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.