Dokumen - Pub - Emotionally Focused Therapy For Couples 0898627303 0898621534

ILeslie S.
Greenberg
Susan M. Johnson
Emotionally Focused
Therapy for Couples
Leslie S. Greenberg, Ph.D.
and Susan M. Johnson, Ed.D.
"Greenberg and Johnson describe a fascinating
and powerful new approach to working with coujr
les. The book is rich in clinical detail,, and the tran-
scripts as well as case descriptions really bring the
approach to life. I am going to use this book when-
ever I teach courses on marital therapy."
- Neil S. Jacobson, Ph.D.
uGreenberg and Johnson have accomplished
more than just a wonderfully clear description of
their method of couples therapy: They have rein-
troduced to the field the powerful idea, often forgot-
ten in the last decade, that feelings and emotions
must receive the attention of family therapists just
as much as observable behavior. Greenberg and
Johnson's approach to couples therapy not only
achieves an integrated model of treatment, but
also fosters the integrati.on ofpeople. This is a book
at the frontier ofcontemporary marital and family
therapy." - Alan S. Gurman, Ph.D.
This book demonstrates how emotional experi -
ence in relationships can be used to reconstruct
intimate bonds. Covering theory, research, and
practice, emotionally focused therapy (EFT) is
an integration of experiential and systemic
approaches and rests on a conceptualization of
adult intimacy as an emotional bond. Focusing
on emotion, without ignoring cognition and
behavior, its aim is to increase accessibility and
responsiveness by integrating new aspects of
self into the relationship and rendering posi-
tions more flexible and adaptive.
EMOTIONALLY FOCUSED THERAPY FOR
COUPLES presents the theoretical bases of
EFI', summarizes outcome data, traces the proc-
ess of the initial interview, and covers all ele-
ments of practice. Two extensive case examples
illustrate the steps of EFT, and specific interven-
tions are described for gaining access to emo-
tional experiences and restructuring
interactions. Completing the volume are in-
continued on back flap

Emotionally Focused Therapy
for Couples
LESLIE S. GREENBERG
SUSAN M. JOHNSON
York University
The Guilford Press

New York London
@ 1988 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
All rights reserved
No part of this book may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical,
photocopying, microfilming, recording, or otherwise, without written
permission from the Publisher.
Printed in the United States of America
Last digit is print number: 9 8 7 6
Library of Congress Cataloging-in-Publication Data

Greenberg, Leslie S.
Emotionally focused therapy for couples.
Bibliography: p.
Includes index.
1. Marital psychotherapy. 2. Emotions.
I. Johnson, Susan M. II. Title.
RC488.5.G7 1988 616.89'156 88-1441
ISBN 0-89862-730-3 ISBN 0-89862-153-4 (pbk.)
To Brenda.
-L.S.G.
To the courage and openness of our clients.

-S.M.J. & L.S.G.
Preface
In the last decade the marital therapy field has exploded. Failure to
develop a satisfying intimate relationship with one's partner has been
reported to be the single most frequently presented problem in therapy.
As the demand for this kind of intervention has increased, well-defined
approaches and strategies for improving adult intimate relationships
have been developed and tested.
The approach outlined in this book began with the authors suddenly
facing the task of working with couples and seeking an approach which
integrated intrapsychic and interpersonal dimensions. Both authors have
been trained in individual therapy using the experiential approach and in
systemic family therapy. Not finding a model of therapy which really
seemed to capture the set of interventions we found ourselves practicing,
we decided to write our own manual. The finished product reflects the
experiential focus on the process of individual experiencing and the
systemic focus on patterns and cycles of interaction. However, it also
reflects our focus on the power of emotional experience in relationships
and how such power could be used to reconstruct intimate bonds. The
aim of therapy is to increase the accessibility and responsiveness which
constitute the strength of such a bond, by integrating new aspects of self
into the relationship and rendering relationship positions more flexible
and adaptive.
The name emotionally focused therapy (EFT) does not mean that
cognition and behavior are unimportant in this approach. It simply
means that the experience and expression of emotion is considered
central to the way couples structure their relationships and central in the
process of changing such relationships.
EFT is not advanced as a panacea but as a therapy which contrib-
utes to the field a particular set of interventions which, like all other
Vll
Vlll PREFACE
interventions, must be fitted to the client's immediate and long-term

goals, distress level, presenting problems, and processing style.
The book presents theory, practice, and research because it is our
belief ( 1) that in the field of psychotherapy, the clinician- scientist is the
pioneer who opens up new frontiers, and (2) that theory without practice
or research without theoretical and practical implications is ultimately
not useful or worthwhile.
The book is organized in the following fashion: Chapter 1 provides
background information concerning our view of emotion in general and
our conceptualization of therapeutic change. Chapter 2 presents the
theoretical bases of EFT and a summary of outcome data. Chapter 3
introduces and deals with general issues concerning the practice of ther-
apy. Chapter 4 focuses upon the process of the initial interview. Chap-
ter 5 presents an overview of the steps of therapy and two extensive case
examples. Chapter 6 delineates specific interventions designed to access
emotional experiences and restructure interactions. Chapter 7 discusses
clinical issues which arise in the practice of EFT. Chapter 8 focuses upon
the process of change and research completed on this topic. Chapter 9
focuses on the importance of an integrative perspective.
Throughout the book we often will refer to marital therapy as the
paradigm case for intimate relationships, because marriage is still the
most prevalent form of intimate bonding between adults in our culture.
This does not imply that marriage is the only form of intimate relation-
ship that can benefit from couples therapy. All couples in intimate
relationships become emotionally and interactionally involved in the
ways described in this book.
The view taken here is a basically optimistic and positive one: that
couples seek positive change, that relatively brief couples therapy can
significantly enhance the quality of relationships and individual function-
ing, and that the effective couples therapist has a powerful contribution
to make to his or her clients' lives. We hope that the content of this book
may help to expand such therapist's awareness of the powerful tools that
they hold in their hands.
-7
Contents
Part One. Theory and Research
Chapter One. Emotion in Interaction 3

Emotion in Human Functioning 4
Model of Emotion 9
The Self-Organizing Function of Emotion 11
Communication 13
Intimacy and Emotional Bonds 18
The "I-Thou" Dialogue 20
Cognition and the Emotion Process in Interaction 21
Relational Beliefs and Testing 24
Trust 26
Summary 27
Chapter Two. An Affective Systemic Approach 29

Experiential Theory 29
The Interactional Systemic Perspective 32
Integrating Experiential and Systemic Perspectives 35
The Process of Change 40
The Evaluation of Emotionally Focused Therapy 47
Summary 53
Part Two. Practice
Chapter Three. General Considerations 57

Conditions for the Use of Emotionally Focused
Therapy 59
lX
X CONTENTS
Emotionally Focused Therapy versus
Other Approaches 62
Overview of the Therapy Process 65
Summary 71
Chapter Four. The Initial Interview 72

Assessing Cycles 72
Establishing a Therapeutic Contract 79
Chapter Five. The Process of Therapy 82

Nine Steps of Therapy 82
Case Example: The Porcupine and the Armadillo 104
Case Example: The Wall That Separates: An Intrusion-
Rejection Pattern 121
Chapter Six. Therapist Interventions 148

Task 1: Accessing Emotional Experience 148
Task 2: Changing Interactional Positions 164
Summary 173
Chapter Seven. Clinical Issues 17 5

Issues Arising in the Process of Accessing Emotion 175
Issues Arising in the Structuring
of New Interactions 178
Alliance Mending 180
Training Issues 182
Examples of Change Events Used in Training 184
Using Emotionally Focused Therapy to Address Individual
Symptomatology 189
Contraindications for Emotionally Focused Therapy 193
Integration in Couples Therapy 195
Part Three. Effecting Change
Chapter Eight. The Process of Change 203

What Are the Change Processes? 203
Observers' Model of the Process
of Conflict Resolution 216
CONTENTS ~
Do Interactions Change? 222

What Processes Relate to Outcome? 223
Summary 225
Chapter Nine. Epilogue: Integration 227
References 231
Index 237
Emotionally Focused Therapy for Couples
PART ONE
Theory and Research

CHAPTER ONE
Emotion in Interaction
Close relationships are possibly the optimal context for investigating and
understanding adult human emotional experiences in general and the
emotional processes affecting marriage in particular. The marital rela-
tionship, representing as it does the primary adult emotional bond, is an
area in life in which feelings and their communication play some of their
most powerful roles. Because so much is at stake, feelings are evoked in
the marital relationship as in perhaps no other. The marital relationship
provides the opportunity for interdependence, the chance to have one's
feelings and needs respected, and the opportunity to be the most impor-
tant person to a significant other. This type of relationship between
adults promotes trust, intimacy, disclosure, and the expression of intense
feelings. Therefore, therapy for couples affords a unique opportunity to
observe and study human affective experience and expression in the
context of people's most significant affectional relationships.
Marriage, we are suggesting, is the home of most people's emotional
life. Subtle changes in the experience and expression of emotions related
to intimacy and identity occur continuously in marriage. These changes
provide the individuals ·in the relationship (and the discriminating ob-
server) with a continuous readout of the current emotional state of each
of the individuals and the state of their relationship. When something
goes wrong in a relationship, a change in emotional experience and
expression is usually the first indicator that there is a problem. Emotions,
we will argue, are complex syntheses of all that is being experienced;
therefore, they provide the most accurate feedback available on a per-
son's current state. When a situation deteriorates or improves, a change
in emotional experience and expression is the index of the situational
change. Feelings, because they are less susceptible to distortion and
conscious control than thinking, are often the best clue to what is going
on within and between people.
3
4 THEORY AND RESEARCH
The practice of marital therapy thus requires a heightened sensitivity

to the emotional conversation that occurs between two people. When a
couple come into therapy, they are generally in emotional pain. They
have been unable to have their feelings understood and their needs and
wants responded to. They feel invalidated by their partner. A therapy
that can successfully help partners access this emotional pain and help
them communicate it will make a significant difference in the quality of
the relationship.
Emotions are primary and universal aspects of human experience,
yet they have not been emphasized sufficiently in theoretical explanations
of change. Although a number of excellent therapists have been highly
adept at working with the experience and expression of feelings in
therapy (Kempler, 1981; Perls, 1973; Rogers, 1951; Satir, 1972), a clear
framework for working with emotion in therapy has not been articulated.
In this book, we attempt to lay out an initial framework for working with
emotion in couples therapy and describe our general approach to chang-
ing distressed relationships.
EMOTION IN HUMAN FUNCTIONING
Emotion has long been the cornerstone of psychology and psychother-

apy, yet it remains a complex and confusing phenomenon. Nevertheless,
advances in the study of emotion have led to a growing consensus of
opinion among theorists and researchers on certain aspects of emotional
functioning. It is becoming increasingly evident, for instance, that certain
primary emotions are biologically adaptive and motivational in nature;
also, it has been found that emotion serves an important communicative
function in social interaction (Buck, _1984; Greenberg & Safran, 1984a,
1987a; Izard, 1977; Izard, Kagan, & Zajonc, 1980; Plutchik & Kellerman,
1980). Infants provide much evidence as to the biological roots of emo-
tion. For instance, they have been shown to have in-wired emotional
responses to specific stimulus configurations. Infants show signs of fear
both to looming shadows and to spider-like forms; they show joy in
response to human facial configurations and anger at restriction. Con-
tact-comfort has been shown to be a primary need of humans as evidenced
by infants' failure to thrive in environments without sufficient human
nourishment. Attachment and loss responses also appear to be in-wired;
infants show anxiety in response to strangers and distress at separation.
EMOTION IN INTERACTION 5
In addition, study of the development of affect is beginning to show an

innate sequence for the onset of different emotions. Distress and smiling
appear in the first months of life. These expressions precede signs of
anger or fear, which appear only after 4 and 8 months, respectively
(Izard, 1979). In addition, certain universal aspects of the facial expres-
sion of emotion have been identified from cross-cultural studies of the
facial expressions of emotion (Ekman & Friesen, 1975), indicating that
these expressive patterns are also in-wired.
The center of our argument concerning the role. of emotion in
therapy in general (Greenberg & Safran, 1984a, 1987a)-and in couples
therapy in particular (Greenberg & Johnson, 1985, 1986)-is that emo-
tions play a potentially adaptive role in human relationships. Emotions
provide an important basis for human behavior. They amplify the effects
of motives on behavior; they orient us toward or away from different
objects in our environment; they constitute a connection between us and
our environment. Emotions are not self-centered nor are they indepen-
dent of others. Rather, they are directed toward others. In this sense,
emotions are not simply inside us, but rather they are actions that
connect us to the world. To feel is to want to act in relation to the world
and to be organized to do it. Emotions are not, however, the same as
drives. Instead, they are rapid, direct responses to situations. They orga-
nize us for action but do not cause or lead to behavior directly; additional
higher level processing of the emotional response leads to motivated
action. Emotions thus provide the impetus for action although they do
not necessarily lead directly to behavior by themselves.
Often feelings are regarded as unimportant and people's experiences
are discounted by labeling them as "just emotional" or "irrational." In
fact, emotions provide essential information about our reactions to situa-
tions, which can be either attended to or ignored. Individuals are com-
plex information-processing systems constantly integrating information
from multiple internal and external sources. The affect subsystem pro-
vides important biologically adaptive information to the total system
(i.e., the person). People function optimally (1) when they utilize all
possible available information to guide their actions and (2) when they
do not use their resources to block out useful internal or external informa-
tion. Having clients in therapy pay attention to their biologically based
affective responses helps them utilize an important source of adaptive
information to aid problem-solving. For example, attending to affective
information helps people to identify with the action tendencies associated
with emotion; furthermore, identification with previously disclaimed ac-

tion tendencies results in more unified, coherent action and thereby
improved interaction.
Emotions can be more or less affected by social experiences and can
thereby be broken into two broad classes for heuristic purposes-biologi-
cally based emotions and socially derived emotions. Those feelings that are
automatic direct responses to situations are biological, and other, more
derivative emotions are social. The latter are complex derivatives of the
former and reflect the influence of learning and culture. They are not
inherently biologically adaptive, and they may or may not' be socially
adaptive. They depend on personal and societal factors and current condi-
tions for their occurrence, and their forms of expression depend on cultural
factors rather than being in-wired. Thus, for example, pride and envy are
socially based emotions that depend on what is culturally regarded as
valuable whereas primary sadness and anger are biologically based re-
sponses to loss or intrusion. The human experience and expression of anger
and sadness can, of course, be strongly influenced by learning. The emotion
system's susceptibility to social influence, however, does not negate the
existence of primary biologically adaptive responses in human beings.
When working with emotion in the creation of therapeutic change, it
is useful to differentiate clinically between classes of emotional expres-
sion (Greenberg & Safran, 1984b, 1987a). Emotions can be divided into
four main categories. The biologically based category is called "adaptive
primary emotions"; two more culturally based categories are referred to
as "secondary emotions" and "instrumental emotions"; and a final cate-
gory, in which biological and cultural factors interact, is called "maladap-
tive primary emotions."
It is only the experience and expression of adaptive primary emotions
that convey biologically adaptive information that aids in problem-
solving, unified action, and constructive interaction. Secondary emotional
reactions often take the form of defensive coping strategies and are
counterproductive in creating change; their expression is, in fact, often
problematic. Secondary responses are the emotional reactions that behav-
iorists and cognitive behaviorists often claim need to be bypassed or
curtailed in therapy. These secondary reactions are often readily available
to consciousness, and the desire to lessen their intensity is often a motiva-
tion for therapy; for example, anger or bitterness toward one,s spouse can
lead to a request for help. Potentially dangerous derivative emotions such
as hatred, revenge, and rage also belong in this secondary category.
To access or heighten secondary reactions in therapy is uncalled for

and could be highly detrimental. Secondary emotions are, however, im-
portant cues for exploring underlying thoughts and feelings. The thera-
pist, then, has to distinguish between secondary reactions and more pri-
mary biologically adaptive emotional responses. This is a mattef of
clinical judgment; anger, for example, can be a primary affective response_
to being violated or a secondary reaction to underlying hurt .or fear. For
example, a woman saying angrily to her husband, "You make me angry
when you don't respond to my touch," may be expressing something quite
different from the woman who says in an angry tone, "Don't tell me who
to be and what to do in my job." In the first case the woman feels hurt and
rejected, and the anger may be a secondary response masking the underly-
ing adaptive feeling of sadness and the need for affection and contact. In
the second case, the woman, feeling that her boundaries are being vio-
lated, is adaptively asserting her rights and signaling with her anger that
she will not allow herself to be dominated. Of course, judgments are
always dependent on context.
Instrumental or functional emotions are emotions that serve a pri-
marily interpersonal function and are often referred to as "roles" or
"manipulative feelings"; examples are expressing helplessness to gain sym-
pathy or expressing anger to avoid responsibility. These expressions are
used to manipulate the responses of others. Such emotional expressions
are relatively easy to interrupt; since the person is in control and can alter
his or her focus of attention, it is easy to divert his or her attention away
from this state. Therapists who focus on instrumental feelings generally
emphasize either understanding why clients do things or the interpersonal
effects of what they do.
Maladaptive primary emotional responses are direct immediate re-
sponses to situations, such as fear of heights, in which the biological
response has become maladaptive. These come about through a negative
learning history in which certain feelings become conditioned to particular
stimuli. In couples therapy, maladaptive emotional responses can be
found in certain cases of fear of intimacy in which a person has learned
that closeness or touch can be dangerous and therefore reacts with fear or
anger. In these cases, the maladaptive primary emotion needs to be
accessed and modified.
Primary emotions, as opposed to secondary reactive and instrumen-
tal emotions, are often not fully in awareness when the client comes to
therapy; they are instead unacknowledged, disavowed, or simply not
being attended to. It is "getting in touch" with these feelings that seems to
be helpful to therapeutic change. When a woman is able to fully expe-
rience the loneliness or fear underlying her aloofness or a man is able to
experience without blame the hurt he feels, the couple will melt into
genuine intimate contact.
Primary emotions come into awareness by means of a synthesis of
sensory and perceptual information and help to form new meanings and
to organize internal experience in a new way. Thus, attending in the pres-
ent to the constant tightening in her jaw and stomach and her feeling of
wanting to curl up and hide can help the woman crack through her aloof
exterior into an acknowledgment of her fear and need to protect herself.
The experience of feeling primary emotions seems to carry its own stamp
of authentication; the client does not doubt their veracity but is rather
intensely involved and moved by them. Feeling involves bodily felt
sensations and is often accompanied by images and evocative language
indicating that the feeling is actually experienced and not just talked
about.
Primary emotions often underlie the stable interactional positions
occupied by distressed partners. Thus, anger or fear may underlie a
defensive position, or fear may underlie an attacking position. Primary
feelings are thus a rich source of information and can be used in therapy to
create new perceptions, responses, and interactional patterns. For exam-
ple, a therapist might work with a client to raise to awareness a primary
emotional experience of sadness and loss underlying a secondary response
such as anger, which placed the partner in the role of wrongdoer.
For the therapist to use emotion as an agent of change, he or she
must continue to explore and probe for affect that is currently unavail-
able and that, when encountered, has a deeply involving or newly discov-
ered quality; for example, the discovery by one partner of a fear of
abandonment or a need for love, which is not generally experienced or
spoken of and which underlies this partner's secondary or instrumental
response of anger, can come as a revelation to both members of a couple.
This new synthesis then has the potential to act as a change agent on both
intra- and interpersonal levels. Hence, the therapist must be able to
identify different classes of emotional experience and adjust his or her
interventions to each. The therapist also must have the skills to evoke
emotional experience, in the present, and to help the client to engage fully
in the experience. This is very different from teaching clients to label
physiological cues or rationally restructuring their experience through
insight. It is the difference between thinking about feeling and feeling

itself, between experience remembered and life itself. New experience
thus needs to be evoked in the present in order to promote adaptive
problem-solving.
A therapist working with emotion in couples therapy, therefore,
needs continually to be assessing whether a particular emotional response
is a primary or secondary reactive emotion. In the latter case, the emo-
tion should be bypassed or probed, to uncover the underlying feeling.
Only primary adaptive emotional responses should be heightened, ex-
pressed, and explored. Thus, the rationally oriented therapist who advo-
cates suppression of feeling and emotional expression in favor of rational
deliberation is, in our view, referring to secondary emotions rather than
primary feelings. Of course, it may be appropriate to discuss the underly-
ing reasons for secondary feelings. For instance, when a partner reports
feeling disappointed, frustrated, or angry at the actions of a spouse, the
therapist needs to delineate the reasons for this response. When, how-
ever, it is discovered that the disgruntled spouse feels unworthy and
unlovable and has felt this way since childhood, it is important to help
him or her acknowledge this experience and express the pain and fear of
criticism. This leads ultimately to the owning of disclaimed experience
and to a focus on self rather than on blaming the other. It also simultane-
ously allows the other, no longer under attack, to be more responsive.
Cognitive and behavioral analyses of couples interaction that do not
include an analysis of emotional processes always miss describing the
whole picture; the refore, they provide less than satisfying accounts of
psychotherapeutic change processes. Only when we begin to conceptual-
ize and analyze therapeutic processes in terms of the combined affective,
cognitive, and behavioral processes involved will we begin to adequately
cover the domain of psychological processes relevant to therapeutic
change (Bradbury & Fincham, 1987). An integrative endeavor of this
nature, however, first requires an explication of emotional processes in
couples therapy.
MODEL OF EMOTION
A comprehensive model of emotion, which, similar to Magda Arnold's

pioneering view ( 1970), emphasizes the role of intuitive appraisal and the
associated adaptive action tendency in emotional experience, seems best
IO THEORY AND RESEARCH
to capture the role of emotion in therapeutic change. In this view, an

emphasis is placed on the fundamental role of the initial, perceptual
experience in the construction and organization of reality (Greenberg &
Johnson, 1985, 1986; Greenberg & Safran, 1981, 1984a, 1987a; Safran &
Greenberg, 1986). Emotional experience generally is seen as having very
little to do with conscious, logical, or higher level conceptual processes.
The experience of feeling sad or feeling angry is much more similar to
"apprehension" or "seeing" than it is to reasoning or solving a logical
problem. In some fundamental sense, then, emotional experience is
prereflective; it is not explicit and deliberate but rather is immediate and
reflexive. This does not mean that emotion is free of cognition. Emo-
tional experience is the product of a preattentive, constructive synthesis
of a set of incoming information. This integrative product is experienced
as emotion and serves to orient us to the world, strongly influencing our
view of ourselves and everything around us. Hence, emotion is essentially
information about our current state and processes; it is also the most
comprehensive source of feedback we have about what is occurring for us
in the moment. This feedback must be attended to in order for it to be
informative; ignoring this information not only makes problem-solving
less informed but also puts the person at risk since important survival-
related information is ignored.
In a related vein, Leventhal's perceptual motor-processing model of
emotion (1979), in which emotion is viewed as a complex integration of a
number of different information-processing components, has recently
been adapted for use in psychotherapy (Greenberg & Safran, 1984a,
1987a). In this model, cognition and emotion are best viewed as being
intertwined or fused complexly rather than linearly related; although
conscious rational "thinking" and conscious passionate "feeling" may be
experientially distinguishable, both feeling and thinking involve cognitive
and affective processes operating at an automatic level, out of awareness.
There is thus no thought without feeling and no feeling without thought.
In this integrative perspective, emotional processing is seen as in-
volving three distinct automatic mechanisms: an expressive motor
system; a schematic or emotional memory; and a conceptual system that
stores rules and beliefs about emotional experiences. In this model,
expressive motor responses are elaborations of responses that were bio-
logically in-wired in the neonate. Schemata are representations of prior
emotional experience that contain stored subjective reactions, stimulus
features, and physiological responses to earlier situations. In addition to
storing earlier experiences, schemata act to guide attention and percep-

tion in current information gathering. The conceptual system is con-
cerned with conscious and volitional processing and can analyze and
evaluate concrete experience, storing the situational antecedents and
consequences of feelings. Experienced emotion results from a preatten-
tive synthesis of expressive motor information, implicit emotional sche-
mata, and conceptual cognition. These components are all aspects of a
person's current experience, much of which is out of awareness. All of
these components are continually being integrated to form conscious
emotional experience. In this model, affect, cognition, physiology, and
behavior are all integrated into a comprehensive model of human emo-
tion. Emotion is thus viewed as providing a framework for perception as
well as motivating behavioral responses.
Network analyses of emotions, such as the one described above, have
begun to be advanced by a number of authors in order to explain how
emotion is produced (Bower, 1981; Lang 1979, 1984). These authors
propose that emotional experience is a construction from physiological
and motor responses, emotional memories, and ideas rather than an
inference made from behavior and the situation, as proposed by earlier
cognitive models of emotion (Schacter & Singer, 1962). In these network
analyses, activating any one of the components of the network stimulates
the other parts of the network. Thus, the evocation in therapy of particu-
lar thoughts, meanings, memories, or expressive motor reactions can be
seen as having a priming effect on the other components and on the
whole network. Emotion is evoked in therapy by attending to and height-
ening available components. Attention to the components serves to acti-
vate the total network with which the components are associated. (The
kinds of techniques that are consistent with this theory of affect and that
are used for working with emotion in couples therapy are the subject of
this book.)
THE SELF-ORGANIZING FUNCTION OF EMOTION
Emotion is best thought of as a disposition to act (Lang 1984). Emotion

is thus a relational experience connnecting the individual and the envi-
ronment; people experience emotion in relation to people or objects in
the world that they are angry at, sad about, or afraid of Also, accom-
panying any feeling is a tendency to act; however, these tendencies or
action dispositions may or may not be transferred into goal-directed

action depending on decisions executed by higher order processing.
Different classes of action are inherent in different emotions, and
exactly what action is taken is a function of learning. Anger, for example,
will lead to aggressive behavior if carried through into action, but the
specific behavior chosen, whether verbal or physical, is a function of
learning. Fear will lead to self-protective, flight behavior if carried into
action. But how that flight is enacted is influenced by experience. Loneli-
ness can lead to affiliative behaviors, which play a strong role in terms of
the survival of the species. Love can lead to affiliation and to procreation.
There are many examples of the interaction of biology and learning
with emotion and action. The infant, for example, has certain innate
responses to looming shadows and facial configurations. These responses
are integrated over time, with experiential and conceptual learning, into a
set of more complex automatic responses, which can be highly adaptive.
In a further example, in a situation in which an individual is physically
threatened, a neural impulse is centrally generated that leads directly to
expressive motor behaviors, promoting fight or flight. Muscle tensions in
the body prepare and organize a person for adaptive action, be it to run
or to defend. The person is thus automatically organized in a complex
fashion with a particular response readiness. Learning interacts with this
organization to rapidly generate specific adaptive behavior in response to
an event that requires action.
Emotions thus help organize people to cope effectively with the envi-
ronment. In addition, human emotions possess a certain salience that
serves to override other cues and to ensure that we attend to emotionally
generated information. Thus, what we feel rather than what we think is
most likely to determine what we do in situations of stress or relaxation.
Our emotions guide our actions unless we deliberately act contrary to the
dictates of feeling. In this sense, emotion can be said to serve a self-
organizing function; we are organized by our emotions to act sad, vulner-
able, deprived, or angry. This self-organizing function of emotion is
crucial in couples therapy, in that what partners feel strongly influences
what they do, how they act, and how they perceive their loved ones.
People are thus active perceivers who construct meaning and organize
and are organized by what they see and hear. Conscious meanings and
perceptions are constructed from the base of the individual's current
emotional state and experiential organization; thus, emotions, thoughts,
bodily sensations, and images are all aspects of the ongoing experiential
process, the organization of which determines the person's behavior

(Greenberg & Safran, 1987b). It is also significant that, at any one
moment, more is going on than is available to awareness or observation;
a person's current organization of experience utilizes only some of the
information available to the person and structures this into only one of a
number of possible self-organizations.
According to this view, people can, depending on their current synthe-
sis of tacit, subsidiary information, be at one point organized as vulner-
able and at another time as assertive (Kaplan & Kaplan, 1985), although
at any one time, there is a particular organization that dominates while
other organizations and aspects of experience are not in focal awareness.
In this manner, a person's immediate organization of experience domi-
nates focal awareness and- governs functioning. For instance, a person
who organizes experience in terms of feelings of hurt and rejection is
inclined to perceive a spouse's actions as directed against him or her,
whereas when this same person organizes these experiences as feeling
loved, he or she may perceive the spouse's same actions as unrelated to
him or her. But if the individual's dominant self-organizations are re-
stricted, his or her response alternatives are limited as well. Hence, an
emotionally focused therapy must address each person's current emo-
tionally based self-organization and the factors influencing this organiza-
tion.
COMMUNICATION
The significance of communication in marriage and family therapy was

initially highlighted by the Palo Alto group (Bateson, Jackson, Haley, &
Weakland, 1956; Jackson, 1967; Watzlawick, Beavin, & Jackson, 1967).
Their analyses of communication set the stage for much of what followed
in the field. They posited that people are always communicating, that
everything done in a relationship is a form of communication, and that it
is impossible not to communicate. In addition, they focused on the
hierarchical structure of communication. They also pointed out the
difference between the report and command aspects of a message, in
which the sender both communicates something (report) and gives a
message about the communication, such as how to interpret it (com-
mand). They found differences between analogic and digital communica-
tion also to be of note. Analogic communication refers to its object by a
representation, usually nonverbal in nature, which has a likeness to the

object but is somehwat ambiguous, such as the shaking of a fist or the
blowing of a kiss. Digital communication represents its object by an
arbitrary name but enables logical precision. The importance of analogic
communication in defining the role of each person in a relationship was
stressed (Bateson, 1955). However, even though the Palo Alto group
recognized the importance of analogic communication, they emphasized
the cognitive, informational aspects of the communication process,
thereby focusing on the encoding and decoding of messages and failing to
pay sufficient attention to the affectional and motivational aspects of
emotional communication. Their basic model of the person was that of a
cybernetic information-processing machine; feelings did not form a part
of this machine. Our model, however, adds emotion to the picture. It
involves a more complex human being, a motivated, affective-cognitive,
information processor. This view regards both emotion and communica-
tion as determinants of behavior and thus can be thought of as offering
an affective-systemic approach to couples therapy.
A great deal of human communication is analogic, emotional commu-
nication, in which small nonverbal signals of emotional states are ex-
changed. People constantly monitor emotional communication, sending
and receiving emotional signals facially, gesturally, and paralinguisti-
cally, and this strongly influences ongoing interaction. The nonverbal
signaling of one person's emotional state to another and the picking up of
this signal is an important part of the work of relating. For example,
depending on all of these factors, the words "I love you" can be genuinely
caring, or they can be extremely hostile. Thus, in couples therapy, the
therapist must observe and listen to the nonverbal emotional conversa-
tion occurring between the partners.
The notion of emotional expression as a biologically based signal
system was first suggested by Darwin ( 1873). In The Expression of
Emotion in Man and Animals, Darwin argued that facial expressions
and other displays had adaptive value in social animals because these
expressions essentially signaled something about the animal's inner state
and that this allowed greater prediction of behavior, greater cooperation,
and the possibility of avoiding unnecessary lethal conflict. This develop-
ment required the evolution of both sending and receiving mechanisms in
the domain of emotional expression. The function of emotions and their
expression, in addition to orienting the organism in the world, is the
communication of this orientation to others. The facial expression of
emotion is known to be cross-culturally consistent (Ekman, 1972) and

generally has priority over verbal expression when the two are inconsis-
tent (Mehrabian, 1972). Thus, the facial expression of emotion is a
powerful regulator of social interaction. For example, facial expression
associated with aggressive emotions communicates an intent of attack
and could intimidate the enemy into leaving. Similarly, facial expression
associated with fear might signal to another individual to come to the
threatened individual's assistance.
Voice quality has also been shown to convey different emotional
states that influence interaction. Dominance, submission, and sympathy
have been shown to be identifiable by vocal characteristics, while emo-
tions such as anger, sadness, indifference, and joy are easily recognizable
from vocal cues alone (Scherer, 1986).
We suggest that the nonverbal signaling function of emotional ex-
pression is of great importance in couples therapy. Emotional expression
is spontaneous rather than intentional or deliberate, and it is analogic
rather than symbolic. The face, for example, will often display anger,
disgust, sadness, or joy before the reaction can be controlled. Smiles are
often used to mask certain feelings but the "felt smile" can be dis-
criminated from a smile masking anger by the different facial muscles
involved (Ekman & Friesen, 1975). Thus, when one partner criticizes the
other, a momentary look of hurt may be seen in the eyes and mouth
before the recipient of the criticism organizes him- or herself to rebut in
anger. Often, when couples quarrel, they tune out the content and listen
only to the tone of voice to evaluate whether the message is hostile or
friendly.
Nonverbal emotional expression is clearly a visible and observable
signal accompanying an emotional state and is generally not under
deliberate control. It is therefore influential in people's reading of each
other's states, particularly when they do not trust the other person and
are searching for valid cues. Thus, facial and vocal expression is trusted
more than content, since emotional expression is the externally observ-
able manifestation of an internal experiential state. It is important to
note, however, that the relationship between experience and expression is
not that of two separate sequentially or causally related processes but
rather of two interdependent processes, that is, expression is not the
external communication of an internal preexisting state but rather a
constitutive aspect of the human emotional experience. Thus, the facial
expression of emotion is integrally involved in the experience of emotion
rather than simply being an external means of conveying what is occur-

ring internally.
Communication of emotion is, in addition, a complex interactional
process, and it is the reciprocal expression of nonverbal emotional cues
that governs much of what occurs in interactions. Intimacy, for example,
is highly controlled by reciprocal nonverbal signals. Signals such as eye
contact, body lean, and spatial placement are highly interactive. When
there is a matching of expectations and desire for involvement between
people, nonverbal signals tend to be reciprocal. These signals are also
used to compensate and offset the behavior of the partner when expecta-
tions and preferences are being violated (Argyle, 1969). The emotional
conversation between partners carried on at the gestural level is therefore
an extremely important aspect of couples communication and couples
therapy. If the therapist is to change the conversation between people in a
marriage, it is essential that the emotional communication be restruc-
tured as well.
Affect is thus a primary signaling system in interpersonal interaction,
since emotion in humans serves a communicative function. From birth,
infants are equipped with a set of adaptive expressive patterns long before
their cognitive capacities are developed. From the start, infants, through
certain organized behavior patterns, communicate their needs, wants, and
distress. Their ability to communicate through the facial musculature is
uniquely developed and serves as a nonverbal system of affective communi-
cation. This affective behavior is not a release but a form of communication
that is either understood or misunderstood by the parent. Babies do not cry
to feel better; they cry to get mommy or daddy to make them feel better.
Affective expression, therefore, is a crucial form of communication.
The expression of particular emotions has particular significance in
human interaction. For example, vulnerability tends to disarm while
anger creates distance. The expression of fear and vulnerability, besides
evoking compassion, also communicates analogically that "this is not an
attack" and often represents a major change in position in the interaction
by that person, especially if the prior position was either blaming or
withdrawing. Similarly, expressions of sadness and pain communicate a
need for support, while newly recognized or expressed anger and resent-
ment can help define differences, delineate individual boundaries in the
relationship, and represent major changes in position in an interaction.
All are complex means of analogic communication.
The degree of closeness- distance and dominance- submission, the

two indices of greatest importance in assessing interaction in couples,
can be changed effectively by appropriate modification of affective ex-
pression. Expression of fear or sadness tends to evoke protection and
compassion in the partner, and this can result in closeness. On the other
hand, anger or disgust produces clear personal and interactional bound-
aries and can result in greater independence, appropriate separateness,
and recognition by the partner of the other's rights. Thus, expression of
vulnerability and need draws people close whereas expression of anger
drives people away. It is the emergence of emotions in the session as
both currently lived experiences and changes in expression that is im-
portant in providing new information in the relationship. This infor-
mation is derived both from the analogic level of communication and
from the difference between the new and the earlier expressions. Thus,
it is not the oft-repeated litany of stale resentments or the contin-
ually expressed sadness or complaining that is sought after in this ther-
apy but rather the previously unexpressed resentment or the buried
sadness.
Finally, communication also serves to determine and maintain the
emotional state of self-organization of one's partner. As previously
stated, one's current state or organization dominates awareness and
governs functioning. This state of organization is, however, a field event
affected by current forces both from within and without the individual
(Kaplan & Kaplan, 1985). Thus, communication received from one's
partner is highly influential in determining one's own current state.
Therefore, communication patterns can maintain current feeling states as
much as current feeling states can maintain certain communication pat-
terns. A person's current experiential state or self-organization is thus
constructed both from internal and external information. Emotional
states organize certain interactional stances and verbal and nonverbal
patterns of communication, while interactional stances and communica-
tion patterns reciprocally organize certain emotional states and the avail-
ability of internal resources and capacities. Thus, a particular state of
self-organization, such as vulnerability or confidence, will alter the type
of message sent in a communication; however, equivalently and co-
equally, a communications stance characterized by acceptance or interest
by one partner can evoke or maintain this new self-organization in the
other partner.
INTIMACY AND EMOTIONAL BONDS
In understanding the origins of emotional life, the need for attachment is

of primal importance. Other needs or drives such as mastery and curios-
ity are important, but attachment is particularly significant in couples
therapy. Attachment needs seen in infancy (Bowlby, 1958, 1969, 1973,
1980), and the primary tendency toward other relatedness, as postulated
by object relations theorists (Fairbairn, 1952; Greenberg & Mitchell,
1983; Guntrip, 1969), appear to be crucial human drives.
Attachment behavior is aimed at maintaining closeness and contact
with other people, particularly with primary caregivers. Harlow (1958)
showed that contact-comfort was a primary mediator of attachment in
primates. Baby monkeys crave touch as much as they crave food. The
attachment system provides infants at birth with a repertoire of inborn
expressive motor responses that enable them to interact with their care-
givers very early in life (Bowlby, 1980).
Marriage, along with other forms of coupling, is a social framework
for the attainment of adult intimacy; it is also one of the most acceptable
social vehicles for human closeness. Just as baby monkeys and children
only feel free to venture forth when they can return to the soothing
softness of a caretaker, so do adults fare much better in the wide world
when they can return for emotional refueling to the haven of a suppor-
tive marriage. The dual psychological processes of connecting and sepa-
rating, joining and individuating, are central to marriage. The closer
people get, the more they are able to be separate; conversely, if people are
not able to be separate they cannot be close. In this dialectical process,
people move from closeness to distance with love and hate and compas-
sion and anger as the joining and separating emotions. Intimacy and
vulnerability are aspects of the communal connecting tendencies, while
boundary setting and contracting are aspects of separating tendencies
(Bakan, 1967).
In our view, interdependence is the goal of healthy attachment. As
object relations theorists have pointed out, a basic tendency in human
nature is to seek contact and connection with other humans. From birth
to old age, human connectedness is an essential need. Interdependence
then is the highest form of development, not independence, as is posited
by many developmental theorists. Interdependence is characterized by a
caring for the other as well as a need for caring, by a concern for the other
as well as a need for support. Maturity in the adult thus involves both a
need for the other and the ability to respond to the needs of the other.
Therefore, the mature adult is a person who needs people and who
possesses the ability to seek and give support. The ability to make and
maintain connections is the true sign of optimal development.
Attachment needs are thus an essential aspect of adulthood and
form the core of the emotional bond in close relationships. Adults, like
children, show a need for easy access to the attachment figure or partner;
a desire for closeness to that figure, especially in times of stress; comfort
and diminished anxiety when accompanied by their partner; and an
increase in distress and anxiety when the partner is inaccessible. If the
affectional bond is perceived as threatened, then attachment behavior
such as clinging, crying, or angry coercion becomes more extreme. In
distressed relationships, where disagreement and distance are perceived
as threatening, such behavior is commonplace and every disagreement is
viewed as a possible threat. Bowlby (1969) placed attachment in the
framework of evolutionary adaptation: In a dangerous world, a close and
responsive attachment figure ensured survival. People alone are essen-
tially powerless and vulnerable, while in pairs they can protect and care
for each other. Attachment behaviors such as clinging and crying are
then adaptive mechanisms rather than a sign of neurosis or developmen-
tal failure. When attachment behaviors achieve their aim and the bond is
secured, then stress is alleviated; if not, withdrawal and despair will ensue
(Bowlby, 1973).
Attachment behaviors can be accounted for in terms of goals and
information-processing. If a set goal of proximity to an attachment figure
is not met, then attachment behaviors will be initiated to create that
proximity. From this point of view, the blaming coercive man who
continues to blame-even though he understands this drives his partner
away-is involved in a desperate need to achieve closeness. Such behav-
iors, governed as they are by set goals, are difficult to bring under
cognitive control; rather, it is the emotional bond that must be restruc-
tured to allow for the closeness and responsiveness necessary to satisfy
the attachment need (Johnson, 1986).
Conflict in couples involves a struggle for separateness and con-
nectedness. In this struggle, each individual searches to satisfy his or her
basic needs for identity and security. Failure to resolve the inevitable
conflict around intimacy leads eventually to feelings of alienation and
deprivation. It is in the context of an innate human need for close contact
with others, a context in which emotional attachment to a few significant
others is a requirement for psychological well-being, that distress in

relationships needs to be seen.
Thus, relationships are a natural arena for the gratification of basic
human needs, and their problems emerge far more from unmet adult
needs than from the neurotic expression of infantile needs (Wile, 1981).
Partners need to be able to reveal their essential selves to each other and
be accepted as they are. They need to be able to say what they feel most
deeply and what they think most profoundly without fear of rejection or
fear of hurting the other. Buber has described this form of relating as the
attainment of an I-thou dialogue.
THE "I-THOU" DIALOGUE
..'Marriage will never be given new life except by that out of which true
marriage always rises, the revealing by two people of the Thou to one
another" (Buber, 1958, p. 51). Over a long period of time, the quality of
close relationships depends on their trustable core-the genuine dialogue.
This dialogue is characterized by Buber as possessing qualities of "pres
ence," in which people make themselves present to each other, "inclusion,"
which is the process of letting another in on one's inner thoughts and
feelings, and "mutuality," in which the above processes are engaged in by
both parties. The genuine dialogue is nonexploitive, and it is a great
resource in relationships, leading to reciprocal giving and mutual benefit.
Buber's notion of the healing that occurs from the "meeting" in the I-thou
dialogue points to the human need for connectedness and the importance
of the emotional bond. In this type of meeting, presence, directness, and
immediacy characterize the moment in which two people genuinely care
about each other's side of the dialogue. Dialogue thus involves responsible
position-taking by both people. In contrast, a manipulative response fo
cuses only one person's expectations and definitions. In an I-thou dialogue,
partners do not impose themselves on each other, nor do they attempt to
have their partner see the world in their manner. The imposer or manipula
tor is interested in another person's qualities only in terms of how they can
be exploited for personal gain. This is not dialogue; dialogue is simultane
ously self-delineating and self-validating for both partners.
Buber refers to the sphere of the interhuman as being of great
importance; this is the sphere between partners in which reality is created.
As Buber proclaims, "the inter-human opens out what otherwise remains

unopened." Couples in dialogue break through the alienation of "seem-
ing" to the communication of "being." They also break through the
inadequacy of their restricted perception of the other and engage in what
Buber calls a person-making present, to see the other as a whole, not to
view him or her analytically or reductionistically. In this process, an
attempt is made to make present to oneself the real person who confronts
one in his or her entirety, wholeness, unity, and uniqueness. This is a
process of forever creating self anew. Where there is genuine dialogue
between partners there is thus brought into being, between partners who
express themselves without reserve and free of semblance, a fruitful
partnership that can be found in no other way. I-thou dialogue is thus
in and of itself healing and generative. Achieving this kind of contact
between parties in therapy is both the process and the goal of therapeutic
change.
COGNITION AND THE EMOTION PROCESS

IN INTERACTION
An important purpose of thinking is the creation of meaning. Emotion is

also involved in providing meaning (Solomon, 1977). Meaning is thus the
overarching concept that integrates emotion and cognition in therapy.
The human being is a constructive information processor who continu-
ally creates meaning based on cognitive and affective processing; mean-
ing then determines much inner experience and overt behavior. Ulti-
mately it is complex constructions or views of reality that govern
interactions in couples and need to be changed in order to change these
interactions. In cognitive psychology, the notion of schemata has come to
represent the individual's internal representation of reality. It is these
schemata, particularly the more affectively based ones, that are the
ultimate target of change in emotionally focused therapy.
Perceptions of one's partner's intentions and behaviors is dependent
on a complex blend of selective attending that results in certain construc-
tions of the other as having particular motives and intentions. These
constructions are based on past learning with significant others and with
the partner. They are stored in the schematic emotional memory and may
lead to distorted perceptions of one's partner or hypersensitivity to minor
manifestations of particular attributes in one's partner. It is these sche-

mata that ultimately require change if the couples are to enjoy lasting
hange.
As mentioned earlier, emotional life and cognitive life are practically
inseparable although theoretically distinct. All interactions with the envi-
ronment involve affect and cognition. There is no affective behavior
without cognitive behavior; hence, since affect and cognition are two
aspects of behavior, it makes no sense to discuss which one causes or
precedes the other. Emotion and cognition are more complementary
aspects of human functioning, not separable entities.
Yet, although we favor the theoretical position that emotion, cogni-
tion, and action are more fused than separate, it is helpful when talking
about clinical practice to distinguish among processes that are predomi-
nantly emotional or predominantly rational or predominantly behavioral.
A repertoire of therapeutic interventions already exists that focuses on
changing what individuals feel, think, or do, or how people interact.
Interventions such as prescribing interactional cycles, setting homework,
challenging beliefs, or reflecting feelings are thought of, respectively, as
interactional, behavioral, cognitive, or affective. These distinctions are
useful at the level of practice. It is important when using these distinctions,
however, to bear in mind that affect, cognition, behavior, and interaction
are ultimately inseparable. Hence, focusing on ways in which cognitive
processes are important in an emotionally focused therapy, we are re-
ferring to these processes at an applied level rather than seeing cognition
as distinct from emotion, action, and interaction. Three particularly im-
portant cognitive processes are described below. These are attribution of
meaning, accessing, and modifying dysfunctional cognitions.
In the process of couples therapy, the therapist is continually work-
ing with people's views of each other, asking them repeatedly what they
observe in their partner, how they interpret what they observe, and what
this leads them to feel and do. In human interaction, it is not simply one
partner's behavior that determines the other's reaction; the meaning
attributed to the partner's behavior is also important. This attribution
process is an important aspect of the emotional conversation in any
couple. Meaning involves both cognition and affect; in fact, emotion is
often regarded as containing tacit meaning and has been spoken of as
involving intuitive appraisal (Arnold, 1970) and evaluation (Solomon,
1977). The point here is that the meaning of a partner's behavior is a
crucial component of interaction in couples and that meaning is intrinsi-

cally both cognitive and affective.
Evidence has recently been mounting demonstrating the effects of
affect on cognition. It appears that mood may determine memory and
cognition as well as cognition and memory determining mood (Bower,
1981). Although the experimental study of these links unfortunately
involves a somewhat linear causal conceptualization of the relationship
between affect and cognition, it highlights that cognitions interact with
and are influenced by emotions. This is in sharp contrast to the previous
emphasis in psychological studies on the primacy of cognition in deter-
mining meaning and feeling. Thus, what people "think" or "say to them-
selves" is somewhat influenced by their feeling states. This is of great
importance in therapy where emotion is very intertwined with cognition.
In therapy, if the therapist wants to access certain dysfunctional
cognitions, he or she may first have to evoke the feelings with which these
thoughts are associated. Certain crucial, interaction-governing cognitions,
such as thoughts that one is unlovable or perceptions that it is impossible to
get what one needs, often only come into operation when the person is in a
particular affective state. Evoking an emotional experience in the present
thus helps access many kinds of dysfunctional "hot cognitions" (Greenberg
& Safran, 1981, 1984a, 1984b, 1987a; Safran & Greenberg, 1982, 1986) that
influence couples' interactions. Thus key cognitions, as to the nature of the
self in relation to the other, are most accessible in couples therapy when the
emotions themselves are aroused. These are cognitions about the self in
relation to the other and are central aspects of the schematic network,
which is involved in emotional processing. When the network is evoked,
that is, when the person is experiencing the emotion, the different aspects of
the network became available to awareness.
In addition, modification of internal processes such as thoughts,
beliefs, and self statements is greatly enhanced by evoking these processes
in a live and currently felt fashion, that is, in the context of the schematic
network to which they belong. Challenging a belief by provision of
inconsistent evidence or by disputation is much more effective when that
belief is currently operating and determining experience and behavior.
Thus, in couples therapy, it is helpful to challenge dysfunctional relation-
ship beliefs such as the belief that disagreements are destructive or that
mind-reading is possible (Eidelson & Epstein, 1982) when they are actu-
ally operating in the moment.
RELATIONAL BELIEFS AND TESTING
At the center of people's self schemata are certain core beliefs about
themselves and their relationships with others that, if they are dysfunc-
tional in nature, cause interpersonal problems and distress in rela-
tionships. Certain core dysfunctional beliefs related to important rela-
tionship issues such as attachment- abandonment or dependence-
independence are found in statements such as, "No one is interested in
me," "No one will be there for me," "I have to be strong; no one is
interested in my struggles," "Don't get close, you only get hurt," etc.
Other core beliefs related to self-worth, assertion, or autonomy are found
in statements such as, "I'm inferior," "Standing up for myself only leads
to disaster," "I'm unlovable," "Anybody who loves me couldn't be
worthy," "I will never allow myself to be disappointed" etc. People
continually act so as to protect themselves from the possible disasters
they believe they may encounter; hence, their behavior is often governed
by certain catastrophic expectations about the consequences of particular
actions.
As Weiss and Sampson (1986) pointed out, however, people are also
always struggling toward adaptation by testing to see if their beliefs are
true. They repeatedly collect evidence to disprove their pathogenic beliefs
when they perceive it is safe to do so. As Weiss and Sampson pointed
out, patients in individual therapy continually test out their uncon-
scious pathogenic beliefs in the relationship with their analysts. If
the therapist passes key tests, that is, provides disconfirming evidence,
the therapy deepens, exploration becomes bolder, and the patient makes
noticeable progress in therapy (Weiss & Sampson, 1986). A similar
process occurs in relationships, as shown in the following example. A
man believes that no one will be there for him, but he continually tests
this out on his partner by slightly disclosing something of importance or
hinting at a need. He does this to see if his partner will "be therefor him."
If he gets evidence to disconfirm his pathogenic belief, that is, if she
responds to his need, she passes the test and deeper connection, trust, and
intimacy will follow. However, couples who come to therapy have often
failed each other's tests, and their interaction has become structured
around these failures . When they enter therapy they are fighting to get
what they need. Their attempted solutions have become the problem, or
they have given up trying to get what they need because the partner has
repeatedly failed their test. Their core beliefs therefore guide people into
self-protective behavior, although there is still continual microtesting of
the partner which may be highly imperceptible to both individuals but
still present.
The task of couples therapy is to subject the core dysfunctional belief
or catastrophic expectation to experiential disconfirmation, that is, to
have the partner pass the test. At the same time, the belief is also brought
out into the open for inspection and exploration. This inspection of the
belief helps access new evidence arising from the partner's new response.
In emotionally focused therapy, it is the partner's new behavior in ther-
apy that acts to disconfirm the pathogenic belief of the other partner.
Following our example, if the man's belief is that no one will be there for
him, he acts in terms of that belief, on the one hand, not to express his
need openly because he fears it will not be met. On the other hand,
however, he still continually tests his partner, essentially to see if he can
trust her to be there for him. The core pathogenic belief needs to be
activated in therapy in order for it to be subjected to disconfirrnation;
however, it needs to be activated not as an abstract intellectualized belief
for therapeutic discussion but rather as a lively felt operating principle so
that it is the currently governing perception and action. Once it is
operating, then the partner needs to respond in a way that will disconfirm
the belief.
The woman who believes "men are not interested in my struggles,
they require me to be strong" is thus brought to the point of trying to
express some inner struggle to test her partner's ability to respond. The
therapist then works to have him respond to her. The therapist may have
the woman disclose her core pathogenic belief by having her say, for
instance, "But what's in it for you to respond to me when I am feeling
vulnerable?" When the man is able to say, "It feels very intimate to me
that you're really letting me in and I feel very close to you," the woman
might cry in pain and in joy. Essentially, she is, at this moment, simul-
taneously experiencing that she never believed that anybody wanted to be
close to her and that her partner really does want to be close to her.
Relational beliefs of this type are a particularly important type of hot
cognition and need to be activated in a currently felt manner to be
subjected to new experiential learning in couples therapy. Couples ther-
apy therefore works toward the experiential disconfirmation of core
dysfunctional relationship beliefs.
TRUST
Trust is another important component of intimate relationships. Trust

strongly influences interaction. If individuals trust their partners, the
meanings attributed to their partners behaviors are more likely to be
positive than if the individuals are mistrustful of their partners. Trust
involves a complex blend of cognitive and emotional elements. The
aspects of trust based on learning involve the person's expectations about
their partner's reliability and dependability while the aspects of trust
based on affective factors involve hope, a feeling of basic security, and
the strength of the bond (Rempel, Holmes, & Zanna, 1985). The breaking
of and reestablishing of trust are often important issues in couples
therapy. These issues need to be worked with, using both cognitive and
affective interventions. The beliefs and expectations that promote wari-
ness need to be brought to awareness and explored, while new emotional
bonding needs to be established.
Disappointment, that is, the failure to have expectations satisfied, is
a related cognitive-affective issue that requires therapeutic focus in cou-
ples therapy. In intimate relationships, disappointment tends to be attrib-
uted to behavioral events mainly when the partner's actions have per-
sonal relevance. Berscheid ( 1983) suggests that events in relationships are
personally relevant if they interrupt or facilitate an individual's plans or
goals. Goals in turn are determined by the individual's needs and desires
and by his or her expectations and beliefs about the possibility of having
such needs and desires met. What one does in a relationship therefore
depends greatly on what one wants and one's expectations that it is worth
trying to get. This presents an important area of intervention. If partners
are not attempting to have their needs met, because, based on prior
learning histories in this or other relationships, they have low expecta-
tions of success, they will end up feeling deprived. Accessing and modify-
ing the expectations, plus making the needs and desires known and
communicated, are important therapeutic strategies involving an empha-
sis on cognitive expectations and emotional needs and desires.
We can thus see that in couples therapy, cognition and emotion need
to be worked with in a fashion that reflects their complex interdepen-
dence. At a theoretical level, affect involves cognition and cognition is
not affect-free. Ultimately, the two are inseparable. Cognitive factors
such as attribution, expectations, beliefs, and thoughts thus all play an
important part in an emotionally focused therapy.
SUMMARY
We have attempted in this chapter to briefly outline the components of

an adequate theoretical framework for the consideration of emotion in
interactional therapy. First, the biologically adaptive role of emotion in
human interaction was noted, next, the role of emotion in organizing
people for action was emphasized. Different classes of emotion were then
differentiated for the purpose of clinical assessment, and primary adap-
tive emotion was identified as an ally in the process of change.
A comprehensive model of emotion was presented in which emotion
is viewed as resulting from the preattentive integration of a number of
different levels of information-processing. Emotion thus provides the
organism with important ongoing feedback about its reactions to situa-
tions based on this complex synthesis of information. It also provides a
continuous readout of a person's responses to situations; it organizes the
person for action. Individuals are thus continually organizing themselves
for. contact with the world through the medium of their emotional
responses to it. Their reactions, as we have shown, depend on how they
integrate information at a tacit level. A person's current organization of
experience thereby governs his or her functioning; emotionally focused
therapy addresses this emotionally based self-organization.
Emotion, as well as affecting a person's self-organization, is also
crucial in defining interaction patterns and thus in determining the other
partner's self-organization and thus his or her responsiveness. Emotion is
a biologically based primary signaling system and is therefore highly
influential in communication in couples. Particular emotions have partic-
ular significance in interaction; expression of the softer, more vulnerable
emotions brings people closer whereas the harder more aggressive emo-
tions create distance. Intimacy and attachment appear to be primary
human needs; the expression of these needs helps reestablish the emo-
tional bond on which marriage is based and leads to a mutually enhanc-
ing noncoercive I- thou dialogue.
In addition to the importance of emotion in self-organization and in
changing interactions, emotion in therapy is closely connected to cogni-
tion. Accessing emotion helps people become aware of dysfunctional
cognitions, facilitates the modification of problematic relational beliefs,
and helps in the reestablishment of trust.
The experience and expression of emotion in therapy is, for all of the
above reasons, a potentially powerful agent in the process of therapeutic
change. Sartre ( 1948) described emotion as a transformation of the

world; it is an orientation to the world and thus intricately involved in the
definition of self. Expressed emotion also has the power to define or
redefine a relationship to the most crucial aspects of our world-intimate
others. Emotion has too long been overlooked as an important vehicle of
change in couples therapy.
The remainder of this book focuses on how to work with emotion to
achieve change in couples therapy. In the next chapter, the theory of
emotionally focused therapy is presented, followed in later chapters by
principles and examples of practice.
CHAPTER TWO
An Affective Systemic
Approach
Emotionally focused couples therapy is an affective systemic approach in

which the emphasis is on changing interactional cycles and changing each
person's intrapsychic experience, which maintains, and is maintained by,
the cycle. In this treatment, the emphasis is first on identifying the
negative interactional cycle early in treatment and then on accessing each
partner's unexpressed underlying emotions, which serve to organize his
or her views of self and partner. The problem cycle, the individuals'
interactional positions, and their behaviors are then redefined in terms of
the newly experienced underlying emotions. Thus, for example, the
blaming of one partner may come to be seen as an expression of an
underlying fear of abandonment, vulnerability, or loneliness, while the
withdrawal or rejection of the other partner may come to be seen as an
attempt at self-protection or fear of engulfment. This approach is based
on an integration of experiential and systemic approaches, as outlined
below.
EXPERIENTIAL THEORY
Gestalt therapy, one of the major experiential therapies, although devel-

oped and usually applied in the context of individual therapy, particu-
larly lends itself to thinking about organism- environment interactions in
the couple (Greenberg, 1982; Kaplan & Kaplan, 1982; Kempler, 1981;
Perls, 1973). Gestalt is holistic; it attempts to overcome both organism-
environment and mind- body dualities by adopting a field conception of
human functioning that leads to focusing on what occurs between the
29
organism and the environment at the contact boundary. The self is

viewed as an ongoing process that comes into existence at the contact
boundary between the organism and the environment to negotiate organ-
ism-environment interactions. Perls's concept of field, drawn from
Lewin (1935), emphasizes that at every moment the individual is a part of
a larger context (or field) and that it is the nature of the relationship
between the individual and the environment that determines behavior.
Neither creates the other; rather, each stands in a relationship of mutual-
ity to the other. In this view, both perception and environment are
important determinants of human behavior, and the self is the organiza-
tion reflecting these influences. Gestalt formation, the forming of a figure
against a background, is that process by which the self comes into
existence in the moment. The gestalt is formed by the integration of
aspects of ourselves and aspects of the environment to form an organized
whole response that satisfies our needs and fulfills the requirements of the
present environment.
Gestalt therapy has focused primarily on working with individuals
and in so doing has emphasized awareness and choice as major change
processes. Although recognizing that the self comes into existence at the
organism-environment contact boundary, gestalt has not placed equal
emphasis on the role of context, that is, the environmental demand, in
determining behavior. With its emphasis on the individual, gestalt ther-
apy has focused on individual awareness, the person's current perceptual
organization of the world, and the figure-background formation process.
The manner in which people interrupt or interfere with their emerging
awareness and experiencing has been seen as central to understanding
individual dysfunction. Although the individual's behavior is seen as
being equally dependent on environmental opportunity as on internal
need, an analysis of environmental influence on the individual has not
been emphasized in this essentially individually oriented therapy.
In an experiential view of human functioning (Perls, Hefferline, &
Goodman, 1951; Rogers, 1951), the individual's internal experiencing is
regarded as the primary referent of therapy. According to this view,
people are neither purely rational nor purely emotional but rather re-
spond holistically to situations in adaptive ways. People are regarded as
wiser than their intellects alone and as functioning more effectively when
they pay attention to all of their internal experiences. In addition, people
are seen as active organizers of their perceptual world, and it is these
perceptions that determine their behavior. The therapist in this approach
AN AFFECTIVE SYSTEMIC APPROACH 31
attempts to enter the person's frame or reference to explore the reality of

the world as it appears to that person. Acceptance of "what is," by both
therapist and client, is a cornerstone of this phenomenological approach.
As blocks to experiencing and restrictions of awareness are encountered,
the client is helped to identify with and integrate these aspects of func-
tioning, thereby expanding the scope of experience and making available
potentially adaptive organismic feelings and needs.
People are viewed as having an inherent tendency to grow and
thrive. All behavior, therefore, begins with individuals' quests to actual-
ize themselves. As such, it can be assumed that at any moment, people's
behaviors are their optimal means of actualizing themselves in their
current contexts, as they perceive them, and as such are legitimate and
valid.
For example, a woman in therapy for her ongoing depressive ma-
laise and dissatisfaction with her marriage may be feeling very hurt and in
need of support, but in her life experience a person who expressed hurt
was regarded as weak and was either depreciated or ignored. Therefore,
when she is hurt, she believes it is important to be strong and organizes
herself accordingly. As a result, when her husband criticizes her, she
defends by attacking verbally, by blaming him, and by telling him he does
not appreciate her. These behaviors bring her neither the comfort nor the
support she needs; rather, they serve to distance her husband. Her
underlying need for support and comfort is an organismically important
one; however, her method of communicating this need is dysfunctional
and is based both on her perceptions and on the contextual conditions
that seem to support these perceptions. She blames her spouse, and he, in
turn, having learned that it is important to be right, defends his actions,
which she then experiences as his lack of support. This interaction is
organized in a reciprocally determined way in which the wife and hus-
band each act according to his or her perceptions of the situation and
mutually alienate one another. In this way, expressions of basically
adaptive human needs for support and self-esteem can result in negative
interactional cycles.
Kaplan and Kaplan ( 1982), writing about gestalt family therapy,
suggest that by focusing on processes between the individual and the
environment, field processes that determine experience can be identified
in the here-and-now of the interactional field. Just as a person may be
viewed as disowning aspects of the experience, such as sadness or anger,
because of internal blocks or splits, so too can these experiences be
viewed as discordant with, or disallowed by, particular relationship rules

or contexts. Also, the experience and expression of certain emotions may
be disallowed because they are a threat to a definition of the self in the
relationship. What people attend to in themselves and their partners is
determined by a set of internal categories or schemas that have their
origins in the relationship itself. Each interaction is a current reminder of
these categories, implying as it does such rules as, "Don't get angry. " In
addition, people's concepts of themselves in a relationship are influenced
by the manner in which they are treated by their partners. The current
functioning of an individual can therefore be viewed as being reflexively
organized by both internal and external field forces.
A person's experience is always organized so that some processes are
relatively dominant and more focally in awareness. This concept is basic
to a gestalt view of human functioning. If individual or contextual factors
act to interfere with the individual's most dominant experience rising to
awareness, dysfunction occurs and restricted awareness results. The per-
son begins selectively to attend to a restricted subset of experience and
blocks off other experiences. The result is that some aspects of experience
fail to be integrated and are disowned or disclaimed. People, therefore,
relate within a limited set of possibilities. In therapy, expanding the range
of experience may open up conflict, but with it comes the possibility of a
fuller, richer relationship. Change can occur in therapy by changing the
conditions that organize a particular form of contact between people, be
it by changing one person's experience and perception, by changing the
context (i.e., the other partner's position and pattern of responses), or,
most likely, by changing both simultaneously and in a reciprocally deter-
mining fashion.
THE INTERACTIONAL SYSTEMIC PERSPECTIVE
Although the interactional perspective articulated by theorists from the

