, and then the two of you end up in a big fight. You feel unloved perhaps and that is painful. Al, you see Ann as perhaps needing much more closeness than you, which you find hard to understand and feel a little pressured by. I can see from your point of view, then, that it's natural to back off when you see her getting angry and to try and avoid an unnecessary fight." The therapist always takes the other's perception and experience into account when speaking of one partner's experience and always attempts to use nonevaluative language, always assuming that people have good reasons for their responses. The use of validation and the provision of clear feedback in an accepting, nonjudgmental manner may be considered as the basis of all effective therapies and is especially important in an experiential approach such as EFT. The clients' behavior is understood from their frame of reference, in terms of their legitimate desires and needs. The positive validation used is a way of legitimizing and accepting these underlying feelings and needs and understanding how behaviors are positive attempts to solve the problems experienced by the client. Withdrawing, for instance, is then a positive attempt to deal with feeling vulnerable, and pursuing is a positive attempt to achieve contact. The therapist must listen experientially without becoming caught in the content or in evaluative judgments as to the nature of the clients' experiences. It is necessary to find the hidden rationality (Wile, 1981) underlying maladaptive behavior. This is an active perspective that the therapist maintains purposefully and deliberately. In order to do this, the therapist has to avoid placing labels on the clients' experiences, either from his or her personal frame of reference ("I couldn't live with this man either-his wife is right, he is irresponsible") or from a professional viewpoint ("This lady is crazy, she's bizarre; she really is the problem"). The two situations in which the therapist is most likely to be caught in such reactions are when a client evokes responses that are problematic in the therapist's own life and when the client threatens the therapist's sense of competence. An awareness of his or her own reactions enables the therapist to circumvent this process, attend to the client's experience, and

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choose an effective intervention. For example, a client who is very animated, angry, and tearful in an initial session recounts a recent incident in which she led her partner to believe that she was about to commit suicide and then waited to see if he would stop her; he did not. The therapist does not respond to the bizarre details of the way this client set up this situation; instead, he or she listens to the experience conveyed by the client. In this specific case, listening experientially involves hearing the essential message that, in this relationship, as she experienced it, her spouse would let her die-that is, there was no safety or protection for her. Thus, she was now at the point of constructing ultimate tests for him in the hope that he would finally show his love. The therapist validated the client's experience and her desire to try to push her spouse into taking care of her as well as her determination to fight for what she wanted.

Step 2: Identify the Negative Interaction Cycle In Step 2 of EFT, the therapist identifies the negative interactional cycles. The sequence of responses that evolved into a cycle may be pieced together from the narration of typical problematic interactions in the relationship. These interactions then begin to be displayed or re-enacted in the session, or the couple may spontaneously exhibit such cycles. The therapist must see the cycle, since a couple's description of their relationship is often inaccurate and always incomplete. A concrete description of each person's responses in a past fight, followed by a request by the therapist for one partner to state explicitly to the other how he or she feels about the other's response, usually evokes a repeat of the original interaction. The identification of the cycle as it occurs is immediate .and vivid in terms of the impact it has on the couple. At this point in therapy, the therapist might describe a cycle as follows: "Muriel, when you attempt to engage Tom, to get him to respond to you in an intimate way, or to tell you his thoughts on a certain topic, you experience him as agreeing with whatever you say or do in a kind of noncommittal way. You find this very unsatisfying and tend to get angry. You even get to the point of threatening to leave the relationship. I guess, Tom, you're saying you find this difficult and you really don't know what to do at this point to improve things, so you withdraw and the two of you don't talk for a day or so." The description of the cycle tends to be general and to focus on behaviors or reactive emotional

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responses, but it is brought into awareness and used to decrease blame and rationalize the interaction process. Such a formulation also tends to give people hope and a greater sense of control in what was previously seen as a hopeless situation. The couple now have a concrete description of what is occurring in their relationship, and they hear the therapist v_alidate and legitimize their positions and the pain that they both experience. Later in therapy, the emotional and cognitive responses that constitute the cycle are referred to and elaborated on. As the cycle continues to be referred to and described in therapy, it becomes more differentiated and more complex until it is described in terms of emotional responses and automatic cognitions rather than behavior. In these cycles, the vulnerabilities and resentments evoked by the partners' behavior and the ensuing attempts at self-protection are the glue that keeps the couple stuck in the problematic pattern. Insight into the nature of the cycle does not seem to be enough to create change; there has to be a new experience that allows an emotional shift to take place, resulting in a new position. However, the act of clarifying the cycle does have the effect of allowing the couple to see how they have a part in perpetuating their own deprivation and distress. It also tends to foster a sense of mutual responsibility without blame, thereby beginning the process of de-escalating conflict. As the therapist develops a clear picture of the pattern of interactions and how each partner evokes the other's responses, then he or she can explore the underlying feelings and needs and validate them. This initiates a process of each partner focusing on the self rather than focusing on, and reacting to, the other. Negative responses, such as criticism or stated indifference, are developed further rather than challenged or labeled as unhelpful. The therapist might say, for example, "I can see that if you do not understand your partner's frustration and really feel a little intimidated by it, you might not know how to respond, so you try to avoid the situation by trying not to care and not to respond at all." At this point, the therapist questions, explores feelings, and clarifies each partner's perceptions, feelings, and reactions to the other in such a way as to engage the couple on an emotional level. In our experience, most cycles, whether initially focused on issues of autonomy or issues of affiliation, are reasonably obvious; however, there are variations. On occasion, a couple will present with a cycle that looks like the classic pursue-distance or blame- withdraw, except that the

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blamer seems to have a cold, disengaged quality. On closer exploration, this usually seems to signify a blame-withdraw cycle in which the blamer has given up and has perhaps already left the relationship emotionally. The presentation of a blame-blame, mutual attack cycle that esca­ lates rapidly in the session can present problems to the therapist, not so much in terms of identification but in terms of control of the sessions. This cycle is difficult for any couple to sustain and can result in physical violence. If physical violence is occurring, then EFf is not recommended as initial intervention. The treatment of chronic mutual attack cycles is problematic and is addressed in Chapter 7. In general, with most couples, it is not difficult to identify the positions each partner takes in the cycle. The therapist can become confused, however, when the couple relate specific incidents; no couple, including the most distressed, always responds in a uniform way, and there will be idiosyncratic reactions. Therefore, the therapist must focus on the consistent responses the couple exhibit rather than the exceptions. In general, the more compelling, urgent, and automatic the reactions the couple display, the more chronic the problem and the more distressed the relationship. One other phenomenon that can be confusing is when, during ther­ apy, couples reciprocally shift positions; for example, the blamer with­ draws and the withdrawer becomes blaming. This is only a first-order change (Watzlawick, Weakland, & Fisch, 1974), that is, a change in elements; however, it is often the precursor to a more profound second­ order change, that is, a change in the structure of the interaction. The identification of positions can also become difficult if the thera­ pist sides with one partner, thereby losing his or her necessary objectivity. For example, a female therapist might identify with the wife in a relation­ ship, finding the behavior of the husband threatening and reprehensible. The therapist might then begin to view the wife's accusations of her spouse as justified in some absolute sense, rather than as a reflection of the wife's emotional reality and the relationship context. In a particular example of this kind of difficulty, a female therapist accepted the wife's slightly less derogatory way of speaking and a small amount of self­ disclosure from her as evidence that she had shifted from her blaming stance in therapy. As a result, the therapist encouraged the withdrawn spouse, the husband, to open up and be accessible to his wife, specifically to attempt to comfort her. The wife, however, had not changed her position at all and had taken the therapist's responses as evidence that she

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was righteously angry at her husband; she then responded to his openness by attacking him in .a severe fashion with the result that the whole process of therapy was endangered. The therapist had lost perspective, focusing too much on the content of the wife's words, and ignoring nonverbal clues such as the wife's tone of voice, body lean, and posture, which were all still accusatory. It is important, then, to identify the partners• positions, paying attention to verbal content and nonverbal analogic communication, and to identify moments when there has been an actual shift in position, so that new interactions can be choreographed at a time when they are likely to be successful.

Step 3: Access Unacknowledged Feelings Underlying lnteractional Positions Step 3 of EFT is the accessing and accepting of unacknowledged feelings underlying interactional positions. This is one of the key steps of treatment; without which significant interactional change will not occur. As with other interventions, this step can be operationalized at varying levels. At first, it may be a relatively superficial adding of emotional responses, not normally attended to, to the description of each partner's positions or interactional cycles. However, as therapy progresses, the emotional responses accessed become more distant from immediate awareness and more central to the way the self is defined. Again, particular attention is paid to vulnerability and fear as well as to unexpressed resentments. Significant events arousing strong emotion are focused on as they occur naturally in the therapy sessions or as such events from the recent past are reconstructed and enacted. The therapist facilitates such enactment by focusing (repeating key words) and heightening the experience as described, until the. clients are actually involved in the experience in the here and now. Clients are thus exposed to new relevant aspects of the self in each other's presence. This process evolves a new synthesis of emotional experience, not a reiteration of previously processed emotional responses or the ventilation of superficial and/ or defensive reactions. There is a quality of active engagement and a focus on inner experience rather than on external reality or the other partner. The therapist may begin by validating superficial reactions such as reactive

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anger, but he or she will then work to access more primary emotions such as the sense of threat that may underlie such anger. Specific relationship positions seem to be associated with particular underlying emotions; for example, the blamer in a relationship often accesses, with the help of a therapist, a sense. of panic and insecurity in relation to the perceived inaccessibility or unresponsiveness of the partner and the corresponding fear that the self is by nature unacceptable or unlovable. Sometimes, in a blamer, a deep mistrust of others and a fear of abandonment or rejection are accessed. The partner taking a withdrawn position, on the other hand, often accesses a sense of intimidation and incompetence in relation to his or her partner, with a corresponding fear as to the unlovable nature of the self, or feelings of resentment concerning the pressure of trying to meet the partner's expectations and needs. A withdrawer may also access a sense of fragility in face of the threat of engulfment by the blamer or a fear that his or her own anger might destroy the other or the relationship. At this point, EFT is somewhat like individual experiential therapy in that the therapist focuses on· facilitating an increased acceptance of self and the disclaimed emotional experience, together with the implied action tendencies. Increased congruence of self as experienced and self as presented to the other is also part of the desired therapeutic process. The basic methods used by the therapist to direct the client in the accessing of emotional responses are taken from gestalt therapy (Perls, 1973; Perls, Hefferline, & Goodman, 1951) and client-centered therapy (Rice, 1974; Rice & Saperia, 1984; Rogers, 1961). The assumption here is that, before clients can become accessible and responsive to their partners, they must reprocess and crystalize their own experience in the relationship. (Therapists' interventions are specifically addressed in Chapter 6.) Two examples of a therapist working to access emotional experience follow. The first concerns a withdrawn partner who is describing a recent fight with his wife. THERAPIST: So what happened for you when she told you that your habit of chewing tobacco was nauseating and she didn't want you to do it? JACK: Well, I misunderstood. I thought she meant don't chew it when we go up to the party. [This is the focus the couple have already taken when discussing this fight, that is, a content focus, resolving nothing.]

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THERAPIST: Yes, but how did you feel when she said that? JACK: I said fine . THERAPIST: And then you popped some tobacco in your mouth. JACK: Yeah, well I misunderstood and then she blew up. THERAPIST: Jack, you have discussed how sensitive you are to what you call put-downs. Somehow, I am just wondering how you felt when Sue commented on the tobacco chewing? JACK: Well, it's like, you are nauseating, you know, she's so logical and right, it's like, I'm nauseating. THERAPIST: What are you feeling right now as you say that? JACK: I feel hurt. I did feel put down. THERAPIST: (Bringing up an image the client had used earlier in the session.) Like old Uncle Charlie? JACK: Yeah, he was just a puppet, all those women, if- they said jump, he said how high, and they commented on him all the time. THERAPIST: How do you feel when you talk about this now? JACK: I feel angry. I'm sure as hell not gonna be another U nclc Charlie. THERAPIST: Yeah, was that what you were saying to Sue when you popped the tobacco in your mouth? JACK: Hmm. THERAPIST: You felt put down and you also heard her telling you what to do. JACK: Yeah, and I sure as hell felt you're (to Sue) not my goddamn mother. THERAPIST: I'll show you. You can't hurt and dominate me. JACK: Yeah, I'm not going to be like Uncle Charlie. THERAPIST: So I'll do what I like. The therapist here is working to elicit the anger and resentment and, eventually, the sense of threat that underlies this client's sullen distancing behavior. The therapist hypothesizes the emotional responses that Jack is not aware of and does not express and facilitates Jack's reprocessing of the event. Jack's nonverbal action of chewing tobacco, after Sue's request that he refrain from doing so, was taken as a sign of no nearing and indiffere nee by his wife rather than an action based on his fear of domination and his anger at what he perceived to be her nonacceptance of him. The second example concerns a couple who came into therapy with problems of alienation and the cessation of their sexual relationship. The

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relationship had been characterized in the early sessions as one in which Linda, the wife, pursued Michael, the husband, for more emotional communication, and he withdrew. Then, unable to have the contact she wanted, Linda withdrew as well, and the couple became alienated from each other. This excerpt is from the end of the fifth session and begins with the therapist focusing on Linda's experience after having had Michael in the earlier part of the session, look at her and express some of his feelings to her. THERAPIST: What's happening? MICHAEL: I, I ... uh. (Pause.) THERAPIST: You experience some pain? MICHAEL: ( Talking to Linda.) This is the same situation, when I tell you something a lot of the time, you never quite accept it, a lot of the time. THERAPIST: It's difficult to touch her. MICHAEL: (Again to Linda.) You're pleased when I tell you something, but you never quite believe it. THERAPIST: ( To wife.) What do you experience? ( Wife sighs.) Would you like to believe him? Can you say this? LINDA: (To Michael.) It's very hard for me to believe you. THERAPIST: You seem so unconvinced? (To Linda.) LINDA: Uh, hmm. THERAPIST: Can you tell him this, something about "I don't know how you could convince me?" LINDA: ( To Michael.) I don't know how you could convince me. I've been feeling really ugly, especially the last few days. THERAPIST: What do you want from him when you're feeling this way? Is there anything he could do for you? LINDA: I don't know. THERAPIST: Do you tell him, "I'm feeling bad, I'm feeling ugly"? LINDA: No. Maybe. Sometimes. (Quietly.) THERAPIST: You're saying that's symbolic of how you're feeling inside? LINDA: Yes, that's how I've been feeling the last few days, really angry, pushed out of sorts, and when I get like that, the message I got that was always fed to me was you're bad if you feel that way, therefore you're ugly.

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From Michael? LINDA : No, from long ago. THERAPIST: So, inside you feel . . . you're getting this message you're bad, you're ugly for feeling angry. What do you want when you feel this way? LINDA: (Sighs and looks down.) What do I want? I usually want pnvacy. THERAPIST: Somehow because you've never known anybody that could help you with that, the best thing is to be alone. LINDA: Uh-huh. (Long pause.) THERAPIST: I imagine I would want someone to hold me and tell me I was special. I don't want to impose that on you as I don't know, but somehow from all you say to me, it sounds like you really want to be loved. LINDA: Uh-huh. THERAPIST: But when you fear or decide that you can't get it, you take space? LINDA: Uh-huh. (She looks down.) THERAPIST: Somehow you 're not sure he can give you this nurturing that you want so much. I don't think he knows that's what you really want, or he doesn't know he could really get to you because he gets so many messages of "leave me alone." (Lengthy pause.) Can you tell me what's happening for you right now? LINDA: Fear. THERAPIST: Can you try to give a name to that fear. I'm afraid ... LINDA: (She looks down; pause.) THERAPIST: You 're afraid that if he gets close to you, or if you let him get close, something bad might happen? LINDA: (After pause.) Yeah! (She looks up.) I guess I'm afraid to reach out. THERAPIST: What might happen if you reach out that's bad? (Long pause.) Somehow you've had a strong learning that if you reach out, you don't get the acceptance you wanted so much. So it's difficult to risk that. LINDA: ( Cries quietly, then reaches for tissue.) THERAPIST: Where does this rejection come from initially? LINDA: Parents. THERAPIST: Who particularly? LINDA: I think both of them. THERAPIST:

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Uh-huh. As you go into this .. . sad space ... does any particular thing emerge for you, what's this feeling? I know it's a difficult tight knot. LINDA: ( She looks up and then down and cries.) THERAPIST: Just some feeling like you can't get what you need? LINDA: Uh-huh. THERAPIST: You just want to be taken for who you are. What's it like for you in that experience? LINDA: (After pause.) I don't know. THERAPIST: Are you beginning to withdraw now? LINDA: Uh-huh. THERAPIST: I see you sit there ... I don't know if I said something that didn't fit. I know you 're inside there wanting something. LINDA: (Cries.) THERAPIST: But it's so difficult to come out? LINDA: Uh-huh. (She breathes.) THERAPIST: I guess you're saying it's easier to close off that part and nurture it yourself, because bringing it out could be so confusing and painful and difficult? LINDA: Yeah! THERAPIST: So you kind of go in there and manage it all yourself? LINDA: Uh-huh. THERAPIST: And I think you're saying it kind of leaves you feeling lonely? LINDA: Yeah! THERAPIST: Yeah. So what is it you would like, as I know you can't be rushed too quickly or be rushed in on too quickly? So what would you like from Michael in these situations? Would you like him to come in after you or would you give him a signal, or you just don't know? LINDA: ( Cries, shakes head, and nods.) THERAPIST: I'm going to push you a little, right, as not knowing keeps you there. What would you like? What would make it easier for you so you could get more of what you want? (Lengthy pause.) I'm going to ask you to do something difficult. Will you look at Michael and tell him you feel pain and hurt? LINDA: (Looks up.) Yeah, I feel hurt. (She sobs loudly.) THERAPIST: Stay with that .. . it's painful. (Long pause.) What would you like? Can you hear me? LINDA: Yes. (She cries.) THERAPIST:

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THERAPIST: What would you like from Michael? (Long pause.) I do know that even if you want something without asking for it, you have to know what you want. What do you want? LINDA: (Looks up.) I don't know. Not to judge me. I don't know if he does, or it's just myself. THERAPIST: Check with him. LINDA: (To Michael.) Do you judge me or is it just myself? MICHAEL: I don't think so when you're just saying what you feel. THERAPIST: ( To Michael.) Will you tell her now as you see her cry what you experience? MICHAEL: ( To Linda.) I share your pain. I want to put my arms around you. I want you not to hurt and I don't want to stop you hurting, but I just want to be with you. THERAPIST: ( To Michael.) Do you know if she wants you to put your arms around her? MICHAEL: ( To Linda.) There are many times you haven't wanted me to put my arms around you. THERAPIST: ( To Linda.) Is that true? LINDA: Yeah! (She holds herself, rubs and then scratches her arm.) THERAPIST: Is that what you wanted then? LINDA: Maybe. (She rubs her arm.) THERAPIST: Try it, will you? Tell Michael, "I want you to hold me." I think you need to reach out when you feel bad. I believe you can do it. LINDA: (To Michael.) Will you hold me? MICHAEL: (Moves over and hugs her.) This experience was then briefly discussed by the therapist, who summarized the major themes.

Step 4: Redefining the Problem(s) in Terms of Underlying Feelings Once underlying feelings have been accessed, the problem is redefined in terms of these newly accessed emotional experiences. For example, one problem cycle was originally defined as the wife making requests, the husband withdrawing, the wife pressuring him for response, and the husband blowing up. With more emotional information, this cycle was redefined as the wife lacking trust and fearing being shut out, with the

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husband having a sense of inadequacy and a desperate need to protect himself from his, as he perceives her, powerful wife. As mentioned earlier, redefinition in terms of generally benevolent, biologically adaptive, underlying feelings and motivations is at the core of the EFT approach. The reframe is an interpretation that integrates the client's affective, cognitive, and behavioral experiences. Such a reframe is highly credible since it is based on information that is vividly experienced and thus accepted as authentic. The reframe must capture and remain true to this underlying experience. Fears and coping reactions such as defensive anger might be framed in terms of key definitions of self in relation to the other, for example, "She is stronger and more competent than me, therefore I am intimidated and avoid contact." The problem is construed, then, in terms of the fears and vulnerabilities of the partners. "Vulnerability," as it is used here, refers to a complex state in which the sense of self, the acceptable definition of self, is at risk, resulting in considerable insecurity, anxiety, and painful affect such as sadness, fear, and a sense of loss. The therapist elaborates on how the partners' vulnerabilities interact to create a sense of deprivation and alienation. A habitual withdrawal might be reframed then as a fear response instead of an attempt to punish or hurt. Since the client by this point in therapy has already begun to experience and express that fear, the reframe is a vivid and compelling clarification of his or her experience rather than a comment eliciting cognitive insight. In couples therapy, the therapist can afford to be directive and to suggest possible underlying feelings without fear of influencing clients toward incorrect or therapistbased views of their inner world or their experience of their partner. This is because their partner is present to challenge such views, and the experience that is being processed is immediate. All suggestions are therefore subject to corrective feedback. Even though the therapist suggests inner states, the client is always the final arbiter of what he or she feels. At this stage of therapy, clients are encouraged to interact with each other in the sessions. There is a strong focus on emotional responses as they occur in the present and the exploration of these feelings in terms of their meanings to both partners. The experience of strong emotion is a powerful modifier of these perceived meanings of behavior both for the experiencer and the observing partner. By the end of this step in therapy, the problem has become framed in specific terms that reflect emotional

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responses rather than perhaps blaming statements such as "the problem is he doesn't talk". A blamer's extreme attacking behavior might be framed in terms of his or her extreme panic at the partner's perceived lack of response. The meaning of the attack is then constructed as " I will do anything to get you to respond to me," rather than "I am trying to hurt or destroy you. " The blamer's accessing of this panic in front of the spouse provides immediate validation for such a reframe.

Step 5: Promote Identification With Disowned Needs and Aspects of Self This step is concerned with the clients identifying with the disowned aspects of experience and disclaimed action tendencies in the redefined cycle. As the cycle is enacted in and out of therapy, partners become aware of their automatic reactions and the disowned aspects of experience underlying such reactions. For example, a withdrawer becomes aware of the feeling of being impinged upon, the fear of being overwhelmed, and the subsequent automatic move to protect himself. In this step, the clients are first helped to differentiate and identify fully with their positions and, in some cases, deliberately to enact behaviors associated with those positions. To continue the example just mentioned, the withdrawer then experiences himself withdrawing, explores this automatic response, and then experiences the fear of impingement. His previously disowned fear in relation to his partner, along with his disclaimed tendency to protect himself, is encountered, embraced, and accepted; it is recognized ,as part of his self. The disowned aspect of self, rather than being avoided and denied, is enacted giving the client greater control of what was previously automatic responding. Experiencing disowned needs can be structured by the therapist or can occur spontaneously in the session as the couple repeat their cycle. The therapist might slow the action down and focus on the level of primary emotion- and the disclaimed response inherent in that emotion- rather than on automatic defensive responses. For example, a timid husband who finds driving exceedingly stressful talks of this feeling in a session. His w1fe becomes irritated and, in the next few seconds, they enact their whole cycle: She attacks, he placates, she escalates the attack, he withdraws, she breaks down crying. The therapist then focuses on the

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wife's attack and the husband's response, replaying the sequence that has just occurred. The therapist might then begin to help the wife to expand and clarify her anger at her husband's fear. The wife may have previously disowned any need for support or security for herself, but now she begins to recognize the fear she experiences as her spouse reveals his anxieties. Finally, the wife acknowledges that, as she listens, she senses that she is alone and that only she is strong and capable, that is, that her spouse cannot support her. The therapist, after exploring this experience, then directs the wife to consider asking for that support and to elaborate on her need for nurturance. This process continues until the wife is accepting and allowing of her desire to be nurtured and beginning to consider expressing this to her spouse. The cycle is then re-enacted, but this time the wife includes the newly discovered aspects of her experience. She replays, with awareness and responsibility, a new expanded sequence that includes new aspects of self involving her need for caring and for someone to lean on. The husband is then asked if he knew how much his wife needed him and how he thinks he could help her. On an analogical level, this introduces a shift in position where he, previously withdrawn, reaches for her in her new vulnerable state. This step cannot occur until both spouses have been through the previous steps of acknowledging the cycle and beginning to access the feelings underlying their positions. In a sense, all previous steps lead to here and all later steps go on from here. Step 5 is a watershed, a key event. Disowned aspects of the self are integrated into awareness and into the relationship. The process continues beyond de-escalation toward a new openness and a new bonding process. The choice as to which partner's experience to focus on at a ny moment depends to a certain extent on who is the most receptive and flexible. However, in general, the sequence that seems to evolve naturally is that the withdrawer or submissive partner is usually one step ahead of the blamer or dominant partner in the therapeutic process. In the above case, for example, the distancing husband had already acknowledged and accepted his anger at his wife and explored on a relatively intense level his own overriding sense of inferiority to her and his desire for her acceptance. Having acknowledged these experiences openly and encountered them in �ront of his wife, he had become present and accessible in the relationship m a new way. The next step was, therefore, fro the therapist to focus on the wife, in order to change her part of the cycle. It also appears rational

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that before a blamer can be induced to reach out from a pos1t1on of vulnerability, the withdrawer has to show some sign of being accessible. The withdrawer often also seems easier to engage than the blamer in the beginning of therapy, particularly with the use of validation. This step in therapy echoes the concept used in experiential therapy (Beisser, 1974; Perls, 1973) of changing into what one is rather than trying even harder to be what one is not. This step may be returned to again and again until the disowned experiences are integrated intrapsychically and interpersonally.

Step 6: Promote Acceptance by Each Partner of the Other Partner's Experience This step involves the facilitation of each partner's acceptance of the other's newly experienced aspects of self and emotional responses. The therapist encourages each partner to express his or her experience with the partner and then facilitates the partner's acknowledgment of this experience, primarily by reprocessing interactions and exploring and blocking nonaccepting responses. The two key processes at this point in therapy are first the exploration and then the expression of underlying feelings such as resentment or vulnerability. The expression of such feelings often evokes issues of trust and fears of disclosure as well as concerns about the other partner's ability to accept and respond to this expression. The latter process, in general, tends to be the more problematic. For example, at this point, a critical blaming wife will usually be able, with the therapist's support, to express her vulnerability and her needs to her spouse. Her husband, however, may resist this new view of his wife and may be unable to respond to his wife in terms of her new experience. Usually, this can be explored in the session as follows: THERAPIST: What happens for you when your wife asks for reassurance like this? (Pause.) You seem very quiet. TREVOR: Well, I guess it's new, I'm not sure, I've always seen her as someone who doesn't need me, you know. THERAPIST: So, you're not quite sure how to respond? TREVOR: Yeah, it's hard to believe that well, well, if I do try to comfort her ...

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THERAPIST: That's what you hear her asking you for? TREVOR: Yeah, but I kind of hesitate, you know. (Pause.) THERAPIST: Can you help your wife understand that hesitation, that reluctance just to rush in and comfort her? TREVOR: Well (addressing Sally) I want to do it, I want to reassure you, but I guess I'm worried that, that ... SALLY: That I'll clobber you. (Laughs.) TREVOR: Yeah, that I won't do it right and that you'll clobber me. Another example of a partner being unwilling to trust the other's new behavior arises when a previously withdrawn partner begins to assert himor herself and express anger or resentment. This can be very intimidating for the blamer, and this intimidation can be expressed by a sudden escalation of blaming and statements suggesting that therapy is, in fact, making things worse. The therapist deals with this by tracking the blaming client's experience and recognizing how alien and frightening it is for that client to see the other suddenly setting limits, giving feedback, and drawing bounderies. The therapist thus helps the blamer to accept the other's new responses and not to see them as a personal threat. At this point in therapy, where openness and goodwill have usually increased substantially, it is

possible to frame this kind of situation in terms of one partner needing the other's help in order to respond. For example, in the above case, at the therapist's direction, Sally may begin to offer ways that she can help Trevor to feel safer in the relationship so that he can risk responding to her in a new and more satisfying way. However, if there appears to be more substantial difficulty in one spouse accepting and responding to the other's new experience, then the therapist focuses on that partner's view of self, his or her past learning in the family of origin, any catastrophic fears he or she is experiencing, or whatever is inhibiting that partner's ability to respond to the other. It is presumed that once the inhibiting factor is reprocessed, then the partner will be capable of more empathic responding. Past incidents are focused on only as they contribute to the present interactions. For example, one client who seemed paralyzed in the face of his wife's authentic request for his caring began to explore the fact that, at these times, he felt overwhelmed and inadequate. He experienced her requests as a criticism and a demand for a closeness that he felt unable to provide. As he further explored his experience, the dominant image that emerged was of a time very early in their marriage were they had had a fight and he had pushed her. She had fallen down the stairs and had hit

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her head . She was unconscious when he found her. This incident, which the couple had not mentioned for years and which the wife had almost forgotten, was vivid and alive for the husband. It had confirmed a view he had of himself as unworthy of trust and love, as a failure in relationships, and even as a dangerous man. Once this incident had been explored, in a conjoint session, and the wife had accepted his difficulties, there seemed to be a shift in his ability to respond to her. The session did not focus on abstract insights as to the causes of the husband's lack of response, and the therapist made very few interpretations. The process was more of accessing the husband's experience, heightening his relatively simple, concrete, primary, emotional responses, and integrating the impact of these responses into the relationship. The interaction pattern here was also conducive to a new intimacy; when the husband disclosed his worst fantasies about himself, he found that, contrary to his expectation, his wife was accepting of him.

Step 7: Facilitate the Expression of Needs and Wants to Restructure the Interaction Step 7 involves the expression of needs and wants. Of course, couples talk of their needs throughout the process of therapy; however, the experience and expression of these needs, the way these needs are likely to be received, and the context of the other partner's likely response have all evolved by this stage of therapy into different forms. The needs and wants of both partners can now be experienced and expressed in a more open, genuine, and direct fashion. At this point in therapy, the focus of each partner has changed from a reactive preoccupation with the other and the effect of the other's behavior to a focus on the self and on the process of eliciting desired behavior from the other by presenting the self differently. A classic shift in EFT is from "You are withholding what I need" to "I'm afraid to ask, but I do want to let you in." As a result of the new emotional synthesis of intra-individual and interpersonal experience, the partners also have a new clarity concerning what they require from the relationship to help them feel secure, accepted, and satisfied. These desires are implicit in and spring naturally from an engagement in emotional experience: couples can now understand that when they feel afraid, they want to be reassured, and when they feel fragile, they want to be nurtured. Emotional experience ha~ a

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motivational component that is recognized by theorists such as Arnold ( I960) and is one of the important change processes in an affect-oriented therapy (Greenberg & Safran, 1987a). The desires that arise at this point in therapy are basic to the emotional bond between partners rather than instrumental or exchangeoriented ; they are on the level of basic requests for contact- comfort, security, recognition of personal worth and identity, and open access to closeness with the partner. One woman, previously dominating and critical, stated to her partner, "I guess I want you to take care of me, to be there for me to lean on, so that I don't always have to be strong. I want you to comfort me when I get overwhelmed by things. In a way, I need you to take me on." This was not stated as a demand but as a statement of needs and wants. Another partner, who was previously placating, selfdesignating, and apologetic in interaction, began to make statements such as "I would like you to be more attentive to me and my needs and do some of the things I like to do." This was stated not in anger but, again, as an assertion of needs and wants. The context is not one of quid pro quo exchange ("I do this for you if you do that for me"), but one in which partners respond to each other's needs in whatever manner they can, because they see how crucial these needs are to their partner's well-being and security in the relationship. They are rewarded by being able to give to an intimate other what only they can give; thus, they feel needed. The relationship becomes a mutual I-thou relationship in which partners reveal themselves and respond authentically. This overcomes the former sense of alienation and isolation and breathes life back into the relationship. Partners can now directly ask for specific responses in such a way as to evoke a caring response. This constitutes a new interactional pattern. Greater trust in each other follows. The attacking partner, for example, can now ask for reassurance in a congruent manner- that is, from a position of vulnerability. The other partner, seeing vulnerability rather than hostility, is likely to respond in an empathetic, caring way. Each time the sequence occurs, the bond between the partners is made more secure. It is important here that the needs and wants are not stated or perceived as demands and are free of blaming. They are statements focused on the self- "I need or I want"- rather than statements focused on the other. Once desires are openly stated, accepted as legitimate, and recognized by the partner, the urgent struggle for an immediate and particular response is lessened. Partners are then more able to accept

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some of each other's desires in terms of the timing and the nature of a particular response. This is facilitated by two factors: The self, having integrated disowned aspects and disclaimed action tendencies, is stronger and more able to tolerate delay, and the conditions evoking and maintaining the partners' nonresponsive positions have changed. The couples' interaction now evokes greater responsiveness, and there is a greater general sense of trust, understanding, and security in the relationship. Also, partners having had some of their needs met during the therapy process do not feel so deprived.

