Case Formulation
As EFT is a process-oriented therapy, case formulation is an ongoing working hypothesis about the client’s core painful emotion, arrived at collaboratively with the client and changes throughout the course of therapy (Goldman & Greenberg, 2015; Greenberg & Goldman, 2007). Diagnosis is process-centered as therapists formulate what is happening as they listen for painful emotions that seem central to the client’s suffering and focus on the client’s moment-by-moment, in-session emotional processing. While setting up empathic, collaborative relationships, the therapist is guided by what is most poignant and painful, and the client’s enduring pain becomes the focus of therapy. Initially, the therapist listens to the client’s stories and their presenting issues and learns what brought them to therapy through the unfolding of their narratives. In addition, the therapist asks how clients have formed and maintained attachment relationships in their lives and how they view and treat themselves. Furthermore, by paying attention to paralinguistic cues, a client’s emotional processing style is observed. For example, it is noted whether clients are interrupting their emotions or are overwhelmed by them, whether they can access their emotions to use them productively or are expressing themselves from external or internal narratives. In the second stage of case formulation, therapists form a clear understanding of a client’s core unhealthy emotion scheme and focus on this. By exploring client in-session indicators, secondary and primary unhealthy emotions, core needs, and how a client interrupts their emotions, the therapist starts to understand a client’s core pain and suffering. In the final stage of case formulation, narrative themes are re-visited, and therapy involves reflecting on new emotions and meanings by offering a space for self-reflection and self-construction.
John participated in a treatment study of 46 clients (Greenberg, Warwar, & Malcolm, 2008) that focused on the resolution of specific unresolved, interpersonal, emotional injuries that: were caused by a significant person in the client’s life; had occurred at least two years prior to the start of therapy; and continue to be distressing. EFT was a well-suited treatment approach for John as it is an effective treatment for depression and interpersonal issues. In addition, as John felt that the source of his problems was related to his problematic developmental history with his father, this treatment study also targeted emotional injury from a significant other. At the start of therapy John could not clearly describe how his issues with his father were connected to his current problems. He reported having feelings of lingering hurt and resentment that continued to be distressing towards his father who had not been in his life for over 27 years. As case formulation is an ongoing moment by moment process in EFT, John’s case formulation is discussed as it evolves throughout the phases of therapy.