Mental Research Institute in Palo Alto (Fisch, Weakland, & Segal, 1983;
Jackson, 1965; Sluzki, 1983; Watzlawick, 1978; Watzlawick et al., 1967)
is not strictly based on systems theory, it falls within a group of theories
that belong to a base paradigm referred to as "family systems theory"
(Sluzki, 1983). The word system has in fact become a kind of cliche that
has lost most of its meaning. Although systems theory has been a corner-
stone of a group of approaches that are similar in their difference from
intrapsychic approaches, the many systems approaches suggest a number

of different ways of understanding dysfunction and of intervening.
What is referred to as "family systems theory" is a loosely knit set of
concepts rooted in general systems theory and cybernetics. (Only those
concepts relevant to couples therapy will be mentioned here, and then
only briefly, to set the stage for integration rather than to explain systems
theory.) The first key systems concept is that "the whole" is organized.
This organization determines how the system functions. In order to
understand events we must study them, not in isolation, but in the
context in which they occur. Relationships between participants and
patterns of interactions between them therefore become the focus of
attention rather than the characteristics of the individuals themselves.
Parts can only be understood in the context of the whole, and changes in
parts affect every other part and the whole.
A second key concept, from cybernetics, suggests that the whole
regulates itself through feedback in order to maintain stability. This is the
idea of homeostasis, in which feedback produces system alteration in
order to keep the system in a state of balance. This concept explains
stability but not change, and it is currently subject to extensive debate
and possible expansion or revision (Dell, 1982; Hoffman, 1981). Regard-
less of one's view of the relevance of homeostasis in describing the
functioning of couples, the concepts of interactional patterning and
circular causality, as opposed to individual dynamics and linear causal-
ity, are crucial in understanding how couples function.
The concept of circular causality suggests that no behavior simply
causes another behavior but rather that each is linked in a circular chain
to other behaviors and events. Thus, partner A nags because partner B
withdraws while partner B withdraws because partner A nags. These
circular interactions form consistent recurring patterns over time. These
patterns are established and maintained by the . partners' actions, and
the therapist is concerned with the effects of what each partner does and
how these behaviors function to maintain the cycle. Individuals are
viewed not as having motives or intentions to act in certain ways but
rather as manifesting particular behaviors in response to contextual
determinants.
This approach is behavioral in nature; however, the systematic view
of behavior is a complex one. Behaviors are not seen as automatic
responses to simple stimuli but rather as parts of reciprocally determined
interactional cycles. In addition to the emphasis on behaviors as part of
34 THEORY AND RES EAR H
an interactional sequence, behaviors are also seen as occurring in the

context of meaning and as being perceived differently and having differ-
ent effects, depending on the meaning contexts in which they occur. Thu~
"scolding," for example, is not a simple unambiguous stimulus but either
a rewarding, approaching behavior or a punishing, rejecting behaviOT,
depending on the meaning in which it is embedded. Similarly, an insult
from a friend within an episode of play is regarded as humor rather than
hostility. Context determines meaning. In this view, behavior is seen
essentially as communication, and all behavior is analyzed in terms of its
communicative significance. Thus in this tradition, the therapist does not
view a member of a couple as possessing a particular attribute such as
"being" selfish, angry, or depressed but he or she rather focuses on the
communicative function of the behavior by referring to the person as
"showing" certain behaviors.
The concept of interactional positioning is of crucial importance in
understanding cycles and each person's behaviors in the cycle. In interac-
tion, a person's actions and speech acts are seen as being proposals and
counterproposals about reciprocal role definitions. A man, in giving
advice, proposes that he adopt a dominant role and his partner a submis-
sive role; depending on her response, she accepts or declines his offer-.
Interaction is like a set of moves and countermoves in a game; therefore,
it is analyzed not in terms of internal experience, but in terms of the
positions people take in relation to each other.
The report and command aspects of messages were noted earlier as
two important aspects of communication. The "report" is the content of
the message, while the "command~, defines the roles of speaker and
listener. For example, if a man asks his partner, "Why did you do that?"
this is a content request for information, although it also contains a
command about the relationship definition. The questioner assumes the
superior role of inquisitor and relegates the responder to the inferior
position of the accused. The partner, if she answers by justifying her
action, in effect accepts the position proposed by the questioner and
thereby acts to confirm a reciprocal role relationship definition of supe-
rior-inferior or leader-follower.
From a systemic point of view, proposing change to a family is seen
as posing a dilemma to the system. Change in the presenting problem
cannot be brought about without other changes in the system occurring.
Usually, the presenting complaint has in effect emerged as the be st
possible solution to the problem and can be seen as an attempt not to
change something else regarded as more difficult to change. Understand-

ing what is preventing other changes or solutions and why and how it is
important for people to adopt the current solution is seen as crucial to
help the therapist not push for change too rapidly.
The therapeutic task in treating conflict in relationships with the
systems approaches is to alter the negative interactional cycle. The thera-
pist can work directly to change the conflict by instructing the couple to
change their interactional positions. To do this, the therapist uses him- or
herself to influence change in behavior directly (Minuchin & Fishman,
1981). Alternately, the therapist can achieve change indirectly by refram-
ing and prescribing what is occurring in the interaction, so that the
behaviors take on new meanings (Sluzki, 1978). A new view of the
interactional cycle makes alternative behaviors possible.
INTEGRATING EXPERIENTIAL
AND SYSTEMIC PERSPECTIVES
Although some approaches do integrate experiential and systematic tra-

ditions in practice (Duhl & Duhl, 1981; Kempler, 1981; Satir, 1964:
Whitaker & Keith, 1981 ), they do so without much attempt to achieve a
theoretical integration. The two traditions thus have not been very
closely linked in the theoretical literature. We believe, however, that
certain basic assumptions in each approach make them good partners for
a productive theoretical synthesis in emotionally focused therapy (EFf).
For instance, both view the person as a fluid system constantly in process
of change rather than as possessing a fixed core or a rigid character based
on psychogenetic determinants. Both approaches also focus on current
functioning rather than on historical determinants as important causes of
specific behaviors.
The potential benefits of integrating these two approaches comes
from devising a new approach that simultaneously focuses on both
intrapsychic and interactional factors. Systemic perspectives focus on
how context influences moment-by-moment behavior, and experiential
therapy focuses on how current intrapsychic states and perception deter-
mine behavior; neither approach posits a core personality or rigid intra-
psychic structure that needs to be changed. Gestalt therapy, for example,
rather than describing enduring characteristics of people or attempting to
explain behavior in terms of causal antecedents, describes ongoing pro-
cesses of experiential organization by which people interact with their

environment. In both experiential and systemic approaches. patholo gy is
seen not as residing in a fixed personality structure, but as arising fr om
attempted solutions that actually maintain the problem or from faulty
views of the situation that lead to inappropriate solutions.
Systemic approaches see the individual in terms of a type of role
theory of self in which the situational demands define the type of role a
person plays in a particular situation. Different social contexts then bring
forth, different "partial selves" (Minuchin, 1974). Experiential therapy
suggests a type of modular self theory in which multiple partial aspects or
potentials of self are organized in a particular way at any time in terms of
dominant current needs (Perls, 1970) and the organism's attempts to
actualize the self. The two theories intersect in allowing the self to be seen
in interaction as a continuous process of context-depe ndent self-organiw
zation striving toward healthy adaptation. The self is thus not something
fixed inside a person's head; rather, the self is an unending process
turning experience into conscious awareness.
Two basic ideas underlie our integrative view. The first is a theoretiw
cal commitment that couples therapy needs to address both (1) the
relationship of the inner psychological world of both partners to their
interaction and (2) the relationship of the interactional, contextual deterw
minants of the partners' behavior to their internal experience. The second
idea, a clinical one, relevant at a more practical level, suggests that the
timing of an intervention is crucial and should be based on process
diagnoses of opportunities for intervention (Greenberg, 1986). Our view
is · that therapy is a complex interactional process in which different
opportunities for intervention present themselves at different times and
that a skilled therapist has a tacit and sometimes explicit idea of what to
do at particular times (Rice & Greenberg, 1984). The therapist is therew
fore constantly making process diagnoses of what is occurring and when
it is opportune to intervene. When good opportunities for intervention
present themselves, the therapist intervenes. In this fashion, interventions
from different sch9ols of thought are integrated for use at different times
to produce change in different targets. For example, when a negative
interactional cycle presents itselC it is identified and elaborated; when an
emotional experience or expression emerges in one partner, it is focused
on and developed; and when a core belief is accessed, it is inspected.
Thus, the therapist intervenes responsively to what is emerging in the
process in the present. Certain theoretical notions, however, guide the
process of what is selected by the therapist as a target for intervention

and how best to intervene at specific moments.
Our view rests on four main principles that guide our process diag-
nosis and intervention. The first is that the self is organized in particular
ways at any moment by emotional experience. The second is that inter-
personal perception serves to maintain self-organization and interac-
tional positions. The third is that certain core beliefs related to persons'
views of themselves in a relationship are continually affecting their be-
havior. The fourth is that interactional patterns in distressed couples are
self-perpetuating and serve to maintain the problem and the inner world
experience of the partners.
Emotion, perception, cognition, and interaction are all aspects of the
problem and therefore are all targets of change. In addition, all processes
are highly interdependent, at many differing levels. For instance, emotion
and perception involve cognition; thus, feeling anger at being betrayed
involves the perception of betrayal, the beliefs around loyalty, and physi-
ological arousal of adrenalin and the subjective experience of anger.
Similarly, cognition is not independent of emotion; all thought involves
feeling, and behavior is determined by, and determines, emotion and
cognition. Hence, taking new actions can lead to feeling new feelings.
Thus, EFT does not focus on emotional experience alone but rather
focuses on multiple levels of experience.
Any intervention may focus on a particular clinical target for a
particular purpose, such as accessing an emotion to change communica-
tion, becoming aware of a belief in order to subject it to new evidence, or
identifying a cycle to increase the sense of mutual causation and thereby
reduce blame. Interventions may be clinically thought of as focusing at
the emotional, cognitive, or interactional level, but all interventions
essentially involve an integration of all these levels.
In the affective systemic approach presented here, the focus of
treatment is thus changing both the interactional cycle and each person's
experience of the relationship. Dysfunctional interaction cycles in cou-
ples have been observed repeatedly to evolve in dealing with issues
concerning closeness and distance and dominance and submission. Once
a negative interaction cycle is in place, it seems to take on a life of its own.
The focus in an integrated approach is, first, on clearly identifying
repetitive interactional sequences of behavior around various issues and
assessing the positions that people adopt in these interactions, and,
second, on reframing their positions and redefining the problem in terms
of their underlying feelings. In this view of marital interaction, communi-

cation is seen as an attempt at establishing a relationship definition that
maintains a particular self-definition.
In an integrated experiential- systemic view, organization of the
individual subsystems and of the whole, that is, the couple system, can be
seen as interdependent and as varying simultaneously and reflexively.
For example, when the interaction is organized in a complementary
fashion, such as "pursue- distance" or "attack- withdraw," the individuals
can be seen as organized so that pursuit and attack, or distancing and
withdrawal, are the dominant aspects of their individual organization.
This organization is maintained simultaneously and is supported by both
(1) the negative interaction cycle (i.e., the couple system functioning) and
(2) certain individual processes being more dominant in focal awareness
(i.e., individual subsystem functioning). Change in interaction is brought
about by reframing negative interactional cycles in terms of underlying
emotional experiences in each partner.
This approach to therapy with couples involves attention to the
current interaction and the current experiential process within the indi-
vidual. Change occurs both by change in people's views of themselves
and by change in their context (i.e., in the partner's communication).
Insight in this approach is not enough to bring about change in people's
views of themselves. Rather, clients must experience, on an emotionally
meaningful level, new aspects of themselves and new aspects of their
partner, thereby creating new interactions. Partners must encounter each
other in the session in a new way and participate in the corrective
emotional experience of an /-thou relationship. This reestablishes the
possibility of them having a positive human relationship with each other.
This approach is predicated on the assumption that the members of
the couple have healthy feelings, needs, and wants that will emerge with
the help of the therapist. A major hypothesis of this approach is that
accessing and expressing primary feelings, needs, and wants by the
partners can aid adaptive problem-solving and produce intimacy. It is
not people's feelings and wants that cause problems in relationships
(Wile, 1981) but the disowning or disallowing of these feelings and wants
that leads to ineffective communication and escalating interactional cy-
cles. A grouchy man, for example, may be avoiding his need for comfort;
likewise, a nagging woman may be sharing anger but feeling loneliness.
Some of the major needs in couples are needs for closeness, contact-
comfort, and intimacy. In addition to needs for connectedness are needs
for separateness, autonomy, and self-definition. Fears of closeness or

separateness and interactional patterns that prevent closeness or auton-
omy are therefore major targets of change.
Our approach involves encouraging people to make explicit state-
ments to their partners of currently experienced feelings and needs.
Emotion in this approach is considered to be both a target and an agent
of change. Emotional experience provides an organizing framework for
the creation of meaning and relationship definition; in particular, it
provides a framework for the perception of the partner. Emotion is also a
source of motivation for new responses.
A strong distinction must be made between "talking about" feelings
versus involvement in the current moment and congruent expression of
experience. Experience and communication of currently experienced
feeling are far more likely to produce change than intellectual insight or
discussion about feelings. Insight is not the key to change in this model;
rather, the active reprocessing of a current powerful emotion in the
presence of the partner and the enacting of a new sequence of responses
based on that emotion are the key elements in therapy. As a result, the
use of good communication is seen as emerging from change than as
bringing about change. Affectively oriented encounters create change in
communication styles as partners experience themselves and one another
differently. For example, the perception of the partner as more accessible
and responsive motivates and facilitates open communication. Poor
communication skills often reflect a relationship definition that disallows
congruent disclosures and open dialogue; hence, when partners witness
the disclosure of fears, for example, rather than defensive reactions, such
as aloofness, new responses are often elicited by their new perceptions of
their partners' vulnerability. This sets a new interactional cycle in pro-
cess.
EFT is thus experiential in that it focuses on the client's experience;
it is also constructivist in that it focuses on how that experience is created
and processed. In the experiential tradition, people are viewed as active
perceivers constructing meanings and organizing experience on the basis
of their current emotional state; experience is accepted as legitimate and
valid in the context in which it occurs. EFT is experiential in that it
focuses on present experience, particularly the emotional responses un-
derlying each partner's stance toward the other, and on the reprocessing
of these responses in such a way as to change interactional positions. In
this approach, the clients' needs and wants are cQnsidered legitimate and
healthy in themselves and are therefore validated by the therapist and

expanded on in the present. It is disowning emotional responses, restrict-
ing awareness, and defensive automatic emotional reactions that are seen
as problematic.
EFT is systemic in that it focuses on the process of interaction,
particularly negative interactional cycles, frames responses within the
context of the other partner's behavior, and enacts previously avoided
interactions in the therapy session. It has been suggested (Stanton, 1979)
that the reenactment of problematic interactions and the enactment of
new interactions choreographed by the therapist are the distinguishing.
features of the structural approach to therapy.
The structuring of proximity and distance is the main concern
(Minuchin & Fishman, 1981). The focus is on the process of interaction,
rather than the content, and on the positions taken by the partners in that
interaction. Each partner habitually responds to the other in ways that
evoke negative reactions, which then reinforce negative emotional re-
sponses. The task of therapy is the interruption of this cycle and the
creation of a more positive cycle. Since each partner's behavior is viewed
as an adjustment to the behavior of the other, the negative cycle is often
framed both as an attempted solution constructed by the partners out of
their need to protect themselves and as a pattern that turns them both
into distressed victims who, in their attempt to create a safer, less threat-
ening relationship, become more and more alienated from each other.
THE PROCESS OF CHANGE
The goal of the EFT approach is the restructuring of the emotional bond.
This goal, along with the different change processes involved in attaining
it, is discussed below.
Restructuring the Emotional Bond
In EFT, an individual's experience and behavior are seen as being simul•

taneously determined from within and without. Context, perception, and
choice all determine behavior. Awareness develops at the organism-
environment contact boundary in order to negotiate dealings between the
organism and the environment. The interaction between the organism
and the environment is viewed holistically, as a system, and the self is

seen as being formed in the moment at the boundary in reference to all
current influences. The interactional system needs to be viewed not only
in terms of the ongoing sequential interactions between participants, but
also as being a field event in which all performances are simultaneously
affecting and being affected by all other performances in the field.
At any moment, all parties in an interaction are under the influence
of multifaceted, multidimensional influences. The system is thus more of
a complex field of forces than a set of discrete, albeit circularly related,
interactions. This field is continually organized by all the changing com
ponent influences, and whatever occurs at any moment represents the
resultant direction of all the constituent forces. A field conception more
accurately captures the bond of interconnectedness between people in
which the participants, in an ever-changing interaction, are constantly
and simultaneously reflecting and defining the other and the self.
The influence process between a couple is thus more like that be
tween two magnets than like that in a homeostatic system. In a magnetic
field, the properties of the magnets together interact to constitute the
field. In a homeostatic self-regulatory system, such as a thermostat, it is
the feedback from the comparator that leads to self-regulation. The
notion of feedback as a means of control is quite different from the idea
of mutual influence in a field. The homeostatic feedback conception of
cybernetics, although at some level helpful in describing the functioning
of couples, is still too discrete and simple in its view of the couple system,
and it does not truly describe or explain what actually occurs in an
interactional system.
The notion of a field is more descriptive of the mutual influence
process in human interaction. In a field, interactions and individuals
become organized in particular ways as a function of the multidimen
sional influences acting at any moment. Although the magnet analogy is
initially useful in describing a field, it breaks down when applied to
human interactional fields because magnets themselves are static, struc
turally stable entities, while individuals are constantly in a process of
change. It is imperative to think of individuals as flexible and kaleido
scopic, as continuously forming organizations that mutually determine
and are determined by the field in which they are placed.
Within this field view, the purpose of EFT can be described as
attempting to change the interactional and emotional field so that indi
viduals and interactions are reorganized to result in more functional
relationships. A major goal of EFT is restructuring the emotional bond

so as to promote a continually regenerative I- thou dialogue between
partners.
Family, marital, and couples problems emerge because of the dys-
functional emotional involvement between people. The goal of therapy is
to alter the nature of this involvement. For instance, when a child begins
as or becomes "the patient," the first step of therapy is breaking the
triangular involvement between parents and child and promoting contact
between the parents so that they can talk to and listen to each other in a
new way. This, then, can become the beginning of couples therapy; that
is, the task of couples therapy is the restructuring of the emotional bond
between the couple toward more accessibility and responsiveness (John-
son, 1986).
If the couple is the presenting problem, rather than a symptomatic
child or one partner, the couple is more able to recognize that their
emotional involvement is unsatisfying, and work on the relationship can
begin directly. The healing possibilities of the I-thou relationship, which
probably once operated in the relationship, have long been forgotten,
and the emotional bond is in need of repair. The relationship has gener-
ally become organized as either too distant or too involved, or there is an
imbalance in the dominance hierarchy-one person is up and the other is
down. While the individuals are engaged in a struggle for self-definition,
the couple needs to be moved to a new level of transaction and mutual
dialogue. To do this, certain aspects of self, those internal capacities and
resources that are not currently being used in the interaction, need to be
accessed and activated, thereby modifying the field. New self-organiza-
tion will lead to new interaction, and new interaction will reciprocally
lead to new self-organizations. Three perspectives on achieving these
kinds of change are presented below.
Changing Self Contexts
Often, the best way to access new aspects of self is to change the context
of the self. Many people believe if they feel unhappy or weak that they
should change themselves to become happier, stronger people. This
highly prevalent view leads people to underestimate the power of the
family or relationship environment and the need for environmental sup-
port. More self-support is sometimes needed, but often more environ-
mental support, in the form of a network of loving and supportive

relationships, is most enhancing. Environmental support often allows
new aspects of self or new self-organizations to emerge. The most impor-
tant element of the context in a couple is the partner.Thus, if the therapist
wishes to access a new aspect of self in partner A, this often can be most
easily done by changing, in an appropriate fashion, partner B's expres-
sion or engagement in the interaction. This, in turn, is done by changing
the field that governs partner B's experience. The therapist has two
avenues of intervention for changing B's experience: interactional and
intrapsychic. The therapist is part of B's field, in the therapy, and can use
him- or herself to evoke and support new parts of the self in B in order to
change A's view of B and ultimately A's self-organization. The therapist
can also work to provide both partners with a new self experience. In an
intrapsychic approach, changing A involves the skills of working with the
individual's inner world to achieve self change, whereas in an interac-
tional approach, changing A involves an understanding of and working
with the reciprocity in the relationship; that is, one achieves change in A
by changing the context that supports A's behavior and experience.
Understanding how context determines behavior and how patterns such
as dominance and submission are reciprocally determining is thus of
major significance in making interactional interventions.
Supporting Fluctuations
One of the major problems of family systems theory has been its inability
to explain the generation of newness and how change, growth, and
creativity take place. Although concepts such as positive feedback and
morphogenesis (changing of the form) exist, they have never been used to
explain how change takes place in a family. New perspectives on system
functioning have, however, emphasized the idea that systems are com-
posed of ongoing processes rather than fixed stable entities and that a
given system at any time is actually a current configuration of processes
(Kaplan & Kaplan, 1982, 1987). Within any current organization, how-
ever, there are always fluctuations that are kept within certain bounds.
Change comes about by amplification of some of the fluctuations (Hoff-
man, 1981; Prigogine, 1976; Prigogine & Stengers, 1984).
In a couple locked into a vicious interactional cycle, there are multiple
sources of momentary fluctuations of experience in each partner that are
dampened and curtailed by repeated patterns of behavior. It is this restric

tion of newness that produces the stability of the negative cycle (Kaplan &,
Kaplan, 1987). The momentary fluctuations are, however, potential sources
of change. In any complex interaction, subprocesses of potential emerging
experiences and expressions are continually not being brought to fruition.
There is always more going on within a person, at any moment, than that
person or his or her partner can accurately symbolize. A particular feeling
of sadness may emerge in a brief sigh by one partner but may be over
looked by either or both of the partners. This potential self-experience
represents a fluctuation in the ongoing self process that is lost. In other
instances, a caring glance from one partner to the other is lost in a rapid
interchange or an offer of concern or understanding, or a flicker of resent
ment or anger is swamped by the predominant customary way of relating.
Yet emerging moments, held in check by dominant self and interactional
organizations, represent the possibility for change. While the systems per
spective that helps us identify patterns such as the negative interactional
cycle tells us about what people keep doing, the process and field perspec
tives focus on how change occurs. Current functioning always provides
clues of alternative organizations and alerts us to look for ways in which
fluctuations are dampened by the interaction.
As the Kaplans ( 1985) point out, certain patterns develop because,
even though they may be painful, they are predictable and reliable. Chang
ing these patterns involves risk and facing the unknown. To venture beyond
established predictable forms of interaction involves a particularly large
risk in a hostile or nonsupportive environment. Thus, the task of the
therapist is to provide sufficient safety to help people become more flexibly
organized and then to help them focus on and develop the emerging
fluctuations in their experiences and interactions. If the previously unsym
bolized sadness or caring glance is brought into awareness and into the
interaction, it will change the course of the subsequent interaction; if
developed sufficiently, it will help to change the rigid pattern of interaction.
The therapist thus focuses on supporting perceived fluctuations.
The crucial feature of a self-organizing system is found not so much
in the preservation of a homeostatic equilibrium but rather in the mainte
nance of coherence of organizing processes by means of continuous
equilibrium restructuring (Dell, 1982). Thus, the aim of the system or self
is not to remain the same but to maintain a coherence that fits best within
the field. A self-organizing system is a growing system, proceeding to
ward more integrated levels of functioning and higher levels of structural
complexity. It is this thrust toward incorporating newness while main-

taining coherence that Prigogine and Stengers (1984) have captured in
their formulation of order through fluctuation. It is this process we are
emphasizing here in suggesting that the therapist support fluctuations to
promote new organizations.
Evoking Emotion
The experience and expression of emotion is important in bringing about

change in a couple's interaction in this approach. Emotional expression is
involved in change on at least two levels in this therapy, for emotion is
both a crucial means of communication and an important self-organizer
and motivator of individual action.
As we have discussed in the previous chapter, emotional expression
in humans is a primary signaling system that serves a communicative
function right from birth. Affective expression, therefore, is a crucial
form of communication, and expression of particular emotions has par-
ticular significance in human interaction. Although expressions of love
and intimacy can be inherently reparative in intimate relationships, these
expressions are often more the result of an affectively oriented couples
therapy than the means whereby the therapy takes place. The primary
emotions expressed most often as part of an affective therapy are fear,
vulnerability, sadness, pain, anger, and resentment.
Major changes in interactional sequences can be brought about by
reframing a negative interactional cycle in terms of the unexpressed
aspect of the person's feeling and restructuring the interaction based on
the need or motivation amplified by the emotional experience. A
"pursue-distance" interaction can therefore be reframed in terms of the
pursuer's underlying caring or fear of isolation and the distancer's fear or
unexpressed resentment. The reframe is much more likely to be expe-
rienced as valid when these previously unacknowledged feelings are
experienced and expressed during therapy. The deeper the experience
and expression of these feelings, the stronger the reframe and the change
in meaning of the interaction. The new expressions are also themselves
changes in the interactional sequence, thereby promoting further changes
in the interaction in a mutually causal circular process. Thus, evoked
loneliness intensifies the need for connection and motivates more affilia-
tive behavior. Evoked anger in the previously passive partner amplifies
the person's need for autonomy and motivates more self-defining actions.
These new behaviors evoke new responses to them. Thus, emotion moti
vates new behaviors, which change interactions.
In addition to the effect of emotion on interaction, the experience of
emotion is the end product of a set of automatic or unconscious informa
tion-processing activities. Emotion, as we discussed, is a construction
from expressive-motor reactions, emotional schemata or memories, and
ideas related in an emotional network rather than the result of an
inference or thought. Activation of any one of the components of the
network or the priming of a number of components can activate the
whole network or other parts of the network.
Emotional experience is therefore as much a function of the inf or
mation-processing that takes place at preconceptual, expressive-motor,
and schematic memory levels as it is a function of conceptual cognition
(Greenberg & Safran, 1984a, 1987a). Purely conscious conceptual change
involving a change in people's reasoning or attributions does not neces
sarily produce a change at an emotional level. This is why emotion needs
to be evoked. Emotional change cannot occur without the evocation of
the network and its restructuring.
Affect is very important in changing attitudes because affectively
laden internal information appears to be closely linked to people's self
schemata and tends to override other cues and dominate the formation of
meaning. Affect plays an important role in three individual change
processes (Greenberg & Safran, 1984a, 1987a) that are highly relevant to
couples therapy. The first is the process of acknowledging previously
unacknowledged, biologically adaptive primary emotions that aid prob
lem-solving. The second is the restructuring of emotion schemata that
contain representations of the self, the other, and the situation. The third
is the modification of core cognitions that emerge for therapeutic consid
eration only when the person is in the aroused affective state. These
processes occur in each individual during the process of successful cou
ples therapy. Accessing biologically adaptive primary emotions, pre
viously not dominant in individuals' organization of their experience,
provides information that helps people define themselves better, in
creases motivation for and enhances problem-solving, and helps partners
communicate their needs more clearly. In emotional restructuring, affec
tively charged emotion schemata are also aroused in order to make them
amenable to change. Using a computer analogy, the underlying response
program needs to be run in order to assess where the problem lies and to
have the program links available for change. As Lang (1983) has pointed
out, the more the stimulus configuration matches the internal structure
or schemata, the more likely the whole structure will be evoked and will
then govern experience. The presence of the emotional experience em-
bedded in the network of associations is necessary before the experience
can be restructured. Thus, fear of intrusion or self-disgust, for instance,
needs to be evoked in therapy in order to change them.
Restructuring is achieved by allowing certain incomplete expres-
sions to run their course and by admitting new information to the
schemata, thereby altering its organization. Inspection of a number of
change episodes (Greenberg & Safran, 1987a) reveals that it is usually a
combination of the relief and recovery after the completed expression of
an emotion, such as grief or anger, and the cognitive reorganization
involved in expressing the emotion that lead to change. Thus, the expe-
rience of the anger at, and loss in relation to, a distant and rejecting
parent and its being worked through to completion allows the person to
incorporate a new understanding of the parent's difficulties and to let go
of the need for attention or love from him or her.
In addition to affect leading to change by altering self-organization
or restructuring schemata, it has become clear that arousal of currently
experienced emotions can provide access to certain state-dependent
learnings. Certain core cognitions, cognitive-affective sequences, and
complex meanings learned originally in particular affective states are
much more accessible when that state is revived. Accessing these "hot
cognitions" (Greenberg & Safran, 1984b, 1987a) can be particularly
important in clarifying couples' interactions because key construals that
induce certain behaviors in the interaction are often not readily available
for recall when the problem is being discussed coolly, after the fact, in
therapy. Helping couples re-create the situation and relive the emotions
in therapy often makes the cognitions governing these behaviors more
available for inspection, clarification, and modification.
THE EVALUATION OF
EMOTIONALLY FOCUSED THERAPY
Research on the outcome of EFT is reviewed briefly below in order to

present the existing evidence on the efficacy of the approach. Research
illuminating the process of change is presented in Chapter 8.
A preliminary point of some interest is that a brief manual describ-

ing EFT was found to be useful for the purposes of training and research .
Presented in the next section, the manual outlines a nine-step procedure
in an attempt to capture the major treatment strategies. From this
manual, an adherence measure was developed for use as an implementa-
tion check in the research studies. Generally, it was found that EFT could
be accurately described and successfully identified by trained raters using
the adherence measure. The raters were able to discriminate EFT from
both a behavioral approach using problem-solving and communication
training (Johnson & Greenberg, 1985a) and a systemic, interactional
approach using paradoxical reframing and prescription (Goldman,
1987).
Results at Termination
Three studies of the effects of manual-guided EFT on moderately to

more severely distressed couples have been conducted. The first study
(Johnson & Greenberg, 1985a) compared the relative effectiveness of
EFT and a cognitive behavioral problem-solving (PS) approach that
involved problem-solving and communication training. Forty-five mod-
erately distressed couples were randomly assigned to one of these two
treatments or to a waiting list control group. Eight sessions of each
treatment were implemented by six experienced therapists who were
committed to the particular approach they were using. Adherence to
treatment manuals was monitored and maintained with a high degree of
consistency. The perceived quality of the therapeutic alliance was also
measured and was found to be equivalently high across treatment groups.
Results in this study indicated that both treatment groups made
significant gains ovt:_r untreated controls on measures of goal attainment,
marital adjustment, intimacy levels, and target complaint reduction. The
effects at termination of EFT were in addition superior to those of the PS
intervention on martial adjustment level (see Table 1), as measured by
the Dyadic Adjustment Scale (DAS; Spanier, 1976), on intellectual inti-
macy, as measured by the Personal Assesment of Intimacy in Relation-
ships (PAIR) (Schaefer & Olson, 1981), and on the target complaint
level.
It has been recently suggested that there are more meaningful ways
of summarizing the effects of treatment than simply reporting group
Table J. Dyadic Adjustment Scale Scores

Study I
Pre Post 2-month follow-up
EFT 92.8 112.7 112.4

PS 91.7 102.4 101.1
C 91.9 91.5
Study III
4-month I-year
Pre Post follow-up follow-up
EFT 86.27 100.14 92.05 99.47

IS 83.86 96.75 101.0 100.72
C 82.50 80.86
Note. EFT= emotionally focused therapy; PS = problem solving; C = control;

IS = interactional systemic.
means (Jacobson & Follette, 1984; Jacobson, Follette, & Revenstorf,

1984). If couples' posttreatment DAS scores are assessed in terms of
effect size (Smith & Glass, 1977), the obtained effect size for the EFT
group was 2.19 and for the PS group was 1.12. That is, the mean effect of
EFT was more than two standard deviations from the postwait mean of
the control group. Another way to view the results is to compare the
treated couples' marital adjustment to that of nondistressed happy cou-
ples. The posttreatment and follow-up mean DAS score for EFT couples
was within two points of Spanier's norm (1976) for married couples
(M = 114.8), and 47% of the EFT couples scored above this norm.
This study was one of the first controlled comparative studies of an
experiential and behavioral treatment for marital distress and indeed one
of the few controlled studies of a more dynamically oriented (as opposed
to behaviorally oriented) marital therapy. The EFT approach has thus
been shown to have a positive effect on couples' ability to achieve goals
and change specific complaints, as well as on variables such as marital
satisfaction, which were more directly addressed by the treatment inter-
ventions and are viewed by marital partners as being highly related to
positive emotions (Broderick, 1981 ). The main limitations of the study
were that all measures were self-reported, and the results can only be
generalized to the population of moderately distressed couples.
THEORY AND RESEARCH
50
The second outcome study (Johnson & Greenberg, 1985b) involved
a within-subjects' design in which control subjects placed on the waiting
list in the first study were treated, and postwait, posttreatment, and
follow-up outcomes were assessed. The therapists in this second study,
however, were novice marital therapists who received 12 hours of train-
ing in EFT plus ongoing weekly supervision. No significant changes on
dependent measures (the same as used in the first study) were found at
the end of the 3-month postwait period. This finding of no change after
waiting adds to the evidence that marital distress is not a phenomenon
prone to spontaneous remission.
After an 8-week EFT treatment, the couples showed change on all
outcome measures. The results were generally consistent with the pre-
vious study; however, the effect size (0.94) was smaller. The most likely
explanation for the smaller effect size would seem to be the inexperience
of the therapists, who were learning how to practice marital therapy in
this project. One of the additional positive findings of this study is that
EFT was delineated with sufficient specificity that it was able to be
successfully taught to novice therapists.
In the third outcome study (Goldman, 1987) EFT was compared
with an interactional systemic (IS) treatment that involved the use of a
team behind a mirror suggesting tasks to restructure the interaction and
sending paradoxical messages (Weeks & L'Abate, 1982) to reframe
and prescribe the negative interaction cycle (Greenberg & Goldman,
1985). In this study, 42 couples were randomly assigned to EFT, to the
IS treatment, or to a waiting list control group. The selection criteria
for this study were set to select couples with lower DAS scores than
in the previous studies in order to test a differential treatment hypothe-
sis that an IS approach would be superior to EFT for more distressed
couples. The couples in this study were the refore somewhat more dis-
tressed than the couples in the first two studies, with a mean DAS
score of 84 as opposed to a mean DAS score of 92 in the earlier
treatments.
In this study, 10 sessions of each treatment were implemented by
seven experienced therapists committed to the approach they were using.
Of the seven therapists using EFT, only one had been a therapist in the
first study, so this represented a new group of therapists. Adherence to
the treatment manuals was monitored, and the core of the EFT treatment
was administered, although the later steps of the manual, involving the
provision of an overview of the couples' functioning, were not as rigor

ously maintained as in the first study. The perceived quality- of the
therapeutic alliance between the couple and the therapist was measured
after the third and final session. The alliance was found to be equivalent
in both groups after the third session.
Results indicate that, at termination, both treatments significantly
improved the quality of the marital relationships when compared with
the waiting condition. Outcome measures included marital adjustment,
goal attainment, target complaints, and conflict resolution. Contrary to
our expectations, no differential outcome effects between the two ap
proaches were found at termination. DAS scores are shown in Table I.
The proportion of couples who had improved their marital adjustment
-as measured by the dyadic adjustment scale (Spanier, 1976) at termi
nation, according to the stringent condition of improvement criterion
suggested by Jacobson et al. (1984)-was 71%, or 10 out of the 14
couples.
Follow-up
In the first study, both the PS and the EFT groups were found to have
maintained their gains at a two-month follow-up. The EFT group was in
fact found to score higher than the PS group at follow-up on two of the
four outcome measures. This was a promising indicator that the effects of
EFT lasted at least until 2 months following therapy. No follow-up was
completed in the second study.
In the third study, couples were followed up after 4 months and I
year with a complex pattern of findings. Although there was no statisti
cally significant difference at the 4-month follow-up between the EFT
and the IS groups when compared with each other, there was a signifi
cant interaction effect. This showed that the EFT group, although main
taining some change, had dropped significantly on three of the four
measures between termination and the 4-month follow-up, whereas the
IS group had remained stable over this period. At a I-year follow-up,
however, the two groups were again indistinguishable, and the EFT
group appeared to have improved from the 4-month follow-up to levels
comparable with its scores at termination. DAS scores are shown in
Table I.
What appears to have happened is that the couples in EFT, having

improved over therapy, lost some of their gains after 4 months, but
regained them after 1 year. Couples in both groups were interviewed
intensively at the 4-month follow-up, and the couples in the EFT spoke
more frequently of the need for check-up sessions foil owing termination
or for more practice to maintain the levels attained at termination. Both
sets of couples , also reported that they would have liked a few more
sessions added to the treatment package of 10 sessions.
One possible interpretation of this data is that EFT provides the
couple with a self-generating set of conditions for maintaining satisfac-
tion, if couples reach normative levels of marital satisfaction
(DAS = 114 ± 10) by termination, as they did in the first study. When,
however, therapy terminates and the couple has not reached a functional
level of satisfaction and intimacy, as occurred with some couples in this
study, although they have experienced some improvement and expe-
rienced some intimacy during therapy, the change is not sufficient to
sustain the improvement, and the couples deteriorate to a degree. Thus,
the findings with the more distressed sample used in this study suggest
that more than 10 sessions of EFT might be beneficial in order to increase
the level of couple satisfaction at termination. In the IS group, couples,
although they terminated at similarly low levels of satisfaction, did not
deteriorate but rather maintained their gains. This suggests that a self-
sustaining process of change has been created. After I year, however, the
EFT group was indistinguishable from the IS group. It is as though,
having had a glimpse of intimacy and greater satisfaction and then lost
some of it, the couples in the EFT treatment found their own way back to
previously achieved levels of satisfaction.
These findings are interesting in light of the attitudes of systemic
therapists toward emotionally oriented treatments. The creation of inti-
macy and expression of feeling are often seen as making people feel good
but not as necessarily producing change. The truth maybe lies somewhere
in between, that unless the emotional system reaches a sufficiently high
level of trust and satisfaction, it does not automatically produce perma-
nent or second-order change. Initially, change may occur by a circular
process whereby good feelings increase motivation to change behavior,
and this change in behavior modifies interaction cycles, which in turn
help to increase good feelings. This needs to occur repeatedly until such
time as trust is developed and the bond is restructured- that is, until such
time the change process is reversible.
SUMMARY
EFT integrates experiential and systemic perspectives. People are viewed

as constructive, self-organizing beings having inherent tendencies to sur-
vive and grow. This process of self-formation is totally context-depen-
dent in that the organism is in dynamic equilibrium with the environ-
ment. Thus, interaction is understood in terms of circular causality or
reciprocal determinism, rather than linear cause and effect. In viewing
the person as a self-organizing system in a continual process of becoming,
in a field constituted both by internal intrapsychic influences and exter-
nal interactional influences, change can be brought about both by
changes in self and changes in context. Thus, therapy focuses on chang-
ing both the interactional cycle and each person's inner experience of self
and the relationship. The process of change is directed toward a restruc-
turing of the emotional bond. This is brought about by changing the
context in order to promote new responses and by supporting emerging
new aspects of self. Evoking and expressing the emotional experience
underlying interactional positions allows the restructuring of intrapsy-
chic and interpersonal processes.
Research has demonstrated that the approach conceptualized above
led to positive change in three studies of the effects of EFT. Significant
effects were found at termination and follow-up on a variety of measures.
Treatment that did not bring couples to a functional level of adjustment
by termination appeared to lose some of its impact over time.
PART TWO
Practice
CHAPTER THREE
General Considerations
'
In emotionally focused couples therapy, intrapsychic and interpersonal
perspectives are combined; interactional positions are assumed to be
maintained both by strong, primary, emotional responses and by the way
interactions are structured and organized-that is, by intrapsychic reali-
ties and the rules of the relationship. Hence, the goal of emotionally
focused therapy (EFT) is to enable a couple to change the habitual
positions they assume in relation to each other and to change the way
each partner experiences the relationship. The direction of this change is
toward genuine dialogue and the fostering of accessibility and respon-
siveness. The emotional experience underlying relationship positions is
then explored and expressed in order to enable couples to reorganize
their relationship-specifically, to take more flexible positions with each
other. These new positions involve new, more differentiated perceptions
of the self and the other and an expanded range of behaviors in response
to the partner.
EFT is based on the concept of intimate relationships as emotional
bonds. The needs of the partners in such relationships are viewed in terms
of the provisions supplied by intimate bonds, such as the affirmation of
worth and identity, the creation of a shared reality, and the provision of
nurturance, security, and intimacy. The general principles of EFT are as
follows:
1. The therapist focuses on the present experience of each partner
in the relationship. Individual past experience is evoked only in the
event that such experience seems to be blocking one partner's ability
to respond to the other in the present relationship. More recent rela-
tionship experiences-for example, the fight the couple had on the week-
end-are evoked in the present by the therapist. Partners then do not
57
PRACTICE
~imply discuss events; they also reexpenence whatever remains unre-

s h~ .
2. The focus is particularly on accessing primary emotional expe-
rirnces, especially each partner's experience of vulnerability and / or fear ,
and having partners communicate these underlying experiences to each
ther; reyealing themselves and their needs for contact and comfort helps
t create a genuine dialogue. Primary emotional responses not fully
attended to, and therefore not available to conscious awareness, never-
theless create an orientation to the partner and to the relationship;
therefore, they override other cues that are inconsistent with this orienta-
tion. As a result, it is essential to bring these primary emotional responses
into awareness and explicitly into the interaction.
3. The focus is on the interactive process rather than the prob-
lematic issues. Since the same interactional patterns emerge in numer-
ous different content issues, the focus is on these patterns; that is,
how the couple fight is more important than what they fight about.
The pragmatic issues presented in therapy are the arena in which the
structure of the relationship and the underlying emotional responses
of each partner are played out. The therapist must view the relation.,-
ship from this niet~level and not become enmeshed in trying to solve
particular issues for a couple. As part of this focus on the interactive
process, all individual responses are viewed in terms of the context in
which they are evoked, that is, the context of the other partner's be-
havior.
4. The focus is on restructuring the interaction using the newly
accessed primary emotions to motivate new behavior. Once the underly-
ing primary emotion is experienced, the partners are encouraged to
express the needs and wants associated with these emotions to each
other. Different emotions dispose individuals to different actions, which
may then be enacted with the partners, changing the interaction. Certain
emotions promote contact and attachment behavior while others pro-
mote distancing or the assertion of control. Thus, fear, vulnerability, or
t4idneu will evoke flight or nurturance-seeking behavior. Anger and
dttiU8t wiJJ evoke assertion and boundary setting. These emotions and
th~ u1ociated action tendencies may then be used to restructure interac-
t-Jon, in term» of uffiliation and autonomy.
In 1ummury, then, EFT concentrat.es on the present, primary, emotional
e¼pc,,1 nee ond the restructuring of tJ1e process of interaction in which this
~, rl 11 ltt evoked ond expressed.
GENERAL CONSIDERATIONS 59
CONDITIONS FOR THE USE

OF EMOTIONALLY FOCUSED THERAPY
The first prerequisite for conducting EFT is that the couple do wish to
reorganize their relationship in terms of an intimate partnership. This does
not imply that from the beginning of therapy the couple have to feel totally
committed to the relationship; some relationships may be redefined as
distant friendships as a result of therapy, and doubts about commitment
are nearly always present in a distressed couple. However, if one partner is
clearly choosing to dissolve the relationship and the other partner is resist-
ing this decision, then EFT does not seem to be appropriate. Some of the
problems couples exhibit also preclude the use of EFT; for example, this
approach is not recommended for physically abusive couples.
The second requirement for EFT, apart from a general consensus as
to the agenda for therapy, is a good working alliance with the therapist.
In EFT, the therapeutic allia~ce is a prerequisite for treatment rather
than being considered as a mechanism of change in and of itself. This
alliance must involve an agreement between the therapist and both clients
as to the goal of therapy and the perceived relevance of the tasks involved
in the therapy process (Bordin, 1979). An appropriate bond between the
therapist and each client, evoking a sense of safety and trust, is the final
element of such a working alliance. This sense of safety is essential in a
therapy that focuses on the exploration of emotional experience. How-
ever, this bond is not as intense as may be expected in individual therapy
since the other partner, the main object of each client's emotional life, is
present; also, one of the goals of the therapy is the attainment of a close
caring bond between the partners.
The quality of the bond aspect of the alliance would seem to be more
crucial in EFT than in behavioral or cognitively oriented couples therapy.
The practice of skills, for example, would seem to require less personal
trust in the therapist than the experiencing of previously unacknowledged
and potentially threatening emotional states. The creation of a safe envi-
ronment is also essential in that EFT involves each client taking considera-
ble personal risks with the other. The reality of this risk becomes apparent
when, even after emotional responses have been explored with the therapist
in front of the partner, a client has great difficulty actually stating these
same feelings to the partner when asked to do so.
The building of an alliance is also an integral part of EFT in that the
beginning stages of EFT particularly involve the therapist validating each
60 PRACTICE
partner's present experience of, and responses in, the relationship. Such
validation builds an alliance and also constitutes the first step in treat-
ment; importantly, it legitimizes clients' responses and encourages them
to explore these responses further.
The therapist must be able to join with both clients in their intrapsy-
chic and interpersonal experiences even though they may present oppos-
ing antithetical views of reality. To join each client without alienating the
other involves the therapist validating each one's experience without
attributing intentionality or blame to the other. The use of descriptive
rather than evaluative language is essential here. It is consistent with this
approach to view the partners as feeling legitimately deprived of such
basic satisfactions as closeness, contact, comfort, and recognition. In a
relationship that is not working well, both partners are usually withhold-
ing affection and caring and are realistically feeling unloved and untrust-
ing. The therapist initially attempts to capture the pain that each partner
feels and to describe how each expresses this pain in the relationship. As
discussed in the previous chapter, the needs for closeness and contact are
considered here in a context of basic healthy functioning rather than in a
context of developmental failure or psychopathology. Hence, the thera-
pist presents a picture of the couple's problem as stemming from adult
unmet needs and perceptions of the partner and the relationship that
result in self-defeating cycles of interaction. Both partners are at o:ice the
creators of the relationship dance and the victims of it. The problem is
thus framed in terms of mutual responsibility and mutual deprivation.
This frame, which always views one partner's behavior in terms of the
evoking stimuli presented by the other, also helps the therapist to main-
tain the neutrality necessary for effective intervention.
Rationale
The rationale for therapy is stated in terms of the fact that couples often
have strong emotional responses to each other that make it difficult for
them to accept the partner and respond in a loving way. As the relation-
ship becomes less and less safe on an emotional level, it then becomes
more and more difficult to be clear about what each person feels and
needs from the other and to express these feelings and needs. Each person
begins to protect him- or herself and enters a relationship of appearance
rather than authenticity. This then leads to less and less willingness to
reveal oneself to one's spouse and more and more distance in the relation-
ship. Ideally, therapy sessions are a safe place for partners to explore
each other's experiences of the relationship and clarify their responses to
each other. The therapist also places the relationship in the context of
bonds and bonding, suggesting, for example, that the accessibility and
responsiveness of the partner is a source of security and comfort for most
people and is crucial in terms of how individuals view themselves and
their world.
This rationale does not involve a didactic statement to the client but
emerges in the first few sessions as the therapist comments on interac-
tions, validates responses, and presents his or her perspective on relation-
ships and relationship problems.
The Process
The therapist must be sensitively attuned to each partner's internal frame

of reference and experience and to the impact of this experience on the
relationship. One of the basic skills of EFT is, in fact, the therapist's
ability to change focus rapidly from an individual intrapsychic expe-
rience to the facilitation of interaction between the partners. The thera-
pist often takes the part of a director or choreographer. He or she guides
the movement of the interactions in a particular direction, talking to
partners about their experiences, crystalizing such experiences and facili-
tating the expression of them. The therapist may develop and expand
particular experiences and conflict themes by blocking or heightening
one of the partner's responses, by talking to one partner about the other,
or by asking one partner to comment on the other's experience; the
possible transactions are numerous. The process resembles that of a play
with different subplots eventually coming together to form a deeper and
more comprehensive meaning than was initially evident.
Even though the emotional climate a therapist creates is supportive
and empathic, the therapist must be active and directive both in terms of
directing the process of therapy and in terms of ascribing meaning to
certain interactional phenomena and the intrapsychic experience under-
lying individuals' positions in the interaction.
The two main tasks of the therapist in EFT after the creation of a
strong therapeutic alliance are to evoke and work with emotional expe-
rience and to help the couple to frame that experience in terms that allow
62 PRACTICE
them to redefine their relationship. (These tasks are discussed in more

detail in Chapter 6.)
EFT is presented to the couple as a brief therapy, lasting anywhere
from 8 to I 5 sessions. It is presented as a therapy that is designed to help
them orient to each other in a different and more satisfying way. Emotional
experience in this case is viewed as an orienting response. The format of
therapy is conjoint except that each partner is usually seen alone for one
session near the beginning of therapy. These individual sessions can help
build a working alliance between the therapist and client and also provide
an opportunity for partners to share openly with the therapist concerning
sensitive issues. Such issues may involve their level of commitment, infor-
mation about past relationships, or frank evaluations of their partners and
the relationship that they may not be willing to share with their partner
present. Later in therapy, each partner may again be seen individually to
address specific blocks in the change process, such as one partner's inability
to respond to the other's expressed needs, but this is often unnecessary. In
general, whenever possible, the couple are seen together. Whenever one
partner is seen alone as part of the assessment procedure or to resolve a
problem later in therapy, the other partner is also given an individual
session since to see only one partner tends to unbalance the therapeutic
alliance; also, a solo session may seem to label this partner as a problem or
as particularly needing the therapist's attention.
The therapist begins by listening to the story of each partner and
fostering open communication between him- or herself and each client
before redirecting the clients to interact with each other. In general, at the
beginning of therapy, each partner will interact with the therapist for the
major part of the session. As therapy progresses, however, the sessions
become more and more involved with the interaction between the
spouses, with the therapist directing the clients' attention to their emo-
tional responses and when necessary, making suggestions or commenting
on the relationship as he or she observes the interaction.
EMOTIONALLY FOCUSED THERAPY

