All EFT Handouts - Slides For Module 1-6

Cutting Edge Couple Therapy for the 21st
Century: A short course in EFT
Dr. Sue Johnson
www.iceeft.com
Copyright: Dr. Susan Johnson 2015

1 www.drsuejohnson.com
LOVE
Most used word / Rated most important goal
It is:
• A mysterious mixture of sex and sentiment ?
(If so: cannot understand it, make or keep it).
• A science of love is impossible.
Or is it:
• An exquisitely logic survival system ?
• Our foremost and most basic need – from the cradle to the grave ?
• Our only defense against “emotional starvation”.
• A haven of safety and strength. Effective Dependency.
Empathic Responsiveness is the Essence
of Emotionally Focused Therapy
The empathic responsiveness of the therapist creates safety. The goal is to

guide partners into this responsiveness with each other.
“Resolve to be tender with the young, compassionate with the aged, sympathetic with the
striving and tolerant with the weak and the wrong.
Sometime in your life you will have been all of these.” (Lloyd Shearer)
Most Basic EFT Intervention: Empathic Reflection

• Creates safety
• Focuses and slows processing
• Better organizes & distills experience – creates coherence
The Problem:
W: Do you love me? (accusing tone)
H: Of course I do. How many times have I told you?
W: Well it doesn’t feel like it (tears, looks down, turns away)
H: (Sighs-exasperated) Well, maybe you have a problem then. I can’t help it if you don’t feel
loved. (Set mouth, lecturing tone.)
W: Right. So it’s my problem is it? Nothing to do with you, right? Nothing to do with your ten
feet thick walls. You’re an emotional cripple. You’ve never felt a real emotion in your life.
H: I refuse to talk to you when you get like this. So irrational. There is no point.
W: Right. This is what always happens. You put up your wall. You go icy. Till I get tired and give
up. Then, after a while, when you want sex you decide that I am not quite so bad after all.
H: There is no point in talking to you. This is a shooting gallery. You’re so aggressive.
Rigid pattern- blame/withdraw.
No safe emotional connection-escalating danger and isolation.
4
Emotionally Focused Couples Therapy
Looks within at how partners construct their emotional experience of relatedness.

• (Using Rogerian Interventions)
Looks between at how partners engage each other

• (using Systemic Interventions and tasks)
In Order To:
• Reprocess / expand emotional responses
• Create new kinds of interactions / change the dance
• Foster secure bonding between partners
website: WWW.ICEEFT.COM
5
5 Basic
THE
1. Reflect
Moves of EFT Present
Process
(within/
between)
Repeat these
5 moves 5.
again and Integrate/Vali 2. Explore
date/Reflect more
again, as you Process primary,
move (View of Self, deeper or
View of Other,
through the Relationship)
new
steps and emotions.
“Tie a bow”
stages of EFT.
3. Set
4. Process up/coherent
the enactment
Enactment/ (disclose
How it more
feels to primary
emotion to
tell/ hear. the partner)
6
The Key Challenges of Couple Therapy
1. To make sense of the drama, the emotional circus, the dilemmas in a

love relationship. To have a map and a way home.
2. To create a secure base for inner and inter exploration - openness and
engagement in therapy - with both partners - in every session.
3. To make potent emotion the agent of change - the therapists friend. To

change how emotion is regulated and expressed in the couple’s dance.
4. To de-escalated demon dialogues that shape disconnection and help the

couple find BALANCE.
5. To shape in the moment positive bonding interactions, removing blocks

and dealing with injuries, risks, fears.
6. To help the couple make the in session changes LAST.

EFT is Experiential EFT is Systematic
• Focus is whole person not the problem • Focus on context/process – Different
per se contexts evoke different aspects of self,
strategies.
• Focus is process – how problem is
constructed in the moment • Find the LEADING, ORGANIZING
ELEMENT and shift this to
• Focus is generating new corrective REORGANIZE system. The SECOND
experience (not explanations) ORDER CHANGE – not simply
symptom
modification.
• Focus on Pattern/Circularity –
feedback loops – two way interactions
that self-perpetuate. Construction is
problematic – open flexibility is health.
How one communicates limits the response options of others – emotional signals organize interactions.
EFT Research
Meets the gold standard set out by bodies such as APA for psychotherapy
research. EFT epitomizes the very highest level set out by this standard.
The meta-analysis (Johnson et al, 1999) of the four most rigorous outcome
studies conducted before the year 2000, showed a larger effect size (1.3) than
any other couple intervention has achieved to date – 70-75% recovered on
DAS with significant improvement – 86-90%
Studies consistently show excellent follow-up results – some studies show that
significant progress continues after therapy. Nine studies on the process of
change validate EFT interventions.
The generalizability of EFT across different kinds of clients and couples e.g.
depression and PTSD – results are consistently positive.
A recent study on EFT effects on attachment security with an FMRI