Step 8: Establish the Emergence of New Solutions Step 8 involves the integration of new solutions into the problem situations that precipitated the couple's entry into therapy. Since the couple are now able to take new positions in relation to each other, many new responses are possible. The therapist helps to delineate the solutions and aids the couple in diffusing possible blocks to positive responding. He or she also highlights and strengthens new positive patterns of interactions. For example, the couple may replay a typical problematic situation from the past but put in new responses, or they may discuss a situation that occurred during the week that they dealt with in a new way. A wife might confront her timid, withdrawing husband with his fearfulness. Since he is now able to "unlatch" the old cycle (Gottman, 1979), instead of distancing and becoming more fearful he is able to reassure her that he is fine and ask her to help him by remaining quiet rather than criticizing him. She, in turn, is able to accept his suggestion and admits her own nervousness and anxiety rather than focusing on the husband. When couples are able to become more accessible and responsive to each other, which in this case implies that both the way the individuals experience the relationship and the rules of the relationship have changed, then couples seem to exhibit greater creativity and skills in problem-solving tasks that previously used to trigger the negative interactional cycle. For example, couples may become more able to cooperate as parents and to solve financial problems more effectively. If the central struggle for a secure emotional bond is resolved, pragmatic instrumental concerns are more easily dealt with, since they are no longer the arena for self- and relationship-defining, emotional-laden conflicts. For example, a

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chronic disagreement about what to do with a summer cottage is easily resolved once the cottage is no longer a symbol to the wife of her husband's separateness and lack of connection with her. When disagreements do occur, they now tend to be centered on issues and thus are resolved more easily. Disagreements now tend to stay on the level of "I have this opinion which is different from yours" rather than "I never get a response from you; I am a victim in this relationship," or "You are an emotional cripple." Specifically, when the emotional climate in the relationship changes in the direction of more trust and security for both partners, then couples are able to use the problemsolving skills already in their repertoire. If any skill deficits exist, more effective responses can be modeled by the therapist. For instance, he or she may construct the dialogue the couple might have if both partners were open and responsive. This is, as Wile ( 1981) suggests, teaching communication without rules and without training as such. The couple can now attempt to substitute positive, self-reinforcing interactional cycles for the negative ones, while the therapist heightens and reinforces the new cycles. Since the relationship is now redefined positively, partners can ask for what they need. For example, the husband who used to take the old position of blamer may begin to attack his wife. However, he can now stop and begin to tell her instead of his sense of insecurity. She, responding to his expressed insecurity, can reassure him. Then he accepts her reassurance and recognizes that she has responded to his need, thereby increasing his trust in her and in the bond between them. She sees how she is necessary and valuable to him as a partner, and is also encouraged to engage in the same process in a reciprocal fashion. Both partners express aspects of self that had been previously unavailable in the relationship. As this positive cycle of accessibility and responsiveness continues, the bond between the couple is strengthened. The couple at this point in therapy are also motivated to break patterns of behavior that contributed to their previous alienation from each I other. They may then decide to structure more intimate time together.

Step 9: Consolidate New Positions Step 9 of EFT is the last in the sequence and, as such, is the most concerned with strengthening and integrating the changes that have taken place in therapy. This involves consolidating the new positions the

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partners have taken in relation to each other and integrating new perspectives on each partner's sense of self and the relationship. The couple are encouraged to clearly differentiate between the old and new patterns of interaction. The therapist facilitates the development of an encompassing view of the interactional cycles, both positive and negative, and the consequences of each. The final sessions are concerned with the same termination issues that any experiential or client-centered therapist addresses in general therapeutic practice. The process of therapy is reviewed, changes are clarified, and future goals in the relationship are discussed. Original issues are reviewed in the light of the present relationship as are any anxieties about terminating therapy. The therapist also considers possible scenarios that may occur when the relationship is under stress and discusses how some form of relapse is inevitable with an accompanying return to the old cycle. The couple and the therapist then specify ways they have found to exit from that cycle, which they can use in the future. The therapist's role here is to strengthen the couple's sense of now being in control of their relationship and being able to handle any future problems. Ideally, sessions are terminated gradually over a number of weeks, being structured further and further apart. A few check-up sessions are also scheduled after termination to monitor the maintenance of treatment effects. Case examples to further illustrate the steps of therapy now follow.

CASE EXAMPLE: THE PORCUPINE AND THE ARMADILLO Kathy and Tom were seen as part of a research project; thus, their therapy was limited to eight conjoint sessions. They were a couple in their 30s who had been together for 7 years and had one 3-year-old child. Tom had previously been married. Kathy was a homemaker, and Tom was an accountant in a large company. They had met in the context of an educationally orientated, personal growth organization, and Kathy had been attracted to Tom by his knowledge and apparent sophistication in this area. She had seen him as someone who could help her become a fulfilled, mature adult. Tom had been attracted to Kathy by her integrity and intelligence, and the relationship had gone well for the first 2 or 3 years with Tom and Kathy moving in together and finally marrying.

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However, for the last 2 years, their relationship had begun to go downhill, and Kathy had begun to seriously consider divorce. The scores for this couple on the Dyadic Adjustment Scale (Spanier, I976), the measure used to assess marital satisfaction, were very low and attested to their distress. Kathy's score (73) was in the range usually found for divorcing couples and Tom's (84), although somewhat higher, was still characteristic of a very distressed relationship. The strength of the relationship as described by the couple was that they both loved their son and felt committed to their task as parents. Also, Kathy described Tom as affectionate and caring, and Tom stated that he wanted very much for their relationship to improve and continue. Both seemed still to share a commitment to the relationship although Kathy was considerably more ambiguous on this topic than Tom. Neither seemed to have particular issues in relation to their family of origin or past romantic relationships. Both were psychologically orientated and had received some individual therapy. They also seemed to have a genuinely shared goal in terms of therapy: to improve their relationship, which had been once a source of happiness and satisfaction for them. As Kathy stated, the present relationship seemed "like such a waste."

Session 1

After a general assignment, the therapist asked the couple to discuss their perceptions of the problem. The problem according to Kathy was that Tom avoided taking any initiative in the relationship and avoided any closeness with her. She pointed out that he shirked his responsibilities as a partner by agreeing to carry out certain tasks and then letting her down. Tom's main complaints were that he was tired of continuous disagreements that were never resolved and that they had no sexual relationship. Both, as is typical of distressed partners, saw the problem mostly in terms of the other's behavior and shortcomings. The negative interaction. cycle between them became immediately clear. Kathy exuded hostility and icy contempt, attacking Tom at every opportunity: for example, "I'd like him to stand up and be a man, not a wimp." Tom, on the other hand, did not withdraw in the sense of becoming silent but vacillated between half-hearted attempts to reciprocate Kathy's attacks, giggling nervously, making jokes, appealing to the therapist, and agreeing with Kathy's disparaging remarks as to his behav-

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ior and character. These responses did not lessen her hostility in any way, and Tom would finally begin to stutter and to take a hopeless and helpless position, concurring with Kathy's opinion of him. The couple presented , then, a clear, very rigid, repetitive, and extreme version of the blame- withdraw cycle. Since they were a sophisticated, psychologically minded couple who seemed to have clear and compatible agendas for therapy, and who quickly formed a therapeutic alliance, and since the therapist had only eight sessions in which to effect change, the therapy process began at a rather faster pace than usual. The therapist pointed out the pattern of the couple's interactions as they were happening in the session. During the process, Tom came up with an image of the relationship as being one between a porcupine, his wife, and an armadillo, himself. The porcupine in this case kept "poking, telling the armadillo you 're doing it wrong, but the armadillo goes into his shell." This image became an important synopsis of their interaction and was used by the therapist to explore their relationship positions and the sequence of their interactions. The stuckness and rigidity of their pattern was expressed in such dead-end exchanges as: ToM: You never come clean, you resent me no matter what I do. KATHY: That's because you never change. or KATHY: It's like blood out of a stone, you never really communicate. ToM: I'm just reluctant, I pull back, I guess you're right. (Laughs.) In the first session the therapist was able to assess the relationship, form a basic alliance with each client, and begin Steps 1 and 2 of therapy, delineating the couple's perceptions of conflict issues and the interactional cycle. The cycle between Tom and Kathy escalated in the first session, with the couple occasionally referring to emotional responses such as rejection; for example, Kathy said, as part of a joke, "I start to feel rejected, guess there must be something wrong with me." This might have lead into some kind of new interaction, but generally Kathy and Tom maintained their positions of blame and withdrew and repeated the negative cycle. As Kathy became more and more angry, Tom became more and more distant, suggesting she talk to her friends instead of to him. The therapist ended the first session by summarizing her view of the relationship so far, describing the interactional cycle, and attempting to

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frame therapy in the most positive and hopeful light possible. She commented, for example, that Kathy and Tom must care for each other to remain in a relationship that had obviously become so painful for both of them. The therapist also presented the rationale for EFT and dealt with any questions or reservations concerning the process.

Session 2 Session 2 began by the therapist recapping the salient points of the first session and describing the negative cycle. At the therapist's suggestion, Kathy then began to describe her feelings when Tom suggested that she talk to her friends instead of to him. Tom was encouraged to take her comments seriously, and the therapist then took the opportunity to explore with Tom what made it so difficult for him to talk to his wife. In the course of a quick bantering exchange, Tom mentioned in a joking way that he was afraid of Kathy and her friends were not. The therapist saw this as an opportunity to begin Step 3, accessing unacknowledged feelings with Tom. She therefore repeated, focused on, and heightened his comment concerning his fear. Tom then became engaged in a process of accessing an overwhelming sense of hopelessness and inadequacy, stating that there was nothing he could do to get his wife to accept him. His fear of his wife's judgments as to his inadequacy became more and more vivid and was accompanied by tears and other signs of strong emotion such as an inner focus and a low-pitched vocal tone. The therapist validated Tom's responses and heightened and clarified his experience whenever possible. The therapist then directed Tom to try to express his feelings to Kathy. In response, Kathy attacked Tom by suggesting that real men are not put off by fear. The therapist, however, blocked the strength of her attack by continuing to legitimize Tom's feelings. She then began to add to the description of the cycle in terms of the emotion expressed in Tom's responses. Particularly, the therapist elaborated on the fact that it was Tom's fear of Kathy's judgments that kept him away from her; although Kathy wanted him to come close, she instead pushed him away with her judgments. Tom wanted her acceptance but was too afraid to even contact her. Hence, the cycle was created by both and painful for both. As the exploration of emotional experience continued, the sense of impasse, of the binds contained in the cycle, became more explicit to the

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couple. In a metaphorical sense, it was as if the room became hotter and the nature of the barrier blocking the way out became more and more clear: thus, there was a mounting pressure to break the barrier. The therapist then began to engage in Step 4 of the process, defining the problem in terms of the cycle, the positions in the cycle, and Tom's feelings , which formed the basis for his position. Toward the end of this session, Tom began to stutter less and engage Kathy a little more.

Session 3 The couple came in having had a relatively harmonious week, with Tom participating more in the relationship. The therapist encouraged the couple to discuss these changes in the relationship and began to search for an opportunity to continue the process of last week, bringing up key statements and incidents from the last session and inquiring about problematic situations or reactions that had happened during the week. Since this is a short-term therapy, this kind of active seeking for therapeutic opportunities is necessary. The therapist continued to focus on Steps 2, 3 and 4 of therapy and to elaborate on the positions each partner took in the cycle. The therapist phrased these in simple terms, describing Kathy's position as "Come out here or I'll kill you," and Tom's position as "Please accept me but I'm not coming anywhere near you." The therapist continued to focus and elaborate on underlying feelings whenever possible and to interpret the problem in terms of these feelings. The couple then began to discuss a recent fight, which the therapist evoked in the session and encouraged the couple to reprocess. Tom, with the therapist's help, described the fight as an overwhelming set of demands made on him by Kathy. He then began to explore his response to Kathy and how he dealt with his sense of intimidation. He explored his experience of being a naughty child in relation to Kathy and his strategy of appeasing her by superficial agreement or by joking, thus protecting himself. He described his response as constantly holding her off. The more engaged he became in this experience, the clearer it became that he took this protective stance constantly whenever he experienced his fear and the ensuing desire to protect himself. He also began to access anger and resentment against Kathy. It was obvious, at this point, that it was very difficult for Tom to allow himself to experience anger toward his

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wife let alone express this anger. However, he was able to begin to feel some resentment and a sense of the defiance that motivated him to climb into his armadillo shell and hold her off. The therapist then supported Tom to express some of this newly discovered emotion to Kathy. However, when he did so, her most positive response was on a very cognitive level: "l see, so you don't ever really agree to anything and that's why you don't come through. You just superficially agree in order to hold me off." She maintained her blaming, hostile stance even in the face of his disclosures, suggesting that "he chose to feel accused." She stated that his hurt and fear, and the fact that he could not express his anger, confirmed his weakness rather than being any kind of comment on her behavior. The therapist was then faced with a withdrawer who appeared to be willing to cooperate in therapy and a firmly entrenched hostile blamer. The agenda for the therapist at this point was to encourage Kathy's engagement in the therapy process. The therapist began to focus on what it was like for Kathy to attempt to reach Tom and come up against his shell, to be agreed with, but avoided. Then Kathy explored her rage and frustration at being shut out. She described an image of hitting Tom with a bat. The therapist encouraged her to imagine herself doing just that and to voice what she would be saying while doing this. Kathy explored her experience, voicing such statements as, "If you don't talk to me, I'll smash you." The intensity and desperateness of her rage surprised Kathy, Tom, and the therapist, but the engagement in this experience seemed more promising for the therapeutic process than Kathy's cold, rational hostility. Ideally, however, negative emotions such as this kind of anger are experienced, not simply ventilated, in order to go beyond them. Therefore, when Kathy fleetingly referred to a sense of helplessness, the therapist focused on this and on the trembling of Kathy's hands. At this point, Kathy spoke in an abstract way about the fact that people sometimes got shaky when hurt, adding that she did not really feel hurt. The therapist suggested in a soft, evocative voice that people also shook when they were afraid. At this point, Kathy began to cry and expressed with intensely emotional involvement her fear that her husband was never really going to be there for her, that he had deserted her, and that she had given up. She then explored this experience further and accessed that she had given up on anyone ever loving her; perhaps, she thought, she was indeed unlovable. This part of the session had the quality of an intense, newly discovered experience. The therapist legitimized and clarified Kathy's hostility and attacking behavior in the relationship in the light of

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this experience. The therapist also reinterpreted the cycle in terms of how it was a logical consequence of Tom and Kathy's vulnerabilities and how they tried to deal with them. At this point, Tom, encouraged by the therapist, reassured Kathy that he recognized her feelings and did not want to desert her. The therapist closed the session by telling the couple to pay attention to the cycle in their relationship as they played it out during the week, and to note their own responses.

Session 4

In this session, the therapist's agenda was to continue Steps 2 to 4 in a more and more significant manner. She also planned to work on Step 5, the identification of disowned aspects of experience, which Tom had already begun to do when talking about his fear of judgment and Kathy had already begun to do when talking about her sense of being deserted. Kathy started the session by immediately attacking Tom, calling him a child and accusing him of laziness. She stated that he was incapable of taking any initiative. The therapist's sense was that Kathy was recoiling from the slight shift in her hostility that had occurred in the last session. Tom said that he had tried during the week to show his concern and his desire to respond to Kathy's needs but that she had discounted his attempts. This view corresponded with the therapist's observations of Kathy's behavior in the sessions. However, as Kathy continued her attack, Tom stood his ground and stated that if Kathy wanted things to change, she had to be willing to give him a break-that is, to accept some of his efforts to reach her and to acknowledge his vulnerability to her judgment and criticism. He added that if she could do this, he did have the strength to involve himself more fully in the relationship. This was a change in Tom's usual position in the interaction, and the therapist focused on, directed, and heightened his comments. Tom then expanded on his desire for acceptance, accessing an incredible sense of fatigue associated with the constant struggle for Kathy's acceptance and the need to always protect himself from her criticisms. The therapist validated and supported Tom in his owning of his need for some safety and acceptance in the relationship. Kathy, however, remained relatively unresponsive, so the therapist intervened, framing Kathy's response in terms of an unwillingness to trust Tom again and the

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fear of allowing him to hurt her. The cycle of "I won't trust him till he proves himselr' and "I can't prove myself till you begin to trust me again" became apparent. Although Kathy would talk about and cognitively explore underlying feelings for a moment, she always returned to attacking Tom and placing all the responsibility for the problem and for change on him. Therefore, the therapist, while supporting Tom and blocking the brunt of some of Kathy's attacks, returned to validating Kathy's sense of being deserted and let down. Kathy explored this feeling further and began to speak of and describe her sense of betrayal in the relationship. The therapist then asked Kathy to tell Tom about this experience. Kathy was able to tell Tom explicitly that she was so angry at him for letting her down that she wanted to hurt him, and that she wasn't sure that she was willing to take the risk of trusting him again. Tom accepted her statement. In the last half of the session, the therapist, faced with Kathy's fixed hostility and refusal to acknowledge Tom's experience, chose to explicate Kathy's apparent drive for revenge and to frame her unwillingness to respond in terms of self-protection and the fear of trusting and risking being hurt again. Since Kathy could not move beyond this point, owning her hostility and her reluctance to be open was her only possible first step toward change. Stating explicitly and with congruent affect where one is in a relationship can be viewed as resistance; here it was viewed as the first step toward change. The pattern shown here, where the withdrawer emerges and begins to be open and responsive, as well as to state some personal boundaries, only to be met with more blaming, is not uncommon. The task for the therapist is to support the withdrawer while helping the blamer to soften his or her position.

Session 5 The couple came into this session in a considerably lighter mood. Kathy had found herself less angry at Tom during the week, and she had initiated love-making for the first time in months. Tom appeared very moved as he described the experience of her warmth and how sad he felt that this was usually absent. Kathy, however, then described an incident in the recent past in which she had felt the sense of betrayal that had been

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accessed in the last session. She also spoke about how she had dealt with this sense of betrayal and other hurts in the relationship by "walling Tom out" and waiting until he proved his caring for her by coming to find her and re-initiating contact. However, when Tom failed to do this, which was usually the case, Kathy then felt totally abandoned and gave up on the relationship. The therapist was now able to summarize the problem cycle in terms of Kathy's and Tom's underlying vulnerabilities and their ways of protecting themselves against these vulnerabilities. The first four steps of therapy tend to recur in this way, each time becoming more differentiated and more meaningful. Tom was able to reciprocally share how he experienced the incidents referred to by Kathy, saying that there was "never any room for me to be the one who needs comfort and attention-I'm supposed to give, and if it's not right, wham, so I keep away." Tom and Kathy were able to interact around these issues in a more open and caring way than previously. They then became stuck again in the dilemma of who was going to reassure who first. Finally, with the therapist's support, Tom became very angry, and he expressed his outrage at Kathy's treatment of him and stated that he was tired of trying to meet her standards. He stated that what he wanted was some reassurance and some recognition in the relationship. This represented a clear shift in position for Tom and opened the way for a possible new pattern of interactions. Kathy responded by becoming relatively quiet and confused. The therapist focused on Kathy's response, which she first identified as confusion. Kathy then admitted that she liked Tom to stand up to her but that she did not want him to become unreasonable. This struck all three people in the room as amazingly humorous. Kathy identified her response as a sense of relief and reassurance that she was important to Tom. Tom then went on to explore how the stance he had just taken differed from his usual one, in which he assumed that the only way to survive in the relationship was to placate and/ or withdraw his attention in an attempt to halt the interaction. As he continued to explore his usual passive stance, he began to access an underlying sense of defiance. The therapist expanded and highlighted this sense of rebellious defiance, and Tom was finally able to confront Kathy, stating that he would not be pushed and controlled as if he was a child and that he did not want any longer to resist her control by placating and avoiding her. The therapist asked what Tom was willing to respond to, and he stated that in the past,

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when he had seen Kathy's need clearly, he had responded . Kathy grudgingly agreed. The session ended with Kathy stating that she did sense that she had been withholding recognition and respect from Tom. When asked how she understood this withholding, she replied that she thought of it in terms of "I'll show you, you can't get away with hurting me, with ignoring me." The therapist summarized by pointing out that both partners in fact felt helpless in the relationship, but they dealt with this feeling in opposing but interlocking ways, Kathy by attacking and Tom by avoiding contact.

Session 6 The couple came in reporting that an unusual amount of open contact had occurred during the week. The therapist's agenda was to focus on Kathy, rather than Tom, and attempt to help her to identify more completely with her disowned needs for contact and support. Ideally, Kathy would then be able to express these needs to Tom, who was, in the therapist's judgment, able and willing to respond. This agenda was dictated by the therapist's perception that although Kathy had become less hostile and had made some progress, she had not really changed her basic position of the betrayed accuser. The agenda, then, was to facilitate a softening of Kathy's blaming position. The critical issue seemed to the therapist to be whether Kathy would be able to trust Tom enough to allow herself to be in a position of openly needing a response from him. The therapist focused the session by recalling some of Kathy's experiences in the relationship that had been explored in past sessions. Kathy responded by commenting that Tom did seem to respond to requests for support rather than to her angry demands. The therapist then focused on how difficult it was for Kathy to ask Tom for help, comfort- or anything. The session progressed to the point where the therapist asked Kathy if she could ask Tom for comfort and then facilitated an exploration of Kathy's resistance to doing this. Kathy began to access a sense of helplessness connected to asking for help and a desire to back off and be cool- and hence to test if Tom cared enough to approach her. At thi& point, the therapist asked Kathy to look at Tom and assess the risk involved in reaching out to him.

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Edited Session Excerpt KATHY: (Looking back and forth between Tom and therapist, playing with necklace,· voice removed and intellectual.) If I didn't need to he in a relationship with someone, I mean, I just would have left him instead of still trying to have this relationship, right? So um, yeah, um, so what J see is like, I realize like the things that I need are, I mean, they are sort of the normal things that everybody needs. THERAPIST: Like what? Can you tell Tom what you need? KATHY: Acknowledgment for who I am as a person um, ah, respect, um ... consideration. (Pauses, looking at Tom.) THERAPIST: Maybe you need to know that even if you're vulnerable and needy that Tom will take care of you rather than somehow close up like an armadillo. KATHY: (Voice hard, emphatic.) Well, that I don't trust him to do it, if I am vulnerable and needy. THERAPIST: Right, you're afraid that he's going to close up. KATHY: My fear is that if I am vulnerable and needy that he can't accept that, so yeah, so he will withdraw, yeah, right. (Nods head.) THERAPIST: Well that's really a big one because then it's like you're risking everything. I mean you've experienced this disappointment in the past so you take a risk, you show your vulnerability and your neediness to Tom, risk everything and he withdraws from you. KA THY: That's right. KATHY: (Pause.) So that's why I get so furious when he closes off. THERAPIST: Right ... umhum. So it's like he's deserting you just like all the other people who've deserted you, disappointed you. KATHY: Right, and that's where, um, (voice soft, fragile) where the hurt goes into anger. THERAPIST: How do you feel when you talk about this, Kathy? KATHY: Well, I feel emotional, I don't know, I assume that that is sadness. (Looking to side and down.) But I don't have, I don't have a specific connection for it. THERAPIST: Well, I guess, listening to you, if you really want something very badly, believe that it, isn't there for you and nobody's going to give it to you, I mean that in itself is sad. (Pause.) And then somehow to get to the point where you can't ask for it anymore, it's just too painful to take that risk, then that's sad, Kathy. (Pause.) I think that makes you feel alone too.

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KATHY: Yeah, it does. (She cries, wipes her eyes.) It also (voice high, child�like), I feel invalidated as a person. THERAPIST: How do you mean? You mean, make that simple for me. Do you feel small or ... KATHY: No, more like I don't exist. ToM: (Fidgets.) Like somebody doesn't notice you're there? KATHY: Um, it's not that they don't notice I am there. ( Voice shaky-having difficulty speaking.) People notice I am there and it's OK if I have the correct behavior appropriate for the situation and if I look the right way. I must have the right behaviors and look half decent because the inner part of me is not acceptable. (Pulling herself together, blows nose.) THERAPIST: So if people really saw your need (soft) they wouldn't accept you or respond to it. KATHY: It's like I go around with this image so if people see that I am not the image that I present, um, I have a belief that they may not respect me. THERAPIST: Do you believe that about Tom, if Tom sees your neediness and your vulnerability and your need to be somehow validated, reassured, that he won't respect you? (Kathy and Tom look at each other, pause.) KATHY: Um, see, I am not sure. It's much easier to accept those characteristics in people that you are not in a relationship with, so you 're not identified with them. THERAPIST: So you 're not sure that he would respect you if he saw your need and you're also not sure that he would respond and you'd end up feeling more alone, even less real. KATHY: That's right. ( Voice shaky again.) THERAPIST: So it's easier to get angry and say (angry voice) "I don't need you, and I'll show you, you can't do this to me, you can't leave me here feeling alone." KATHY: Yeah. (Nodding, pause, looking down.) THERAPIST: Can you look at Tom for a minute? KATHY: (Laughs, wipes eyes.) If I can see. (Looks at Tom.) THERAPIST: How does it feel to just look at him? KATHY: (Pause.) Well I go into my analysis about what he's think.­ mg. THERAPIST: Um, do you want to know how he's reacting to you? KATHY: Yeah.

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THERAPIST: (To Tom .) How does it feel to sit and listen to Kathy talk like that? ToM: I feel, um, I feel more comfortable, a lot more human, you know, I don't feel like I have to play a role or meet anybody's expectations, like in the first session when I first sort of detected within you that your vulnerability you know, I really felt like, yeah, I felt like I could respond, truly respond, you know what I mean. THERAPIST: You were not being pushed, or somehow coerced, or somehow blamed. ToM: Yeah, that's right, I didn't feel there was a demand, a hook of some kind. It was like there was just you who, however, you were you know, so it brings forth in me other qualities, other parts of me. THERAPIST: How do you feel about Kathy right now? TOM: I feel, ah, like I want to be with you. (Looking at Kathy, laughs.) I feel close and willing to share. THERAPIST: So you would like to be able to be there for Kathy? ToM: Yeah, yeah I would. (Pause.) Give me a chance, I will. (Pause, Tom laughs.) KATHY: Yeah, I've done that before and you withdrew, you know, you pull your mask down, it's like you know, I don't want to give you a second chance. (Tom nods.) THERAPIST: But have you done it before, have you really showed Tom your vulnerability in the last while in your relationship? KATHY: No, I stopped doing that because it didn't work, but I showed more in the first few years than I do now. THERAPIST: I wonder if Tom understood what you were showing, or asking for? KATHY: Well, my beliefs are that, he understood but, it was, um, threatening to him, he's attracted to, um, to strong women or women who appear to be strong, play that role. (Tom and Kathy laugh.) THERAPIST: (To Tom.) Do you like that analysis of yourself? ToM: No. THERAPIST: I didn't think so. TOM: Some of my best women friends are kind of wimpy. (Laughing.) KATHY: Yeah, but they're not the ones you've lived with. THERAPIST: I heard you say, Tom, that you'd like Kathy to give you the chance to be there for her. ToM: Yeah.

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THERAPIST: To be with her and to validate her, to give her the feeling that she's real in the world and you're responding to her- and I saw you, Kathy, wrinkling your nose (Kathy laughs) and thinking maybe that's too big a risk, like I don't believe you, I don't believe you're going to be there. KATHY: I do think that. THERAPIST: Was he there for you right here? KATHY: Yeah, he's here for me right now, um, but how I see it is like there's someone else here, he has nothing at stake. ToM: So when it gets down to the nitty-gritty, when you really need somebody ... KATHY: When it gets to when there's nobody else around, THERAPIST: What's the difference when I am here? KATHY: Well, it's like (pause) how I see the difference is that he feels safe when you 're here. THERAPIST: That's right, that's right. KATHY: And I am not sure why he feels so much safer when there's someone else around. (To Tom .) It's like I don't know what you are afraid of that you need to have someone else there in order to be with me. THERAPIST: (To Kathy.) I just want to slow down here, I agree with you my fantasy about this relationship is that if Tom felt safe there is no way that he wouldn't respond to you and be there for you, and I think if Tom's busy defending himself responding to the, if you like, to the weapons in your hand, that you've got because you don't really believe that he's going to be there, then he probably won't be there because he gets preoccupied with not feeling safe. KATHY: There's still something about it that I don't get. (Looks down, pauses.) ToM: It seems like you don't really trust. You don't even trust what was going on here. I mean that's your excuse. It doesn't meet your conditions. KATHY: No! I wasn't asking you for anything. I wasn't in a situation of need. THERAPIST: Well, I saw you asking for something, I saw you asking for some kind of recognition. I am not sure though, I mean, Kathy, I also have a sense that for you it would be very difficult, I mean I hear your doubts and I don't want to say they're not important but it would be very difficult for you to allow Tom to come in and be with you and respond to you. I mean it would be almost like . .. KATHY : I'd have to put my sword down. (Soft, small laugh.)

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THERAPIST: You know, you've had it for a long time- you've needed it lots. ( Very soft voice.) KATHY: Yeah, it would be like being a whole new way, playing a different game. Yeah, so yeah, that would be hard. THERAPIST: See, I think you listen to lots of reasons to not believe Tom's ability to respond to you because, it's really scary to take that kind of a risk. That's something that's been dangerous and painful for you. It's not easy. KATHY: Yeah, it doesn't feel like something that I can just give up. ( Gestures tossing something away with her hand.) THERAPIST: No, no. KA THY: Right. THERAPIST: My feeling is that it will probably be a very gradual thing or that maybe you just don't want to do it right now. Maybe you're not ready to do it right now, you know? There were good reasons for holding back. It probably saved your life at some point, right? (Pause.) You survived being alone even though it was painful, you survived. If you let Tom in, that's really different. (Kathy cries.) KA THY: Yeah, that's true. THERAPIST: (Pause.) Tom, where are you? ToM: I am just empathizing with that. The way I've been thinking is like well "change, damn it," but when I reflect on my own weapons, it is very sad. The sadness is that you have to sacrifice in terms of living for the sake of this stupid thing that really didn't mean anything, yet you had to have it. KATHY: Well, you can't say it really didn't mean anything. I'd have died if I didn't have my weapons to keep people out. THERAPIST: (To Tom.) So you can relate to what Kathy is saying? TOM: Totally. THERAPIST: Can you guys just comfort each other right now. ( Tom and Kathy giggle.) Could you allow Tom to comfort you right now, Kathy? KATHY: I don't want to be comforted. (Small laugh.) THERAPIST: OK, let's stop. That was a good session. KATHY: Yeah. (Softly, clears throat.) THERAPIST: You guys have a lot to give each other. KATHY: Umhum. (Pause.) We do have potential, don't we? (Softly.) THERAPIST: Oh yes!

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Here the therapist attempted to work with Kathy's block to accepting Tom's caring and comfort and promote acceptance of his inability to respond under threat (Step 6). The therapist focused on Kathy's resistance to becoming vulnerable to Tom, and Kathy did seem to respond.