VERSUS OTHER APPROACHES
To further clarify EFT, it seems useful to compare the change strategies

used in EFT with those typical of other approaches to couples therapy.
All couples therapists deal with the same problems; all attempt to reduce
blaming, coercion, and conflict escalation, and all attempt to encourage

trust and goodwill. Most approaches attempt to clarify partners' desires,
encourage mutual responsibility for problems, and modify communica-
tion patterns in general (Gurman, 1978). However, various approaches
focus on different relationship paradigms which are then reflected in
general treatment strategies and in specific interventions.
If the troubled relationship is viewed mainly in terms of being a
conclusive unconscious contract between conflicting individuals who are
projecting past conflicts onto the present, then the treatment strategy is
one of promoting insight into generic causes (Sager, 1981). A possible
intervention here might be an interpretation of present events in terms of
past problems. If the relationship, on the other hand, is viewed in terms
of family systems theory, that is, in terms of symptom-maintaining
transactions, the treatment strategy is to change the pattern of transac-
tions without referring to individual motivations or experience. This may
be achieved by reframing and prescriptions, by the use of therapeutic
paradox (Fisch et al., 1983; Haley, 1976), or by directing people to
interact differently (Minuchin & Fishman, 1981; Sluzki, 1978). If the
relationship is viewed in terms of a bargain in which the participants do
not have the skill to negotiate effectively, as in the case of social exchange
theory, then the treatment strategy might be to substitute skillful behav-
iors for unproductive responses by teaching people to control their
communication patterns. In this case, the interventions might focus on
teaching and rehearsing specific skill sequences or making rational con-
tracts for the exchange of desired behaviors (Jacobson & Holtzworth-
Munroe, 1985; Jacobson & Margolin, 1979; Stuart 1980).
If, however, the relationship is viewed in terms of an emotional bond
that has become threatened or insecure and in terms of trust that has
been shattered, then the treatment strategy, as in EFT, is to heal the bond
and to reestablish trust, by promoting the experience and expression of
emotions underlying interactional positions. This is done by exploring
the emotional experiences of the couple in such a way as to help each of
them to evoke acceptance and contact from their partner. Partners reveal
themselves to each other as they really are and acknowledge and accept
each other. In this case, the interventions involve reflecting and heighten-
ing authentic emotional responses and needs underlying the structure of
the bond, such as the distress at being abandoned and the need for
security. The art lies in being able to help people access these emotions
and overcome blocks to expressing and listening to such experiences.
64 PRACTICE
To take a pragmatic example, if one spouse turns to the other and

states, "I can't bear it when you talk so coolly about this,:' how would
therapists from other approaches conceptualize and respond to this
statement? A psychodynamic therapist, searching for underlying dy-
namic motivations and perceptual distortions, might say, "You spoke of
your father always being "cool" in the last session. Does this response
seem familiar to you?" In the strategic systems paradigm, the therapist
might reframe the interaction as one based on the cool partner's caring or
concern for the other. In the behavioral approach, the therapist, focusing
on negotiating new behaviors, might suggest that the speaker pinpoint
exactly what the partner does that evokes this response and that she state
specifically how she would like his behavior to change. In the emotionally
focused approach, the therapist might direct the client's attention to a
current aspect of their experience that would help restructure the interac-
tion. The therapist might say, "How are you feeling right now? There
seems to be a kind of desperateness in your voice."
Each therapist is attempting to change the communication process;
however, the EFT approach differs from the psychodynamic in that the
focus is on the immediate emotional experience rather than on a more
abstract understanding of generic origins; also, EFT views context as
helping construct inner experience. EFT differs from the systemic and
behavioral approaches in that the exploration of inner experience is a
priority. The other three approaches to a certain extent all use a more
rational conceptual model, although the conceptual processes involved in
the different approaches may vary from complex insights about patterns
of responses to a skill-building process involving negotiation or problem-
solving skills. The EFT approach, in contrast, assumes that emotional
responses are the most relevant source of information likely to lead to an
adaptive response in the situation; on the other hand, in the systems and
behavioral approaches, the exploration of emotional experience is gener-
ally considered to be detrimental or irrelevant. If emotion is addressed,
for example, in the behavioral approaches, the expression of already-
formulated emotion is seen as simply one step in the rational problem-
solving process. In psychodynamic approaches, emotional responses are
often seen as infantile responses requiring socialization.
Negative, reactive emotional expressions such as blaming the partner
have been considered generally problematic in all approaches to couples
therapy. Thus, if a husband says to his wife, "You've never loved me and
you only care about yourself," therapists from the behavioral approaches
might attempt to suggest that this kind of blaming is dysfunctional and

substitute other statements or help the client to pinpoint his grievance more
specifically. However, these interventions tend to bypass or ignore the
client's immediate experience and his feelings of rage and rejection; instead,
the client is encouraged to detach himself and control his emotions. The
more analytic therapist might make an interpretation as to the intrapsychic
origins of this type of remark and explore the blamer's relationship with a
rejecting parent; this, then, disregards the ongoing interaction patterns
between partners. The EFT therapist, in contrast, would attempt to focus
on the present felt experience, validate this experience, and then begin to
unfold what it is that this client feels and ultimately wants from his partner.
In the EFT approach, the negative reactive emotional experience is vali-
dated; this is the first step on the path toward accessing the more primary
and adaptive underlying emotional responses.
These are legitimate reservations concerning the expression of such
negative feelings in couples therapy. For instance, some therapists feel that
this expression tends to solidify the status quo and create more distance
between the couple. However, this reservation is valid only if emotion is
simply ventilated rather than acknowledged or used as a stepping stone to
the exploration of authentic underlying feelings. It is the exploration that
then leads to new response patterns and a restructuring of the relationship.
The different relationship paradigms and approaches imply then a
different focus for the change process. Interactional patterns can either be
understood from an intrapsychic point of view, reframed in order to change
their meaning, structured differently by the use of rules and positive control
techniques, or, in the case of EFT, restructured by reconstructing -underly-
ing emotional states. Redefinition of the interaction in terms of underlying
emotions influences the current emotional states and experiential organiza-
tions of the partners, predisposing them to become more open and respon-
sive to each other. In EFT, new aspects of the self and the other are brought
into focal awareness, revealed, and then integrated into the couple's interac-
tions in order to restructure the emotional bond.
OVER VIEW OF THE THERAPY PROCESS
In this section, an overview of therapy is presented followed by a case

example describing the therapy process and then an example of the
process in one session of EFT. The steps of therapy are presented in a
66 PRACTICE
brief, linear manner. (A further delineation of these steps, together with a

description of therapist interventions and an exposition of techniques, is
given in Chapters 5 and 6.) This overview is designed to orient the reader
to the following chapters. Although the steps are presented in a linear
fashion, progress through them is often circular; the therapist often goes
back and retraces various steps at varying levels of awareness as unac-
knowledged emotional responses slowly become clear. Each step is also
described more fully in Chapter 5.
The nine steps of therapy are as follows:
l. Delineate the issues presented by the couple and assess how these
issues express core conflicts in the areas of separateness-con-
nectedness and dependence-independence.
2. Identify the negative interaction cycle.
3. Access unacknowledged feelings underlying interactional posi-
tions.
4. Redefine the problem(s) in terms of the underlying feelings.
5. Promote identification with disowned needs and aspects of self.
6. Promote acceptance by each partner of the other partner's expe-
rience.
7. Facilitate the expression of needs and wants to restructure the
interaction.
8. Establish the emergence of new solutions.
9. Consolidate new positions.
Case Example: The Steps of Therapy
John and Tess, a couple in their early 20s, came into therapy having been
married for 2 years. The presenting problem was stated in terms of sexual
dysfunction, in this case, vaginismus on the part of the wife. The couple
had attended a sexual dysfunction clinic and had been told there was no
physical cause for their problem. The problem had resulted in a short
separation and a brief affair on the part of the wife. The couple•s
perception of the problem was as follows: Tess believed that there was
"something wrong with her," and John was frustrated that his marriage
seemed to be on the rocks when, as he saw it, he was doing everything he
could to maintain the relationship. The sexual problem was not apparent
in courtship but appeared directly after the marriage.
In terms of basic issues of affiliation and dependence, John was at

once very dominating in his manner, speaking loudly and frequently, and
very desirous of physical and emotional closeness. Tess, on the other
hand, seemed very passive, presenting herself in a very submissive and
withdrawn manner, speaking very quietly, not making eye contact, and
allowing her husband to direct the session. Both stated that they wanted
the relationship to continue.
Identifying the negative interactional cycle was a simple matter in
that the couple enacted it constantly in front of the therapist. They also
described a sequence in their everyday life in which John initiated con-
tact, and when Tess did not respond as he wished, he became critical and
then attempted to push her into being with him or into making love. The
pattern here was very clear: The more he pushed the more she withdrew.
John would finally withdraw in a huff until the sequence began again.
The therapist identified the negative cycle and pointed out that the pat-
tern seemed to hold no matter what topic was discussed or where the
couple were, in a session or at home. This pattern of pursue-distance is
one of the most typical in couples' attempts to achieve intimacy and
security and is particularly common in distressed couples entering ther-
apy. Two other cycles, mutual distance and mutual blaming, are often
attempted solutions to unresolved basic pursue-distance cycles. In ther-
apy, the two "solution" cycles, if probed, often reveal themselves to be
variants of the basic cycle of the pursue-distance form. A second funda-
mental pattern is that of dominance-submission in which the partners
become involved in a complementary one up-one down pattern that
becomes part of each partner's self-definition. The elements of separate-
ness-connectedness (affiliation) and dependence-independence (power)
are always present in any interactional position and in any cycle; how-
ever, the way a particular couple interact often leads the therapist to
focus more on one aspect than the other.
In this case, Tess, as well as withdrawing, adopted a submissive
position, using her sexual symptom to avoid domination. John, as well as
pursuing Tess for closeness, adopted a dominant position. The cycle here
thus could be viewed from both power and affiliation perspectives; that
is, it can be seen as a submissive distancing response evoking and result-
ing from a dominant pursuing response. In an optimally functioning
relationship, responses are flexible but centered around a basic level of
equality and interdependence which then facilitates the resolution of
affiliation issues. Security, arising from a sense of having some control in
68 PRACTICE
the relationship, would seem to be a prerequisite to intimacy and the

accessibility and responsiveness necessary to the maintenance of close,
satisfying bonds.
The therapist, having identified for the couple the basic cycle as a
pursue-distance cycle, began to explore the unacknowledged feelings
implicit in the positions that this couple took with each other. The main
focus of therapy became John's anger and frustration and the basic sense
of helplessness underlying his initial dominant style. John also began to
talk about how afraid he was of losing his wife and his anxieties about
being alone. For Tess, therapy began to center on her sense of being
overwhelmed and invaded by John. The therapist then began to reframe
the problem in terms of Tess's sense of intimidation and fear and John's
sense of helplessness and dependency on his wife; that is, the therapist
framed the problem in terms of their underlying emotional responses to
each other and to the pattern of their interactions. Tess began to explore
her fears of being taken over and engulfed not only in sexual areas but in
other areas such as finances, decision-making, etc. She also examined her
almost physical fear in the face of her spouse's aggressive manner. The
therapist used reflection, evocative imagery, and other experiential tech-
niques to facilitate the accessing of the couple's experiences. For instance,
the therapist began by exploring John's experience of Tess's withdrawal.
This involved John's sense of rejection (which was at first denied), his
very strong sense of inadequacy as a lover and a partner, and panic at
being isolated from his spouse. His previously disclaimed tendency to
dominate his partner was placed in the context of his anxiety and his fear
of losing his wife.
At first, John was not receptive to Tess's expression of feelings of
intimidation and fear. He intellectually discounted them and pointed out
how inaccurate and mistaken they were; she then became confused and
withdrawn. A vivid evocation and reprocessing of her fear in the session
were necessary before Tess was able to own this fear and communicate it
to John in such a manner that they could both see that her response to
the fear was to shut him out and retreat inside herself. John was encour-
aged at this time to experience and express the feelings of loneliness and
failure that he experienced in the relationship. Tess was surprised but
responsive to John's expressions of anxiety and his fears of inadequacy.
The therapeutic task at this point was to help John hear how Tess
experienced his approaches to her. Each partner now began to see how
their responses evoked certain emotions and reactions in the other.
The therapist now could help the couple restructure the interaction
using newly accessed emotion to motivate new behavior. Having ex
pressed her fear and having had it validated and accepted, Tess was able to
assert her needs for safety and comfort rather than withdraw. New, more
contactful and assertive behavior on her part now became possible. She
began to express her desire for some autonomy and control in sexual areas
as well as in others. John began to ask for reassurance a'i to his wife's
caring and positive regard for him and to talk of his need for closeness.
New emotional syntheses led them to new action tendencies.
As the couple began to take new positions with each other, Tess
started to talk clearly and assert herself more, requesting certain kinds of
approaches to sexuality and to closeness in general. John became much
less demanding and aggressive and in fact presented himself to his wife as
vulnerable and needing to be wooed back into a sexual relationship with
her. Tess began to take more control, initiating sexual contact, running
her own finances, and responding to John's need for reassurance.
At the end of therapy, the couple were more balanced and flexible in
their positions with each other. They had started to make love and were
able to reassure each other about their commitment. They engaged in
genuine dialogues with each other in therapy and were thereby able to tap
resources in the relationship and to create again the unique sense of
caring and commitment that constitutes the life force of an intimate
relationship. Therapy ended with the couple role-playing each other as
they were at the beginning of the change process. She was able to play at
being forceful and intimidating and he at being passive and withdrawn.
The couple had found new solutions to their sexual problem and had also
restructured their interactions to include more equality and closeness.
The link between the presenting symptom of vaginismus and the struc
ture of the relationship was very clear in this case, and once the relation
ship was reorganized the symptom disappeared.
In this therapy process, John, a critical pursuer, accessed his vulner
ability and communicated his fear of being unaccepted to his wife. Tess, a
passive withdrawer, also accessed and expressed her fears in the relation
ship and was able to respond to John's vulnerability. Both partners
redefined their positions in the relationship so that they felt more person
ally secure and were more accessible and responsive to each other's needs.
This kind of process is not viewed in terms of a structural personality
change but rather within an experiential and systemic framework. A
couple's dysfunctional ways of processing experience and contextual
70 PRACTICE
constraints result in the utilization of only a limited amount of the

information available in a particular situation; this information is struc-
tured into only one of a number of possible self-organizations. When
partners resynthesize their emotional responses, they are able to con-
struct experience in new ways-in this case example, in terms of either
vulnerability or assertiveness. New aspects of self are thus accessed and
revealed and are then supported by the partner's new positive responses.
A new context results in new aspects of self being activated and revealed.
Finally, an authentic dialogue begins in which loving and commitment to
the other's well being is reestablished.
The Therapy Process in a Single Session
Presented next is a description of a session in which a couple complete a

treatment sequence. This session was a microcosm of the whole treatment
process. It was the eighth session with a sophisticated older couple who
had had a long but very stormy relationship. The session began with the
partners, Sylvia and James, having a fight abo11t his reluctance to take
her fishing with him. The fight followed the already-identified pattern of
their interactions, in which Sylvia became angry and accusatory and
James became cool, justifying his actions logically and calmly. As Sylvia
became more and more demanding, James threw up his hands and
suggested that her demands were boundless and that the relationship was
hopeless.
The therapist intervened to focus Sylvia on her feelings of panic at
James's perceived distance and indifference to her need for contact and
closeness. Sylvia focused on her inner experience, which had been ex-
plored in a previous session, and was able to express her vulnerability to
James in an authentic manner without implying criticism of him. James,
however, did not respond to her in a symmetrical fashion; instead, he
implied that she was in fact "too needy." At this point, the therapist
intervened. If the therapist had not moved quickly, the newly experienced
vulnerability would have become costly to Sylvia, and the interaction
would have escalated again into an argument. Instead, the therapist
worked with James to explore his response to Sylvia by expanding,
heightening, and replaying the sequence of interactions. Sylvia reiterated
in a vivid, immediate, and authentic way her fears that James did not
want the kind of closeness that she desired. Eventually, James revealed
that he had become terrified while listening to Sylvia's need for reassur-
ance and preoccupied with his own sense of always having been a failure
in intimate relationships. He also acknowledged that his usual way of
protecting himself was to become logical and accusatory. He further
revealed that many labels had been placed on him by a past wife concern-
ing his deficiencies, and that he had never communicated to Sylvia his
sadness and hopelessness in the face of these labels. Finally, James
experienced a great sadness and expressed his sense that he would never
be accepted and would never be able to make anybody happy. This was
at once a core belief concerning his own identity and a key appraisal
contributing to his position in the relationship with Sylvia. At this point,
the therapist encouraged Sylvia to respond to James and comfort him,
which James then reciprocated in kind. The therapist ended the session
by suggesting that the couple ask each other for help; Sylvia, with her
fear of vulnerability in the relationship, and James, ·with his sense of
personal deficiency.
This couple had made good progress previous to this session, going
through the steps of therapy in a more measured way. This session
seemed to be a critical enactment of their negative cycle; however, this
time the experience was reprocessed and resynthesized. New aspects of
the self were acknowledged by each partner, followed by new responses
in the other. As the relationship had been, it was structured to reinforce
Sylvia's sense of insecurity and James's sense of inadequacy, resulting in
them constantly protecting themselves from each other and thus endan-
gering the bond between them.
SUMMARY
As this chapter has outlined, the essential elements of EFT are considered
to be the reprocessing, the acknowledgment, and the expression in the
present of authentic emotional responses, which then lead to new interac-
tional patterns. Prerequisites for the use of EFT were outlined, together
with a rationale for therapy and the main tasks of the therapist. A
comparison with the practice of other approaches was also made, and an
overview of the therapy process and case examples were given. The
following chapters will consider the process of therapy in more detail.
CHAPTER FOUR
The Initial Interview
In the first interview, the EFT therapist has three main tasks: ( 1) to build
a therapeutic relationship with each of the two partners; (2) to assess the
relationship from a clinical standpoint, particularly in terms of the cycles
of interaction and the positions that each partner takes in these cycles;
and (3) to begin to establish a contract for therapy with the couple, that
is, an agreement concerning the purpose of therapy and the overall
structure. The building of an alliance was discussed in the previous
chapter; this chapter deals with the second and third of these three tasks.
ASSESSING CYCLES
The therapist begins by discussing each partner's perception of the prob-

lem and expectations of the therapy process. The focus here is on how
each partner experiences the relationship and views the self in relation to
the other. The therapist also observes how each partner elicits responses
from the other that confirm his or her intrapsychic reality; for example,
when confronted a husband withdraws, evoking attacking behavior from
his wife, confirming his sense of helplessness and his desire to protect
himself. The therapist attempts to gain a sense of the way each partner
experiences the relationship and how this experience is translated into the
positions each takes with the other. Generally, the position each partner
takes and the experiences underlying that position are validated by the
therapist whenever possible. The therapist in accepting each partner's
experience creates an atmosphere of safety and encourages a lack of
defensiveness and further exploration. Thus, the responses of a partner
who has been harassing his wife in an extremely dominating way, insist-
ing on knowing every detail of her life, might be validated or made
72
THE INITIAL INTER VIEW 73
legitimate by a therapist framing these responses in terms of the hus-

band's sense of exclusion from his wife's life and his fears of losing her.
This legitimizing of where people are when they enter therapy is a natural
consequence of the experiential view that it is not people's impulses or
desires that are the problem, but rather, the discounting or disallowing of
these desires; therapy attempts to change people into what they are rather
than what they are not. Accurate empathic reflections are the main
vehicle for validations. Each partners' responses are legitimized in terms
of his or her experience in the relationship and perceptions of the pattern
of responses offered by the partner that cue these experiences. Thus, the
therapist might say, "I understand that when you don't know where she
is, you become angry and you feel deserted. Then when she does come
home, her reluctance to talk to you, since she sees that you are angry, is
even more upsetting." This validation of an individual partner's expe-
rience must be done in such a way as to be acceptable to the other partner
as well-that is, in a way that this does not discount the other partner's
experience. This kind of validation also tends to diffuse negative emo-
tional responses such as anger, while encouraging self-exploration rather
than a focus on blaming the other partner.
The therapist next begins to delineate patterns in the process of
interactions. This begins by the therapist observing a behavioral sequence
as the couple enact the sequence in the session or as they narrate recent
episodes of conflict. The therapist begins to see how the partners attempt
to make contact or maintain distance, influence the other, and/ or protect
themselves in the relationship. Distressed couples exhibit extremely rigid,
repetitive patterns of interaction that can be easily identified most of the
time. These patterns or "cycles," so called since the actions of each spouse
are at once a stimulus for and a response to the actions of the other, are
automatic, immediate, and self-perpetuating, with the couple taking ha-
bitual positions in each interaction. Thus, the therapist might observe
that as the husband begins to describe the relationship in a slow, quiet
voice, the wife interrupts, discounts his description, and criticizes his
perspective. The husband then smiles nervously at his wife and tries to
reason with her in a placating tone; when this produces no response, he
withdraws into silence with a shrug of his shoulders. The wife then
attacks him for his lack of participation, and he agrees with her. Finally,
the wife ends the sequence by addressing the therapist, commenting on
her husband's passivity. This couple might then describe a typical recent
distressing incident in their marriage, which will follow the same pattern.
74 PRACTICE
The processes of these negative cycles of interaction can be deline-

ated on many levels, verbal or nonverbal, overt or covert, often it is very
interesting just to note the nonverbal communication in a couple. For
example, the husband may talk fast, twisting his hands and glancing at
his wife; meanwhile, the wife purses her lips, points her finger at him, and
leans forward; then, his eyes become wider, he holds his hands tighter,
and he leans back in his chair. As the sessions continue, the therapist will
describe the cycle in terms of internal cognitive and emotional responses
and finally in terms of underlying primary emotional responses; at first,
however, it is important to observe the sequence of interactions at a
behavioral level before probing deeper to levels out of awareness.
Two basic generic cycles or interactional patterns regularly emerge
in our work with distressed couples and have been identified by other
observers as well. The first, in the domain of affiliation, has been referred
to as pursue-distance, intrude-reject, or accuse-withdraw. Variants of
the pursue-distance cycle are, first, mutual withdrawal, where both par-
ties take symmetrical positions and distance as a response to conflict or
anxiety, and, second, mutual attack, where each partner blames the other
in an attempt to change the other. The other generic cycle, in the domain
of autonomy, is dominance-submission, blame-placate, or up-down.
Symmetrical variants of the dominance- submission cycle are mutual
helplessness, in which both partners behave in a more and more depen-
dent and helpless fashion in response to stress, or mutual competitive-
ness, in which each tries to outdo the other.
The pursue-distance pattern is one in which complementary behav-
iors (dissimilar but fitted)· evoke each other, rather than one in which
reciprocal symmetrical behaviors occur (Watzlawick et al., 1967). Reci-
procity often does not seem to apply for acts of rejection, which tend
rather to elicit complementary behaviors such as emotional appeals or
coercive tactics. Each partner's attempt to reduce his or her anxiety then
contributes to the other's distress. The abandoned, pursuing partner
clasps more tightly, thereby eliciting even more withdrawal from the
other partner. As the pursuer strives more and more for closeness, the
withdrawer, threatened by demands for contact, strives more and more
for a sense of autonomy. This kind of response cycle is consistent with the
predictions of bonding theory (Bowlby, 1969; Johnson, 1986), in which
perceived insecurity as to the bond between partners elicits protest and
proximity-seeking behavior. The more the pursuing partner attempts to
suppress unresolved feelings of dependency, the more these feelings will
THE INITIAL INTERVIEW 75
then emerge in exaggerated forms such as tantrums, whining, nagging,

and complaining. Such behaviors increase the negative impact on the
withdrawing partner and help to maintain that pattern of behavior. The
couple are then in a bind, as whatever they do increases their distress. It is
not hard to see from this description why marital distress is not a
phenomenon that is subject to spontaneous remission.
In the mutual withdrawal pattern, conflictual communication is
limited to hints, allusions, or brief rational discussion. This pattern
constitutes a symmetrical interaction in which each partner mirrors the
behavior of the other, in a form of negative reciprocity. Here withdrawal
is seen by the couple as a safer alternative to active communication,
which may become punishing and unmanageable. This kind of relation-
ship pattern is based on the avoidance of conflict and is likely to be
related to the partners' schemata or structures for organizing experience,
which influence each partner's actual and fantasied interpersonal interac-
tions. Such schemata link confrontations with extreme anxiety and lead
to a denial or distortion of conflictual situations. When, occasionally,
mutual withdrawers flip into mutual accusation, this then tends to rein-
force their fears of open expression.
The mutual accusation pattern is closely aligned with descriptions in
the literature of aversive control strategies, escalating conflict patterns,
and cross-complaining. This cycle is one that couples find exceedingly
difficult to exit from, since each feels provoked and frustrated. As the
conflict continues, each partner becomes more and more sensitive and
overreactive, leading to intense hostility, a need for revenge, and an
inability to empathize with the other partner. Feeling understood and
acknowledged enables people to exit from this cycle.
A rigid dominance-submission cycle precludes secure interdepen-
dence and is always associated with difficulties in the affiliative domain.
The central issue here is not the attainment of contact, however, but the
question of control. Often, submissive partners are also distancers, since
both roles are associated with a certain passive stance in the relationship;
however, when control is the issue, the conflict is usually framed by the
couple in terms of competence and inadequacy.
All relationship positions include affiliative and control elements. The
element that is operationalized most clearly in the interaction becomes the
focus of therapy. The clients' underlying experiences tend to differ accord-
ing to which element is most prominent in the interaction. A distancer, for
example, may typically access fears of being engulfed by the pursuer,
76 PRACTICE
whereas a submissive spouse will access fears of rejection, worthlessness,

and inadequacy. The meshing of control and affiliative issues can be seen in
the responses of the most active partner, that is, the dominant or pursuing
partner, who often sends interpersonal messages that link these two as-
pects, such as, "You are not there for me [affiliation] and therefore there
must be something wrong with you [control]." In any case, whether control
or affiliation is the focal problem, the therapist supports the underlying
aspects of self not operating in the relationship in order to shift interac-
tional positions and facilitate secure interdependence. The therapist then
supports the potential for responsible self-assertion and boundary marking
in the submissive partner and the vulnerability of the dominant partner.
Whether the couple's interaction is most prominently centered
around control or affiliation, both elements are always present. The
dominant partner attempts to coerce the other into fulfilling his or her
affiliative needs, whether these needs are concerned with levels of close-
ness and distance or with becoming the kind of person that the other can
rely on and feel secure with. The struggle is always about how the
relationship will be defined and by whom it will be defined.
These patterns of interaction, while present in all relationships to
some degree, are particularly characteristic of and rigid in distressed
couples' interactions. They revolve around core issues in marital conflict,
particularly those of closeness-separateness and dependence-indepen-
dence. The attack-withdraw or pursue-distance pattern seems to be most
common in couples coming for therapy with intimacy problems. It is
possible that most couples in mutual withdrawal do not come for therapy
since the relationship may be functionally at an end. Often, when a
couple presents in therapy with mutual withdrawal, it becomes apparent
that one member has already left the relationship and the therapeutic
task is to help the other accept this fact. The attack-attack pattern is a
little more frequent, but it is difficult to sustain and usually evolves into
attack- withdrawal. The submit-dominate pattern presents more clearly
as a power struggle in which affiliative concerns are secondary. Couples
involved in cycles where control-autonomy is the main issue often seem
to exhibit more physical symptoms and more explicit struggles about
how and by whom the self is to be defined. The therapist attending to the
process of interaction in the session identifies the pattern and the posi-
tions each partner takes. The therapist also invites the couple to narrate
how they usually relate to each other in times of conflict or stress, in
order to identify patterns and positions.
Origins of the Cycle
The etiology of each couple's dance is a matter for speculation. It may be

partly a result of each partner's general style or personality, predisposing
partners to perceive the responses of their spouses in a particular manner
and to react to threat in a particular fashion . Experiential approaches,
which view people as active creators of their world and the way they
perceive that world, are consistent with the concept of such predisposi-
tions. These predispositions may be viewed in information-processing
terms as schemata that direct attention and influence the interpretation
of new stimuli. Thus, withdrawers may have had past experiences that
predispose them to believe that exposing their feelings to intimate others
is a dangerous activity to be avoided, or they may believe that they are so
unworthy that if they reveal themselves, they will be rejected. The way
partners habitually and automatically process information and organize
experiences will, of course, influence their perceptions of and responses
to each other. However, couples have many other self-organizations
available to them, and the task of therapy is to activate new aspects of self
by changing both the intrapsychic experience and the interpersonal con-
text.
In the beginning stages of marital therapy, it seems more useful,
rather than focusing on innate predispositions, to focus on each partner's
position as it is evoked and maintained by the immediate emotional
experiences in the relationship and the responses of the partner. The
behavior of the partners is then viewed as a function of the relationship
rather than in terms of personality traits or psychopathology. It is useful
in this context to take a relationship history. The telling of this history
helps to clarify what each partner expected and wanted from the relation-
ship and how their particular cycle, of which they are the creators and the
victims, evolved. It is noteworthy, for example, that a husband taking a
passive, withdrawn position in relation to a dominating, intrusive wife
first met her when he was a patient coming to her as a nurse to learn to
manage his diabetes. Key events in the evolution of the relationship
should be noted and explored, particularly in relation to the positions the
partners now take with each other. The therapist can also ascertain what
the norms are in this relationship as to closeness and distance and the
issues of influence and control. The developmental stage of the relation-
ship is also noted, since it implies particular priorities and tasks that
influence how the couple relate to each other.
78 PRACTICE
Having explored and validated the clients_' reactions to each other

and their perceptions of the relationship, and having ascertained the
nature of the negative interactional cycle, the therapist goes on to enquire
into each partner's present life status and life history. This is not in terms
of extensive information gathering or focusing on past events, such as
those that may have occurred in the family of origin. Instead, the thera-
pist needs data with which to hypothesize about each partner's vulnera-
bilities and the sources of anxiety stemming from past life experiences
that may be reflected in present interactions. The self-concept and self-
esteem of each partner are noted since how we see and evaluate ourselves
is intimately connected with the feedback we receive from our most
significant other. As the therapist obtains a sense of how the clients
define themselves, the positions they take in relation to each other
become clearer and clearer. For example, a woman who is the oldest of
four children and who as a child played a parental role to her siblings and
her own parents, may believe that self-control and self-reliance are the
highest virtues. She therefore would have particular difficulty accepting
her partner when he adopts a passive position and expresses his anxieties
about his competence or ability to cope. She does not allow any such
expression of frailty in herself and reacts in a blaming, critical way to her
partner. He, in turn, sees her as super-competent, super-capable, and,
thus, not in need of his love and protection.
Particular immediate life stresses, such as certain occupational
priorities, also affect a relationship and influence partners' abilities to
respond to each other. For example, one partner in an older couple may
suddenly begin to experience great rage at her spouse to the point where
this began to threaten the relationship. In the first session of therapy, this
partner may relate how her daughter had suddenly died a year before. It
would then become apparent that the rage the client experienced was
primarily the result of her husband's inability, as she saw it, to comfort
her in her grief and to take the place of the lost daughter in terms of
closeness and companionship.
After gathering the relationship and personal histories, the therapist
then attempts to enter each partner's phenomenological world in order to
draw hypotheses as to the insecurities, vulnerabilities, and/ or resentments
underlying the position each client takes in the negative interactional cycle.
The therapist observes how particular experiences elicit particular interac-
tional responses, and how these responses elicit reactions from the other
partner that then tend to confirm each partner's inner experience.
Assessment in this approach to therapy then consists of the follow-

ing:
1. Entering the phenomenological world of the client as he or she

engages with the partner while hypothesizing as to the vulnerabil-
ities and / or resentments of each client and observing how each
attempts to protect himself or herself from the revelation of such
vulnerability or resentments.
2. Identifying the negative interactional cycle.
3. Identifying the positions each partner takes in the sequence of
interactions.
4. Gauging the clients' openness and flexibility in terms of how
likely they are to respond to the therapist's attempts to access
underlying feelings and to respond to open communication from
each other.
ESTABLISHING A THERAPEUTIC CONTRACT
The third main task of the therapist in EFT is to reach a consensus with
the couple about the goals and nature of therapy. This task may take up
to three sessions to complete.
The greatest issue facing the therapist here is the varying agendas
that some partners bring to therapy in regard to the relationship and the
process of therapy itself. The therapist has to ascertain each partner's
level of commitment to the relationship. Some partners come to therapy
to avoid ending a relationship that is, in fact, implicitly at an end for one
of the partners. These clients usually come to therapy out of feelings of
guilt or as a response to pressure from their partner. Often, these partners
present with a mutual withdrawal cycle. It may become clear to the
therapist that there is a calculated lack of involvement and emotional
attachment on the part of at least one partner, and that the task for this
partner appears to be the dissolution rather than the re-creation of a
bond. The therapist then may choose to explore this area in a separate
session with each partner. If one partner has, in fact, already emotionally
left the relationship, the best intervention appears to be the presentation
of this assessment to the couple, followed by the facilitation of a decision
as to the future nature of the relationship. In this case, the therapist may
be in the position of helping one member state explicitly that he or she
80 PRACT ICE
wishes to dissolve the bond and helping the other to begin to accept th is
as a fact. However, EFT is not designed for couples who are in the
intentional process of relationship dissolution since the process of ther-
apy is oriented toward the reorganization of intimate bonds. Separating
couples may benefit from individual therapy, from divorce mediation, or
from some kind of short-term, problem-solving intervention aimed at
helping them to reach reasonable decisions as to how best to separate.
The therapist can often gauge the level of commitment and motiva-
tion of partners for therapy by focusing on the strength of the relationship
and the positive involvement that they may still have with each other. If
individual partners cannot identify any relationship strengths, do not
express dissatisfaction with distance or conflict, and show themselves as
generally not invested in the relationship or unwilling to consider any of
the possible alternatives to their cycle, then their commitment is question-
able. In couples who are still committed to the relationship and feel
emotionally attached to each other, an exploration of the good times they
experienced in their relationship is useful in terms of creating hope and
gauging the level of possible movement in the relationship. In the course
of discussing the relationship's strengths, it may also become clear that the
couple have, in fact, much to offer each other and can, under particular
circumstances, respond to each other's needs.
Partners may also have differing levels of commitment to therapy
even if both still wish to be involved in the relationship. The therapist has
to acknowledge and explore any reluctance to engage in therapy on the
part of either of the partners. Usually, this is dealt with, as are other types
of resistance in this model, by exploration and validation of that
partner's feelings. Generally, all the therapist can do is to address the
client's concerns and to create as safe and as positive an atmosphere as
possible while accepting the couple's reservations and anxieties. The
therapist can encourage and reassure but cannot persuade or coerce.
In general, the therapist must attempt to assess the capacity for
change and movement that each client exhibits. The therapist also ob-
serves the relative flexibility- rigidity of the interactive negative cycle, the
intensity of the cycle, and the willingness of the partners to take some
responsibility for their part in this cycle. In this context, the therapist
notices how clients respond to probes and reflections and how they react
to each other.
Generally, by the end of the second session, the therapist has a clear
concept of each partner's position as well as some specific hypotheses as
THE INITIAL INTER VIEW 81
to the emotional experience underlying this position. The therapist may

also have a sense of how each partner's position is part of a self-
reinforcing negative interactional cycle. Furthermore, the therapist also
has begun to understand the level of commitment in the relationship and
the present state of the relationship in terms of the distress- satisfaction it
affords to both partners. If the picture is clear in terms of the cycle and
the direction for therapy, and a good alliance has been formed with each
partner, then there may be no necessity for individual sessions at this
point. Later the individual sessions can be used as one method of work-
ing through blocks in the therapy process as they arise, although it is
preferable to meet conjointly throughout.
CHAPTER FIVE
The Process of Therapy
This chapter is concerned with the elaboration of the nine steps of

therapy presented in Chapter 3. The focus here is on the general strate
gies of therapy and the change process engaged in by the partners.
NINE STEPS OF THERAPY
Step 1: Delineate Conflict Issues in the Struggle

Between the Partners
The first step in therapy is to delineate core issues in the conflict between
the partners. The partners are encouraged to make as complete a state
ment as they can of their perceptions of the relationship and their
experiences of the problems in the relationship. The therapist deals with
opposing reality claims by validating the partners' experiences in the
relationship and viewing the positions they take with each other as a
natural consequence of these experiences.
Although the first sessions are concerned with assessment, they are
also inevitably part of the treatment intervention. The questions the
therapist asks should elicit information, but they should also challenge
the client. For example, the therapist may ask a dominant, withdrawn
male, who portrays himself as a tower of strength, whom he goes to for
support when he needs it. During the questioning, the therapist focuses
on the process of the interaction rather than the content of the couple's
complaints and begins to identify themes in the struggle between the
partners. These themes, usually concerning affiliation and autonomy,
emerge as the therapist asks questions, watches the couple interact, takes
the history of the relationship, and asks the partners about their personal
82
THE PROCESS OF THERAPY 83
priorities and expectations. It may become apparent from the couple's

interaction that one partner, for example, defines the struggle as one in
which he resists domination by his wife, while his wife defines the struggle
as an attempt to create a reliable, secure relationship.
The particular approach of the therapist will, of course, color the
information he or she requests, pays attention to, and processes during
the assessment. Unlike psychodynamic therapists, EFT therapists assume
that if there are any past experiences relevant to the present relationship,
they will be enacted in the present and can, therefore, be dealt with by
focusing on current interactions. Behavioral therapists would be more
likely to focus on specific behaviors exhibited by the partners, such as
pleasing and displeasing behaviors and the reinforcement patterns that
maintain these behaviors. Behaviorists also focus more on the evaluation
of skill deficiencies. However, EFT therapists focus on the partners'
experience of the relationship, particularly on their emotional responses
to each other and how these responses mediate the closeness or separate-
ness of the bond between them and the process of self-definition. At this
stage in therapy, psychoanalytic, behavioral, and EFT therapists might
ask similar questions- for example "How do you feel when he shouts at
you? "-but they will develop the intervention in very different directions.
The analyst probes for past response patterns projected onto the present
relationship; the behaviorist might seek to specify the effect of a behavior
on the partner from a rational, problem-solving point of view; the EFT
therapist will focus on underlying felt experience.
The EFT therapist, as he or she identifies and clarifies the positions
each partner takes with the other, frames the problem in terms of emo-
tional pain, deprivation of emotional needs, and insecure attachment.
The therapist responds to the partners with the assumption that they are
doing the best they can in the situation as they see it. The focus is
particularly on the fears and vulnerabilities experienced by the partners
in the relationship and how their attempts to get each other to respond,
while protecting themselves, influence the interaction.
The therapist initiates a balanced alliance with both partners by
focusing on the relationship rather than on individual traits, history,
etc. Since distressed couples are particularly likely to make charac-
terological attributions ("He's lazy like his father"), the therapist, in
contrast, begins right from the beginning to relate the behavior and
experience of each partner to the other's responses and perceptions. The
therapist then links context, experience, and response in statements such
-
84 PRACTICE
as, "When you see him looking at you that way, you feel small and then
attack him."
An example of the kind of summary statement an EFT therapist
might make of a couple's problem cycle at this stage is, "So the problem
here is that you, Ann, feel very uncomfortable with the distance you
perceive between yourself and Al, but when you attempt to talk with him
about this, you end up getting angry, you feel misunderstood, and then
the two of you end up in a big fight. You feel unloved perhaps and that is
painful. Al, you see Ann as perhaps needing much more closeness than
you, which you find hard to understand and feel a little pressured by. I
can see from your point of view, then, that it's natural to back off when
you see her getting angry and to try and avoid an unnecessary fight." The
therapist always takes the other's perception and experience into account
when speaking of one partner's experience and always attempts to use
nonevaluative language, always assuming that people have good reasons
for their responses. The use of validation and the provision of clear
feedback in an accepting, nonjudgmental manner may be considered as
the basis of all effective therapies and is especially important in an
experiential approach such as EFT. The clients' behavior is understood
from their frame of reference, in terms of their legitimate desires and
needs. The positive validation used is a way of legitimizing and accepting
these underlying feelings and needs and understanding how behaviors are
positive attempts to solve the problems experienced by the client. With-
drawing, for instance, is then a positive attempt to deal with feeling
vulnerable, and pursuing is a positive attempt to achieve contact.
The therapist must listen experientially without becoming caught in
the content or in evaluative judgments as to the nature of the clients'
experiences. It is necessary to find the hidden rationality (Wile, 1981)
underlying maladaptive behavior. This is an active perspective that the
therapist maintains purposefully and deliberately. In order to do this, the
therapist has to avoid placing labels on the clients' experiences, either
from his or her personal frame of reference ("I couldn't live with this man
either-his wife is right, he is irresponsible") or from a professional
viewpoint ("This lady is crazy, she's bizarre; she really is the problem").
The two situations in which the therapist is most likely to be caught in
such reactions are when a client evokes responses that are problematic in
the therapist's own life and when the client threatens the therapist's sense
of competence. An awareness of his or her own reactions enables the
therapist to circumvent this process, attend to the client's experience, and
choose an effective intervention. For example, a client who is very

animated, angry, and tearful in an initial session recounts a recent inci-
dent in which she led her partner to believe that she was about to commit
suicide and then waited to see if he would stop her; he did not. The
therapist does not respond to the bizarre details of the way this client set
up this situation; instead, he or she listens to the experience conveyed by
the client. In this specific case, listening experientially involves hearing
the essential message that, in this relationship, as she experienced it, her
spouse would let her die-that is, there was no safety or protection for
her. Thus, she was now at the point of constructing ultimate tests for him
in the hope that he would finally show his love. The therapist validated
the client's experience and her desire to try to push her spouse into taking
care of her as well as her determination to fight for what she wanted.
Step 2: Identify the Negative Interaction Cycle
In Step 2 of EFT, the therapist identifies the negative interactional cycles.

The sequence of responses that evolved into a cycle may be pieced
together from the narration of typical problematic interactions in the
relationship. These interactions then begin to be displayed or re-enacted
in the session, or the couple may spontaneously exhibit such cycles. The
therapist must see the cycle, since a couple's description of their relation-
ship is often inaccurate and always incomplete. A concrete description of
each person's responses in a past fight, followed by a request by the
therapist for one partner to state explicitly to the other how he or she
feels about the other's response, usually evokes a repeat of the original
interaction. The identification of the cycle as it occurs is immediate .and
vivid in terms of the impact it has on the couple.
At this point in therapy, the therapist might describe a cycle as
follows: "Muriel, when you attempt to engage Tom, to get him to
respond to you in an intimate way, or to tell you his thoughts on a certain
topic, you experience him as agreeing with whatever you say or do in a
kind of noncommittal way. You find this very unsatisfying and tend to
get angry. You even get to the point of threatening to leave the relation-
ship. I guess, Tom, you're saying you find this difficult and you really
don't know what to do at this point to improve things, so you withdraw
and the two of you don't talk for a day or so." The description of the
cycle tends to be general and to focus on behaviors or reactive emotional
86 PRACTICE
responses, but it is brought into awareness and used to decrease blame

and rationalize the interaction process. Such a formulation also tends to
give people hope and a greater sense of control in what was previously
seen as a hopeless situation. The couple now have a concrete description
of what is occurring in their relationship, and they hear the therapist
v_alidate and legitimize their positions and the pain that they both expe-
rience.
Later in therapy, the emotional and cognitive responses that consti-
tute the cycle are referred to and elaborated on. As the cycle continues to
be referred to and described in therapy, it becomes more differentiated
and more complex until it is described in terms of emotional responses
and automatic cognitions rather than behavior.
In these cycles, the vulnerabilities and resentments evoked by the
partners' behavior and the ensuing attempts at self-protection are the
glue that keeps the couple stuck in the problematic pattern. Insight into
the nature of the cycle does not seem to be enough to create change; there
has to be a new experience that allows an emotional shift to take place,
resulting in a new position. However, the act of clarifying the cycle does
have the effect of allowing the couple to see how they have a part in
perpetuating their own deprivation and distress. It also tends to foster a
sense of mutual responsibility without blame, thereby beginning the
process of de-escalating conflict.
As the therapist develops a clear picture of the pattern of interac-
tions and how each partner evokes the other's responses, then he or she
can explore the underlying feelings and needs and validate them. This
initiates a process of each partner focusing on the self rather than
focusing on, and reacting to, the other. Negative responses, such as
criticism or stated indifference, are developed further rather than chal-
lenged or labeled as unhelpful. The therapist might say, for example, "I
can see that if you do not understand your partner's frustration and really
feel a little intimidated by it, you might not know how to respond, so you
try to avoid the situation by trying not to care and not to respond at all."
At this point, the therapist questions, explores feelings, and clarifies each
partner's perceptions, feelings, and reactions to the other in such a way as
to engage the couple on an emotional level.
In our experience, most cycles, whether initially focused on issues of
autonomy or issues of affiliation, are reasonably obvious; however, there
are variations. On occasion, a couple will present with a cycle that looks
like the classic pursue-distance or blame- withdraw, except that the
blamer seems to have a cold, disengaged quality. On closer exploration,

this usually seems to signify a blame-withdraw cycle in which the blamer
has given up and has perhaps already left the relationship emotionally.
The presentation of a blame-blame, mutual attack cycle that esca
lates rapidly in the session can present problems to the therapist, not so
much in terms of identification but in terms of control of the sessions.
This cycle is difficult for any couple to sustain and can result in physical
violence. If physical violence is occurring, then EFf is not recommended
as initial intervention. The treatment of chronic mutual attack cycles is
problematic and is addressed in Chapter 7.
In general, with most couples, it is not difficult to identify the
positions each partner takes in the cycle. The therapist can become
confused, however, when the couple relate specific incidents; no couple,
including the most distressed, always responds in a uniform way, and
there will be idiosyncratic reactions. Therefore, the therapist must focus
on the consistent responses the couple exhibit rather than the exceptions.
In general, the more compelling, urgent, and automatic the reactions the
couple display, the more chronic the problem and the more distressed the
relationship.
One other phenomenon that can be confusing is when, during ther
apy, couples reciprocally shift positions; for example, the blamer with
draws and the withdrawer becomes blaming. This is only a first-order
change (Watzlawick, Weakland, & Fisch, 1974), that is, a change in
elements; however, it is often the precursor to a more profound second
order change, that is, a change in the structure of the interaction.
The identification of positions can also become difficult if the thera
pist sides with one partner, thereby losing his or her necessary objectivity.
For example, a female therapist might identify with the wife in a relation
ship, finding the behavior of the husband threatening and reprehensible.
The therapist might then begin to view the wife's accusations of her
spouse as justified in some absolute sense, rather than as a reflection of
the wife's emotional reality and the relationship context. In a particular
example of this kind of difficulty, a female therapist accepted the wife's
slightly less derogatory way of speaking and a small amount of self
disclosure from her as evidence that she had shifted from her blaming
stance in therapy. As a result, the therapist encouraged the withdrawn
spouse, the husband, to open up and be accessible to his wife, specifically
to attempt to comfort her. The wife, however, had not changed her
position at all and had taken the therapist's responses as evidence that she
88 PRACTICE
was righteously angry at her husband; she then responded to his openness
by attacking him in .a severe fashion with the result that the whole process
of therapy was endangered. The therapist had lost perspective, focusing
too much on the content of the wife's words, and ignoring nonverbal
clues such as the wife's tone of voice, body lean, and posture, which were
all still accusatory.
It is important, then, to identify the partners• positions, paying
attention to verbal content and nonverbal analogic communication, and
to identify moments when there has been an actual shift in position, so
that new interactions can be choreographed at a time when they are likely
to be successful.
Step 3: Access Unacknowledged Feelings

Underlying lnteractional Positions
Step 3 of EFT is the accessing and accepting of unacknowledged feelings

underlying interactional positions. This is one of the key steps of treat-
ment; without which significant interactional change will not occur. As
with other interventions, this step can be operationalized at varying
levels. At first, it may be a relatively superficial adding of emotional
responses, not normally attended to, to the description of each partner's
positions or interactional cycles. However, as therapy progresses, the
emotional responses accessed become more distant from immediate
awareness and more central to the way the self is defined. Again, particu-
lar attention is paid to vulnerability and fear as well as to unexpressed
resentments.
Significant events arousing strong emotion are focused on as they
occur naturally in the therapy sessions or as such events from the recent
past are reconstructed and enacted. The therapist facilitates such enact-
ment by focusing (repeating key words) and heightening the experience
as described, until the. clients are actually involved in the experience in
the here and now. Clients are thus exposed to new relevant aspects of the
self in each other's presence. This process evolves a new synthesis of
emotional experience, not a reiteration of previously processed emo-
tional responses or the ventilation of superficial and/ or defensive reac-
tions. There is a quality of active engagement and a focus on inner
experience rather than on external reality or the other partner. The
therapist may begin by validating superficial reactions such as reactive
anger, but he or she will then work to access more primary emotions such
as the sense of threat that may underlie such anger.
Specific relationship positions seem to be associated with particular
underlying emotions; for example, the blamer in a relationship often
accesses, with the help of a therapist, a sense. of panic and insecurity in
relation to the perceived inaccessibility or unresponsiveness of the
partner and the corresponding fear that the self is by nature unacceptable
or unlovable. Sometimes, in a blamer, a deep mistrust of others and a
fear of abandonment or rejection are accessed. The partner taking a
withdrawn position, on the other hand, often accesses a sense of intimi-
dation and incompetence in relation to his or her partner, with a corres-
ponding fear as to the unlovable nature of the self, or feelings of resent-
ment concerning the pressure of trying to meet the partner's expectations
and needs. A withdrawer may also access a sense of fragility in face of the
threat of engulfment by the blamer or a fear that his or her own anger
might destroy the other or the relationship. At this point, EFT is some-
what like individual experiential therapy in that the therapist focuses on·
facilitating an increased acceptance of self and the disclaimed emotional
experience, together with the implied action tendencies. Increased con-
gruence of self as experienced and self as presented to the other is also
part of the desired therapeutic process.
The basic methods used by the therapist to direct the client in the
accessing of emotional responses are taken from gestalt therapy (Perls,
1973; Perls, Hefferline, & Goodman, 1951) and client-centered therapy
(Rice, 1974; Rice & Saperia, 1984; Rogers, 1961). The assumption here is
that, before clients can become accessible and responsive to their
partners, they must reprocess and crystalize their own experience in the
relationship. (Therapists' interventions are specifically addressed in
Chapter 6.) Two examples of a therapist working to access emotional
experience follow. The first concerns a withdrawn partner who is describ-
ing a recent fight with his wife.
THERAPIST: So what happened for you when she told you that your
habit of chewing tobacco was nauseating and she didn't want you to
do it?
JACK: Well, I misunderstood. I thought she meant don't chew it
when we go up to the party. [This is the focus the couple have already
taken when discussing this fight, that is, a content focus, resolving
nothing.]
90 PRACTICE
THERAPIST: Yes, but how did you feel when she said that?
JACK: I said fine .
THERAPIST: And then you popped some tobacco in your mouth.
JACK: Yeah, well I misunderstood and then she blew up.
THERAPIST: Jack, you have discussed how sensitive you are to what
you call put-downs. Somehow, I am just wondering how you felt when
Sue commented on the tobacco chewing?
JACK: Well, it's like, you are nauseating, you know, she's so logical
and right, it's like, I'm nauseating.
THERAPIST: What are you feeling right now as you say that?
JACK: I feel hurt. I did feel put down.
THERAPIST: (Bringing up an image the client had used earlier in the
session.) Like old Uncle Charlie?
JACK: Yeah, he was just a puppet, all those women, if- they said
jump, he said how high, and they commented on him all the time.
THERAPIST: How do you feel when you talk about this now?
JACK: I feel angry. I'm sure as hell not gonna be another U nclc
Charlie.
THERAPIST: Yeah, was that what you were saying to Sue when you
popped the tobacco in your mouth?
JACK: Hmm.
THERAPIST: You felt put down and you also heard her telling you
what to do.
JACK: Yeah, and I sure as hell felt you're (to Sue) not my goddamn
mother.
THERAPIST: I'll show you. You can't hurt and dominate me.
JACK: Yeah, I'm not going to be like Uncle Charlie.
THERAPIST: So I'll do what I like.
The therapist here is working to elicit the anger and resentment and,
eventually, the sense of threat that underlies this client's sullen distancing
behavior. The therapist hypothesizes the emotional responses that Jack is
not aware of and does not express and facilitates Jack's reprocessing of the
event. Jack's nonverbal action of chewing tobacco, after Sue's request that
he refrain from doing so, was taken as a sign of no nearing and indiffere nee
by his wife rather than an action based on his fear of domination and his
anger at what he perceived to be her nonacceptance of him.
The second example concerns a couple who came into therapy with
problems of alienation and the cessation of their sexual relationship. The
relationship had been characterized in the early sessions as one in which

Linda, the wife, pursued Michael, the husband, for more emotional
communication, and he withdrew. Then, unable to have the contact she
wanted, Linda withdrew as well, and the couple became alienated from
each other.
This excerpt is from the end of the fifth session and begins with the
therapist focusing on Linda's experience after having had Michael in the
earlier part of the session, look at her and express some of his feelings to
her.
THERAPIST: What's happening?

