Middle Phase of Therapy: Resolving Unfinished Business
John’s work in the previous session regarding his critical shaming voice
was an example of productive emotional processing. In co-constructing
meaning with the therapist in the next session, John understood how his
self-critical voice and his shame-based depression were related to his
father’s treatment of him and consequently in terms of the collaborative
case formulation, John’s abusive childhood became another focus of the
therapy. John and his therapist continued to co-explore his feelings of
being unlovable and not worthy of love and how this was a longstanding
painful emotion from childhood. Although there was ongoing physical
abuse, John tearfully expresses that the physical abuse was not nearly
the worst of it. The most painful part was “…. a feeling that he
couldn’t care less about me, because if he loved me, he wouldn’t have
treated me the way he did.” As John started to feel comfortable opening
up in relation to what he experienced in his family, the therapist
provided a lot of relational validation and support and empathy for
these painful experiences. The therapeutic relationship in EFT is an
important condition as well as a mechanism of change as we see the
deliberate and automatic regulation principles in operation as the
client initially feels soothed by the therapist’s presence, acceptance,
and validation (deliberate regulation) and eventually internalizes the
soothing provided by the therapist (automatic regulation). In addition,
the emotion transformation principle of corrective emotional
interpersonal experience is demonstrated throughout the therapy; John
feels safe, understood, prized, and accepted by his therapist, which is
corrective and leads to change. A suggestion for between-session work
was given to John starting off with psychoeducation and a rationale
about how it can be helpful to write about unresolved feelings towards a
significant other, and that it would be helpful to the in-session work
the following week, as they had agreed to focus on his feelings of hurt
and resentment towards his father. John agreed that he was comfortable
writing a letter to his father about his unresolved feelings and would
bring it into the session.
John did bring his letter in to the session the following week, and it
was a starting point for his work in the session. The use of the empty
chair intervention to resolve unfinished business for emotional injury
with a significant other was indicated as he had feelings of lingering
hurt and resentment towards his father and had written about this in the
letter. John had several dialogues over the next few sessions
confronting his father and focusing on his unresolved feelings, directed
by the therapist to recall and explore episodic memories of his
childhood as an important process. Initially he starts off with
secondary protective anger which is a typical starting point of
unfinished business. Once he gets past the protective anger, he says
tearfully, “I can’t look at him without crying.” Through these
dialogues, and many tears, he expresses the painful feeling of core
shame, and extreme feelings of worthlessness and feeling unlovable.
Subsequently, from this painful place the newly emerging associated
unmet childhood needs were expressed: “I needed to feel loved, I needed
to feel lovable, I needed a father who cared about me. … as a
result, I have lived my life feeling so worthless.” The therapist
provided a lot of validation for the importance of this need for John,
“It makes so much sense that you needed this! It is a basic human need
that all children need to feel safe, loved, and worthy!”
In a later session John reflects poignantly:
You know, in many ways I never had a family … I’m missing that
particular kind of love, I guess, that … [His voice breaking,
he covers his face, and begins sobbing] … the love that only a
parent could give a child …. [a deep sigh as he gathers
himself]. I had aunts and uncles that, who I know love me, but it
couldn’t make up for it.
Following this, newly emerging healthy anger was expressed towards his
father and an entitlement to his needs, “I am angry at you for how you
treated me! It wasn’t right! I deserved to feel loved! I deserved to
have a father who cared for me!” This assertive anger is a key primary
healthy emotion that assists in transforming unhealthy emotion schemes.
For John, it was important in helping him to access a sense of healthy
entitlement to assert his sense of worth and his needs. Later, this was
followed by the poignant expression of the sadness of grief for the
years he lost with his father in a dysfunctional relationship, as well
as for the boy who felt so unlovable and defective. Grief is also a
healthy healthy emotion whereby individuals can acknowledge their wounds
as they mourn their losses and express their sadness without collapsing
into distress. Once again, the transformation principle of changing
emotion with emotion is demonstrated in this example. Underlying the
secondary protective anger, the painful emotion scheme of shame is
accessed and expressed, which allows access and expression of adaptive
unmet needs, and transforms the shame to healthy assertive and healthy
anger, and the healthy sadness of grief.
At the end of the session, the therapist and John spend some time
reflecting on the in-session work. With the intention to strengthen this
new self-organization of being entitled to feel loved and worthwhile and
angry that these needs were not met, the therapist asks John, “What
does that vulnerable child part of you who was deprived of these
important needs, need from the man you are today to heal from feeling so
worthless and unloved?” John replied, “He needs me to listen to him
and remind him that I love him.” It was suggested to John that if it
fits, he could try to do this between sessions when he was making time
for the boy. In addition, it was suggested to John that it may be
helpful to reflect on what he was feeling in relation to his father and
to share what comes up in the next session if he felt aligned to do
this. In the following sessions, it was apparent that John was
increasingly more compassionate towards himself which was a meaningful
change for John. Self-compassion is an important primary healthy emotion
that allows individuals to internally soothe and care for themselves and
aids in the transformation of unhealthy emotion schemes.