Session 7 This couple worked with unusual intensity, so it was somewhat of a relief to the therapist that the last two sessions were more low key than the previous sessions. Kathy began the seventh session by again bringing up her fear of trusting Tom and "letting down my barrier."Tom then expressed directly his need for acceptance and caring in the relationship and his sense of "squirming resistance" to Kathy's demands. Tom then engaged Kathy as to what she really needed from him. She disclosed that she had turned to their child to fulfill her needs for comfort and affection and had cut Tom off from that aspect of herself. She acknowledged that she perhaps had to make the relationship safer for Tom before he could offer her closeness. The therapist focused on the need that Kathy had turned to her child to fulfill. Kathy spoke of her need for recognition, comfort, and security, although her statements were in relation to her child rather than in relation to Tom. The therapist then framed the future of the relationship as being dependent on each partner helping the other to be open and responsive. By this point in therapy, the interaction patterns of the couple had changed. Tom was much more assertive and less withdrawing in the relationship, and Kathy, although unable to ask Tom directly for what she needed, was visibly less hostile, more relaxed, and more open to Tom. The stuck rigid cycle that the couple had presented in the first session was no longer apparent.

Session 8 This session focused on the changes in the way Tom and Kathy saw themselves and each other and their interaction patterns. The therapist summarized the apparent changes and the new positions that each

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partner had assumed . The therapist also delineated future goals - specifically, the building of trust. In this session, Kathy seemed to be open to and accepting of Tom's expression of fear in the face of her judgments , a nd he was able to encounter her without withdrawing. Tom stated that he was willing to risk "getting clobbered., to show Kathy he cared and to help her to trust him . Kathy stated that she felt less aggressive toward Tom , and less cut off from him, and was willing to help him feel safer in the relationship . The couple also discussed incidents that had occurred during the week that previously would have triggered an escalating negative cycle but for which they had found new solutions. For example, Tom had agreed to pick up a baby-sitter so that he and Kathy could go out, but had forgotten to do so. When he arrived at the house, Kathy confronted him . However, Tom did not placate or withdraw from Kathy. Instead, he simply defined the situation as one in which he had made a mistake, he reassured Kathy that it would not occur again, and he told her how he planned to prevent such a recurrence. He had also pointed out that if she wished to launch an attack on him that was up to her, but he was not going to respond in his usual fashion. Kathy calmed down and they went out and had a pleasant evening together. They also related a similar incident in their sexual relationship that they were able to resolve in a new way.

Conclusion This couple improved significantly on outcome measures at the termination of treatment and continued to show improvement at follow-up. The progress of therapy had involved a reciprocal redefinition of self and the relationship for both partners. Both Tom and Kathy seemed more able to accept and respond to each other. Tom had redefined himself in a more assertive way in the relationship, and Kathy had begun to define herself less in terms of aggression and more in terms of vulnerability. Relationship transactions had been made explicit and had become more flexible and more positive. As can be seen from the description of these sessions, the therapist typically circles through the steps of treatment, retracing steps as deepening and development occurs over time. One partner, often the partner

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taking the withdrawn position, usually takes the lead in therapy. The rate at which couples progress and the areas in which partners become blocked are very idiosyncratic. The process, however, is one in which clear patterns emerge. Often it is easier to get a couple to some kind of deescalation, perhaps to Step 4, than to elicit the further steps of mutual accessibility and responsiveness. This case example focused mainly on the clients' activities, statements, and progress in therapy. The following chapter focuses on the principles of therapist intervention.

CASE EXAMPLE: THE WALL THAT SEPARATESAN INTRUSION-REJECTION PATTERN Michael and Linda had been married for 5 years and had one 2-year-old child. Michael was a 29-year-old, first-year law student, and Linda was a 32-year-old teacher. In the pretherapy assessment, the couple reported on the target-complaints instrument that their major concerns were lack of intimacy and lack of communication. In addition to her concern about lack of intimacy and communication, Linda reported wanting a better sexual relationship. On the goal-attainment measure given before treatment, Michael expected, as the result of treatment, a more relaxed atmosphere with more physical contact (four times a week) and fewer sharp words (once a month), while Linda wanted more hugging and more time talking (at least a half hour a day). Michael's DAS score was 89 with Linda's at 97, putting them between one and two deviations below the norm of married couples (Spanier, 1976). At termination, his DAS score had risen 20 points to 109 and hers had risen 16 points to a score of 113 (the norm being a couple mean of 114). Michael reported a great improvement in intimacy and communication at termination, while Linda reported feeling somewhat better about these two issues with a slight improvement in their sexual relationship. Both partners reported somewhat better than expected results regarding their goal attainment: Linda reported that they now achieved much more eye contact, ease in getting close, more body contact, more trust, and more sharing of intense feelings. Michael felt they had attained a heightened level of interest in each other, were more attentive, and had good contact every day. A description of the therapy process follows.

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Session 1

The session began with Michael stating in a halting fashion that communication was the problem, while Linda said she wanted more time together, greater intimacy, and Michael to share his feelings with her. Michael said that he had difficulty expressing his feelings but would like to be able to do so. Linda added that she was feeling so hopeless about getting what she needed that she was considering leaving Michael. The negative interaction cycle was clear from the beginning of the session. Linda pursued Michael for greater closeness and demanded that he share more of his feelings. He generally withdrew at home, although, with considerable encouragement from the therapist in the session, he said he felt guilty about not giving Linda what she wanted. Michael added that, at home, the more Linda attacked him, the more he withdrew into his books. A transcript of the opening episode is given below. This excerpt begins a few minutes after the therapist inquired about the couple's reasons for coming into therapy. Edited Session Excerpt LINDA: I think it's just more around communication, emotional issues, wanting more intimacy-more emotional intimacy I guess. THERAPIST: Who wants more intimacy? LINDA: Well I certainly do. THERAPIST: Uh-huh. LINDA: And so do you! (To Michael, said half kidding.) THERAPIST: What was that? And so do you? LINDA: Well, I suppose I'm the one that's really instigating it. THERAPIST: Uh-huh, so you're wanting more intimacy, right? LINDA: Yes, right. THERAPIST: And what do you perceive him as doing in response to that? Or how does he react? LINDA: I feel like he wants to respond to that, but neither of us really know how. You know, what to do. THERAPIST: Yeah. Yeah. LINDA: It's actually been an issue for a long time but it's only recently that I have felt really like we've got to do something now. THERAPIST: Umhum.

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I'm not going to wait any longer. THERAPIST: What happened to make it different? LINDA: Just deeper, deeper dissatisfaction, I think. THERAPIST: So it's sort of always been that way but it's been getting more and more, you've felt more of a need , right? LINDA: Yes. THERAPIST: Um. (To Michael.) What do you think about what Linda says? MICHAEL: Well (stutters) it has been a concern for quite a while. I think I feel the need for, a greater need for closeness, she feels a need greater than I do. I am aware of the issue but I'm not quite as affected by it as Linda. THERAPIST: So somehow you, I understand, you're saying she has a greater need for intimacy than you do. She is expressing a greater need but you recognize that there is something more that you would maybe like too. So it's not that she wants it and you don't want it. You're saying that you 're open to it. MICHAEL: Yep. THERAPIST: Yes, but. It's difficult? Or, that's the problem? MICHAEL: Well it is difficult, I do think that there is a lack of intimacy, uh, it is neither one's total fault, one way or the other, but I'm probably more to blame. THERAPIST: U mhum, You feel that or she feels that? MICHAEL: No, I feel that. I'm sure she agrees. THERAPIST: OK that must be a difficult feeling to have, that you're more to blame, it's an unpleasant thing I guess. MICHAEL: Yes, it is. THERAPIST: Does that make you feel sad or down sometimes? MICHAEL: Somewhat. THERAPIST: Yeah, what does she do when you feel this way? MICHAEL: When I feel ... ? THERAPIST: Down or sad or upset about this. MICHAEL: Well, I don't know if she's aware, when I'm, sometimes she's aware of when I'm down or sad about different things. THERAPIST: Can you tell Linda now about how you feel about not being able to be as intimate as you would both like. I mean I'm not sure that she knows what it feels like for you. MICHAEL: (To Linda.) Well, I think I feel slightly caged by it, I get the feeling of futility that I would like to be more open, but I don't really know how to go about it. LINDA:

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THERAPIST: (To Linda.) What happens for you when he says this'? What do you actually feel? You know we're just beginning and I know it's a little strange, this stuff, but it is a very real concern you're talking about, and I'm wondering what kind of response you might have when he says that to you. LINDA: Well, we've . .. I think we've talked about it a number of times. THERAPIST: Yeah, yeah, but . . . LINDA: And I feel different things at different times. THERAPIST: What did you feel right now? LINDA: A sense of fear. THERAPIST: Fear. Uh-huh. LINDA: Because I'm kind of frightened that, u 'm, that he may not . . . THERAPIST: Can you tell him? LINDA: (To Michael.) That you may not be able to respond to that need that I've had for a long time. THERAPIST: So you're afraid that he might not be able to meet that need of yours and you'll be left empty or alone. LINDA: Yes, and also I'm much more demanding about it now. THERAPIST: Sure. LINDA: It's at the point where I feel that there's a possibility of us separating which I've never felt before. THERAPIST: So that's scary ... what do you feel when you say this? LINDA: Very depressed. THERAPIST: yes. LINDA: Very down. THERAPIST: OK (To Linda.) I noticed you smiled when you said that and I understand that you're anxious. (Michael and Linda smile at each

other.) THERAPIST: What happens when you look at each other? And you smile? LINDA: I was thinking this situation is, um, I don't know how Michael feels about it but I have been in different types of, therapy-type or education-type programs and it takes me a long time before I actually feel that I talk in a way that is very open and honest. When someone else is there. THERAPIST: Right. LINDA: I'm feeling like there's this third person sitting here and you know, we're trying to talk about things that we can't even talk about by ourselves. Never mind that there's a third person around.

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THERAPIST: I see, you're sort of thinking about the situation and the difficulty. LINDA: Yes. THERAPIST: I am actually pushing you very quickly, but it seems to me that there is something to talk about and I understand that anxiety of me suddenly saying do this and do this, yeah. LINDA: It's OK. It's OK. THERAPIST: But you somehow both laughed at the same time and I was sort of struck with the sense of you doing it at the same time, so you do communicate. So you were focused on the difficulty of being genuine and talking about difficult things. (To Michael.) OK, but let's go back to what it is that she does that can be helpful for you. MICHAEL: I don't know. I know that when tensions relax between us it's much easier for me to be open and when they're not it's, uh, just becomes a very vicious circle. The more you want from me the less I can give and the more you want because I give less. LINDA: Right, yes. THERAPIST: So that is the vicious circle that we are talking about here. LINDA: Oh yes, yes it is, yes. THERAPIST: You stated that very clearly. LINDA: Yes .. . that's it. THERAPIST: (To Michael.) That the more she wants the less it's possible for you to give, and then the less it's possible for you to give the more Linda wants. The more you feel caged and ungiving the more demanding Linda becomes, right? MICHAEL: yes. LINDA: A perception I have also in recent months is that I'm getting kind of angrier and angrier and therefore I think I'm becoming more attacking. THERAPIST: yes. LINDA: I mean sometimes when we fight, well, usually it's me getting angry and Michael not saying very much you know, it gets kind of ugly. THERAPIST: Yes, yes. LINDA: And I have the feeling, and I may be wrong, I mean, I don't know what's happening for sure but things are getting kind of more ugly, and that I'm starting to attack quite a bit more, because I'm demanding that from him and he just feels more caged and says, well what am I supposed to do, and I say well I don't know what you can do.

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THERAPIST: OK, so we could predict that if you get into a fight that this is what would happen. That y ou would become more demanding and eventually more attacking. LINDA: Yes. THERAPIST: Right? Right. How do you attack? LINDA: Well, now I'm getting more where I attack just for the sake of hurting. 111 say things that I know ... THERAPIST: will hurt? LINDA: Yes, will hurt. THERAPIST: Right, right. (To Michael.) Do you know that this is happening? MICHAEL: Yes, but it doesn't prevent me from being hurt. THERAPIST: Yes, it doesn't usually. So you do get hurt? MICHAEL: Oh yeah. THERAPIST: And what do you do when you're hurt? MICHAEL: Well, withdraw, sort of. THERAPIST: How do you withdraw? MICHAEL: I become silent. THERAPIST: Umhum. Do you remove yourself physically? MICHAEL: No, I focus my attention on other things. THERAPIST: OK. And so you're doing that to protect yourself, but also you know that in some way it gets at her, it's a way of fighting too, I think you're saying that. MICHAEL: Yes. THERAPIST: Yeah? (To Linda.) And you sort of attack and start attacking indiscriminantly. LINDA: Yes, because the further away he gets, then the angrier I get. THERAPIST: Right. Then what happens? OK, so you escalate your attack, let's try to get concrete if we can, so you can describe it to me. LINDA: Sure. THERAPIST: The last time this occurred or a situation where it often occurs, and maybe describe ... LINDA: Well I can think of a week or two ago. We got into a situation which I would call one of our ugliest fights. I don't know, do you agree with that? MICHAEL: Depends on which one you're talking about. LINDA: In the restaurant. MICHAEL: Yeah, probably a typical fight.

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The therapist then tracked a concrete situation in which the couple had a fight in a restaurant. After discussing the fight, Linda commented that even though she had told Michael that she wanted to leave the relationship and had been very upset, he had not even bothered to ask her how she was feeling the next day. The therapist, after responding to Linda's hurt, asked Michael how he had perceived the situation. He replied that it had been an ugly fight and that he had said things that he knew would hurt Linda. He then told Linda that he had not been ignoring her statement about leaving but that he felt excluded from the decision-making process. This sequence demonstrated how Linda, desperately wanting a response from Michael, would pursue him, complaining that he did not respond. He in turn would withdraw by not asking her about her plans for leaving and by saying he had been excluded from the process. This latter response managed to frustrate Linda's current need for reassurance and reinforced her experience of him as emotionally unavailable. The therapist then asked Michael about how he felt when Linda talked in the se~sion about separation. He replied that he felt terrified. The couple then began to talk more intimately with each other. Michael expressed his feelings of vulnerability and sadness, and Linda expressed her loneliness, her need for intimacy, and her fear. The session ended shortly thereafter on a note of positive contact, and the therapist gave the couple the homework assignment of sharing their sadness and good feelings with each other. The transcript of this discussion follows. In it, the therapist attempts to have Michael express his feelings, to provide a new expenence for the couple, and to emphasize the possibilities of change. THERAPIST: This was at the restaurant? MICHAEL: I'm not sure why we were suddenly fighting but we certainly were. As Linda said it was a very ugly fight. She called me a few names and I said something to her that I knew would hurt her. THERAPIST: u mhum. LINDA: (To Michael.) How do you experience what happened after, though? Because I don't feel you ever responded to that either. MICHAEL: Well, I thought we talked about that. I wasn't ignoring what you had told me, what we had talked about. I don't think I was sitting back hoping it would disappear. But, the way you had presented it

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to me I didn't feel that any of the decision was mine. You ex.eluded me from, from what you were going to ... you were going to make up your mind. THERAPIST: About leaving or staying? MICHAEL: About leaving, about what was going to happen. LINDA: Well how could I include you in that then? MICHAEL: You could have asked me what I thought about sepa­ rating instead of telling me that you had been giving it considerable thought. LINDA: And what do you think about separating? Or maybe I should say the possibility of. MICHAEL: It terrifies me ... I think it would be ... (Sighs.) It's not what I would like. I think we could have possibility together. I also really don't want to look forward to the experience of separating. I know how I would feel ... THERAPIST: (To Linda.) What happens for you? LINDA: Um, I start feeling really sad. ( To Michael.) And also getting kind of scared to trust you. THERAPIST: To trust him with what? Can you tell him? LINDA: (To Michael.) I guess I feel like we've been through this so many times before, about me wanting more and you saying, well, I don't know what to do about it. Your reply is usually something like, you don't know how to get in touch with your feelings. THERAPIST: Michael doesn't know how to get in touch with his ... LINDA: This is what he usually says. And I ... THERAPIST: (To Michael.) Can you tell her what you're feeling right now, Michael? Because I think you're feeling a lot. MICHAEL: Well, I guess I'm anxious. THERAPIST: What do you want from Linda? MICHAEL: What do I want, uh, period? THERAPIST: Right now. When you tell her that you'd be terrified if she left. That you feel ... MICHAEL: Well, I'd like her to believe me. THERAPIST: Can you tell her? MICHAEL: (To Linda.) I'd like you to believe me I do feel these things ... THERAPIST: You have some idea that she may not believe you. MICHAEL: As you've said, we've gone through this before. THERAPIST: So what do you want her to believe?

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MICHAEL: That I do care. That these things do matter. At the same time my feeling is that, it isn't enough. THERAPIST: What more is needed, are you willing to give . . . I think that's important that you're saying that you do care. What more are you saying? M1c HAEL: ( To Linda.) I wish that we could establish the intimacy that you so obviously need. THERAPIST: ( To Michael.) What is it that you believe she needs when you say the intimacy? What kind of things? Can you tell her? MICHAEL: Greater understanding, uh, more obvious . . . THERAPIST: More? MICHAEL: (To Linda.) More obvious and continual caring. I'd like to be able to still be involved in the things that I do, whatever, school, and not lose sight of you ... at times, it's very hard. THERAPIST: (To Linda.) What's been happening for you as you sat here listening to Michael? LINDA: Mostly sadness I think. THERAPIST: Can you say something about that sadness? What are you saying? What are you sad about? LINDA: Um .. . sad that that is what we lose touch with all the time. Um ... (To Michael.) I guess it's what makes me think you really don't care. I can hear what you're saying now, um ... THERAPIST: So you do hear something now? What do you hear? LINDA: I hear him saying that he's terrified. THERAPIST: Can you tell him? LINDA: (To Michael.) I hear you saying that you're terrified, that you would be sad if I left, that, um, that you would rather change what is happening. THERAPIST: (To Linda.) I think what you're saying is you're unsure ... (To Michael.) Sorry, did you want to say anything? MICHAEL: ( To Linda.) Well, I'm not saying that I want you to stay just because things would be bad if you left. THERAPIST: ( To Michael.) She has difficulty hearing that you care for her. Can you tell her again? MICHAEL: (To Linda.) I do care ... you mean a lot to me. (Voice shaky.) THERAPIST: ( To Linda.) What do you feel? LINDA: ( To Michael.) I feel that there's part of me that really wants to believe you and there's another part of me that is really shut off from that.

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THERAPIST: Shut off because of the past. LINDA: Yes. THERAPIST: Hurts and feelings of deprivation. (To Michael.) I think that's what you're feeling, right? That, somehow there's a wall out there and it's difficult for her to see you. How can you convince her? MICHAEL: I don't know ... THERAPIST: What would you like to try, to convince her? MICHAEL: I don't know (sigh) it's a problem of faith. If we can make that leap of faith, it becomes easy to believe ... THERAPIST: (To Linda.) Do you understand, what he's saying to you? LINDA: ( To Michael.) I think so but I feel that the leap of faith that you talk about is something that Ive continually done in the past, then end up getting burnt. I see if you were like this on a continual basis, I think we could share fine, but you're not, it's like once every 3 or 4 months or whatever. I mean maybe that's not quite fair, but it's not very often. I mean, I feel we go for weeks without openness, and I play into that just as much as you play into, but that is my concern so that it's like only when I say I can't stand it anymore, then you open up and then things just go back to old patterns. Nothing really changes. At least those are my perceptions of it. THERAPIST: (To Michael.) What happened for you? You raised your left eyebrow? ( To Linda.) Did you see him? LINDA: Yes. THERAPIST: (To Linda.) What happens for you when he does that? LINDA: (Sighs.) THERAPIST: Did you have a response to that? LINDA: Well, it just makes me always want to keep trying to convince him that that's how I really feel. THERAPIST: Well, what did that mean to you that he raised his left eyebrow? LINDA: That he's getting short ... impatient. THERAPIST: So you two have an exquisite communication system, which I can't read but I know that you have. OK, so he was going to ... you perceived him as maybe getting a little impatient. (To Michael.) Do you know what she means when she says she felt you were getting impatient? She sees it as impatience, I don't know what was happening for you ... ? MICHAEL: I think that we have a lot more to share than this anxiety over . . . I open up like this once every 3 or 4 months or whatever. (To Linda.) When you come down on me very hard, it is like a battering ram.

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I think that we could have openness and sharing about so many other things as well. LINDA: Like . .. MICHAEL: Right now what we're communicating is our anxiety, our sadness, our loneliness, and those are very, very powerful. They pull down the defenses but I think that we could have intimacy, much more easily by being easier with each other. THERAPIST: Michael, how would you like to achieve intimacy? Because I think you two experience and achieve intimacy in different ways. It is important to let each other know those ways. And you're saying, processing the fight or looking at what's wrong, difficult, isn't the only way of achieving intimacy for you. MICHAEL: What I mean is that at least at one time, we did. We shared a lot of good feelings as well, a lot of laughter, a lot of those feelings of general well-being that arose from being together. And whatever has gotten between that, is very strong, it takes situations like this to break it down but I don't want to live in this sort of turmoil day to day, I don't think that it is necessary to be on edge and I think that it certainly has a lot of validity, but not continual validity. It is very important that things have gotten to a stage where it takes situations like this to open up, but ... THERAPIST: I understand. (To Linda.) Do you understand what he's talking about? (She nods.) (To Michael.) I think you are saying there is this wall between you and it's difficult to achieve the intimacy you once had, the good feelings. One thing you do is you continually try to hit this wall and break it down, you know, it's there continually. LINDA: U mhum, yes. THERAPIST: (To Michael.) And you're saying, well maybe we could, it doesn't have to be all that's there. MICHAEL: Well, I don't know that's what I meant by a leap of faith, that I don't know how to get around that wall. If you get around it then it's easy to share things. But getting around it, I don't know. THERAPIST: What is it that she wants from you? There's also something you want from her, but, right now I'd like just to focus on what does she want from you? What would help take some bricks out of your wall? MICHAEL: I think greater understanding, greater appreciation of what she is, and what she's been doing in individual therapy? THERAPIST: So a greater understanding of what's happening for her? And what's difficult about that for you?

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Well, uh, I g uess part of it is I feel excluded by it. THERAPIST: Have you told her that before? MICHAEL:

MICHAEL: No. THERAPIST: ( To LINDA:

Linda.) Do yo u understand?

I think so.

MICHAEL: ( To

Linda.) And it's not that I would want you to remain

unchanging. It's not that I don't recognize that you had a deep need for large changes in the past few years ... THERAPIST: ( To Michael.) But somehow you feel excluded, you say. MICHAEL: (To Linda.) Well, I think that, that you know with the deterioration of our relationship, you took more and more time. THERAPIST: So you are feeling kind of rejected or excluded. MICHAEL: Um, yes. THERAPIST: Umhum, umhum ... and what would you like from her? MICHAEL: (To Linda.) For your understanding. THERAPIST: Of what? MICHAEL: Of me as a person. THERAPIST: ( To Michael.) What about you? MICHAEL: I guess I've always looked at a couple as complementing each other, I think that we do complement each other quite well in many areas. THERAPIST: Are you wanting her to understand how you comple­ ment her, or how you felt together? That she would appreciate you? MICHAEL: That's right. THERAPIST: (To linda.) I apologize if I'm rushing you. I'm aware that we're going to need to end soon so I just wanted to get a sense of where you are, or part of it. So I'm wanting to know how you're reacting to what Michael has said. LINDA: Well, I guess my reaction is I just want to wait and see what develops over the next few weeks or whatever. THERAPIST: (To Michael.) Do you know what she means? MICHAEL: If she can't make that leap of faith, I didn't plan to push. THERAPIST: So you're saying "I want you," or "I would like you to make that leap of faith and commit yourself but I understand if you don't feel that trust." ls that it? MICHAEL: Well, I don't feel that leaps of faith are the things fairy tales are made of, but it would take a lot more than me saying that.

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The therapist then summarized the session. After the session both partners felt some progress had been made and said they felt that they had established some common ground as a starting point for working toward greater intimacy. The therapist reported that the problem had been defined in terms of underlying emotions and that basic positions taken by the couple and the cycle had been defined.

Session 2 In the second session, the couple worked on the pursue-withdraw cycle identified in the first session in an explicit fashion, explicating each partner's underlying feelings and disowned parts-specifically, Linda's need for support and Michael's need to protect himself. Linda stated that her awareness of Michael's need to protect himself increased her sense of caution about how much she wanted to trust him. Michael reported that he was clearer on their needs and less apt to ascribe blame and that, during the prior week, between sessions, they had been more open and felt closer to each other.

Session 3 The third session saw the emergence of a deeper underlying intrusionrejection pattern in their relationship. Linda expressed that she felt afraid when she opened up with Michael in the session, and the therapist attempted to explore Linda's fear and confusion in the moment. Linda associated these feelings with their sexual relationship and then disclosed that they had a significant sexual problem in that she often tensed up and withdrew during sex. She talked about feeling out of control and intruded on, while Michael felt hurt and angry at being rejected. Michael then described how he went to extreme lengths not to pressure Linda or make her feel guilty, but that it did not seem to do much good. Linda, in response to the therapist, again described her fear and carried on to say that her attitudes were a problem and that she did not experience a flow in love-making. Linda explored her caution and experienced some feelings of hopelessness about herself and about anyone ever being able to

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give her the acceptance she needed. Michael expressed a commitment to try, and the therapist explored with him some of his feelings of sexual inadequacy and how his insecurities and sensitivity to rejection fed into their sexual problems. The transcript of portions of this episode follows. Edited Session Excerpt THERAPIST: Somehow I'm feeling that it's important for you to talk a little about your caution because that's an important thing. Are you feeling cautious right now, when you talk with him about a fairly delicate moment in your sexual relationship? LINDA: Yes . THERAPIST: What are you cautious of ? See if you can tell him about your caution. LINDA: (To Michael.) Um, I'm cautious of telling you how I feel because I feel that your reaction may not be that (sigh) ... because we always get stuck when we start to talk about that issue.I feel as though it's always been very sensitive in our relationship. THERAPIST: What is it you're anticipating that he will do? LINDA: Well, I mean part of it is related to my father I think.You know I felt as a child to be really kind of, my space to be intruded upon. That my father would touch me physically, um, and that I didn't like it at certain times, but I didn't have any choice. THERAPIST: Umhum. LINDA: Or he would want to be kissing us and stuff like that. THERAPIST: Umhum. LINDA: So I know that it's like a lot of, don't touch me. THERAPIST: Umhum. LINDA: With a lot of resentment, hatred that has nothing to do with Michael. THERAPIST: I see, right. LINDA: But still I'm unable to separate that so ... THERAPIST: I'm not sure, when you're saying your father touched you, whether he touched you sexually or ... ? LINDA: No, except that, you know, he touched us in ways that rm not sure. THERAPIST: Yeah, but it wasn't an explicitly sexual ... LINDA: No, no. THERAPIST: There might have been some sexual aspects.

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LINDA: Yes. THERAPIST: So that you have some feeling of, don 't touch. LINDA: Yes, I have a lot of that. THERAPIST: Yes, yes . So, what's your caution? LINDA: Um, I guess that he, you know, that I feel that he's going to jump on me, or take advantage of me or ... THERAPIST: OK, OK. That he'll invade, cross your boundaries in some way. LINDA: Yes. THERAPIST: Quicker than you want. LINDA: Than I want, yeah. THERAPIST: Right, right. And your caution is that he won't pay heed to your saying no? Or just that you feel tense about how you've been invaded in the past, by your father and so on. I'm not sure, am I being clear? You know I'm not sure if you try to say no, but you feel that he pressures you? LINDA: Well, whenever I say no I feel very guilty. THERAPIST: OK. LINDA: Whether or not it's him pressuring me I don't know. THERAPIST: I'm still trying to understand. So one aspect of caution is that you just need to protect yourself because you're going to get invaded possibly. But somehow it's as if you start to talk about it, your feeling is it won't go anywhere ... it will get stuck. I'm not sure how you get stuck there or what it is that stuck means. LINDA: Well, if I'm too tired or I don't feel like it, and then his response might be, that he gets hurt. THERAPIST: yes. LINDA: Or feels rejected. THERAPIST: yes. LINDA: And so he kind of just draws away. THERAPIST: Yes, OK: OK. Let me see i~ I und~rst'and. He m~g~t approach you or be touching you in some f ash10n and you set some hm1t because you feel intruded on at that time. Then he feels hurt and withdraws. And then you feel both guilty and rejected and angry. And then you might withdraw and you're both left feeling kind of isolated and rejected. LINDA: Yes. Or another way would be, I may have those feelings but just go ahead and go through the sexual act and really not be that into it.

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THERAPIST: Right. So somehow this sequence for you pivots around when something's happening to you that you don't want to happen. When you're feeling intruded upon. LINDA: I just feel so out of control. THERAPIST: Yes. And what does Michael do at that time, as far as you experience it? Do you tell him your feelings? LINDA: No. THERAPIST: Uh-huh. OK. Let me try to shift for a moment to Michael and ask what it is that you see as the issue right here. She feels somewhat out of control. MICHAEL: Well, I mean this is not recent, you must not have the impression that this is a problem only in the last few months. So you don't let me know when you're feeling out of control? Well, uh, you do. We stop, whatever, when you reach a point when you feel out of control? That you don't want to let go. Don't you tell me? LINDA: Well, maybe part of the time. THERAPIST: What is he feeling now do you think? LINDA: I think he's feeling hurt. MICHAEL: I'm feeling quite hurt, yes. THERAPIST: I thought you sounded angry. MICHAEL: Oh well certainly I mean (stutters) angry, resentful, hurt, and self-pity. (To Linda.) I feel that, um, I go to extreme lengths not to pressure you make you feel guilty, um ... THERAPIST: And . . . MICHAEL: It doesn't do much good. Oh, it doesn't do enough good. ( To Linda.) I hold back my feelings so that I won't be pressuring you and, huh, well our sexual relationship mirrors our overall relationship. ( To therapist.) I try to get close in sex and she is not interested. THERAPIST: OK. And you feel quite rejected, hurt, resentful, and it's a long-standing cycle between you. MICHAEL: Sure. THERAPIST: OK. (To Linda.) What do you feel now as he talks about his side of this? LINDA: (sigh) that he thinks that if he holds back his feelings ( To Michael.) you think if you hold your feelings back that I don't feel pressured by that. But I still know how you 're feeling, so I feel pressure myself. Um ... THERAPIST: What do you feel right now as you say this? LINDA: This fear.

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THERAPIST: Fear? (She nods.) I'd like to hear what's the fear about? LINDA: Um, fear of talking about it. THERAPIST: Yes, so just fear where, you feel tight, you feel? LINDA: Oh yes, my heart is constricting. THERAPIST: And you feel afraid, afraid that this isn't going to work out but also afraid of something else. I don't quite have a sense of it but what, what's the fear? It's important to talk about this fear ... LINDA: I don't know. THERAPIST: Uh-huh. You're afraid that .. . I don't know, I don't know if you're afraid that you won't be able to respond. LINDA: Well, I have a lot of fear of that because I can't. THERAPIST: Yes. And that's a pretty frightening place to be because somehow you're saying you don't know whether you can let go. Then, on top of that, there's him out there, you feel kind of responsible about that too, his feelings maybe. (Linda puts her head down.) LINDA: U mhum. THERAPIST: Uh-huh, but somehow just within yourself you're struggling with the not knowing whether you can really let go, or how to do it, or what will work. And you kind of struggle with that. LINDA: U mhum. THERAPIST: And there's this thing about . having been intruded on when you were little and putting up some barriers. I guess just sort of being confused really about how to make it all work for you ... (Linda nods.) And what happens then? (Linda's head goes up.) LINDA: Well, it seems to me for myself that it's because I have so many attitudes my sexual feelings are blocked. And it doesn't happen for me, or at least it hasn't happened that often for me. THERAPIST: Umhum, umhum. And so you're saying it's difficult to change the attitudes because you don't have the experience that kind of allows you to free up, then change the attitudes. LINDA: U mhum. THERAPIST: So you sort of feel caught up in a cycle. LINDA: Yeah. THERAPIST: Within yourself and then you're knowing that he's feeling rejected outside too. LINDA: U mhum. THERAPIST: And eventually that leaves you feeling in a corner even if he's not saying, you kind of feel, you know, that he's feeling hurt and rejected.