MICHAEL: I, I ... uh. (Pause.)
THERAPIST: You experience some pain?
MICHAEL: ( Talking to Linda.) This is the same situation, when I tell
you something a lot of the time, you never quite accept it, a lot of the
time.
THERAPIST: It's difficult to touch her.
MICHAEL: (Again to Linda.) You're pleased when I tell you some-
thing, but you never quite believe it.
THERAPIST: ( To wife.) What do you experience? ( Wife sighs.) Would
you like to believe him? Can you say this?
LINDA: (To Michael.) It's very hard for me to believe you.
THERAPIST: You seem so unconvinced? (To Linda.)
LINDA: Uh, hmm.
THERAPIST: Can you tell him this, something about "I don't know
how you could convince me?"
LINDA: ( To Michael.) I don't know how you could convince me. I've
been feeling really ugly, especially the last few days.
THERAPIST: What do you want from him when you're feeling this
way? Is there anything he could do for you?
LINDA: I don't know.
THERAPIST: Do you tell him, "I'm feeling bad, I'm feeling ugly"?
LINDA: No. Maybe. Sometimes. (Quietly.)
THERAPIST: You're saying that's symbolic of how you're feeling
inside?
LINDA: Yes, that's how I've been feeling the last few days, really
angry, pushed out of sorts, and when I get like that, the message I got
that was always fed to me was you're bad if you feel that way, therefore
you're ugly.
92 PRACTICE
THERAPIST: From Michael?

LINDA : No, from long ago.
THERAPIST: So, inside you feel . . . you're getting this message
you're bad, you're ugly for feeling angry. What do you want when you
feel this way?
LINDA: (Sighs and looks down.) What do I want? I usually want
pnvacy.
THERAPIST: Somehow because you've never known anybody that
could help you with that, the best thing is to be alone.
LINDA: Uh-huh. (Long pause.)
THERAPIST: I imagine I would want someone to hold me and tell me
I was special. I don't want to impose that on you as I don't know, but
somehow from all you say to me, it sounds like you really want to be
loved.
LINDA: Uh-huh.
THERAPIST: But when you fear or decide that you can't get it, you
take space?
LINDA: Uh-huh. (She looks down.)
THERAPIST: Somehow you 're not sure he can give you this nurturing
that you want so much. I don't think he knows that's what you really
want, or he doesn't know he could really get to you because he gets so
many messages of "leave me alone." (Lengthy pause.) Can you tell me
what's happening for you right now?
LINDA: Fear.
THERAPIST: Can you try to give a name to that fear. I'm afraid ...
LINDA: (She looks down; pause.)
THERAPIST: You 're afraid that if he gets close to you, or if you let
him get close, something bad might happen?
LINDA: (After pause.) Yeah! (She looks up.) I guess I'm afraid to
reach out.
THERAPIST: What might happen if you reach out that's bad? (Long
pause.) Somehow you've had a strong learning that if you reach out,
you don't get the acceptance you wanted so much. So it's difficult to risk
that.
LINDA: ( Cries quietly, then reaches for tissue.)
THERAPIST: Where does this rejection come from initially?
LINDA: Parents.
THERAPIST: Who particularly?
LINDA: I think both of them.
THERAPIST: Uh-huh. As you go into this .. . sad space ... does any
particular thing emerge for you, what's this feeling? I know it's a difficult
tight knot.
LINDA: ( She looks up and then down and cries.)
THERAPIST: Just some feeling like you can't get what you need?
LINDA: Uh-huh.
THERAPIST: You just want to be taken for who you are. What's it
like for you in that experience?
LINDA: (After pause.) I don't know.
THERAPIST: Are you beginning to withdraw now?
LINDA: Uh-huh.
THERAPIST: I see you sit there ... I don't know if I said something
that didn't fit. I know you 're inside there wanting something.
LINDA: (Cries.)
THERAPIST: But it's so difficult to come out?
LINDA: Uh-huh. (She breathes.)
THERAPIST: I guess you're saying it's easier to close off that part and
nurture it yourself, because bringing it out could be so confusing and
painful and difficult?
LINDA: Yeah!
THERAPIST: So you kind of go in there and manage it all yourself?
LINDA: Uh-huh.
THERAPIST: And I think you're saying it kind of leaves you feeling
lonely?
LINDA: Yeah!
THERAPIST: Yeah. So what is it you would like, as I know you can't
be rushed too quickly or be rushed in on too quickly? So what would you
like from Michael in these situations? Would you like him to come in
after you or would you give him a signal, or you just don't know?
LINDA: ( Cries, shakes head, and nods.)
THERAPIST: I'm going to push you a little, right, as not knowing
keeps you there. What would you like? What would make it easier for
you so you could get more of what you want? (Lengthy pause.) I'm going
to ask you to do something difficult. Will you look at Michael and tell
him you feel pain and hurt?
LINDA: (Looks up.) Yeah, I feel hurt. (She sobs loudly.)
THERAPIST: Stay with that .. . it's painful. (Long pause.) What
would you like? Can you hear me?
LINDA: Yes. (She cries.)
94 PRACTICE
THERAPIST: What would you like from Michael? (Long pause.) I do

know that even if you want something without asking for it, you have to
know what you want. What do you want?
LINDA: (Looks up.) I don't know. Not to judge me. I don't know if
he does, or it's just myself.
THERAPIST: Check with him.
LINDA: (To Michael.) Do you judge me or is it just myself?
MICHAEL: I don't think so when you're just saying what you feel.
THERAPIST: ( To Michael.) Will you tell her now as you see her cry
what you experience?
MICHAEL: ( To Linda.) I share your pain. I want to put my arms
around you. I want you not to hurt and I don't want to stop you hurting,
but I just want to be with you.
THERAPIST: ( To Michael.) Do you know if she wants you to put
your arms around her?
MICHAEL: ( To Linda.) There are many times you haven't wanted me
to put my arms around you.
THERAPIST: ( To Linda.) Is that true?
LINDA: Yeah! (She holds herself, rubs and then scratches her arm.)
THERAPIST: Is that what you wanted then?
LINDA: Maybe. (She rubs her arm.)
THERAPIST: Try it, will you? Tell Michael, "I want you to hold me."
I think you need to reach out when you feel bad. I believe you can do it.
LINDA: (To Michael.) Will you hold me?
MICHAEL: (Moves over and hugs her.)
This experience was then briefly discussed by the therapist, who

summarized the major themes.
Step 4: Redefining the Problem(s) in Terms of

Underlying Feelings
Once underlying feelings have been accessed, the problem is redefined in

terms of these newly accessed emotional experiences. For example, one
problem cycle was originally defined as the wife making requests, the
husband withdrawing, the wife pressuring him for response, and the
husband blowing up. With more emotional information, this cycle was
redefined as the wife lacking trust and fearing being shut out, with the
husband having a sense of inadequacy and a desperate need to protect

himself from his, as he perceives her, powerful wife. As mentioned
earlier, redefinition in terms of generally benevolent, biologically adap-
tive, underlying feelings and motivations is at the core of the EFT
approach.
The reframe is an interpretation that integrates the client's affective,
cognitive, and behavioral experiences. Such a reframe is highly credible
since it is based on information that is vividly experienced and thus
accepted as authentic. The reframe must capture and remain true to this
underlying experience. Fears and coping reactions such as defensive
anger might be framed in terms of key definitions of self in relation to the
other, for example, "She is stronger and more competent than me,
therefore I am intimidated and avoid contact." The problem is construed,
then, in terms of the fears and vulnerabilities of the partners. "Vulnerabil-
ity," as it is used here, refers to a complex state in which the sense of self,
the acceptable definition of self, is at risk, resulting in considerable
insecurity, anxiety, and painful affect such as sadness, fear, and a sense of
loss. The therapist elaborates on how the partners' vulnerabilities interact
to create a sense of deprivation and alienation.
A habitual withdrawal might be reframed then as a fear response
instead of an attempt to punish or hurt. Since the client by this point in
therapy has already begun to experience and express that fear, the
reframe is a vivid and compelling clarification of his or her experience
rather than a comment eliciting cognitive insight. In couples therapy, the
therapist can afford to be directive and to suggest possible underlying
feelings without fear of influencing clients toward incorrect or therapist-
based views of their inner world or their experience of their partner. This
is because their partner is present to challenge such views, and the
experience that is being processed is immediate. All suggestions are
therefore subject to corrective feedback. Even though the therapist sug-
gests inner states, the client is always the final arbiter of what he or she
feels.
At this stage of therapy, clients are encouraged to interact with each
other in the sessions. There is a strong focus on emotional responses as
they occur in the present and the exploration of these feelings in terms of
their meanings to both partners. The experience of strong emotion is a
powerful modifier of these perceived meanings of behavior both for the
experiencer and the observing partner. By the end of this step in therapy,
the problem has become framed in specific terms that reflect emotional
96 PRACTICE
responses rather than perhaps blaming statements such as "the problem

is he doesn't talk". A blamer's extreme attacking behavior might be
framed in terms of his or her extreme panic at the partner's perceived lack
of response. The meaning of the attack is then constructed as " I will do
anything to get you to respond to me," rather than "I am trying to hurt or
destroy you. " The blamer's accessing of this panic in front of the spouse
provides immediate validation for such a reframe.
Step 5: Promote Identification With Disowned Needs

and Aspects of Self
This step is concerned with the clients identifying with the disowned
aspects of experience and disclaimed action tendencies in the redefined
cycle. As the cycle is enacted in and out of therapy, partners become
aware of their automatic reactions and the disowned aspects of expe-
rience underlying such reactions. For example, a withdrawer becomes
aware of the feeling of being impinged upon, the fear of being over-
whelmed, and the subsequent automatic move to protect himself. In this
step, the clients are first helped to differentiate and identify fully with
their positions and, in some cases, deliberately to enact behaviors asso-
ciated with those positions. To continue the example just mentioned, the
withdrawer then experiences himself withdrawing, explores this auto-
matic response, and then experiences the fear of impingement. His pre-
viously disowned fear in relation to his partner, along with his disclaimed
tendency to protect himself, is encountered, embraced, and accepted; it is
recognized ,as part of his self. The disowned aspect of self, rather than
being avoided and denied, is enacted giving the client greater control of
what was previously automatic responding.
Experiencing disowned needs can be structured by the therapist or
can occur spontaneously in the session as the couple repeat their cycle.
The therapist might slow the action down and focus on the level of
primary emotion- and the disclaimed response inherent in that emo-
tion- rather than on automatic defensive responses. For example, a
timid husband who finds driving exceedingly stressful talks of this feeling
in a session. His w1fe becomes irritated and, in the next few seconds, they
enact their whole cycle: She attacks, he placates, she escalates the attack,
he withdraws, she breaks down crying. The therapist then focuses on the
wife's attack and the husband's response, replaying the sequence that has
just occurred. The therapist might then begin to help the wife to expand
and clarify her anger at her husband's fear. The wife may have previously
disowned any need for support or security for herself, but now she begins
to recognize the fear she experiences as her spouse reveals his anxieties.
Finally, the wife acknowledges that, as she listens, she senses that she is
alone and that only she is strong and capable, that is, that her spouse
cannot support her. The therapist, after exploring this experience, then
directs the wife to consider asking for that support and to elaborate on
her need for nurturance. This process continues until the wife is accepting
and allowing of her desire to be nurtured and beginning to consider
expressing this to her spouse.
The cycle is then re-enacted, but this time the wife includes the newly
discovered aspects of her experience. She replays, with awareness and
responsibility, a new expanded sequence that includes new aspects of self
involving her need for caring and for someone to lean on. The husband is
then asked if he knew how much his wife needed him and how he thinks
he could help her. On an analogical level, this introduces a shift in
position where he, previously withdrawn, reaches for her in her new
vulnerable state.
This step cannot occur until both spouses have been through the
previous steps of acknowledging the cycle and beginning to access the
feelings underlying their positions. In a sense, all previous steps lead to
here and all later steps go on from here. Step 5 is a watershed, a key
event. Disowned aspects of the self are integrated into awareness and into
the relationship. The process continues beyond de-escalation toward a
new openness and a new bonding process.
The choice as to which partner's experience to focus on at a ny
moment depends to a certain extent on who is the most receptive and
flexible. However, in general, the sequence that seems to evolve naturally
is that the withdrawer or submissive partner is usually one step ahead of
the blamer or dominant partner in the therapeutic process. In the above
case, for example, the distancing husband had already acknowledged and
accepted his anger at his wife and explored on a relatively intense level his
own overriding sense of inferiority to her and his desire for her acceptance.
Having acknowledged these experiences openly and encountered them in
�ront of his wife, he had become present and accessible in the relationship
m a new way. The next step was, therefore, fro the therapist to focus on
the wife, in order to change her part of the cycle. It also appears rational
98 PRACTICE
that before a blamer can be induced to reach out from a pos1t1on of

vulnerability, the withdrawer has to show some sign of being accessible.
The withdrawer often also seems easier to engage than the blamer in the
beginning of therapy, particularly with the use of validation.
This step in therapy echoes the concept used in experiential therapy
(Beisser, 1974; Perls, 1973) of changing into what one is rather than
trying even harder to be what one is not. This step may be returned to
again and again until the disowned experiences are integrated intrapsych-
ically and interpersonally.
Step 6: Promote Acceptance by Each Partner

of the Other Partner's Experience
This step involves the facilitation of each partner's acceptance of the

other's newly experienced aspects of self and emotional responses. The
therapist encourages each partner to express his or her experience with
the partner and then facilitates the partner's acknowledgment of this
experience, primarily by reprocessing interactions and exploring and
blocking nonaccepting responses.
The two key processes at this point in therapy are first the explora-
tion and then the expression of underlying feelings such as resentment or
vulnerability. The expression of such feelings often evokes issues of trust
and fears of disclosure as well as concerns about the other partner's
ability to accept and respond to this expression. The latter process, in
general, tends to be the more problematic. For example, at this point, a
critical blaming wife will usually be able, with the therapist's support, to
express her vulnerability and her needs to her spouse. Her husband,
however, may resist this new view of his wife and may be unable to
respond to his wife in terms of her new experience. Usually, this can be
explored in the session as follows:
THERAPIST: What happens for you when your wife asks for reassur-
ance like this? (Pause.) You seem very quiet.
TREVOR: Well, I guess it's new, I'm not sure, I've always seen her as
someone who doesn't need me, you know.
THERAPIST: So, you're not quite sure how to respond?
TREVOR: Yeah, it's hard to believe that well, well, if I do try to
comfort her ...
THERAPIST: That's what you hear her asking you for?

TREVOR: Yeah, but I kind of hesitate, you know. (Pause.)
THERAPIST: Can you help your wife understand that hesitation, that
reluctance just to rush in and comfort her?
TREVOR: Well (addressing Sally) I want to do it, I want to reassure
you, but I guess I'm worried that, that ...
SALLY: That I'll clobber you. (Laughs.)
TREVOR: Yeah, that I won't do it right and that you'll clobber me.
Another example of a partner being unwilling to trust the other's new

behavior arises when a previously withdrawn partner begins to assert him-
or herself and express anger or resentment. This can be very intimidating
for the blamer, and this intimidation can be expressed by a sudden escala-
tion of blaming and statements suggesting that therapy is, in fact, making
things worse. The therapist deals with this by tracking the blaming client's
experience and recognizing how alien and frightening it is for that client to
see the other suddenly setting limits, giving feedback, and drawing bound-
eries. The therapist thus helps the blamer to accept the other's new re-
sponses and not to see them as a personal threat. At this point in therapy,
where openness and goodwill have usually increased substantially, it is
possible to frame this kind of situation in terms of one partner needing the
other's help in order to respond. For example, in the above case, at the
therapist's direction, Sally may begin to offer ways that she can help Trevor
to feel safer in the relationship so that he can risk responding to her in a
new and more satisfying way. However, if there appears to be more
substantial difficulty in one spouse accepting and responding to the other's
new experience, then the therapist focuses on that partner's view of self, his
or her past learning in the family of origin, any catastrophic fears he or she
is experiencing, or whatever is inhibiting that partner's ability to respond to
the other. It is presumed that once the inhibiting factor is reprocessed, then
the partner will be capable of more empathic responding.
Past incidents are focused on only as they contribute to the present
interactions. For example, one client who seemed paralyzed in the face of
his wife's authentic request for his caring began to explore the fact that,
at these times, he felt overwhelmed and inadequate. He experienced her
requests as a criticism and a demand for a closeness that he felt unable to
provide. As he further explored his experience, the dominant image that
emerged was of a time very early in their marriage were they had had a
fight and he had pushed her. She had fallen down the stairs and had hit
100 PRACTICE
her head . She was unconscious when he found her. This incident, which
the couple had not mentioned for years and which the wife had almost
forgotten, was vivid and alive for the husband. It had confirmed a view
he had of himself as unworthy of trust and love, as a failure in relation-
ships, and even as a dangerous man. Once this incident had been ex-
plored, in a conjoint session, and the wife had accepted his difficulties,
there seemed to be a shift in his ability to respond to her. The session did
not focus on abstract insights as to the causes of the husband's lack of
response, and the therapist made very few interpretations. The process
was more of accessing the husband's experience, heightening his rela-
tively simple, concrete, primary, emotional responses, and integrating the
impact of these responses into the relationship. The interaction pattern
here was also conducive to a new intimacy; when the husband disclosed
his worst fantasies about himself, he found that, contrary to his expecta-
tion, his wife was accepting of him.
Step 7: Facilitate the Expression of Needs and Wants

to Restructure the Interaction
Step 7 involves the expression of needs and wants. Of course, couples

talk of their needs throughout the process of therapy; however, the
experience and expression of these needs, the way these needs are likely
to be received, and the context of the other partner's likely response have
all evolved by this stage of therapy into different forms. The needs and
wants of both partners can now be experienced and expressed in a more
open, genuine, and direct fashion. At this point in therapy, the focus of
each partner has changed from a reactive preoccupation with the other
and the effect of the other's behavior to a focus on the self and on the
process of eliciting desired behavior from the other by presenting the self
differently. A classic shift in EFT is from "You are withholding what I
need" to "I'm afraid to ask, but I do want to let you in."
As a result of the new emotional synthesis of intra-individual and
interpersonal experience, the partners also have a new clarity concerning
what they require from the relationship to help them feel secure, ac-
cepted, and satisfied. These desires are implicit in and spring naturally
from an engagement in emotional experience: couples can now under-
stand that when they feel afraid, they want to be reassured, and when
they feel fragile, they want to be nurtured. Emotional experience ha~ a
THE PROCESS OF THERAPY 10]
motivational component that is recognized by theorists such as Arnold

( I960) and is one of the important change processes in an affect-oriented
therapy (Greenberg & Safran, 1987a).
The desires that arise at this point in therapy are basic to the
emotional bond between partners rather than instrumental or exchange-
oriented ; they are on the level of basic requests for contact- comfort,
security, recognition of personal worth and identity, and open access to
closeness with the partner. One woman, previously dominating and
critical, stated to her partner, "I guess I want you to take care of me, to be
there for me to lean on, so that I don't always have to be strong. I want
you to comfort me when I get overwhelmed by things. In a way, I need
you to take me on." This was not stated as a demand but as a statement
of needs and wants. Another partner, who was previously placating, self-
designating, and apologetic in interaction, began to make statements
such as "I would like you to be more attentive to me and my needs and do
some of the things I like to do." This was stated not in anger but, again,
as an assertion of needs and wants.
The context is not one of quid pro quo exchange ("I do this for you
if you do that for me"), but one in which partners respond to each other's
needs in whatever manner they can, because they see how crucial these
needs are to their partner's well-being and security in the relationship.
They are rewarded by being able to give to an intimate other what only
they can give; thus, they feel needed. The relationship becomes a mutual
I-thou relationship in which partners reveal themselves and respond
authentically. This overcomes the former sense of alienation and isola-
tion and breathes life back into the relationship.
Partners can now directly ask for specific responses in such a way as to
evoke a caring response. This constitutes a new interactional pattern.
Greater trust in each other follows. The attacking partner, for example, can
now ask for reassurance in a congruent manner- that is, from a position of
vulnerability. The other partner, seeing vulnerability rather than hostility, is
likely to respond in an empathetic, caring way. Each time the sequence
occurs, the bond between the partners is made more secure.
It is important here that the needs and wants are not stated or
perceived as demands and are free of blaming. They are statements
focused on the self- "I need or I want"- rather than statements focused
on the other. Once desires are openly stated, accepted as legitimate, and
recognized by the partner, the urgent struggle for an immediate and
particular response is lessened. Partners are then more able to accept
102 PRACTICE
some of each other's desires in terms of the timing and the nature of a
particular response. This is facilitated by two factors: The self, having
integrated disowned aspects and disclaimed action tendencies, is stronger
and more able to tolerate delay, and the conditions evoking and main-
taining the partners' nonresponsive positions have changed. The couples'
interaction now evokes greater responsiveness, and there is a greater
general sense of trust, understanding, and security in the relationship.
Also, partners having had some of their needs met during the therapy
process do not feel so deprived.
Step 8: Establish the Emergence of New Solutions
Step 8 involves the integration of new solutions into the problem situa-
tions that precipitated the couple's entry into therapy. Since the couple
are now able to take new positions in relation to each other, many new
responses are possible.
The therapist helps to delineate the solutions and aids the couple in
diffusing possible blocks to positive responding. He or she also highlights
and strengthens new positive patterns of interactions. For example, the
couple may replay a typical problematic situation from the past but put
in new responses, or they may discuss a situation that occurred during the
week that they dealt with in a new way. A wife might confront her timid,
withdrawing husband with his fearfulness. Since he is now able to "un-
latch" the old cycle (Gottman, 1979), instead of distancing and becoming
more fearful he is able to reassure her that he is fine and ask her to help
him by remaining quiet rather than criticizing him. She, in turn, is able to
accept his suggestion and admits her own nervousness and anxiety rather
than focusing on the husband.
When couples are able to become more accessible and responsive to
each other, which in this case implies that both the way the individuals
experience the relationship and the rules of the relationship have
changed, then couples seem to exhibit greater creativity and skills in
problem-solving tasks that previously used to trigger the negative interac-
tional cycle. For example, couples may become more able to cooperate as
parents and to solve financial problems more effectively. If the central
struggle for a secure emotional bond is resolved, pragmatic instrumental
concerns are more easily dealt with, since they are no longer the arena for
self- and relationship-defining, emotional-laden conflicts. For example, a
chronic disagreement about what to do with a summer cottage is easily

resolved once the cottage is no longer a symbol to the wife of her
husband's separateness and lack of connection with her.
When disagreements do occur, they now tend to be centered on
issues and thus are resolved more easily. Disagreements now tend to stay
on the level of "I have this opinion which is different from yours" rather
than "I never get a response from you; I am a victim in this relationship,"
or "You are an emotional cripple." Specifically, when the emotional
climate in the relationship changes in the direction of more trust and
security for both partners, then couples are able to use the problem-
solving skills already in their repertoire. If any skill deficits exist, more
effective responses can be modeled by the therapist. For instance, he or
she may construct the dialogue the couple might have if both partners
were open and responsive. This is, as Wile ( 1981) suggests, teaching
communication without rules and without training as such.
The couple can now attempt to substitute positive, self-reinforcing
interactional cycles for the negative ones, while the therapist heightens and
reinforces the new cycles. Since the relationship is now redefined positively,
partners can ask for what they need. For example, the husband who used
to take the old position of blamer may begin to attack his wife. However,
he can now stop and begin to tell her instead of his sense of insecurity. She,
responding to his expressed insecurity, can reassure him. Then he accepts
her reassurance and recognizes that she has responded to his need, thereby
increasing his trust in her and in the bond between them. She sees how she
is necessary and valuable to him as a partner, and is also encouraged to
engage in the same process in a reciprocal fashion. Both partners express
aspects of self that had been previously unavailable in the relationship. As
this positive cycle of accessibility and responsiveness continues, the bond
between the couple is strengthened.
The couple at this point in therapy are also motivated to break pat-
terns of behavior that contributed to their previousI
alienation from each
other. They may then decide to structure more intimate time together.
Step 9: Consolidate New Positions
Step 9 of EFT is the last in the sequence and, as such, is the most
concerned with strengthening and integrating the changes that have
taken place in therapy. This involves consolidating the new positions the
104 PRACTICE
partners have taken in relation to each other and integrating new per-
spectives on each partner's sense of self and the relationship. The couple
are encouraged to clearly differentiate between the old and new patterns
of interaction. The therapist facilitates the development of an encompass-
ing view of the interactional cycles, both positive and negative, and the
consequences of each.
The final sessions are concerned with the same termination issues
that any experiential or client-centered therapist addresses in general
therapeutic practice. The process of therapy is reviewed, changes are
clarified, and future goals in the relationship are discussed. Original
issues are reviewed in the light of the present relationship as are any
anxieties about terminating therapy. The therapist also considers possi-
ble scenarios that may occur when the relationship is under stress and
discusses how some form of relapse is inevitable with an accompanying
return to the old cycle. The couple and the therapist then specify ways
they have found to exit from that cycle, which they can use in the future.
The therapist's role here is to strengthen the couple's sense of now
being in control of their relationship and being able to handle any future
problems. Ideally, sessions are terminated gradually over a number of
weeks, being structured further and further apart. A few check-up ses-
sions are also scheduled after termination to monitor the maintenance of
treatment effects.
Case examples to further illustrate the steps of therapy now follow.
CASE EXAMPLE: THE PORCUPINE

AND THE ARMADILLO
Kathy and Tom were seen as part of a research project; thus, their
therapy was limited to eight conjoint sessions. They were a couple in their
30s who had been together for 7 years and had one 3-year-old child. Tom
had previously been married. Kathy was a homemaker, and Tom was an
accountant in a large company. They had met in the context of an
educationally orientated, personal growth organization, and Kathy had
been attracted to Tom by his knowledge and apparent sophistication in
this area. She had seen him as someone who could help her become a
fulfilled, mature adult. Tom had been attracted to Kathy by her integrity
and intelligence, and the relationship had gone well for the first 2 or
3 years with Tom and Kathy moving in together and finally marrying.
However, for the last 2 years, their relationship had begun to go down-
hill, and Kathy had begun to seriously consider divorce.
The scores for this couple on the Dyadic Adjustment Scale (Spanier,
I976), the measure used to assess marital satisfaction, were very low and
attested to their distress. Kathy's score (73) was in the range usually
found for divorcing couples and Tom's (84), although somewhat higher,
was still characteristic of a very distressed relationship. The strength of
the relationship as described by the couple was that they both loved their
son and felt committed to their task as parents. Also, Kathy described
Tom as affectionate and caring, and Tom stated that he wanted very
much for their relationship to improve and continue. Both seemed still to
share a commitment to the relationship although Kathy was considerably
more ambiguous on this topic than Tom. Neither seemed to have particu-
lar issues in relation to their family of origin or past romantic relation-
ships. Both were psychologically orientated and had received some indi-
vidual therapy. They also seemed to have a genuinely shared goal in
terms of therapy: to improve their relationship, which had been once a
source of happiness and satisfaction for them. As Kathy stated, the
present relationship seemed "like such a waste."
Session 1
After a general assignment, the therapist asked the couple to discuss their
perceptions of the problem. The problem according to Kathy was that
Tom avoided taking any initiative in the relationship and avoided any
closeness with her. She pointed out that he shirked his responsibilities as
a partner by agreeing to carry out certain tasks and then letting her down.
Tom's main complaints were that he was tired of continuous disagree-
ments that were never resolved and that they had no sexual relationship.
Both, as is typical of distressed partners, saw the problem mostly in terms
of the other's behavior and shortcomings.
The negative interaction. cycle between them became immediately
clear. Kathy exuded hostility and icy contempt, attacking Tom at every
opportunity: for example, "I'd like him to stand up and be a man, not a
wimp." Tom, on the other hand, did not withdraw in the sense of
becoming silent but vacillated between half-hearted attempts to recipro-
cate Kathy's attacks, giggling nervously, making jokes, appealing to the
therapist, and agreeing with Kathy's disparaging remarks as to his behav-
106 PRACTICE
ior and character. These responses did not lessen her hostility in any way,
and Tom would finally begin to stutter and to take a hopeless and
helpless position, concurring with Kathy's opinion of him. The couple
presented , then, a clear, very rigid, repetitive, and extreme version of the
blame- withdraw cycle.
Since they were a sophisticated, psychologically minded couple who
seemed to have clear and compatible agendas for therapy, and who quickly
formed a therapeutic alliance, and since the therapist had only eight ses-
sions in which to effect change, the therapy process began at a rather faster
pace than usual. The therapist pointed out the pattern of the couple's
interactions as they were happening in the session. During the process,
Tom came up with an image of the relationship as being one between a
porcupine, his wife, and an armadillo, himself. The porcupine in this case
kept "poking, telling the armadillo you 're doing it wrong, but the armadillo
goes into his shell." This image became an important synopsis of their
interaction and was used by the therapist to explore their relationship
positions and the sequence of their interactions. The stuckness and rigidity
of their pattern was expressed in such dead-end exchanges as:
ToM: You never come clean, you resent me no matter what I do.
KATHY: That's because you never change.
or
KATHY: It's like blood out of a stone, you never really communicate.
ToM: I'm just reluctant, I pull back, I guess you're right. (Laughs.)
In the first session the therapist was able to assess the relationship,
form a basic alliance with each client, and begin Steps 1 and 2 of therapy,
delineating the couple's perceptions of conflict issues and the interac-
tional cycle.
The cycle between Tom and Kathy escalated in the first session, with
the couple occasionally referring to emotional responses such as rejec-
tion; for example, Kathy said, as part of a joke, "I start to feel rejected,
guess there must be something wrong with me." This might have lead into
some kind of new interaction, but generally Kathy and Tom maintained
their positions of blame and withdrew and repeated the negative cycle. As
Kathy became more and more angry, Tom became more and more
distant, suggesting she talk to her friends instead of to him.
The therapist ended the first session by summarizing her view of the
relationship so far, describing the interactional cycle, and attempting to
frame therapy in the most positive and hopeful light possible. She com-
mented, for example, that Kathy and Tom must care for each other to
remain in a relationship that had obviously become so painful for both of
them. The therapist also presented the rationale for EFT and dealt with
any questions or reservations concerning the process.
Session 2
Session 2 began by the therapist recapping the salient points of the first
session and describing the negative cycle. At the therapist's suggestion,
Kathy then began to describe her feelings when Tom suggested that she
talk to her friends instead of to him. Tom was encouraged to take her
comments seriously, and the therapist then took the opportunity to
explore with Tom what made it so difficult for him to talk to his wife. In
the course of a quick bantering exchange, Tom mentioned in a joking
way that he was afraid of Kathy and her friends were not. The therapist
saw this as an opportunity to begin Step 3, accessing unacknowledged
feelings with Tom. She therefore repeated, focused on, and heightened
his comment concerning his fear. Tom then became engaged in a process
of accessing an overwhelming sense of hopelessness and inadequacy,
stating that there was nothing he could do to get his wife to accept him.
His fear of his wife's judgments as to his inadequacy became more and
more vivid and was accompanied by tears and other signs of strong
emotion such as an inner focus and a low-pitched vocal tone. The
therapist validated Tom's responses and heightened and clarified his
experience whenever possible. The therapist then directed Tom to try to
express his feelings to Kathy.
In response, Kathy attacked Tom by suggesting that real men are
not put off by fear. The therapist, however, blocked the strength of her
attack by continuing to legitimize Tom's feelings. She then began to add
to the description of the cycle in terms of the emotion expressed in Tom's
responses. Particularly, the therapist elaborated on the fact that it was
Tom's fear of Kathy's judgments that kept him away from her; although
Kathy wanted him to come close, she instead pushed him away with her
judgments. Tom wanted her acceptance but was too afraid to even
contact her. Hence, the cycle was created by both and painful for both.
As the exploration of emotional experience continued, the sense of
impasse, of the binds contained in the cycle, became more explicit to the
108 PRACTI CE
couple. In a metaphorical sense, it was as if the room became hotter and

the nature of the barrier blocking the way out became more and more
clear: thus, there was a mounting pressure to break the barrier. The
therapist then began to engage in Step 4 of the process, defining the
problem in terms of the cycle, the positions in the cycle, and Tom's
feelings , which formed the basis for his position. Toward the end of this
session, Tom began to stutter less and engage Kathy a little more.
Session 3
The couple came in having had a relatively harmonious week, with Tom
participating more in the relationship. The therapist encouraged the
couple to discuss these changes in the relationship and began to search
for an opportunity to continue the process of last week, bringing up key
statements and incidents from the last session and inquiring about prob-
lematic situations or reactions that had happened during the week. Since
this is a short-term therapy, this kind of active seeking for therapeutic
opportunities is necessary.
The therapist continued to focus on Steps 2, 3 and 4 of therapy and
to elaborate on the positions each partner took in the cycle. The therapist
phrased these in simple terms, describing Kathy's position as "Come out
here or I'll kill you," and Tom's position as "Please accept me but I'm not
coming anywhere near you." The therapist continued to focus and elabo-
rate on underlying feelings whenever possible and to interpret the prob-
lem in terms of these feelings.
The couple then began to discuss a recent fight, which the therapist
evoked in the session and encouraged the couple to reprocess. Tom, with
the therapist's help, described the fight as an overwhelming set of de-
mands made on him by Kathy. He then began to explore his response to
Kathy and how he dealt with his sense of intimidation. He explored his
experience of being a naughty child in relation to Kathy and his strategy
of appeasing her by superficial agreement or by joking, thus protecting
himself. He described his response as constantly holding her off. The
more engaged he became in this experience, the clearer it became that he
took this protective stance constantly whenever he experienced his fear
and the ensuing desire to protect himself. He also began to access anger
and resentment against Kathy. It was obvious, at this point, that it was
very difficult for Tom to allow himself to experience anger toward his
wife let alone express this anger. However, he was able to begin to feel
some resentment and a sense of the defiance that motivated him to climb
into his armadillo shell and hold her off. The therapist then supported
Tom to express some of this newly discovered emotion to Kathy. How-
ever, when he did so, her most positive response was on a very cognitive
level: "l see, so you don't ever really agree to anything and that's why you
don't come through. You just superficially agree in order to hold me off."
She maintained her blaming, hostile stance even in the face of his disclo-
sures, suggesting that "he chose to feel accused." She stated that his hurt
and fear, and the fact that he could not express his anger, confirmed his
weakness rather than being any kind of comment on her behavior. The
therapist was then faced with a withdrawer who appeared to be willing to
cooperate in therapy and a firmly entrenched hostile blamer.
The agenda for the therapist at this point was to encourage Kathy's
engagement in the therapy process. The therapist began to focus on what
it was like for Kathy to attempt to reach Tom and come up against his
shell, to be agreed with, but avoided. Then Kathy explored her rage and
frustration at being shut out. She described an image of hitting Tom with
a bat. The therapist encouraged her to imagine herself doing just that and
to voice what she would be saying while doing this. Kathy explored her
experience, voicing such statements as, "If you don't talk to me, I'll
smash you." The intensity and desperateness of her rage surprised Kathy,
Tom, and the therapist, but the engagement in this experience seemed
more promising for the therapeutic process than Kathy's cold, rational
hostility. Ideally, however, negative emotions such as this kind of anger
are experienced, not simply ventilated, in order to go beyond them.
Therefore, when Kathy fleetingly referred to a sense of helplessness, the
therapist focused on this and on the trembling of Kathy's hands. At this
point, Kathy spoke in an abstract way about the fact that people some-
times got shaky when hurt, adding that she did not really feel hurt. The
therapist suggested in a soft, evocative voice that people also shook when
they were afraid. At this point, Kathy began to cry and expressed with
intensely emotional involvement her fear that her husband was never
really going to be there for her, that he had deserted her, and that she had
given up. She then explored this experience further and accessed that she
had given up on anyone ever loving her; perhaps, she thought, she was
indeed unlovable. This part of the session had the quality of an intense,
newly discovered experience. The therapist legitimized and clarified
Kathy's hostility and attacking behavior in the relationship in the light of
110 PRACTICE
this experience. The therapist also reinterpreted the cycle in terms of how
it was a logical consequence of Tom and Kathy's vulnerabilities and how
they tried to deal with them.
At this point, Tom, encouraged by the therapist, reassured Kathy
that he recognized her feelings and did not want to desert her. The
therapist closed the session by telling the couple to pay attention to the
cycle in their relationship as they played it out during the week, and to
note their own responses.
Session 4
In this session, the therapist's agenda was to continue Steps 2 to 4 in a

more and more significant manner. She also planned to work on Step 5,
the identification of disowned aspects of experience, which Tom had
already begun to do when talking about his fear of judgment and Kathy
had already begun to do when talking about her sense of being deserted.
Kathy started the session by immediately attacking Tom, calling him
a child and accusing him of laziness. She stated that he was incapable of
taking any initiative. The therapist's sense was that Kathy was recoiling
from the slight shift in her hostility that had occurred in the last session.
Tom said that he had tried during the week to show his concern and his
desire to respond to Kathy's needs but that she had discounted his
attempts. This view corresponded with the therapist's observations of
Kathy's behavior in the sessions. However, as Kathy continued her
attack, Tom stood his ground and stated that if Kathy wanted things to
change, she had to be willing to give him a break-that is, to accept some
of his efforts to reach her and to acknowledge his vulnerability to her
judgment and criticism. He added that if she could do this, he did have
the strength to involve himself more fully in the relationship. This was a
change in Tom's usual position in the interaction, and the therapist
focused on, directed, and heightened his comments.
Tom then expanded on his desire for acceptance, accessing an in-
credible sense of fatigue associated with the constant struggle for Kathy's
acceptance and the need to always protect himself from her criticisms.
The therapist validated and supported Tom in his owning of his need for
some safety and acceptance in the relationship. Kathy, however, re-
mained relatively unresponsive, so the therapist intervened, framing
Kathy's response in terms of an unwillingness to trust Tom again and the
THE PROCESS OF THERAPY III
fear of allowing him to hurt her. The cycle of "I won't trust him till he
proves himselr' and "I can't prove myself till you begin to trust me again"
became apparent. Although Kathy would talk about and cognitively
explore underlying feelings for a moment, she always returned to attack-
ing Tom and placing all the responsibility for the problem and for change
on him.
Therefore, the therapist, while supporting Tom and blocking the
brunt of some of Kathy's attacks, returned to validating Kathy's sense of
being deserted and let down. Kathy explored this feeling further and
began to speak of and describe her sense of betrayal in the relationship.
The therapist then asked Kathy to tell Tom about this experience. Kathy
was able to tell Tom explicitly that she was so angry at him for letting her
down that she wanted to hurt him, and that she wasn't sure that she was
willing to take the risk of trusting him again. Tom accepted her state-
ment.
In the last half of the session, the therapist, faced with Kathy's fixed
hostility and refusal to acknowledge Tom's experience, chose to explicate
Kathy's apparent drive for revenge and to frame her unwillingness to
respond in terms of self-protection and the fear of trusting and risking
being hurt again. Since Kathy could not move beyond this point, owning
her hostility and her reluctance to be open was her only possible first step
toward change. Stating explicitly and with congruent affect where one is
in a relationship can be viewed as resistance; here it was viewed as the
first step toward change.
The pattern shown here, where the withdrawer emerges and begins
to be open and responsive, as well as to state some personal boundaries,
only to be met with more blaming, is not uncommon. The task for the
therapist is to support the withdrawer while helping the blamer to soften
his or her position.
Session 5
The couple came into this session in a considerably lighter mood. Kathy
had found herself less angry at Tom during the week, and she had
initiated love-making for the first time in months. Tom appeared very
moved as he described the experience of her warmth and how sad he felt
that this was usually absent. Kathy, however, then described an incident
in the recent past in which she had felt the sense of betrayal that had been
112 PRACTICE
accessed in the last session. She also spoke about how she had dealt with
this sense of betrayal and other hurts in the relationship by "walling Tom
out" and waiting until he proved his caring for her by coming to find her
and re-initiating contact. However, when Tom failed to do this, which
was usually the case, Kathy then felt totally abandoned and gave up on
the relationship. The therapist was now able to summarize the problem
cycle in terms of Kathy's and Tom's underlying vulnerabilities and their
ways of protecting themselves against these vulnerabilities. The first four
steps of therapy tend to recur in this way, each time becoming more
differentiated and more meaningful. Tom was able to reciprocally share
how he experienced the incidents referred to by Kathy, saying that there
was "never any room for me to be the one who needs comfort and
attention-I'm supposed to give, and if it's not right, wham, so I keep
away." Tom and Kathy were able to interact around these issues in a
more open and caring way than previously. They then became stuck
again in the dilemma of who was going to reassure who first.
Finally, with the therapist's support, Tom became very angry, and
he expressed his outrage at Kathy's treatment of him and stated that he
was tired of trying to meet her standards. He stated that what he wanted
was some reassurance and some recognition in the relationship. This
represented a clear shift in position for Tom and opened the way for a
possible new pattern of interactions.
Kathy responded by becoming relatively quiet and confused. The
therapist focused on Kathy's response, which she first identified as confu-
sion. Kathy then admitted that she liked Tom to stand up to her but that
she did not want him to become unreasonable. This struck all three
people in the room as amazingly humorous. Kathy identified her re-
sponse as a sense of relief and reassurance that she was important to
Tom.
Tom then went on to explore how the stance he had just taken
differed from his usual one, in which he assumed that the only way to
survive in the relationship was to placate and/ or withdraw his attention
in an attempt to halt the interaction. As he continued to explore his usual
passive stance, he began to access an underlying sense of defiance. The
therapist expanded and highlighted this sense of rebellious defiance, and
Tom was finally able to confront Kathy, stating that he would not be
pushed and controlled as if he was a child and that he did not want any
longer to resist her control by placating and avoiding her. The therapist
asked what Tom was willing to respond to, and he stated that in the past,
when he had seen Kathy's need clearly, he had responded . Kathy grudg-
ingly agreed.
The session ended with Kathy stating that she did sense that she had
been withholding recognition and respect from Tom. When asked how
she understood this withholding, she replied that she thought of it in
terms of "I'll show you, you can't get away with hurting me, with ignoring
me." The therapist summarized by pointing out that both partners in fact
felt helpless in the relationship, but they dealt with this feeling in oppos-
ing but interlocking ways, Kathy by attacking and Tom by avoiding
contact.
Session 6
The couple came in reporting that an unusual amount of open contact

had occurred during the week. The therapist's agenda was to focus on
Kathy, rather than Tom, and attempt to help her to identify more
completely with her disowned needs for contact and support. Ideally,
Kathy would then be able to express these needs to Tom, who was, in
the therapist's judgment, able and willing to respond. This agenda was
dictated by the therapist's perception that although Kathy had become
less hostile and had made some progress, she had not really changed
her basic position of the betrayed accuser. The agenda, then, was to
facilitate a softening of Kathy's blaming position. The critical issue
seemed to the therapist to be whether Kathy would be able to trust Tom
enough to allow herself to be in a position of openly needing a response
from him.
The therapist focused the session by recalling some of Kathy's expe-
riences in the relationship that had been explored in past sessions. Kathy
responded by commenting that Tom did seem to respond to requests for
support rather than to her angry demands. The therapist then focused on
how difficult it was for Kathy to ask Tom for help, comfort- or any-
thing. The session progressed to the point where the therapist asked
Kathy if she could ask Tom for comfort and then facilitated an explora-
tion of Kathy's resistance to doing this. Kathy began to access a sense of
helplessness connected to asking for help and a desire to back off and be
cool- and hence to test if Tom cared enough to approach her. At thi&
point, the therapist asked Kathy to look at Tom and assess the risk
involved in reaching out to him.
114 PRA CT rCF,
Edited Session Excerpt
KATHY: (Looking back and forth between Tom and therapist, play-
ing with necklace,· voice removed and intellectual.) If I didn't need to he
in a relationship with someone, I mean, I just would have left him instead
of still trying to have this relationship, right? So um, yeah, um, so what J
see is like, I realize like the things that I need are, I mean, they are sort of
the normal things that everybody needs.
THERAPIST: Like what? Can you tell Tom what you need?
KATHY: Acknowledgment for who I am as a person um, ah, respect,
um ... consideration. (Pauses, looking at Tom.)
THERAPIST: Maybe you need to know that even if you're vulnerable
and needy that Tom will take care of you rather than somehow close up
like an armadillo.
KATHY: (Voice hard, emphatic.) Well, that I don't trust him to do it,
if I am vulnerable and needy.
THERAPIST: Right, you're afraid that he's going to close up.
KATHY: My fear is that if I am vulnerable and needy that he can't
accept that, so yeah, so he will withdraw, yeah, right. (Nods head.)
THERAPIST: Well that's really a big one because then it's like you're
risking everything. I mean you've experienced this disappointment in the
past so you take a risk, you show your vulnerability and your neediness
to Tom, risk everything and he withdraws from you.
KA THY: That's right.
KATHY: (Pause.) So that's why I get so furious when he closes off.
THERAPIST: Right ... umhum. So it's like he's deserting you just like
all the other people who've deserted you, disappointed you.
KATHY: Right, and that's where, um, (voice soft, fragile) where the
hurt goes into anger.
THERAPIST: How do you feel when you talk about this, Kathy?
KATHY: Well, I feel emotional, I don't know, I assume that that is
sadness. (Looking to side and down.) But I don't have, I don't have a
specific connection for it.
THERAPIST: Well, I guess, listening to you, if you really want some-
thing very badly, believe that it, isn't there for you and nobody's going to
give it to you, I mean that in itself is sad. (Pause.) And then somehow to
get to the point where you can't ask for it anymore, it's just too painful to
take that risk, then that's sad, Kathy. (Pause.) I think that makes you feel
alone too.
KATHY: Yeah, it does. (She cries, wipes her eyes.) It also (voice high,
child�like), I feel invalidated as a person.
THERAPIST: How do you mean? You mean, make that simple for me.
Do you feel small or ...
KATHY: No, more like I don't exist.
ToM: (Fidgets.) Like somebody doesn't notice you're there?
KATHY: Um, it's not that they don't notice I am there. ( Voice
shaky-having difficulty speaking.) People notice I am there and it's OK
if I have the correct behavior appropriate for the situation and if I look
the right way. I must have the right behaviors and look half decent
because the inner part of me is not acceptable. (Pulling herself together,
blows nose.)
THERAPIST: So if people really saw your need (soft) they wouldn't
accept you or respond to it.
KATHY: It's like I go around with this image so if people see that I am
not the image that I present, um, I have a belief that they may not respect
me.
THERAPIST: Do you believe that about Tom, if Tom sees your
neediness and your vulnerability and your need to be somehow validated,
reassured, that he won't respect you? (Kathy and Tom look at each other,
pause.)
KATHY: Um, see, I am not sure. It's much easier to accept those
characteristics in people that you are not in a relationship with, so you 're
not identified with them.
THERAPIST: So you 're not sure that he would respect you if he saw
your need and you're also not sure that he would respond and you'd end
up feeling more alone, even less real.
KATHY: That's right. ( Voice shaky again.)
THERAPIST: So it's easier to get angry and say (angry voice) "I don't
need you, and I'll show you, you can't do this to me, you can't leave me
here feeling alone."
KATHY: Yeah. (Nodding, pause, looking down.)
THERAPIST: Can you look at Tom for a minute?
KATHY: (Laughs, wipes eyes.) If I can see. (Looks at Tom.)
THERAPIST: How does it feel to just look at him?
KATHY: (Pause.) Well I go into my analysis about what he's think.
mg.
THERAPIST: Um, do you want to know how he's reacting to you?
KATHY: Yeah.
116 PRACTICE
THERAPIST: (To Tom .) How does it feel to sit and listen to Kathy talk
like that?
ToM: I feel, um, I feel more comfortable, a lot more human, you
know, I don't feel like I have to play a role or meet anybody's expecta-
tions, like in the first session when I first sort of detected within you that
your vulnerability you know, I really felt like, yeah, I felt like I could
respond, truly respond, you know what I mean.
THERAPIST: You were not being pushed, or somehow coerced, or
somehow blamed.
ToM: Yeah, that's right, I didn't feel there was a demand, a hook of
some kind. It was like there was just you who, however, you were you
know, so it brings forth in me other qualities, other parts of me.
THERAPIST: How do you feel about Kathy right now?
TOM: I feel, ah, like I want to be with you. (Looking at Kathy,
laughs.) I feel close and willing to share.
THERAPIST: So you would like to be able to be there for Kathy?
ToM: Yeah, yeah I would. (Pause.) Give me a chance, I will. (Pause,
Tom laughs.)
KATHY: Yeah, I've done that before and you withdrew, you know,
you pull your mask down, it's like you know, I don't want to give you a
second chance. (Tom nods.)
THERAPIST: But have you done it before, have you really showed
Tom your vulnerability in the last while in your relationship?
KATHY: No, I stopped doing that because it didn't work, but I
showed more in the first few years than I do now.
THERAPIST: I wonder if Tom understood what you were showing, or
asking for?
KATHY: Well, my beliefs are that, he understood but, it was, um,
threatening to him, he's attracted to, um, to strong women or women
who appear to be strong, play that role. (Tom and Kathy laugh.)
THERAPIST: (To Tom.) Do you like that analysis of yourself?
ToM: No.
THERAPIST: I didn't think so.
TOM: Some of my best women friends are kind of wimpy.
(Laughing.)
KATHY: Yeah, but they're not the ones you've lived with.
THERAPIST: I heard you say, Tom, that you'd like Kathy to give you
the chance to be there for her.
ToM: Yeah.
THERAPIST: To be with her and to validate her, to give her the feeling
that she's real in the world and you're responding to her- and I saw you,
Kathy, wrinkling your nose (Kathy laughs) and thinking maybe that's too
big a risk, like I don't believe you, I don't believe you're going to be there.
KATHY: I do think that.
THERAPIST: Was he there for you right here?
KATHY: Yeah, he's here for me right now, um, but how I see it is like
there's someone else here, he has nothing at stake.
ToM: So when it gets down to the nitty-gritty, when you really need
somebody ...
KATHY: When it gets to when there's nobody else around,
THERAPIST: What's the difference when I am here?
KATHY: Well, it's like (pause) how I see the difference is that he feels
safe when you 're here.
THERAPIST: That's right, that's right.
KATHY: And I am not sure why he feels so much safer when there's
someone else around. (To Tom .) It's like I don't know what you are
afraid of that you need to have someone else there in order to be with me.
THERAPIST: (To Kathy.) I just want to slow down here, I agree with
you my fantasy about this relationship is that if Tom felt safe there is no
way that he wouldn't respond to you and be there for you, and I think if
Tom's busy defending himself responding to the, if you like, to the
weapons in your hand, that you've got because you don't really believe
that he's going to be there, then he probably won't be there because he
gets preoccupied with not feeling safe.
KATHY: There's still something about it that I don't get. (Looks
down, pauses.)
ToM: It seems like you don't really trust. You don't even trust what
was going on here. I mean that's your excuse. It doesn't meet your
conditions.
KATHY: No! I wasn't asking you for anything. I wasn't in a situation
of need.
THERAPIST: Well, I saw you asking for something, I saw you asking
for some kind of recognition. I am not sure though, I mean, Kathy, I also
have a sense that for you it would be very difficult, I mean I hear your
doubts and I don't want to say they're not important but it would be very
difficult for you to allow Tom to come in and be with you and respond to
you. I mean it would be almost like . ..
KATHY : I'd have to put my sword down. (Soft, small laugh.)
I I8 PRACTICE
THERAPIST: You know, you've had it for a long time- you've needed
it lots. ( Very soft voice.)
KATHY: Yeah, it would be like being a whole new way, playing a
different game. Yeah, so yeah, that would be hard.
THERAPIST: See, I think you listen to lots of reasons to not believe
Tom's ability to respond to you because, it's really scary to take that kind
of a risk. That's something that's been dangerous and painful for you. It's
not easy.
KATHY: Yeah, it doesn't feel like something that I can just give up.
( Gestures tossing something away with her hand.)
THERAPIST: No, no.
KA THY: Right.
THERAPIST: My feeling is that it will probably be a very gradual thing
or that maybe you just don't want to do it right now. Maybe you're not
ready to do it right now, you know? There were good reasons for holding
back. It probably saved your life at some point, right? (Pause.) You
survived being alone even though it was painful, you survived. If you let
Tom in, that's really different. (Kathy cries.)
KA THY: Yeah, that's true.
THERAPIST: (Pause.) Tom, where are you?
ToM: I am just empathizing with that. The way I've been thinking is
like well "change, damn it," but when I reflect on my own weapons, it is
very sad. The sadness is that you have to sacrifice in terms of living for
the sake of this stupid thing that really didn't mean anything, yet you had
to have it.
KATHY: Well, you can't say it really didn't mean anything. I'd have
died if I didn't have my weapons to keep people out.
THERAPIST: (To Tom.) So you can relate to what Kathy is saying?
TOM: Totally.
THERAPIST: Can you guys just comfort each other right now. ( Tom
and Kathy giggle.) Could you allow Tom to comfort you right now,
Kathy?
KATHY: I don't want to be comforted. (Small laugh.)
THERAPIST: OK, let's stop. That was a good session.
KATHY: Yeah. (Softly, clears throat.)
THERAPIST: You guys have a lot to give each other.
KATHY: Umhum. (Pause.) We do have potential, don't we? (Softly.)
THERAPIST: Oh yes!
Here the therapist attempted to work with Kathy's block to accept-

ing Tom's caring and comfort and promote acceptance of his inability to
respond under threat (Step 6). The therapist focused on Kathy's resis-
tance to becoming vulnerable to Tom, and Kathy did seem to respond.
Session 7
This couple worked with unusual intensity, so it was somewhat of a relief

to the therapist that the last two sessions were more low key than the
previous sessions.
Kathy began the seventh session by again bringing up her fear of
trusting Tom and "letting down my barrier."Tom then expressed directly
his need for acceptance and caring in the relationship and his sense of
"squirming resistance" to Kathy's demands. Tom then engaged Kathy as
to what she really needed from him. She disclosed that she had turned to
their child to fulfill her needs for comfort and affection and had cut Tom
off from that aspect of herself. She acknowledged that she perhaps had to
make the relationship safer for Tom before he could offer her closeness.
The therapist focused on the need that Kathy had turned to her child
to fulfill. Kathy spoke of her need for recognition, comfort, and security,
although her statements were in relation to her child rather than in
relation to Tom. The therapist then framed the future of the relationship
as being dependent on each partner helping the other to be open and
responsive.
By this point in therapy, the interaction patterns of the couple had
changed. Tom was much more assertive and less withdrawing in the
relationship, and Kathy, although unable to ask Tom directly for what
she needed, was visibly less hostile, more relaxed, and more open to Tom.
The stuck rigid cycle that the couple had presented in the first session was
no longer apparent.
Session 8
This session focused on the changes in the way Tom and Kathy saw
themselves and each other and their interaction patterns. The therapist
summarized the apparent changes and the new positions that each
120 PRACTIC E
partner had assumed . The therapist also delineated future goals - specifi-
cally, the building of trust. In this session, Kathy seemed to be open to
and accepting of Tom's expression of fear in the face of her judgments ,
a nd he was able to encounter her without withdrawing. Tom stated that
he was willing to risk "getting clobbered., to show Kathy he cared and to
help her to trust him . Kathy stated that she felt less aggressive toward
Tom , and less cut off from him, and was willing to help him feel safer in
the relationship .
The couple also discussed incidents that had occurred during the
week that previously would have triggered an escalating negative cycle
but for which they had found new solutions. For example, Tom had
agreed to pick up a baby-sitter so that he and Kathy could go out, but
had forgotten to do so. When he arrived at the house, Kathy confronted
him . However, Tom did not placate or withdraw from Kathy. Instead, he
simply defined the situation as one in which he had made a mistake, he
reassured Kathy that it would not occur again, and he told her how
he planned to prevent such a recurrence. He had also pointed out that if
she wished to launch an attack on him that was up to her, but he was not
going to respond in his usual fashion. Kathy calmed down and they went
out and had a pleasant evening together. They also related a similar
incident in their sexual relationship that they were able to resolve in a
new way.
Conclusion
This couple improved significantly on outcome measures at the termina-

tion of treatment and continued to show improvement at follow-up. The
progress of therapy had involved a reciprocal redefinition of self and the
relationship for both partners. Both Tom and Kathy seemed more able to
accept and respond to each other. Tom had redefined himself in a more
assertive way in the relationship, and Kathy had begun to define herself
less in terms of aggression and more in terms of vulnerability. Relation-
ship transactions had been made explicit and had become more flexible
and more positive.
As can be seen from the description of these sessions, the therapist
typically circles through the steps of treatment, retracing steps as deepen-
ing and development occurs over time. One partner, often the partner
taking the withdrawn position, usually takes the lead in therapy. The rate
at which couples progress and the areas in which partners become
blocked are very idiosyncratic. The process, however, is one in which
clear patterns emerge. Often it is easier to get a couple to some kind of de-
escalation, perhaps to Step 4, than to elicit the further steps of mutual
accessibility and responsiveness. This case example focused mainly on
the clients' activities, statements, and progress in therapy. The following
chapter focuses on the principles of therapist intervention.
CASE EXAMPLE: THE WALL THAT SEPARATES-

AN INTRUSION-REJECTION PATTERN
Michael and Linda had been married for 5 years and had one 2-year-old
child. Michael was a 29-year-old, first-year law student, and Linda was a
32-year-old teacher. In the pretherapy assessment, the couple reported on
the target-complaints instrument that their major concerns were lack of
intimacy and lack of communication. In addition to her concern about
lack of intimacy and communication, Linda reported wanting a better
sexual relationship.
On the goal-attainment measure given before treatment, Michael
expected, as the result of treatment, a more relaxed atmosphere with
more physical contact (four times a week) and fewer sharp words (once a
month), while Linda wanted more hugging and more time talking (at
least a half hour a day). Michael's DAS score was 89 with Linda's at 97,
putting them between one and two deviations below the norm of married
couples (Spanier, 1976). At termination, his DAS score had risen 20
points to 109 and hers had risen 16 points to a score of 113 (the norm
being a couple mean of 114). Michael reported a great improvement in
intimacy and communication at termination, while Linda reported feel-
ing somewhat better about these two issues with a slight improvement in
their sexual relationship. Both partners reported somewhat better than
expected results regarding their goal attainment: Linda reported that
they now achieved much more eye contact, ease in getting close, more
body contact, more trust, and more sharing of intense feelings. Michael
felt they had attained a heightened level of interest in each other, were
more attentive, and had good contact every day. A description of the
therapy process follows.
122 PRACTICE
Session 1
The session began with Michael stating in a halting fashion that commu-
nication was the problem, while Linda said she wanted more time to-
gether, greater intimacy, and Michael to share his feelings with her.
Michael said that he had difficulty expressing his feelings but would like
to be able to do so. Linda added that she was feeling so hopeless about
getting what she needed that she was considering leaving Michael.
The negative interaction cycle was clear from the beginning of the
session. Linda pursued Michael for greater closeness and demanded that
he share more of his feelings. He generally withdrew at home, although,
with considerable encouragement from the therapist in the session, he
said he felt guilty about not giving Linda what she wanted. Michael
added that, at home, the more Linda attacked him, the more he withdrew
into his books.
A transcript of the opening episode is given below. This excerpt
begins a few minutes after the therapist inquired about the couple's
reasons for coming into therapy.
LINDA: I think it's just more around communication, emotional

issues, wanting more intimacy-more emotional intimacy I guess.
THERAPIST: Who wants more intimacy?
LINDA: Well I certainly do.
THERAPIST: Uh-huh.
LINDA: And so do you! (To Michael, said half kidding.)
THERAPIST: What was that? And so do you?
LINDA: Well, I suppose I'm the one that's really instigating it.
THERAPIST: Uh-huh, so you're wanting more intimacy, right?
LINDA: Yes, right.
THERAPIST: And what do you perceive him as doing in response to
that? Or how does he react?
LINDA: I feel like he wants to respond to that, but neither of us really
know how. You know, what to do.
THERAPIST: Yeah. Yeah.
LINDA: It's actually been an issue for a long time but it's only
recently that I have felt really like we've got to do something now.
THERAPIST: Umhum.
LINDA: I'm not going to wait any longer.

