So, you have learned the basic tenets of EFT. You are beginning to more solidly understand the difference between compassion and empathy, and you can reliable “fall back” to effective empathy when you are stuck in a session. You can identify markers. You can guide a client through the basics of a variety of therapeutic tasks – and that was an exciting stage to get to – beginning to see the power of chairwork and your clients’ response to it! If you’re following the typical progression in learning this powerful model, you are now beginning to feel … lost. Maybe even a bit overwhelmed. Welcome to intermediate practice!
In the first blog in this series, we focused on the beginner stages of learning Emotion Focused Therapy for individual clients. In this article, we’ll focus on holding faith and deepening into the intermediate stage of practice. I feel like I spent a long time in this stage, and there is a lot to learn. It’s also worth it!
At this stage of learning, therapists shift from asking “But what do I do?” to “What do I do when, and why?” I love this stage! In part, that’s because I am a big theory geek and the questions that arise at this stage always fill me with energy and excitement. I love witnessing the shift from therapist caution and consternation to therapist curiosity, reflection, experimentation, and growth! This is when emergent EFT therapists really work to deepen their understanding of theory, how it informs technique…and how to set all of that heady stuff aside to return to in-the-moment empathic attunement with their client. What a dance!
Learning goals at this stage of development include:
- Learning case formulation
- Learning to differentiate primary and secondary emotion and why it matters
- Learning to work with and through common stuck points in EFT’s therapeutic tasks
Case Formulation
Depending on the modality you’re coming to EFT from, you may think that case formulation is essential or superfluous. Whether you love treatment planning or find it onerous, it is important. Research informs us that client and therapist agreement on a treatment focus early in therapy predicts positive outcome. This makes sense – if the client and therapist think they are working on different things, they are not going to be working together or pulling in the same direction. If the therapist is simply following the client and never leading, productive work can certainly happen, but it will be haphazard and inefficient. At an intermediate stage of development, I recommend that you be able to clearly differentiate supportive counselling from goal-informed psychotherapy, and hone your skills on creating an EFT-specific case formulation to guide and assess your treatment plan and progress across sessions.
Supportive counselling
There is nothing wrong with supportive counselling. But, it is different from active treatment. When I agree to supportive counselling with a client it is because the client does not have a particular aspect of themselves or their experience that they wish to change. Rather, things in their life may be moving along ok, but they want to have a place where they can bounce ideas around or explore their inner world and see what comes of it. Our goal then (because yes, we still have one), is to simply make space for self-reflection, exploration, and growth each time the client attends a session with me.
Goal-informed psychotherapy
In an Ontario-based context, psychotherapy is recognized as a controlled act that is required to be provided by an authorized registered health care provider. According to the Psychotherapy Act (2007), to engage in the controlled act of psychotherapy means to:
“treat, by means of psychotherapy technique delivered through a therapeutic relationship, an individual’s serious disorder of thought, cognition, mood, emotional regulation, perception or memory that may seriously impair the individual’s judgement, insight, behaviour, communication or social functioning.”
So, when we are engaging in psychotherapy, we are using techniques, delivered through a therapeutic relationship, to treat a specific problem. To do so, we need to have a focus (the problem), a goal for changing the problem, and a treatment plan to help us to do so. What helps us do this? Our case formulation of course!
In Emotion Focused Therapy, we use the acronym MENSIT to help us to track six variables that are central to case formulation and treatment planning:
- Markers: a verbal or nonverbal signal that a client’s core painful emotion or stuck emotion process has been activated in the moment.
- Emotion: patterns of primary maladaptive emotions that are repeatedly activated in the client, that are considered unhelpful, repetitive, and stuck parts of the client’s experience.
- Needs that remain unmet.
- Secondary emotions: a client’s common reactions to their own underlying primary feelings.
- Interruption of emotion: a client’s idiosyncratic patterns of stopping themselves from feeling.
- Themes: a client’s central narratives about self and/or others in the world.
Creating your own guide (or working with a supervisor who provides one) to help you build a case formulation for each client is a great way to hone your skills in this area.
Primary and Secondary Emotions
If empathy is the foundation that the house of Emotion Focused Therapy is built upon, and if the markers and tasks are the walls and furniture in the house of EFT, being able to reliably (enough) differentiate between primary and secondary emotion is the electricity that makes everything in the house work. The type of emotion we are working with is the key to helping our clients get to the bottom of what is truly troubling them, and then to transforming places of stuckness and pain that underlie symptoms and patterns of avoidance.
Primary Emotions
Primary emotions are a reaction to an event or situation in our lives. They are the first thing we feel in response to a change in our environment. They can be “adaptive” – giving us information that helps us understand what we need in the present context, and organizing us to get our needs met, or they can be “maladaptive” – leading us away from what we need. Typically, maladaptive emotions are like emotional intrusions from the past into the present. They tell us more about what we needed in a past interaction than about what we need in the present moment. For example, a child may naturally feel nervous when they face a new physical challenge. With encouragement and attention to their own capacities, they may overcome their nervousness to accurately assess their capacities and try something new, slowly expanding their physical competence and confidence. If, however, the child is ridiculed each time they get nervous in the face of a new challenge, the child may learn to respond to challenges with an automatic feeling of shame, followed by collapse, and withdrawal. This would be an example of the development of a primary maladaptive emotion scheme of shame and resulting behavioural avoidance moving forward. Going forward, these maladaptive feelings of shame don’t result from an accurate perception of the client’s present capacities or performance – rather they result from an internalization of reactions to past events.