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LINDA: Umhum. Well / would be if I felt that I could never approach him. THERAPIST: Uh-huh. LINDA: That I always had to wait. I would feel very unsatisfied with that. THERAPIST: And yet he stays with you. LINDA: U mhum. THERAPIST: Maybe, it's important in some way for him too. When did he know that you weren't able to let go so easily? LINDA: But over time I always just pretended to have an orgasm. I have thought up to this point that, I'm almost totally responsible for our own sexual relationship being what it is ... because my feeling is (to Michael) you don't have any problems responding . . . MICHAEL: Well, I guess I'm guilty of feeling so sexually insecure that I've allowed things to, I've allowed myself to feel so rejected that I don't approach you, that doesn't make things easier for you. I'm responsible in that way, uh. THERAPIST: Do you believe him when he says this? I think he's saying something really important. LINDA: Well I don't really understand what he's saying. THERAPIST: { To Michael.) Can you tell her . . . MICHAEL: ( To Linda.) I'm saying that, uh, if I were to approach you more, things would probably be easier for you as well, as well. We wouldn't be in quite the bind that we are in, but because I do feel so insecure, I do get very hurt by rejection, uh. THERAPIST: ( To Michael.) Can you tell her what you mean by insecure? I think it's very important because I think she really needs to understand. MICHAEL: Well . . . THERAPIST: You know, I think you're saying something real important, that if you didn't feel some insecurity then she could say no and it wouldn't feel as painful as you. So you have your own pain in this area.

Session 4 The fourth session took place after a IO-day period in which the wife was away on a visit to friends. This session was less intense than the previous ones. The couple talked about their feelings about being apart for a

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while. A number of different important topics were touched on with the partners able to talk to each other in a mutually accepting I-thou fashion. Linda talked without blame about the fact that she needed more contact than Michael did during conversations while Michael let Linda know that he was satisfied with her recent involvement in sexual contact. This helped her feel better about not always being '"all there" during sexual activity. This session also dealt with Michael's sense of Linda's expectations. He was generally anxious in his style and stammered in his speech. He felt a sense of external expectation, by completing the sentence "Right now I imagine you expect me to ... , " captured accurately his internal process and gave him more control over this automatic response. Linda was surprised to see this part of Michael and told him she did not ex­ pect nearly as much as he thought she did. The session ended with her expressing a greater feeling of safety with him and he concurred. On the questionnaire item concerning change in the session, Michael said that he felt that "without getting into the heavies we were able to amicably express our feelings about a variety of issues thus identifying and appreciating the other's side." Linda said she had a greater aware­ ness of her partner and that from the time apart both had an increased sense of self-identity and a feeling that they had more to bring to the relationship. This was the midway point, and the therapy in the following sessions moved to a deeper level. The alliance between each partner and the therapist was good and the couple worked productively. Session 5 The fifth session focused predominately on the wife's feeling of fear and vulnerability in her sense of being intruded upon. Linda went deeply into her confusion and inner emptiness. The therapist gently directed her to face her fear of annihilation and rejection and reflected Linda's pain and terror of losing herself. Linda went through a feeling of fear to contact her need for comfort and contact, and she expressed what she needed to her husband who responded supportively. Both partners were somewhat without words at the end of the session. This was a key session in which underlyin g em otion was experienced and communicated. Michael re­ ported that they had worked on trust and that "I felt something changed,

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a lot happened in this session but I can't describe it" whereas Linda said she "further trusted her partner, had asked him to hold her and had learned to ask for what she needed. " (The transcript of this portion of the session appears on pp. 91 - 94 as an example of accessing unacknowledged feelings.)

Session 6 In the sixth session, the couple talked about Michael's fears of expressing negative emotions, including his fear of hurting Linda and being rejected. Linda's fear of being destroyed or feeling vulnerable if Michael did express negative emotions was also discussed. At this stage in the therapy, the therapist felt it to be important to have Michael express some of his underlying feelings to Linda to balance her work in the previous session, but this was not achieved in this session.

Session 7 The following session, however, focused predominantly on the feelings underlying Michael's distancing. Using evocative responding, the therapist evoked Michael's inner sense of loneliness and explored with him a memory of a teenage experience. This experience involved being all alone on a dusty road with no one in the world knowing where he was or caring. He talked about his feelings of isolation and being an independent loner, invulnerable to hurt. This was followed by Michael talking about his feelings of responsiblity all his life for his impaired father. The therapist then worked to have Michael connect his inner experience of loneliness to his environment by expressing this to his wife. Michael first stated to Linda that "expressing my feelings puts a burden on you .. . I've never wanted to do that," but then, with the therapist's encouragement, he talked in a most poignant manner about how isolated, lonely, and responsible he felt in their marriage. Linda heard and was deeply touched and felt nourished by the contact, which met her need for greater closeness. (The therapist suggested that, during the week, they each identify with the disowned experience and deliberately, in awareness, do what they would normally do.)

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Edited Session Excerpt THERAPIST: (To Michael.) But somehow through all this you developed a real sensitivity to being rejected or somehow just not feeling as supported as you would have liked, because what I hear is your difficulty in expressing what you need and want or when you feel your limits are being extended. And you know it's often true with a man that it's more difficult to tell what his feelings are. I don't know how you really feel. Some sense of rejection or ... If you were to describe one main feeling for you that gives you difficulty ... MICHAEL: Well, I guess I've never really felt that I've belonged. Um. THERAPIST: OK. That's very understandable in the way you describe your family of origin. And somehow you 're very sensitive to wanting to belong with Linda. MICHAEL: yes. THERAPIST: And so the other side of belonging is kind of being cast out or being rejected. MICHAEL: yes. THERAPIST: Yeah? A sense of nobody really caring is what you're saying. And so I imagine that's what's activated for you when Linda gets

angry or threatens, and I've heard her threaten to leave. That must really evoke quite terrifying images for you of being cast out, of not belonging once again. MICHAEL: Of not belonging, of failing. THERAPIST: Umhum. Yeah, because failure's an important issue for you, right? MICHAEL: I try not to look at marriage as being a test that one either passes or fails but . . . THERAPIST: But whatever one thinks rationally, it's kind of like when the partner presses your buttons, it activates those more primitive kinds offears, fears of not belonging. Was it like that for you, I mean what do you actually feel when she rejects or threatens? MICHAEL: I think, like I'm very young, like I'm a little boy wanting to cry. THERAPIST: (To Linda.) Does he ever cry? LINDA: Not very often, but he has. THERAPIST: And what do you feel when he cries? LINDA: I feel like we've shared something.

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THERAPIST: So you 're open to his crying. LINDA: Yes. THERAPIST: You will give him a shoulder to cry on? LINDA: Sure. THERAPIST: (To Michael.) But I guess that's pretty scary for you because in some way you're so afraid that you might be pushed away. It's difficult because you had to learn to hold yourself together, it sounds like. It's kind of like you had to do it alone. Is that true? MICHAEL: Yes. THERAPIST: Yeah. Do you have images of yourself as alone? MICHAEL: Yeah, I think I've always believed in that as a goal, being independent. THERAPIST: U mhum, self-sufficient. MICHAEL: Being self-sufficient. THERAPIST: You know, somehow I have this image of you struggling alone, kind of, silently without complaining. And yet inside really feeling quite isolated. MICHAEL: Rather than being ... I think I'm tough but . . . THERAPIST: I don't mean to challenge your independence as being a bad thing. I agree with you it's a lesson, you know that life has to teach, that if you can look after yourself you can't get hurt as much. MICHAEL: Well, but, I don't think it a good thing to not get hurt by not feeling. THERAPIST: U mhum, umhum. MICHAEL: As I say, I've learned certain lessons I don't know if, if Ive learned what I should have learned. THERAPIST: Umhum. I guess it's this issue of, if you just allowed yourself to ask Linda or be nurtured, somehow that lonely, frightened little boy inside of you, it might feel more secure, it might feel that you actually do belong. But in a sense I feel like I'm giving a lecture. It's something you've been working with for a long time, as to how much you can come out, or how much you need to protect yourself. MICHAEL: I think that it's something that we need to work on. Um, it tends to get pushed aside because I can endure, uh. THERAPIST: Yes, but still what stays with me is this image of you not complaining and kind of quiet but somehow ... MICHAEL: Sort of the miserable image. THERAPIST: Well, there is a pain inside. Much more the stoic martyr. You know I don't see you as being really miserable.

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MICHAEL: No, neither do I. THERAPIST: But somehow I think sometimes Linda needs to know about that fear of you being on your own or not belonging. MICHAEL: Well, we're not talking about separating now. If we were, that is something that I would hide. THERAPIST: Can you tell her how you felt when you were talking about it. MICHAEL: Well, uh, desperate, very lonely, frightened, um, I think that dream I had summarizes my feelings about it. THERAPIST: What was your dream? MICHAEL: Um, well I can't remember exactly what the dream was but it had to do with Gail (his child) being taken away from me, it was so real that I woke up just sobbing ... THERAPIST: But it hasn't been your way to tell Linda about some of these feelings. Or to tell anybody, because somehow you never knew that anybody really cared enough. MICHAEL: Yes, but now what I started to say was that I feel that expressing my feelings places an unfair burden. (To Linda.) If we were splitting up and you decided not to leave simply because my feelings of being rejected were so great, I feel that's ... THERAPIST: You know I'm going to interrupt cause I hear you saying that to Linda but I think that's true, when you're in the process of splitting up, you know, it's sort of like the rules are different somehow, because I wouldn't want to express my feelings of hurt or rejection to someone who is saying they didn't want to be with me because it would be like offering my throat knowing that it was going to get slit, to use a horrible image. Um, but I think the same thing applies when you aren't threatening separation. That somehow you either don't want to burden her, as you put it, with your feelings or, somehow it's risky to do so too. It's almost safer to cradle myself here inside because that way nobody can hurt me. And you know I'm hearing you've learned to do that, and you've done it well, and that it's an important skill to have. You know it gives you a strength and a resilience to live through life and yet there's a loneliness and somehow to be able to let yourself out from under your own control seems important. MICHAEL: Yeah, yeah. Well I'm not satisfied with just holding things in. THERAPIST: Umhum, umhum. (To Linda.) What are you experiencing as you sit and listen? LINDA: I like it!

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THERAPIST: ( To Michael.) I'd like you, rather than trying quickly to be different, to first be where you are. And what I'm hearing from you is that where you are is tucked away inside of you, or that coming out would be a major change for you. I want you to watch this process of how you need to, feel the need to be your own counsellor. Do you, sort of understand what I'm saying? MICHAEL: I think so. THERAPIST: Yeah, and so that some time when you find yourself with the feeling that you 're holding back, rather than trying to rev yourself up to express it, I'd like you to deliberately do whatever you do. Maybe say, well maybe if I express this anger it'll probably lead to Linda rejecting me or to her getting angry so therefore, I'll just hold it to myself, OK? Or if you are feeling some other feeling where you tend to hold it to yourself, I'd like you to deliberately hold it back, but do it in awareness. You know I think you often just do it, automatically. MICHAEL: OK. THERAPIST: (To Linda.) We've talked more about Michael today but I think you know there's a similar issue for you, you also close off, right? LINDA: Yes. THERAPIST: And I remember so vividly when you were saying "I need space." You need to take space. And although I've suggested and we've talked about the importance of you reaching out and asking to be held, I'd like you to p_ractice your own way of taking space. LINDA: Umhum. THERAPIST: Taking space for yourself, but also feeling like, I can't come out because I'd probably be judged. And I don't know what sorts of things you say to yourself but it sounds like to me it may be it, it's just too risky out there or it's just too dangerous, I'll get wiped out, 111 get destroyed. LINDA: Yes. THERAPIST: If you catch yourself feeling some of that need to pull away or to protect yourself, you can actively do it. LINDA: Umhum. THERAPIST: Deliberately and consciously because I think you were doing that automatically too, you know? Just pulling away and then later comes the anger and the attack and all that, you know. After the session Michael reported that he had "isolated a very important issue and pattern of behavior which caused many difficulties

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them." while Linda reported that she felt a change in her partner's A~:cptance of some of the bad feelings that occurred in his early family life. Both partners reported being almost totally resolved about the concerns that brought them into therapy. f

Session 8 In the eighth and final session, the couple discussed different ways of giving support to each other and how not to take differences as an invalidation of each other. They also clarified how, at times of stress, their cycle would reappear and what it was they would each need at that time. The following reports were obtained in a 4-month follow-up in which the partners were asked to identify helpful incidents from the therapy.

Linda: Incident 1 At one point I was feeling really sad about some things going on in my life, and what I usually do is that I get farther and farther away from Michael, and cut myself off. He also distances himself. And, at one point I ended up crying and realized how difficult it was for me to experience that with another person as opposed to going through it on my own and then later telling about it. There seems to be a big difference between those two things. And, very difficult to ask for comfort. INTERVIEWER: So, in this experience you were feeling sad and began to cry. And, you experienced how uncomfortable it felt to be that vulnerable or open in the presence of your spouse. What else do you remember that happened? LINDA: I was willing to ask for Michael to hold me when we got home. INTERVIEWER: So, you began to cry, and then what happened? LINDA: The counsellor suggested that I might want to ask Michael for something. And, I said, "No, I certainly wouldn't." And he asked Michael then how it made him feel to see me like that. Michael at that point in time was feeling very supportive. But, it brought out that he does feel overwhelmed and very afraid of my emotions. But, at the same time LINDA:

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he was feeling like he wanted to reach out and I was able to look at him and to see that he was actually caring rather than being judgmental or analyzing what was going on. And, so I asked if he would hold me when we got home. INTERVIEWER: And , you began to say how this experience was helpful for you. It was helpful because . .. LINDA: Yes. Because part of our difficulty for myself is that I feel isolated from him and that is in part because I am unable to ask. And , I felt at that time as if we were working on something together, sharing an experience. I didn't really want anything from him, not to make it better or worse. Just to kind of be there and support. INTERVIEWER: And, how it was helpful is that you experienced that you were able to reach out and to express your need for closeness. LINDA: At that particular time, yes. INTERVIEWER: What changed for you through this experience? LINDA: I think what changed for me is that up until that point in time I didn't think it would be possible to feel that with him. As well, it sort of shifted the way I viewed what was happening in that it was some of my responsibility as well as his. Whereas, I think up until then I'd been blaming him more for my isolation or my not being able to reach out. I think that's what probably shifted the most. INTERVIEWER: How do you think this change occurred? LINDA: I guess because I realized that what I do is shut him out, put up a lot of blocks around me. And, what I need to do is reach out. I don't know how to say the shift actually happened except going through the experience of reaching out and not having defenses at that point in time just changed how I seemed to view it anyway. And I haven't answered your question but I don't know how.

Linda: Incident 2 One of the things that came up was that he feels really scared and frightened when I feel emotional because he's scared that he's going to lose control. Because it seems that what I'm going through is so intense that he couldn't possibly handle it. And, he related feeling that way with the therapist's help, related it to incidents in his family with his father where his father got angry a lot. And, he's never been able to stand the way that his father gets out of control. So, I think that he was able to make the LINDA:

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connection between the way that he is relating now in th is situation with the way that it was in his upbringing. Because up until that time that was very new for him too, to think that his family did have this influence on him.

Michael: Incident I I think around the fourth or fifth session, the therapist had us just look at each other. We'd been talking about each other, I guess, and he had us focus on each other, and try and see each other anew rather than continuing on in a past frame of reference. I NTERVIEWER: What else do you remember about this incident? MICHAEL: We stopped at that time. I NTERVIEWER: Do you mean you stopped talking? MICHAEL: It made us realize that there is another side, that there is another person involved rather than a collection of ideas, connotations from the past; that there were two of us struggling there. M ICHAEL:

Michael: Incident 2 When Linda cried and then told me she needed to be hugged when she felt bad, that made me feel needed. INTERVIEWER: What changed for you through this experience? MICHAEL: I think I felt more trust. Trusted and trusting like she cared for me and I could be received. I wouldn't be rejected. MICHAEL:

Conclusion This brief treatment was then somewhat successful in bringing about change in the relationship. The therapist felt that more work with Michael might help to relieve his anxiety and stammering and help him to deal more directly with his anger and vulnerability. The therapist also felt that Linda could benefit from further work on her fear and sexual anxiety. At a 2-month follow-up, the couple had maintained their gains and did return for six more sessions of couples therapy after 6 months, saying they wanted to complete the work they had started. These sessions followed along similar lines and proved to be successful.

CHAPTER SIX

Therapist Interventions

There are two main tasks for the therapist using EFT once an alliance characterized by an atmosphere of nonjudgmental acceptance has been established with each client. The tasks are accessing the emotional experience underlying interactional positions and using this emotional experience and expression to evoke new responses and change interactional positions. The most crucial aspect of the first task is the unfolding of new aspects of self not currently operating in the relationship. The most crucial aspect of the second task is the redefining of interactional cycles in terms of this emotional experience so as to aid the couple in the redefinition of the relationship. These tasks are presented in terms of basic principles of treatment and specific interventions.

TASK 1: ACCESSING EMOTIONAL EXPERIENCE The EFT therapist uses a synthesis of gestalt and client-centered approaches adapted for couples therapy. The moment-to-moment experience of the client is the key point of reference in the therapy. Clients are regarded as experts on their own experience, and the therapist is a catalyst who helps evoke underlying experience. The therapist does not, then, possess a set structure for therapy; rather, the therapist has a map concerning common features and patterns in relationships and how best to create change. Always, however, the clients' experience is the reference point for the therapy process. The therapist looks for opportunities to focus the clients' experience and to guide their interaction in a certain direction, in a way that remains true to the essential nature of the clients' experience and view of reality. The therapist focuses on the clients' moment-by-moment construction of 148

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reality, particularly the clients' emotional responses and how these affect the ongoing process of interaction. The overall strategy, as in any experiential therapy, is to enter the clients' frame of reference and explore the reality of the world as it appears to each partner. In _couples' therapy, the clients' most important world is that of their relationship. Hence, the therapist observes what each partner attends to , how partners construct their emotional experience, and how this in turn affects the organization of the relationship. The accessing of emotional experience in the session is of crucial importance, particularly after the interactional cycle has been made clear (Step 2), unacknowledged feelings have been accessed (Step 3), and disowned feelings have been owned (Step 5). However, emotional experience is accessed all through therapy, with varying degrees of centrality. As discussed earlier, the accessing of emotional resl?onses that are not normally attended to leads to a synthesis of new emotional experience. The model of emotion used here is a constructivist, informationprocessing model. Emotion that is brought into awareness in the present is not seen as having been outside of awareness; rather, it is viewed as being newly synthesized in the present, from subsidiary components. Thus, different self and experiential organizations are possible at any moment, utilizing more or less of the available subsidiary information. Bringing emotion to awareness involves both discovery and creation. When evoking emotion in the session, it is the therapist's task to help each partner focus on relevant implicit components. An example of such a component might be the sense of threat expressed in the tightness of the facial muscles, which is an implicit aspect of a reactive anger response. Primary emotions experienced in the session, such as anger, sadness, or fear, are considered currently synthesized experiences not present prior to this synthesis. Only the components such as the biologically based, expressive motor-level responses and schematic emotional memories existed prior to the experience of emotion in the session. As potential information, these components may or may not be processed and integrated with other levels of processing to constitute the conscious experience of a currently felt emotion. It is not then simply that couples disclose formerly withheld emotions and aspects of themselves to each other and have these disclosures confirmed. It is also that each partner has a new experience of self and of self in relation to other. Thus, the blamer who organizes her emotions in terms of anger and her sense of self in terms of a resentful victim can later describe herself more in terms of her need for closeness and her panic at her partner's inaccessibility.

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As has already been stated, accessing here does not mean discussing or gaining insight into a feeling. Insight may be part of the process, but there is also an active engagement in new experience. Thus, an expression of fear of abandonment emerges from attending to the hollow in the pit of the stomach, the urge to cry out in pain, the image of a lost child, and a memory of feeling alone in one's house and the unspoken thought "nobody loves me." All of this is synthesized in the present into a focal experience of sadness. Then, when this network of components is activated in therapy, the person is no longer talking about feelings; instead, he or she is experiencing and expressing in an authentic fashion. It is this lively experience that is sought in EFT, for it renders both the inner experience and interaction amenable to restructuring. This formulation of emotion and the process of therapy leads logically to the kind of interventions described below, such as empathic reflection, evocative responding, and the creation of experiential experiments. Such interventions encourage the activation and reprocessing of key emotional experiences.

Principles

In general, the process of tracking and exploring emotional experience in individuals follows the principles of accessing emotion laid out by Greenberg and Safran ( 1987). These principles are as follows: • Attending. The client attends to new aspects of experience m response to the direction of the therapist. • Refocusing. The client refocuses on inner experience as the therapist encourages the client to "stay with" and expand meaningful moments. • Immediacy. The client focuses on the present, the poignancy of the immediate moment. • Expression Analysis. The client attends to nonverbal expressions such as voice tone and gesture, with the help of the therapist. • Intensification. The client intensifies experience by methods such as repetition and the use of concrete metaphors. • Symbolization. The client symbolizes experience in a way that helps to capture the essence of what has occurred. • Establishing Intents. The client begins to formulate intentions and action tendencies based on new experience.

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Interventions There are two broad styles of intervention in couples therapy for accessing emotional experience, responding and directing. Specific interven-

tions within these two categories are described below. Task 1. Accessing Emotion: Operations I. Responding A. Empathic reflection B. Feedback on nonverbal actions C. Evocative responding II. Directing A. Process directions and inquiries 1. Directing attention 2. Directing inquiries and replays B. Experiments in awareness 1. Repeating key sentences 2. Directing the client to repeat a phrase to heighten its impact 3. Using images and metaphors 4. Setting up contact experiments C. Enactments 1. Vivifying enactments 2. Position enactment 3. Impasse enactment D. Empathic interpretation of current emotional experience 1. Conjectures 2. Elaborations 3. Explications 4. Suggestions

5. Inferring catastrophic expections

Responding In these interventions, the therapist responds to the client with empathic reflection, feedback on nonverbal actions, and evocative responding. EMPATHIC REFLECTION

In EFT, there is a focus on the reflection of feeling and validation of the meaning of client statements, particularly emotionally laden statements. The therapist empathically reflects the core content, particularly the emotional content, in these statements. "Reflection" implies more than

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the repetition and acceptance of feeling. There is listening for what is implied but not stated- an unfolding of, or a more complete symbolization of, experience. For example, the therapist, hearing the unspoken pain in an angry comment, will feed back to the client a reflection that includes the experience of pain; reflection is used in a broader sense than implied by a simple repetition. However, as in client-centered therapy, reflection underscores the significance of particular comments and the therapist's validation places them in a context of legitimate human responses that the client does not need to hide, disown, or defend. A sense of entitlement is presumed to facilitate the abandonment of dysfunctional protective and controlling stances. The acceptance of the client's experience, resulting in the client feeling understood and accepted on his or her own terms, is an essential prerequisite to growth and change in the experiential model of therapy. The therapist structures an interpersonal context in which both partners can receive validating responses from the therapist and eventually from each other. The security- created by the therapist acts, in a sense, as an antidote to the general level of anxiety and the climate of disqualification and self-protectiveness that characterizes distressed couples. This lack of security results in constricted experiencing and presentation of self, along with rigid interactional positions that tend to leave each partner with very limited response alternatives. The creation of a context in which both partners are accepted and valued, and their positions are portrayed as legitimate given how they each experience the relationship, is essential. Under such conditions of acceptance, previously unacceptable aspects of self can emerge and be integrated into the self-concept and into the relationship. Empathic reflection and validation encourages the client to become more engaged with his or her experience so that such experience is expanded on and crystalized. Many of the principles of accessing emotion in individuals detailed above can be operationalized in reflection, particularly attending, refocusing, immediacy, and symbolization. Perhaps the most powerful effect is that the client's attention is directed to the core aspects of experience and is focused on what is poignant and meaningful in the present moment. Validation is much easier to implement if the therapist has a model of relationship distress that emphasizes current causal factors and health, rather than long-standing intrapsychic causal factors and pathology. The most useful assumption would seem to be that, given their habitual mode of processing experience in the relationship, and the nature or rules of that relationship, clients are coping as best they can. All behavior and all

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responses, including extreme emotional responses, are viewed as having their own implicit rationale and logic. This logic emerges as key aspects of experience are reprocessed and clarified. Example

THERAPIST: (After a 2-minute statement by the client.) The main feeling for you right now seems to be one of rejection, the feeling that you are not valued in this relationship. I can understand that you experience Harry's actions as rejecting and that it is painful for you.

FEEDBACK ON NONVERBAL ACTIONS

The therapist observes nonverbal patterns and feeds back his or her observations to the client. Non verbal cues may contradict explicit client statements or may suggest added meanings of which the client is unaware. After bringing attention to nonverbal expressions, the client is often asked what he or she is experiencing. The other partner is also asked to react to the nonverbal expressions since such nonverbals often carry analogic messages concerning the nature of the relationship. Nonverbal expression is a channel for emotional experience, the spontaneous external communication of an internal state. The avoided aspects of experience are often implicit in nonverbal behavior, and, thus, such behavior can be use_d to begin the reprocessing of critical responses. As with the empathic reflection of verbal processes, this focus on nonverbal behavior induces an inner tracking, with intense concentration on the immediate inner experience. As described earlier, it is schematic or perceptual memory rather than verbal or conceptual memory that predominates in such accessing of emotional experience; hence, nonverbal actions such as gestures or tone of voice provide a window into such automatic schematic processing·- that is, a window into the experience itself rather than into the label placed on the experience. Example THERAPIST:

I noticed, Jim, that as Maureen seemed to get upset with

you, you tended to lean back in your chair and look away. What do you experience when you do this?

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THERAPIST: Maureen what happens for you, when you notice Jim lean back in his chair like that, and how do you feel? EVOCATIVE RESPONDING Evocative responding to the clients' experiences in the session, or to recent out-of-session experiences that the therapist wishes to bring into the present to process further, is a key aspect of EFT. Evocative responding is an attempt by the therapist to help a client expand and differentiate a problematic reaction the client is experiencing (Rice, 1974; Rice & Saperia, 1984). In couples therapy, this problematic reaction is a response one partner has or has had to the other in a particular situation, whether in the session or in the past. Such a reaction is usually an exaggerated automatic response that is viewed by the client as undesirable and evokes negative responses in the other partner. An example is the instant frustration or attacking behavior elicited in one partner by a perceived lack of response in his or her withdrawn partner. The therapist works with the client to unfold this experience, to open up the idiosyncratic meaning of the moment, and to have this communicated to the other partner. The therapist's intervention at any one moment may be focused on the stimulus situation, the response to the stimulus, one partner's level of arousal, or the meaning of the total experience. As Rice (1974) and Rice & Saperia (1984) demonstrated in the study of evocative responding, the client encounters his or her experience and reprocesses it, so that it becomes possible to reorganize such experience, including elements hitherto avoided or ignored. The purpose of this intervention, then, is to use sensory connotative language to unfold inner subjective reactions to the stimulus situation. The client can then form less automatic and more accurate, complete constructions of his or her own experience. The therapist must use vivid, concrete language to evoke and expand this experience. As Rice (1974) suggested, metaphors are particularly useful since they can be both concrete and open and, as such, can be used to convey the unique quality of individual experience. The therapist's nonverbal behaviors are also important in intervention. Often, the therapist uses an evocative voice tone and leans toward the client; how the question is asked is as important as the question itself.

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Example • Asking a question. THERAPIST: Is this painful for you? • Asking about the impact of a stimulus, focusing on how cues are processed. THERAPIST: What is it about the way she asks for attention that makes you so uncomfortable? • Focusing on personal responses. THERAPIST: What happens inside you when Pat says no to your request for attention? • Focusing on level of arousal or general response. THERAPIST: How do you feel when you say that? (or) How do you feel, right now, in your body? All of these questions-What happens? How do you feel? What is it like for you?-help clients to encounter and differentiate their experiences.

Directing In these interventions, the therapist directs the client's processing of experience, structures experiments in awareness, facilitates the enactment of facets of inner and interpersonal experience, and constructs interpretations of underlying feelings and vulnerabilities. The principles of intensification and symbolization are particularly relevant here.

PROCESS DIRECTIONS AND INQUIRIES The therapist tracks the clients' processing of experience and directs attention to aspects of immediate experiencing that would otherwise be glossed over or pass unnoticed. This may occur in the context of intrapersonal or interpersonal responses. The therapist may suggest, for example, that a client focus on a remark he or she made a moment ago or continue to explore a particular image or feeling. Direct inquiries as to what is happening in

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the client's phenomenological world at the present moment help the client to reprocess key aspects of experience.

Example • Directing attention. THERAPIST: Can you just go back to what you were saying about feeling like you are in a room without any doors and when Terry starts to shout at you it's like you begin to run from wall to wall, faster and faster? • Directing inquiries and replays. THERAPIST: Can you stop for a moment, please? What just happened there? Jim looked at you and said that you didn't know how to love and you looked down and were silent just for a moment, before you replied so vehemently. What happened for you when he said that?

EXPERIMENTS IN AWARENESS

Experiments can take many forms. The therapist may have clients focus on themselves in an explicit fashion or encourage them to try out new expressions and to become aware of new experiences. Experiments may also be used to heighten responses, to render elements of experience more vivid and significant, and to structure a feared interaction. In terms of focusing on the self, the client is invited to concentrate on an immediate inner experience that occurs in the session. For instance, the therapist may direct the client to focus on the felt sense elicited by a particular event or moment, such as the partner shouting at the client (Gendlin, 1979). During this process, the client is encouraged to put aside cognitive labels, analysis, and coping strategies and simply explore the inner experience. Meanwhile, the therapist encourages the client to explore and track his or her responses in such a way as to create increased salience of, a vivid encounter with, or crystalization of key moments. The use of concrete evocative language is important here, particularly the use of image or metaphor. Images and metaphors appear to have a unique ability to capture an experience without creating premature closure or labeling. Awareness experiments often involve the clients trying out new or expanded ways to express their experiences. The clients may be asked to

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repeat key sentences or to repeat statements in a different way; for example, using "won't" instead of "can't" or replacing impersonal statements with more personal referents such as replacing "it's hard" with "I am afraid to." The therapist may also feed the client a sentence that crystalizes the client's experience up to this point and then invite the client to finish the sentence-that is, to unfold the experience further. While clients will often label their responses in such a way as to package and close down further exploration, these experiments tend to invite further processing rather than labeling and closure. Experiments that promote contact between partners are most useful, helping the partners to make contact with each other, based on their inner experience or on the lack of an experience or response. Thus, one partner may be asked to experiment with saying to the other "I miss you," "I need distance," or "I disagree" and see how it feels. Or the experience of being in the relationship may be dramatized by asking one partner to go down on his or her knees and look up pleadingly-or by asking the partners to turn their backs and fold their arms while they continue talking to each other. In addition, trying to do that which is feared or difficult, like reaching out or expressing anger, can be experimented with.

Example • Repeating key sentences. THERAPIST: Stop for a minute here. Tom, you just said something really interesting-you said "Well, your friends talk to you ... but they ate not afraid." • Directing the client to repeat a phrase to heighten its impact. THERAPIST: (In a very slow quiet voice.) Could you say that again Angela? Could you say, "He'll never let me in"? • Using images and metaphors. The therapist uses images that the clients supply or creates images for the clients that seem to sum up in a concise way responses or patterns of responses. THERAPIST: So when you feel shut out, you push harder and harder. You push on the door. [Such an image conveys no evaluation of the client's actions and evokes a simple but vivid picture for the client to grasp and use to clarify his or her experience.]