THERAPIST: What happened to make it different?
LINDA: Just deeper, deeper dissatisfaction, I think.
THERAPIST: So it's sort of always been that way but it's been getting
more and more, you've felt more of a need , right?
LINDA: Yes.
THERAPIST: Um. (To Michael.) What do you think about what Linda says?
MICHAEL: Well (stutters) it has been a concern for quite a while. I
think I feel the need for, a greater need for closeness, she feels a need
greater than I do. I am aware of the issue but I'm not quite as affected by
it as Linda.
THERAPIST: So somehow you, I understand, you're saying she has a
greater need for intimacy than you do. She is expressing a greater need
but you recognize that there is something more that you would maybe
like too. So it's not that she wants it and you don't want it. You're saying
that you 're open to it.
MICHAEL: Yep.
THERAPIST: Yes, but. It's difficult? Or, that's the problem?
MICHAEL: Well it is difficult, I do think that there is a lack of
intimacy, uh, it is neither one's total fault, one way or the other, but I'm
probably more to blame.
THERAPIST: U mhum, You feel that or she feels that?
MICHAEL: No, I feel that. I'm sure she agrees.
THERAPIST: OK that must be a difficult feeling to have, that you're
more to blame, it's an unpleasant thing I guess.
MICHAEL: Yes, it is.
THERAPIST: Does that make you feel sad or down sometimes?
MICHAEL: Somewhat.
THERAPIST: Yeah, what does she do when you feel this way?
MICHAEL: When I feel ... ?
THERAPIST: Down or sad or upset about this.
MICHAEL: Well, I don't know if she's aware, when I'm, sometimes
she's aware of when I'm down or sad about different things.
THERAPIST: Can you tell Linda now about how you feel about not
being able to be as intimate as you would both like. I mean I'm not sure
that she knows what it feels like for you.
MICHAEL: (To Linda.) Well, I think I feel slightly caged by it, I get
the feeling of futility that I would like to be more open, but I don't really
know how to go about it.
124 PRACTICE
THERAPIST: (To Linda.) What happens for you when he says this'?
What do you actually feel? You know we're just beginning and I know it's
a little strange, this stuff, but it is a very real concern you're talking
about, and I'm wondering what kind of response you might have when he
says that to you.
LINDA: Well, we've . .. I think we've talked about it a number of
times.
THERAPIST: Yeah, yeah, but . . .
LINDA: And I feel different things at different times.
THERAPIST: What did you feel right now?
LINDA: A sense of fear.
THERAPIST: Fear. Uh-huh.
LINDA: Because I'm kind of frightened that, u 'm, that he may not . . .
THERAPIST: Can you tell him?
LINDA: (To Michael.) That you may not be able to respond to that
need that I've had for a long time.
THERAPIST: So you're afraid that he might not be able to meet that
need of yours and you'll be left empty or alone.
LINDA: Yes, and also I'm much more demanding about it now.
THERAPIST: Sure.
LINDA: It's at the point where I feel that there's a possibility of us
separating which I've never felt before.
THERAPIST: So that's scary ... what do you feel when you say this?
LINDA: Very depressed.
THERAPIST: yes.
LINDA: Very down.
THERAPIST: OK (To Linda.) I noticed you smiled when you said that
and I understand that you're anxious. (Michael and Linda smile at each
other.)
THERAPIST: What happens when you look at each other? And you
smile?
LINDA: I was thinking this situation is, um, I don't know how Michael
feels about it but I have been in different types of, therapy-type or educa-
tion-type programs and it takes me a long time before I actually feel that I
talk in a way that is very open and honest. When someone else is there.
THERAPIST: Right.
LINDA: I'm feeling like there's this third person sitting here and you
know, we're trying to talk about things that we can't even talk about by
ourselves. Never mind that there's a third person around.
THERAPIST: I see, you're sort of thinking about the situation and the
difficulty.
LINDA: Yes.
THERAPIST: I am actually pushing you very quickly, but it seems to
me that there is something to talk about and I understand that anxiety of
me suddenly saying do this and do this, yeah.
LINDA: It's OK. It's OK.
THERAPIST: But you somehow both laughed at the same time and I
was sort of struck with the sense of you doing it at the same time, so you
do communicate. So you were focused on the difficulty of being genuine
and talking about difficult things. (To Michael.) OK, but let's go back to
what it is that she does that can be helpful for you.
MICHAEL: I don't know. I know that when tensions relax between us
it's much easier for me to be open and when they're not it's, uh, just
becomes a very vicious circle. The more you want from me the less I can
give and the more you want because I give less.
LINDA: Right, yes.
THERAPIST: So that is the vicious circle that we are talking about
here.
LINDA: Oh yes, yes it is, yes.
THERAPIST: You stated that very clearly.
LINDA: Yes .. . that's it.
THERAPIST: (To Michael.) That the more she wants the less it's
possible for you to give, and then the less it's possible for you to give the
more Linda wants. The more you feel caged and ungiving the more
demanding Linda becomes, right?
MICHAEL: yes.
LINDA: A perception I have also in recent months is that I'm getting
kind of angrier and angrier and therefore I think I'm becoming more
attacking.
THERAPIST: yes.
LINDA: I mean sometimes when we fight, well, usually it's me getting
angry and Michael not saying very much you know, it gets kind of ugly.
THERAPIST: Yes, yes.
LINDA: And I have the feeling, and I may be wrong, I mean, I don't
know what's happening for sure but things are getting kind of more ugly,
and that I'm starting to attack quite a bit more, because I'm demanding
that from him and he just feels more caged and says, well what am I
supposed to do, and I say well I don't know what you can do.
126 PRACTICE
THERAPIST: OK, so we could predict that if you get into a fight that
this is what would happen. That y ou would become more demanding and
eventually more attacking.
LINDA: Yes.
THERAPIST: Right? Right. How do you attack?
LINDA: Well, now I'm getting more where I attack just for the sake
of hurting. 111 say things that I know ...
THERAPIST: will hurt?
LINDA: Yes, will hurt.
THERAPIST: Right, right. (To Michael.) Do you know that this is
happening?
MICHAEL: Yes, but it doesn't prevent me from being hurt.
THERAPIST: Yes, it doesn't usually. So you do get hurt?
MICHAEL: Oh yeah.
THERAPIST: And what do you do when you're hurt?
MICHAEL: Well, withdraw, sort of.
THERAPIST: How do you withdraw?
MICHAEL: I become silent.
THERAPIST: Umhum. Do you remove yourself physically?
MICHAEL: No, I focus my attention on other things.
THERAPIST: OK. And so you're doing that to protect yourself, but
also you know that in some way it gets at her, it's a way of fighting too, I
think you're saying that.
MICHAEL: Yes.
THERAPIST: Yeah? (To Linda.) And you sort of attack and start
attacking indiscriminantly.
LINDA: Yes, because the further away he gets, then the angrier I get.
THERAPIST: Right. Then what happens? OK, so you escalate your
attack, let's try to get concrete if we can, so you can describe it to me.
LINDA: Sure.
THERAPIST: The last time this occurred or a situation where it often
occurs, and maybe describe ...
LINDA: Well I can think of a week or two ago. We got into a
situation which I would call one of our ugliest fights. I don't know, do
you agree with that?
MICHAEL: Depends on which one you're talking about.
LINDA: In the restaurant.
MICHAEL: Yeah, probably a typical fight.
The therapist then tracked a concrete situation in which the couple

had a fight in a restaurant. After discussing the fight, Linda commented
that even though she had told Michael that she wanted to leave the
relationship and had been very upset, he had not even bothered to ask her
how she was feeling the next day. The therapist, after responding to
Linda's hurt, asked Michael how he had perceived the situation. He
replied that it had been an ugly fight and that he had said things that he
knew would hurt Linda. He then told Linda that he had not been
ignoring her statement about leaving but that he felt excluded from the
decision-making process. This sequence demonstrated how Linda, des-
perately wanting a response from Michael, would pursue him, complain-
ing that he did not respond. He in turn would withdraw by not asking her
about her plans for leaving and by saying he had been excluded from the
process. This latter response managed to frustrate Linda's current need
for reassurance and reinforced her experience of him as emotionally
unavailable.
The therapist then asked Michael about how he felt when Linda
talked in the se~sion about separation. He replied that he felt terrified.
The couple then began to talk more intimately with each other. Michael
expressed his feelings of vulnerability and sadness, and Linda expressed
her loneliness, her need for intimacy, and her fear. The session ended
shortly thereafter on a note of positive contact, and the therapist gave the
couple the homework assignment of sharing their sadness and good
feelings with each other. The transcript of this discussion follows. In it,
the therapist attempts to have Michael express his feelings, to provide a
new expenence for the couple, and to emphasize the possibilities of
change.
THERAPIST: This was at the restaurant?

MICHAEL: I'm not sure why we were suddenly fighting but we cer-
tainly were. As Linda said it was a very ugly fight. She called me a few
names and I said something to her that I knew would hurt her.
THERAPIST: u mhum.
LINDA: (To Michael.) How do you experience what happened after,
though? Because I don't feel you ever responded to that either.
MICHAEL: Well, I thought we talked about that. I wasn't ignoring
what you had told me, what we had talked about. I don't think I was
sitting back hoping it would disappear. But, the way you had presented it
128 PRACTICE
to me I didn't feel that any of the decision was mine. You ex.eluded me
from, from what you were going to ... you were going to make up your
mind.
THERAPIST: About leaving or staying?
MICHAEL: About leaving, about what was going to happen.
LINDA: Well how could I include you in that then?
MICHAEL: You could have asked me what I thought about sepa
rating instead of telling me that you had been giving it considerable
thought.
LINDA: And what do you think about separating? Or maybe I
should say the possibility of.
MICHAEL: It terrifies me ... I think it would be ... (Sighs.) It's not
what I would like. I think we could have possibility together. I also really
don't want to look forward to the experience of separating. I know how I
would feel ...
THERAPIST: (To Linda.) What happens for you?
LINDA: Um, I start feeling really sad. ( To Michael.) And also getting
kind of scared to trust you.
THERAPIST: To trust him with what? Can you tell him?
LINDA: (To Michael.) I guess I feel like we've been through this so
many times before, about me wanting more and you saying, well, I don't
know what to do about it. Your reply is usually something like, you don't
know how to get in touch with your feelings.
THERAPIST: Michael doesn't know how to get in touch with his ...
LINDA: This is what he usually says. And I ...
THERAPIST: (To Michael.) Can you tell her what you're feeling right
now, Michael? Because I think you're feeling a lot.
MICHAEL: Well, I guess I'm anxious.
THERAPIST: What do you want from Linda?
MICHAEL: What do I want, uh, period?
THERAPIST: Right now. When you tell her that you'd be terrified if
she left. That you feel ...
MICHAEL: Well, I'd like her to believe me.
THERAPIST: Can you tell her?
MICHAEL: (To Linda.) I'd like you to believe me I do feel these
things ...
THERAPIST: You have some idea that she may not believe you.
MICHAEL: As you've said, we've gone through this before.
THERAPIST: So what do you want her to believe?
MICHAEL: That I do care. That these things do matter. At the same

time my feeling is that, it isn't enough.
THERAPIST: What more is needed, are you willing to give . . . I think
that's important that you're saying that you do care. What more are you
saying?
M1c HAEL: ( To Linda.) I wish that we could establish the intimacy
that you so obviously need.
THERAPIST: ( To Michael.) What is it that you believe she needs
when you say the intimacy? What kind of things? Can you tell her?
MICHAEL: Greater understanding, uh, more obvious . . .
THERAPIST: More?
MICHAEL: (To Linda.) More obvious and continual caring. I'd like
to be able to still be involved in the things that I do, whatever, school,
and not lose sight of you ... at times, it's very hard.
THERAPIST: (To Linda.) What's been happening for you as you sat
here listening to Michael?
LINDA: Mostly sadness I think.
THERAPIST: Can you say something about that sadness? What are
you saying? What are you sad about?
LINDA: Um .. . sad that that is what we lose touch with all the time.
Um ... (To Michael.) I guess it's what makes me think you really don't
care. I can hear what you're saying now, um ...
THERAPIST: So you do hear something now? What do you hear?
LINDA: I hear him saying that he's terrified.
THERAPIST: Can you tell him?
LINDA: (To Michael.) I hear you saying that you're terrified, that
you would be sad if I left, that, um, that you would rather change what is
happening.
THERAPIST: (To Linda.) I think what you're saying is you're unsure
... (To Michael.) Sorry, did you want to say anything?
MICHAEL: ( To Linda.) Well, I'm not saying that I want you to stay
just because things would be bad if you left.
THERAPIST: ( To Michael.) She has difficulty hearing that you care
for her. Can you tell her again?
MICHAEL: (To Linda.) I do care ... you mean a lot to me. (Voice
shaky.)
THERAPIST: ( To Linda.) What do you feel?
LINDA: ( To Michael.) I feel that there's part of me that really wants to
believe you and there's another part of me that is really shut off from that.
130 PRACTICE
THERAPIST: Shut off because of the past.

LINDA: Yes.
THERAPIST: Hurts and feelings of deprivation. (To Michael.) I think
that's what you're feeling, right? That, somehow there's a wall out there
and it's difficult for her to see you. How can you convince her?
MICHAEL: I don't know ...
THERAPIST: What would you like to try, to convince her?
MICHAEL: I don't know (sigh) it's a problem of faith. If we can make
that leap of faith, it becomes easy to believe ...
THERAPIST: (To Linda.) Do you understand, what he's saying to you?
LINDA: ( To Michael.) I think so but I feel that the leap of faith that
you talk about is something that Ive continually done in the past, then end
up getting burnt. I see if you were like this on a continual basis, I think we
could share fine, but you're not, it's like once every 3 or 4 months or
whatever. I mean maybe that's not quite fair, but it's not very often. I mean,
I feel we go for weeks without openness, and I play into that just as much as
you play into, but that is my concern so that it's like only when I say I can't
stand it anymore, then you open up and then things just go back to old
patterns. Nothing really changes. At least those are my perceptions of it.
THERAPIST: (To Michael.) What happened for you? You raised your
left eyebrow? ( To Linda.) Did you see him?
LINDA: Yes.
THERAPIST: (To Linda.) What happens for you when he does that?
LINDA: (Sighs.)
THERAPIST: Did you have a response to that?
LINDA: Well, it just makes me always want to keep trying to con-
vince him that that's how I really feel.
THERAPIST: Well, what did that mean to you that he raised his left
eyebrow?
LINDA: That he's getting short ... impatient.
THERAPIST: So you two have an exquisite communication system,
which I can't read but I know that you have. OK, so he was going to ...
you perceived him as maybe getting a little impatient. (To Michael.) Do
you know what she means when she says she felt you were getting
impatient? She sees it as impatience, I don't know what was happening
for you ... ?
MICHAEL: I think that we have a lot more to share than this anxiety
over . . . I open up like this once every 3 or 4 months or whatever. (To
Linda.) When you come down on me very hard, it is like a battering ram.
I think that we could have openness and sharing about so many other
things as well.
LINDA: Like . ..
MICHAEL: Right now what we're communicating is our anxiety, our
sadness, our loneliness, and those are very, very powerful. They pull
down the defenses but I think that we could have intimacy, much more
easily by being easier with each other.
THERAPIST: Michael, how would you like to achieve intimacy? Be-
cause I think you two experience and achieve intimacy in different ways.
It is important to let each other know those ways. And you're saying,
processing the fight or looking at what's wrong, difficult, isn't the only
way of achieving intimacy for you.
MICHAEL: What I mean is that at least at one time, we did. We
shared a lot of good feelings as well, a lot of laughter, a lot of those
feelings of general well-being that arose from being together. And what-
ever has gotten between that, is very strong, it takes situations like this to
break it down but I don't want to live in this sort of turmoil day to day, I
don't think that it is necessary to be on edge and I think that it certainly
has a lot of validity, but not continual validity. It is very important that
things have gotten to a stage where it takes situations like this to open up,
but ...
THERAPIST: I understand. (To Linda.) Do you understand what he's
talking about? (She nods.) (To Michael.) I think you are saying there is
this wall between you and it's difficult to achieve the intimacy you once
had, the good feelings. One thing you do is you continually try to hit this
wall and break it down, you know, it's there continually.
LINDA: U mhum, yes.
THERAPIST: (To Michael.) And you're saying, well maybe we could,
it doesn't have to be all that's there.
MICHAEL: Well, I don't know that's what I meant by a leap of faith,
that I don't know how to get around that wall. If you get around it then
it's easy to share things. But getting around it, I don't know.
THERAPIST: What is it that she wants from you? There's also some-
thing you want from her, but, right now I'd like just to focus on what does
she want from you? What would help take some bricks out of your wall?
MICHAEL: I think greater understanding, greater appreciation of
what she is, and what she's been doing in individual therapy?
THERAPIST: So a greater understanding of what's happening for her?
And what's difficult about that for you?
132 PRACTICE
MICHAEL: Well, uh, I g uess part of it is I feel excluded by it.

THERAPIST: Have you told her that before?
MICHAEL: No.
THERAPIST: ( To Linda.) Do yo u understand?
LINDA: I think so.
MICHAEL: ( To Linda.) And it's not that I would want you to remain
unchanging. It's not that I don't recognize that you had a deep need for
large changes in the past few years ...
THERAPIST: ( To Michael.) But somehow you feel excluded, you say.
MICHAEL: (To Linda.) Well, I think that, that you know with the
deterioration of our relationship, you took more and more time.
THERAPIST: So you are feeling kind of rejected or excluded.
MICHAEL: Um, yes.
THERAPIST: Umhum, umhum ... and what would you like from
her?
MICHAEL: (To Linda.) For your understanding.
THERAPIST: Of what?
MICHAEL: Of me as a person.
THERAPIST: ( To Michael.) What about you?
MICHAEL: I guess I've always looked at a couple as complementing
each other, I think that we do complement each other quite well in many
areas.
THERAPIST: Are you wanting her to understand how you comple
ment her, or how you felt together? That she would appreciate you?
MICHAEL: That's right.
THERAPIST: (To linda.) I apologize if I'm rushing you. I'm aware
that we're going to need to end soon so I just wanted to get a sense of
where you are, or part of it. So I'm wanting to know how you're reacting
to what Michael has said.
LINDA: Well, I guess my reaction is I just want to wait and see what
develops over the next few weeks or whatever.
THERAPIST: (To Michael.) Do you know what she means?
MICHAEL: If she can't make that leap of faith, I didn't plan to push.
THERAPIST: So you're saying "I want you," or "I would like you to
make that leap of faith and commit yourself but I understand if you don't
feel that trust." ls that it?
MICHAEL: Well, I don't feel that leaps of faith are the things fairy
tales are made of, but it would take a lot more than me saying that.
The therapist then summarized the session.

After the session both partners felt some progress had been made
and said they felt that they had established some common ground as a
starting point for working toward greater intimacy. The therapist re-
ported that the problem had been defined in terms of underlying emo-
tions and that basic positions taken by the couple and the cycle had been
defined.
Session 2
In the second session, the couple worked on the pursue-withdraw cycle

identified in the first session in an explicit fashion, explicating each
partner's underlying feelings and disowned parts-specifically, Linda's
need for support and Michael's need to protect himself. Linda stated that
her awareness of Michael's need to protect himself increased her sense of
caution about how much she wanted to trust him. Michael reported that
he was clearer on their needs and less apt to ascribe blame and that,
during the prior week, between sessions, they had been more open and
felt closer to each other.
Session 3
The third session saw the emergence of a deeper underlying intrusion-

rejection pattern in their relationship. Linda expressed that she felt afraid
when she opened up with Michael in the session, and the therapist at-
tempted to explore Linda's fear and confusion in the moment. Linda
associated these feelings with their sexual relationship and then disclosed
that they had a significant sexual problem in that she often tensed up and
withdrew during sex. She talked about feeling out of control and in-
truded on, while Michael felt hurt and angry at being rejected. Michael
then described how he went to extreme lengths not to pressure Linda or
make her feel guilty, but that it did not seem to do much good. Linda, in
response to the therapist, again described her fear and carried on to say
that her attitudes were a problem and that she did not experience a flow
in love-making. Linda explored her caution and experienced some feel-
ings of hopelessness about herself and about anyone ever being able to
134 PRACTICE
give her the acceptance she needed. Michael expressed a commitment to

try, and the therapist explored with him some of his feelings of sexual
inadequacy and how his insecurities and sensitivity to rejection fed into
their sexual problems. The transcript of portions of this episode follows.
THERAPIST: Somehow I'm feeling that it's important for you to talk
a little about your caution because that's an important thing. Are you
feeling cautious right now, when you talk with him about a fairly delicate
moment in your sexual relationship?
LINDA: Yes .
THERAPIST: What are you cautious of ? See if you can tell him about
your caution.
LINDA: (To Michael.) Um, I'm cautious of telling you how I feel
because I feel that your reaction may not be that (sigh) ... because we
always get stuck when we start to talk about that issue.I feel as though
it's always been very sensitive in our relationship.
THERAPIST: What is it you're anticipating that he will do?
LINDA: Well, I mean part of it is related to my father I think.You
know I felt as a child to be really kind of, my space to be intruded upon.
That my father would touch me physically, um, and that I didn't like it at
certain times, but I didn't have any choice.
THERAPIST: Umhum.
LINDA: Or he would want to be kissing us and stuff like that.
THERAPIST: Umhum.
LINDA: So I know that it's like a lot of, don't touch me.
THERAPIST: Umhum.
LINDA: With a lot of resentment, hatred that has nothing to do with
Michael.
THERAPIST: I see, right.
LINDA: But still I'm unable to separate that so ...
THERAPIST: I'm not sure, when you're saying your father touched
you, whether he touched you sexually or ... ?
LINDA: No, except that, you know, he touched us in ways that rm
not sure.
THERAPIST: Yeah, but it wasn't an explicitly sexual ...
LINDA: No, no.
THERAPIST: There might have been some sexual aspects.
LINDA: Yes.
THERAPIST: So that you have some feeling of, don 't touch.
LINDA: Yes, I have a lot of that.
THERAPIST: Yes, yes . So, what's your caution?
LINDA: Um, I guess that he, you know, that I feel that he's going to
jump on me, or take advantage of me or ...
THERAPIST: OK, OK. That he'll invade, cross your boundaries in
some way.
LINDA: Yes.
THERAPIST: Quicker than you want.
LINDA: Than I want, yeah.
THERAPIST: Right, right. And your caution is that he won't pay heed
to your saying no? Or just that you feel tense about how you've been
invaded in the past, by your father and so on. I'm not sure, am I being
clear? You know I'm not sure if you try to say no, but you feel that he
pressures you?
LINDA: Well, whenever I say no I feel very guilty.
THERAPIST: OK.
LINDA: Whether or not it's him pressuring me I don't know.
THERAPIST: I'm still trying to understand. So one aspect of caution
is that you just need to protect yourself because you're going to get
invaded possibly. But somehow it's as if you start to talk about it, your
feeling is it won't go anywhere ... it will get stuck. I'm not sure how you
get stuck there or what it is that stuck means.
LINDA: Well, if I'm too tired or I don't feel like it, and then his
response might be, that he gets hurt.
THERAPIST: yes.
LINDA: Or feels rejected.
THERAPIST: yes.
LINDA: And so he kind of just draws away.
THERAPIST: Yes, OK: OK. Let me see i~ I und~rst'and. He m~g~t
approach you or be touching you in some f ash10n and you set some hm1t
because you feel intruded on at that time. Then he feels hurt and with-
draws. And then you feel both guilty and rejected and angry. And then
you might withdraw and you're both left feeling kind of isolated and
rejected.
LINDA: Yes. Or another way would be, I may have those feelings
but just go ahead and go through the sexual act and really not be that
into it.
136 PRACTICE
THERAPIST: Right. So somehow this sequence for you pivots around

when something's happening to you that you don't want to happen.
When you're feeling intruded upon.
LINDA: I just feel so out of control.
THERAPIST: Yes. And what does Michael do at that time, as far as
you experience it? Do you tell him your feelings?
LINDA: No.
THERAPIST: Uh-huh. OK. Let me try to shift for a moment to
Michael and ask what it is that you see as the issue right here. She feels
somewhat out of control.
MICHAEL: Well, I mean this is not recent, you must not have the
impression that this is a problem only in the last few months. So you
don't let me know when you're feeling out of control? Well, uh, you do.
We stop, whatever, when you reach a point when you feel out of control?
That you don't want to let go. Don't you tell me?
LINDA: Well, maybe part of the time.
THERAPIST: What is he feeling now do you think?
LINDA: I think he's feeling hurt.
MICHAEL: I'm feeling quite hurt, yes.
THERAPIST: I thought you sounded angry.
MICHAEL: Oh well certainly I mean (stutters) angry, resentful, hurt,
and self-pity. (To Linda.) I feel that, um, I go to extreme lengths not to
pressure you make you feel guilty, um ...
THERAPIST: And . . .
MICHAEL: It doesn't do much good. Oh, it doesn't do enough good.
( To Linda.) I hold back my feelings so that I won't be pressuring you and,
huh, well our sexual relationship mirrors our overall relationship. ( To
therapist.) I try to get close in sex and she is not interested.
THERAPIST: OK. And you feel quite rejected, hurt, resentful, and it's
a long-standing cycle between you.
MICHAEL: Sure.
THERAPIST: OK. (To Linda.) What do you feel now as he talks
about his side of this?
LINDA: (sigh) that he thinks that if he holds back his feelings ( To
Michael.) you think if you hold your feelings back that I don't feel
pressured by that. But I still know how you 're feeling, so I feel pressure
myself. Um ...
THERAPIST: What do you feel right now as you say this?
LINDA: This fear.
THERAPIST: Fear? (She nods.) I'd like to hear what's the fear about?
LINDA: Um, fear of talking about it.
THERAPIST: Yes, so just fear where, you feel tight, you feel?
LINDA: Oh yes, my heart is constricting.
THERAPIST: And you feel afraid, afraid that this isn't going to work
out but also afraid of something else. I don't quite have a sense of it but
what, what's the fear? It's important to talk about this fear ...
LINDA: I don't know.
THERAPIST: Uh-huh. You're afraid that .. . I don't know, I don't
know if you're afraid that you won't be able to respond.
LINDA: Well, I have a lot of fear of that because I can't.
THERAPIST: Yes. And that's a pretty frightening place to be because
somehow you're saying you don't know whether you can let go. Then, on
top of that, there's him out there, you feel kind of responsible about that
too, his feelings maybe. (Linda puts her head down.)
LINDA: U mhum.
THERAPIST: Uh-huh, but somehow just within yourself you're strug-
gling with the not knowing whether you can really let go, or how to do it,
or what will work. And you kind of struggle with that.
LINDA: U mhum.
THERAPIST: And there's this thing about . having been intruded on
when you were little and putting up some barriers. I guess just sort of
being confused really about how to make it all work for you ... (Linda
nods.) And what happens then? (Linda's head goes up.)
LINDA: Well, it seems to me for myself that it's because I have so
many attitudes my sexual feelings are blocked. And it doesn't happen for
me, or at least it hasn't happened that often for me.
THERAPIST: Umhum, umhum. And so you're saying it's difficult to
change the attitudes because you don't have the experience that kind of
allows you to free up, then change the attitudes.
LINDA: U mhum.
THERAPIST: So you sort of feel caught up in a cycle.
LINDA: Yeah.
THERAPIST: Within yourself and then you're knowing that he's feel-
ing rejected outside too.
LINDA: U mhum.
THERAPIST: And eventually that leaves you feeling in a corner even
if he's not saying, you kind of feel, you know, that he's feeling hurt and
rejected.
138 PRACTICE
LINDA: Umhum. Well / would be if I felt that I could never ap-

proach him.
THERAPIST: Uh-huh.
LINDA: That I always had to wait. I would feel very unsatisfied with
that.
THERAPIST: And yet he stays with you.
LINDA: U mhum.
THERAPIST: Maybe, it's important in some way for him too. When
did he know that you weren't able to let go so easily?
LINDA: But over time I always just pretended to have an orgasm. I
have thought up to this point that, I'm almost totally responsible for our
own sexual relationship being what it is ... because my feeling is (to
Michael) you don't have any problems responding . . .
MICHAEL: Well, I guess I'm guilty of feeling so sexually insecure
that I've allowed things to, I've allowed myself to feel so rejected that I
don't approach you, that doesn't make things easier for you. I'm respon-
sible in that way, uh.
THERAPIST: Do you believe him when he says this? I think he's
saying something really important.
LINDA: Well I don't really understand what he's saying.
THERAPIST: { To Michael.) Can you tell her . . .
MICHAEL: ( To Linda.) I'm saying that, uh, if I were to approach you
more, things would probably be easier for you as well, as well. We
wouldn't be in quite the bind that we are in, but because I do feel so
insecure, I do get very hurt by rejection, uh.
THERAPIST: ( To Michael.) Can you tell her what you mean by
insecure? I think it's very important because I think she really needs to
understand.
MICHAEL: Well . . .
THERAPIST: You know, I think you're saying something real impor-
tant, that if you didn't feel some insecurity then she could say no and it
wouldn't feel as painful as you. So you have your own pain in this area.
Session 4
The fourth session took place after a IO-day period in which the wife was
away on a visit to friends. This session was less intense than the previous
ones. The couple talked about their feelings about being apart for a
while. A number of different important topics were touched on with the

partners able to talk to each other in a mutually accepting I-thou
fashion. Linda talked without blame about the fact that she needed more
contact than Michael did during conversations while Michael let Linda
know that he was satisfied with her recent involvement in sexual contact.
This helped her feel better about not always being '"all there" during
sexual activity.
This session also dealt with Michael's sense of Linda's expectations.
He was generally anxious in his style and stammered in his speech. He
felt a sense of external expectation, by completing the sentence "Right
now I imagine you expect me to ... , " captured accurately his internal
process and gave him more control over this automatic response. Linda
was surprised to see this part of Michael and told him she did not ex
pect nearly as much as he thought she did. The session ended with
her expressing a greater feeling of safety with him and he concurred.
On the questionnaire item concerning change in the session, Michael said
that he felt that "without getting into the heavies we were able to
amicably express our feelings about a variety of issues thus identifying
and appreciating the other's side." Linda said she had a greater aware
ness of her partner and that from the time apart both had an increased
sense of self-identity and a feeling that they had more to bring to the
relationship.
This was the midway point, and the therapy in the following sessions
moved to a deeper level. The alliance between each partner and the
therapist was good and the couple worked productively.
Session 5
The fifth session focused predominately on the wife's feeling of fear and
vulnerability in her sense of being intruded upon. Linda went deeply into
her confusion and inner emptiness. The therapist gently directed her to
face her fear of annihilation and rejection and reflected Linda's pain and
terror of losing herself. Linda went through a feeling of fear to contact
her need for comfort and contact, and she expressed what she needed to
her husband who responded supportively. Both partners were somewhat
without words at the end of the session. This was a key session in which
underlyin g em otion was experienced and communicated. Michael re
ported that they had worked on trust and that "I felt something changed,
140 PRACTICE
a lot happened in this session but I can't describe it" whereas Linda said
she "further trusted her partner, had asked him to hold her and had
learned to ask for what she needed. " (The transcript of this portion of the
session appears on pp. 91 - 94 as an example of accessing unacknowledged
feelings.)
Session 6
In the sixth session, the couple talked about Michael's fears of expressing
negative emotions, including his fear of hurting Linda and being rejected.
Linda's fear of being destroyed or feeling vulnerable if Michael did
express negative emotions was also discussed. At this stage in the ther-
apy, the therapist felt it to be important to have Michael express some of
his underlying feelings to Linda to balance her work in the previous
session, but this was not achieved in this session.
Session 7
The following session, however, focused predominantly on the feelings

underlying Michael's distancing. Using evocative responding, the thera-
pist evoked Michael's inner sense of loneliness and explored with him a
memory of a teenage experience. This experience involved being all alone
on a dusty road with no one in the world knowing where he was or
caring. He talked about his feelings of isolation and being an independent
loner, invulnerable to hurt. This was followed by Michael talking about
his feelings of responsiblity all his life for his impaired father. The
therapist then worked to have Michael connect his inner experience of
loneliness to his environment by expressing this to his wife. Michael first
stated to Linda that "expressing my feelings puts a burden on you .. .
I've never wanted to do that," but then, with the therapist's encourage-
ment, he talked in a most poignant manner about how isolated, lonely,
and responsible he felt in their marriage. Linda heard and was deeply
touched and felt nourished by the contact, which met her need for greater
closeness. (The therapist suggested that, during the week, they each
identify with the disowned experience and deliberately, in awareness, do
what they would normally do.)
THERAPIST: (To Michael.) But somehow through all this you deve-
loped a real sensitivity to being rejected or somehow just not feeling as
supported as you would have liked, because what I hear is your difficulty
in expressing what you need and want or when you feel your limits are
being extended. And you know it's often true with a man that it's more
difficult to tell what his feelings are. I don't know how you really feel.
Some sense of rejection or ... If you were to describe one main feeling
for you that gives you difficulty ...
MICHAEL: Well, I guess I've never really felt that I've belonged. Um.
THERAPIST: OK. That's very understandable in the way you describe
your family of origin. And somehow you 're very sensitive to wanting to
belong with Linda.
MICHAEL: yes.
THERAPIST: And so the other side of belonging is kind of being cast
out or being rejected.
MICHAEL: yes.
THERAPIST: Yeah? A sense of nobody really caring is what you're
saying. And so I imagine that's what's activated for you when Linda gets
angry or threatens, and I've heard her threaten to leave. That must really
evoke quite terrifying images for you of being cast out, of not belonging
once again.
MICHAEL: Of not belonging, of failing.
THERAPIST: Umhum. Yeah, because failure's an important issue for
you, right?
MICHAEL: I try not to look at marriage as being a test that one either
passes or fails but . . .
THERAPIST: But whatever one thinks rationally, it's kind of like when
the partner presses your buttons, it activates those more primitive kinds
offears, fears of not belonging. Was it like that for you, I mean what do
you actually feel when she rejects or threatens?
MICHAEL: I think, like I'm very young, like I'm a little boy wanting
to cry.
THERAPIST: (To Linda.) Does he ever cry?
LINDA: Not very often, but he has.
THERAPIST: And what do you feel when he cries?
LINDA: I feel like we've shared something.
142 PRACTICE
THERAPIST: So you 're open to his crying.

LINDA: Yes.
THERAPIST: You will give him a shoulder to cry on?
LINDA: Sure.
THERAPIST: (To Michael.) But I guess that's pretty scary for you
because in some way you're so afraid that you might be pushed away. It's
difficult because you had to learn to hold yourself together, it sounds
like. It's kind of like you had to do it alone. Is that true?
MICHAEL: Yes.
THERAPIST: Yeah. Do you have images of yourself as alone?
MICHAEL: Yeah, I think I've always believed in that as a goal, being
independent.
THERAPIST: U mhum, self-sufficient.
MICHAEL: Being self-sufficient.
THERAPIST: You know, somehow I have this image of you struggling
alone, kind of, silently without complaining. And yet inside really feeling
quite isolated.
MICHAEL: Rather than being ... I think I'm tough but . . .
THERAPIST: I don't mean to challenge your independence as being a
bad thing. I agree with you it's a lesson, you know that life has to teach,
that if you can look after yourself you can't get hurt as much.
MICHAEL: Well, but, I don't think it a good thing to not get hurt by
not feeling.
THERAPIST: U mhum, umhum.
MICHAEL: As I say, I've learned certain lessons I don't know if, if Ive
learned what I should have learned.
THERAPIST: Umhum. I guess it's this issue of, if you just allowed
yourself to ask Linda or be nurtured, somehow that lonely, frightened
little boy inside of you, it might feel more secure, it might feel that you
actually do belong. But in a sense I feel like I'm giving a lecture. It's
something you've been working with for a long time, as to how much you
can come out, or how much you need to protect yourself.
MICHAEL: I think that it's something that we need to work on. Um, it
tends to get pushed aside because I can endure, uh.
THERAPIST: Yes, but still what stays with me is this image of you not
complaining and kind of quiet but somehow ...
MICHAEL: Sort of the miserable image.
THERAPIST: Well, there is a pain inside. Much more the stoic martyr.
You know I don't see you as being really miserable.
MICHAEL: No, neither do I.

THERAPIST: But somehow I think sometimes Linda needs to know
about that fear of you being on your own or not belonging.
MICHAEL: Well, we're not talking about separating now. If we were,
that is something that I would hide.
THERAPIST: Can you tell her how you felt when you were talking
about it.
MICHAEL: Well, uh, desperate, very lonely, frightened, um, I think
that dream I had summarizes my feelings about it.
THERAPIST: What was your dream?
MICHAEL: Um, well I can't remember exactly what the dream was
but it had to do with Gail (his child) being taken away from me, it was so
real that I woke up just sobbing ...
THERAPIST: But it hasn't been your way to tell Linda about some of
these feelings. Or to tell anybody, because somehow you never knew that
anybody really cared enough.
MICHAEL: Yes, but now what I started to say was that I feel that
expressing my feelings places an unfair burden. (To Linda.) If we were
splitting up and you decided not to leave simply because my feelings of
being rejected were so great, I feel that's ...
THERAPIST: You know I'm going to interrupt cause I hear you saying
that to Linda but I think that's true, when you're in the process of
splitting up, you know, it's sort of like the rules are different somehow,
because I wouldn't want to express my feelings of hurt or rejection to
someone who is saying they didn't want to be with me because it would
be like offering my throat knowing that it was going to get slit, to use a
horrible image. Um, but I think the same thing applies when you aren't
threatening separation. That somehow you either don't want to burden
her, as you put it, with your feelings or, somehow it's risky to do so too.
It's almost safer to cradle myself here inside because that way nobody can
hurt me. And you know I'm hearing you've learned to do that, and you've
done it well, and that it's an important skill to have. You know it gives
you a strength and a resilience to live through life and yet there's a
loneliness and somehow to be able to let yourself out from under your
own control seems important.
MICHAEL: Yeah, yeah. Well I'm not satisfied with just holding things in.
THERAPIST: Umhum, umhum. (To Linda.) What are you experienc-
ing as you sit and listen?
LINDA: I like it!
144
PRACTICE
THERAPIST: ( To Michael.) I'd like you, rather than trying quickly to

be different, to first be where you are. And what I'm hearing from you is
that where you are is tucked away inside of you, or that coming out
would be a major change for you. I want you to watch this process of
how you need to, feel the need to be your own counsellor. Do you, sort of
understand what I'm saying?
MICHAEL: I think so.
THERAPIST: Yeah, and so that some time when you find yourself with
the feeling that you 're holding back, rather than trying to rev yourself up
to express it, I'd like you to deliberately do whatever you do. Maybe say,
well maybe if I express this anger it'll probably lead to Linda rejecting me
or to her getting angry so therefore, I'll just hold it to myself, OK? Or if
you are feeling some other feeling where you tend to hold it to yourself,
I'd like you to deliberately hold it back, but do it in awareness. You know
I think you often just do it, automatically.
MICHAEL: OK.
THERAPIST: (To Linda.) We've talked more about Michael today but
I think you know there's a similar issue for you, you also close off, right?
LINDA: Yes.
THERAPIST: And I remember so vividly when you were saying "I need
space." You need to take space. And although I've suggested and we've
talked about the importance of you reaching out and asking to be held,
I'd like you to p_ractice your own way of taking space.
LINDA: Umhum.
THERAPIST: Taking space for yourself, but also feeling like, I can't
come out because I'd probably be judged. And I don't know what sorts of
things you say to yourself but it sounds like to me it may be it, it's just too
risky out there or it's just too dangerous, I'll get wiped out, 111 get
destroyed.
LINDA: Yes.
THERAPIST: If you catch yourself feeling some of that need to pull
away or to protect yourself, you can actively do it.
LINDA: Umhum.
THERAPIST: Deliberately and consciously because I think you were
doing that automatically too, you know? Just pulling away and then later
comes the anger and the attack and all that, you know.
After the session Michael reported that he had "isolated a very

important issue and pattern of behavior which caused many difficulties
145
THE PROCESS OF THERAPY
f them." while Linda reported that she felt a change in her partner's
A~:cptance of some of the bad feelings that occurred in his early family
life. Both partners reported being almost totally resolved about the
concerns that brought them into therapy.
Session 8
In the eighth and final session, the couple discussed different ways of
giving support to each other and how not to take differences as an
invalidation of each other. They also clarified how, at times of stress,
their cycle would reappear and what it was they would each need at that
time.
The following reports were obtained in a 4-month follow-up in
which the partners were asked to identify helpful incidents from the
therapy.
Linda: Incident 1
LINDA: At one point I was feeling really sad about some things going
on in my life, and what I usually do is that I get farther and farther away
from Michael, and cut myself off. He also distances himself. And, at one
point I ended up crying and realized how difficult it was for me to
experience that with another person as opposed to going through it on
my own and then later telling about it. There seems to be a big difference
between those two things. And, very difficult to ask for comfort.
INTERVIEWER: So, in this experience you were feeling sad and began
to cry. And, you experienced how uncomfortable it felt to be that
vulnerable or open in the presence of your spouse. What else do you
remember that happened?
LINDA: I was willing to ask for Michael to hold me when we got
home.
INTERVIEWER: So, you began to cry, and then what happened?
LINDA: The counsellor suggested that I might want to ask Michael
for something. And, I said, "No, I certainly wouldn't." And he asked
Michael then how it made him feel to see me like that. Michael at that
point in time was feeling very supportive. But, it brought out that he does
feel overwhelmed and very afraid of my emotions. But, at the same time
146 PRACTICE
he was feeling like he wanted to reach out and I was able to look at him
and to see that he was actually caring rather than being judgmental or
analyzing what was going on. And, so I asked if he would hold me when
we got home.
INTERVIEWER: And , you began to say how this experience was help-
ful for you. It was helpful because . ..
LINDA: Yes. Because part of our difficulty for myself is that I feel
isolated from him and that is in part because I am unable to ask. And , I
felt at that time as if we were working on something together, sharing an
experience. I didn't really want anything from him, not to make it better
or worse. Just to kind of be there and support.
INTERVIEWER: And, how it was helpful is that you experienced that
you were able to reach out and to express your need for closeness.
LINDA: At that particular time, yes.
INTERVIEWER: What changed for you through this experience?
LINDA: I think what changed for me is that up until that point in
time I didn't think it would be possible to feel that with him. As well, it
sort of shifted the way I viewed what was happening in that it was some
of my responsibility as well as his. Whereas, I think up until then I'd been
blaming him more for my isolation or my not being able to reach out. I
think that's what probably shifted the most.
INTERVIEWER: How do you think this change occurred?
LINDA: I guess because I realized that what I do is shut him out, put
up a lot of blocks around me. And, what I need to do is reach out. I don't
know how to say the shift actually happened except going through the
experience of reaching out and not having defenses at that point in time
just changed how I seemed to view it anyway. And I haven't answered
your question but I don't know how.
Linda: Incident 2
LINDA: One of the things that came up was that he feels really scared
and frightened when I feel emotional because he's scared that he's going to
lose control. Because it seems that what I'm going through is so intense that
he couldn't possibly handle it. And, he related feeling that way with the
therapist's help, related it to incidents in his family with his father where his
father got angry a lot. And, he's never been able to stand the way that his
father gets out of control. So, I think that he was able to make the
connection between the way that he is relating now in th is situation with the
way that it was in his upbringing. Because up until that time that was very
new for him too, to think that his family did have this influence on him.
Michael: Incident I
M ICHAEL: I think around the fourth or fifth session, the therapist

had us just look at each other. We'd been talking about each other, I
guess, and he had us focus on each other, and try and see each other anew
rather than continuing on in a past frame of reference.
I NTERVIEWER: What else do you remember about this incident?
MICHAEL: We stopped at that time.
I NTERVIEWER: Do you mean you stopped talking?
MICHAEL: It made us realize that there is another side, that there is
another person involved rather than a collection of ideas, connotations
from the past; that there were two of us struggling there.
Michael: Incident 2
MICHAEL: When Linda cried and then told me she needed to be

hugged when she felt bad, that made me feel needed.
INTERVIEWER: What changed for you through this experience?
MICHAEL: I think I felt more trust. Trusted and trusting like she
cared for me and I could be received. I wouldn't be rejected.
Conclusion
This brief treatment was then somewhat successful in bringing about

change in the relationship. The therapist felt that more work with
Michael might help to relieve his anxiety and stammering and help him
to deal more directly with his anger and vulnerability. The therapist also
felt that Linda could benefit from further work on her fear and sexual
anxiety. At a 2-month follow-up, the couple had maintained their gains
and did return for six more sessions of couples therapy after 6 months,
saying they wanted to complete the work they had started. These sessions
followed along similar lines and proved to be successful.
CHAPTER SIX
Therapist Interventions
There are two main tasks for the therapist using EFT once an alliance
characterized by an atmosphere of nonjudgmental acceptance has been
established with each client. The tasks are accessing the emotional expe-
rience underlying interactional positions and using this emotional expe-
rience and expression to evoke new responses and change interactional
positions. The most crucial aspect of the first task is the unfolding of new
aspects of self not currently operating in the relationship. The most
crucial aspect of the second task is the redefining of interactional cycles in
terms of this emotional experience so as to aid the couple in the redefini-
tion of the relationship. These tasks are presented in terms of basic
principles of treatment and specific interventions.
TASK 1: ACCESSING EMOTIONAL EXPERIENCE
The EFT therapist uses a synthesis of gestalt and client-centered ap-

proaches adapted for couples therapy. The moment-to-moment expe-
rience of the client is the key point of reference in the therapy. Clients are
regarded as experts on their own experience, and the therapist is a
catalyst who helps evoke underlying experience. The therapist does not,
then, possess a set structure for therapy; rather, the therapist has a map
concerning common features and patterns in relationships and how best
to create change. Always, however, the clients' experience is the reference
point for the therapy process.
The therapist looks for opportunities to focus the clients' experience
and to guide their interaction in a certain direction, in a way that remains
true to the essential nature of the clients' experience and view of reality.
The therapist focuses on the clients' moment-by-moment construction of
148
THERAPIST INTERVENTIONS 149
reality, particularly the clients' emotional responses and how these affect
the ongoing process of interaction. The overall strategy, as in any experien-
tial therapy, is to enter the clients' frame of reference and explore the reality
of the world as it appears to each partner. In _couples' therapy, the clients'
most important world is that of their relationship. Hence, the therapist
observes what each partner attends to , how partners construct their emo-
tional experience, and how this in turn affects the organization of the
relationship. The accessing of emotional experience in the session is of
crucial importance, particularly after the interactional cycle has been made
clear (Step 2), unacknowledged feelings have been accessed (Step 3), and
disowned feelings have been owned (Step 5). However, emotional expe-
rience is accessed all through therapy, with varying degrees of centrality.
As discussed earlier, the accessing of emotional resl?onses that are
not normally attended to leads to a synthesis of new emotional expe-
rience. The model of emotion used here is a constructivist, information-
processing model. Emotion that is brought into awareness in the present
is not seen as having been outside of awareness; rather, it is viewed as
being newly synthesized in the present, from subsidiary components.
Thus, different self and experiential organizations are possible at any
moment, utilizing more or less of the available subsidiary information.
Bringing emotion to awareness involves both discovery and creation.
When evoking emotion in the session, it is the therapist's task to help each
partner focus on relevant implicit components. An example of such a
component might be the sense of threat expressed in the tightness of the
facial muscles, which is an implicit aspect of a reactive anger response.
Primary emotions experienced in the session, such as anger, sadness, or
fear, are considered currently synthesized experiences not present prior to
this synthesis. Only the components such as the biologically based, expres-
sive motor-level responses and schematic emotional memories existed
prior to the experience of emotion in the session. As potential informa-
tion, these components may or may not be processed and integrated with
other levels of processing to constitute the conscious experience of a
currently felt emotion. It is not then simply that couples disclose formerly
withheld emotions and aspects of themselves to each other and have these
disclosures confirmed. It is also that each partner has a new experience of
self and of self in relation to other. Thus, the blamer who organizes her
emotions in terms of anger and her sense of self in terms of a resentful
victim can later describe herself more in terms of her need for closeness
and her panic at her partner's inaccessibility.
150 PRACTICE
As has already been stated, accessing here does not mean discussing
or gaining insight into a feeling. Insight may be part of the process, but
there is also an active engagement in new experience. Thus, an expression
of fear of abandonment emerges from attending to the hollow in the pit of
the stomach, the urge to cry out in pain, the image of a lost child, and a
memory of feeling alone in one's house and the unspoken thought "no-
body loves me." All of this is synthesized in the present into a focal
experience of sadness. Then, when this network of components is acti-
vated in therapy, the person is no longer talking about feelings; instead, he
or she is experiencing and expressing in an authentic fashion.
It is this lively experience that is sought in EFT, for it renders both
the inner experience and interaction amenable to restructuring. This
formulation of emotion and the process of therapy leads logically to the
kind of interventions described below, such as empathic reflection, evoc-
ative responding, and the creation of experiential experiments. Such
interventions encourage the activation and reprocessing of key emotional
experiences.
Principles
In general, the process of tracking and exploring emotional experience in

individuals follows the principles of accessing emotion laid out by Green-
berg and Safran ( 1987). These principles are as follows:
• Attending. The client attends to new aspects of experience m

response to the direction of the therapist.
• Refocusing. The client refocuses on inner experience as the therapist
encourages the client to "stay with" and expand meaningful moments.
• Immediacy. The client focuses on the present, the poignancy of the
immediate moment.
• Expression Analysis. The client attends to nonverbal expressions
such as voice tone and gesture, with the help of the therapist.
• Intensification. The client intensifies experience by methods such
as repetition and the use of concrete metaphors.
• Symbolization. The client symbolizes experience in a way that
helps to capture the essence of what has occurred.
• Establishing Intents. The client begins to formulate intentions and
action tendencies based on new experience.
Interventions
There are two broad styles of intervention in couples therapy for access-
ing emotional experience, responding and directing. Specific interven-
tions within these two categories are described below.
Task 1. Accessing Emotion: Operations

I. Responding
A. Empathic reflection
B. Feedback on nonverbal actions
C. Evocative responding
II. Directing
A. Process directions and inquiries
1. Directing attention
2. Directing inquiries and replays
B. Experiments in awareness
1. Repeating key sentences
2. Directing the client to repeat a phrase to heighten its impact
3. Using images and metaphors
4. Setting up contact experiments
C. Enactments
1. Vivifying enactments
2. Position enactment
3. Impasse enactment
D. Empathic interpretation of current emotional experience
1. Conjectures
2. Elaborations
3. Explications
4. Suggestions
5. Inferring catastrophic expections
Responding
In these interventions, the therapist responds to the client with empathic
reflection, feedback on nonverbal actions, and evocative responding.
EMPATHIC REFLECTION
In EFT, there is a focus on the reflection of feeling and validation of the

meaning of client statements, particularly emotionally laden statements.
The therapist empathically reflects the core content, particularly the
emotional content, in these statements. "Reflection" implies more than
152 PRACTICE
the repetition and acceptance of feeling. There is listening for what is

implied but not stated- an unfolding of, or a more complete symboliza-
tion of, experience. For example, the therapist, hearing the unspoken
pain in an angry comment, will feed back to the client a reflection that
includes the experience of pain; reflection is used in a broader sense than
implied by a simple repetition. However, as in client-centered therapy,
reflection underscores the significance of particular comments and the
therapist's validation places them in a context of legitimate human re-
sponses that the client does not need to hide, disown, or defend.
A sense of entitlement is presumed to facilitate the abandonment of
dysfunctional protective and controlling stances. The acceptance of the
client's experience, resulting in the client feeling understood and accepted
on his or her own terms, is an essential prerequisite to growth and change in
the experiential model of therapy. The therapist structures an interpersonal
context in which both partners can receive validating responses from the
therapist and eventually from each other. The security- created by the
therapist acts, in a sense, as an antidote to the general level of anxiety and
the climate of disqualification and self-protectiveness that characterizes
distressed couples. This lack of security results in constricted experiencing
and presentation of self, along with rigid interactional positions that tend to
leave each partner with very limited response alternatives. The creation of a
context in which both partners are accepted and valued, and their positions
are portrayed as legitimate given how they each experience the relationship,
is essential. Under such conditions of acceptance, previously unacceptable
aspects of self can emerge and be integrated into the self-concept and into
the relationship. Empathic reflection and validation encourages the client
to become more engaged with his or her experience so that such experience
is expanded on and crystalized.
Many of the principles of accessing emotion in individuals detailed
above can be operationalized in reflection, particularly attending, refoc-
using, immediacy, and symbolization. Perhaps the most powerful effect
is that the client's attention is directed to the core aspects of experience
and is focused on what is poignant and meaningful in the present mo-
ment. Validation is much easier to implement if the therapist has a model
of relationship distress that emphasizes current causal factors and health,
rather than long-standing intrapsychic causal factors and pathology. The
most useful assumption would seem to be that, given their habitual mode
of processing experience in the relationship, and the nature or rules of
that relationship, clients are coping as best they can. All behavior and all
responses, including extreme emotional responses, are viewed as having

their own implicit rationale and logic. This logic emerges as key aspects
of experience are reprocessed and clarified.
Example
THERAPIST: (After a 2-minute statement by the client.) The main

feeling for you right now seems to be one of rejection, the feeling that you
are not valued in this relationship. I can understand that you experience
Harry's actions as rejecting and that it is painful for you.
FEEDBACK ON NONVERBAL ACTIONS
The therapist observes nonverbal patterns and feeds back his or her
observations to the client. Non verbal cues may contradict explicit client
statements or may suggest added meanings of which the client is un-
aware. After bringing attention to nonverbal expressions, the client is
often asked what he or she is experiencing. The other partner is also
asked to react to the nonverbal expressions since such nonverbals often
carry analogic messages concerning the nature of the relationship.
Nonverbal expression is a channel for emotional experience, the
spontaneous external communication of an internal state. The avoided
aspects of experience are often implicit in nonverbal behavior, and, thus,
such behavior can be use_d to begin the reprocessing of critical responses.
As with the empathic reflection of verbal processes, this focus on nonver-
bal behavior induces an inner tracking, with intense concentration on the
immediate inner experience. As described earlier, it is schematic or
perceptual memory rather than verbal or conceptual memory that pre-
dominates in such accessing of emotional experience; hence, nonverbal
actions such as gestures or tone of voice provide a window into such
automatic schematic processing·- that is, a window into the experience
itself rather than into the label placed on the experience.
Example
THERAPIST: I noticed, Jim, that as Maureen seemed to get upset with

you, you tended to lean back in your chair and look away. What do you
experience when you do this?
154 PRACTICE
or
THERAPIST: Maureen what happens for you, when you notice Jim
lean back in his chair like that, and how do you feel?
EVOCATIVE RESPONDING
Evocative responding to the clients' experiences in the session, or to
recent out-of-session experiences that the therapist wishes to bring into
the present to process further, is a key aspect of EFT. Evocative respond-
ing is an attempt by the therapist to help a client expand and differentiate
a problematic reaction the client is experiencing (Rice, 1974; Rice &
Saperia, 1984). In couples therapy, this problematic reaction is a re-
sponse one partner has or has had to the other in a particular situation,
whether in the session or in the past. Such a reaction is usually an
exaggerated automatic response that is viewed by the client as unde-
sirable and evokes negative responses in the other partner. An exam-
ple is the instant frustration or attacking behavior elicited in one part-
ner by a perceived lack of response in his or her withdrawn partner.
The therapist works with the client to unfold this experience, to open
up the idiosyncratic meaning of the moment, and to have this commu-
nicated to the other partner. The therapist's intervention at any one
moment may be focused on the stimulus situation, the response to the
stimulus, one partner's level of arousal, or the meaning of the total
experience. As Rice (1974) and Rice & Saperia (1984) demonstrated in
the study of evocative responding, the client encounters his or her expe-
rience and reprocesses it, so that it becomes possible to reorganize such
experience, including elements hitherto avoided or ignored. The purpose
of this intervention, then, is to use sensory connotative language to
unfold inner subjective reactions to the stimulus situation. The client can
then form less automatic and more accurate, complete constructions of
his or her own experience. The therapist must use vivid, concrete lan-
guage to evoke and expand this experience. As Rice (1974) suggested,
metaphors are particularly useful since they can be both concrete and
open and, as such, can be used to convey the unique quality of individual
experience. The therapist's nonverbal behaviors are also important in
intervention. Often, the therapist uses an evocative voice tone and leans
toward the client; how the question is asked is as important as the
question itself.
Example
• Asking a question.
THERAPIST: Is this painful for you?
• Asking about the impact of a stimulus, focusing on how cues are
processed.
THERAPIST: What is it about the way she asks for attention that
makes you so uncomfortable?
• Focusing on personal responses.