In my experience, many clinicians struggle at first to different primary adaptive and maladaptive emotions. Here are some patterns to watch for in your clients:
Signs that Emotions are Primary and Adaptive
- These feelings seem new, emergent, and fresh (not familiar, repetitive, and stuck).
- The intensity of the emotion makes sense in the current situation or context.
When your client’s emotions are in this realm, help your client pay attention, understand what this emotion is telling them about what they need, and help your client identify ways to act to meet this need. Common primary adaptive feelings are summarized in the table below.
Primary Adaptive Emotions
Copied with permission from Thompson, S. & Greenberg, L. (2023). Emotion Focused Therapy: An Overview in Foroughe, M. (Ed.), The Clinical Manual of Emotion Focused Therapy for Youth and Caregivers. Routledge.
Signs that Emotions are Primary and Maladaptive
- These feelings seem stuck, repetitive, familiar, and old.
- The intensity of the emotion may not make sense in the current situation or context.
When these emotions are active, we want to help the client to deepen and fully explore these emotions to help the client to transform them. We’ll talk more about why it is important to activate primary maladaptive emotions to transform them in the next installment on advanced stages of learning Emotion Focused Therapy.
In EFT, we think of three primary maladaptive emotions – four if you consider that there are two manifestations of primary fear – fear of physical harm and fear of abandonment. Memorizing these can help you to notice them when they arise.
Primary Maladaptive Feelings
Copied with permission from Thompson, S. & Greenberg, L. (2023). Emotion Focused Therapy: An Overview in Foroughe, M. (Ed.), The Clinical Manual of Emotion Focused Therapy for Youth and Caregivers. Routledge.
Secondary Emotions
Secondary emotions are reactions to our own reaction. They are often learned through emotion-socialization processes and will vary across time, and across cultures. Like primary maladaptive emotions, they don’t tell us much about what a client really needs in the moment. Instead, they tell us more about the social rules about emotions that our client has internalized growing up. At their best, secondary emotions can give us information about the best way to express our underlying emotions and needs in the current context in order to have our needs met. At their worst, they may cover up or get in the way of knowing how we really feel, knowing what we need, and communicating our needs clearly to others. When a client is in secondary emotion, we want to name and validate the emotion, and then seek to empathically attune to and reflect the deeper underlying primary emotion.
Signs that Emotions are Secondary
- They are reactions to reactions.
- They don’t tend to shift in response to empathic reflection and validation. This makes sense. If we validate anxiety or hopelessness people don’t tend to feel better…or less hopeless or anxious. In contrast, validating deep pain or aloneness tends to result in a client feeling more understood and seen and that feels … good.
In my experience, it takes some time to reliably learn to differentiate primary and secondary emotion.
Be patient with yourself. Seek out a supervisor for help in this area if needed. If you want to read more on the topic, check out my additional blog posts on these topics including There are Different Categories of Emotions and They Aren’t Equally Helpful, and Managing My Feelings in Good Times and Bad.
Common Stuck Points in EFT’s Therapeutic Tasks
The final learning opportunity I see emerging at the intermediate stage is a shift from internalizing the basic steps of any therapeutic task to encountering common stuck points or technical crises in the tasks. At this stage, working with a supervisor, or enrolling in a master class on a specific task can provide valuable learning opportunities for the clinician. You can learn more about your local training institute or upcoming master classes through the website for the International Society for Emotion Focused Therapy.
The intermediate stage of learning in Emotion Focused Therapy is all about becoming fluent in this new language, and becoming comfortable and competent in the dance steps of this model. Now that you have done your own reading, and attended some workshops or courses, it’s time to find a supervisor or a consultation group to tailor your learning to your needs. Your local institute should be able to help you find a supervisor or consultant in your area. If the Eastern time zone is accessible to you, and you want to learn more about consultation and supervision through Transforming Emotions, check out our Therapist Resources page. If you would prefer a group training experience, check out my Emotion Focused Therapy for Busy Professionals course. If you have some great resources to share that we’re missing out on, please feel free to let us know!
Want to learn more about practicing Emotion Focused Therapy with your individual clients? Join us for EFT Fundamentals for Busy Professionals!
Watson, J. C., & Greenberg, L. S. (1996). Pathways to change in the psychotherapy of depression: Relating process to session change and outcome. Psychotherapy: Theory, Research, Practice, Training, 33(2), 262–274.
Goldman, R. N., & Greenberg, L. S. (2015). Case formulation in emotion-focused therapy: Co-creating clinical maps for change. American Psychological Association.