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Setting up contact experiments. THERAPIST: Can you look at your husband right now? How does it feel to just look at him? CLIENT: Awful, lousy ... he thinks I'm impossible. THERAPIST: Help me understand how it is lousy. Where do you feel it? CLIENT: I get a tight feeling here in my chest. I want to cry, to give up. [The therapist then expands on and encourages the client to elaborate on the tightness, the crying, and the sense of defeat or helplessness.] ENACTMENTS

The therapist encourages the partners to make concrete and explicit certain aspects of their experience, to speak from that experience, and to enact aspects of the positions they take with each other. Such enactments use an intrapsychic focus but can also be used in a more interpersonal manner when restructuring a relationship. The line between an enactment and an experiment is sometimes vague in that enactments can also constitute contact experiments. In enactments, the clients, having expanded and clarified some aspect of their experience in the relationship, are encouraged either to share this directly with one another or to enact aspects of a specific interactional position. In the latter case, for example, a wife who has taken a passive withdrawn position in the relationship, but who has accessed underlying feelings of defiance and fear of being engulfed by her spouse, is encouraged to enact these new aspects of her position in an active manner, taking responsibility for her part of the relationship dance. This creates a new level of contact with her partner, on a level that has hitherto been avoided. The therapist may direct the client to enact such a position in physical terms, by turning away from the spouse whenever the client feels threatened. The therapist may also direct a couple to enact their impasse or the point in the cycle where the interactions become stuck. This is done by first labeling the stuck point and then suggesting that, given that the couple are not currently ready to yield any ground, they should explore and accept their entrenched positions and become aware of the importance of these positions to each of them. The partners are then asked to enact their respective positions in relation to each other. This makes the impasses vivid and immediate.

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Example

• Vivifying enactments. The therapist, having helped the client access new experience, speaks for that part of the client that is not normally operationalized in this relationship. The client then enacts this new aspect of self. THERAPIST: So, Sarah, can you say to Scott, "I am so afraid of you, I find it hard to look at you, even here, to let you see me''? • Position enactment. THERAPIST: So, John, can you talk to Jane about your response to her pushing. CLIENT: Well, I don't like it ... and I put up a wall. THERAPIST: You're telling Jane "If you push, 111 resist you. You are not going to dominate me." CLIENT: Right, back off, let me choose. THERAPIST: Tell this to her. • Impasse enactment. THERAPIST: So, Carol, can you try to get John to hear you, to respond to your need for reassurance? CLIENT: He won't. THERAPIST: Can you try-and, John, I'd like you to protect yourself every time you feel attacked. [The couple then play out their dance.] Another example is as follows: THERAPIST: Joan, last night, did you show Jim you needed his attention? JoAN: Well, I said I was going for a walk. THERAPIST: Did you ask him for what you needed? JoAN: No. (Defiant absolute tone, folds her arms on her chest.) JIM: You never ask. JOAN: I get tired of asking. You'll give reasons why you can't be with me, you'll do what you want to do-or you'll pretend to accommodate and pout. THERAPIST: So if you ask you'll be disappointed. You don't trust he1l hear you and respond. JOAN: It doesn't matter what I do. (Shrugs.) THERAPIST: How do you feel as you say this, Joan?

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JoAN: I don't know . . . I feel like getting mad . THERAPIST: Can you tell him, "I refuse to ask, to feel helpless in front of you"? JOAN: Yes, yes ... I won't do that. J1M: ( Crosses legs, looks away.) Fine. (Sets his jaw.) THERAPIST: What are you saying, Jim? JIM: Fine. THERAPIST: Seems like you have just shut down, drawn back, given up? JIM : Yes . . . that's how she is. THERAPIST: And this is how you are . .. Something like, I refuse to be intimidated and ordered around? JIM: Right. (To Joan.) You order, not ask. (Long silence.) THERAPIST: So I guess we're stuck here. Joan, you refuse to put your weapon down and ask, and Jim, you distance and protect yourself. This is your whole relationship, isn't it? Joan, can you tell him again, "I won't ask"? [The therapist then replays the whole impasse sequence making it more and more explicit.] All of the above interactions dramatize and make concrete implicit aspects of experience and relationship positions.

EMPATHIC INTERPRETATION OF CURRENT EMOTIONAL EXPERIENCE

The EFT therapist infers the client's current state and experience from nonverbal, verbal, interactional, and context cues in order to help access further experiencing. This inference is conjectural rather than definitive and is as close to and true to the clients' experience as possible. Such an interpretation is not an abstract intellectualization so much as a clarification of immediate experience, an ascribing of meaning on a concrete level which then leads to new ways of viewing such experience. These interpretations are not then designed as cognitive labels for experience nor to tell clients something new about themselves. Rather, the interpretations are exploratory responses designed to access experience. The intent is not to substitute one meaning for another but to help the clients to focus more intensely on their experience as it is. Emotional experience contains within it implicit and immediately valid meaning sets; one does not doubt intense sadness and does not need to search very

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long for its meaning. The goal is then to access experience rather than to create cognitive insight or understanding as to the causes of behavior. It may, for example, be important simply to heighten an already formu­ lated emotion or to add another element to such a formulation. It also may be important to suggest an aspect of experience that the client at present is unaware of, as in, for example, suggesting that a client has considerable anxiety about a particular issue or response. The inferences used here arise from the therapist's empathic immer­ sion in the clients' experience, his or her knowledge of the interactional patterns and positions of the couple, and knowledge of the kinds of intrapsychic experience that are associated with such patterns and posi­ tions-not from a psychodiagnostic perspective on the individuals' char­ acter structure. Inferences also arise from the theoretical model underly­ ing EFT; for example, when clients have difficulty symbolizing their needs in a relationship, the therapist might present several concrete formulations such as, "You want to know that he is there for you emotionally-that you can lean on him and be comforted." The hope is that one of these formulations will crystalize the client's experience. The therapist's suggestions arise in part from the provisions of relationships suggested by bonding and attachment theory (Weiss, 1982), which is the basis o'f EFT. The concern from an experiential perspective is that therapist interpretations could possibly distort the clients' experience and impede the clients' discovery of their own awareness. This danger is, however, reduced in couples therapy since the system and the problem­ atic cycle are visible to the therapist, while the other partner provides immediate corrective feedback. One area in which interpretations, as outlined above, are particu­ larly useful is helping the client access and explore core catastrophic fantasies and expectations. Such core beliefs about the self and the response of others to the self relate directly to the clients' sense of interpersonal security and therefore to each partner's ability to be accessi­ ble and responsive. These core beliefs are one example of "hot cogni­ tions" and can be assessed by evocative responding or unfolded with the help of interpretation. After having explored and synthesized the emo­ tional experience, often very painful, in which this core belief is em­ bedded, the client may benefit from a succinct symbolization of such a core belief by the therapist. Examples of such interpretations might be concrete, vivid statements about possible fears of engulfment, of the unacceptable nature of the self, or the fear of relying on and trusting the

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other in a world where no one seems ultimately trustworthy. This process in turn aids in the accurate framing of intentions and desires.

Example

• Conjecturing about aspects of experience that the client is presently unaware of. THERAPIST: Even though it is not what you are saying, I think you are feeling afraid, and it is hard for you to experience this. I may be wrong but this is what I sense, that you are feeling afraid. • Elaborating on the client's experience, taking a step that the client seems unable to take, or making explicit what the client seems unable to formulate. THERAPIST: So my sense of this is that anything is better than giving up and feeling the panic, anything, attacking or screaming, anything is better. • Explicating for some aspect of the client's experience that the client does not yet own. CLIENT: Well, I'm not sure-I'm confused. THERAPIST: Maybe you're feeling something like, "I'm so afraid of your response that I'm having difficulty focusing on this issue without getting confused." • Indirectly giving the clients suggestions or cogmtive organizers with which to explore their experience and so begin the reprocessing of a key experience. THERAPIST: So often people in this kind of situation end up feeling isolated. It may seem out of proportion but they begin to feel perhaps as if their spouse has almost deserted them, and that they are all alone. The evocative language here is designed to strike a chord in the client and access the emotional response implicit in the situation, which up until now may have been described in a cool rational manner. Another form of this kind of intervention that is sometimes useful when a client finds it very difficult to identify with any kind of underlying feeling is a disquisition. A disquisition is a general story shared by the therapist about other clients who felt

/.

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or experienced certain emotions. This narrative is not, of course, necessarily true; it is a detailed way of describing a possible similar situation or set of responses that may reflect some of the present clients' reality. This is a nonthreatening indirect way of suggesting or probing for certain experiences with a relatively closed partner. Inferring catastrophic expectations. THERAPIST: It seems like you 're saying that to let Sarah in means that you will lose yourself, dissolve, that she will eat you up. She seems more needy than you are.

Other Techniques In EFT, the therapist may occasionally use other techniques found in the humanistic experiential therapist's armamentarium, such as self-disclosure. For example, as part of the process of validating a client's fear response to his wife's anger, a therapist disclosed her fear of flying as an example of how most people fear the unfamiliar. This was particularly relevant since the client was a pilot and saw flying as the epitome of safety. Direct confrontation does not tend to play a large part in EFT. Positions are generally uncovered or developed rather than confronted; instead, the clients are confronted by each other's responses and the process of therapy itself. Thus, after a blamer has enacted his angry response to his spouse, and the spouse has withdrawn, the client herself may remark, "Oh-of course doing that pushes him away." Also, if the therapist believ~s that clients have good and valid reasons for their responses, direct confrontation is out of place. In fact, the therapist's acceptance of each client is a model for the partners to use in viewing their own responses and those of the partner. These interactions result in a process whereby clients track and evaluate their own responses and experience. The first task of therapy, then, is concerned with helping the client to access and acknowledge primary emotional responses such as those connected with catastrophic fantasies or expectations. This is a process both of discovery and creation; however, it is only one half of the change process. The second half involves the creation of new meaning and the expression of feelings to modify interactional patterns.

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TASK 2: CHANGING INTERACTIONAL POSITIONS The second major task in EFT, then, is to use the emotional experience of the partners to motivate new behavior by evoking new responses that change interactional patterns. This involves a more interpersonal focus. The therapist has to see the interpersonal significance of intrapersonal experience and help the couple to integrate this experience into their interactional patterns. Certain emotional responses tend to be associated with certain relationship positions. The therapist, in order to change such positions, focuses particularly on these. For example, the therapist may focus on vulnerability in the blamer and on boundary defining in the withdrawer. In general, the therapist helps the couple frame their experience in such a way as to undermine rigid positions and facilitate contact. The therapist also uses generally validating frameworks to describe interactional cycles such as lack of safety or security or the need for protection from the threat. The therapist assumes that desires consistent with bonding theory, such as desires for recognition and support, are present for each partner in the relationship, even if unacknowledged. How does the therapist then choreograph new interactional patterns?

Principles As with accessing emotional experience, it is possible to formulate a set of general principles for changing interaction patterns. These principles are as follows:

• Tracking Interactions. The therapist highlights patterns and follows and expands sequences as well as key incidents. • Refocusing Interactions. The therapist repeatedly brings the couple's attention back to these patterns and events. • Reframing. The therapist frames the couple's problems in terms of context and interactional cycles. • Directing and Choreographing. The therapist directs the interaction in such a way as to gradually expand, explicate, and finally restructure positions.

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• Repositioning. The therapist uses the new intrapsychic experience to create new relationship positions. As with Minuchin's structural family therapy (Minuchin, 1974), the basis for interventions is the concept that transactional patterns reflect the structure of a relationship, as embodied in repetitive rigid patterns and positions. The main features of the relationship map in couples therapy are the autonomy-dependence and the closeness-distance patterns that the couple enact and that constitute each partner's position in the relationship. The goal of therapy is to help the partners restructure their interaction from the present rigid stalemate to an open, responsive, I-thou connectedness and interdependence. In such a relationship, both partners have a sense of boundary and autonomy and a sense of belonging. Therapy, then, consists of a set of steps in which the partners move closer to a positive interactional cycle in which underlying experience and interactional positions can be made congruent and integrated in such a way as to elicit contact and caring from each other. For example, a woman who consistently blames and thus pushes her partner away is encouraged to access her underlying feelings, that is, to focus on herself rather than on her partner. The therapist, having accessed these feelings, then uses them to reframe and restructure interactions so that the blamer can openly ask for what she needs and evoke a positive response.

Interventions Just as the interventions of the first task of EFT can be subsumed under the headings of responding and directing, the interventions here can be subsumed under the general headings of reframing and restructuring. All the interventions presented here mesh with, build on, and interact with the more intrapsychically oriented interventions of the first task. In general in EFT, the dichotomy between intrapersonal and interpersonal becomes somewhat irrelevant, as the dancer and the dance are indistinguishable. The individuals and the context are reflections of each other and the process of treatment illustrates this, with intrapsychic interventions feeding into or springing from interpersonal interventions and vice versa.

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PRACTICE Task 2. Changing lnteractional Positions: Operations l. Rcframing A. Placing behavior in the context of the cycle B. Framing difficulties in terms of underlying vulnerabilities C. Giving a metaperspective ll. Restructuring A. Instructing the partner to interact in a particular way B. Choreographing a new pattern of interaction

Reframing PLACING BEHAVIOR IN THE CONTEXT OF THE CYCLE

The therapist continually places each partner's behavior in the context of the interactional cycle and the responses evoked by the other partner's behavior. This is perhaps the most basic intervention arising from the structural systemic perspective. The main difference between the work of such theorists as Minuchin and Fishman (1981) and EFT is that the elements of intrapsychic experience and motivation are directly included in EFT whereas these elements are considered irrelevant in traditional systemic approaches. This is not reframing in the strategic sense of the term; the frame is not arbitrary but arises frqm an emotional uncovering. Placing behavior in the context of the cycle counteracts each partner's view of the relationship as one in which the other is agent and he or she is simply reacting to the other's behavior-that is, both partners' responses are seen as actively constructing the distressing rela­ tionship. As part of this intervention, the therapist accepts and validates the clients' reality but places it within a larger and more complete picture-that is, within the context of the other's behavior. This fosters mutuality and creates a context in which the clients may learn to change their own behaviour to evoke different responses from each other, rather than attempting to change each other. The therapist constantly frames the partners' positions in terms of interaction cycles that both create and suffer from. As part of this intervention, the therapist might label behav­ ior that one partner sees as "selfish" (a reflection of the nature of self) as in fact being "needy" (a reflection of the nature of the relationship). The patterns of interaction are then presented as causal agents, reflecting and evoking intrapsychic experience. The focus is on tracking the process of interaction and placing each partner's responses in the context of the couple's negative self-defeating cycles. In intrapsychic interventions, the

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focus is on how clients process experience; here, it is on how they interact together. The reframing of problematic responses in terms of imperatives created by context legitimizes responses and also sets the stage for new patterns of interaction. The framing of distancing behavior, for example, in terms of self-protection in the face of perceived aggressiveness on the part of the other partner creates new possibilities concerning how the distancing self is perceived and responded to. The distancer is framed as "driven away" rather than as innately aloof and uncaring. Example Placing one partner's behavior in the context of the other's behavior. THERAPIST: So your sense is that Andrea's anger is unjustified and that she is being very unfair? HusBAND: Yes, she got that from her mother, her temper. THERAPIST: It is difficult for you to imagine that her anger is connected to you, to your taking distance and closing her out? HusBAND: What else can I do? THERAPIST: Yes, I understand. You try to avoid a fight and she sees you as going away and not caring. She tries to get you to hear her and you see her as being impossible and hostile. Positive reframing, in terms of context. CLIENT: I know I get verbally abusive and .I hate myself for it. I can't get to him. THERAPIST: So the abuse is about getting a reaction from him. The way things are between you, you don't know how to contact him. He seems unreachable, unless you get angry.

FRAMING DIFFICULTIES IN TERMS OF UNDERLYING VULNERABILITIES

The therapist deals with blocks to the enactment of new interactions or new responses by framing these blocks in terms of underlying vulnerabilities. In this intervention, the client is directed to engage the partner on a level that makes the difficulty explicit and reflects on the nature of the relationship. In the case where one partner is unable to accept or respond to new aspects of self and new responses expressed by the other, this

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method of dealing with such blocks protects the other from the negative impact of the partner's lack of response. The therapist then attempts to access the emotional experience underlying this lack of response.

Example • Framing blocks in terms of underlying intrapsychic vulnerabilities. THERAPIST: Is it hard for you Cal ... hard for you to comfort her? CAL: Yeah, I don't know why .. . THERAPIST: Can you look at her? What do you see? CAL: She's crying, she looks sad, but I've tried before. THERAPIST: Maybe you want to know if your offer will be accepted? Maybe you still want to stay behind that shield of yours you were talking about? CAL: Yeah, like, is it really safe to come out? (Laughs.) or THERAPIST: Can you look at your wife and tell her about your fear of her criticism? HusBAND: No I can't. THERAPIST: It's hard to look her in the eye and say that. HUSBAND: She11 mock me. 111 be exposed. THERAPIST: Can you tell her, I feel so unsafe, it's terrifying to let you close enough to hurt me? HUSBAND: Yeah. (Looks at wife.) I have to keep you away.

GIVING A METAPERSPECTIVE

The metaperspective, in part, involves viewing and expressing one partner's behavior in terms of the stimulus offered by the other. However, the therapist also clarifies the working of the negative cycle, always heightening any change in position or new responses. The therapist also elucidates on how interaction patterns reinforce each person's self-definition. This intervention teaches the couple how to integrate awareness of the process of interaction into their everyday relationship. It gives an added perspective and facilitates the creation of an I- thou dialogue. It also attempts to make more explicit the control that the couple have over their own relationship and the process by which they construct it.

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Example How would you change your response to help Jim to be a little less afraid of coming close? CLIENT: Well, I guess, I could try to tell him some of the feelings we\re talked about here. Maybe not get angry so quickly, risk asking him, so I don't have to be this angry bitch all the time. It's hard to love someone who is angry all the time. THERAPIST:

Restructuring Just as reframing attempts to change the meaning of responses and positions, restructuring attempts to reprocess present interactions and construct and enact more adaptable and flexible patterns.

INSTRUCTING THE PARTNER TO INTERACT IN A PARTICULAR WAY

The therapist here may stop the interaction and pick out a particular small incident or set of responses for further expansion. The therapist may also ask the client to communicate new aspects of experience or new aspects of self that are not usually evoked or operationalized in the relationship. It is not enough for a client to engage in a new experience or discover a new aspect of self in front of the other spouse. This new experience has to then be directly communicated to the partner-that is, it has to be enacted and thus turned into a relationship event. The EFT therapist allies with the aspects of self in both partners that have the potential, if enacted, to change the context, the structure of the relationship. The therapist then tracks interventions, directs the expression of new emotional experience to the partner, directs one partner to respond to the other, and encourages each to state needs and wants explicitly. In order to heighten and intensify a particular interaction, the therapist may focus on and repeat a certain set of responses. This has the effect of highlighting the pattern of interactions and focusing on particular elements and positions in the interaction. Thus, key interactions that serve to maintain the structure of the relationship are focused on and made accessible for intervention. This kind of intervention is useful, for example, when a partner changes his or her behavior in a positive fashion only to have this

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positive response invalidated by the other spouse, as when a withdrawn wife becomes open and self-revealing for a moment only to be attacked by her husband who either does not see or does not trust this change. In this case, of course, the attack, if not attended to, will evoke further withdrawal, confirming· the blaming spouse's mistrust in his partner's new response. It is also useful to have partners enact, in a clear, concise manner, their dysfunctional patterns. The therapist can then replay the interaction and highlight the automatic vicious cycle that the couple have constructed. It is next possible to take o.ne element of this cycle and begin to expand it intrapsychically or interpersonally by directing the couple to interact concerning this element so that the pattern is expanded and modified. Repeating key interpersonal messages, at a slower speed, with heightened expressiveness and clarity, tends to create a context in which the couple can see how they create their relationship as they do it. This kind of immediacy can be powerful and dramatic.

Example • Direct the expression of new emotion experience to the spouse. THERAPIST: Can you look at your spouse? Can you tell her, "I'm so afraid, I'm so afraid that you'll turn away''? or

THERAPIST: You used a very strong image there, the image of playing with fire. Can you share with your wife how afraid you are of her anger, how for you it is like playing with fire? or

THERAPIST: Can you tell him, "I'm so angry at you, it does not matter what you do right now, I will not hear you or accept it''? • Ask for the other's response to a partner's experience. THERAPIST: What's happening to you Larry, as Chris is crying? or

THERAPIST: How do you respond to Chris talking about how hurt he feels? • Encourage the client to check out assumptions and perceptions. THERAPIST: Can you ask if he is thinking of leaving?

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Replaying crucial interactions. THERAPIST: Can you stop for a moment? Something interesting happened there. Mary, you started to talk about how painful this relationship is for you. I saw you trying to reach Jim, to have him understand. (Mary nods.) Then, Jim, you said, "Well if it's so easy to say, how come you haven't done it before." Do you remember? What happened there? J1M: Well it seems like she can open up if she wants to. THERAPIST: (Repeats what he has just said, only directed to Mary.) MARY: He shut me down. (Therapist nods.) THERAPIST: Can you tell Jim? MARY: (To Jim.) When I do try and open up you shut me down, so then I run away. THERAPIST: Can you say that again? Can you say, "You shut me down"? or THERAPIST: Can we stop for a moment and go back? Sue, you said you need time by yourself, and then, Dan, you responded. As part of that response you said "You're so independent. If I really needed you, I'd be in bad shape." Do you remember? DAN: Did I say that? Yes ... OK. MARY: I didn't really hear that. (To Dan.) Did you say that? THERAPIST: (To Mary.) You did not hear his fear of what would happen if he really needed you? MARY: No. Now I hear it. THERAPIST: Dan, could you say that again to Mary, please? or THERAPIST: Stop ... there is your whole relationship, right there. Linda, you said, "Well, you've always had a problem-you never could express feelings-or even really feel them." And, Dan, you responded "Oh yeah, well I guess I don't love you then, do I?" What do you two hear in this? 111 repeat it again.

CHOREOGRAPHING A NEW PATTERN OF INTERACTION

The therapist uses new emotional experience and new aspects of self to redefine the relationship in terms of autonomy-dependence and closeness- distance. The emotions associated with attachment tend to be those of sadness, fear, and joy. Emotional responses that tend to create bound-

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ary definition are anger and disgust. As the partners expand and explicate their interactional position, the therapist first structures the enactment of such positions in the present and in terms of underlying experience. Once this is achieved, new desires become apparent and become the basis of new interactions. Thus, a withdrawn partner begins to demand respect and to take some overt control in the relationship; from this new, more secure, position he is able to respond to the therapist's suggestion that he help his partner with her needs .for contact and closeness. The withdrawer then becomes engaged in a new task, position, or role, that of assisting his previously hostile partner to reach him. Such shifts in interaction create new perceptions of the partner, operationalize new aspects of self, and evoke a new context. Another example of such a relational shift is when a client who is involved in coercive strategies to achieve closeness begins to recognize and enact her underlying fear of depending on and trusting her partner. The shift in terms of pragmatic interactions might be from "You keep me out, I'll show you" to "I am afraid to trust, to let you in." In a blame-withdraw cycle, two of the most crucial new patterns are where the withdrawer offers comfort and contact to the blamer and the blamer softens to a position of vulnerability and asks for what he or she needs from the withdrawer. For example, having supported the withdrawer and made a judgment that she is now likely to respond to her partner, and having accessed the vulnerability of the blamer, the therapist sees the opportunity for a new kind of contact and so directs the blamer to ask his partner, from a position of vulnerability, to respond to his needs. The therapist then helps the withdrawer to respond in a supportive accepting manner. The steps in this intervention involve structuring the expression of new aspects of self, new desires, and needs to the other; tracking the effect of such expression; guiding the evolution of new interactions; and setting the stage for the maintenance of new positions by symbolizing clearly how each partner has changed position and has thereby invited the other to dance in a new way. In the above example, the steps might involve the therapist directing the blamer to ask for support and reassurance, tracking and structuring the withdrawer's response, guiding and heightening the new interaction of reaching and responding, and finally symbolizing this new relationship event and its new possibilities.

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Example HusBAND: Maybe I do need some support, maybe. I'm tired of always being so strong, so in control. THERAPIST: So can you ask her, can you look at her and ask her? I'd like you to. HusBAND: (Long silence, then to wife.) I'd like you to hold me sometimes, take care of me, comfort me. THERAPIST: What's happening for you right now, Cindy? WIFE: I'm amazed, surprised, I feel confused. THERAPIST: How do you feel toward John? WIFE: Like I want to hold him and rock him like a kid. This kind of interaction represents a shift in position, in that the blamer has focused on his own needs and now asks for a response rather than attacking or blaming the other. The withdrawer instead of protecting herself is able to be accessible and responsive. This event appears to be a crucial one, differentiating couples who make significant gains in EFT and those who do not change.

SUMMARY The therapist in EFT acts as a guide to a new experiential synthesis and as a guide to the integration of that synthesis into a new definition of self in relation to the other. The therapist is an evoker of new experience, a partner in the processing of that experience, and a director of new interaction patterns. It is assumed that the therapist is monitoring the therapeutic alliance from moment to moment and assessing the effect of interventions on both clients. Any rupture in the alliance in which a client feels unfairly judged or not recognized will undermine progress and must be seen, addressed, and resolved before therapy continues. One of the main issues that arises when teaching EFT to therapists is the question of how to know which emotion to elicit, when, and to gain what effect. To address this question, the therapist must engage in constant process diagnosis (Greenberg & Johnson, 1986). Knowledge of the positions and the configurations of underlying feelings usually asso-

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ciated with certain positions, such as deprivation and isolation in blamers, provides a road map. However, every couple is idiosyncratic and there is a sense in which the therapist sifts through the experience of both clients looking for the emotional experiences that, if heightened rather than avoided, could help the couple change positions. If the therapist views the task as restructuring a bond, then bonding theory, which posits innate needs such as the need for security and recognition, provides one guide to the clients' experience. If the therapist views the task as motivating new affiliative responses, then soft emotions such as compassion might be used to elicit approach behavior and assertive emotions such as anger might be used to create boundaries and help define the self as separate and autonomous from the partner. The guides to which emotion it is appropriate to elicit are then the clients' immediate responses and the feeling that the therapist hypothesizes underlie such responses. In general, the current process of what is happening within and between partners and the therapist's sense of what is lively and poignant are the best guides to the choice of focus and intervention. Good affective intervention is guided not by a theoretical framework, but rather by the sensitive perception of each partner's unique experience and personal meanings, as they are revealed in the present. The therapist needs to be open, to hear and to see what the couple is saying and doing, and to integrate all the verbal and nonverbal cues of the moment with the current interactional sequences, the context of the problem, and the therapist's own theoretical and existential understandings. Establishing the uniqueness of what is happening for this couple in the moment, and their reasons for their feelings, is the best information for guiding interventions to disrupt their cycle. This is a moment-bymoment diagnosis of the ongoing process in which the therapist has to decide when the system is most amenable to a particular intervention or when a particular experience may be usefully heightened and explored to facilitate future interactional shifts. These issues are also addressed in the following chapter.

CHAPTER SEVEN

Clinical Issues

This chapter addresses a variety of issues that anse during therapy, including issues in the accessing of emotion, the structuring of new interactions, the training of therapists, the addressing of individual symptomatology, general contraindications for the use of EFT, and the integration of different approaches in couples therapy.

ISSUES ARISING IN THE PROCESS OF ACCESSING EMOTION Certain general issues emerge in the process of accessing emotional experience, particularly for therapists who are new to EFT. The first issue involves how to differentiate the level and type of emotional experience that may be usefully explored in therapy. The distinction between , !_Ypes of emotion-primary, secondary or reactive, and instrumental·•ffas been discussed earlier. The main point is that it is primary emotional responses that need to be focused on and expanded in therapy in order to achieve change. It is possible for clients and therapists to discuss emotion on a relatively uninvolved and superficial level, perhaps as part of identifying an interactional cycle. Beginning therapists, who may be uncomfortable with accessing more intense emotional experience, tend to do only this. The effect is usually that the couple gain some intellectual insight into their problems, but they create little change in the positions they take with one another. Emotional responses must be evoked by the therapist and experienced by the clients, as vividly and intensely as possible, otherwise no new aspect of self is realized and changes do not occur. It may be that the new therapist will use abstract terms or complex interpre175

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tations that encourage the clients to intellectualize or simply place labels on experiences. Even if the therapist uses reasonably evocative language and vivid images, he or she may speak too fast and neglect to use nonverbals such as voice or posture to support the appropriate use of words. As in experiential approaches in general, the therapist is in some sense a resonating board for the experiences of the clients. The therapist then processes the clients' responses and uses his or her own experience as a guide to what occurs in the clients' world. The therapist is, as Kempler (1981) suggests, "being skillfully" rather than simply being skillful. EFT, like other therapies, works best when it is integrated into the personal style of the therapist. Therapists therefore have to be relatively comfortable and flexible with emotional experience themselves in order to allow and explore it with others. A therapist for whom such experience is personally threatening will tend to rescue clients from their feelings and address only superficial levels of experience, thereby containing rather than expanding the client's exploration. The other extreme is to focus on the indiscriminate ventilation of emotion on the assumption that discharge or expression, in and of itself, is an agent of change. If the emotion is negative, this process may actually entrench already negative patterns in the relationship. At the very least, this kind of intervention simply results in frustrated clients and a stagnant therapeutic process. The repetitive expression of secondary reactive emotions, rather than of primary emotions, is not progress, in the sense that this is exactly what many distressed couples normally do with each other; they express their frustrations, complaints, and resentments quite easily of their own accord. This kind of ventilation approach to emotional expression in therapy is perhaps the reason why many practitioners of couples therapy, particularly those from the behavioral school, have considered emotion as irrelevant to therapeutic change or, at worst, actually detrimental to such change. The expression of negative emotion has also been considered a problem rather than a constructive process in that negative affective expression may create distance and alienate partners from each other; indeed, if emotional experience is limited to the ventilation of negative reactive responses, this would seem to be the logical result. Another issue, particularly for the new therapist, is that some clients are less predisposed to allow themselves to experience emotion than others. Once the therapist has experience with EFT, however, this does not seem to be a particularly difficult problem. Although some clients do

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need more help in accessing their experience than others, it is also true that, for these clients, emotion when it is experienced is a very powerful and potent agent for change. At first, for these clients, the therapist may have to empathically interpret underlying feelings, but usually this pro­ cess is relevant and rewarding for these clients, and they are soon able to speak for themselves. Accessing underlying feelings is not then a process of demanding that someone express emotion; rather, it is the provision of a safe environment and the type of conditions in which a person is able to focus on an aspect of experience hitherto avoided or ignored. Clients' attitudes toward emotion and the expression of emotion often emerge in this context. For example, the therapist asks how the husband feels as he hears his wife describe their sexual life as empty, impersonal, and alienating. The husband replies in a calm, detached manner that he can understand her point of view and nothing is pedect. Next, when the therapist repeats key phrases used by the wife and probes for an emotional response, the husband replies that there is no point, and also it is not his style, to wallow in feelings. The therapist then elicits a feeling of hurt by using evocative responding and asks the husband to tell his wife how hard it is for him to look at her and express his hurt. The husband's reservations about expressing emotion (and therefore of being seen as weak and not in control) then emerge. Key cognitions concerning the experience and expression of emotion are thus addressed and made immediate and concrete in the process of therapy. After the husband experiments with expressing his emotions, the therapist also encourages the wife to express her response, to share the impact his emotional expression has had on her; for example, that she feels reassured that he does care about their relationship and does in fact have a response, even if it is usually inhibited or not attended to. There is thus an educational component to EFT. The therapist in some cases teaches the client about the role of emotional experience and expression in relationships, but this teaching is experiential, rather than didactic. Inability to express particular feelings and respond to a partner is dealt with by validating and encouraging clients to deal with their blocks to expression as they experience them in the moment. For example, the therapist might explore how difficult it is for a wife to risk being open to her partner and encourage her to express both her unwillingness and her difficulty in responding to her spouse. Blocks to expression and respon­ siveness thus become integrated into the process of accessing the affect underlying interactional patterns. Such blocks are dealt with in general

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by validation and exploration. This approach then makes it unnecessary to directly confront issues of compliance and cooperation in the treatment process. The question of which emotion to focus on does not arise if clients are fully engaged in the therapy process. The most salient aspect of experience, when paid attention to, naturally evokes relevant responses. Asking a client what he is experiencing as his wife lectures and attacks him verbally, and he looks away and sighs, is often sufficient. If, however, clients are emotionally inaccessible, therapists can use their own empathic sense of the clients' relationship positions as a guide to the clients' present experience, particularly including those emotions that if expressed would threaten the relationship structure. Useful questions for beginning therapists to ask, then, are as follows: What would this client have to experience to maintain this relationship position? What would this ·client have to experience and express in order to step out of this position? The issues that arise concerning the evocation of emotional experience can then be summed up in the statement that primary emotional experiences must be evoked, experienced, and integrated into the relationship to create change in the relationship's structure. Novice therapists must be taught to evoke rather than discuss emotion, to validate reactive emotional responses, and then to help the client explore beyond this level of experience. Once primary emotion is accessed, the therapist must know how to use this emotion to create relationship change.