component shows that EFT changes attachment security and the way contact
with a partner mediates the effect of threat on the brain.
9
Changing Responsiveness to
Threat with EFT
The Focus of EFT (The 4 P’s)
EXPERIENTIAL
• PRESENT MOMENT (Emotion brings past alive. Past used to validate present blocks,
styles, fears).
• PRIMARY AFFECT – Focus on / Validate
SYSTEMIC
• PROCESS (across time) – PIVITOL MOMENTS
• POSITIONS / PATTERNS of interaction – self sustaining feedback loops
THE THERAPIST IS A PROCESS CONSULTANT !
EMOTION
Cue- Rapid appraisal of environment – Body arousal
Meaning/Reappraisal – Action Tendency (Arnold)
• Source of information – fit between environment cues and needs / goals
• Vital element in meaning
• Primes action response
• Communicates – organizes social interactions
Six core emotions (facial expressions) and adaptive actions.
ANGER Assert, defend self
SADNESS Seek support, withdraw
SURPRISE/EXCITEMENT Attend, explore
DISGUST / SHAME Hide, expel, avoid
FEAR Flee, freeze, give up goal
JOY Contact, engaging
Panksepp’s attachment “panic”

Code of attachment tells us:
Primary need is “felt security” with other

A safe haven - to go to
A secure base – to go out from
“ARE you there for me?”

Are you Accessible – Do I matter ?
Are you Responsive to my need – Can I depend ?
Are you Engaged with me ?
Emotional presence is “solution”

Couples Therapy Based on
Attachment Theory:
1. Focuses on attachment needs and forms of engagement and

disengagement.
2. Privileges emotion – The music of the attachment dance.
3. Creates the therapy session as a secure base.
4. Shapes new bonding responses – events.
5. Addresses impasses – attachment injuries.
EFT: Stages and Steps
STAGE ONE: DE-ESCALATION
1. Assessment
2. Identify negative cycle / Attachment issues
3. Access underlying attachment emotions
4. Frame problem – cycle, attachment needs/fears
(Steps 1-4)
STAGE TWO – RESTRUCTURING THE BOND
5. Access implicit needs, fears, models of self
6. Promote acceptance by other – expand dance
7. Structure emotional engagement – express attachment needs.
(Steps 5-7)
Antidote/Bonding Events
STAGE THREE: CONSOLIDATION
8. New Solutions to pragmatic issues
9. New positions / cycles – enact new stories – of problems and repair
(Steps 8-9)
EFT ASSESSMENT
Therapist Tasks
• Create a collaborative therapeutic alliance
• Explore agenda for:

1) the relationship
2) therapy - Are they compatible and appropriate ?
• Present therapy contract e.g. number of sessions
• Assess relationship status:

• 1) Perceptions of problems and strengths,
• 2) Cycles – negative and positive,
• 3) Relationship history/key events,
• 4) Brief attachment history,
• 5) Observe interaction,
• 6) Check for violence/abuse.
• Assess prognostic indicators:

• 1) Degree of reactivity
• 2) Strength of attachment
• 3) Openness – response to therapist – engagement
• Contraindication for EFT – cannot create safety in session – cannot foster openness in
good faith 18
Interventions in EFT
Task 1: Reprocessing Emotion
• Reflect (name, order, distil) emotional processing as it occurs. Make explicit. Use
NACC language: Now and immediate, Alive – vivid – felt, Concrete, tangible, specific,
Attachment channel.
• Validate habitual emotion regulation strategies, ways of seeing, action tendencies, stuck
places, attachment longings and fears, and shifts – new steps in the dance.
• Ask Evocative Questions - unpack automatic ways of constructing experience. Replay

key process moments. Name and integrate the elements of emotional experience.
“What happens to you when you hear that tension in her voice?”
• Heighten elements of experience (use repetition, images) to deepen clients

engagement.
• Interpret – make small conjectures – at the leading edge of experience. Tentative. Most
intense using proxy voice.
19
Interventions in EFT
Task 2: Creating New Interactions
• Reflect - steps in the partners dance and the impact of dance.
• Reframe – Attachment meanings, interactions / cycle.
• Shape interactions – Request the direct sharing of clear distilled messages.
Respect reluctance and slice risks thinner (simply share how hard it is to share).
Contain negative messages with “catch the bullet” interactions.
Therapists help clients:
 Enact present positions to make them clear.
 Turn new emotional experience into new signals to a partner
 Enact to heighten new responses and their impact on the other.

