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.