ISSUES ARISING IN THE STRUCTURING OF NEW INTERACTIONS Even if the emotion expressed by the couple is authentic primary emotion, emerging from a current synthesis of new emotional experience and explicating each partner's relationship position, it is not enough, in and of itself, to create change in relationship patterns. The power of the interpersonal context is such that emotional expression, unless amplified and used, becomes an insignificant deviation in the overall pattern of interactions. Thus, new experience in one partner must lead to the expression of a need to the other and must evoke a new acceptance, a new response, from the other. If, for example, a therapist has helped a withdrawn, passive husband access a sense of anger and defiance ('ll will

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not be controlled") in relation to his partner, the therapist is responsible for helping that client to differentiate and develop this emotion, until he can frame it into a request for recognition and respect that is likely to be accepted by his partner. Such a request redefines the power and distance aspects of the husband's position in the relationship. The therapist is thus responsible not only for helping access the emotion but also for helping the client to own it and frame it in such a way that the other spouse can listen and respond. Therefore, in this example, the therapist's role is to help the withdrawn husband communicate new experiences and desires to his spouse and to facilitate her acceptance of his new response. Another issue that arises here is one of timing. The therapist must judge the appropriate time to encourage a new interaction based on the new emotional experience of the partners. The way this issue usually presents itself in therapy is that the therapist has to decide, for instance, if it is appropriate to encourage a pursuer, from a new experience of vulnerability, to reach for the withdrawer and attempt to evoke a positive caring response; to encourage a withdrawer to become more accessible and open to his or her partner; to support a nonassertive partner to express needs and set boundaries; or to help a dominant partner relinquish control and accept direction from the other partner. Both partners have to be prepared for such interactions, and they should only be introduced when there is a reasonable possibility that the observing partner will be able to at least listen sympathetically to the expression of a new feeling. This sequence, of course, often breaks down, giving the therapist the opportunity to work directly with responses that maintain the distressed cycle. It is extremely useful to replay a sequence in which a new response occurred-for example, an assertive statement by a usually placating, withdrawing wife-that was acknowledged or discounted or that even evoked hostile attack. The replaying of this sequence confronts the responding partner with his or her own behavior, which, in this example, maintains the wife's passivity and makes it difficult for her to engage with him and give him what he needs. Thus, partners learn how each evokes in the other the behavior that causes their distress. However, if the therapist is not active and allows a series of situations to occur in which, for instance, a withdrawer approaches, becomes accessible, and is constantly rebuffed, or a pursuer discloses from a position of vulnerability and is repeatedly attacked, this undermines the therapy process. Similarly, a situation in which a deferrer asserts him- or herself only to have the controller redouble efforts to control, or when a

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controller gives up control only to have the placater seek direction, can convince partners that change in their partners and in their relationship is impossible. If a partner discloses vulnerability, or an underlying need, and is attacked by the other, the therapist can often deflect or diffuse such an attack and focus on the feelings underlying the attack. There do seem to be specific points in therapy where there is an opportunity for a new interaction to occur; if these points are missed or misjudged by the therapist, progress can be substantially impeded. Therefore, the therapist must be able, if necessary, to protect each partner from the response of the other. This also relates to the treatment of violent relationships, in that it is difficult in such relationships for the therapist to create safety and for the abused partner to feel safe enough to express vulnerability. In such relationships, it is likely that assertion or vulnerability will not be respected and may even be taken advantage of. Similarly, the abusing partner may be terrified of his or her own vulnerability and any sense that the partner will take advantage of this vulnerability may lead him or her to attempt to assert dominance. For these reasons, EFT is not the initial treatment of choice for violent couples. Related to the issue of timing and the structuring of new interactions is the necessity to monitor the therapeutic alliance attentively. Couples therapy entails a constant process of balancing and maintaining a therapeutic alliance with both partners simultaneously. This is especially important in a treatment such as EFT, for reasons discussed previously. Any potential breach in this alliance has to be attended to immediately and addressed before the process of therapy can continue. Specifically, the alliance with both spouses must be positive and secure before the therapist attempts to structure new interactions. If, for example, the therapist senses resentment arising from either of the partners toward the therapeutic process, or toward the therapist, he or she must explore this experience and do whatever is necessary to re-establish the client's confidence in him or her and in the process.

ALLIANCE MENDING How does the EFT therapist repair a damaged alliance when necessary? Therapists have to ask themselves what action of theirs evoked the distant, defensive, or hostile behavior the client is exhibiting. Did the therapist go too fast, assume too much, or not respond to the client's

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concerns? The vulnerability each client exhibits with the partner may also be evoked by the therapist, especially when the therapist is challenging particular blocks or defensive stances that clients use to protect themselves. At this point, the alliance is particularly vulnerable to damage, and the therapist has to pay particular attention to this aspect of the process. The repair process involves the following steps. ( 1) The therapist must recognize the breach in the alliance and deliberately focus upon it rather than upon the intrapsychic experience of the client or the relationship between the spouses. For example, "I get a sense that you feel very uncomfortable with me right now," or, if the therapist wishes to relate to the alliance with the other partner, "I have a sense that you feel that I'm being hard on your partner and you feel protective of him," or, relating to the relationship, "You're not sure that I'm really seeing your relationship as it is and approaching it in the right way?" (2) The therapist probes the client's experience of the breach, for example, "I don't quite understand, is it that you're angry with me for supporting your husband when he tells you his concerns?" (3) Validating and legitimizing the client's experience and relating the therapist's actions to therapeutic goals and concern for self, other, and the relationship follows. For example, "I can understand how it might seem unfair to you that I'm giving your spouse so much support right now, but I think it's important for him to be able to tell you all his resentments so that you know what they are and the two of you can begin to deal with them." (4) Finally, the therapist acts to restore the partnership in terms of bond, goal, and task; as by asking "Do you feel reassured as to my concern for you and the importance of what we are exploring right now if we are to help the two of you get closer?" It is important for the therapist to acknowledge and take responsibility for any unnecessary pain he or she may have evoked in the client while at the same time reserving the right to challenge and question: "Perhaps I did not support you enough; it is very hard to experience this kind of fear. I think it is important to continue to explore it, but maybe you can tell me how I can support you more." A particular issue arises when a couple's presenting pattern reflects the treatment rationale, that is, the need to experience and express underlying feelings. A potential imbalance in the alliance formation process then presents itself. It is important in these instances that the therapist not ally with the partner who is complaining of the other partner's inaccessibility. Rather, the therapist needs to validate the withdrawer's need for self-protection until such a time as this person feels safe

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enough to express feelings. This pattern can be especially tricky when the therapist is female and the emotionally withdrawn client is the man, with the woman demanding more expressiveness. This is also the most common pattern presenting in therapy. The fem ale therapist here has to be especially careful not to be perceived as only the female partner's ally. Another interesting situation is where one person, often the male partner, complains that the other is too emotional and attempts to close her down if she is too expressive. Here, both the fear of emotion and the need for control must be dealt with, along with the woman's understanding of her partner's fear and her ability to reassure him that she will not lose control and overwhelm him. Both of the above relationship patterns are of particular interest in EFT because of their correspondence and potential clash with the espoused treatment rationale.

TRAINING ISSUES Couples therapy is a complex process. The novice therapist is faced with a multidimensional, multileveled, dynamic phenomenon. At any moment there are many aspects of this phenomenon that require the therapist's attention. First, the therapist must establish, monitor, and maintain an alliance with each partner in the presence of the other. Of course, a therapist may deliberately choose during the course of therapy to unbalance this alliance for therapeutic effect; however, such unbalancing must be deliberate and its consequences carefully attended to. Second, the therapist must attend to, track, and process each client's moment-tomoment experience and hypothesize as to underlying emotions that may be crucial in maintaining present positions and may be used later in restructuring the interaction. Third, the therapist must be aware of the effect on the other partner of each partner's statements and the therapist's comments to each partner. Fourth, the therapist must be aware of the implications of one partner's experience and interactional sequences for. the structure of the relationship. Fifth, the therapist must be able to see the relevance of the client's current experience and interactional process to the present focus or subtasks of therapy, that is, the potential for change implied in each interaction, and must be able to choose specific interventions to meet immediate process goals. From all of the above, it is not difficult to see why the usual first response of the novice therapist to couples sessions is confusion and information overload.

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EFT has been effectively taught in the following manner: theoretical presentation; presentation of a clinical overview, goals, strategies, and interventions; group observation of videotaped therapy sessions plus transcript analysis and role-playing concerning specific tasks and issues in therapy; and intense group and individual supervision of therapy cases using videotapes of actual therapy sessions. As with any treatment that involves the integration of two approaches, EFT is more complex and therefore more difficult to learn than a pure approach that involves a single perspective. However, the treatment steps and specific interventions, as outlined, do facilitate the teaching and learning of this approach. The main pressures that students new to couples therapy must face when learning to implement EFT are the following: 1. Students must formulate a systemic perspective of couple's interaction patterns. They have to focus on process and learn to see how each partner's responses are evoked and maintained by the responses of the other. Some students have difficulty maintaining this perspective, especially if they have been previously trained to focus on intrapsychic factors. 2. Students must learn to access emotional experience and particularly to evoke that experience in the present, with the use of appropriate nonverbal behavior. This especially involves the use of evocative voice tone and appropriate pacing to slow the process of the session. Such pacing creates the opportunity for the attentional focus required in the synthesis of new emotion. The ability to create and to hold a couple to an emotional focus and to refocus them when they stray comes only with experience. The trainee therapist needs to learn how to take charge of the interaction and use directive skills to identify and create an emotional focus. 3. The nonjudgmental stance of the experiential therapist is a stance that must be learned and maintained by a self-monitoring process. To see pathology or to blame the clients for their relationship positions and their resistance to change is a constant temptation. In particular, the process of helping the blamer to uncover vulnerability or soften, one of the key change events in EFT, can result in frustration for the novice therapist, since the blamer very often does not easily give up this position. This may then result in a tendency for the therapist to confront one partner excessively rather than to validate and expand his or her position or explore blocks to change. The ability to redirect the blamer to underlying

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feelings in order to obtain a softening is one of the key distinguishing features of more experienced therapists. 4. Students often have difficulty initially in learning to combine interpersonal and intrapsychic interventions. They have to learn to evoke and use intrapsychic material to create new relationship events and vice versa. This kind of skill can only be acquired through experience and through clinical supervision. The good EFT therapist has the ability to use present experience in order to create a new dialogue between partners. The therapist needs to focus on that aspect of underlying experience that will enhance the interaction and open up new possibilities in that interaction. The therapist also has to be able to find ways to facilitate the kind of expression that is able to be heard by the other partner. This ability to help partners phrase their experience in terms of needs, without blame, and in a way that is not threatening to the other spouse, is an important skill that must be focused on in training. 5. Some of the basic difficulties students experience in EFT are the same as in other couples' therapies, such as learning how to balance alliances and structure a couple's session. The ability to take control of a couple's interaction pattern and begin to direct that pattern is in itself a new and demanding task for most students. Apart from learning general theory, specific steps, strategies, and interventions, it is also important for students to understand how change occurs in this model of therapy. When a student is clear as to the specific in-session client performances that lead to specific interactional shifts or change events, it is easier to work toward and facilitate such performances. As part of their training, then, students are exposed as much as possible to clinical examples of key change events. Examples of three such events from the therapy process of three different couples follows.

EXAMPLES OF CHANGE EVENTS USED IN TRAINING The first excerpt illustrates the expansion and elucidation of a withdrawn partner's position, the second the beginning of the process of uncovering vulnerability in a blaming partner, and the third the creation of a new interaction arising from these two processes. The excerpts are divided into intervention points for ease of presentation.

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Excerpt I: The Expansion of a Withdrawer's Position

I. The therapist brings up the issue of the withdrawing husband's frustration and anger. 2. The couple discuss the situations in which the anger arises. For instance, the blaming wife feels harassed and overwhelmed by the house­ hold chores and accuses her husband of not contributing.The therapist then helps the couple explore the stimulus situation and each person's reaction in that situation. The therapist uses empathic reflection and evocative responding. 3. The therapist focuses on, and by evocative responding helps, the withdrawn husband to make the elements of his anger more explicit.The husband explores how he deals with his anger. He does not express it since "there is no point because she (his wife) won't listen to me." 4. The wife responds, "I defend my point of view." The therapist validates each partner's perception of the situation: the wife's desire to protect her need for help in the house as legitimate and the husband's desire to be listened to.The therapist also expands this incident, relating it to their interpersonal positions and the general cycle of blame-pursue, withdraw-distance in their relationship. 5. The therapist reflects and heightens the withdrawer's interper­ sonal message, "I want you to listen to me," and, with evocative respond­ ing and interpretation, heightens underlying feelings. The withdrawer responds by elaborating on his message, as, "I feel judged and criticized ... I am wrong, that's the message ... so I get mad." The therapist interprets and adds to the client's statement,relating it to themes elabo­ rated on in previous sessions.The themes here involve the demand for the husband to be perfect, as concerned about chores as his wife is, and his need for some acceptance.The husband is then, after some dialogue with his wife,able to be directly angry,as in, "I'm not going to be clubbed and feel like a worm just because you're feeling overwhelmed." For this client, this is a very strong assertive remark. 6.The blamer now attacks with "You deserve it ... it's your fault •.. you let me down ...I have to carry the burden of tasks and I have to say how I feel." The therapist validates the blamer's anger and the feeling of being overwhelmed and unsupported, focusing on the blamer's feelings rather than her accusations of her partner. 7. The therapist asks the withdrawer to respond to this, thereby inhibiting the usual withdrawal.The withdrawer points out that he does

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do many chores around the house. The therapist elaborates that it seems that the husband can never do enough to please his wife. The husband accepts this and expands his experience and his response to this experience, which is to become resentful and withdraw, feel helpless, and passively resist his wife's demands. The blamer interrupts, but the therapist blocks her and instead supports her to listen to her spouse. The therapist then frames the position of the withdrawer as, "I won't keep trying to get your approval." The withdrawer accepts this and, as directed by the therapist, repeats it to his spouse, adding that he feels good saying this. 8. The therapist asks the blamer to respond to this. The blamer bursts into tears and says that she also feels like she is always struggling to get her partner's approval; she adds that this is the reason for her being "obsessive and hassled" and feeling "I should have everything perfect for you, so I kill myself trying." The therapist supports and validates this remark and asks the blamer to check with her spouse if her performance as a housekeeper is crucial to his love and acceptance. 9. The withdrawer expresses acceptance of his wife as a person and suggests that she doesn't need to be perfect to merit his love. The therapist asks him to repeat this. 10. The blamer recognizes that she cannot believe her husband's statement and feels unacceptable as a person. In this episode, the withdrawing husband was able to confront and engage the blaming wife, making his position explicit. The wife then began to focus on her underlying feelings rather than accusing her spouse. The couple were given homework, which was to talk about how they behave or feel they have to behave in order to get each other's acceptance.

Excerpt 2: The Beginning of the Process of Softening in a Blaming Partner 1. The therapist validates and expands on the dominant, distancing partner's angry comments and criticisms of his wife. These criticisms involve the wife being, in the husband's eyes, unreasonable, a loser who does not ask for what she wants and then feels sorry for herself and complains constantly. The therapist uses evocative responding to explore

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the husband's basic perceptions of his wife's unreasonableness and helps the client to symbolize the implicit message that he receives from his wife, which is that he has failed as a provider and as a spouse; the husband's respo nse to this is that he refuses to become an "indentured slave." 2. The therapist directs and supports the wife to respond to this, focusing on her need to be listened to and recognized for her contributions to the relationship and the business partnership that the couple share. 3. The blamer states that his wife does not want to be listened toshe simply wants to prove him guilty. He ignores her responses and repeats the previous remarks. The therapist then focuses on the image of the "slave" and encourages the client to enact this position, enumerating all the actions taken to please his wife and to satisfy her demands. 4. With the therapist's help, the husband then begins to access a fear of being judged as a failure by his wife and a configuration of helplessness, desperation, and panic accompanying this fear. The therapist empathically explores this fear in order to expand the husband's experience of this emotion and directs him periodically to communicate his newly accessed experience to his wife in a simple, concrete, and congruent fashion. 5. The husband begins to do this, but then reverts to a blaming mode. The therapist validates the husband's vulnerability to his wife's "judgments" and "demands" and clarifies his angry interpersonal message as one of "get off my back." The therapist then refocuses the process on the husband's fear, using a soft, slow voice to repeat the phrases that the husband has used previously. 6. The therapist asks the wife to share her responses as she listens to her husband; she expresses concern and support and some surprise since she has "never seen this side of him before." The therapist helps the wife to articulate her surprise and her support to her husband in spite of her "disorientation." 7. The husband, with the help of the therapist, continues to elaborate on and symbolize his fear and, conversely, his need for his wife's acceptance and approval. He also expresses his terror of her leaving him. At this point, the previously dominant blamer is now expressing vulnerability to his wife. This evokes new responses and perceptions in his spouse and constitutes a new less dominant relationship position for him. 8. The therapist relates the above process to the process of relationship definition, specifically the closeness- distance cycle. The frame used

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is that the husband , angry and fearful , protects himself against his wife and therefore does not respond to her needs for recognition and closeness. Simple action metaphors are powerful here; the therapist interprets the husband's distance in the relationship, generally and in the session, in terms of his "walling her off. " The husband accepts this metaphor and develops it. The therapist uses evocative responding to clarify the stimulus, response, and experience involved in the husband's distancing. The husband elaborates on his sense of never being able to meet his wife's demands and his feeling of being "beaten up." The therapist directs him to state his position to his wife as, "I'm afraid to be vulnerable and let you close." The husband 's distance is thus framed as fear, and his statement brings him closer to his wife. 9. The therapist asks the wife to respond; she does so in a positive and accepting manner.

Excerpt 3: New Interaction Patterns Arising After a Softening Episode A usual chronic argument arises concerning the wife's desire to spend some weekends shopping with friends. Previously, the wife would withdraw and the husband's behavior would escalate into angry threats and bullying. 1. The therapist comments on this process and points out that this is the couple's usual cycle, with the usual result being a lack of resolution and mutual alienation. 2. The therapist asks the wife to tell her husband how she ftrels when he threatens her. The wife (previously the submissive withdrawer) indicates that she is tired of threats. The therapist elaborates on this, using material from previous sessions, and helps the wife to take an explicit stand, as in "I will not be controlled by threats, they make me angry." This stance is the combination of many weeks of therapy and is a more powerful position than the wife has previously taken. 3. The husband becomes silent and tearful. The therapist invites him to become aware of his inner experience, when he has difficulty going beyond "scared," the therapist empathically interprets his experience in terms formulated by the husband himself in previous sessions. This formulation includes relational issues such as being terrified of losing his

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wife and desperately needing reassurance as to the bond between them. It also includes as more self-schema-orientated issues such as feeling inadequate, unlovable, and never being "good enough." The husband focuses particularly on the last issue and expands it, elaborating on his sense of insecurity. 4. The therapist directs the husband to tell his wife about his emotional experience. The wife comforts him, stating that she can understand his feelings. Aided by the therapist, who repeats key words and sentences, the wife states her limits. These limits are that she cannot constantly reassure him, especially in the face of his "lashing out," which the therapist frames as "driving her away.•~ 5. The therapist asks the husband for his response to what his wife has said. He replies that he knows he's driving her away by his demands and threats. The therapist then places the husband's inadequacy in a relational context. This involves framing it as a difficulty in trust; the husband has difficulty trusting that the wife loves him (and she of course cannot prove this to him) and sees himself as needing her much more than she needs him. The husband concurs with this formulation. 6. The wife responds by stating that her need for separate activities does not mean that she does not need her spouse; she then elaborates on

her need for his support and love. 7. The therapist evocatively responds and encourages a dialogue regarding the wife's needs and the husband's ability to fulfill them. The couple agree that the husband has in the past, and can now, fulfill these needs. The value of reading transcripts and seeing videotaped or live examples of such events cannot be overemphasized. The student then has a clear sense of the couple's destination, as well as a road map and a set of directions.

USING EMOTIONALLY FOCUSED THERAPY TO ADDRESS INDIVIDUAL SYMPTOMATOLOGY Individual symptoms, such as phobias or depression, which have repercussions in intimate relationships may be viewed as a function of the individual's position in a relationship and as being maintained by the interactional patterns of that relationship. Symptoms are viewed then as

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being both system maintained and system maintaining. Individual sympto ms can function in such a way as to balance power or regulate closeness and distance in a relationship; thus, they enable the couple to maintain the bond between them. Without addressing the issue which comes first, the individual symptom or the interactional pattern in which it is embedded, it is possible to focus on the interpersonal elements of a symptom and, by so doing, modify other cognitive and affective aspects (Horowitz & Vitkus, 1986). For example, resolving interpersonal issues and taking a new and more equal position with one's partner may reduce negative views of self, especially since the self is constantly being defined in relation to one's intimate others, and may thus reduce overall levels of depression and enhance a client's general sense of efficacy. There has been a general shift toward more interactional models in the treatment of individual disorders such as depression. This shift has often involved, however, a change of focus rather than a change of modality, a focus on interpersonal issues rather than an actual use of marital therapy. However, couple-oriented interventions, such as EFT, are being used more and more frequently to address such disorders, either as an adjunct to individual therapy or as the primary mode of treatment. A number of EFT sessions may then be used as part of the treatment of such disorders, or EFT alone may be used to change the interpersonal context, thus modifying the problematic symptoms. EFf has been used to address various individual symptoms, including sexual problems such as vaginismus, psychosomatic problems such as chronic pain, and phobias in which relationship distress is also present. However, the most common individual symptom occurring with relationship distress is depression. The relationship between these two presenting problems has been well-documented (Haas, Clarkin, & Glick, 1985). In particular, there is evidence that 50% of clients requesting treatment for depression also evidence distress in their relationships and that unresolved conflicts are implicated in relapse. lnteractional patterns are more and more being viewed as an essential part of the depressive process, whether depression is viewed from a reinforcement, cognitive, or a more dynamic or systemic viewpoint. On a clinical level, EFf appears to be effective in modifying depression in one partner. As the relationship changes to a more open and supportive one, and as the individual's position in relation to the other partner is redefined, depressive symptoms remit. Research is at present being conducted to verify this effect.

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On a clinical level, it makes sense that certain aspects of the process of EFT would modify depressive symptoms. For example, symptoms can be modified by validating the depressed partner's affective responses so that these responses may be owned and addressed in the relationship. This allows the person to be more active in attempting to meet his or her interpersonal needs. Creating a context in which couples can be generally more accepting and responsive to each other also affects such symptoms. In general, the creation of a more secure interpersonal bond in which each individual is defined in such a way as to enhance a sense of selfesteem and self-efficacy is a powerful antidote to the sense of loss, emotional disconnectedness, and/ or failure and inadequacy that often underlies depressive symptoms. EFT attempts to deal with intrapsychic and interpersonal factors along with the negative interactional cycles that maintain one partner in the depressive position. In the area of phobic disorders, it appears that relationship factors are particularly involved in the generation and maintenance of agoraphobia. Chambless and Goldstein (1981) have suggested two categories of agoraphobia, simple and complex, the latter being more prevalent. Simple phobias are predicated by specific traumatic events. Complex phobias are associated with relationship conflict, a dependent personality style, and a wide range of symptoms. Often, complex phobias do not yield to behavior therapy or, if they do, they recur as a function of interpersonal conflict. Couples therapy is relevant for dealing with both relationshiprelated phobias and the impact that most simple phobias have on the relationship. Agoraphobia, which occurs predominantly in women, seems highly related to sex role issues. The agoraphobic woman becomes more and more dependent and is unable to achieve or to be confident outside the home. The husbands of agoraphobic women, in many instances, initially welcome their wives' dependence, although they eventually become resentful of the restrictions placed on them by their wives' phobias. The wife's incompetence often serves to support the husband as the competent one in the relationship, and her phobia deemphasizes any differences or conflicts that occur between them. In this context, it would appear that it is difficult to treat agoraphobia successfully without some attempt to modify the couple's relationship. Even in cases where the quality of the relationship is in some sense peripheral to symptom maintenance, the modification of the relationship can improve the individual client's ability to deal effectively with chronic

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symptom patterns. An example of a client with numerous, chronic, debilitating phobias who came into EFT for a marital problem is briefly summarized below. A couple, both in their early 50s presented with the problem of marital dissatisfaction arising directly out of the husband 's numerous phobias, which limited his range of activities and thus the quality of his marital life. The many sessions of individual therapy that he had engaged in to modify these phobias had also affected the couple's financial solvency. This client refused to drive up or down hills, over bridges, or on freeways, to ride in elevators, or to park in underground parking lots. These behaviors evoked frustration and anger in his wife, who would then berate him for his weakness and incompetence while overfunctioning for him. In brief, as therapy progressed with these clients, it became clear that the husband's withdrawal in his interactions with his wife and the general position he adopted with her, which was one of passive dependence, was related to the occurrence of his phobias and his very low level of self-esteem. He was gradually able to express his sense of intimidation in the relationship with his wife, and his underlying anger, when accessed, enabled him to demand some respect and equal consideration from her. When his wife was able to express and accept her need to depend on her spouse, rather than constantly exhorting him to be strong and to try to be more competent, the husband began to support her and take a more active role in the relationship. He was also able to ask for her acceptance of his fears; furthermore, he clarified for his spouse how her anxiety and resulting criticism toward him actually exacerbated his difficulty in dealing with his problems. Specifically, he was able to tell his wife that it was her anxious vigilance, lack of confidence, and attempts to tell him how to drive that prevented him driving uphill, not his fear per se. He then suggested.how she could be more helpful to him so that he could deal with his fears effectively. The husband's image of himself also appeared to improve as his wife's need for his support became apparent. The change in relationship definition did not remove this client's phobias; however, it did appear to have an impact on his evaluation of himself as a competent person who could offer something to others, thereby improving his ability to cope with his problems effectively. The marital relationship became a source of support for him rather than an additional problem in his life. In this type of case, whether a symptom is an expression of predominantly individual problems or an issue of relationship definition may be unimportant. More important is that interven-

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tions focusing on the positions that people assume in their key relationships may create a powerful arena for change, in the direction of increased adaptation and coping ability. Is couples therapy, EFT or any other, sufficient to create individual change in and of itself? It has been suggested that of the three levels of intervention, family, couple, and individual, the couple level has the most potential to create change across the other two levels (Lewis, Beavers, Gossett, & Philipps, 1976). It is also true that all therapeutic interventions in some sense deal with how people see themselves in relation to others and how they interact with others; couples therapy deals with a relationship with a specific other-one that is central to the client's life. This relationship is also present in therapy and dynamically occurring in the session rather than being a topic of conversation and discussion. The question of whether changing a client's position in relation to his or her most significant other is sufficient on its own to change aspects of individual personality, behavior, and emotional response outside the immediate context of this close relationship is an interesting one. According to our view of a constantly forming self in context, it seems highly probable that couples therapy will lead to individual change that can be generalized beyond the couple. This change, however, will depend on other factors embedded in the other contexts in which the self is involved. Thus, whether becoming more understanding or assertive in marriage will lead to the same behavior at work depends not only on changes in self, but also on factors in the work context that determine behavior. Empirical investigation of the impact of couples therapy on individual change is awaited to provide more definitive answers to this question.

CONTRAINDICATIONS FOR EMOTIONALLY FOCUSED THERAPY Since EFT is based on the conceptualization of the relationship as an intimate emotional bond, and the process of therapy is one that enhances accessibility and intimacy, the implementation of the nine steps of EFf is not appropriate for couples who are clearly engaged in the process of dissolving their relationship. It is not always clear in the beginning of therapy that the process is one of dissolution; the picture presented at the beginning of therapy may be one of differing or ambiguous agendas for

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the therapy process. One partner may still appear willing to engage in therapy and in the relationship, while the other may hold back yet still be unwilling to state his or her intention of leaving. The therapist in this case gives direct feedback as to how he or she sees the state of the relationship and each partner's agenda for therapy. As the first three steps of EFT are engaged upon, the therapist notes each partner's responses. Step 4 of therapy in such a case becomes a framing of these responses or lack of responses in terms of the partner's apparently differing agendas for therapy and for the relationship. The therapeutic task is then to make one partner's disengagement from the relationship explicit, to help the couple clarify the choices open to them, and to support both partners in their grief and disorientation. EFT is not recommended as an initial treatment intervention in relationships in which arguments have escalated to the point of violence. First, the resistance to experiencing and expressing underlying feelings may be too great in the abusive as well as in the victimized partner. Second, the expression of such feelings may be inappropriate, in that it may add to an already volatile and escalating cycle. In our experience, the most effective treatment for this presenting problem is one in which the abusive partner takes part in an individual or group treatment orientated toward ensuring that he or she learns to control his or her anger and aggression. Controlling the violence then becomes the overriding treatment priority since without this, any other therapeutic intervention will end in failure. This initial treatment process may, however, be followed by educationally orientated couples sessions in which both partners learn to control escalating interactions in their relationship. At a later stage, EFT may be appropriate, but it seems preferable both ethically and clinically that violence is viewed and treated as an individual rather than a relationship issue. This is especially necessary in light of the fact that most abusive partners tend to deny responsibility and blame the other partner for their violent behavior. Related issues such as intense jealousy can be dealt with within the framework of EFT or using EFT-oriented interventions. The insecurity underlying the jealous response and the accompanying coercive attempts to contain and control the spouse seem to be amenable to the EFT approach. Unless the problem is a specific physiological dysfunction, sexual interactions usually reflect the rules and the structure of the relationship in general and so are amenable to EFT interventions. Once partners experience the relationship differently, and respond to each other differ-

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ently on an emotional level, then sexual issues tend to resolve themselves. Strong negative emotions, particularly fear and anger, seem to be incompatible with the positive experience of sexuality, and this framework can be used with clients to legitimize any lack of sexual response that appears to be problematic. When both clients feel safe and accepted in their relationship and can communicate openly, then the maximum conditions for the development of a satisfying sexual relationship exist. Extreme individual symptoms such as suicide attempts or psychosis are contraindications for EFT. Expressions of underlying vulnerability may not be positive for the experiencer in these cases. Couples exhibiting these symptom patterns may respond to a more strategic approach to therapy. We have also encountered interactional cycles in multiproblem couples that are so rigid and automatic that, although it is possible to obtain a shift in positions during the session, this change becomes eroded in the week between sessions. These couples never seem to initiate a positive cycle. The change process does not seem to "take." In these couples, it may be that success in couples therapy is to recognize that they can separate or that individual therapy is necessary. If both can agree to this kind of change, then EFT can be said to have had a clarifying effect in facilitating this decision. The couples who respond best to EFT typically present with problems of recurrent fights, alienation, and lack of intimacy. There is still a minimum amount of basic trust and investment in the relationship, even if such trust has been eroded by painful interactions. The couples often phrase their issues in terms of a communication problem or in terms of one partner desiring more close contact than the other. These couples still have some sense of commitment to the relationship in spite of high levels of distress, doubt, and frustration.