RISSSC
Repeat
Images - use
Simple words
Slow pace
Soft voice
Client’s words
In Stage 2: Reconstructing of Attachment Interactions
There are two key change event:
1. Withdrawer Re-engagement
2. Blamer Softening
Withdrawer Re-engagement is when a previous distant, inhibited, defended, stonewalling

partner emerges and engages with their enactments in session.
In Attachment Terms:
• The withdrawer now becomes accessible and able to stay emotionally engaged with self and
the other.
• He can coherently express his hurts, fears, the models of self and other cued by these
emotions.
• He can reach for – ask for the response he needs from his partner and begin to actively shape
the relationship.
Example: “I have been so afraid, So afraid of not meeting your standards. I have shut you out. I
have numbed you out. I didn’t know what else to do. So I got paralyzed. But I do want us to be
close and I don’t want you to hurt – to be lonely. I am not going to walk on eggshells anymore. I
want to dance with you – but not with you keeping score. I think we can do this now. I want us
to try. 22
A Key Change Event in EFT:
A SOFTENING
Prerequisites:
De-escalation of negative cycle (Stage 1)
Withdrawer re-engagement
• A previous hostile, critical spouse accesses “softer” emotions and risks

reaching out to his/her partner who is engaged and responsive. In this
vulnerable state, the previously hostile partner asks for attachment needs
to be met.
• At this point, both spouses are attuned, engaged and responsive. A

bonding event then occurs which redefines the relationship as a safe
haven and a secure base.
ATTACHMENT INJURY
• A betrayal of trust / abandonment at crucial moment of need.
• A form of relationship trauma – defines relationship as insecure.
• An impasse in repair process – blocks trust.
Attachment significance is key – not content.
Indelible imprint – only way out is through
RESOLUTION OF ATTACHMENT INJURIES
• Articulate injury and impact. “NEVER AGAIN!”
• The other acknowledges hurt partner’s pain and elaborates on the evolution of the event.
• The hurt partner integrates narrative and emotion. He/She accesses attachment fears and longings.
• The other owns responsibility – expresses regret – while staying attuned / engaged. (I feel your hurt –
your pain impacts me)
• The hurt partner asks for comfort / reassurance.
• The other responds – antidote bonding event.
• Relationship is redefined as potential safe haven.
• New narrative is constructed.

EMOTION: Trigger – Appraisal (initial perceptions) – Body arousal – Reappraisal (models – self and
other – cycles, identity, attachment) – Action, tendency = emotion.
W: You are so difficult – I can’t tolerate your attitude.
H: (Throws up his hands and turns to look out the window).
Th: What happens to you as your wife says “….”?
H: Nothing – I am used to this. She says this stuff all the time.
Th: You feel nothing as she says “…..”? (Repeat cue)
H: This happens lots – I just try to roll with it – forget it – (Shifts to coping)
Th: You try to forget these times when she tells you that you are too difficult for her to tolerate? (he
nods) But in that split second before you try to push it aside and “forget” her words – what
happens to you? When she tells you, you are too difficult?
H: Don’t know. I just move away.
Th: There is something here that is hard? – upsetting? – you can’t take it in – that is too hard? (he
nods) What do you hear her say?
H: (Appraisal – threat). She’s saying that I’m hopeless – this relationship is doomed – down the
tubes.
Th: (Body arousal) You threw up your hands – like this – that is the hopelessness – the
defeat?
H: I guess so – yes –
Th: It’s like you throw up your hands and you give up – it’s hopeless –
H: Yeah – (looks down at shoes – quiet voice) There is nothing I can do.
26
H: yep, I have totally blown it. I’ll never make it with her. She has her standards and I can’t ….I’ll
never….(tears).
Th: (Action tendency) So you withdraw to protect yourself. And then you (the wife) get even
angrier (she nods) and that is the cycle that has taken over the relationship and leaves you both alone
(attachment significance) And that brings tears for you?
H: No – my eyes are just watering…
Th: You say to yourself – “I have blown it – lost her – I’ll never make it with her? Some part of you
wants to throw up your hands – like “I’ll never please her – have her love” – is that it?
H: right – my brother said – there is a time you get married and he told me I was too young – but
you do what you do – all my family got married young (exit)
Th: I’d like to go back – So when you hear your wife’s anger you move away – try to forget it – and
she sees – what did she say? She sees “coldness” and “indifference” (she nods). But in fact, you are
trying to deal with a huge sense of defeat and hopelessness - a sense of failure – a fear that you can
never please her –
H: Yes – that’s it – I think that’s it –
Th: (Enactment) Can you tell her please –
W: I do get critical – I do. Well anyone would. He just acts like he is a house guest, a visitor. He
goes off to his room on his computer and he works. And it’s been that way for ever. Like last night,
you just disappeared!!! (Points at him, then crosses her arms across her chest and looks as if
she could cry) the invisible man– my husband. 27
I guess I just don’t understand – if closeness is so important to you – how come you are so
cold to me in bed. I get that I am just a nuisance for you. I get mad cause there is never ever
a time when sex is okay. You make excuses or stay up and work. The bed is empty. You
mock me - tell me I just want to get my rocks off. I can’t remember the last time you came
on to me even a little bit. ( Shakes his head) It’s just useless. Doesn’t matter what I do ( he
takes his head in his hands and his voice goes soft). The other night, I made a kind of real
careful come-on and you curled your lip at me. Like I was some small snotty nosed kid to be
gotten rid of – put aside ( His face tenses and he slams his hand down on the arm of the
chair) Like it was a big joke or something – that I would have the gall to come onto you – to
ask for something from you. The Ice Queen herself.
(Silence. He sinks back into the chair now) But I have said this all before – there is no point.
I don’t past the test, so no sex for Stephen. ( voice very low now )– I am not going to beg for
some warmth. So I stay away now and turn off – no point in this charade. You read your
book – I turn away and try to sleep. I don’t want to do this anymore. (He closes his eyes and
puts his head down in his hands again). It used to be really good between us – but now
……………………
Find the Cue – Perception (implicit) – Body response – Meaning re self and attachment
relationship – Actions/ Moves and how linked to the negative cycle
What is the primary emotion ?

