Clinical Practices and Summary
The objective of EFT for depression is to transform unhealthy emotion schemes (in EFT referred to as maladaptive emotion schemes) that are seen as the source of depression. Through the therapy process, primary healthy emotions are accessed to transform unhealthy emotions. To do this, the client needs to be engaged in a process of productive emotional processing which has been shown to be related to good outcome across therapies. In EFT, guided by the principles of emotional change, productive emotional processing involves approaching, accepting, tolerating, symbolizing, regulating, making meaning of, and utilizing or transforming emotions.
In the case illustration with John, an important emotional processing sequence related to positive outcome is demonstrated in the transformation principle of changing emotion with emotion in EFT. For example, in John’s emotional process he moves from the secondary reactive emotion of anger that covers shame, to primary unhealthy shame; this allows him to access and express his unmet needs to feel loved, safe, worthy, and cared for. Subsequently, newly transformative primary emotions of healthy anger, the sadness of grief, and compassion towards self are accessed and expressed with the help of the therapist. This change process reflects the important transformation principle of emotional change in EFT, changing emotion with emotion . Helping depressed clients access underlying primary unhealthy emotions such as shame or fear that are masked by secondary emotions such as anger or hopelessness is an essential factor in treating depression. Equally important, is the provision of a safe, attuned, empathic relationship to facilitate therapy work focused on emotion. In addition, the validation, acceptance, presence, and soothing by the therapist is fundamental to a client’s ability to engage in the in-session work on emotion and represents the transformation principle of changing emotion with corrective interpersonal experience.
In EFT, between-session work is most helpful when facilitated in certain situations. First and foremost, homework is suggested from a close attunement to what is most alive and activated in the client’s current in-session experiential work. The EFT therapist is viewed an emotion coach who is highly attuned to the client’s moment-by-moment experience and facilitates client emotional experience in the client’s developmental learning grasp. Homework may be proposed by the therapist, but it is collaborated on and co-constructed by the both the client and therapist; this helps with engagement and empowers the client to be an active rather than a passive recipient. As all interventions are in EFT, homework should be uniquely tailored to a client’s pain and suffering, therapy goals, challenges, and strengths. Having clients collaborate on and envision the context, of how, when, and with who the between-session work would take place in their daily lives, makes approaching the homework more conceivable and promotes the exploration of it to be experienced as positive and productive no matter what the outcome. Having clients co-design their tasks also empower them to feel a sense of self-efficacy in being able to solve their own problems. In addition, as is the case with any in-session work in EFT, homework is offered alongside experiential teaching and rationales which are highly relevant to the client’s goals and case formulation; this results in an increase in the perceived relevance of the proposed tasks to the client’s goals and current in-session experience. It is important to highlight that compliance is not the goal, but that the purpose is exploration, experimentation, and awareness of what happens, which can be informative and important to advance the therapy process as it reveals where the client is having difficulty. Predicting that homework offered will not go as expected also makes between-session exercises and tasks more approachable. As is necessary with all in-session work in EFT, there must be a strong therapeutic alliance and an agreement on the tasks and goals of therapy. Finally, homework is offered with empathy, relational support and encouragement. If these conditions are facilitated, collaborating on between-session tasks will be experienced by both the client and the therapist as a natural part of the in-session work.