INTEGRATION IN COUPLES THERAPY Couples therapy involves simultaneously changing partners and how they relate. As a result, couples therapists have generally tended toward flexibility and eclecticism rather than purity in their strategies to order to meet this challenge. There has recently been a movement to deliberately foster the integration of different treatment models. The advantages of such integration have been discussed at length (Goldfried & Newman, 1986; Gurman, 1981). By integrating different approaches, the therapist can arrive at a

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more comprehensive and effective treatment package that melds the strengths of various approaches. Such an integration can render treatment more flexible and responsive to the individual differences in clients and to variations in presenting problems. The question of when and how it is best to integrate different approaches is, however, a complex one. There appear to be four basic approaches to integration (Johnson & Greenberg, 1987): (1) technical eclecticism; (2) the amalgamation of new strategies from a different model into one particular approach; (3) the creation of a new synthesis of two or more approaches into a theoretical and clinical unity; and (4) the use of specific change strategies at different times for different types of problems. The first approach has often involved the listing of therapeutic operations, such as contingency contracting, and the incorporation of such operations at specific points in the therapy process. Sager's work ( 1981) is an example of this eclectic strategy. One of the problems with such an approach is that it is difficult to stipulate exactly which intervention should be applied at which specific point. Another difficulty is that integration ideally requires the merging of elements into a new dynamic whole; yet if the assessment and understanding of the couple's difficulties is essentially from only one framework, the incorporation of specific interventions from different and often opposing frameworks would constitute an expansion rather than integration. In such a treatment package, the different change processes and views of exactly what needs to be changed may become confused and may result in "a gigantic mish-mash of theories, methods and outcomes that is forever beyond the capacity of scientific research to resolve" (Eysenck & Beech, 1971, p. 602). This type of technical eclecticism is focused at the level of therapist intervention, but the genesis of the problem, the goals of therapy, and the process of change are still seen from the point of view of a single approach and will still reflect the limitations of this approach. It is possible to consider the interventions used in EFT in this manner. For example, some of the interventions for accessing affect might be used at various points in other approaches. A family-of-origin approach to couples therapy could, perhaps, in order to link past and present and make insights more immediate, implement some of the same experiential techniques. The issue, however, is how these elements fit within the overall context of therapy. The use of such interventions in a behavioral approach would seem to be problematic since the goals of therapy, views of human functioning, paradigms of intimacy, and factors

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such as the nature of the alliance are very different. It is not just therapist operations but how they are implemented and the overall context that define the nature of treatment. The second approach to integration is to amalgamate two or more strategies under the umbrella of one theoretical approach. Strategies or theoretical concepts taken from other approaches are then interpreted as consonant with the original model of dysfunction. Feldman (1979), for example, attempts to amalgamate analytic, social learning, and systems perspectives using the concept of conflict as a homeostatic device used by the couple to regulate intimacy levels. This model considers the interaction between partners, but the overriding framework is analytic with oedipal fears playing a preeminent role. The change processes involved are also analytic, including the use of insight, the examination of transference connections, and the analysis of dreams. The result is a version of analytic couples therapy expanded on a theoretical level to include such concepts as reinforcement and reciprocal interaction patterns. Such an expansion may be useful in and of itself, but as a model of integration it is limited. It may be possible, using this model, to incorporate some of the experiential strategies used in EFT, for example, into a purely systemic model, viewing the individual as a subsystem. However, these interven­ tions would then be used in systemic ways for systemic ends. The third approach to integration is to merge two or more ap­ proaches to couples therapy into a new synthesis that includes both the intrapsychic and interpersonal and melds therapeutic strategies and inter­ ventions from these different approaches. There are a number of chal­ lenges involved in such a task. First, there has to be some kind of basic compatibility, inherent or constructed, between the way the two ap­ proaches view the phenomena of intimate relationships, the phenomena of marital distress, and the process of change. In such an approach it is possible to assess multiple levels of interac­ tion and domains of experience. Ideally, the interaction of different strategies and interventions should be made specific on all levels-the levels of theory, strategy, and intervention. It is necessary that theorists be able to specify which particular interventions occur when and how they fit within the overall framework of the new therapy, which consti­ tutes a synthesis of the two original perspectives. EFT is an example of the above approach. Gurman (1981) and Segraves ( 1982) have also used similar methods. EFT as a synthesis of experiential and systemic approaches has been discussed in Chapter 2.

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PRACTICE

The fourth approach to integration is a form of technical integration that involves administering appropriate change strategies at appropri~te times for particular types of problems. This involves the definition of different therapeutic tasks or stages, such as the creation of intimacy or the modification of a rigid power imbalance. Each task or stage has its own goals, strategies, and change processes designed specifically to address the particular types of problems or processes presented in therapy (Greenberg & Johnson, 1986; Rice & Greenberg, 1984). In this approach, intervention is based on the process diagnosis of opportunities for different types of interventions. Therapy is then a complex transactional process between client and therapist in which different opportunities for intervention are presented by different types of client performance patterns. The therapist is constantly making process diagnoses of what occurs in therapy and of when it is best to utilize a particular intervention. Thus, the therapist "digs where the ground is soft" and "strikes when the iron is hot." The work of Pinsof ( 1983) is an example of this approach. The focus in this work is on the total patient system, including individual, couple, and family aspects of the problem. The presenting problem is viewed in terms of a set of possible determinants and a set of different interventions for different determinants. For example, if a problem determinant is fear, the task is the identification and working through of catastrophic expectations. The therapist may address different aspects of a problem in different ways; for example, he or she may teach partners conflict resolution skills so they can cooperate concerning their problematic child, then change to a trust-inducing strategy if this issue is found to be impeding cooperation. The therapist begins with the simplest and most direct interventions, assuming client health and problem simplicity until such assumptions are challenged. In this approach, EFT strategies and interventions might be used at particular points in therapy to achieve particular goals. For example, as suggested earlier, after a client has received treatment for violent behavior, there may come a time when couples therapy to increase intimacy is particularly appropriate. One of the problems here is that, in the field of couples therapy, particular approaches have not defined their strengths and limitations as to the problems and types of couples who are likely to respond to a particular treatment. A brief clinical example of technical integration is appropriate here. A couple presented for therapy with a history of marital violence and constant arguments. In therapy sessions, there was little evidence of trust

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or willingness to listen; both partners would constantly attack the other partner. Initial interventions consisted of teaching anger-control skills to both partners, particularly the abuser, and structuring interactions to create de-escalation. The therapy process then progressed to include emotionally focused interventions that allowed both spouses to access new aspects of themselves in the relationship and build a new level of trust and openness. The husband, however, became increasingly reluctant to remain accessible to his spouse and to respond to her requests for closeness. At this point, the therapist engaged in a number of individual sessions focusing on this partner's perceptions of close relationships and the dangers inherent in them, which he had learned in his family of origin. Having resolved the blocks and anxieties this client was experiencing, couple therapy continued with the goals of creating intimacy and integrating new positive interactional patterns into the relationship on a permanent basis. This kind of integration also assumes that the therapist has mastered a wide variety of techniques that can be applied as different tasks arise in therapy. To facilitate this kind of integration, research is needed that addresses the differential processes and outcomes arising from the implementation of specific techniques applied to specific therapeutic tasks. The most sound basis for attempts at integration would seem to be a knowledge of client change processes and which interventions facilitate such processes. This topic is addressed in the next chapter.

PART THREE

Effecting Change

CHAPTER EIGHT

The Process of Change

In this chapter, research on the process of change in EFT is reviewed to illuminate how EFT leads to change and to point toward possible minitheories of change. Ultimately, unless we know what processes lead to what outcome, we remain in the position of administering our treatments without knowing how they really work. This is more akin to the administration of home remedies than the administration of professional treatment. Thus, explaining how change takes place in psychotherapy by relating process to outcome is a crucial goal of psychotherapy researcha goal that will lead to the construction of therapeutic microtheory (Greenberg, 1986; Greenberg & Pinsof, 1986). Two main types of investigation must be undertaken to establish processes of change. Intensive analysis of in-session change leads to the discovery of change processes, whereas designs relating process to outcome help to test hypotheses that certain processes and outcomes are linked. Both types of studies have been carried out on EFT. The primary hypothesis about the process of change in EFT is that accessing underlying emotion leads to change in partners' perceptions of self and each other, leading to change in the interaction. In order to collect evidence to test this hypothesis, and to discover what other change processes operate in this therapy, a number of studies were conducted to isolate active ingredients of change in EFT.

WHAT ARE THE CHANGE PROCESSES? Couples Reports The first study of the process of change investigated client's perceptions of change processes in EFf (Greenberg, James, & Conry, 1988; 203

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James, 1985). Twenty-one couples who had received EFT were interviewed 4 months after therapy and asked to describe incidents in therapy that stood out for them as helpful or not helpful. They were asked to describe what changes took place in these incidents and how these changes occurred . Using categorization methodology (Wiley, 1967), 37 graduate students in counseling psychology sorted the 52 incident descriptions provided by the clients into categories according to their perceptions of similarities and dissimilarities among the items. The sorters' ratings were then computer analyzed using Latent Partition Analysis (Wiley, 1967) to reveal underlying or latent categories. This analysis yielded five latent categories. These categories were then descriptively named by the investigators. Next, the category labels were given to two new raters who were trained in the EFT model; they were asked to sort the incidents under the appropriate headings. They were found to do this reliably, and their ratings agreed to an acceptable level with the primary categorization. The five change process categories were as follows: 1. Expression of the new feeling leads to change in interpersonal perception. 2. Awareness of feelings and needs leads to greater sense of entitlement. 3. Acquiring self or interactional understanding leads to change in interaction. 4. Taking responsibility for own feelings results in taking a selforiented focus. 5. Receiving validation from therapist leads to change in behavior of both partners. The first category has not been discussed previously in the couple therapy literature and constitutes, in our view, the most interesting discovery in this study. It appears from client reports that the expression, in a vivid manner, of primary feelings not previously expressed, created perceptual change that in turn led to interactional change. This change process, set in motion by expressing primary feelings, seemed then to have two components. The first component is a shift in interpersonal perception. It appears that when partner A observes the expression of new feelings by partner B, or when partner B expresses his or her own previously unacknowledged feelings (the former pattern was reported more frequently than the latter), the result is a new perception of

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partner A. This suggests that the importance of expressing new feelings in couples therapy may lie in changing the partners' perceptions of each other, rather than changing the individual's view of him- or herself. In other words, the communicative and interpersonal aspects of expressing new feelings are possibly more important than the intrapsychic aspect. The second component of this change process is that the expression of new feelings leads to change in the interaction. Partners who had observed each other express new feelings or who expressed new feelings reported more understanding and accepting of each other, feeling closer to each other, and behaving differently toward each other. In other words, expressing new feelings seems to elicit new, more supportive interactions in the relationship. This finding suggests that the expression of new feelings may be important in the process of change in EFT, and that its primary importance may lie in changing how partners perceive and respond to each other. The expression of emotion, particularly at the nonverbal level, appears to be a primary channel of communication in human beings; from infancy, it is a powerful means of evoking prosocial or altruistic responses in attachment figures. The expression of emotion in couples therapy appears to have a similar potency. It must be stressed, however, that the effects of the expression of new feelings on interpersonal perceptions and couples interactions discovered in this study are the authors' interpretation of processes described by couples as leading to change. As such, they remain hypotheses requiring further testing using appropriate methods of verification. · The other four client-perceived change processes identified in this study are similar to change processes described in the couples therapy literature and support certain views about change processes in intrapsychic approaches to couples therapy. It appears that the experience of expressing feeling leads to the positive valuing of the expression of feeling by the person doing the expressing (most frequently stated by men in this sample), and that the expression of needs increases the motivation of both members to meet these needs, while also increasing self-disclosure and feelings of intimacy. If couples' problems often stem from their inability to express feelings and needs in the relationship, the sense of entitlement and positive valuing of the expression of feelings is an important change process. Intellectual and emotional understanding of relationship dynamics, plus self and partner dynamics, appear, in this sample, to lead to new

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responses in the relationship. In addition, when partners came to a new awareness of personal responsibility for their experiences in the relationship, this resulted in making a shift from attributing blame to taking a self-focus. This supports the ideas in the couples therapy literature that suggest that the attainment of a self-focus is essential to successful change (Bowen, 1978). Finally, a small number of incidents were reported in which the therapist's validation of some aspect of the partner's experience led to change. The partners who felt validated by the therapist changed their self-views, while the partners observing their partners being validated changed their behavior toward that partner. This change process supports the notion that partners lack a sense of entitlement to their own positions and that the therapist's support of each partner's experience can be helpful. The study of client-reported change processes in EFT suggests that the experience and expression of new feelings, appropriately managed in a therapeutic environment, can be helpful in couples therapy. In addition, it appears that emotional expression may be significant in leading to change in partner's perceptions of each other (rather than change in self perceptions) and thereby to change in interactions between partners. Examples of client statements made to interviewers at the follow-up period are provided below to give the flavor of incidents in the five categories. The reports of each member of two couples is given, fallowed by a variety of individuals' statements. Couple 1 THE MALE PARTNER

I was telling Aretha how I felt about her, and how I felt about one point when we broke up. I was trying to tell her about how I felt when she had left me and how I didn't feel that I could go on. And I got really emotional and very very hurt. And I just about started crying. And, I didn't ... I just sort of hung on. I literally hung on ... physically even hung on to the chair. And I remember talking about how I didn't feel that I could exist without her at that time, and how hurt I felt. But, the difference was I didn't say it in a blameful way. Usually, I would have blamed her for hurting me, for leaving me at that time. In other words, that it was her fault for her doing that to another person, namely me. But GEORGE:

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this time I was just hurt and was expressing that, expressing that I really wanted her. I couldn't say love her, or anything like that. I talked a lot about just how I felt about the incident. And it seemed to make a difference with her ... how she felt about me. And also I realized how hard it was for me to say something like that, how much easier it was for me to be angry at her for not giving me what I wanted in our relationship. And it made an impression on me because I realized how hard it was for me to say something like that and how easy it was for me to blame. And it seemed to make an impression on her .. . that I didn't blame her as such. She didn't usually ... she would just be defensive about it. And, just opening up made a difference to me. This incident fell into Category 1.

THE FEMALE PARTNER

ARETHA: I can't describe the exact circumstances. It was a session where . .. I think for the last couple of sessions George had been doing most of the talking with the counsellor. And George was talking about how he felt, basically that he feels like taking on other people's problems and likes to help them, and at the same time being oppressed by that. And I guess it was the way it was described, basically as a weight over his head all the time. And I guess it was the vividness of that description. I can just see this huge concrete block hanging over his head by a thread. And my reaction was, why don't you move out from under it so it doesn't fall on you? Like, he was really wrapped up in it. I guess it was really understanding how he felt, and understanding where a lot of the blame came from. And a lot of things clicked for me then, I think, in terms of George's perception, problems. And, that was really helpful. INTERVIEWER: So, you were in this session and George began to speak about this ... ARETHA: Well, he was trying to describe his inability to divorce himself from other people's problems, and the burden he felt it was. And, at the same time, unable to give it up. INTER VIEWER: And you pictured this image ... ARETHA: I don't know whether it was me or the therapist who brought in that image. It took a lot of weight off me knowing that George had taken it on himself rather than the fact that I was inflicting my

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problems on him. It was really important for me to know that. It made me feel a lot easier and more compassionate toward him. Whereas before, all my problems were just one more pain in his neck. So, it was j ust important to see my position in things more clearly. This incident fell into Category 3.

Couple 2 THE MALE PARTNER

SIMON: Well, one time Muriel cried. I can't remember what she cried about, but, it did me good to see her cry. INTERVIEWER: So, you were there with Muriel and the counsellor, and Muriel began to cry. SIMON: Yes, I think this was when she found out that the doctor, that she couldn't have kids. I told her that I didn't really care whether we did or not .. . that I wouldn't put her through the strain anymore. She was very emotional that night because of all of this. That's the incident that I remember. It meant a lot to see her cry. INTERVIEWER: Her crying that night had a real impact on you. SIMON: It did because normally she wouldn't do that in front of anybody. For her to do that meant an awful lot. I know my wife very well, and for her to do that is something. It moves me. Now, if I were to cry, it would be the same. But, for a man it's different. I see it's different, but we all have to cry sometime. This incident fell into Category I.

THE FEMALE PARTNER

MURIEL: It had been quite an emotional session anyway, and I had a lot of insecurities because of a particular problem that we had, okay. So, no matter how often Simon said it was okay, you're pretty or whatever, it just wasn't quite enough for me because he was just trying to appease me a lot of times, so I thought. So, we'd had a rather emotional session, and I'm kind of emotional anyway, and I think it was at that point that I was talking about not being able to ask for affection, and was saying that it

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was kind of Victorian, to me that's the way I am, the way I was brought up. And, I don't know how we got around to my physical appearance ... he's always thoug ht of me as overweight and that really bothered me because I had two older brothers who always called me fatty. So, we'd been talking about my physical appearance and how I wasn't that attrac­ tive and I was ready to cry, and my husband turned to me and said, "You are beautiful; I love you the way you are." And, I burst into tears, which I thought was really stupid because it was a dumb thing. But it's just that he said that in front of somebody else which kind of said to me that he really believed that. It just hit me, that maybe he really means this rather than saying, "It's okay, you're really attractive ... it's all right, let's forget all this garbage." But, when he said this in front of somebody else and he looked at me and was really emotional and very sincere about it, it was really obvious. I just couldn't believe it. I think that really made me feel awfully good. So, it was a good thing in counseling. Maybe I believe him more now when he says things like that ... that he's not just saying things to make me happy, although that's a nice thing to do. But, I just needed a bit more, I guess. This incident fell into Category I. Couple 3 THE MALE PARTNER

I think it was one of the first sessions. And, basically, we were discussing a problem that we were having with my temperament, and the handling of it. And, Penny expressed a fear for her well-being in that when I became upset or mad I became very aggressive type of thing. Not necessarily physically. And, as a result of that she would withdraw and that would just complicate the problem because then I would get more frus­ trated and get the impression that she didn't care and didn't want to talk about it. And when that was brought out, and she expressed this fear, it kind of made me feel . . . well, initially I felt like I was some kind of woman beater. And, I found that to be very dramatic in that I had never considered myself to be a woman b eater in that I'm not physically aggressive. How­ ever, with Penny's fears for her well-being, I found that very dramatic. INTERVIEWER: So, you were in the room, and Penny was talking about how afraid she gets when you•re mad. And, this was quite a EARL:

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revelation to you. She was expressing this fear, and what else do you remember that happened in this incident? EARL : Well, basically, I guess, I broke down a bit. You know with tears and that sort of thing. That's it. INTERVIEWER: What were you feeling or experiencing as you were crying? EARL: I guess confusion in that I didn't consider myself to be a woman beater. Sorry. And, I guess I don't think that I ever showed it . . . that I would physically hurt her. It was just that I would lose control of my temper to the point where she didn't know what was going to happen sort of thing. This incident fell into Category 1. Couple 4 THE FEMALE PARTNER

HoLLY: The most powerful thing for me for my own experience was the one which I just talked to you about where I got very upset and just felt, this is hopeless. You know, we 're going nowhere, it's been a very painful sort of relationship, David doesn't hear me, and he's not going to hear me. I just felt totally down and angry ... like a real mixture . . . real sadness and at the same time anger, because I thought that I had given a lot and invested a lot of time and, you know, where we are. And that he wasn't being open with me, he wasn't communicating with me, he wasn't listening to me when I communicated with him. Just, I don't want any part of the relationship, and I want to go. Now! INTERVIEWER: So, you were in the room and you were experiencing a mixture of despair about your relationship, and also some anger. And then what happened? HoLLY: I erupted with it. I'm usually quite a calm person. I don't have that much anger. So, this was a really quite different experience for me. INTERVIEWER: You expressed your anger? HOLLY: I was feeling crying inside. Whether I had tears or not I don't know. I haven't seen the tape, so I can only tell you about what was in here. But, I'm sure that my facial expression must have shown it, the voice, loudness probably, tone, hands probably . . . there would be a lot

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of showing of that. And, David listened to it ... it must have been a very shocking experience because it was totally different from anything that he had seen from me before. And, like I say, a very rare occurrence for me. Very powerful. So, then, he listened to me out, and by listening acknowledged that he could see how powerful this whole thing was for me. INTERVIEWER: What sort of things were you saying in this incident? HoLLY: Just the type of thing I've told you ... that I didn't feel he was listening to me and being honest with me. You know, I didn't feel there was any hope for the situation. And, then the therapist elicited from David how David felt when he heard these things: could he really hear what I was saying and my concern? And, that was good. David was very upset. I believe David was crying at some point during that time at the fact that I just wanted to break it off. And that didn't reach me the way it normally would reach because I still had all this anger at this point. But it did help diffuse it somewhat by taking the emphasis off me for a moment. And, then, at the end, I can't remember what the homework, the project was. But, something that he asked David to concentrate on his time, I felt was good whatever it was. I felt that it was an acknowledgment that finally I was being heard. And, that was very important that there would be some expectation of David. Not that I was going to have to carry the whole thing, do everything. So, that was really good. That gave me something that I thought was positive, some goal to go toward. So, I really felt that he had heard me, and that he was then able to communicate with David. David was always able to hear the therapist more than he could me because there wasn't the emotional sea between them. So, he was like a translator. This fell into Category I. Couple 5 THE MALE PARTNER

BRIAN: I was telling Audrey how I felt about her, and · how I felt about a point where we broke up I was telling her how I felt when she had left me and how I didn't feel that I could go on. And, / got really emotional and very very hurt. And, I just about started crying. And, I didn't- I just sort of hung on. I literally hung on- physically even hung

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on to the chair. And, I remember talking about how I didn't feel that I could exist without her at that time, and how hurt I felt. But, the difference was I didn't say it in a blameful way. Usually, I would have blamed her for hurting me, for leaving me at that time. In other words, that it was her fault for her doing that to another person, namely me. But this time I was just hurt and was expressing that, expressing that I really wanted her. I couldn't say love her, or anything like that. I talked a lot about just how I felt about the incident. And, it seemed to make a difference with her-how she felt about me. And, also I realized how hard it was for me to say something like that, how much easier it was for me to be angry at her for not giving me what I wanted in our relationship. And, it made an impression on me because / realized how hard it was for me to say something like that and how easy it was/or me to blame. And it seemed to make an impression on her-that I didn't blame her as such. She didn't usually-she would just be defensive about it. And, just opening up made a difference to me. INTERVIEWER: How was this incident helpful? BRIAN: It made me almost pick on her less. I didn't have to go after her to get what I wanted, for us to be loving to one another, which is what most people want in a relationship-what I want. I could express something to her without driving her away. A lot of times if I expressed anger or blame or anything like that, she just-she was just sort of driven away from me. She gets cold, and she feels blamed and so on. So, I can say something toward her. And, she didn't react. And, I didn't get the opposite reaction I wanted to. Instead of driving her away, and her withdrawing to save her own emotional state, she didn 't. She stayed where she was. She didn't sort of stonewall and ignore it or get angry or something-or-other. I got something out of it that I wanted just by being myself, by saying what I really felt. And, that was a really important thing for me to realize-that / could be myself or express certain things and get what I wanted without driving her away. I didn't have to be angry or force her to give me my own way. INTERVIEWER: And, what changed for you through this incident? BRIAN: I think / became more accepting of both my needs-instead of being angry, saying, "Okay, I need this from her, I need to be liked. I need to be loved or whatever. I need this thing from her." And, I accepted that, /didn't get as angry both at myself/or being so-called weak and at her for not giving me what I wanted. I just seemed to make things easier between us. Because very often the anger at my needing something would drive her away and make me very hard to get along with. And, the less

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2)3

angry she got and the more open and accepting of me, the easier it was for me to be nice to her. That's about the best 1 can put it. INTERVIEWER: How did this change occur? BRIAN: It really didn't occur in the incident. It took a while to integrate the incident. This fell into Category 2. Couple 6 THE MALE PARTNER

HowIE: Throughout the sessions I think we worked on a lot of things that I had personally found that were personal needs or awareness that I was coming to. I didn't have that good feelings about myself and my role in the relationship, and self-worth, and all those things about my sense of vulnerability and so forth. And, this one particular session we sort of worked on, at least the therapist picked up what was happening and in a very beautiful way made me feel that I was OK. And, I came to feel like I ... I really owned that. And, in a way that I had never felt before. It really seemed to be a turning point. Not only in my relationship but in my life as well. As an individual, it made a big difference on how I faced the rest of the world, not only my relationship with Lilly. And, I found that since then I've become more assertive ... not that life has become any easier, but I've felt that the challenges I've faced, I've felt better about facing them. And, I still deal with frustrations and anxieties and all the problems that I've had before, but I seem not to be overwhelmed by them as I was in the past. INTERVIEWER: So, you were in this session, and your therapist picked up on your self-esteem. What happened in the actual incident? How1E: In a very beautiful way he reiterated a lot of the stuff I had been coming up with. He sort of paraphrased a lot of the things. And, made me aware of how hard I have been on myself ... how much I had put responsibilities on me, that if I didn't take care of business the world was going to fall apart. Essentially, how hard I had been on myself, how I had been beating myself over the head, and allowing myself to be put in the pressure cooker all the time. And, he was very sensitive to that in a very beautiful way, and it really came home to me that I didn't have to take on all those responsibilities ... it's not that I'm going to become irresponsible ... but in order for me to have self-worth I don't have to

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solve everybody else's problems and I don't have to be the big brother or father figure or whatever to all those around me; that I've got to allow them to grow at their pace as well. It seemed that there was this big burden that was lifted off my shoulders and I felt a lot better about myself. And , it happened within a period of about an hour or so when we were dealing with that particular issue. It was very moving. INTERVIEWER: What changed for you through this incident? LILLY: The change for me- it's hard to describe because there's an emotional thing that went through me. An experience that I find difficult to put into words. But, I was on the verge of tears because I felt I'd finally recognized Howie and that I didn't have to live up to a whole lot of expectations all the time. And, it was really a great relief. So, that's the best that I can describe it. This fell into Category 3. Couple 7 THE FEMALE PARTNER

I think probably the one incident that stands out for me and that comes to mind periodically, I think it was about our fifth session, when Norm was relating a fight that we had had. And, as I sat there listening to Norm and our therapist dialoguing, it was just like someone turned a light bulb on in my head in that I realized for the first time that a lot of the difficulty that I had previously put on Norm's shoulders-as far as being his fault and that kind of thing, that I was feeding into a lot of that. And, I think at that point in time, and I actually said, "Just a minute here, something just happened for me. I realized that what he's telling you, when I came in here I thought that was totally his fault, that he was in the wrong. And, when he relates that back, what I just realized is that this and similar problems along this line-I feed into it. No wonder he's acting that way; no wonder we're getting that kind of reaction when this kind of stuff happens. I'm doing this. It's not just Norm. It's me too." So, that was a real eye opener for me, and I think the most valuable lesson that I had. FLORENCE:

This fell into Category 4.

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Couple 8 THE FEMALE PARTNER SHELLv:

... And, I just felt so much pain. It was easy for him. He just said, "Well, that's the way it is. You just have to accept it." And, I couldn't.I think that came out in the first couple of sessions. I think what helped me-I think our therapist really felt the pain that I was express­ ing. I think she really felt that she would have been very hurt as well. And, that made me feel good.That made me feel good that I wasn't just that way, but probably most women would have reacted that way as well. And, I think Steve felt that too.I think he realized that I wasn't blowing anything out of proportion or I wasn't at weak moments just getting extremely upset at nothing. But, that there was something valid to my feelings....She supported the way I felt and said she could understand why I was so upset.And, when he heard that I think-and she also talked to him about it because I think there were a few incidents where he reacted because I got upset and couldn't cope.And, it was when I really totally broke loose and I just was a basket case that he would support me. But, if I was really upset about something and was handling it, and was upset about it, he would push it aside and say, "Well, you've got to get over those things-you can't let that upset your day." And, I was always having to set them aside. And, I was never able to cry and express my sadness. INTERVIEWER: OK.You may already have answered this for me, but I'd like to ask how this incident was helpful to you-this incident of expressing your feelings. SHELLY: I guess it was helpful that someone was there to listen ....It was helpful that she was just able to sit and listen and support me. INTERVIEWER: Okay. What changed for you through this incident? SHELLY: I don't know what changed for me. I think it helped Steve to understand a little bit more. I feel that if I was upset I could tell Steve without him sort of putting me down right away for-I'd have the confidence to express it to him.So often I wouldn't because he would get mad at me for being upset. So, I'd just let it go. Whereas now, I don't think he'd do that. I don't think I've done it lately, so I don't know for sure. But, I think he'd really try to understand why I was feeling the way I was and not right away become defensive and angry because I was sad. I think sometimes he felt it was all on his shoulders; that if I was sad he was

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partly to blame. And , yet, there was nothing that he could do about it. So, he'd get angry. INTERVIEW ER: How did this change occur? SHELLY: Because I think when we were in those sessions she helped him understand my pain. Sometimes when you express yourself, you say it one way and the person takes it the wrong way. And, she would be there to say, "Well, no Steve, I don't think she means it that way. I think what she's saying is this." And, then he would start to understand what I was feeling. This fell into Category 5. The study of client-reported change processes in EFT suggested that the experience and expression of new feelings appropriately managed in a therapeutic environment was helpful in couples therapy. In addition, it suggested the novel idea that emotional expression may be significant in leading to changes in partners' perceptions of each other (rather than to changes in self perceptions) and thereby to changes in interactions between partners.