THERAPIST: What happens inside you when Pat says no to your
request for attention?
• Focusing on level of arousal or general response.
THERAPIST: How do you feel when you say that? (or) How do you
feel, right now, in your body?
All of these questions-What happens? How do you feel? What is it

like for you?-help clients to encounter and differentiate their experi-
ences.
Directing
In these interventions, the therapist directs the client's processing of
experience, structures experiments in awareness, facilitates the enactment
of facets of inner and interpersonal experience, and constructs interpreta-
tions of underlying feelings and vulnerabilities. The principles of intensi-
fication and symbolization are particularly relevant here.
PROCESS DIRECTIONS AND INQUIRIES

The therapist tracks the clients' processing of experience and directs
attention to aspects of immediate experiencing that would otherwise be
glossed over or pass unnoticed.
This may occur in the context of intrapersonal or interpersonal
responses. The therapist may suggest, for example, that a client focus on
a remark he or she made a moment ago or continue to explore a
particular image or feeling. Direct inquiries as to what is happening in
156 PRACTICE
the client's phenomenological world at the present moment help the

client to reprocess key aspects of experience.
Example
• Directing attention.
THERAPIST: Can you just go back to what you were saying about
feeling like you are in a room without any doors and when Terry
starts to shout at you it's like you begin to run from wall to wall,
faster and faster?
• Directing inquiries and replays.
THERAPIST: Can you stop for a moment, please? What just happened
there? Jim looked at you and said that you didn't know how to love
and you looked down and were silent just for a moment, before you
replied so vehemently. What happened for you when he said that?
EXPERIMENTS IN AWARENESS
Experiments can take many forms. The therapist may have clients focus
on themselves in an explicit fashion or encourage them to try out new
expressions and to become aware of new experiences. Experiments may
also be used to heighten responses, to render elements of experience more
vivid and significant, and to structure a feared interaction.
In terms of focusing on the self, the client is invited to concentrate on
an immediate inner experience that occurs in the session. For instance, the
therapist may direct the client to focus on the felt sense elicited by a
particular event or moment, such as the partner shouting at the client
(Gendlin, 1979). During this process, the client is encouraged to put aside
cognitive labels, analysis, and coping strategies and simply explore the
inner experience. Meanwhile, the therapist encourages the client to explore
and track his or her responses in such a way as to create increased salience
of, a vivid encounter with, or crystalization of key moments. The use of
concrete evocative language is important here, particularly the use of image
or metaphor. Images and metaphors appear to have a unique ability to
capture an experience without creating premature closure or labeling.
Awareness experiments often involve the clients trying out new or
expanded ways to express their experiences. The clients may be asked to
repeat key sentences or to repeat statements in a different way; for

example, using "won't" instead of "can't" or replacing impersonal state-
ments with more personal referents such as replacing "it's hard" with "I
am afraid to." The therapist may also feed the client a sentence that
crystalizes the client's experience up to this point and then invite the
client to finish the sentence-that is, to unfold the experience further.
While clients will often label their responses in such a way as to package
and close down further exploration, these experiments tend to invite
further processing rather than labeling and closure.
Experiments that promote contact between partners are most useful,
helping the partners to make contact with each other, based on their
inner experience or on the lack of an experience or response. Thus, one
partner may be asked to experiment with saying to the other "I miss
you," "I need distance," or "I disagree" and see how it feels. Or the
experience of being in the relationship may be dramatized by asking one
partner to go down on his or her knees and look up pleadingly-or by
asking the partners to turn their backs and fold their arms while they
continue talking to each other. In addition, trying to do that which is
feared or difficult, like reaching out or expressing anger, can be experi-
mented with.
Example
• Repeating key sentences.

THERAPIST: Stop for a minute here. Tom, you just said something
really interesting-you said "Well, your friends talk to you ... but
they ate not afraid."
• Directing the client to repeat a phrase to heighten its impact.
THERAPIST: (In a very slow quiet voice.) Could you say that again
Angela? Could you say, "He'll never let me in"?
• Using images and metaphors. The therapist uses images that the
clients supply or creates images for the clients that seem to sum up
in a concise way responses or patterns of responses.
THERAPIST: So when you feel shut out, you push harder and
harder. You push on the door. [Such an image conveys no evalua-
tion of the client's actions and evokes a simple but vivid picture for
the client to grasp and use to clarify his or her experience.]
158 PRACTICE
Setting up contact experiments.

THERAPIST: Can you look at your husband right now? How does it
feel to just look at him?
CLIENT: Awful, lousy ... he thinks I'm impossible.
THERAPIST: Help me understand how it is lousy. Where do you
feel it?
CLIENT: I get a tight feeling here in my chest. I want to cry, to give
up. [The therapist then expands on and encourages the client to
elaborate on the tightness, the crying, and the sense of defeat or
helplessness.]
ENACTMENTS
The therapist encourages the partners to make concrete and explicit

certain aspects of their experience, to speak from that experience, and to
enact aspects of the positions they take with each other. Such enactments
use an intrapsychic focus but can also be used in a more interpersonal
manner when restructuring a relationship. The line between an enact-
ment and an experiment is sometimes vague in that enactments can also
constitute contact experiments.
In enactments, the clients, having expanded and clarified some
aspect of their experience in the relationship, are encouraged either to
share this directly with one another or to enact aspects of a specific
interactional position. In the latter case, for example, a wife who has
taken a passive withdrawn position in the relationship, but who has
accessed underlying feelings of defiance and fear of being engulfed by her
spouse, is encouraged to enact these new aspects of her position in an
active manner, taking responsibility for her part of the relationship
dance. This creates a new level of contact with her partner, on a level that
has hitherto been avoided. The therapist may direct the client to enact
such a position in physical terms, by turning away from the spouse
whenever the client feels threatened. The therapist may also direct a
couple to enact their impasse or the point in the cycle where the interac-
tions become stuck. This is done by first labeling the stuck point and then
suggesting that, given that the couple are not currently ready to yield any
ground, they should explore and accept their entrenched positions and
become aware of the importance of these positions to each of them. The
partners are then asked to enact their respective positions in relation to
each other. This makes the impasses vivid and immediate.
Example
• Vivifying enactments. The therapist, having helped the client ac-

cess new experience, speaks for that part of the client that is not
normally operationalized in this relationship. The client then
enacts this new aspect of self.
THERAPIST: So, Sarah, can you say to Scott, "I am so afraid of
you, I find it hard to look at you, even here, to let you see me''?
• Position enactment.
THERAPIST: So, John, can you talk to Jane about your response to
her pushing.
CLIENT: Well, I don't like it ... and I put up a wall.
THERAPIST: You're telling Jane "If you push, 111 resist you. You
are not going to dominate me."
CLIENT: Right, back off, let me choose.
THERAPIST: Tell this to her.
• Impasse enactment.
THERAPIST: So, Carol, can you try to get John to hear you, to
respond to your need for reassurance?
CLIENT: He won't.
THERAPIST: Can you try-and, John, I'd like you to protect your-
self every time you feel attacked. [The couple then play out their
dance.]
Another example is as follows:

THERAPIST: Joan, last night, did you show Jim you needed his
attention?
JoAN: Well, I said I was going for a walk.
THERAPIST: Did you ask him for what you needed?
JoAN: No. (Defiant absolute tone, folds her arms on her chest.)
JIM: You never ask.
JOAN: I get tired of asking. You'll give reasons why you can't be
with me, you'll do what you want to do-or you'll pretend to
accommodate and pout.
THERAPIST: So if you ask you'll be disappointed. You don't trust
he1l hear you and respond.
JOAN: It doesn't matter what I do. (Shrugs.)
THERAPIST: How do you feel as you say this, Joan?
160 PRACTICE
JoAN: I don't know . . . I feel like getting mad .

THERAPIST: Can you tell him, "I refuse to ask, to feel helpless in
front of you"?
JOAN: Yes, yes ... I won't do that.
J1M: ( Crosses legs, looks away.) Fine. (Sets his jaw.)
THERAPIST: What are you saying, Jim?
JIM: Fine.
THERAPIST: Seems like you have just shut down, drawn back,
given up?
JIM : Yes . . . that's how she is.
THERAPIST: And this is how you are . .. Something like, I refuse to
be intimidated and ordered around?
JIM: Right. (To Joan.) You order, not ask. (Long silence.)
THERAPIST: So I guess we're stuck here. Joan, you refuse to put
your weapon down and ask, and Jim, you distance and protect
yourself. This is your whole relationship, isn't it? Joan, can you tell
him again, "I won't ask"? [The therapist then replays the whole
impasse sequence making it more and more explicit.]
All of the above interactions dramatize and make concrete implicit

aspects of experience and relationship positions.
EMPATHIC INTERPRETATION OF
CURRENT EMOTIONAL EXPERIENCE
The EFT therapist infers the client's current state and experience from
nonverbal, verbal, interactional, and context cues in order to help access
further experiencing. This inference is conjectural rather than definitive
and is as close to and true to the clients' experience as possible. Such an
interpretation is not an abstract intellectualization so much as a clarifica-
tion of immediate experience, an ascribing of meaning on a concrete level
which then leads to new ways of viewing such experience.
These interpretations are not then designed as cognitive labels for
experience nor to tell clients something new about themselves. Rather,
the interpretations are exploratory responses designed to access expe-
rience. The intent is not to substitute one meaning for another but to help
the clients to focus more intensely on their experience as it is. Emotional
experience contains within it implicit and immediately valid meaning
sets; one does not doubt intense sadness and does not need to search very
long for its meaning. The goal is then to access experience rather than to
create cognitive insight or understanding as to the causes of behavior. It
may, for example, be important simply to heighten an already formu
lated emotion or to add another element to such a formulation. It also
may be important to suggest an aspect of experience that the client at
present is unaware of, as in, for example, suggesting that a client has
considerable anxiety about a particular issue or response.
The inferences used here arise from the therapist's empathic immer
sion in the clients' experience, his or her knowledge of the interactional
patterns and positions of the couple, and knowledge of the kinds of
intrapsychic experience that are associated with such patterns and posi
tions-not from a psychodiagnostic perspective on the individuals' char
acter structure. Inferences also arise from the theoretical model underly
ing EFT; for example, when clients have difficulty symbolizing their
needs in a relationship, the therapist might present several concrete
formulations such as, "You want to know that he is there for you
emotionally-that you can lean on him and be comforted." The hope is
that one of these formulations will crystalize the client's experience. The
therapist's suggestions arise in part from the provisions of relationships
suggested by bonding and attachment theory (Weiss, 1982), which is the
basis o'f EFT. The concern from an experiential perspective is that
therapist interpretations could possibly distort the clients' experience and
impede the clients' discovery of their own awareness. This danger is,
however, reduced in couples therapy since the system and the problem
atic cycle are visible to the therapist, while the other partner provides
immediate corrective feedback.
One area in which interpretations, as outlined above, are particu
larly useful is helping the client access and explore core catastrophic
fantasies and expectations. Such core beliefs about the self and the
response of others to the self relate directly to the clients' sense of
interpersonal security and therefore to each partner's ability to be accessi
ble and responsive. These core beliefs are one example of "hot cogni
tions" and can be assessed by evocative responding or unfolded with the
help of interpretation. After having explored and synthesized the emo
tional experience, often very painful, in which this core belief is em
bedded, the client may benefit from a succinct symbolization of such a
core belief by the therapist. Examples of such interpretations might be
concrete, vivid statements about possible fears of engulfment, of the
unacceptable nature of the self, or the fear of relying on and trusting the
162 PRACTICE /.
other in a world where no one seems ultimately trustworthy. This process '
in turn aids in the accurate framing of intentions and desires.
Example
• Conjecturing about aspects of experience that the client is pres-

ently unaware of.
THERAPIST: Even though it is not what you are saying, I think you
are feeling afraid, and it is hard for you to experience this. I may
be wrong but this is what I sense, that you are feeling afraid.
• Elaborating on the client's experience, taking a step that the client
seems unable to take, or making explicit what the client seems
unable to formulate.
THERAPIST: So my sense of this is that anything is better than
giving up and feeling the panic, anything, attacking or screaming,
anything is better.
• Explicating for some aspect of the client's experience that the
client does not yet own.
CLIENT: Well, I'm not sure-I'm confused.
THERAPIST: Maybe you're feeling something like, "I'm so afraid of
your response that I'm having difficulty focusing on this issue
without getting confused."
• Indirectly giving the clients suggestions or cogmtive organizers
with which to explore their experience and so begin the reprocess-
ing of a key experience.
THERAPIST: So often people in this kind of situation end up feeling
isolated. It may seem out of proportion but they begin to feel
perhaps as if their spouse has almost deserted them, and that they
are all alone.
The evocative language here is designed to strike a chord in the
client and access the emotional response implicit in the situation,
which up until now may have been described in a cool rational
manner. Another form of this kind of intervention that is some-
times useful when a client finds it very difficult to identify with any
kind of underlying feeling is a disquisition. A disquisition is a
general story shared by the therapist about other clients who felt
or experienced certain emotions. This narrative is not, of course,

necessarily true; it is a detailed way of describing a possible similar
situation or set of responses that may reflect some of the present
clients' reality. This is a nonthreatening indirect way of suggesting
or probing for certain experiences with a relatively closed partner.
Inferring catastrophic expectations.
THERAPIST: It seems like you 're saying that to let Sarah in means
that you will lose yourself, dissolve, that she will eat you up. She
seems more needy than you are.
Other Techniques
In EFT, the therapist may occasionally use other techniques found in the
humanistic experiential therapist's armamentarium, such as self-disclo-
sure. For example, as part of the process of validating a client's fear
response to his wife's anger, a therapist disclosed her fear of flying as an
example of how most people fear the unfamiliar. This was particularly
relevant since the client was a pilot and saw flying as the epitome of
safety.
Direct confrontation does not tend to play a large part in EFT.
Positions are generally uncovered or developed rather than confronted;
instead, the clients are confronted by each other's responses and the
process of therapy itself. Thus, after a blamer has enacted his angry
response to his spouse, and the spouse has withdrawn, the client herself
may remark, "Oh-of course doing that pushes him away." Also, if the
therapist believ~s that clients have good and valid reasons for their
responses, direct confrontation is out of place. In fact, the therapist's
acceptance of each client is a model for the partners to use in viewing
their own responses and those of the partner. These interactions result in
a process whereby clients track and evaluate their own responses and
experience.
The first task of therapy, then, is concerned with helping the client to
access and acknowledge primary emotional responses such as those
connected with catastrophic fantasies or expectations. This is a process
both of discovery and creation; however, it is only one half of the change
process. The second half involves the creation of new meaning and the
expression of feelings to modify interactional patterns.
164 PRACTICE
TASK 2: CHANGING INTERACTIONAL POSITIONS
The second major task in EFT, then, is to use the emotional experience of
the partners to motivate new behavior by evoking new responses that
change interactional patterns. This involves a more interpersonal focus.
The therapist has to see the interpersonal significance of intrapersonal
experience and help the couple to integrate this experience into their
interactional patterns. Certain emotional responses tend to be associated
with certain relationship positions. The therapist, in order to change such
positions, focuses particularly on these. For example, the therapist may
focus on vulnerability in the blamer and on boundary defining in the
withdrawer. In general, the therapist helps the couple frame their expe-
rience in such a way as to undermine rigid positions and facilitate contact.
The therapist also uses generally validating frameworks to describe
interactional cycles such as lack of safety or security or the need for
protection from the threat. The therapist assumes that desires consistent
with bonding theory, such as desires for recognition and support, are
present for each partner in the relationship, even if unacknowledged.
How does the therapist then choreograph new interactional patterns?
Principles
As with accessing emotional experience, it is possible to formulate a set

of general principles for changing interaction patterns. These principles
are as follows:
• Tracking Interactions. The therapist highlights patterns and fol-

lows and expands sequences as well as key incidents.
• Refocusing Interactions. The therapist repeatedly brings the cou-

ple's attention back to these patterns and events.
• Reframing. The therapist frames the couple's problems in terms of
context and interactional cycles.
• Directing and Choreographing. The therapist directs the interac-
tion in such a way as to gradually expand, explicate, and finally
restructure positions.
• Repositioning. The therapist uses the new intrapsychic experience

to create new relationship positions.
As with Minuchin's structural family therapy (Minuchin, 1974), the

basis for interventions is the concept that transactional patterns reflect
the structure of a relationship, as embodied in repetitive rigid patterns
and positions. The main features of the relationship map in couples
therapy are the autonomy-dependence and the closeness-distance pat-
terns that the couple enact and that constitute each partner's position in
the relationship. The goal of therapy is to help the partners restruc-
ture their interaction from the present rigid stalemate to an open, respon-
sive, I-thou connectedness and interdependence. In such a relationship,
both partners have a sense of boundary and autonomy and a sense of
belonging. Therapy, then, consists of a set of steps in which the partners
move closer to a positive interactional cycle in which underlying expe-
rience and interactional positions can be made congruent and integrated
in such a way as to elicit contact and caring from each other. For
example, a woman who consistently blames and thus pushes her partner
away is encouraged to access her underlying feelings, that is, to focus on
herself rather than on her partner. The therapist, having accessed these
feelings, then uses them to reframe and restructure interactions so that
the blamer can openly ask for what she needs and evoke a positive
response.
Interventions
Just as the interventions of the first task of EFT can be subsumed under
the headings of responding and directing, the interventions here can be
subsumed under the general headings of reframing and restructuring. All
the interventions presented here mesh with, build on, and interact with
the more intrapsychically oriented interventions of the first task. In
general in EFT, the dichotomy between intrapersonal and interpersonal
becomes somewhat irrelevant, as the dancer and the dance are indistin-
guishable. The individuals and the context are reflections of each other
and the process of treatment illustrates this, with intrapsychic interven-
tions feeding into or springing from interpersonal interventions and vice
versa.
166 PRACTICE
Task 2. Changing lnteractional Positions: Operations

l. Rcframing
A. Placing behavior in the context of the cycle
B. Framing difficulties in terms of underlying vulnerabilities
C. Giving a metaperspective
ll. Restructuring
A. Instructing the partner to interact in a particular way
B. Choreographing a new pattern of interaction
Reframing
PLACING BEHAVIOR IN THE CONTEXT OF THE CYCLE
The therapist continually places each partner's behavior in the context of

the interactional cycle and the responses evoked by the other partner's
behavior. This is perhaps the most basic intervention arising from the
structural systemic perspective. The main difference between the work of
such theorists as Minuchin and Fishman (1981) and EFT is that the
elements of intrapsychic experience and motivation are directly included
in EFT whereas these elements are considered irrelevant in traditional
systemic approaches. This is not reframing in the strategic sense of the
term; the frame is not arbitrary but arises frqm an emotional uncovering.
Placing behavior in the context of the cycle counteracts each
partner's view of the relationship as one in which the other is agent and
he or she is simply reacting to the other's behavior-that is, both
partners' responses are seen as actively constructing the distressing rela
tionship. As part of this intervention, the therapist accepts and validates
the clients' reality but places it within a larger and more complete
picture-that is, within the context of the other's behavior. This fosters
mutuality and creates a context in which the clients may learn to change
their own behaviour to evoke different responses from each other, rather
than attempting to change each other. The therapist constantly frames
the partners' positions in terms of interaction cycles that both create and
suffer from. As part of this intervention, the therapist might label behav
ior that one partner sees as "selfish" (a reflection of the nature of self) as
in fact being "needy" (a reflection of the nature of the relationship). The
patterns of interaction are then presented as causal agents, reflecting and
evoking intrapsychic experience. The focus is on tracking the process of
interaction and placing each partner's responses in the context of the
couple's negative self-defeating cycles. In intrapsychic interventions, the
focus is on how clients process experience; here, it is on how they interact

together.
The reframing of problematic responses in terms of imperatives
created by context legitimizes responses and also sets the stage for new
patterns of interaction. The framing of distancing behavior, for example,
in terms of self-protection in the face of perceived aggressiveness on the
part of the other partner creates new possibilities concerning how the
distancing self is perceived and responded to. The distancer is framed as
"driven away" rather than as innately aloof and uncaring.
Example
Placing one partner's behavior in the context of the other's behavior.

THERAPIST: So your sense is that Andrea's anger is unjustified and
that she is being very unfair?
HusBAND: Yes, she got that from her mother, her temper.
THERAPIST: It is difficult for you to imagine that her anger is
connected to you, to your taking distance and closing her out?
HusBAND: What else can I do?
THERAPIST: Yes, I understand. You try to avoid a fight and she
sees you as going away and not caring. She tries to get you to hear
her and you see her as being impossible and hostile.
Positive reframing, in terms of context.
CLIENT: I know I get verbally abusive and .I hate myself for it. I
can't get to him.
THERAPIST: So the abuse is about getting a reaction from him. The
way things are between you, you don't know how to contact him.
He seems unreachable, unless you get angry.
FRAMING DIFFICULTIES IN TERMS OF

UNDERLYING VULNERABILITIES
The therapist deals with blocks to the enactment of new interactions or

new responses by framing these blocks in terms of underlying vulnerabil-
ities. In this intervention, the client is directed to engage the partner on a
level that makes the difficulty explicit and reflects on the nature of the
relationship. In the case where one partner is unable to accept or respond
to new aspects of self and new responses expressed by the other, this
168 PRACTICE
method of dealing with such blocks protects the other from the negative
impact of the partner's lack of response. The therapist then attempts to
access the emotional experience underlying this lack of response.
Example
• Framing blocks in terms of underlying intrapsychic vulnerabili-

ties.
THERAPIST: Is it hard for you Cal ... hard for you to comfort her?
CAL: Yeah, I don't know why .. .
THERAPIST: Can you look at her? What do you see?
CAL: She's crying, she looks sad, but I've tried before.
THERAPIST: Maybe you want to know if your offer will be ac-
cepted? Maybe you still want to stay behind that shield of yours
you were talking about?
CAL: Yeah, like, is it really safe to come out? (Laughs.)
or
THERAPIST: Can you look at your wife and tell her about your fear
of her criticism?
HusBAND: No I can't.
THERAPIST: It's hard to look her in the eye and say that.
HUSBAND: She11 mock me. 111 be exposed.
THERAPIST: Can you tell her, I feel so unsafe, it's terrifying to let
you close enough to hurt me?
HUSBAND: Yeah. (Looks at wife.) I have to keep you away.
GIVING A METAPERSPECTIVE
The metaperspective, in part, involves viewing and expressing one

partner's behavior in terms of the stimulus offered by the other. How-
ever, the therapist also clarifies the working of the negative cycle, always
heightening any change in position or new responses. The therapist also
elucidates on how interaction patterns reinforce each person's self-defini-
tion. This intervention teaches the couple how to integrate awareness of
the process of interaction into their everyday relationship. It gives an
added perspective and facilitates the creation of an I- thou dialogue. It
also attempts to make more explicit the control that the couple have over
their own relationship and the process by which they construct it.
Example
THERAPIST: How would you change your response to help Jim to be

a little less afraid of coming close?
CLIENT: Well, I guess, I could try to tell him some of the feelings
we\re talked about here. Maybe not get angry so quickly, risk asking him,
so I don't have to be this angry bitch all the time. It's hard to love
someone who is angry all the time.
Restructuring
Just as reframing attempts to change the meaning of responses and
positions, restructuring attempts to reprocess present interactions and
construct and enact more adaptable and flexible patterns.
INSTRUCTING THE PARTNER TO INTERACT IN

A PARTICULAR WAY
The therapist here may stop the interaction and pick out a particular
small incident or set of responses for further expansion. The therapist
may also ask the client to communicate new aspects of experience or new
aspects of self that are not usually evoked or operationalized in the
relationship. It is not enough for a client to engage in a new experience or
discover a new aspect of self in front of the other spouse. This new
experience has to then be directly communicated to the partner-that is,
it has to be enacted and thus turned into a relationship event. The EFT
therapist allies with the aspects of self in both partners that have the
potential, if enacted, to change the context, the structure of the relation-
ship.
The therapist then tracks interventions, directs the expression of new
emotional experience to the partner, directs one partner to respond to the
other, and encourages each to state needs and wants explicitly. In order
to heighten and intensify a particular interaction, the therapist may focus
on and repeat a certain set of responses. This has the effect of highlight-
ing the pattern of interactions and focusing on particular elements and
positions in the interaction. Thus, key interactions that serve to maintain
the structure of the relationship are focused on and made accessible for
intervention. This kind of intervention is useful, for example, when a
partner changes his or her behavior in a positive fashion only to have this
170 PRACTICE
positive response invalidated by the other spouse, as when a withdrawn

wife becomes open and self-revealing for a moment only to be attacked
by her husband who either does not see or does not trust this change. In
this case, of course, the attack, if not attended to, will evoke further
withdrawal, confirming· the blaming spouse's mistrust in his partner's
new response.
It is also useful to have partners enact, in a clear, concise manner,
their dysfunctional patterns. The therapist can then replay the interaction
and highlight the automatic vicious cycle that the couple have con-
structed. It is next possible to take o.ne element of this cycle and begin to
expand it intrapsychically or interpersonally by directing the couple to
interact concerning this element so that the pattern is expanded and
modified. Repeating key interpersonal messages, at a slower speed, with
heightened expressiveness and clarity, tends to create a context in which
the couple can see how they create their relationship as they do it. This
kind of immediacy can be powerful and dramatic.
Example
• Direct the expression of new emotion experience to the spouse.

THERAPIST: Can you look at your spouse? Can you tell her, "I'm so
afraid, I'm so afraid that you'll turn away''?
or
THERAPIST: You used a very strong image there, the image of
playing with fire. Can you share with your wife how afraid you are
of her anger, how for you it is like playing with fire?
or
THERAPIST: Can you tell him, "I'm so angry at you, it does
not matter what you do right now, I will not hear you or accept
it''?
• Ask for the other's response to a partner's experience.
THERAPIST: What's happening to you Larry, as Chris is crying?
or
THERAPIST: How do you respond to Chris talking about how hurt
he feels?
• Encourage the client to check out assumptions and perceptions.
THERAPIST: Can you ask if he is thinking of leaving?
THERAPIST INTERVENTIONS 17 l
Replaying crucial interactions.

THERAPIST: Can you stop for a moment? Something interesting
happened there. Mary, you started to talk about how painful this
relationship is for you. I saw you trying to reach Jim, to have him
understand. (Mary nods.) Then, Jim, you said, "Well if it's so easy
to say, how come you haven't done it before." Do you remember?
What happened there?
J1M: Well it seems like she can open up if she wants to.
THERAPIST: (Repeats what he has just said, only directed to Mary.)
MARY: He shut me down. (Therapist nods.)
THERAPIST: Can you tell Jim?
MARY: (To Jim.) When I do try and open up you shut me down,
so then I run away.
THERAPIST: Can you say that again? Can you say, "You shut me
down"?
or
THERAPIST: Can we stop for a moment and go back? Sue, you said
you need time by yourself, and then, Dan, you responded. As part
of that response you said "You're so independent. If I really
needed you, I'd be in bad shape." Do you remember?
DAN: Did I say that? Yes ... OK.
MARY: I didn't really hear that. (To Dan.) Did you say that?
THERAPIST: (To Mary.) You did not hear his fear of what would
happen if he really needed you?
MARY: No. Now I hear it.
THERAPIST: Dan, could you say that again to Mary, please?
or
THERAPIST: Stop ... there is your whole relationship, right there.
Linda, you said, "Well, you've always had a problem-you never
could express feelings-or even really feel them." And, Dan, you
responded "Oh yeah, well I guess I don't love you then, do I?"
What do you two hear in this? 111 repeat it again.
CHOREOGRAPHING A NEW PATTERN OF INTERACTION
The therapist uses new emotional experience and new aspects of self to
redefine the relationship in terms of autonomy-dependence and close-
ness- distance. The emotions associated with attachment tend to be those
of sadness, fear, and joy. Emotional responses that tend to create bound-
172 PRACTICE
ary definition are anger and disgust. As the partners expand and expli-
cate their interactional position, the therapist first structures the enact-
ment of such positions in the present and in terms of underlying expe-
rience. Once this is achieved, new desires become apparent and become
the basis of new interactions. Thus, a withdrawn partner begins to
demand respect and to take some overt control in the relationship; from
this new, more secure, position he is able to respond to the therapist's
suggestion that he help his partner with her needs .for contact and
closeness. The withdrawer then becomes engaged in a new task, position,
or role, that of assisting his previously hostile partner to reach him. Such
shifts in interaction create new perceptions of the partner, operationalize
new aspects of self, and evoke a new context. Another example of such a
relational shift is when a client who is involved in coercive strategies to
achieve closeness begins to recognize and enact her underlying fear of
depending on and trusting her partner. The shift in terms of pragmatic
interactions might be from "You keep me out, I'll show you" to "I am
afraid to trust, to let you in."
In a blame-withdraw cycle, two of the most crucial new patterns are
where the withdrawer offers comfort and contact to the blamer and the
blamer softens to a position of vulnerability and asks for what he or she
needs from the withdrawer. For example, having supported the with-
drawer and made a judgment that she is now likely to respond to her
partner, and having accessed the vulnerability of the blamer, the therapist
sees the opportunity for a new kind of contact and so directs the blamer
to ask his partner, from a position of vulnerability, to respond to his
needs. The therapist then helps the withdrawer to respond in a supportive
accepting manner.
The steps in this intervention involve structuring the expression of
new aspects of self, new desires, and needs to the other; tracking the ef-
fect of such expression; guiding the evolution of new interactions; and
setting the stage for the maintenance of new positions by symboliz-
ing clearly how each partner has changed position and has thereby
invited the other to dance in a new way. In the above example, the steps
might involve the therapist directing the blamer to ask for support and
reassurance, tracking and structuring the withdrawer's response, guid-
ing and heightening the new interaction of reaching and responding,
and finally symbolizing this new relationship event and its new possi-
bilities.
Example
HusBAND: Maybe I do need some support, maybe. I'm tired of

always being so strong, so in control.
THERAPIST: So can you ask her, can you look at her and ask her? I'd
like you to.
HusBAND: (Long silence, then to wife.) I'd like you to hold me
sometimes, take care of me, comfort me.
THERAPIST: What's happening for you right now, Cindy?
WIFE: I'm amazed, surprised, I feel confused.
THERAPIST: How do you feel toward John?
WIFE: Like I want to hold him and rock him like a kid.
This kind of interaction represents a shift in position, in that the

blamer has focused on his own needs and now asks for a response rather
than attacking or blaming the other. The withdrawer instead of protect-
ing herself is able to be accessible and responsive. This event appears to
be a crucial one, differentiating couples who make significant gains in
EFT and those who do not change.
SUMMARY
The therapist in EFT acts as a guide to a new experiential synthesis and

as a guide to the integration of that synthesis into a new definition of self
in relation to the other. The therapist is an evoker of new experience, a
partner in the processing of that experience, and a director of new
interaction patterns.
It is assumed that the therapist is monitoring the therapeutic alliance
from moment to moment and assessing the effect of interventions on
both clients. Any rupture in the alliance in which a client feels unfairly
judged or not recognized will undermine progress and must be seen,
addressed, and resolved before therapy continues.
One of the main issues that arises when teaching EFT to therapists is
the question of how to know which emotion to elicit, when, and to gain
what effect. To address this question, the therapist must engage in
constant process diagnosis (Greenberg & Johnson, 1986). Knowledge of
the positions and the configurations of underlying feelings usually asso-
174 PRACTICE
ciated with certain positions, such as deprivation and isolation in blam-

ers, provides a road map. However, every couple is idiosyncratic and
there is a sense in which the therapist sifts through the experience of both
clients looking for the emotional experiences that, if heightened rather
than avoided, could help the couple change positions. If the therapist
views the task as restructuring a bond, then bonding theory, which posits
innate needs such as the need for security and recognition, provides one
guide to the clients' experience. If the therapist views the task as motiva-
ting new affiliative responses, then soft emotions such as compassion
might be used to elicit approach behavior and assertive emotions such as
anger might be used to create boundaries and help define the self as
separate and autonomous from the partner. The guides to which emotion
it is appropriate to elicit are then the clients' immediate responses and the
feeling that the therapist hypothesizes underlie such responses. In
general, the current process of what is happening within and between
partners and the therapist's sense of what is lively and poignant are the
best guides to the choice of focus and intervention.
Good affective intervention is guided not by a theoretical frame-
work, but rather by the sensitive perception of each partner's unique
experience and personal meanings, as they are revealed in the present.
The therapist needs to be open, to hear and to see what the couple is
saying and doing, and to integrate all the verbal and nonverbal cues of
the moment with the current interactional sequences, the context of the
problem, and the therapist's own theoretical and existential understand-
ings. Establishing the uniqueness of what is happening for this couple in
the moment, and their reasons for their feelings, is the best information
for guiding interventions to disrupt their cycle. This is a moment-by-
moment diagnosis of the ongoing process in which the therapist has to
decide when the system is most amenable to a particular intervention or
when a particular experience may be usefully heightened and explored to
facilitate future interactional shifts. These issues are also addressed in the
following chapter.
CHAPTER SEVEN
Clinical Issues
This chapter addresses a variety of issues that anse during therapy,

including issues in the accessing of emotion, the structuring of new
interactions, the training of therapists, the addressing of individual symp-
tomatology, general contraindications for the use of EFT, and the inte-
gration of different approaches in couples therapy.
ISSUES ARISING IN THE PROCESS

OF ACCESSING EMOTION
Certain general issues emerge in the process of accessing emotional

experience, particularly for therapists who are new to EFT. The first
issue involves how to differentiate the level and type of emotional expe-
rience that may be usefully explored in therapy. The distinction between
, !_Ypes of emotion-primary, secondary or reactive, and instrumental-
·•ffas been discussed earlier. The main point is that it is primary emotional
responses that need to be focused on and expanded in therapy in order to
achieve change.
It is possible for clients and therapists to discuss emotion on a
relatively uninvolved and superficial level, perhaps as part of identifying
an interactional cycle. Beginning therapists, who may be uncomfortable
with accessing more intense emotional experience, tend to do only this.
The effect is usually that the couple gain some intellectual insight into
their problems, but they create little change in the positions they take
with one another. Emotional responses must be evoked by the therapist
and experienced by the clients, as vividly and intensely as possible,
otherwise no new aspect of self is realized and changes do not occur. It
may be that the new therapist will use abstract terms or complex interpre-
175
176 PRACTICE
tations that encourage the clients to intellectualize or simply place labels

on experiences. Even if the therapist uses reasonably evocative language
and vivid images, he or she may speak too fast and neglect to use
nonverbals such as voice or posture to support the appropriate use of
words. As in experiential approaches in general, the therapist is in some
sense a resonating board for the experiences of the clients. The therapist
then processes the clients' responses and uses his or her own experience as
a guide to what occurs in the clients' world. The therapist is, as Kempler
(1981) suggests, "being skillfully" rather than simply being skillful. EFT,
like other therapies, works best when it is integrated into the personal
style of the therapist. Therapists therefore have to be relatively comfort-
able and flexible with emotional experience themselves in order to allow
and explore it with others. A therapist for whom such experience is
personally threatening will tend to rescue clients from their feelings and
address only superficial levels of experience, thereby containing rather
than expanding the client's exploration.
The other extreme is to focus on the indiscriminate ventilation of
emotion on the assumption that discharge or expression, in and of itself,
is an agent of change. If the emotion is negative, this process may actually
entrench already negative patterns in the relationship. At the very least,
this kind of intervention simply results in frustrated clients and a stag-
nant therapeutic process. The repetitive expression of secondary reactive
emotions, rather than of primary emotions, is not progress, in the sense
that this is exactly what many distressed couples normally do with each
other; they express their frustrations, complaints, and resentments quite
easily of their own accord. This kind of ventilation approach to emo-
tional expression in therapy is perhaps the reason why many practition-
ers of couples therapy, particularly those from the behavioral school,
have considered emotion as irrelevant to therapeutic change or, at worst,
actually detrimental to such change. The expression of negative emotion
has also been considered a problem rather than a constructive process in
that negative affective expression may create distance and alienate
partners from each other; indeed, if emotional experience is limited to the
ventilation of negative reactive responses, this would seem to be the
logical result.
Another issue, particularly for the new therapist, is that some clients
are less predisposed to allow themselves to experience emotion than
others. Once the therapist has experience with EFT, however, this does
not seem to be a particularly difficult problem. Although some clients do
CLINICAL ISSUES 177
need more help in accessing their experience than others, it is also true
that, for these clients, emotion when it is experienced is a very powerful
and potent agent for change. At first, for these clients, the therapist may
have to empathically interpret underlying feelings, but usually this pro
cess is relevant and rewarding for these clients, and they are soon able to
speak for themselves. Accessing underlying feelings is not then a process
of demanding that someone express emotion; rather, it is the provision of
a safe environment and the type of conditions in which a person is able to
focus on an aspect of experience hitherto avoided or ignored.
Clients' attitudes toward emotion and the expression of emotion
often emerge in this context. For example, the therapist asks how the
husband feels as he hears his wife describe their sexual life as empty,
impersonal, and alienating. The husband replies in a calm, detached
manner that he can understand her point of view and nothing is pedect.
Next, when the therapist repeats key phrases used by the wife and probes
for an emotional response, the husband replies that there is no point, and
also it is not his style, to wallow in feelings. The therapist then elicits a
feeling of hurt by using evocative responding and asks the husband to tell
his wife how hard it is for him to look at her and express his hurt. The
husband's reservations about expressing emotion (and therefore of being
seen as weak and not in control) then emerge. Key cognitions concerning
the experience and expression of emotion are thus addressed and made
immediate and concrete in the process of therapy. After the husband
experiments with expressing his emotions, the therapist also encourages
the wife to express her response, to share the impact his emotional
expression has had on her; for example, that she feels reassured that he
does care about their relationship and does in fact have a response, even
if it is usually inhibited or not attended to. There is thus an educational
component to EFT. The therapist in some cases teaches the client about
the role of emotional experience and expression in relationships, but this
teaching is experiential, rather than didactic.
Inability to express particular feelings and respond to a partner is
dealt with by validating and encouraging clients to deal with their blocks
to expression as they experience them in the moment. For example, the
therapist might explore how difficult it is for a wife to risk being open to
her partner and encourage her to express both her unwillingness and her
difficulty in responding to her spouse. Blocks to expression and respon
siveness thus become integrated into the process of accessing the affect
underlying interactional patterns. Such blocks are dealt with in general
178 PRACTICE
by validation and exploration. This approach then makes it unnecessary

to directly confront issues of compliance and cooperation in the treat-
ment process.
The question of which emotion to focus on does not arise if clients
are fully engaged in the therapy process. The most salient aspect of
experience, when paid attention to, naturally evokes relevant responses.
Asking a client what he is experiencing as his wife lectures and attacks
him verbally, and he looks away and sighs, is often sufficient. If, how-
ever, clients are emotionally inaccessible, therapists can use their own
empathic sense of the clients' relationship positions as a guide to the
clients' present experience, particularly including those emotions that if
expressed would threaten the relationship structure. Useful questions for
beginning therapists to ask, then, are as follows: What would this client
have to experience to maintain this relationship position? What would
this ·client have to experience and express in order to step out of this
position?
The issues that arise concerning the evocation of emotional expe-
rience can then be summed up in the statement that primary emotional
experiences must be evoked, experienced, and integrated into the rela-
tionship to create change in the relationship's structure. Novice therapists
must be taught to evoke rather than discuss emotion, to validate reactive
emotional responses, and then to help the client explore beyond this level
of experience. Once primary emotion is accessed, the therapist must
know how to use this emotion to create relationship change.
ISSUES ARISING IN THE STRUCTURING

OF NEW INTERACTIONS
Even if the emotion expressed by the couple is authentic primary emo-

tion, emerging from a current synthesis of new emotional experience and
explicating each partner's relationship position, it is not enough, in and
of itself, to create change in relationship patterns. The power of the
interpersonal context is such that emotional expression, unless amplified
and used, becomes an insignificant deviation in the overall pattern of
interactions. Thus, new experience in one partner must lead to the
expression of a need to the other and must evoke a new acceptance, a new
response, from the other. If, for example, a therapist has helped a
withdrawn, passive husband access a sense of anger and defiance ('ll will
CLINICAL ISSUES 179
not be controlled") in relation to his partner, the therapist is responsible

for helping that client to differentiate and develop this emotion, until he
can frame it into a request for recognition and respect that is likely to be
accepted by his partner. Such a request redefines the power and distance
aspects of the husband's position in the relationship. The therapist is thus
responsible not only for helping access the emotion but also for helping
the client to own it and frame it in such a way that the other spouse can
listen and respond. Therefore, in this example, the therapist's role is to
help the withdrawn husband communicate new experiences and desires
to his spouse and to facilitate her acceptance of his new response.
Another issue that arises here is one of timing. The therapist must
judge the appropriate time to encourage a new interaction based on the
new emotional experience of the partners. The way this issue usually
presents itself in therapy is that the therapist has to decide, for instance, if
it is appropriate to encourage a pursuer, from a new experience of
vulnerability, to reach for the withdrawer and attempt to evoke a positive
caring response; to encourage a withdrawer to become more accessible
and open to his or her partner; to support a nonassertive partner to
express needs and set boundaries; or to help a dominant partner relin-
quish control and accept direction from the other partner. Both partners
have to be prepared for such interactions, and they should only be
introduced when there is a reasonable possibility that the observing
partner will be able to at least listen sympathetically to the expression of
a new feeling. This sequence, of course, often breaks down, giving the
therapist the opportunity to work directly with responses that maintain
the distressed cycle. It is extremely useful to replay a sequence in which a
new response occurred-for example, an assertive statement by a usually
placating, withdrawing wife-that was acknowledged or discounted or
that even evoked hostile attack. The replaying of this sequence confronts
the responding partner with his or her own behavior, which, in this
example, maintains the wife's passivity and makes it difficult for her to
engage with him and give him what he needs. Thus, partners learn how
each evokes in the other the behavior that causes their distress.
However, if the therapist is not active and allows a series of situa-
tions to occur in which, for instance, a withdrawer approaches, becomes
accessible, and is constantly rebuffed, or a pursuer discloses from a
position of vulnerability and is repeatedly attacked, this undermines the
therapy process. Similarly, a situation in which a deferrer asserts him- or
herself only to have the controller redouble efforts to control, or when a
180 PRACTICE
controller gives up control only to have the placater seek direction, can
convince partners that change in their partners and in their relationship is
impossible. If a partner discloses vulnerability, or an underlying need,
and is attacked by the other, the therapist can often deflect or diffuse
such an attack and focus on the feelings underlying the attack.
There do seem to be specific points in therapy where there is an
opportunity for a new interaction to occur; if these points are missed or
misjudged by the therapist, progress can be substantially impeded. There-
fore, the therapist must be able, if necessary, to protect each partner from
the response of the other. This also relates to the treatment of violent
relationships, in that it is difficult in such relationships for the therapist
to create safety and for the abused partner to feel safe enough to express
vulnerability. In such relationships, it is likely that assertion or vulnera-
bility will not be respected and may even be taken advantage of. Sim-
ilarly, the abusing partner may be terrified of his or her own vulnerability
and any sense that the partner will take advantage of this vulnerability
may lead him or her to attempt to assert dominance. For these reasons,
EFT is not the initial treatment of choice for violent couples.
Related to the issue of timing and the structuring of new interactions
is the necessity to monitor the therapeutic alliance attentively. Couples
therapy entails a constant process of balancing and maintaining a thera-
peutic alliance with both partners simultaneously. This is especially im-
portant in a treatment such as EFT, for reasons discussed previously.
Any potential breach in this alliance has to be attended to immediately
and addressed before the process of therapy can continue. Specifically,
the alliance with both spouses must be positive and secure before the
therapist attempts to structure new interactions. If, for example, the
therapist senses resentment arising from either of the partners toward
the therapeutic process, or toward the therapist, he or she must explore
this experience and do whatever is necessary to re-establish the client's
confidence in him or her and in the process.
ALLIANCE MENDING
How does the EFT therapist repair a damaged alliance when necessary?
Therapists have to ask themselves what action of theirs evoked the
distant, defensive, or hostile behavior the client is exhibiting. Did the
therapist go too fast, assume too much, or not respond to the client's
CLINICAL ISSUES 181
concerns? The vulnerability each client exhibits with the partner may also
be evoked by the therapist, especially when the therapist is challenging
particular blocks or defensive stances that clients use to protect them-
selves. At this point, the alliance is particularly vulnerable to damage,
and the therapist has to pay particular attention to this aspect of the
process. The repair process involves the following steps. ( 1) The therapist
must recognize the breach in the alliance and deliberately focus upon it
rather than upon the intrapsychic experience of the client or the relation-
ship between the spouses. For example, "I get a sense that you feel very
uncomfortable with me right now," or, if the therapist wishes to relate to
the alliance with the other partner, "I have a sense that you feel that I'm
being hard on your partner and you feel protective of him," or, relating to
the relationship, "You're not sure that I'm really seeing your relationship
as it is and approaching it in the right way?" (2) The therapist probes the
client's experience of the breach, for example, "I don't quite understand,
is it that you're angry with me for supporting your husband when he tells
you his concerns?" (3) Validating and legitimizing the client's experience
and relating the therapist's actions to therapeutic goals and concern for
self, other, and the relationship follows. For example, "I can understand
how it might seem unfair to you that I'm giving your spouse so much
support right now, but I think it's important for him to be able to tell you
all his resentments so that you know what they are and the two of you
can begin to deal with them." (4) Finally, the therapist acts to restore the
partnership in terms of bond, goal, and task; as by asking "Do you feel
reassured as to my concern for you and the importance of what we are
exploring right now if we are to help the two of you get closer?" It is
important for the therapist to acknowledge and take responsibility for
any unnecessary pain he or she may have evoked in the client while at the
same time reserving the right to challenge and question: "Perhaps I did
not support you enough; it is very hard to experience this kind of fear. I
think it is important to continue to explore it, but maybe you can tell me
how I can support you more."
A particular issue arises when a couple's presenting pattern reflects
the treatment rationale, that is, the need to experience and express
underlying feelings. A potential imbalance in the alliance formation
process then presents itself. It is important in these instances that the
therapist not ally with the partner who is complaining of the other
partner's inaccessibility. Rather, the therapist needs to validate the with-
drawer's need for self-protection until such a time as this person feels safe
182 PRACTICE
enough to express feelings. This pattern can be especially tricky when the
therapist is female and the emotionally withdrawn client is the man, with
the woman demanding more expressiveness. This is also the most com-
mon pattern presenting in therapy. The fem ale therapist here has to be
especially careful not to be perceived as only the female partner's ally.
Another interesting situation is where one person, often the male partner,
complains that the other is too emotional and attempts to close her down
if she is too expressive. Here, both the fear of emotion and the need for
control must be dealt with, along with the woman's understanding of her
partner's fear and her ability to reassure him that she will not lose control
and overwhelm him. Both of the above relationship patterns are of
particular interest in EFT because of their correspondence and potential
clash with the espoused treatment rationale.
TRAINING ISSUES
Couples therapy is a complex process. The novice therapist is faced with

a multidimensional, multileveled, dynamic phenomenon. At any moment
there are many aspects of this phenomenon that require the therapist's
attention. First, the therapist must establish, monitor, and maintain an
alliance with each partner in the presence of the other. Of course, a
therapist may deliberately choose during the course of therapy to unbal-
ance this alliance for therapeutic effect; however, such unbalancing must
be deliberate and its consequences carefully attended to. Second, the
therapist must attend to, track, and process each client's moment-to-
moment experience and hypothesize as to underlying emotions that may
be crucial in maintaining present positions and may be used later in
restructuring the interaction. Third, the therapist must be aware of the
effect on the other partner of each partner's statements and the therapist's
comments to each partner. Fourth, the therapist must be aware of the
implications of one partner's experience and interactional sequences for.
the structure of the relationship. Fifth, the therapist must be able to see
the relevance of the client's current experience and interactional process
to the present focus or subtasks of therapy, that is, the potential for
change implied in each interaction, and must be able to choose specific
interventions to meet immediate process goals. From all of the above, it
is not difficult to see why the usual first response of the novice therapist
to couples sessions is confusion and information overload.
CLINICAL ISSUES 183
EFT has been effectively taught in the following manner: theoretical

presentation; presentation of a clinical overview, goals, strategies, and
interventions; group observation of videotaped therapy sessions plus
transcript analysis and role-playing concerning specific tasks and issues
in therapy; and intense group and individual supervision of therapy cases
using videotapes of actual therapy sessions.
As with any treatment that involves the integration of two ap-
proaches, EFT is more complex and therefore more difficult to learn
than a pure approach that involves a single perspective. However, the
treatment steps and specific interventions, as outlined, do facilitate the
teaching and learning of this approach. The main pressures that students
new to couples therapy must face when learning to implement EFT are
the following:
1. Students must formulate a systemic perspective of couple's inter-
action patterns. They have to focus on process and learn to see how each
partner's responses are evoked and maintained by the responses of the
other. Some students have difficulty maintaining this perspective, espe-
cially if they have been previously trained to focus on intrapsychic
factors.
2. Students must learn to access emotional experience and particu-
larly to evoke that experience in the present, with the use of appropriate
nonverbal behavior. This especially involves the use of evocative voice
tone and appropriate pacing to slow the process of the session. Such
pacing creates the opportunity for the attentional focus required in the
synthesis of new emotion. The ability to create and to hold a couple to an
emotional focus and to refocus them when they stray comes only with
experience. The trainee therapist needs to learn how to take charge of the
interaction and use directive skills to identify and create an emotional
focus.
3. The nonjudgmental stance of the experiential therapist is a stance
that must be learned and maintained by a self-monitoring process. To see
pathology or to blame the clients for their relationship positions and their
resistance to change is a constant temptation. In particular, the process of
helping the blamer to uncover vulnerability or soften, one of the key
change events in EFT, can result in frustration for the novice therapist,
since the blamer very often does not easily give up this position. This may
then result in a tendency for the therapist to confront one partner
excessively rather than to validate and expand his or her position or
explore blocks to change. The ability to redirect the blamer to underlying
184 PRACTICE
feelings in order to obtain a softening is one of the key distinguishing

features of more experienced therapists.
4. Students often have difficulty initially in learning to combine
interpersonal and intrapsychic interventions. They have to learn to evoke
and use intrapsychic material to create new relationship events and vice
versa. This kind of skill can only be acquired through experience and
through clinical supervision. The good EFT therapist has the ability to
use present experience in order to create a new dialogue between
partners. The therapist needs to focus on that aspect of underlying
experience that will enhance the interaction and open up new possi-
bilities in that interaction. The therapist also has to be able to find
ways to facilitate the kind of expression that is able to be heard by
the other partner. This ability to help partners phrase their experience
in terms of needs, without blame, and in a way that is not threatening to
the other spouse, is an important skill that must be focused on in
training.
5. Some of the basic difficulties students experience in EFT are the
same as in other couples' therapies, such as learning how to balance
alliances and structure a couple's session. The ability to take control of a
couple's interaction pattern and begin to direct that pattern is in itself a
new and demanding task for most students.
Apart from learning general theory, specific steps, strategies, and
interventions, it is also important for students to understand how change
occurs in this model of therapy. When a student is clear as to the specific
in-session client performances that lead to specific interactional shifts or
change events, it is easier to work toward and facilitate such perfor-
mances. As part of their training, then, students are exposed as much
as possible to clinical examples of key change events. Examples of
three such events from the therapy process of three different couples
follows.
EXAMPLES OF CHANGE EVENTS USED IN TRAINING
The first excerpt illustrates the expansion and elucidation of a withdrawn

partner's position, the second the beginning of the process of uncovering
vulnerability in a blaming partner, and the third the creation of a new
interaction arising from these two processes. The excerpts are divided
into intervention points for ease of presentation.
CLINICAL ISSUES 185
Excerpt I: The Expansion of a Withdrawer's Position
I. The therapist brings up the issue of the withdrawing husband's

frustration and anger.
2. The couple discuss the situations in which the anger arises. For
instance, the blaming wife feels harassed and overwhelmed by the house
hold chores and accuses her husband of not contributing.The therapist
then helps the couple explore the stimulus situation and each person's
reaction in that situation. The therapist uses empathic reflection and
evocative responding.
3. The therapist focuses on, and by evocative responding helps, the
withdrawn husband to make the elements of his anger more explicit.The
husband explores how he deals with his anger. He does not express it
since "there is no point because she (his wife) won't listen to me."
4. The wife responds, "I defend my point of view." The therapist
validates each partner's perception of the situation: the wife's desire to
protect her need for help in the house as legitimate and the husband's
desire to be listened to.The therapist also expands this incident, relating
it to their interpersonal positions and the general cycle of blame-pursue,
withdraw-distance in their relationship.
5. The therapist reflects and heightens the withdrawer's interper
sonal message, "I want you to listen to me," and, with evocative respond
ing and interpretation, heightens underlying feelings. The withdrawer
responds by elaborating on his message, as, "I feel judged and criticized
... I am wrong, that's the message ... so I get mad." The therapist
interprets and adds to the client's statement,relating it to themes elabo
rated on in previous sessions.The themes here involve the demand for the
husband to be perfect, as concerned about chores as his wife is, and his
need for some acceptance.The husband is then, after some dialogue with
his wife,able to be directly angry,as in, "I'm not going to be clubbed and
feel like a worm just because you're feeling overwhelmed." For this client,
this is a very strong assertive remark.
6.The blamer now attacks with "You deserve it ... it's your fault
•.. you let me down ...I have to carry the burden of tasks and I have to
say how I feel." The therapist validates the blamer's anger and the feeling
of being overwhelmed and unsupported, focusing on the blamer's feelings
rather than her accusations of her partner.
7. The therapist asks the withdrawer to respond to this, thereby
inhibiting the usual withdrawal.The withdrawer points out that he does
186 PRACTICE
do many chores around the house. The therapist elaborates that it seems
that the husband can never do enough to please his wife. The husband
accepts this and expands his experience and his response to this expe-
rience, which is to become resentful and withdraw, feel helpless, and
passively resist his wife's demands. The blamer interrupts, but the thera-
pist blocks her and instead supports her to listen to her spouse. The
therapist then frames the position of the withdrawer as, "I won't keep
trying to get your approval." The withdrawer accepts this and, as directed
by the therapist, repeats it to his spouse, adding that he feels good saying
this.
8. The therapist asks the blamer to respond to this. The blamer
bursts into tears and says that she also feels like she is always struggling
to get her partner's approval; she adds that this is the reason for her being
"obsessive and hassled" and feeling "I should have everything perfect for
you, so I kill myself trying." The therapist supports and validates this
remark and asks the blamer to check with her spouse if her performance
as a housekeeper is crucial to his love and acceptance.
9. The withdrawer expresses acceptance of his wife as a person and
suggests that she doesn't need to be perfect to merit his love. The
therapist asks him to repeat this.
10. The blamer recognizes that she cannot believe her husband's
statement and feels unacceptable as a person.
In this episode, the withdrawing husband was able to confront and

engage the blaming wife, making his position explicit. The wife then
began to focus on her underlying feelings rather than accusing her
spouse. The couple were given homework, which was to talk about how
they behave or feel they have to behave in order to get each other's
acceptance.
Excerpt 2: The Beginning of the Process of Softening

in a Blaming Partner
1. The therapist validates and expands on the dominant, distancing

partner's angry comments and criticisms of his wife. These criticisms
involve the wife being, in the husband's eyes, unreasonable, a loser who
does not ask for what she wants and then feels sorry for herself and
complains constantly. The therapist uses evocative responding to explore
CLINICAL ISSUES 187
the husband's basic perceptions of his wife's unreasonableness and helps

the client to symbolize the implicit message that he receives from his wife,
which is that he has failed as a provider and as a spouse; the husband's
respo nse to this is that he refuses to become an "indentured slave."
2. The therapist directs and supports the wife to respond to this,
focusing on her need to be listened to and recognized for her contribu-
tions to the relationship and the business partnership that the couple
share.
3. The blamer states that his wife does not want to be listened to-
she simply wants to prove him guilty. He ignores her responses and
repeats the previous remarks. The therapist then focuses on the image of
the "slave" and encourages the client to enact this position, enumerating
all the actions taken to please his wife and to satisfy her demands.
4. With the therapist's help, the husband then begins to access a fear
of being judged as a failure by his wife and a configuration of helpless-
ness, desperation, and panic accompanying this fear. The therapist em-
pathically explores this fear in order to expand the husband's experience
of this emotion and directs him periodically to communicate his newly
accessed experience to his wife in a simple, concrete, and congruent
fashion.
5. The husband begins to do this, but then reverts to a blaming
mode. The therapist validates the husband's vulnerability to his wife's
"judgments" and "demands" and clarifies his angry interpersonal mes-
sage as one of "get off my back." The therapist then refocuses the process
on the husband's fear, using a soft, slow voice to repeat the phrases that
the husband has used previously.
6. The therapist asks the wife to share her responses as she listens to
her husband; she expresses concern and support and some surprise since
she has "never seen this side of him before." The therapist helps the wife
to articulate her surprise and her support to her husband in spite of her
"disorientation."
7. The husband, with the help of the therapist, continues to elaborate
on and symbolize his fear and, conversely, his need for his wife's accep-
tance and approval. He also expresses his terror of her leaving him. At
this point, the previously dominant blamer is now expressing vulnerabil-
ity to his wife. This evokes new responses and perceptions in his spouse
and constitutes a new less dominant relationship position for him.
8. The therapist relates the above process to the process of relation-
ship definition, specifically the closeness- distance cycle. The frame used
188 PRACTICE
is that the husband , angry and fearful , protects himself against his wife
and therefore does not respond to her needs for recognition and close-
ness. Simple action metaphors are powerful here; the therapist interprets
the husband's distance in the relationship, generally and in the session, in
terms of his "walling her off. " The husband accepts this metaphor and
develops it. The therapist uses evocative responding to clarify the stimu-
lus, response, and experience involved in the husband's distancing. The
husband elaborates on his sense of never being able to meet his wife's
demands and his feeling of being "beaten up." The therapist directs him
to state his position to his wife as, "I'm afraid to be vulnerable and let you
close." The husband 's distance is thus framed as fear, and his statement
brings him closer to his wife.
9. The therapist asks the wife to respond; she does so in a positive
and accepting manner.
Excerpt 3: New Interaction Patterns Arising

