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.