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Cutting Edge Couple Therapy for the 21st

Century: A short course in EFT

Dr. Sue Johnson

Copyright: Dr. Susan Johnson 2015

The empathic responsiveness of the therapist creates safety. The goal is to

Most Basic EFT Intervention: Empathic Reflection

W: Do you love me? (accusing tone)

H: Of course I do. How many times have I told you?

W: Well it doesn’t feel like it (tears, looks down, turns away)

H: There is no point in talking to you. This is a shooting gallery. You’re so aggressive.

Rigid pattern- blame/withdraw.

No safe emotional connection-escalating danger and isolation.

Looks within at how partners construct their emotional experience of relatedness.

Looks between at how partners engage each other

1. To make sense of the drama, the emotional circus, the dilemmas in a

3. To make potent emotion the agent of change - the therapists friend. To

4. To de-escalated demon dialogues that shape disconnection and help the

5. To shape in the moment positive bonding interactions, removing blocks

6. To help the couple make the in session changes LAST.

A recent study on EFT effects on attachment security with an FMRI

• PRIMARY AFFECT – Focus on / Validate

• PROCESS (across time) – PIVITOL MOMENTS

• POSITIONS / PATTERNS of interaction – self sustaining feedback loops

THE THERAPIST IS A PROCESS CONSULTANT !

SADNESS Seek support, withdraw

SURPRISE/EXCITEMENT Attend, explore

DISGUST / SHAME Hide, expel, avoid

FEAR Flee, freeze, give up goal

JOY Contact, engaging

Panksepp’s attachment “panic”

Primary need is “felt security” with other

“ARE you there for me?”

Emotional presence is “solution”

1. Focuses on attachment needs and forms of engagement and

2. Privileges emotion – The music of the attachment dance.

3. Creates the therapy session as a secure base.

4. Shapes new bonding responses – events.

5. Addresses impasses – attachment injuries.

STAGE ONE: DE-ESCALATION

2. Identify negative cycle / Attachment issues

3. Access underlying attachment emotions

4. Frame problem – cycle, attachment needs/fears

STAGE TWO – RESTRUCTURING THE BOND

5. Access implicit needs, fears, models of self

6. Promote acceptance by other – expand dance

7. Structure emotional engagement – express attachment needs.

STAGE THREE: CONSOLIDATION

8. New Solutions to pragmatic issues

9. New positions / cycles – enact new stories – of problems and repair

• Create a collaborative therapeutic alliance

• Explore agenda for:

• Present therapy contract e.g. number of sessions

• Assess relationship status:

• Assess prognostic indicators:

Task 1: Reprocessing Emotion

• Ask Evocative Questions - unpack automatic ways of constructing experience. Replay

• Heighten elements of experience (use repetition, images) to deepen clients

Task 2: Creating New Interactions

• Reflect - steps in the partners dance and the impact of dance.