After a Softening Episode
A usual chronic argument arises concerning the wife's desire to spend

some weekends shopping with friends. Previously, the wife would with-
draw and the husband's behavior would escalate into angry threats and
bullying.
1. The therapist comments on this process and points out that this is
the couple's usual cycle, with the usual result being a lack of resolution
and mutual alienation.
2. The therapist asks the wife to tell her husband how she ftrels when
he threatens her. The wife (previously the submissive withdrawer) indi-
cates that she is tired of threats. The therapist elaborates on this, using
material from previous sessions, and helps the wife to take an explicit
stand, as in "I will not be controlled by threats, they make me angry."
This stance is the combination of many weeks of therapy and is a more
powerful position than the wife has previously taken.
3. The husband becomes silent and tearful. The therapist invites him
to become aware of his inner experience, when he has difficulty going
beyond "scared," the therapist empathically interprets his experience in
terms formulated by the husband himself in previous sessions. This
formulation includes relational issues such as being terrified of losing his
CLINICAL ISSUES 189
wife and desperately needing reassurance as to the bond between them. It

also includes as more self-schema-orientated issues such as feeling inade-
quate, unlovable, and never being "good enough." The husband focuses
particularly on the last issue and expands it, elaborating on his sense of
insecurity.
4. The therapist directs the husband to tell his wife about his emo-
tional experience. The wife comforts him, stating that she can understand
his feelings. Aided by the therapist, who repeats key words and sentences,
the wife states her limits. These limits are that she cannot constantly
reassure him, especially in the face of his "lashing out," which the
therapist frames as "driving her away.•~
5. The therapist asks the husband for his response to what his wife
has said. He replies that he knows he's driving her away by his demands
and threats. The therapist then places the husband's inadequacy in a
relational context. This involves framing it as a difficulty in trust; the
husband has difficulty trusting that the wife loves him (and she of course
cannot prove this to him) and sees himself as needing her much more
than she needs him. The husband concurs with this formulation.
6. The wife responds by stating that her need for separate activities
does not mean that she does not need her spouse; she then elaborates on
her need for his support and love.
7. The therapist evocatively responds and encourages a dialogue
regarding the wife's needs and the husband's ability to fulfill them. The
couple agree that the husband has in the past, and can now, fulfill these
needs.
The value of reading transcripts and seeing videotaped or live exam-

ples of such events cannot be overemphasized. The student then has a
clear sense of the couple's destination, as well as a road map and a set of
directions.
USING EMOTIONALLY FOCUSED THERAPY

TO ADDRESS INDIVIDUAL SYMPTOMATOLOGY
Individual symptoms, such as phobias or depression, which have reper-

cussions in intimate relationships may be viewed as a function of the
individual's position in a relationship and as being maintained by the
interactional patterns of that relationship. Symptoms are viewed then as
190 PRACTICE
being both system maintained and system maintaining. Individual symp-

to ms can function in such a way as to balance power or regulate closeness
and distance in a relationship; thus, they enable the couple to maintain
the bond between them. Without addressing the issue which comes first,
the individual symptom or the interactional pattern in which it is em-
bedded, it is possible to focus on the interpersonal elements of a symptom
and, by so doing, modify other cognitive and affective aspects (Horowitz
& Vitkus, 1986). For example, resolving interpersonal issues and taking a
new and more equal position with one's partner may reduce negative
views of self, especially since the self is constantly being defined in
relation to one's intimate others, and may thus reduce overall levels of
depression and enhance a client's general sense of efficacy.
There has been a general shift toward more interactional models in
the treatment of individual disorders such as depression. This shift has
often involved, however, a change of focus rather than a change of
modality, a focus on interpersonal issues rather than an actual use of
marital therapy. However, couple-oriented interventions, such as EFT,
are being used more and more frequently to address such disorders,
either as an adjunct to individual therapy or as the primary mode of
treatment. A number of EFT sessions may then be used as part of the
treatment of such disorders, or EFT alone may be used to change the
interpersonal context, thus modifying the problematic symptoms.
EFf has been used to address various individual symptoms, includ-
ing sexual problems such as vaginismus, psychosomatic problems such as
chronic pain, and phobias in which relationship distress is also present.
However, the most common individual symptom occurring with rela-
tionship distress is depression. The relationship between these two pre-
senting problems has been well-documented (Haas, Clarkin, & Glick,
1985). In particular, there is evidence that 50% of clients requesting
treatment for depression also evidence distress in their relationships and
that unresolved conflicts are implicated in relapse. lnteractional patterns
are more and more being viewed as an essential part of the depressive
process, whether depression is viewed from a reinforcement, cognitive, or
a more dynamic or systemic viewpoint. On a clinical level, EFf appears
to be effective in modifying depression in one partner. As the rela-
tionship changes to a more open and supportive one, and as the individu-
al's position in relation to the other partner is redefined, depressive
symptoms remit. Research is at present being conducted to verify this
effect.
CLINICAL ISSUES 191
On a clinical level, it makes sense that certain aspects of the process

of EFT would modify depressive symptoms. For example, symptoms can
be modified by validating the depressed partner's affective responses so
that these responses may be owned and addressed in the relationship.
This allows the person to be more active in attempting to meet his or her
interpersonal needs. Creating a context in which couples can be generally
more accepting and responsive to each other also affects such symptoms.
In general, the creation of a more secure interpersonal bond in which
each individual is defined in such a way as to enhance a sense of self-
esteem and self-efficacy is a powerful antidote to the sense of loss,
emotional disconnectedness, and/ or failure and inadequacy that often
underlies depressive symptoms. EFT attempts to deal with intrapsychic
and interpersonal factors along with the negative interactional cycles that
maintain one partner in the depressive position.
In the area of phobic disorders, it appears that relationship factors
are particularly involved in the generation and maintenance of agorapho-
bia. Chambless and Goldstein (1981) have suggested two categories of
agoraphobia, simple and complex, the latter being more prevalent. Sim-
ple phobias are predicated by specific traumatic events. Complex phobias
are associated with relationship conflict, a dependent personality style,
and a wide range of symptoms. Often, complex phobias do not yield to
behavior therapy or, if they do, they recur as a function of interpersonal
conflict.
Couples therapy is relevant for dealing with both relationship-
related phobias and the impact that most simple phobias have on the
relationship. Agoraphobia, which occurs predominantly in women,
seems highly related to sex role issues. The agoraphobic woman becomes
more and more dependent and is unable to achieve or to be confident
outside the home. The husbands of agoraphobic women, in many in-
stances, initially welcome their wives' dependence, although they eventu-
ally become resentful of the restrictions placed on them by their wives'
phobias. The wife's incompetence often serves to support the husband as
the competent one in the relationship, and her phobia deemphasizes any
differences or conflicts that occur between them. In this context, it would
appear that it is difficult to treat agoraphobia successfully without some
attempt to modify the couple's relationship.
Even in cases where the quality of the relationship is in some sense
peripheral to symptom maintenance, the modification of the relationship
can improve the individual client's ability to deal effectively with chronic
192 PRACTICE
symptom patterns. An example of a client with numerous, chronic,

debilitating phobias who came into EFT for a marital problem is briefly
summarized below.
A couple, both in their early 50s presented with the problem of
marital dissatisfaction arising directly out of the husband 's numerous
phobias, which limited his range of activities and thus the quality of his
marital life. The many sessions of individual therapy that he had engaged
in to modify these phobias had also affected the couple's financial sol-
vency. This client refused to drive up or down hills, over bridges, or on
freeways, to ride in elevators, or to park in underground parking lots.
These behaviors evoked frustration and anger in his wife, who would
then berate him for his weakness and incompetence while overfunction-
ing for him. In brief, as therapy progressed with these clients, it became
clear that the husband's withdrawal in his interactions with his wife and
the general position he adopted with her, which was one of passive
dependence, was related to the occurrence of his phobias and his very low
level of self-esteem. He was gradually able to express his sense of intimi-
dation in the relationship with his wife, and his underlying anger, when
accessed, enabled him to demand some respect and equal consideration
from her. When his wife was able to express and accept her need to
depend on her spouse, rather than constantly exhorting him to be strong
and to try to be more competent, the husband began to support her and
take a more active role in the relationship. He was also able to ask for her
acceptance of his fears; furthermore, he clarified for his spouse how her
anxiety and resulting criticism toward him actually exacerbated his diffi-
culty in dealing with his problems. Specifically, he was able to tell his wife
that it was her anxious vigilance, lack of confidence, and attempts to tell
him how to drive that prevented him driving uphill, not his fear per se.
He then suggested.how she could be more helpful to him so that he could
deal with his fears effectively. The husband's image of himself also
appeared to improve as his wife's need for his support became apparent.
The change in relationship definition did not remove this client's phobias;
however, it did appear to have an impact on his evaluation of himself as a
competent person who could offer something to others, thereby improv-
ing his ability to cope with his problems effectively. The marital relation-
ship became a source of support for him rather than an additional
problem in his life. In this type of case, whether a symptom is an
expression of predominantly individual problems or an issue of relation-
ship definition may be unimportant. More important is that interven-
CLINICAL ISSUES 193
tions focusing on the positions that people assume in their key relation-
ships may create a powerful arena for change, in the direction of in-
creased adaptation and coping ability.
Is couples therapy, EFT or any other, sufficient to create individual
change in and of itself? It has been suggested that of the three levels of
intervention, family, couple, and individual, the couple level has the most
potential to create change across the other two levels (Lewis, Beavers,
Gossett, & Philipps, 1976). It is also true that all therapeutic interven-
tions in some sense deal with how people see themselves in relation to
others and how they interact with others; couples therapy deals with a
relationship with a specific other-one that is central to the client's life.
This relationship is also present in therapy and dynamically occurring in
the session rather than being a topic of conversation and discussion. The
question of whether changing a client's position in relation to his or her
most significant other is sufficient on its own to change aspects of
individual personality, behavior, and emotional response outside the
immediate context of this close relationship is an interesting one.
According to our view of a constantly forming self in context, it
seems highly probable that couples therapy will lead to individual change
that can be generalized beyond the couple. This change, however, will
depend on other factors embedded in the other contexts in which the self
is involved. Thus, whether becoming more understanding or assertive in
marriage will lead to the same behavior at work depends not only on
changes in self, but also on factors in the work context that determine
behavior. Empirical investigation of the impact of couples therapy on
individual change is awaited to provide more definitive answers to this
question.
CONTRAINDICATIONS FOR EMOTIONALLY

FOCUSED THERAPY
Since EFT is based on the conceptualization of the relationship as an

intimate emotional bond, and the process of therapy is one that enhances
accessibility and intimacy, the implementation of the nine steps of EFf is
not appropriate for couples who are clearly engaged in the process of
dissolving their relationship. It is not always clear in the beginning of
therapy that the process is one of dissolution; the picture presented at the
beginning of therapy may be one of differing or ambiguous agendas for
194 PRACTICE
the therapy process. One partner may still appear willing to engage in
therapy and in the relationship, while the other may hold back yet still be
unwilling to state his or her intention of leaving. The therapist in this case
gives direct feedback as to how he or she sees the state of the relationship
and each partner's agenda for therapy. As the first three steps of EFT are
engaged upon, the therapist notes each partner's responses. Step 4 of
therapy in such a case becomes a framing of these responses or lack of
responses in terms of the partner's apparently differing agendas for
therapy and for the relationship. The therapeutic task is then to make one
partner's disengagement from the relationship explicit, to help the couple
clarify the choices open to them, and to support both partners in their
grief and disorientation.
EFT is not recommended as an initial treatment intervention in
relationships in which arguments have escalated to the point of violence.
First, the resistance to experiencing and expressing underlying feelings
may be too great in the abusive as well as in the victimized partner.
Second, the expression of such feelings may be inappropriate, in that it
may add to an already volatile and escalating cycle. In our experience,
the most effective treatment for this presenting problem is one in which
the abusive partner takes part in an individual or group treatment orien-
tated toward ensuring that he or she learns to control his or her anger and
aggression. Controlling the violence then becomes the overriding treat-
ment priority since without this, any other therapeutic intervention will
end in failure. This initial treatment process may, however, be followed
by educationally orientated couples sessions in which both partners learn
to control escalating interactions in their relationship. At a later stage,
EFT may be appropriate, but it seems preferable both ethically and
clinically that violence is viewed and treated as an individual rather than
a relationship issue. This is especially necessary in light of the fact that
most abusive partners tend to deny responsibility and blame the other
partner for their violent behavior. Related issues such as intense jealousy
can be dealt with within the framework of EFT or using EFT-oriented
interventions. The insecurity underlying the jealous response and the
accompanying coercive attempts to contain and control the spouse seem
to be amenable to the EFT approach.
Unless the problem is a specific physiological dysfunction, sexual
interactions usually reflect the rules and the structure of the relationship
in general and so are amenable to EFT interventions. Once partners
experience the relationship differently, and respond to each other differ-
CLINICAL ISSUES 195
ently on an emotional level, then sexual issues tend to resolve themselves.

Strong negative emotions, particularly fear and anger, seem to be incom-
patible with the positive experience of sexuality, and this framework can
be used with clients to legitimize any lack of sexual response that appears
to be problematic. When both clients feel safe and accepted in their
relationship and can communicate openly, then the maximum conditions
for the development of a satisfying sexual relationship exist.
Extreme individual symptoms such as suicide attempts or psychosis
are contraindications for EFT. Expressions of underlying vulnerability
may not be positive for the experiencer in these cases. Couples exhibiting
these symptom patterns may respond to a more strategic approach to
therapy. We have also encountered interactional cycles in multiproblem
couples that are so rigid and automatic that, although it is possible to
obtain a shift in positions during the session, this change becomes eroded
in the week between sessions. These couples never seem to initiate a
positive cycle. The change process does not seem to "take." In these
couples, it may be that success in couples therapy is to recognize that they
can separate or that individual therapy is necessary. If both can agree to
this kind of change, then EFT can be said to have had a clarifying effect
in facilitating this decision.
The couples who respond best to EFT typically present with prob-
lems of recurrent fights, alienation, and lack of intimacy. There is still a
minimum amount of basic trust and investment in the relationship, even
if such trust has been eroded by painful interactions. The couples often
phrase their issues in terms of a communication problem or in terms of
one partner desiring more close contact than the other. These couples still
have some sense of commitment to the relationship in spite of high levels
of distress, doubt, and frustration.
INTEGRATION IN COUPLES THERAPY
Couples therapy involves simultaneously changing partners and how they

relate. As a result, couples therapists have generally tended toward flexibil-
ity and eclecticism rather than purity in their strategies to order to meet this
challenge. There has recently been a movement to deliberately foster the
integration of different treatment models. The advantages of such integra-
tion have been discussed at length (Goldfried & Newman, 1986; Gurman,
1981). By integrating different approaches, the therapist can arrive at a
196 PRACTICE
more comprehensive and effective treatment package that melds the

strengths of various approaches. Such an integration can render treatment
more flexible and responsive to the individual differences in clients and to
variations in presenting problems. The question of when and how it is best
to integrate different approaches is, however, a complex one.
There appear to be four basic approaches to integration (Johnson &
Greenberg, 1987): (1) technical eclecticism; (2) the amalgamation of new
strategies from a different model into one particular approach; (3) the
creation of a new synthesis of two or more approaches into a theoretical
and clinical unity; and (4) the use of specific change strategies at different
times for different types of problems.
The first approach has often involved the listing of therapeutic
operations, such as contingency contracting, and the incorporation of
such operations at specific points in the therapy process. Sager's work
( 1981) is an example of this eclectic strategy. One of the problems with
such an approach is that it is difficult to stipulate exactly which interven-
tion should be applied at which specific point. Another difficulty is that
integration ideally requires the merging of elements into a new dynamic
whole; yet if the assessment and understanding of the couple's difficulties
is essentially from only one framework, the incorporation of specific
interventions from different and often opposing frameworks would con-
stitute an expansion rather than integration. In such a treatment pack-
age, the different change processes and views of exactly what needs to be
changed may become confused and may result in "a gigantic mish-mash
of theories, methods and outcomes that is forever beyond the capacity of
scientific research to resolve" (Eysenck & Beech, 1971, p. 602). This type
of technical eclecticism is focused at the level of therapist intervention,
but the genesis of the problem, the goals of therapy, and the process of
change are still seen from the point of view of a single approach and will
still reflect the limitations of this approach.
It is possible to consider the interventions used in EFT in this
manner. For example, some of the interventions for accessing affect
might be used at various points in other approaches. A family-of-origin
approach to couples therapy could, perhaps, in order to link past and
present and make insights more immediate, implement some of the same
experiential techniques. The issue, however, is how these elements fit
within the overall context of therapy. The use of such interventions in a
behavioral approach would seem to be problematic since the goals of
therapy, views of human functioning, paradigms of intimacy, and factors
CLINICAL ISSUES 197
such as the nature of the alliance are very different. It is not just therapist
operations but how they are implemented and the overall context that
define the nature of treatment.
The second approach to integration is to amalgamate two or more
strategies under the umbrella of one theoretical approach. Strategies or
theoretical concepts taken from other approaches are then interpreted as
consonant with the original model of dysfunction. Feldman (1979), for
example, attempts to amalgamate analytic, social learning, and systems
perspectives using the concept of conflict as a homeostatic device used by
the couple to regulate intimacy levels. This model considers the interaction
between partners, but the overriding framework is analytic with oedipal
fears playing a preeminent role. The change processes involved are also
analytic, including the use of insight, the examination of transference
connections, and the analysis of dreams. The result is a version of analytic
couples therapy expanded on a theoretical level to include such concepts as
reinforcement and reciprocal interaction patterns. Such an expansion may
be useful in and of itself, but as a model of integration it is limited.
It may be possible, using this model, to incorporate some of the
experiential strategies used in EFT, for example, into a purely systemic
model, viewing the individual as a subsystem. However, these interven
tions would then be used in systemic ways for systemic ends.
The third approach to integration is to merge two or more ap
proaches to couples therapy into a new synthesis that includes both the
intrapsychic and interpersonal and melds therapeutic strategies and inter
ventions from these different approaches. There are a number of chal
lenges involved in such a task. First, there has to be some kind of basic
compatibility, inherent or constructed, between the way the two ap
proaches view the phenomena of intimate relationships, the phenomena
of marital distress, and the process of change.
In such an approach it is possible to assess multiple levels of interac
tion and domains of experience. Ideally, the interaction of different
strategies and interventions should be made specific on all levels-the
levels of theory, strategy, and intervention. It is necessary that theorists
be able to specify which particular interventions occur when and how
they fit within the overall framework of the new therapy, which consti
tutes a synthesis of the two original perspectives.
EFT is an example of the above approach. Gurman (1981) and
Segraves ( 1982) have also used similar methods. EFT as a synthesis of
experiential and systemic approaches has been discussed in Chapter 2.
198 PRACTICE
The fourth approach to integration is a form of technical integration

that involves administering appropriate change strategies at appropri~te
times for particular types of problems. This involves the definition of
different therapeutic tasks or stages, such as the creation of intimacy or
the modification of a rigid power imbalance. Each task or stage has its
own goals, strategies, and change processes designed specifically to ad-
dress the particular types of problems or processes presented in therapy
(Greenberg & Johnson, 1986; Rice & Greenberg, 1984). In this approach,
intervention is based on the process diagnosis of opportunities for dif-
ferent types of interventions. Therapy is then a complex transactional
process between client and therapist in which different opportunities for
intervention are presented by different types of client performance pat-
terns. The therapist is constantly making process diagnoses of what
occurs in therapy and of when it is best to utilize a particular interven-
tion. Thus, the therapist "digs where the ground is soft" and "strikes
when the iron is hot." The work of Pinsof ( 1983) is an example of this
approach. The focus in this work is on the total patient system, including
individual, couple, and family aspects of the problem. The presenting
problem is viewed in terms of a set of possible determinants and a set of
different interventions for different determinants. For example, if a prob-
lem determinant is fear, the task is the identification and working
through of catastrophic expectations. The therapist may address differ-
ent aspects of a problem in different ways; for example, he or she may
teach partners conflict resolution skills so they can cooperate concerning
their problematic child, then change to a trust-inducing strategy if this
issue is found to be impeding cooperation. The therapist begins with the
simplest and most direct interventions, assuming client health and prob-
lem simplicity until such assumptions are challenged.
In this approach, EFT strategies and interventions might be used at
particular points in therapy to achieve particular goals. For example, as
suggested earlier, after a client has received treatment for violent behav-
ior, there may come a time when couples therapy to increase intimacy is
particularly appropriate. One of the problems here is that, in the field of
couples therapy, particular approaches have not defined their strengths
and limitations as to the problems and types of couples who are likely to
respond to a particular treatment.
A brief clinical example of technical integration is appropriate here.
A couple presented for therapy with a history of marital violence and
constant arguments. In therapy sessions, there was little evidence of trust
CLINICAL ISSUES 199
or willingness to listen; both partners would constantly attack the other

partner. Initial interventions consisted of teaching anger-control skills to
both partners, particularly the abuser, and structuring interactions to
create de-escalation. The therapy process then progressed to include
emotionally focused interventions that allowed both spouses to access
new aspects of themselves in the relationship and build a new level of
trust and openness. The husband, however, became increasingly reluc-
tant to remain accessible to his spouse and to respond to her requests for
closeness. At this point, the therapist engaged in a number of individual
sessions focusing on this partner's perceptions of close relationships and
the dangers inherent in them, which he had learned in his family of
origin. Having resolved the blocks and anxieties this client was expe-
riencing, couple therapy continued with the goals of creating intimacy
and integrating new positive interactional patterns into the relationship
on a permanent basis.
This kind of integration also assumes that the therapist has mastered
a wide variety of techniques that can be applied as different tasks arise in
therapy. To facilitate this kind of integration, research is needed that
addresses the differential processes and outcomes arising from the imple-
mentation of specific techniques applied to specific therapeutic tasks. The
most sound basis for attempts at integration would seem to be a knowl-
edge of client change processes and which interventions facilitate such
processes. This topic is addressed in the next chapter.
PART THREE
Effecting Change
CHAPTER EIGHT
The Process of Change
In this chapter, research on the process of change in EFT is reviewed to

illuminate how EFT leads to change and to point toward possible mini-
theories of change. Ultimately, unless we know what processes lead to
what outcome, we remain in the position of administering our treatments
without knowing how they really work. This is more akin to the adminis-
tration of home remedies than the administration of professional treat-
ment. Thus, explaining how change takes place in psychotherapy by
relating process to outcome is a crucial goal of psychotherapy research-
a goal that will lead to the construction of therapeutic microtheory
(Greenberg, 1986; Greenberg & Pinsof, 1986). Two main types of investi-
gation must be undertaken to establish processes of change. Intensive
analysis of in-session change leads to the discovery of change processes,
whereas designs relating process to outcome help to test hypotheses that
certain processes and outcomes are linked. Both types of studies have
been carried out on EFT.
The primary hypothesis about the process of change in EFT is that
accessing underlying emotion leads to change in partners' perceptions of
self and each other, leading to change in the interaction. In order to
collect evidence to test this hypothesis, and to discover what other change
processes operate in this therapy, a number of studies were conducted to
isolate active ingredients of change in EFT.
WHAT ARE THE CHANGE PROCESSES?
Couples Reports
The first study of the process of change investigated client's percep-

tions of change processes in EFf (Greenberg, James, & Conry, 1988;
203
204 EFFECTING CHANGE
James, 1985). Twenty-one couples who had received EFT were inter-
viewed 4 months after therapy and asked to describe incidents in therapy
that stood out for them as helpful or not helpful. They were asked to
describe what changes took place in these incidents and how these
changes occurred . Using categorization methodology (Wiley, 1967), 37
graduate students in counseling psychology sorted the 52 incident de-
scriptions provided by the clients into categories according to their
perceptions of similarities and dissimilarities among the items. The sor-
ters' ratings were then computer analyzed using Latent Partition Analysis
(Wiley, 1967) to reveal underlying or latent categories. This analysis
yielded five latent categories. These categories were then descriptively
named by the investigators. Next, the category labels were given to two
new raters who were trained in the EFT model; they were asked to sort
the incidents under the appropriate headings. They were found to do this
reliably, and their ratings agreed to an acceptable level with the primary
categorization. The five change process categories were as follows:
1. Expression of the new feeling leads to change in interpersonal

perception.
2. Awareness of feelings and needs leads to greater sense of entitle-
ment.
3. Acquiring self or interactional understanding leads to change in
interaction.
4. Taking responsibility for own feelings results in taking a self-
oriented focus.
5. Receiving validation from therapist leads to change in behavior
of both partners.
The first category has not been discussed previously in the couple
therapy literature and constitutes, in our view, the most interesting
discovery in this study. It appears from client reports that the expression,
in a vivid manner, of primary feelings not previously expressed, created
perceptual change that in turn led to interactional change.
This change process, set in motion by expressing primary feelings,
seemed then to have two components. The first component is a shift in
interpersonal perception. It appears that when partner A observes the
expression of new feelings by partner B, or when partner B expresses his or
her own previously unacknowledged feelings (the former pattern was re-
ported more frequently than the latter), the result is a new perception of
THE PROCESS OF CHANGE 205
partner A. This suggests that the importance of expressing new feelings in

couples therapy may lie in changing the partners' perceptions of each other,
rather than changing the individual's view of him- or herself. In other
words, the communicative and interpersonal aspects of expressing new
feelings are possibly more important than the intrapsychic aspect.
The second component of this change process is that the expression
of new feelings leads to change in the interaction. Partners who had
observed each other express new feelings or who expressed new feelings
reported more understanding and accepting of each other, feeling closer
to each other, and behaving differently toward each other. In other
words, expressing new feelings seems to elicit new, more supportive
interactions in the relationship.
This finding suggests that the expression of new feelings may be
important in the process of change in EFT, and that its primary impor-
tance may lie in changing how partners perceive and respond to each
other. The expression of emotion, particularly at the nonverbal level,
appears to be a primary channel of communication in human beings;
from infancy, it is a powerful means of evoking prosocial or altruistic
responses in attachment figures. The expression of emotion in couples
therapy appears to have a similar potency. It must be stressed, however,
that the effects of the expression of new feelings on interpersonal percep-
tions and couples interactions discovered in this study are the authors'
interpretation of processes described by couples as leading to change. As
such, they remain hypotheses requiring further testing using appropriate
methods of verification. ·
The other four client-perceived change processes identified in this
study are similar to change processes described in the couples therapy
literature and support certain views about change processes in intrapsy-
chic approaches to couples therapy. It appears that the experience of
expressing feeling leads to the positive valuing of the expression of feeling
by the person doing the expressing (most frequently stated by men in this
sample), and that the expression of needs increases the motivation of
both members to meet these needs, while also increasing self-disclosure
and feelings of intimacy. If couples' problems often stem from their
inability to express feelings and needs in the relationship, the sense of
entitlement and positive valuing of the expression of feelings is an impor-
tant change process.
Intellectual and emotional understanding of relationship dynamics,
plus self and partner dynamics, appear, in this sample, to lead to new
responses in the relationship. In addition, when partners came to a new

awareness of personal responsibility for their experiences in the relation-
ship, this resulted in making a shift from attributing blame to taking a
self-focus. This supports the ideas in the couples therapy literature that
suggest that the attainment of a self-focus is essential to successful change
(Bowen, 1978).
Finally, a small number of incidents were reported in which the
therapist's validation of some aspect of the partner's experience led to
change. The partners who felt validated by the therapist changed their
self-views, while the partners observing their partners being validated
changed their behavior toward that partner. This change process sup-
ports the notion that partners lack a sense of entitlement to their own
positions and that the therapist's support of each partner's experience can
be helpful.
The study of client-reported change processes in EFT suggests that
the experience and expression of new feelings, appropriately managed in
a therapeutic environment, can be helpful in couples therapy. In addi-
tion, it appears that emotional expression may be significant in leading to
change in partner's perceptions of each other (rather than change in self
perceptions) and thereby to change in interactions between partners.
Examples of client statements made to interviewers at the follow-up
period are provided below to give the flavor of incidents in the five
categories. The reports of each member of two couples is given, fallowed
by a variety of individuals' statements.
Couple 1
THE MALE PARTNER
GEORGE: I was telling Aretha how I felt about her, and how I felt
about one point when we broke up. I was trying to tell her about how I
felt when she had left me and how I didn't feel that I could go on. And I
got really emotional and very very hurt. And I just about started crying.
And, I didn't ... I just sort of hung on. I literally hung on ... physically
even hung on to the chair. And I remember talking about how I didn't
feel that I could exist without her at that time, and how hurt I felt. But,
the difference was I didn't say it in a blameful way. Usually, I would have
blamed her for hurting me, for leaving me at that time. In other words,
that it was her fault for her doing that to another person, namely me. But
this time I was just hurt and was expressing that, expressing that I really
wanted her. I couldn't say love her, or anything like that. I talked a lot
about just how I felt about the incident. And it seemed to make a
difference with her ... how she felt about me. And also I realized how
hard it was for me to say something like that, how much easier it was for
me to be angry at her for not giving me what I wanted in our relationship.
And it made an impression on me because I realized how hard it was for
me to say something like that and how easy it was for me to blame. And it
seemed to make an impression on her .. . that I didn't blame her as such.
She didn't usually ... she would just be defensive about it. And, just
opening up made a difference to me.
This incident fell into Category 1.
THE FEMALE PARTNER
ARETHA: I can't describe the exact circumstances. It was a session

where . .. I think for the last couple of sessions George had been doing
most of the talking with the counsellor. And George was talking about
how he felt, basically that he feels like taking on other people's problems
and likes to help them, and at the same time being oppressed by that.
And I guess it was the way it was described, basically as a weight over his
head all the time. And I guess it was the vividness of that description. I
can just see this huge concrete block hanging over his head by a thread.
And my reaction was, why don't you move out from under it so it doesn't
fall on you? Like, he was really wrapped up in it. I guess it was really
understanding how he felt, and understanding where a lot of the blame
came from. And a lot of things clicked for me then, I think, in terms of
George's perception, problems. And, that was really helpful.
INTERVIEWER: So, you were in this session and George began to speak
about this ...
ARETHA: Well, he was trying to describe his inability to divorce
himself from other people's problems, and the burden he felt it was. And,
at the same time, unable to give it up.
INTER VIEWER: And you pictured this image ...
ARETHA: I don't know whether it was me or the therapist who
brought in that image. It took a lot of weight off me knowing that George
had taken it on himself rather than the fact that I was inflicting my
problems on him. It was really important for me to know that. It made

me feel a lot easier and more compassionate toward him. Whereas
before, all my problems were just one more pain in his neck. So, it was
j ust important to see my position in things more clearly.
Couple 2
THE MALE PARTNER
SIMON: Well, one time Muriel cried. I can't remember what she cried
about, but, it did me good to see her cry.
INTERVIEWER: So, you were there with Muriel and the counsellor, and
Muriel began to cry.
SIMON: Yes, I think this was when she found out that the doctor, that
she couldn't have kids. I told her that I didn't really care whether we did
or not .. . that I wouldn't put her through the strain anymore. She was
very emotional that night because of all of this. That's the incident that I
remember. It meant a lot to see her cry.
INTERVIEWER: Her crying that night had a real impact on you.
SIMON: It did because normally she wouldn't do that in front of
anybody. For her to do that meant an awful lot. I know my wife very
well, and for her to do that is something. It moves me. Now, if I were to
cry, it would be the same. But, for a man it's different. I see it's different,
but we all have to cry sometime.
This incident fell into Category I.
THE FEMALE PARTNER
MURIEL: It had been quite an emotional session anyway, and I had a

lot of insecurities because of a particular problem that we had, okay. So,
no matter how often Simon said it was okay, you're pretty or whatever, it
just wasn't quite enough for me because he was just trying to appease me
a lot of times, so I thought. So, we'd had a rather emotional session, and
I'm kind of emotional anyway, and I think it was at that point that I was
talking about not being able to ask for affection, and was saying that it
was kind of Victorian, to me that's the way I am, the way I was brought
up. And, I don't know how we got around to my physical appearance ...
he's always thoug ht of me as overweight and that really bothered me
because I had two older brothers who always called me fatty. So, we'd
been talking about my physical appearance and how I wasn't that attrac
tive and I was ready to cry, and my husband turned to me and said, "You
are beautiful; I love you the way you are." And, I burst into tears, which I
thought was really stupid because it was a dumb thing. But it's just that
he said that in front of somebody else which kind of said to me that he
really believed that. It just hit me, that maybe he really means this rather
than saying, "It's okay, you're really attractive ... it's all right, let's
forget all this garbage." But, when he said this in front of somebody else
and he looked at me and was really emotional and very sincere about it, it
was really obvious. I just couldn't believe it. I think that really made me
feel awfully good. So, it was a good thing in counseling. Maybe I believe
him more now when he says things like that ... that he's not just saying
things to make me happy, although that's a nice thing to do. But, I just
needed a bit more, I guess.
This incident fell into Category I.
Couple 3
THE MALE PARTNER
EARL: I think it was one of the first sessions. And, basically, we were
discussing a problem that we were having with my temperament, and the
handling of it. And, Penny expressed a fear for her well-being in that when
I became upset or mad I became very aggressive type of thing. Not
necessarily physically. And, as a result of that she would withdraw and that
would just complicate the problem because then I would get more frus
trated and get the impression that she didn't care and didn't want to talk
about it. And when that was brought out, and she expressed this fear, it
kind of made me feel . . . well, initially I felt like I was some kind of woman
beater. And, I found that to be very dramatic in that I had never considered
myself to be a woman b eater in that I'm not physically aggressive. How
ever, with Penny's fears for her well-being, I found that very dramatic.
INTERVIEWER: So, you were in the room, and Penny was talking
about how afraid she gets when you•re mad. And, this was quite a
revelation to you. She was expressing this fear, and what else do you
remember that happened in this incident?
EARL : Well, basically, I guess, I broke down a bit. You know with
tears and that sort of thing. That's it.
INTERVIEWER: What were you feeling or experiencing as you were
crying?
EARL: I guess confusion in that I didn't consider myself to be a
woman beater. Sorry. And, I guess I don't think that I ever showed it . . .
that I would physically hurt her. It was just that I would lose control of
my temper to the point where she didn't know what was going to happen
sort of thing.
Couple 4
THE FEMALE PARTNER
HoLLY: The most powerful thing for me for my own experience was
the one which I just talked to you about where I got very upset and just
felt, this is hopeless. You know, we 're going nowhere, it's been a very
painful sort of relationship, David doesn't hear me, and he's not going to
hear me. I just felt totally down and angry ... like a real mixture . . . real
sadness and at the same time anger, because I thought that I had given a
lot and invested a lot of time and, you know, where we are. And that he
wasn't being open with me, he wasn't communicating with me, he wasn't
listening to me when I communicated with him. Just, I don't want any
part of the relationship, and I want to go. Now!
INTERVIEWER: So, you were in the room and you were experiencing a
mixture of despair about your relationship, and also some anger. And
then what happened?
HoLLY: I erupted with it. I'm usually quite a calm person. I don't
have that much anger. So, this was a really quite different experience
for me.
INTERVIEWER: You expressed your anger?
HOLLY: I was feeling crying inside. Whether I had tears or not I don't
know. I haven't seen the tape, so I can only tell you about what was in
here. But, I'm sure that my facial expression must have shown it, the
voice, loudness probably, tone, hands probably . . . there would be a lot
of showing of that. And, David listened to it ... it must have been a very
shocking experience because it was totally different from anything that
he had seen from me before. And, like I say, a very rare occurrence for
me. Very powerful. So, then, he listened to me out, and by listening
acknowledged that he could see how powerful this whole thing was
for me.
INTERVIEWER: What sort of things were you saying in this incident?
HoLLY: Just the type of thing I've told you ... that I didn't feel he
was listening to me and being honest with me. You know, I didn't feel
there was any hope for the situation. And, then the therapist elicited from
David how David felt when he heard these things: could he really hear
what I was saying and my concern? And, that was good. David was very
upset. I believe David was crying at some point during that time at the
fact that I just wanted to break it off. And that didn't reach me the way it
normally would reach because I still had all this anger at this point. But it
did help diffuse it somewhat by taking the emphasis off me for a moment.
And, then, at the end, I can't remember what the homework, the project
was. But, something that he asked David to concentrate on his time, I felt
was good whatever it was. I felt that it was an acknowledgment that
finally I was being heard. And, that was very important that there would
be some expectation of David. Not that I was going to have to carry the
whole thing, do everything. So, that was really good. That gave me
something that I thought was positive, some goal to go toward. So, I
really felt that he had heard me, and that he was then able to communi-
cate with David. David was always able to hear the therapist more than
he could me because there wasn't the emotional sea between them. So, he
was like a translator.
This fell into Category I.
Couple 5
THE MALE PARTNER
BRIAN: I was telling Audrey how I felt about her, and · how I felt
about a point where we broke up I was telling her how I felt when she had
left me and how I didn't feel that I could go on. And, / got really
emotional and very very hurt. And, I just about started crying. And, I
didn't- I just sort of hung on. I literally hung on- physically even hung
on to the chair. And, I remember talking about how I didn't feel that I
could exist without her at that time, and how hurt I felt. But, the
difference was I didn't say it in a blameful way. Usually, I would have
blamed her for hurting me, for leaving me at that time. In other words,
that it was her fault for her doing that to another person, namely me. But
this time I was just hurt and was expressing that, expressing that I really
wanted her. I couldn't say love her, or anything like that. I talked a lot
about just how I felt about the incident. And, it seemed to make a
difference with her-how she felt about me. And, also I realized how
hard it was for me to say something like that, how much easier it was for
me to be angry at her for not giving me what I wanted in our relationship.
And, it made an impression on me because / realized how hard it was for
me to say something like that and how easy it was/or me to blame. And it
seemed to make an impression on her-that I didn't blame her as such.
She didn't usually-she would just be defensive about it. And, just
opening up made a difference to me.
INTERVIEWER: How was this incident helpful?
BRIAN: It made me almost pick on her less. I didn't have to go after
her to get what I wanted, for us to be loving to one another, which is what
most people want in a relationship-what I want. I could express some-
thing to her without driving her away. A lot of times if I expressed anger
or blame or anything like that, she just-she was just sort of driven away
from me. She gets cold, and she feels blamed and so on. So, I can say
something toward her. And, she didn't react. And, I didn't get the
opposite reaction I wanted to. Instead of driving her away, and her
withdrawing to save her own emotional state, she didn 't. She stayed
where she was. She didn't sort of stonewall and ignore it or get angry or
something-or-other. I got something out of it that I wanted just by being
myself, by saying what I really felt. And, that was a really important
thing for me to realize-that / could be myself or express certain things
and get what I wanted without driving her away. I didn't have to be angry
or force her to give me my own way.
INTERVIEWER: And, what changed for you through this incident?
BRIAN: I think / became more accepting of both my needs-instead
of being angry, saying, "Okay, I need this from her, I need to be liked. I
need to be loved or whatever. I need this thing from her." And, I accepted
that, /didn't get as angry both at myself/or being so-called weak and at
her for not giving me what I wanted. I just seemed to make things easier
between us. Because very often the anger at my needing something would
drive her away and make me very hard to get along with. And, the less
THE PROCESS OF CHANGE 2)3
angry she got and the more open and accepting of me, the easier it was
for me to be nice to her. That's about the best 1 can put it.
INTERVIEWER: How did this change occur?
BRIAN: It really didn't occur in the incident. It took a while to
integrate the incident.
This fell into Category 2.
Couple 6
THE MALE PARTNER
HowIE: Throughout the sessions I think we worked on a lot of things

that I had personally found that were personal needs or awareness that I
was coming to. I didn't have that good feelings about myself and my role
in the relationship, and self-worth, and all those things about my sense of
vulnerability and so forth. And, this one particular session we sort of
worked on, at least the therapist picked up what was happening and in a
very beautiful way made me feel that I was OK. And, I came to feel like I
... I really owned that. And, in a way that I had never felt before. It
really seemed to be a turning point. Not only in my relationship but in my
life as well. As an individual, it made a big difference on how I faced the
rest of the world, not only my relationship with Lilly. And, I found that
since then I've become more assertive ... not that life has become any
easier, but I've felt that the challenges I've faced, I've felt better about
facing them. And, I still deal with frustrations and anxieties and all the
problems that I've had before, but I seem not to be overwhelmed by them
as I was in the past.
INTERVIEWER: So, you were in this session, and your therapist picked
up on your self-esteem. What happened in the actual incident?
How1E: In a very beautiful way he reiterated a lot of the stuff I had
been coming up with. He sort of paraphrased a lot of the things. And,
made me aware of how hard I have been on myself ... how much I had
put responsibilities on me, that if I didn't take care of business the world
was going to fall apart. Essentially, how hard I had been on myself, how I
had been beating myself over the head, and allowing myself to be put in
the pressure cooker all the time. And, he was very sensitive to that in a
very beautiful way, and it really came home to me that I didn't have to
take on all those responsibilities ... it's not that I'm going to become
irresponsible ... but in order for me to have self-worth I don't have to
solve everybody else's problems and I don't have to be the big brother or
father figure or whatever to all those around me; that I've got to allow
them to grow at their pace as well. It seemed that there was this big
burden that was lifted off my shoulders and I felt a lot better about
myself. And , it happened within a period of about an hour or so when we
were dealing with that particular issue. It was very moving.
INTERVIEWER: What changed for you through this incident?
LILLY: The change for me- it's hard to describe because there's an
emotional thing that went through me. An experience that I find difficult
to put into words. But, I was on the verge of tears because I felt I'd finally
recognized Howie and that I didn't have to live up to a whole lot of
expectations all the time. And, it was really a great relief. So, that's the
best that I can describe it.
Couple 7
THE FEMALE PARTNER
FLORENCE: I think probably the one incident that stands out for me
and that comes to mind periodically, I think it was about our fifth
session, when Norm was relating a fight that we had had. And, as I sat
there listening to Norm and our therapist dialoguing, it was just like
someone turned a light bulb on in my head in that I realized for the first
time that a lot of the difficulty that I had previously put on Norm's
shoulders-as far as being his fault and that kind of thing, that I was
feeding into a lot of that. And, I think at that point in time, and I actually
said, "Just a minute here, something just happened for me. I realized that
what he's telling you, when I came in here I thought that was totally his
fault, that he was in the wrong. And, when he relates that back, what I
just realized is that this and similar problems along this line-I feed into
it. No wonder he's acting that way; no wonder we're getting that kind of
reaction when this kind of stuff happens. I'm doing this. It's not just
Norm. It's me too." So, that was a real eye opener for me, and I think the
most valuable lesson that I had.

