Mary Fitzgibbons, Ph.D.
Why would anyone choose to spend the money and time in going to therapy? It can be costly if your insurance doesn’t apply and it can be emotionally painful. Generally, by the time clients make the effort to find someone who they hope that they can trust and who will help them in resolving the problem, they are experiencing a good amount of pain or inner turmoil. Most clients come into this setting with varying amounts of hope and confusion. Their medical doctor has prescribed different types of treatments. One, of course, is prescription drugs. But many feel as though medications may not be the only option. Referring someone to therapy is becoming a more common phenomenon, but that can also be problematic. What kind of therapy am I going to need? What is going to work? One can easily become really confused over different types of therapy, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) or Emotionally Focused Therapy (EFT). There are many other psychological treatments, but the question remains, “What is going to help me change?”
While each theory has its pros and cons, it is important that the therapist be clear as to how he or she approaches the work. The reason is that it is the therapist’s job to help the client create change, and the change should be lasting change. This would be very difficult to do if the therapist didn’t eventually come to a belief as to how this should be done. Hoping that this theory or that theory may work but not being sure is akin to going to a surgeon for a hip operation and the surgeon questioning which procedures will be most effective as he begins the surgery.
One of the better known therapies today is Cognitive Behavioral Therapy (CBT), which is derived from behavioral and cognitive psychology. Its purpose is to address current issues by developing good coping strategies. One of the ways it does this is by changing thoughts and cognitions, beliefs and attitudes. Its purpose is to treat specific problems, so it becomes a problem-focused, action-oriented approach. CBT’s focus is to help the client challenge his or her beliefs and replace present ways of thinking, which include overgeneralizations, self-defeating thoughts, and the tendency to minimize the positives and maximize the negatives, with more realistic and balanced ways of thinking. The therapist and client work together to come up with strategies and goals that will help the client achieve some resolution of the problems. The goal is to decrease the symptoms that the client is presenting. Its advocates say that it is effective in treating depression and anxiety, along with Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, and aggression and Conduct Disorder in children and youth.
There are certain clients that can be very difficult to treat. Dialectical Behavior Therapy was created by Marsha Linehan with the express purpose of working with “non-motivated” patients. Some of these people had been raised in severely invalidating families. Thus their trust level with the therapist is difficult to obtain. DBT strives to make the therapist an ally to the client. The focus of the therapist is to accept and validate the client’s feelings, even when they may be very difficult. It is the therapist’s role to confront the client when the latter’s feelings are maladaptive. This theory draws from other traditions such as cognitive behavioral therapy and assertiveness training. The therapist and client address the client’s issues on a hierarchical basis, going from the most serious behaviors such as self- injurious or suicidal ideation to quality of life issues. The client is taught various skills. Often group therapy is used to hone these skills. Mindfulness is an important component of this theory, in that it helps individuals accept and tolerate the strong and difficult emotions that challenge their lives. This contributes to helping the client emotionally regulate emotions. DBT is often used in cases of depression or Borderline Personality Disorder.
Many clients may assume that most theories focus on emotion. In fact, many people hesitate before they decide to see a therapist because the fear is that, “I’m going to feel feelings I don’t want to experience,” or, “I’m afraid if I feel those negative feelings I’ll never be all right again.” While this may sound like an exaggeration, it is often the reason many people hesitate or refuse to come to therapy. It would surprise most people that emotion has not been the central aspect in most therapeutic models until the last twenty years. Behavior and cognition had been the focus in the past. Yet when we look at making changes in our life, the reason for wanting to change is often that we are not happy with the way we are feeling. We may be sad because a relationship that we value is ending. Or we may feel helpless because our child is making decisions that are risky and we are at a loss as to how to deal with it. No one feels the need for therapy unless they are feeling sad, frightened, angry, helpless, or depressed and, most importantly, they don’t know how to change these emotions so that they feel better. It is all about feelings. While many therapies discuss emotions, the emphasis is not directly on changing those emotions.
Most therapists acknowledge that they are eclectic in their therapeutic approach. This means they may use various techniques from different therapy modalities. While this is true for most of us, this author would like to share what she has found to be an effective theoretical model in her years of doing therapy. It is called Emotionally Focused Therapy (EFT). EFT is based on the premise that emotions are connected to human needs and, when we work through these emotions, problematic emotional states and interpersonal relationships can be changed.
EFT is based on Carl Rogers’ empathic attunement. That is, the therapist “gets” the client and is attuned to the client. Clients feel as though they are understood by their therapist. The emphasis is on engaging the client in an emotional experience that is in the present – what is going on with me right now? The theory is that we become more likely to change only after we can access the most primary emotion that we are experiencing. For example, Jane is angry because it seems as though a couple of her good friends aren’t including her in their regular nights out. She flies off the handle with others at the least provocation. Her anger is always present. After her sessions with her EFT therapist, she is able to access her deeper feelings of being truly sad because she has never felt as though she was special to anyone. The therapist, in this process, is validating the negative feelings that she entered into therapy with which is called a secondary emotion but then is able to reprocess her deeper feelings (her sadness) which are called primary emotions. Within EFT, this is what creates the change.
There are some key elements that are critical in creating this change:
- Carl Rogers believed that the relationship between the client and therapist is critical to the therapeutic process. There has to be a trustworthiness between the two. The client has to have the sense that the therapist sees the value in the client and the therapist understands the client.
- The attachment process is an important component. This refers to the original relationship between mother and child. If this bond does not develop securely in infancy and early childhood, it will have emotional ramifications at a later time. This is often the basis of the emotional issues that we may have twenty or thirty years from now. For example, Tom’s mother had a serious illness following his birth. For a number of months, she was unable to hold him or feed him. Though no one’s fault, Tom developed an insecure attachment style. This meant that he was never secure or safe in his attachment relationships, such as with a partner or close friends. He becomes highly anxious when he realizes that a relationship is falling apart. In order to resolve this anxiety, he has to allow himself to experience the emotion in order to change. It is through the therapeutic process that he begins to be able to develop a sense of safety and security in his serious relationships.
- The focus of the EFT therapist is on the present. While the issue may have begun in the past (Tom’s lack of early nurturing from his mother) the present feelings are what the therapist deals with. It is a highly experiential approach. The client becomes aware of his deepest primary feelings and how he experiences them. The EFT therapist will help the client not only identify the emotion but where this feeling is being felt in the body. It is in this experiential process that people change. This is because change comes about when one emotion replaces another emotion. Tom goes from feeling anxious to being secure and confident in the relationship.
The reason why the EFT approach seems effective is that is has been this therapist’s experience that long-lasting change does not come about when we attempt to change the other person’s thought patterns. It is the emotions that must change. This may be a more difficult process, but it is longer lasting. When EFT achieves its goals, the emotional changes are longer lasting and they become a part of the client’s emotional fabric.
Dr. Mary Fitzgibbons is a licensed psychologist and the Director of West County Psychological Associates. Before beginning her career as a psychologist, Dr. Fitzgibbons was in education for 20 years, in both elementary and secondary levels.