OBSERVERS' MODEL OF THE PROCESS OF CONFLICT RESOLUTION In the second study of the process of couples' conflict resolution (Greenberg & Plysiuk, I 985; Plysiuk, 1985), five episodes of conflict resolution in specific sessions were intensively analyzed using task analytic methods (Greenberg, 1984) in an attempt to build a model of the process of conflict resolution. Four successful resolution performances were compared with one unsuccessful performance in order to identify performance components that were common to successful performances as opposed to unsuccessful performances. The task analytic procedure used involves the generation of an initial rational model of the investigators' best guess at how resolution occurs. This is based on existing theory and clinical experience. This model acts as the hypothesized resolution performance, which is compared with a number of actual resolution performances in which the couples' interactions are coded on a variety of process measures selected to measure hypothesized resolution compo-

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nents. This comparison of actual performance with hypothesized perfor­ mances leads to the development of an empirically grounded, refined model of conflict-resolution performance. In our first rational analysis, we hypothesized that an interactional sequence, which began with the pursuer blaming a partner, who would withdraw or defend, would shift when the pursuer changed from blaming to an expression of underlying vulnerability. We hypothesized that the withdrawer, seeing the partner's vulnerability, would reach out and make contact, either by accepting the partner's statements or by disclosing feelings. The pursuer, seeing the partner as accessible, would ask for reassurance or state personal needs, and the withdrawer, feeling closer to the partner, would provide reassurance or acceptance. This provision of reassurance by the withdrawer would be accepted by the pursuer, who would in turn express appreciation or acknowledgment of the with­ drawer, who, experiencing acceptance, would state his or her own needs. At this point, both partners would be operating from a new view of self and other, and there would be an increase in sense of acceptance and safety, with partners negotiating with each other. This rational analysis and our review of process measurement instru­ ments suggested that the experiencing scale (ES; Klein, Mathieu, Gend­ lin, & Kiesler, 1969) and the structural analyses of social behavior (SASB; Benjamin, Foster, Roberto, & Estroff, 1986) would be the most helpful measurement instruments with which to capture components of the hypothesized model. Having generated the above hypothesized model, the next step was to inspect actual conflict-resolution performances. For the empirical analysis, videotapes of each resolution event were transcribed, and each statement in each interaction was coded by two raters on ES and two raters on SASB. Information was also gathered from some couples on their view of what occurred in the event using interpersonal process recall (IPR; Elliot, 1986). Using this method, the couple reviews a tape of the event within a few days of its occurrence and are asked to recall what they were thinking and feeling at different moments of the interaction. In this way the in vestigator gains a picture of the partners' internal processes and perceptions. Using the coding and IPR information, performance diagrams were graphed representing the moment-by-moment interactions. After the interactions were graphed on performance diagrams, they were inspected and compared with one another to reveal identifiable interactional pat-

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terns that occurred consistently across all resolution events. A consistent sequence of patterns of interactional behaviors was discovered, which led to the conceptualization of four staged components of task resolution, occurring in a set sequence. In the initial stage of the task, the partners are in conflict. The pursuer is engaged in blaming behavior and the withdrawer is either avoiding, protesting, or appeasing. The second component begins when either one of the partners openly discloses his or her feelings or needs, and the other partner responds with understanding, comforting, or helping behavior. One of the unexpected patterns that emerged, quite different from the hypothesized performance, was the third component, in which the pursuer temporarily reverted to blaming behavior, while the withdrawer did not revert to protesting or defending behavior but continued to affirm and understand the other partner. In each resolution event, the pursuers appeared to "test" their partners to see if their new, more understanding, behavior was genuine. If their partners held to their positive behavior, the couple proceeded to the next stage of resolution. In the fourth component, both partners trustingly disclosed feelings or needs while responding with empathic and affirming, protecting, or comforting behaviors. These four patterns were labeled escalation, deescalation, testing, and mutual openness. Examples of these patterns are given in the following vignette. This resolution event occurred in the fifth session with a couple whose presenting problem was marital dissatisfaction and conflict. In the early sessions, the couple identified a negative cycle in which the wife, Jennie, desired closeness with her husband, Peter, but was afraid her needs would not be met. In her attempts to avoid the risk of being hurt, she would approach Peter with hostile demands, and he would respond to her anger by withdrawing or defending himself. In the resolution event, the escalation sequence involved Jennie accusing Peter of defending himself on the weekend even though she felt she hadn't been critical of him. His response in the session was to simply say "yeah" with a compliant yielding or submitting flavor. This was consistent with his wife's complaints that he gave in to her but that it did not mean a thing. Peter's response only aggravated Jennie further, and she proceeded to attack him as being irrelevant to her life. This escalation moved to a de-escalation with the therapist's help. After Jennie focused on her underlying feelings, she was able to disclose to Peter openly her fear of rejection and need for acceptance. He listened

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in an understanding way and empathized with the need for recognition and acceptance; this encouraged Jennie to talk further about her experience. She talked about how it was easier to get angry with Peter and say she doesn't need him than risk being vulnerable with him. At the therapist's prompting, Peter asked Jennie how she was feeling toward him at that moment; Jennie said she felt comfortable, that she had been vulnerable with him a few moments ago and had seen that it was "okay with him for her to be vulnerable." Peter then expressed to Jennie that he wanted to be with her, that he felt close and wanted to share his feelings more openly. The couple entered the testing phase with Peter saying he would like to be there for Jennie when she felt vulnerable and needy. She at this point gestured nonverbally with her face and shrugged. In response to the therapist's query about her nonverbal response, Jennie referred to it as "my skepticism." Peter remained positive and conveyed understanding of how she felt. Her response was again untrusting: "I've done that before and you weren't there. I don't want to try again." Jennie became more upset and began to blame Peter for not responding. Peter disagreed with Jennie, twice saying that he didn't really abandon her as she felt. He was friendly in manner even though Jennie tried to refute his disagreements. Peter again spoke of his desire to respond to her, and she responded negatively, coded in SASB as "refuse person's caregiving" followed by a "belittling and blaming" statement. Peter then appealed to Jennie to let her guard down and to stop keeping him away because of her fear that she might get hurt. He asked her to accept him for what he had to offer, rather than to set conditions that he had to meet before she would trust him. The couple entered into mutual openness when the therapist focused on Jennie's feelings and she talked about her barrier, about how hard it was to let it down, and tearfully concluded that she had needed it since she was a child, to protect her from hurt and invalidation. Jennie then talked to Peter about how hard it was for her to trust and how scared she was. She also empathized with how difficult it must be for him when she is rejecting. Peter then talked about his difficulties. He said he felt very anxious and often did not quite know what to do when he felt rejected, that he felt desperate and then withdrew as a way of protecting himself. Jennie nodded her head in an understanding response to him, and when the therapist commented on this they both stated that it was wonderful to be able to talk to each other in this way. In response to the therapist's query on how they felt, they both said they felt good toward each other,

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with Jennie saying she felt more open and trusting and Peter expressing his caring for her. A comparison of the rational analysis and the coded transcripts of actual performance events, such as the one above, resulted in the construction of a four-step interactional model of relationship conflict resolution. The rational analyses, empirical measures and information obtained through the IPRs all contributed to the following more detailed outline of the charl;lcteristics of the four stages.

Escalation

The patterns in the five performance diagrams suggested that escalation could be defined as a sequence involving both partners where three or more sequential statements (a statement is a talking turn of one partner) are coded on the nonaffiliative side of the SASB scale. In the performance events, we saw three variations on the escalation pattern. The first variation, attack-defend, is the most common: One partner, according to SASB categories, "belittles and blames" the other, who either "sulks and appeases" or "defers and submits" in response. The attacking partner responds to the defender with another blame. Information generated from the rational analysis and a content analysis of the performance events suggested that the partners' focus in escalation is on representing their own position. The pursuer is often covertly or overtly complaining about something the withdrawer is or is not doing. Withdrawers often feel criticized and inadequate. They are either quick to defend themselves against their partner's attacks or are wary of saying anything for fear they will only be discounted. Both partners are usually feeling angry, frustrated, and unheard.

De-escalation

In the performance models, de-escalation occurred as a sequence in which one partner either openly disclosed his or her experience or asked for what he or she needed. The other partner responded with "affirming and understanding" or "helping and protecting" behavior. One partner brought into focal awareness experiences not previously discussed as in, "I feel and accept my vulnerability." The other partner then perceived the

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first partner in a new way, and this allowed him or her to respond to the partner's new behavior- a request for reassurance from a position of vulnerability. In rating the de-escalation and mutual openness stages on the ES, it was found that the interactions in de-escalation occurred at a lower level of experiencing than those in mutual openness. (This finding is given further attention in the discussion of mutual openness.)

Testing The testing sequence followed on the heels of de-escalation. Initially, there was a positive interaction in which the withdrawer responded to the pursuer's open expression of feelings or needs with "helping and protecting," "nurturing and comforting," or "trusting and relying" behavior. The withdrawers continued to validate their partners or their positions. Rather than this leading to further disclosure on the pursuers' parts, the pursuers suddenly switched to "belittling and blaming," "sulking and appeasing," or "walling off and avoiding" behavior. Both the SASB codes and the content of the resolution confirmed the investigators' hunch that the pursuer was dealing with the issue of trust. The pursuers, having exposed a little of themselves, having tentatively put out a need, and having had their partners respond to them, were not sure if they could trust their partners' responses as totally genuine and likely to occur consistently. At this time, the pursuers spoke of their own "wariness" or "guardedness," or complained about times in the past where they had been vulnerable and then been rejected by their partners. If the withdrawers defended or counterattacked at this point, the couples moved back to escalation. However, if the withdrawers maintained a congruent nonescalatory stance, either expressing continued acceptance or nonhostile challenges, the resolution process continued. Thus, it was the withdrawers' maintenance of a congruent nonescalatory stance that distinguished testing from escalation.

Mutual Openness As the SASB process indicators for mutual openness and de-escalation are very similar, sequence information and the depth of experiencing were used to differentiate mutual openness from de-escalation. In de-

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escalation, one partner openly disclosed his or her experience or expressed a need , while the other partner responded with "affirming and understanding'' or "helping and protecting" behavior. With mutual openness, however, the process involved both partners taking turns disclosing their experiences and affirming each other. Ratings on the ES also reached a higher level than they did in de-escalation: In mutual openness, the couples not only reached a higher level of experiencing than they reach in de-escalation, but they also maintain experiencing levels of 5 and 6 over a number of interactional sequences. In mutual openness, there is an emotional reconciliation of the partners and a reaffirmation of the relationship. The couples tend to conclude their discussions with statements that convey empathic understanding and support for each other. Confirmation of the importance of the relationship occurs rather than proposals for concrete solutions or negotiations about how their interactions will be different in the future. Before concluding the discussion of the mutual openness stage, it is important to note that, while the partners may express frustration and some negativity in mutual openness, there is also an earnest attempt to trustingly disclose experience and to empathically listen to the experience of the other partner. The above study differs in a number of ways from studies of couples conflict that have been completed to date. This is the first study in which couples' interactions in the process of conflict resolution have been rigorously tracked as the couples resolved conflicts in therapy sessions. While other studies have identified phases of couples conflict and interaction patterns that differentiate distressed from nondistressed couples (Gottman, Markman, & Notarious, 1977), this study outlines consistent, recurring performance patterns or stages that couples move through in resolving their conflicts in therapy. The phenomenon of testing, outlined in the performance model, is a discovery of this study and an important addition to our clinical knowl~dge of the process of resolving a pursuedistance conflict.

DO INTERACTIONS CHANGE?

In a further study of the process of change (Vaughan, 1986), episodes of conflict interaction in the second and the seventh session of eight session

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therapies were compared to test the hypothesis that EFT led to a change in negative interactional cycles. Conflict episodes from the second and seventh sessions of 22 successfully treated couples were transcribed and rated on the SASB. The four primary hypotheses of the study were supported by the findings, which showed that EFT brought about a significant reduction in frequency of negative, disaffiliative behaviors and negative, disaffilia­ tive sequences with an increase in positive, affiliative behaviors and sequences. In addition, EFT was shown to be effective in producing increases in the frequency of positive, other-focused behaviors and posi­ tive self-focused behaviors. EFT also resulted in a decrease in negative reciprocal blame-blame sequences and negative and complementary blame-placate sequences. No changes, however, were found in the fre­ quency of controlling behaviors or positive complementary sequences. This study demonstrated that couples interacted more positively toward the end of EFT, showing more affiliative, supportive, and self­ disclosing behavior as well as interacting with more of a mutual sense of goodwill towards each other. This suggests that the negative interactional cycle had been modified. WHAT PROCESSES RELATE TO OUTCOME? Two types of studies have attempted to relate process to outcome. In the first type of study, the role of emotional experience and interaction between the couple in good and bad sessions was related to clients' reports of change. In the second type of study, the alliance with the therapist was related to change. In the session-based studies, two studies comparing peak and poor sessions of therapy showed that peak sessions were characterized by deep experiencing and more affiliative interaction than poor sessions. In the first of these studies (Johnson & Greenberg, 1988), the peak sessions of the three most improved and the three least improved couples who had received EFT were compared. The peak sessions of the most improved couples showed generally deeper experiencing and more affiliative re­ sponses. More specifically, it was hypothesized that in successful couples, blamers in peak sessions would soften their interactive stance. The occur­ rence of a softening event was defined by a precise pattern of process Variables including high levels of experiencing and quadrant one scores

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(disclosing self, affirming other) on the SASB. Five such events were identified in the peak sessions of the improved couples, while none was found in the peak sessions of the unimproved group. The hypothesis was thus confirmed, supporting the clinical theory of EFT that suggests that an identified change event occurs when the blaming spouse reprocesses intense affective experience and discloses such experience~ this then evokes a new response in the partner, resulting in a shift in a negative interaction cycle. This kind of study represents a beginning in identifying key ingredients in the change process in one approach to couples therapy. In the second study (Alden, 1987), peak and poor sessions of a sample of 11 couples were compared using a combination of therapists' and couple's reports of which sessions produced the most progress and change. These peak sessions were compared with poorer sessions. A 20-minute conflict resolution episode was selected at comparable points in each session and rated for depth of experience (ES) in the whole episode and for degree of affiliative behavior and interaction (SASB) in the last half of the episode. Sessions reported as peak sessions showed significantly greater depths of experience and more affiliative behavior and interaction. These studies provide evidence to support the idea that depth of experience and acceptance are involved in the change process in EFT. The final study to be reported here investigated the relationship between the working alliance and therapeutic outcome. Measures of the alliance on the couples therapy alliance scale (Pinsof & Catherall, 1984) were taken on 56 subjects (28 couples) who had received EFT. The overall strength of the alliance early in treatment was not found to be predictive of outcome, although one component, the other-therapist component (which measures one partner's view of the strength the alliance between the therapist and the other partner), correlated significantly with outcome on a variety of measures. Another finding of interest was that the strength of the alliance increased significantly over treatment and that the termination alliance did correlate with outcome. These results indicate two important processes. First, the alliance itself in this form of couples therapy does not directly relate to outcome. It appears, however, that the alliance at the end of treatment does relate to outcome. In EFT, the alliance is probably the soil without which the treatment will not "take," but it does not in and of itself lead to change. Movement from an initially good alliance to an even better one, however, seems to be an

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indication that change has taken place. A good final alliance can not really be said to be predictive of outcome but should rather be viewed as a correlate of good outcome. However, it does indicate that couples who change in EFT have a strong alliance with their therapists and that this alliance is strengthened over treatment.

SUMMARY From the process studies, it appears that clients who experience and express new underlying feelings in therapy are viewed differently by their partners and feel more entitled to their needs. Change is also caused by an increased understanding of what is going on in the relationship, the taking of a self focus, and by feeling that experience was validated by the therapist. In successful episodes of conflict resolution, the partners, after engaging in an initial escalating cycle, de-escalate the cycle by one partner disclosing inner experience and the other responding affirmatively. After de-escalation, the pursuer may "test" the withdrawer by re-escalating; if the withdrawer retains a nonescalating stance, the couple proceed to resolution characterized by mutual openness. Couples at the end of therapy showed similar types of changes in their interactional cycles in that they engaged in more affiliative actions and interactions plus more supportive and disclosing behavior. Good sessions in EFT were shown to be characterised by greater depth of experience and affiliative interaction in conflict episodes and by the "softening" of the blamer. Although the alliance with the therapist did not predict outcome, the alliance was found to be high and to improve over treatment; it is possibly best thought of as the soil for productive therapy rather than an actual mechanism of change. Thus, we see that EFT brings about certain changes in interaction by a process of focusing on underlying feelings. The effect of emotional expression on interaction is then an important element in the process of change. It is, however, only one of the possible change processes in couples therapy. The question then remains as how to build a comprehensive model of change processes in couples therapy and to specify the place in this model of the emotional change process described above. Rather than attempting to develop yet another brand of therapy and to clamor for its superiority, it is our intention to promote the view that

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EFT can have significant effects in helping to ameliorate negative interaction cycles, in reducing conflict, and in promoting trust and intimacy. Although EFT can be practiced as a pure form of therapy and has been for the purposes of its evaluation, it appears to us to hold more promise ultimately in a more complex integrative model for working with couples. An approach that integrates different elements and change processes, depending on the couple's degree of distress, unique situation, needs, and goals, seems most likely to provide the best results.

CHAPTER NINE

Epilogue: Integration

Throughout this work we have attempted to convey an integrative perspective to treatment. The major attempt at integration involves a synthesis of an intrapsychic experiential perspective and a systemic interactional perspective. The individual perspective focuses on the self, while the systemic focuses on context. We have suggested an integrated perspective to couples therapy in which the therapist works with both the self and the system. In couples therapy, working with either perspective alone misses important aspects of dysfunction. Focusing on the system alone, using restructuring, reframing, or paradoxical intervention to change interactions, misses the fact that individuals exist with certain temperaments, personal characteristics, and a degree of stability across situations and time. Although it is not possible to understand partners without taking their social context into account, it is limiting to focus on their interaction separated from individual experience. People do not just react and interact as a function of their partner's behavior. Rather, individuals have needs; they construct personal views of reality and are centers of agency and action. They are undoubtedly connected ·in circular, sometimes automatic, interactional cycles, but this does not deny that they are also capable of intentional behavior and are internally motivated. On the other hand, the intrapsychic view that people are separate individuals and separate individuals alone overlooks the fact that people are embedded in a social context that is highly influential in determining their behavior. Observing the interactional process and its circularity in couples opens up new avenues of understanding of what is occurring in the dysfunction. To miss this more systemic view in treating couples is to operate with a great handicap. Partners' behaviors clearly do evoke reciprocal behaviors from each other, sometimes idiosyncratic, but always highly linked. 227

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Implicit in our approach to handling this integration is a particular view of self-functioning. We view the self as a system consisting of many processes or parts organized to act in a more or less integrated fashion. In this view, the individual is seen as possessing multiple possible self organizations, each of which is activated by different contexts. These different possible selves are integrated by an overarching self-organizing process. This view of modular self-organization is gaining support in the study of brain functioning (Gazzaniga, 1986; Sperry, 1968), in which it appears that different left and right hemisphere modules may · exist as autonomous functioning units. Gestalt therapy has been especially significant in providing methods for working with different parts of the self in individuals. However, the gestalt approach, although stressing organismenvironment contact, lacked an adequate theory of interaction and has not dealt explicitly with couples interaction. Principles of functioning of the whole self await explication, but the concept of multiple selves operating as parts of a total system does appear to explain aspects of functioning in couples in a most helpful way. We see this concept of an overall self-organizing process that, in interaction with the environment, activates a partial self-organization as an important view of functioning that allows an integration between intrapsychic and interactional perspectives. A second focus throughout this book has been on the importance of integrative views of emotion, cognition, and action. First, at a theoretical level, emotion is seen as an integration of expressive motor, schematic, and conceptual processing, making it a function of many elements. Second, at a clinical level, EFT works with emotional experience, constructive meaning and circular interaction, thereby integrating emotion, cognition, and action into a single approach. Each possible self activated in a particular context is essentially a self-in-situation schema that organizes feeling, thought, and action. EFf thus combines experiential and systemic perspectives in a synergistic fashion, combining contextual and intrapsychic determinants of behavior. It combines into a single approach interventions that access and explore underlying emotions to produce self-reorganization, with interventions that reframe behaviors in negative interactional cycles in order to produce interactional change. At a theoretical level, it is therefore a hybrid of these two approaches. It also, however, makes an attempt to go beyond these two schools to look at how couples actually change in therapy and thereby reaches toward a more complete form of

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theoretical integration. In incorporating a number of affective change processes-such as acknowledging underlying feelings; cognitive changes processes, such as accessing hot cognitions and inspecting core beliefs; and interactional and behavioral change processes such as reframing cycles, restructuring interactions, and practicing new behavior-EFT attempts to provide a conceptual synthesis in which dysfunction is viewed in terms of affective, cognitive, behavioral, and interactional process. This is the direction that must be pursued to arrive at a complete theoretical integration. Finally, a technical or more applied level of integration, involving a type of systematic matching of strategy to problem, represents a third type of integration in this approach. In our form of technical integration, the practitioner chooses, in a theory-guided fashion, particular types of interventions for particular types of conditions or problems as they emerge in the therapy. This is not the differential treatment notion of a particular treatment for a specific type of couple or marital problem. The differential treatment approach is too deterministic and static in concep­ tion. It neglects the complex transactional nature of therapy, in which all participants are constantly changing what they do in relation to how their environment is changing. In this type of technical integration, the ap­ propriate intervention is best conceptualized as occurring at a particular time in therapy when a specific interactional configuration presents itself. This time can be a particular moment in a session or a particular phase or state of therapy when the couple is working on particular kinds of issues. In this approach, process diagnoses are made of the emergence of partic­ ular patterns that are best treated with particular types of interventions. Thus, attack-defend patterns, unexpressed feelings, or dysfunctional re­ lational beliefs are identified and dealt with using interventions designed for these types of problems. In addition, the therapist assesses the level of conflict in the couple and the stage or phases of therapy, such as early, middle, or late, and chooses interventions appropriate to that stage. Once patterns of presenting problems or phases have been diagnosed, then interventions that suit the situation are selected. In this process diagnostic approach, markers of problem states that are currently amenable to intervention are identified. Thus, the therapist makes different interventions at different points in therapy dependent on the couple's current state and processes. This is a process or ecological view in which the client-therapist system is seen as always in flux, and interventions are viewed as investigatory probes that provide feedback

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and guide future action. Thus, the therapist "digs where the ground is soft" and "strikes when the iron is hot." Location and timing of interventions are at the core of whether the intervention will be absorbed and make an impact. In this process / ecological view of couples therapy, interventions with an emotional focus can be combined at any time with other types of interventions aimed more at genetic insight, awareness of collusive processes, behavior modification, cognitive modification, structural change, or reframing. Accessing emotion, when done appropriately, can help to deepen the process, change perception, evoke cognitions, and motivate new behavior. Thus, specific emotionally focused interventions, such as focusing on what is being felt, can be used in a general fashion within a variety of therapeutic orientations to enliven and enrich the process. The total package of interventions that we have called EFT, however, seems best for resolving couples conflict when used in the manner described in this book.

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Index

Accessing clinical issues, 175- 178 principles, 150 therapist interventions, 148- 163 therapy steps, 88- 94 Ac.cuse- withdraw cycle, 74 "Adaptive primary emotions" characteristics, 6 evoking of, 46, 47 Affect cognition interaction , 23 evoking of, 45-47 innate aspects, 5 nonverbal communication, 16 Affective systemic approach, 29- 53 Afftliation case example, 67- 70 interview assessment , 74- 76 and outcome, 223, 224 Agoraphobia, 191 Analogic communication, 13, 14,

16 Anger innate aspects, 5 vocal cues, 15 Arousal, 46, 47 Attachment and emotional bonds, 18- 20 innate aspects, 4, 5 Attending accessing emotion principle, 150 in empathic reflection, 152 Attribution of meaning, 22, 23 Automatic behavior, 96, 97 Autonomy-dependence, 165 Awareness experiments, 156- 158

B Behavioral therapy conflict delineation, 83 versus emotionally focused therapy, 4853, 63- 65 Beliefs, 24, 25 Biologically based emotions, 6 Blame- blame sequences, 223 Blame- placate sequences, 223 Blame- withdrawal cycle (see also Pursuedistance cycle) and accessing, 89 case example, 104- 121 choreographing interactions, 172, 173 conflict resolution, 217- 222 and disowned needs, 96- 98 identification of, 86, 87 reframing, 95, 96 and therapist training, 183-188 Blocks framing difficulties, 167, 168 and validation, 177, 178 Bonding (see Emotional bond) Boundary setting, 18

C

Change process (see Therapeutic change) Characterological attributions, 83 Choreographing interactions, 164, 171 173 Chronic pain, 190 Circular causality, 33 Client-centered therapy, 89, 148

237

INDEX

238 Closeness-d istance and affective expression, 17 interaction positions, 165 G:;ognition and emotion, model, I0, 11 , 228 integrative view, 21- 23, 228 systems approach, 37 Command messages characteristics, 13 and reciprocal roles, 34 Commitment, 79-8 1 Communication and emotion, 4, 13- 17 self-organization, 17 and therapeutic change, 39 Communication training, 48- 53 Complex phobias, 191 Conflict issues, 82- 85 Conflict resolution, 216- 222 Conjoint therapy, 62 Consolidation, l 03, 104 Constructivism, 39, 149 Context effects and change, 38, 42, 43 and meaning, 34 Contracting and emotional bonds, 18 social exchange theory, 63 Core beliefs empathic interpretation, 161 interactional systems, 36, 37 Couples therapy alliance scale, 224 Cultural aspects, emotions, 5 Cybernetic model and family systems, 33 homeostatic feedback conception, 41 Palo Alto group, 14

D Darwin, Charles, 14 De-escalation, 218- 221 Dependence- independence, 67- 70 Depression, 189- 191 Digital communication, 13, 14 Direct confrontation, 163 Directing and accessing emotions, 155, 156 changing interactions, 164

Directive therapy, 63 Disowned experiences, 96- 98 Disquisition, 162, 163 Distance, structuring of, 40 Distress, innate aspects, 5 Dominance- submission and affective expression, 17 case example, 67- 70 interview assessment, 74, 75 vocal cues, 15 Dyadic Adjustment Scale, 48, 51

E Eclecticism, 195- 199 Ecological approach, 229, 230 Emotion (see also Accessing) in change process, 204, 205 classification, 6 cognition interaction, 21- 23 evoking of, 45-47, 149 in human functioning, 4-9 integrative view, 228 model of, 9- 11, 149 self-organizing function, 11- 13 Emotional bond importance of, 18- 20, 61 restructuring, 40-43 theory of, 74, 75 and therapeutic alliance, 59 Emotional restructuring, 46, 47 Emotional schemata (see Schemata) Empathic interpretation, 160-163 Empathic reflection, 151 - 153 Enactments, 158- 160 Entitlement, 152 Environmental support, 42, 43 Escalation, 218- 220 Evocative responding, 154, 155 Experiencing scale, 217, 221, 224 Experiential learning, 25 Experiential theory, 29-32 characteristics, 29- 32 disowned experiences, 98 integrative models, 197, 227230 and systems perspective, 35-40 Expression analysis principle, 150

239

INDEX F Facial expression emotion communication, 14, 15 innate aspects, .5 Family-of-origin approach, I 96 Family systems (see Systems approach) Family therapy, 193 Fear, innate aspects, .5 Feedback family systems, 33 versus mutual influence, 41 nonverbal actions, 1.53 Feelings, and change process, 204, 20.5 Field theory and change process, 41 characteristics, 29-31 First-order change, 87 Fluctuating systems, 43-45 G General systems theory, 33 (see also Systems approach) Gestalt therapy accessing emotions, 89, 148 in couples, 29-32 and self-organization, 228 systemic perspective, 3.5, 36 Gestures, 16

H History-taking, 77, 78 Homeostasis family systems, 33 versus magnetic systems, 4 I "Hot cognitions" accessing, 23; 4 7 empathic int�rpretations, 161 I "I-thou" dialogue, 20, 21, 38 Images, 156-1.58 Immediacy principle accessing emotion, 150 in empathic reflection, I 52

Impasse enactment, 159 '"Inclusion," 20 Individual therapy, 193 Infancy, innate emotions, 4, 5 Information-processing attachment behaviors, 19 and emotion, model, 10, 149 Initial interview, 72-81 Insight, 38, 39 "Instrumental emotions," 6, 7 Integrative approaches, 195-199, 227-230 Intensification principle accessing emotion, 150 and directing, 155, 156 Intention principle, 150 Interactional positioning family systems, 34, 35 interventions, 164-173 principles, 164, 165 reframing, 164-169 restructuring, 169-171 Interactional systems (see Systems approach) Interpersonal perception and change process, 204 self-organization, 37 Interpersonal process recall, 217 Interpretation, 160-163 Intimacy and emotional bonds, 18-20 nonverbal communication, 16 Intrude-reject cycle case example, 121 interview assessment, 74 L Latent Partition Analysis, 204 Learning, and emotion, 12 Leventhal's model, IO M Magnet analogy, 41 "Maladaptive primary emotions," 6, 7 Marital adjustment, 49-52 Meanings, and attribution, 22, 23

240

INDEX

Metaphors awareness experiments, 156- 158 in evocative respond ing, 154 Modular self theory, 36, 228 Mood, and cognition, 23 Motivation and change, ·1,01 and emotion, 4 Mutual blaming case example, 67- 70 interview assessment, 74 Mutual distance, 67- 70 Mutual openness, 218- 222 .. Mutuality," 20

N

Negative emotion, ventilation, 176 Negative interactional cycle case example, 67 identification of, 85-88 interview assessment, 74-76 and outcome, 224 therapy effect, 222, 223 therapy step, 66 Network analyses, 11 Nonverbal behavior accessing emotion, 150 in couples therapy, 15 emotion communication, 14, 16, 150 interview assessment, 74 therapist feedback, 153 training issues, 183

Paradoxical reframing, 48- 53 "Partial selves," 36 Perceptual motor-processing model, 10 Personal Assessment of Intimacy in Relationships (PAIR), 48 Phobias, 189- 193 Position enactment, 159 Power issues, 67- 70 Predisposition, 77 Prescriptions, 63 Prigogine's theory, 45 Primary emotions characteristics, 6, 7, 149 clinical issues, 175-178 evoking of, 46, 47, 57, 58, 149 versus secondary emotions, 9 and therapeutic change, 7-9 Problem-solving approach and emotions, 5, 6 and therapy, 48-52 Proximity, 40 Psychodynamic therapy conflict delineation, 83 versus emotionally focused therapy, 6365 Psychosis, 195 Psychosomatic problems, 190 Pursue-distance cycle and bonding theory, 74, 75 case example, 67- 70 identification of, 86, 87 interview assessment, 74- 76

R 0 Object relations, 18 Outcome process factors, 223- 225 studies of, 47- 52

p Pain, 190

PAIR (see Personal Assessment of Intimacy in Relationships) Palo Alto group, 13, 14, 32

Reciprocal roles, 34 "Reflection" intervention, 151 - 153 Refocusing principle accessing emotion, 150 and change, 164 in empathic reflection, 152 Reframing and change, 164- 169 evoking emotion, 45-47 and family systems, 35, 37 therapy step, 94-96 Report messages characteristics, 13 and reciprocal roles, 34

241

INDEX Repositioning interactions, 165 Restructuring, 169- 171 Roles, 36

characteristics, 32- 35 and experiential approach, 35-40 integrative models, 197, 227- 230 self theory, 36 therapeutic task, 35, 37

s Schemata and arousal, 46, 4 7 and cognition, 2 I - 23 emotion model, I 0, 11 relational beliefs, 24 Second-order change, 87 "Secondary emotions" characteristics, 6 and therapeutic change, 9 Self-concept, 78 Self-controls, 42, 43 Self-disclosure, I 63 Self-esteem, 78 Self-focus, 206 Self-organization change process, 42-47 and communication, 17 and fluctuation, 44, 45 gestalt approach, 228 systemic theory, 36, 37, 228 Separateness-connectedness, 67-70 Separation anxiety, 4 Sexual interactions, 194, 195 Sexual problems, 190 Simple phobias, 191 Smiling, 5 Social exchange theory, 63 Socially derived emotions, 6 "Softening," I 88, 189, 225 Stranger anxiety, 4 Strategic systems paradigm, 64 Stress, 78 Structural analysis of social behavior instrument, 217, 220, 221, 224 Structural approach, 40 Submission, vocal cues, 15 Suicide attempts, 195 Symbolization principle accessing emotion, 150 and directing, 155, 156 in empathic reflection, 152, 161 Systems approach change explanation, 43-45

T Technical eclecticism, 196, 198, 229 Termination issues, 104 Testing, 218-221 Therapeutic alliance clinical issues, 180-182 monitoring of, 180 and outcome, 224, 225 therapy condition, 59, 60 Therapeutic change couples reports, 203- 216 experiential-systemic approach, 39 and outcome, 223- 225 process of, 40-47, 203- 226 and therapist training, 184-189 Therapeutic contract, 79-81 Therapeutic paradox, 63 Therapists accessing emotion principles, 148163 experiential listening, 84 patient bond, 59, 60 tasks of, 61, 62 Timing, interventions, 179 Tracking interactions principle, 164 Training issues, 182-189 Trust, 26

u Unconscious conflicts, 63- 65

V

Validation and accessing emotion, 151- 153, 177, 178 change process role, 206 and therapeutic alliance, 84, 85, 181 Ventilation approach, 176

INDEX

242 Violence and negative cycles, 87 therapy contraindication, 194 Vivifying enactments, 159 Vocal cues, emotion, 15 Vulnerability and emotional bonds, 18 and reframing, 95, 167, 168

w Withdrawal interview assessment, 75, 76 reframing, 95, 96 therapist training, 185, 186 Working alliance (see Therapeutic alliance)

continued from front flap depth discussions of clinical issues that arise in practice, and an analysis of the change process. A significant new work, EMOTIONALLY FOCUSED THERAPY FOR COUPLES will be of value to any therapist, regardless of orientation, who treats couples.

About the Authors

Leslie S. Greenberg, Ph.D. Leslie S. Greenberg is Professor in the Department of Psychology at York University in Canada. Co-editor of PATTERNS OF CHANGE: Intensive Analysis of Psychotherapy Process and THE PSYCHOTHERAPEUTIC PROCESS: A Research Handbook, and author of numerous research articles, he is on the editorial board of a number of journals on individual and marital therapy. He maintains a part-time private practice and is associated with the training of therapists.

Susan M. Johnson, Ed.D. Susan M. Johnson is Associate Professor in the School of Psychology and Coordinator of Training at the Centre for Psychological Services at the University of Ottawa in Canada. The author of numerous research and theoretical articles on marriage and marital therapy, she also maintains a part-time private practice. Cover design by Howard Brotman

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