Couple 8
THE FEMALE PARTNER
SHELLv: ... And, I just felt so much pain. It was easy for him. He
just said, "Well, that's the way it is. You just have to accept it." And, I
couldn't.I think that came out in the first couple of sessions. I think what
helped me-I think our therapist really felt the pain that I was express
ing. I think she really felt that she would have been very hurt as well.
And, that made me feel good.That made me feel good that I wasn't just
that way, but probably most women would have reacted that way as well.
And, I think Steve felt that too.I think he realized that I wasn't blowing
anything out of proportion or I wasn't at weak moments just getting
extremely upset at nothing. But, that there was something valid to my
feelings....She supported the way I felt and said she could understand
why I was so upset.And, when he heard that I think-and she also talked
to him about it because I think there were a few incidents where he
reacted because I got upset and couldn't cope.And, it was when I really
totally broke loose and I just was a basket case that he would support me.
But, if I was really upset about something and was handling it, and was
upset about it, he would push it aside and say, "Well, you've got to get
over those things-you can't let that upset your day." And, I was always
having to set them aside. And, I was never able to cry and express my
sadness.
INTERVIEWER: OK.You may already have answered this for me, but
I'd like to ask how this incident was helpful to you-this incident of
expressing your feelings.
SHELLY: I guess it was helpful that someone was there to listen ....It
was helpful that she was just able to sit and listen and support me.
INTERVIEWER: Okay. What changed for you through this incident?
SHELLY: I don't know what changed for me. I think it helped Steve to
understand a little bit more. I feel that if I was upset I could tell Steve
without him sort of putting me down right away for-I'd have the
confidence to express it to him.So often I wouldn't because he would get
mad at me for being upset. So, I'd just let it go. Whereas now, I don't
think he'd do that. I don't think I've done it lately, so I don't know for
sure. But, I think he'd really try to understand why I was feeling the way I
was and not right away become defensive and angry because I was sad. I
think sometimes he felt it was all on his shoulders; that if I was sad he was
partly to blame. And , yet, there was nothing that he could do about it.
So, he'd get angry.
INTERVIEW ER: How did this change occur?
SHELLY: Because I think when we were in those sessions she helped
him understand my pain. Sometimes when you express yourself, you say
it one way and the person takes it the wrong way. And, she would be
there to say, "Well, no Steve, I don't think she means it that way. I think
what she's saying is this." And, then he would start to understand what I
was feeling.
The study of client-reported change processes in EFT suggested that

the experience and expression of new feelings appropriately managed in a
therapeutic environment was helpful in couples therapy. In addition, it
suggested the novel idea that emotional expression may be significant in
leading to changes in partners' perceptions of each other (rather than to
changes in self perceptions) and thereby to changes in interactions be-
tween partners.
OBSERVERS' MODEL OF THE PROCESS

OF CONFLICT RESOLUTION
In the second study of the process of couples' conflict resolution (Green-

berg & Plysiuk, I 985; Plysiuk, 1985), five episodes of conflict resolution
in specific sessions were intensively analyzed using task analytic methods
(Greenberg, 1984) in an attempt to build a model of the process of
conflict resolution. Four successful resolution performances were com-
pared with one unsuccessful performance in order to identify perfor-
mance components that were common to successful performances as
opposed to unsuccessful performances. The task analytic procedure used
involves the generation of an initial rational model of the investigators'
best guess at how resolution occurs. This is based on existing theory and
clinical experience. This model acts as the hypothesized resolution per-
formance, which is compared with a number of actual resolution perfor-
mances in which the couples' interactions are coded on a variety of
process measures selected to measure hypothesized resolution compo-
nents. This comparison of actual performance with hypothesized perfor

mances leads to the development of an empirically grounded, refined
model of conflict-resolution performance.
In our first rational analysis, we hypothesized that an interactional
sequence, which began with the pursuer blaming a partner, who would
withdraw or defend, would shift when the pursuer changed from blaming
to an expression of underlying vulnerability. We hypothesized that the
withdrawer, seeing the partner's vulnerability, would reach out and make
contact, either by accepting the partner's statements or by disclosing
feelings. The pursuer, seeing the partner as accessible, would ask for
reassurance or state personal needs, and the withdrawer, feeling closer to
the partner, would provide reassurance or acceptance. This provision of
reassurance by the withdrawer would be accepted by the pursuer, who
would in turn express appreciation or acknowledgment of the with
drawer, who, experiencing acceptance, would state his or her own needs.
At this point, both partners would be operating from a new view of self
and other, and there would be an increase in sense of acceptance and
safety, with partners negotiating with each other.
This rational analysis and our review of process measurement instru
ments suggested that the experiencing scale (ES; Klein, Mathieu, Gend
lin, & Kiesler, 1969) and the structural analyses of social behavior
(SASB; Benjamin, Foster, Roberto, & Estroff, 1986) would be the most
helpful measurement instruments with which to capture components of
the hypothesized model.
Having generated the above hypothesized model, the next step was
to inspect actual conflict-resolution performances. For the empirical
analysis, videotapes of each resolution event were transcribed, and each
statement in each interaction was coded by two raters on ES and two
raters on SASB. Information was also gathered from some couples on
their view of what occurred in the event using interpersonal process recall
(IPR; Elliot, 1986). Using this method, the couple reviews a tape of the
event within a few days of its occurrence and are asked to recall what they
were thinking and feeling at different moments of the interaction. In this
way the in vestigator gains a picture of the partners' internal processes
and perceptions.
Using the coding and IPR information, performance diagrams were
graphed representing the moment-by-moment interactions. After the
interactions were graphed on performance diagrams, they were inspected
and compared with one another to reveal identifiable interactional pat-
terns that occurred consistently across all resolution events. A consistent

sequence of patterns of interactional behaviors was discovered, which led
to the conceptualization of four staged components of task resolution,
occurring in a set sequence.
In the initial stage of the task, the partners are in conflict. The
pursuer is engaged in blaming behavior and the withdrawer is either
avoiding, protesting, or appeasing. The second component begins when
either one of the partners openly discloses his or her feelings or needs,
and the other partner responds with understanding, comforting, or help-
ing behavior. One of the unexpected patterns that emerged, quite differ-
ent from the hypothesized performance, was the third component, in
which the pursuer temporarily reverted to blaming behavior, while the
withdrawer did not revert to protesting or defending behavior but con-
tinued to affirm and understand the other partner. In each resolution
event, the pursuers appeared to "test" their partners to see if their new,
more understanding, behavior was genuine. If their partners held to their
positive behavior, the couple proceeded to the next stage of resolution. In
the fourth component, both partners trustingly disclosed feelings or
needs while responding with empathic and affirming, protecting, or
comforting behaviors. These four patterns were labeled escalation, de-
escalation, testing, and mutual openness. Examples of these patterns are
given in the following vignette.
This resolution event occurred in the fifth session with a couple
whose presenting problem was marital dissatisfaction and conflict. In the
early sessions, the couple identified a negative cycle in which the wife,
Jennie, desired closeness with her husband, Peter, but was afraid her
needs would not be met. In her attempts to avoid the risk of being hurt,
she would approach Peter with hostile demands, and he would respond
to her anger by withdrawing or defending himself.
In the resolution event, the escalation sequence involved Jennie
accusing Peter of defending himself on the weekend even though she felt
she hadn't been critical of him. His response in the session was to simply
say "yeah" with a compliant yielding or submitting flavor. This was
consistent with his wife's complaints that he gave in to her but that it did
not mean a thing. Peter's response only aggravated Jennie further, and
she proceeded to attack him as being irrelevant to her life.
This escalation moved to a de-escalation with the therapist's help.
After Jennie focused on her underlying feelings, she was able to disclose
to Peter openly her fear of rejection and need for acceptance. He listened
in an understanding way and empathized with the need for recognition

and acceptance; this encouraged Jennie to talk further about her expe-
rience. She talked about how it was easier to get angry with Peter and say
she doesn't need him than risk being vulnerable with him. At the thera-
pist's prompting, Peter asked Jennie how she was feeling toward him at
that moment; Jennie said she felt comfortable, that she had been vulnera-
ble with him a few moments ago and had seen that it was "okay with him
for her to be vulnerable." Peter then expressed to Jennie that he wanted
to be with her, that he felt close and wanted to share his feelings more
openly.
The couple entered the testing phase with Peter saying he would like to
be there for Jennie when she felt vulnerable and needy. She at this point
gestured nonverbally with her face and shrugged. In response to the thera-
pist's query about her nonverbal response, Jennie referred to it as "my
skepticism." Peter remained positive and conveyed understanding of how
she felt. Her response was again untrusting: "I've done that before and you
weren't there. I don't want to try again." Jennie became more upset and
began to blame Peter for not responding. Peter disagreed with Jennie, twice
saying that he didn't really abandon her as she felt. He was friendly in
manner even though Jennie tried to refute his disagreements. Peter again
spoke of his desire to respond to her, and she responded negatively, coded
in SASB as "refuse person's caregiving" followed by a "belittling and
blaming" statement. Peter then appealed to Jennie to let her guard down
and to stop keeping him away because of her fear that she might get hurt.
He asked her to accept him for what he had to offer, rather than to set
conditions that he had to meet before she would trust him.
The couple entered into mutual openness when the therapist focused
on Jennie's feelings and she talked about her barrier, about how hard it
was to let it down, and tearfully concluded that she had needed it since
she was a child, to protect her from hurt and invalidation. Jennie then
talked to Peter about how hard it was for her to trust and how scared she
was. She also empathized with how difficult it must be for him when she
is rejecting. Peter then talked about his difficulties. He said he felt very
anxious and often did not quite know what to do when he felt rejected,
that he felt desperate and then withdrew as a way of protecting himself.
Jennie nodded her head in an understanding response to him, and when
the therapist commented on this they both stated that it was wonderful to
be able to talk to each other in this way. In response to the therapist's
query on how they felt, they both said they felt good toward each other,
with Jennie saying she felt more open and trusting and Peter expressing
his caring for her.
A comparison of the rational analysis and the coded transcripts of
actual performance events, such as the one above, resulted in the con-
struction of a four-step interactional model of relationship conflict reso-
lution. The rational analyses, empirical measures and information ob-
tained through the IPRs all contributed to the following more detailed
outline of the charl;lcteristics of the four stages.
Escalation
The patterns in the five performance diagrams suggested that escalation

could be defined as a sequence involving both partners where three or
more sequential statements (a statement is a talking turn of one partner)
are coded on the nonaffiliative side of the SASB scale. In the perfor-
mance events, we saw three variations on the escalation pattern. The first
variation, attack-defend, is the most common: One partner, according to
SASB categories, "belittles and blames" the other, who either "sulks and
appeases" or "defers and submits" in response. The attacking partner
responds to the defender with another blame. Information generated
from the rational analysis and a content analysis of the performance
events suggested that the partners' focus in escalation is on representing
their own position. The pursuer is often covertly or overtly complaining
about something the withdrawer is or is not doing. Withdrawers often
feel criticized and inadequate. They are either quick to defend themselves
against their partner's attacks or are wary of saying anything for fear they
will only be discounted. Both partners are usually feeling angry, frus-
trated, and unheard.
De-escalation
In the performance models, de-escalation occurred as a sequence in

which one partner either openly disclosed his or her experience or asked
for what he or she needed. The other partner responded with "affirming
and understanding" or "helping and protecting" behavior. One partner
brought into focal awareness experiences not previously discussed as in,
"I feel and accept my vulnerability." The other partner then perceived the
first partner in a new way, and this allowed him or her to respond to the
partner's new behavior- a request for reassurance from a position of
vulnerability. In rating the de-escalation and mutual openness stages on
the ES, it was found that the interactions in de-escalation occurred at a
lower level of experiencing than those in mutual openness. (This finding
is given further attention in the discussion of mutual openness.)
Testing
The testing sequence followed on the heels of de-escalation. Initially,

there was a positive interaction in which the withdrawer responded to the
pursuer's open expression of feelings or needs with "helping and protect-
ing," "nurturing and comforting," or "trusting and relying" behavior. The
withdrawers continued to validate their partners or their positions.
Rather than this leading to further disclosure on the pursuers' parts, the
pursuers suddenly switched to "belittling and blaming," "sulking and
appeasing," or "walling off and avoiding" behavior. Both the SASB
codes and the content of the resolution confirmed the investigators'
hunch that the pursuer was dealing with the issue of trust. The pursuers,
having exposed a little of themselves, having tentatively put out a need,
and having had their partners respond to them, were not sure if they
could trust their partners' responses as totally genuine and likely to occur
consistently. At this time, the pursuers spoke of their own "wariness" or
"guardedness," or complained about times in the past where they had
been vulnerable and then been rejected by their partners. If the with-
drawers defended or counterattacked at this point, the couples moved
back to escalation. However, if the withdrawers maintained a congruent
nonescalatory stance, either expressing continued acceptance or nonhos-
tile challenges, the resolution process continued. Thus, it was the with-
drawers' maintenance of a congruent nonescalatory stance that distin-
guished testing from escalation.
Mutual Openness
As the SASB process indicators for mutual openness and de-escalation

are very similar, sequence information and the depth of experiencing
were used to differentiate mutual openness from de-escalation. In de-
escalation, one partner openly disclosed his or her experience or ex-

pressed a need , while the other partner responded with "affirming and
understanding'' or "helping and protecting" behavior. With mutual open-
ness, however, the process involved both partners taking turns disclosing
their experiences and affirming each other. Ratings on the ES also
reached a higher level than they did in de-escalation: In mutual openness,
the couples not only reached a higher level of experiencing than they
reach in de-escalation, but they also maintain experiencing levels of 5 and
6 over a number of interactional sequences.
In mutual openness, there is an emotional reconciliation of the
partners and a reaffirmation of the relationship. The couples tend to
conclude their discussions with statements that convey empathic under-
standing and support for each other. Confirmation of the importance of
the relationship occurs rather than proposals for concrete solutions or
negotiations about how their interactions will be different in the future.
Before concluding the discussion of the mutual openness stage, it is
important to note that, while the partners may express frustration and
some negativity in mutual openness, there is also an earnest attempt to
trustingly disclose experience and to empathically listen to the experience
of the other partner.
The above study differs in a number of ways from studies of couples

conflict that have been completed to date. This is the first study in which
couples' interactions in the process of conflict resolution have been
rigorously tracked as the couples resolved conflicts in therapy sessions.
While other studies have identified phases of couples conflict and interac-
tion patterns that differentiate distressed from nondistressed couples
(Gottman, Markman, & Notarious, 1977), this study outlines consistent,
recurring performance patterns or stages that couples move through in
resolving their conflicts in therapy. The phenomenon of testing, outlined
in the performance model, is a discovery of this study and an important
addition to our clinical knowl~dge of the process of resolving a pursue-
distance conflict.
DO INTERACTIONS CHANGE?
In a further study of the process of change (Vaughan, 1986), episodes of

conflict interaction in the second and the seventh session of eight session
rHE PROCESS OF CHANGE 223
therapies were compared to test the hypothesis that EFT led to a change
in negative interactional cycles. Conflict episodes from the second and
seventh sessions of 22 successfully treated couples were transcribed and
rated on the SASB.
The four primary hypotheses of the study were supported by the
findings, which showed that EFT brought about a significant reduction
in frequency of negative, disaffiliative behaviors and negative, disaffilia
tive sequences with an increase in positive, affiliative behaviors and
sequences. In addition, EFT was shown to be effective in producing
increases in the frequency of positive, other-focused behaviors and posi
tive self-focused behaviors. EFT also resulted in a decrease in negative
reciprocal blame-blame sequences and negative and complementary
blame-placate sequences. No changes, however, were found in the fre
quency of controlling behaviors or positive complementary sequences.
This study demonstrated that couples interacted more positively
toward the end of EFT, showing more affiliative, supportive, and self
disclosing behavior as well as interacting with more of a mutual sense of
goodwill towards each other. This suggests that the negative interactional
cycle had been modified.
WHAT PROCESSES RELATE TO OUTCOME?
Two types of studies have attempted to relate process to outcome. In the

first type of study, the role of emotional experience and interaction
between the couple in good and bad sessions was related to clients'
reports of change. In the second type of study, the alliance with the
therapist was related to change.
In the session-based studies, two studies comparing peak and poor
sessions of therapy showed that peak sessions were characterized by deep
experiencing and more affiliative interaction than poor sessions. In the
first of these studies (Johnson & Greenberg, 1988), the peak sessions
of the three most improved and the three least improved couples who had
received EFT were compared. The peak sessions of the most improved
couples showed generally deeper experiencing and more affiliative re
sponses. More specifically, it was hypothesized that in successful couples,
blamers in peak sessions would soften their interactive stance. The occur
rence of a softening event was defined by a precise pattern of process
Variables including high levels of experiencing and quadrant one scores
(disclosing self, affirming other) on the SASB. Five such events were
identified in the peak sessions of the improved couples, while none was
found in the peak sessions of the unimproved group. The hypothesis was
thus confirmed, supporting the clinical theory of EFT that suggests
that an identified change event occurs when the blaming spouse repro-
cesses intense affective experience and discloses such experience~ this
then evokes a new response in the partner, resulting in a shift in a
negative interaction cycle. This kind of study represents a beginning in
identifying key ingredients in the change process in one approach to
couples therapy.
In the second study (Alden, 1987), peak and poor sessions of a
sample of 11 couples were compared using a combination of therapists'
and couple's reports of which sessions produced the most progress and
change. These peak sessions were compared with poorer sessions. A
20-minute conflict resolution episode was selected at comparable points
in each session and rated for depth of experience (ES) in the whole
episode and for degree of affiliative behavior and interaction (SASB) in
the last half of the episode. Sessions reported as peak sessions showed
significantly greater depths of experience and more affiliative behavior
and interaction. These studies provide evidence to support the idea that
depth of experience and acceptance are involved in the change process
in EFT.
The final study to be reported here investigated the relationship
between the working alliance and therapeutic outcome. Measures of the
alliance on the couples therapy alliance scale (Pinsof & Catherall, 1984)
were taken on 56 subjects (28 couples) who had received EFT.
The overall strength of the alliance early in treatment was not found
to be predictive of outcome, although one component, the other-thera-
pist component (which measures one partner's view of the strength the
alliance between the therapist and the other partner), correlated signifi-
cantly with outcome on a variety of measures. Another finding of interest
was that the strength of the alliance increased significantly over treatment
and that the termination alliance did correlate with outcome. These
results indicate two important processes. First, the alliance itself in this
form of couples therapy does not directly relate to outcome. It appears,
however, that the alliance at the end of treatment does relate to outcome.
In EFT, the alliance is probably the soil without which the treatment will
not "take," but it does not in and of itself lead to change. Movement from
an initially good alliance to an even better one, however, seems to be an
indication that change has taken place. A good final alliance can not
really be said to be predictive of outcome but should rather be viewed as
a correlate of good outcome. However, it does indicate that couples who
change in EFT have a strong alliance with their therapists and that this
alliance is strengthened over treatment.
SUMMARY
From the process studies, it appears that clients who experience and
express new underlying feelings in therapy are viewed differently by their
partners and feel more entitled to their needs. Change is also caused by
an increased understanding of what is going on in the relationship, the
taking of a self focus, and by feeling that experience was validated by the
therapist.
In successful episodes of conflict resolution, the partners, after en-
gaging in an initial escalating cycle, de-escalate the cycle by one partner
disclosing inner experience and the other responding affirmatively. After
de-escalation, the pursuer may "test" the withdrawer by re-escalating; if
the withdrawer retains a nonescalating stance, the couple proceed to
resolution characterized by mutual openness. Couples at the end of
therapy showed similar types of changes in their interactional cycles in
that they engaged in more affiliative actions and interactions plus more
supportive and disclosing behavior.
Good sessions in EFT were shown to be characterised by greater
depth of experience and affiliative interaction in conflict episodes and by
the "softening" of the blamer. Although the alliance with the therapist
did not predict outcome, the alliance was found to be high and to
improve over treatment; it is possibly best thought of as the soil for
productive therapy rather than an actual mechanism of change. Thus, we
see that EFT brings about certain changes in interaction by a process of
focusing on underlying feelings. The effect of emotional expression on
interaction is then an important element in the process of change. It is,
however, only one of the possible change processes in couples therapy.
The question then remains as how to build a comprehensive model of
change processes in couples therapy and to specify the place in this model
of the emotional change process described above.
Rather than attempting to develop yet another brand of therapy and
to clamor for its superiority, it is our intention to promote the view that
EFT can have significant effects in helping to ameliorate negative interac-

tion cycles, in reducing conflict, and in promoting trust and intimacy.
Although EFT can be practiced as a pure form of therapy and has been
for the purposes of its evaluation, it appears to us to hold more promise
ultimately in a more complex integrative model for working with cou-
ples. An approach that integrates different elements and change pro-
cesses, depending on the couple's degree of distress, unique situation,
needs, and goals, seems most likely to provide the best results.
CHAPTER NINE
Epilogue: Integration
Throughout this work we have attempted to convey an integrative per-

spective to treatment. The major attempt at integration involves a synthe-
sis of an intrapsychic experiential perspective and a systemic interac-
tional perspective. The individual perspective focuses on the self, while
the systemic focuses on context. We have suggested an integrated per-
spective to couples therapy in which the therapist works with both the
self and the system. In couples therapy, working with either perspective
alone misses important aspects of dysfunction. Focusing on the system
alone, using restructuring, reframing, or paradoxical intervention to
change interactions, misses the fact that individuals exist with certain
temperaments, personal characteristics, and a degree of stability across
situations and time. Although it is not possible to understand partners
without taking their social context into account, it is limiting to focus on
their interaction separated from individual experience. People do not just
react and interact as a function of their partner's behavior. Rather,
individuals have needs; they construct personal views of reality and are
centers of agency and action. They are undoubtedly connected ·in circu-
lar, sometimes automatic, interactional cycles, but this does not deny that
they are also capable of intentional behavior and are internally moti-
vated. On the other hand, the intrapsychic view that people are separate
individuals and separate individuals alone overlooks the fact that people
are embedded in a social context that is highly influential in determining
their behavior. Observing the interactional process and its circularity in
couples opens up new avenues of understanding of what is occurring in
the dysfunction. To miss this more systemic view in treating couples is to
operate with a great handicap. Partners' behaviors clearly do evoke
reciprocal behaviors from each other, sometimes idiosyncratic, but al-
ways highly linked.
227
Implicit in our approach to handling this integration is a particular

view of self-functioning. We view the self as a system consisting of many
processes or parts organized to act in a more or less integrated fashion. In
this view, the individual is seen as possessing multiple possible self
organizations, each of which is activated by different contexts. These
different possible selves are integrated by an overarching self-organizing
process. This view of modular self-organization is gaining support in the
study of brain functioning (Gazzaniga, 1986; Sperry, 1968), in which it
appears that different left and right hemisphere modules may · exist as
autonomous functioning units. Gestalt therapy has been especially signif-
icant in providing methods for working with different parts of the self in
individuals. However, the gestalt approach, although stressing organism-
environment contact, lacked an adequate theory of interaction and has
not dealt explicitly with couples interaction. Principles of functioning of
the whole self await explication, but the concept of multiple selves
operating as parts of a total system does appear to explain aspects of
functioning in couples in a most helpful way. We see this concept of an
overall self-organizing process that, in interaction with the environment,
activates a partial self-organization as an important view of functioning
that allows an integration between intrapsychic and interactional per-
spectives.
A second focus throughout this book has been on the importance of
integrative views of emotion, cognition, and action. First, at a theoretical
level, emotion is seen as an integration of expressive motor, schematic,
and conceptual processing, making it a function of many elements.
Second, at a clinical level, EFT works with emotional experience, con-
structive meaning and circular interaction, thereby integrating emotion,
cognition, and action into a single approach. Each possible self activated
in a particular context is essentially a self-in-situation schema that organ-
izes feeling, thought, and action.
EFf thus combines experiential and systemic perspectives in a syn-
ergistic fashion, combining contextual and intrapsychic determinants of
behavior. It combines into a single approach interventions that access
and explore underlying emotions to produce self-reorganization, with
interventions that reframe behaviors in negative interactional cycles in
order to produce interactional change. At a theoretical level, it is there-
fore a hybrid of these two approaches. It also, however, makes an
attempt to go beyond these two schools to look at how couples actually
change in therapy and thereby reaches toward a more complete form of
EPILOGUE: INTEGRATION 229
theoretical integration. In incorporating a number of affective change

processes-such as acknowledging underlying feelings; cognitive changes
processes, such as accessing hot cognitions and inspecting core beliefs;
and interactional and behavioral change processes such as reframing
cycles, restructuring interactions, and practicing new behavior-EFT
attempts to provide a conceptual synthesis in which dysfunction is viewed
in terms of affective, cognitive, behavioral, and interactional process.
This is the direction that must be pursued to arrive at a complete
theoretical integration.
Finally, a technical or more applied level of integration, involving a
type of systematic matching of strategy to problem, represents a third
type of integration in this approach. In our form of technical integration,
the practitioner chooses, in a theory-guided fashion, particular types of
interventions for particular types of conditions or problems as they
emerge in the therapy. This is not the differential treatment notion of a
particular treatment for a specific type of couple or marital problem. The
differential treatment approach is too deterministic and static in concep
tion. It neglects the complex transactional nature of therapy, in which all
participants are constantly changing what they do in relation to how their
environment is changing. In this type of technical integration, the ap
propriate intervention is best conceptualized as occurring at a particular
time in therapy when a specific interactional configuration presents itself.
This time can be a particular moment in a session or a particular phase or
state of therapy when the couple is working on particular kinds of issues.
In this approach, process diagnoses are made of the emergence of partic
ular patterns that are best treated with particular types of interventions.
Thus, attack-defend patterns, unexpressed feelings, or dysfunctional re
lational beliefs are identified and dealt with using interventions designed
for these types of problems. In addition, the therapist assesses the level of
conflict in the couple and the stage or phases of therapy, such as early,
middle, or late, and chooses interventions appropriate to that stage. Once
patterns of presenting problems or phases have been diagnosed, then
interventions that suit the situation are selected.
In this process diagnostic approach, markers of problem states that
are currently amenable to intervention are identified. Thus, the therapist
makes different interventions at different points in therapy dependent on
the couple's current state and processes. This is a process or ecological
view in which the client-therapist system is seen as always in flux, and
interventions are viewed as investigatory probes that provide feedback
and guide future action. Thus, the therapist "digs where the ground is
soft" and "strikes when the iron is hot." Location and timing of interven-
tions are at the core of whether the intervention will be absorbed and
make an impact.
In this process / ecological view of couples therapy, interventions
with an emotional focus can be combined at any time with other types of
interventions aimed more at genetic insight, awareness of collusive pro-
cesses, behavior modification, cognitive modification, structural change,
or reframing. Accessing emotion, when done appropriately, can help to
deepen the process, change perception, evoke cognitions, and motivate
new behavior. Thus, specific emotionally focused interventions, such as
focusing on what is being felt, can be used in a general fashion within a
variety of therapeutic orientations to enliven and enrich the process. The
total package of interventions that we have called EFT, however, seems
best for resolving couples conflict when used in the manner described in
this book.
References
Alden, L. (1987). Peak and poor sessions of couples therapy. Unpublished masters thesis.
University of British Columbia, Vancouver, BC.
Argyle, M. (1969). Social interaction. New York: Atherton Press.
Arnold, M . B. (1960). Emotion and personality (Vols. I and 2). New York: Columbia
University Press.
Arnold, M . B. (1970). Feelings and emotions. New York: Academic Press.
Bahn, D. (1967). On method: Toward a reconstruction ofpsychological investigation. San
Francisco: Jossey-Bass.
Bateson, G. (1955). A theory of play and fantasy. Psychiatric Research Reports, 2, 39-51.
Bateson, G., Jackson, P ., Haley, J ., & Weakland, J . (1956). Toward a theory of schizophre-
nia. Behavioral Science, 1(4), 251-264.
Beisser, A. (1974). The paradoxical theory of change. In J. Fagan & I. L. Sheperd (Eds.),
Gestalt therapy now: Theory, techniques, applications. New York: Harper & Row.
Benjamin, L. (1986). Adding social and intrapsychic descriptors to Axis I of DSM-III. In
T. Millon & G. Klerman (Eds.), Contemporary directions in psychopathology. New
York: Guilford Press.
Benjamin, L., Foster, S., Roberto, L., & Estroff, S. (1986). Breaking the family code:
Analysis of videotapes of family interactions by Structural Analysis of Social Behav-
ior (SASB). In L. Greenberg & W. Pinsof (Eds.), The psychotherapeutic process: A
research handbook. New York: Guilford Press.
Berscheid, E. (1983). Emotion. In H. H. Kelley, E. Berscheid, A. Christensen, J. H. Harvey,
T. L. Huston, G. Levinger, E. McClintock, L. A. Peplan, & D. R . Paterson. Close
relationships. San Francisco: W. H. Freeman.
Bordin, E. (J 979). The generalizability of the psychoanalytic concept of the working
alliance. Psychotherapy: Theory, Research and Practice, 16, 252-260.
Bowen, M. (1978). Family therapy in clinical practice. New York: Aronson.
Bower, G. H. (1981). Mood and memory. American Psychologist, 31, 129- 148.
Bowlby, J. (1958). The nature of the child's tie to his mother. International Journal of
Psychoanalysis, 39, 350-373.
Bowlby, J. (1969). Attachment and loss: Vol. I: Attachment. New York: Basic Books.
Bowlby, J . (1973). Attachment and loss: Vol. II: Separation, anxiety, and anger. New York:
Basic Books.
Bowlby, J. (1980). Attachment and loss: Vol. Ill: Loss, sadness and depression. London:
Hogarth.
Bradbury, T ., & Fincham, F. (1987). Affect and cognition in close relationships: Towards
an integrative model. Cognition and Emotion, I, 59- 87.
231
232 REFERENCES
Broderick, C. ( 1981 ). A method for deviation of areas for assessment in marital relation-
ships. The American Journal of Family Therapy, 9, 25- 34.
Buber, M. (1958). / and thou. New York: Charles Scribner's Sons.
Buck, R . (1984). The communication of emotion. New York: Guilford Press.
Chambless, D. L., & Goldstein, A. J. (1981). Clinical treatment of agoraphobia. In M.
Mavissakalian & D. Barlow (Eds.), Phobia: Psychological and pharmacological
treatment. New York: Guilford Press.
Darwin, C. ( 1873). The expression of emotion in man and animals. New York: Philosophi-
cal Library.
Dell, P. (1982). Beyond homeostasis: Toward a concept of coherence. Family Process, 21 ,
21-41.
Duhl, B. S., & Duhl, F. J . (1981). Integrative family therapy. In A. S . Gurman & D. P .
Kniskern (Eds.), Handbook of family therapy. New York: Brunner/Maze!.
Eidelson, R., & Epstein, N. (1982). Cognition and marital maladjustment: Development of
a measure of unrealistic relationship beliefs. Journal of Consulting and Clinical
Psychology, 50, 715- 720.
Ekman, P. (1972). Universal and cultural differences in facial expressions of emotion. In
J. R . Cole (Ed.), Nebraska symposium on motivation (pp. 207- 283). Lincoln, NE:
University of Nebraska Press.
Ekman, P., & Frcisen, W. V. (1975). Unmasking the/ace. Englewood Cliffs, NJ: Prentice-Hall.
Elliot R. ( 1986). Interpersonal process recall (IPR) as a psychotherapy process research
method. In L. Greenberg & W. Pinsof (Eds.), The psy chotherapeutic process: A
research handbook. New York: Guilford Press.
Eysenck, H., & Beech, H. (1971). Counterconditioning and related methods. In A. E.
Bergin & S . L. Garfield (Eds.), Handbook of psychotherapy and behavior change.
New York: Wiley.
Fairbairn, R . ( 1952). Object relations theory of personality. New York: Basic Books.
Feldman, L. B. (1979). Marital conflict and marital intimacy: An integrative psychody-
namic, behavioral, and systemic model. Family Process, 18, 69-78.
Fisch, R., Weakland, J. H., & Segal, L. (1983). The tactics of change: Doing therapy
briefly. San Francisco: Jossey-Bass.
Gazzaniga, M. (1986). The Social Brain: Discovering the Networks of the Mind. New York:
Basic Books.
Gendlin, E. (1979). Experiential psychotherapy. In R. Corsini (Ed.), Current psychothera-
pies (rev. ed.). Itasca, IL: Peacock.
Goldfried, M . R ., & Newman, C. (1986). Psychotherapy integration: An historical perspec-
tive. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy. New York:
Brunner/ Maze!.
Goldman, A. (1987). Systematically and emotionally focused marital therapies: A compara-
live outcome. Unpublished doctoral dissertation. University of British Columbia,
Vancouver, BC.
Gottman, J . M . (1979). Marital interaction. New York: Academic Press.
Gottman, J . M., Markman, H., & Notarius, C. (1977). The topography of marital conflict:
A sequential analysis of verbal and nonverbal behavior. Journal of Marital and
Family Therapy, 39(3), 461-477.
Greenberg, L . S. (1982). The relationship in Gestalt therapy. In M. Lambert (Ed.), Psycho-
lherapy and the patient relationship. Homeward, IL: Dorsey Press.
Greenberg, L. S. (1984). A task analysis of interpersonal conflict resolution. In L. N. Rice
& L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of psychotherapy
process. New York: Guilford Press .
REFERENCES 233
Greenberg, L. S. (1986). Research strategies. In L. Greenberg & W. Pinsof (Eds.), The

psychotherapeutic process: A research handbook. New York: Guilford Press.
Greenberg, L. S., & Goldman, A. ( 1985). lnteractional systemic treatment manual. U npub-
lished manuscript, University of British Columbia, Vancouver, BC.
Greenberg, L. S ., James, P., & Conry, R. (1988). Perceived change processes in emotion-
ally focused couples therapy. Family Psychology, 2, 4-23.
Greenberg, L. S., & Johnson, S. (1985). Emotionally focused couples therapy: An affective
systemic approach. In N. S. Jacobson & A. S. Gurman (Eds.), Handbook of clinical
and marital therapy. New York: Guilford Press.
Greenberg, L. S., & Johnson, S . (1986). Affect in marital therapy. Journal of Marital and
Family Therapy, 12, 1-10.
Greenberg, L. S., & Johnson, S . (1987). Change process research in marital therapy.
l.Jnpublished Manuscript, York University, Toronto.
Greenberg, L. S., & Pinsof, W. (Eds.). (1986). The psychotherapeutic process: A research
handbook. New York: Guilford Press.
Greenberg, L. S., & Plysiuk, M. (1985). Towards task analysis of couples conflict resolu-
tion. Paper presented at American Family Therapy Association, San Diego, CA.
Greenberg, L. S., & Safran, J. D . (1981). Encoding and cognitive therapy: Changing what
clients attend to. Psychotherapy Theory, Research and Practice, 18, 163- 169.
Greenberg, L. S ., & Safran, J. D. (1984a). Integrating affect and cognition: A perspective
on the process of therapeutic change. Cognitive Therapy and Research, 8, 555-578.
Greenberg, L. S., & Safran, J. (1984b). Hot cognition: Emotion coming in from the cold. A
reply to Rachman and Mahoney. Cognitive Therapy and Research, 8, 559- 578.
Greenberg, L. S., & Safran, J . D . (1987a). Emotion in psychotherapy: Affect and cognition
in the process of change. New Yorlc: Guilford Press.
Greenberg, L. S., & Safran J. D. (1987b). Emotion cognition and action. In H. Eyesenck &
I. Martin (Eds.), Foundations of behavior therapy. New York: Plenum.
Guntrip, H. ( 1969). Schizoid phenomena, object relations and the self _N ew York: Interna-
tional Universities.
Gurman, A. S . (1978). Contemporary marital therapies: A critique and comparative analy-
sis of psychoanalytic, behavioral and systems theory approaches. In T. J. Paolino &
B. S . McCrady (Eds.), Marriage and marital therapy. New York: Brunner/ Mazel.
Gurman, A. S . ( 1981 ). Integrative marital therapy: Toward the development of an interper-
sonal approach. In S. H. Budman (Ed.), Forms of brief therapy. New York: Guil-
ford Press.
Haas, A. L. , Clarkin, J. J., & Glick, I. D. (1985). Marital and family treatment of depres-
sion. In E. E. Beckham & W. R. Leber (Eds.), Handbook of depression. Home-
wood, IL: Dorsey.
Haley, J. (1976). Problem-solving therapy. San Francisco: Jossey-Bass.
Harlow, H. (1958). The nature of love. American Psychologist, 13, 673-685.
Hoffman, L. (1981). Foundations offamily therapy. New York: Basic Books.
Horowitz, L. M., & Vitkus, J. (1986). The interpersonal basis of psychiatric symptoms.
Clinical Psychology Review, 6, 443-469,
Izard, C. E. (Ed.). (1977). Human emotions. New York: Plenum Press.
Izard, C . E. (Ed.). (1979). Emotion in personality and psychopathology. New York: Ple-
num.
Izard, C. E., Kagan, J ., & Zajonc, R. B. (Eds.). (1980). Emotio11, cognition, and behavior.
New York: Cambridge University Press.
Jackson, D . D. {1965). Family rules: The marital quid pro quo. Archives of General
Psychiatry, 12, 589- 594.
234
REFERENCES
Jackson, D . D. (1967). Therapy, communication, and change. Palo Alto, CA: Science and
Behavior Books.
Jacobson, N. S., & Follette, W. C., (1984). Outcome research in behavioral marital therapy:
A methodological and conceptual reappraisal. In K. Hahlweg & N. S. Jacobson
(Eds.). Marital interaction: Analysis and modification (pp. 113- 129). New York:
Guilford Press.
Jacobson, N. S., Follette, N. S., & Revenstorf, D. (1984). Psychotherapy outcome re-
search: Methods for reporting variability and evaluating clinical significance. Behav-
ior Therapy, 15, 336- 352.
Jacobson, N. S., & Holtzworth-Munroe, A. (1985). Marital therapy: A social learning-
cognitive perspective. In N. S. Jacobson & A . S. Gurman (Eds.), Clinical handbook
of marital therapy. New York: Guilford Press.
Jacobson, N. S., & Margolin, G. (1979). Marital therapy: Strategies based on social
learning and behavior exchange principles. New York: Brunner/ Maze!.
James, P. (1985). Couples ' perception of change in therapy. Unpublished masters thesis,
University of British Columbia, Vancouver, BC.
Johnson, S. (1986). Bonds or bargains: Relationship paradigms and their significance for
marital therapy. Journal of Marital and Family Therapy, 12, 259-267.
Johnson, S., & Greenberg, L. (1985a). The differential effects of experiential and problem-
solving interventions in resolving marital conflict. Journal of Consulting and Clini-
cal Psychology, 53, 175-184.
Johnson, S. M ., & Greenberg, L. S. (1985b). Emotionally focused marital therapy: An
outcome study. Journal of Marital and Family Therapy, JJ, 313- 317.
Johnson, S. M ., & Greenberg, L. S. (1987). Integration in marital therapy: Issues and
progress. The International Journal of Eclectic Psychotherapy, 6, 202-215.
Johnson, S. M., Greenberg, L. S. (1988). Relating process to outcome in marital therapy.
Journal of Marriage and Family Therapy, 14, 175- 184.
Kaplan, M. L., & Kaplan, N. R. ( 1982). Organization of experience among family members
in the immediate present: A Gesalt/systems integration. Journal of Marital and
Family Therapy, 8, 5-14.
Kaplan, M. L., & Kaplan, N. R. (1985). The Linearity Issue and Gestalt Therapy's Theory
of Experiential Organization. Psychotherapy, 22, 5-15.
Kaplan, N. R., & Kaplan, M. L. (1987). Processes of experiential organization in individual
and family systems. Psychotherapy, 24, 561-569.
Kempler, W. (1981). Experiential psychotherapy within families. New York: Brunner/
Maze!.
Klein, M. H., Mathieu, P. L., Gendlin, E. T., & Kiesler, D. J . (1969). The experiencing
scale: A research and training manual (Vol. 1). Madison, WI: University of Wiscon-
sin Extension Bureau of Audiovisual Instruction.
Lang, P. J . (1979). A bio-informational theory of emotional imagery. Psychophysiology,
16, 495- 512.
Lang, P. J. (1983). Cognition in emotion: Concept and action. In C. E. Izard, J. Kagan, &
R. B. Zajonc (Eds.), Emotion, cognition, and behavior. New York: Cambridge
University Press.
Lang, P. J. (1984). The cognitive psychophysiology of emotion: Fear and anxiety. In A. H.
Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ:
Lawrence Erlbaum Associates.
Leventhal, H. (1979). A perceptual-motor processing model of emotion. In P. Pliner,
K. Blankstein, & I. M. Spigel (Eds.), Perception of emotion in self and others (Vol.
5). New York: Plenum Press.
REFERENCES 235
Lewin, K. ( 1935). A dynamic theory of personality. New York: McGraw-Hill.

Lewis, J . M., Beavers, W. R ., Gossett, J . T., & Phillips, V. A. (1976). No single thread:
Psychological health in family systems. New York: Brunner/ Mazel.
Mehrabian, A. ( 1972). Nonverbal communication. Chicago: Aldine-Atherton.
Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University
Press.
Minuchin, S., & Fishman, C. (1981). Family therapy techniques. Cambridge, MA: Harvard
University Press.
Perls, F. (1970). Four Lectures. In J . Fagan & L. L. Sheperd (Eds.), Gestalt therapy now.
New York: Harper & Row.
Perls, F. (1973). The Gestalt approach and eye witness to therapy. Palo Alto, CA: Science
and Behavior Books.
Perts, F ., Hefferline, R., & Goodman, P. (1951). Gestalt therapy. New York: Dell.
Pinsof, W. (1983). Integrative problem-centered therapy: Toward the synthesis of family
and individual psychotherapies. Journal of Marital and Family Therapy, 9, 19- 35.
Pinsof, W ., Catherall, D. (1984). The integrative psychotherapy alliance: Family, couple
and individual therapy scales. Chicago: Center for Family Studies, The Family
Institute of Chicago, Northwestern University.
Plutchik, R., & Kellerman, H. (Eds.), (1980). Emotion: Theory, research, and experience:
Vol. I. Theories of emotion. New York: Academic Press.
Plysiuk, M. (1985). A process study of marital conflict resolution. Unpublished masters
thesis, University of British Columbia, Vancouver, BC.
Prigogine, I. (1976). Order through fluctuation: Self-organization and social system. In
E. Jantsch & C. Waddington (Eds.), Evolution and consciousness: Human systems
in transition. Reading, MA: Addison-Wesley.
Prigogine, I., & Stengers, I. (1984). Order out of chaos: Man's new dialogue with nature.
New York: Bantam.
Rempel, J ., Holmes, J., & Zanna, M. (1985). Trust in close relationships. Journal of
Personality and Social Psychology, 49, 1-18.
Rice, L. N. (1974). The evocative function of the therapist. In D. Wexler & L. Rice (Eds.),
Innovations in client-centered therapy. New York: Interscience.
Rice, L. N., & Greenberg, L. S. (1984). Patterns of change: Intensive analysis of psycho-
therapy process. New York: Guilford Press.
Rice, L. N., & Saperia, E. (1984). Task analysis of the resolution of problematic reactions.
In L. N. Rice & L. S. Greenberg (Eds.), Patterns of change: Intensive analysis of
psychotherapy process. New York: Guilford Press.
Rogers, C . R . (1951). Client-centered therapy. Boston: Houghton-Mifflin.
Rogers, C. R. (1961). On becoming a person. Boston: Houghton-Mifflin.
Safran, J. D., & Greenberg, L. S. (1982). Eliciting "hot cognitions" in cognitive therapy.
Canadian Psychology, 23, 83-87.
Safran, J . D., & Gre~nberg L. S. (1986). Hot cognition and psychotherapy process: An
information processing/ ecological approach. In P . Kendall (Ed.), Advances in cog-
nitive-behavioural research and therapy (Vol. 5). New York: Academic Press.
Sager, C. J . (1981). Couples therapy and marriage contracts. In A. S. Gurman & D . P .
Kniskern (Eds.), Handbook offamily therapy. New York: Brunner/ Maze!.
Sartre, J . P. (1968). The emotions: Outline of a theory. New York: Philosophical Library.
Satir, V. (1962). Husband-wife conferences in the home. Marriage and Family Living, 24,
151 - 154.
Satir, V. (1964). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books.
Satir, V. (1972). Peoplemaking. Palo Alto, CA: Science and Behavior Books.
236 REFERENCES
Schachter, S ., & Singer, J . E. (1962). Cognitive, social, and physiological determinants of
emotional state. Psychological Review, 69, 379- 399.
Schaefer, M. I., & Olson, D . H . (1981). Assessing intimacy: The PAIR inventory. Journal
of Marital and Family Therapy, l, 41- 60.
Scherer, K. (1986). Vocal affect expression: A review and a model for future research.
Psy chological Bulletin, 99(2), 143- 165.
Seagrave, S. T. (1982). Marital Therapy. New York: Plenum Press.
Sluzki, C. E. (1978). Marital therapy from a systems theory perspective. In T . J . Paolino &
B. S. McCrady (Eds.), Marriage and marital therapy. New York: Brunner/ Maze!.
Sluzki, C. E. (1983). Process structure and world views: Toward an integrated view of
systemic models in family therapy. Family Process, 22, 469-476.
Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies.
American Psychologist, 32, 752-760.
Solomon, R. (1977). The passions. New York: Anchor Press.
Spanier, G. (1976). Measuring dyadic adjustment. Journal of Marriage and Family, 13,
I 13-126.
Sperry, R. (1968). Hemisphere deconnection and unity in conscious awareness. American
Psychology, 23, 723-733.
Stanton, M . (1979). An integrated structural/strategic approach to family therapy. Journal
of Marital and Family Therapy, 5, 427-439.
Stuart, R. B. (1980). Helping couples change: A social learning approach to marital
therapy. New York: Aronson.
Vaughan, P. (1986). lnteractional change in emotionally focused couples therapy. Unpub-
lished masters thesis, University of British Columbia, BC.
Watzlawick, P. (1978). The language of change. New York: Basic Books.
Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communica-
tion: A study of interactional patterns, pathologies and paradoxes. New York:
W. W. Norton.
Watzlawick, P., Weakland, J. H ., & Fisch, R. (1974). Change: Principles of problem
formation and problem resolution. New York: W. W. Norton.
Weeks, G. R., & L'Abate, L. (1982). Paradoxical psychotherapy: Theory and practice with
individuals, couples, and families. New York: Brunner/ Mazel.
Weiss, R. (1982). Attachment in adult life. In C. Murray Parks & J. Stevenson-Hinde
(Eds.), The place of attachment in human behavior. New York: Basic Books.
Weiss, J., & Sampson, H . (1986). The psychoanalytic process. New York: Guilford Press.
Whitaker, C., & Keith, D . (1981). Symbolic-experiential family therapy. In A . Gurman &
D . P . Kniskern (Eds.), Handbook of family therapy. New York: Brunner/ Mazel.
Wile, D. E. (1981). Couples therapy: A non-traditional approach. New York: Wiley &
Sons.
Wiley, D. E. (1967). Latent partition analysis. Psychometrica, 32, 183-193.
Index
Accessing
B
clinical issues, 175- 178
principles, 150
Behavioral therapy
therapist interventions, 148- 163
conflict delineation, 83
therapy steps, 88- 94
versus emotionally focused therapy, 48-
Ac.cuse- withdraw cycle, 74
53, 63- 65
"Adaptive primary emotions"
Beliefs, 24, 25
characteristics, 6
Biologically based emotions, 6
evoking of, 46, 47
Blame- blame sequences, 223
Affect
Blame- placate sequences, 223
cognition interaction , 23 Blame- withdrawal cycle (see also Pursue-
evoking of, 45-47 distance cycle)
innate aspects, 5 and accessing, 89
nonverbal communication, 16 case example, 104- 121
Affective systemic approach, 29- 53 choreographing interactions, 172, 173
Afftliation conflict resolution, 217- 222
case example, 67- 70 and disowned needs, 96- 98
interview assessment , 74- 76 identification of, 86, 87
and outcome, 223, 224 reframing, 95, 96
Agoraphobia, 191 and therapist training, 183-188
Analogic communication, 13, 14, Blocks
16 framing difficulties, 167, 168
Anger and validation, 177, 178
innate aspects, 5 Bonding (see Emotional bond)
vocal cues, 15 Boundary setting, 18
Arousal, 46, 47
Attachment
and emotional bonds, 18- 20 C
innate aspects, 4, 5
Attending Change process (see Therapeutic change)
accessing emotion principle, 150 Characterological attributions, 83
in empathic reflection, 152 Choreographing interactions, 164, 171 -
Attribution of meaning, 22, 23 173
Automatic behavior, 96, 97 Chronic pain, 190
Autonomy-dependence, 165 Circular causality, 33
Awareness experiments, 156- 158 Client-centered therapy, 89, 148
237
238 INDEX
Closeness-d istance Directive therapy, 63

and affective expression, 17 Disowned experiences, 96- 98
interaction positions, 165 Disquisition, 162, 163
G:;ognition Distance, structuring of, 40
and emotion, model, I0, 11 , 228 Distress, innate aspects, 5
integrative view, 21- 23, 228 Dominance- submission
systems approach, 37 and affective expression, 17
Command messages case example, 67- 70
characteristics, 13 interview assessment, 74, 75
and reciprocal roles, 34 vocal cues, 15
Commitment, 79-8 1 Dyadic Adjustment Scale, 48, 51
Communication
and emotion, 4, 13- 17
self-organization, 17 E
and therapeutic change, 39
Communication training, 48- 53 Eclecticism, 195- 199
Complex phobias, 191 Ecological approach, 229, 230
Conflict issues, 82- 85 Emotion (see also Accessing)
Conflict resolution, 216- 222 in change process, 204, 205
Conjoint therapy, 62 classification, 6
Consolidation, l 03, 104 cognition interaction, 21- 23
Constructivism, 39, 149 evoking of, 45-47, 149
Context effects in human functioning, 4-9
and change, 38, 42, 43 integrative view, 228
and meaning, 34 model of, 9- 11, 149
Contracting self-organizing function, 11- 13
and emotional bonds, 18 Emotional bond
social exchange theory, 63 importance of, 18- 20, 61
Core beliefs restructuring, 40-43
empathic interpretation, 161 theory of, 74, 75
interactional systems, 36, 37 and therapeutic alliance, 59
Couples therapy alliance scale, 224 Emotional restructuring, 46, 47
Cultural aspects, emotions, 5 Emotional schemata (see
Cybernetic model Schemata)
and family systems, 33 Empathic interpretation, 160-163
homeostatic feedback conception, 41 Empathic reflection, 151 - 153
Palo Alto group, 14 Enactments, 158- 160
Entitlement, 152
Environmental support, 42, 43
D Escalation, 218- 220
Evocative responding, 154, 155
Darwin, Charles, 14 Experiencing scale, 217, 221, 224
De-escalation, 218- 221 Experiential learning, 25
Dependence- independence, 67- 70 Experiential theory, 29-32
Depression, 189- 191 characteristics, 29- 32
Digital communication, 13, 14 disowned experiences, 98
Direct confrontation, 163 integrative models, 197, 227-
Directing 230
and accessing emotions, 155, 156 and systems perspective, 35-40
changing interactions, 164 Expression analysis principle, 150
INDEX 239
F Impasse enactment, 159

'"Inclusion," 20
Facial expression Individual therapy, 193
emotion communication, 14, 15 Infancy, innate emotions, 4, 5
innate aspects, .5 Information-processing
Family-of-origin approach, I 96 attachment behaviors, 19
Family systems (see Systems approach) and emotion, model, 10, 149
Family therapy, 193 Initial interview, 72-81
Fear, innate aspects, .5 Insight, 38, 39
Feedback "Instrumental emotions," 6, 7
family systems, 33 Integrative approaches, 195-199, 227-230
versus mutual influence, 41 Intensification principle
nonverbal actions, 1.53 accessing emotion, 150
Feelings, and change process, 204, 20.5 and directing, 155, 156
Field theory Intention principle, 150
and change process, 41 Interactional positioning
characteristics, 29-31 family systems, 34, 35
First-order change, 87 interventions, 164-173
Fluctuating systems, 43-45 principles, 164, 165
reframing, 164-169
restructuring, 169-171
G Interactional systems (see Systems
approach)
General systems theory, 33 (see also Interpersonal perception
Systems approach) and change process, 204
Gestalt therapy self-organization, 37
accessing emotions, 89, 148 Interpersonal process recall, 217
in couples, 29-32 Interpretation, 160-163
and self-organization, 228 Intimacy
systemic perspective, 3.5, 36 and emotional bonds, 18-20
Gestures, 16 nonverbal communication, 16
Intrude-reject cycle
case example, 121
H interview assessment, 74
History-taking, 77, 78
Homeostasis
L
family systems, 33
versus magnetic systems, 4 I
Latent Partition Analysis, 204
"Hot cognitions"
Learning, and emotion, 12
accessing, 23; 4 7
Leventhal's model, IO
empathic int�rpretations, 161
I M
"I-thou" dialogue, 20, 21, 38 Magnet analogy, 41

Images, 156-1.58 "Maladaptive primary emotions,"
Immediacy principle 6, 7
Marital adjustment, 49-52
accessing emotion, 150
Meanings, and attribution, 22, 23
in empathic reflection, I 52
240 INDEX
Metaphors Paradoxical reframing, 48- 53

awareness experiments, 156- 158 "Partial selves," 36
in evocative respond ing, 154 Perceptual motor-processing model, 10
Modular self theory, 36, 228 Personal Assessment of Intimacy in
Mood, and cognition, 23 Relationships (PAIR), 48
Motivation Phobias, 189- 193
and change, ·1,01 Position enactment, 159
and emotion, 4 Power issues, 67- 70
Mutual blaming Predisposition, 77
case example, 67- 70 Prescriptions, 63
interview assessment, 74 Prigogine's theory, 45
Mutual distance, 67- 70 Primary emotions
Mutual openness, 218- 222 characteristics, 6, 7, 149
.. Mutuality," 20 clinical issues, 175-178
evoking of, 46, 47, 57, 58, 149
versus secondary emotions, 9
N and therapeutic change, 7-9
Problem-solving approach
Negative emotion, ventilation, 176 and emotions, 5, 6
Negative interactional cycle and therapy, 48-52
case example, 67 Proximity, 40
identification of, 85-88 Psychodynamic therapy
interview assessment, 74-76 conflict delineation, 83
and outcome, 224 versus emotionally focused therapy, 63-
therapy effect, 222, 223 65
therapy step, 66 Psychosis, 195
Network analyses, 11 Psychosomatic problems, 190
Nonverbal behavior Pursue-distance cycle
accessing emotion, 150 and bonding theory, 74, 75
in couples therapy, 15 case example, 67- 70
emotion communication, 14, 16, 150 identification of, 86, 87
interview assessment, 74 interview assessment, 74- 76
therapist feedback, 153
training issues, 183
R
0 Reciprocal roles, 34
"Reflection" intervention, 151 - 153
Object relations, 18 Refocusing principle
Outcome accessing emotion, 150
process factors, 223- 225 and change, 164
studies of, 47- 52 in empathic reflection, 152
Reframing
and change, 164- 169
p evoking emotion, 45-47
and family systems, 35, 37
Pain, 190 therapy step, 94-96
PAIR (see Personal Assessment of Report messages
Intimacy in Relationships) characteristics, 13
Palo Alto group, 13, 14, 32 and reciprocal roles, 34
INDEX 241
Repositioning interactions, 165 characteristics, 32- 35

Restructuring, 169- 171 and experiential approach, 35-40
Roles, 36 integrative models, 197, 227- 230
self theory, 36
therapeutic task, 35, 37
s
Schemata T
and arousal, 46, 4 7
and cognition, 2 I - 23 Technical eclecticism, 196, 198, 229
emotion model, I 0, 11 Termination issues, 104
relational beliefs, 24 Testing, 218-221
Second-order change, 87 Therapeutic alliance
"Secondary emotions" clinical issues, 180-182
characteristics, 6 monitoring of, 180
and therapeutic change, 9 and outcome, 224, 225
Self-concept, 78 therapy condition, 59, 60
Self-controls, 42, 43 Therapeutic change
Self-disclosure, I 63 couples reports, 203- 216
Self-esteem, 78 experiential-systemic approach, 39
Self-focus, 206 and outcome, 223- 225
Self-organization process of, 40-47, 203- 226
change process, 42-47 and therapist training, 184-189
and communication, 17 Therapeutic contract, 79-81
and fluctuation, 44, 45 Therapeutic paradox, 63
gestalt approach, 228 Therapists
systemic theory, 36, 37, 228 accessing emotion principles, 148-
Separateness-connectedness, 67-70 163
Separation anxiety, 4 experiential listening, 84
Sexual interactions, 194, 195 patient bond, 59, 60
Sexual problems, 190 tasks of, 61, 62
Simple phobias, 191 Timing, interventions, 179
Smiling, 5 Tracking interactions principle, 164
Social exchange theory, 63 Training issues, 182-189
Socially derived emotions, 6 Trust, 26
"Softening," I 88, 189, 225
Stranger anxiety, 4
Strategic systems paradigm, 64 u
Stress, 78
Structural analysis of social behavior Unconscious conflicts, 63- 65
instrument, 217, 220, 221, 224
Structural approach, 40
Submission, vocal cues, 15 V
Suicide attempts, 195
Symbolization principle Validation
accessing emotion, 150 and accessing emotion, 151- 153, 177,
and directing, 155, 156 178
in empathic reflection, 152, 161 change process role, 206
Systems approach and therapeutic alliance, 84, 85, 181
change explanation, 43-45 Ventilation approach, 176
242 INDEX
Violence w
and negative cycles, 87
therapy contraindication, 194 Withdrawal
Vivifying enactments, 159 interview assessment, 75, 76
Vocal cues, emotion, 15 reframing, 95, 96
Vulnerability therapist training, 185, 186
and emotional bonds, 18 Working alliance (see Therapeutic
and reframing, 95, 167, 168 alliance)
continued from front flap
depth discussions of clinical issues that arise in

practice, and an analysis of the change process.
A significant new work, EMOTIONALLY
FOCUSED THERAPY FOR COUPLES will be
of value to any therapist, regardless of orienta-
tion, who treats couples.
About the Authors
Leslie S. Greenberg, Ph.D.

Leslie S. Greenberg is Professor in the Depart-
ment of Psychology at York University in Can-
ada. Co-editor of PATTERNS OF CHANGE:
Intensive Analysis of Psychotherapy Process
and THE PSYCHOTHERAPEUTIC PROCESS:
A Research Handbook, and author of numerous
research articles, he is on the editorial board of a
number of journals on individual and marital
therapy. He maintains a part-time private prac-
tice and is associated with the training of thera-
pists.
Susan M. Johnson, Ed.D.
Susan M. Johnson is Associate Professor in the
School of Psychology and Coordinator of
Training at the Centre for Psychological Serv-
ices at the University of Ottawa in Canada. The
author of numerous research and theoretical
articles on marriage and marital therapy, she
also maintains a part-time private practice.
Cover design by Howard Brotman

ALSO AVAILABLE FROM GUILFORD
Focused Expressive Psychotherapy

Freeing the Overcontrolled Patient
Roger J. Daldrup, Ph.D., Larry E. Beutler, Ph.D.,
David Engle, Ph.D., and Leslie S. Greenberg, Ph.D.
"One only has w experi£nce this approach w know its effectiveness and
see the remarkable therapeutic changes possible. FEP is a significant
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pist and will prove itself in the years w come" -John Gladfelter, Ph.D.
This unique manual provides explicit procedw·es for effectively treat-

ing clients with constricted emotions. The authors present the
assumptions and principles of FEP, define the roles and responsibili-
ties of both the therapist and client, and offer numerous techniques
for clinical practice.
233 Pages, ISBN 0-89862-729-X, Cat. #2729
THE GUILFORD PRESS

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ISBN 0-89862-730-3

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ILeslie S.

continued on back flap

The Guilford Press

Last digit is print number: 9 8 7 6

Library of Congress Cataloging-in-Publication Data

To the courage and openness of our clients.

interventions, must be fitted to the client's immediate and long-term

Part One. Theory and Research

Chapter One. Emotion in Interaction 3

Chapter Two. An Affective Systemic Approach 29

Part Two. Practice

Chapter Three. General Considerations 57

Chapter Four. The Initial Interview 72

Chapter Five. The Process of Therapy 82

Chapter Six. Therapist Interventions 148

Chapter Seven. Clinical Issues 17 5

Part Three. Effecting Change

Chapter Eight. The Process of Change 203

Do Interactions Change? 222

Chapter Nine. Epilogue: Integration 227

Theory and Research

The practice of marital therapy thus requires a heightened sensitivity

EMOTION IN HUMAN FUNCTIONING

Emotion has long been the cornerstone of psychology and psychother-

In addition, study of the development of affect is beginning to show an

with emotion; furthermore, identification with previously disclaimed ac-

To access or heighten secondary reactions in therapy is uncalled for

insight. It is the difference between thinking about feeling and feeling

A comprehensive model of emotion, which, similar to Magda Arnold's

to capture the role of emotion in therapeutic change. In this view, an

storing earlier experiences, schemata act to guide attention and percep-

THE SELF-ORGANIZING FUNCTION OF EMOTION

Emotion is best thought of as a disposition to act (Lang 1984). Emotion

action dispositions may or may not be transferred into goal-directed

process, the organization of which determines the person's behavior

The significance of communication in marriage and family therapy was

representation, usually nonverbal in nature, which has a likeness to the

emotion is known to be cross-culturally consistent (Ekman, 1972) and

rather than simply being an external means of conveying what is occur-

The degree of closeness- distance and dominance- submission, the

INTIMACY AND EMOTIONAL BONDS

In understanding the origins of emotional life, the need for attachment is

others is a requirement for psychological well-being, that distress in

THE "I-THOU" DIALOGUE

As Buber proclaims, "the inter-human opens out what otherwise remains

COGNITION AND THE EMOTION PROCESS

An important purpose of thinking is the creation of meaning. Emotion is

manifestations of particular attributes in one's partner. It is these sche-

crucial component of interaction in couples and that meaning is intrinsi-

RELATIONAL BELIEFS AND TESTING

Trust is another important component of intimate relationships. Trust

We have attempted in this chapter to briefly outline the components of

change. Sartre ( 1948) described emotion as a transformation of the

Emotionally focused couples therapy is an affective systemic approach in

Gestalt therapy, one of the major experiential therapies, although devel-

organism and the environment at the contact boundary. The self is

attempts to enter the person's frame or reference to explore the reality of

viewed as discordant with, or disallowed by, particular relationship rules

dampened and curtailed by repeated patterns of behavior. It is this restric

provision of an overview of the couples' functioning, were not as rigor