Framework Family Counseling in Home Therapy for a More Connected Family

Open access peer-reviewed affiliate

Emotionally Focused Family Therapy: Rebuilding Family Bonds

Submitted: October 16th, 2018 Reviewed: January tenth, 2019 Published: February 16th, 2019

DOI: ten.5772/intechopen.84320

Abstruse

Relationships with parents, siblings, and other family unit members go through transitions every bit they movement along the life bicycle. Resilient families realign their relationships to respond to the changing demands and stressors within the family organisation. Those who are unable, discover themselves in repetitive patterns marked past conflict and distress, ofttimes resulting in their need to seek treatment. Based on zipper theory, Emotionally Focused Family Therapy (EFFT) is a pragmatic short-term handling arroyo designed to alleviate distress in family unit functioning. This chapter provides an overview of EFFT process, its theoretical underpinnings and the strategies EFT family therapists apply to promote positive outcomes. The presentation of a case study provides a unique lens where the therapist illustrates moment to moment interventions in an try to create new and more than favorable family interactions, ones that heighten family members' feelings of attachment, empathy, communication and stability.

Keywords

emotionally focused family therapy
family distress
adolescence
attachment
negative interactions

Katherine Stavrianopoulos*
- John Jay College of Criminal Justice, The City University of New York, New York, Us

*Address all correspondence to: stavros@jjay.cuny.edu

1. Introduction

In the last 20 years, research studies take demonstrated the effectiveness of emotionally focused couple therapy (EFT) in helping couples repair their distressed relationships. The natural extension and broader awarding of EFT couple'south treatment can prove especially valuable and constructive when working in a family system [1, 2]. The foundational principles of Emotionally Focused Couple'southward Therapy is based on attachment and bonding theories that aim to assistance individuals gain a greater awareness of their emotions, to provide them with strategies to effectively cope, regulate, and transform their emotions[3]. It is a curt term, prove-based arroyo that allows the therapist to prepare goals, target key processes, and chart a destination for couples to identify and remove those emotional blocks which derail the promotion of healthy functioning, while providing alternative approaches that serve to increment levels of attentiveness, empathy and feelings attachment and belonging with i another.

Co-ordinate to Johnson, [4] EFFT is similar to emotionally focused therapy for couples, except that with families, the goal is "to modify family relationships in the direction of increased accessibility and responsiveness, thus helping the family create a secure base for children to grow and go out from." Working within a larger family system can be especially daunting as therapists attempt to navigate the vast landscape of family dynamics encompassing multiple, complex interpersonal processes between members, especially the powerful bonds that exist betwixt parent and kid, which when weak and cleaved—are often the root of familiar distress and dysfunction. The core of the human experience of a family lies inside its ability to create supportive bonds that sustain information technology during turbulent and stressful times in its life bicycle. The application of EFT to family treatment offers a practical, useful and expedient model from which to finer bolster stronger and more empathic bonds between parents and their children.

This chapter provides an overview of EFFT process, its theoretical underpinnings and the strategies EFT family unit therapists apply to promote healthy family operation. Through a presentation of a case study, beginning therapists are provided a unique lens from which to view the interactions of both family unit and therapist as they attempt to create new family interactions, marked by increased parental accessibility and responsiveness to children, which ultimately leads to their enhanced sense of zipper, communication, belongingness and security.

2. Theoretical framework

Emotionally Focused Family Therapy (EFFT) is an integration of humanistic [5] and systemic therapeutic approaches [6]. The focus of handling is on the ongoing structure of a family'south nowadays feel and how patterns of interaction are organized and expressed betwixt family members. Some other significant aspect of EFFT is its detailed attention to emotions. Identifying emotions is viewed by the therapist as essential in how family members view themselves and others, or an consequence. Emotions are hard wired in our brain and are meant to inform us almost our environs. They as well, contain physical impulses, which are designed by nature to exist an firsthand and adaptive call to action. In EFFT, emotions are categorized as primary and secondary. Principal emotions have been identified by researchers as universal emotions, such as joy, anger, fear, sadness, surprise, and shame. These emotions are frequently outside of people's awareness. Secondary emotions are defined every bit reactions, and they assist people cope with their primary emotions. The word "emotion" comes from the Latin discussion, emovare significant "to move." Emotions are openly identified, shared and often reframed by the EFFT therapist, as a vehicle to help family members navigate into new and more favorable patterns of interaction, 1's that are more empathic and capable of building rubber and healthier relationships.

EFFT is grounded in attachment theory and based on the work of psychologist John Bowlby [seven]. Bowlby maintains that human beings are biologically and fundamentally driven to pursue relationships that create security and belonging. He contends that the nearly critical attachment relationship is an baby'south sense of protection created by the primary caregiver (typically the mother) through a series of reciprocal interactions which promote bonding and love. Equally Karen [eight] in Condign Attached says about love, "Yous don't need to be rich or smart or talented or funny; you just have to be there." A parent's emotionally engaged presence makes all the difference between disconnection and security. Throughout the cycle children and adolescents achieve out to their primary zipper figures when they are in distress. If they experience parents as non- responsive or unavailable, it is natural for them to feel isolated, frightened and anxious. Feelings of insecurity in children are likely to heighten expressions that phone call for parental reassurance. Conversely, children may engage in behaviors that disengage and avoid their expressions of distress, particularly in moments of need [9, 10, eleven]. In either scenario the resulting negative relational experiences foster instability and anxiety in the family organisation.

In EFFT, one'southward sense of a secure attachment is linked to positive mental health. Children who are securely attached are best able to turn to their attachment figures for comfort and support [12]. Mikulincer and Shaver [13] capture the distinction betwixt these anticipated patterns of attachment beliefs as shown in their research when they depict the issues of secure vs. insecure scripts. The secure script is: "If I encounter an obstruction and/or become distressed, I can approach a significant other for help; he or she is likely to exist available and supportive; I will feel relief and comfort as a result of proximity to this person; I can then render to other activities [xiii]." However, when the zipper system remains in an activated state, there are two different insecure coping responses. The avoidant (dismissive) approach "includes rapid self-protective responses to danger without examining one's emotions, consulting other people or seeking to receive help from them [13]." The implicit script is, "If I am in distress, I volition carry on with other activities." In contrast, the broken-hearted approach is described as always beingness on guard for threat, and having difficulty receiving condolement. The implicit script is, "If I am in distress, I volition reach for you lot and achieve for you lot and achieve for you, endlessly and to no avail."

Attachment feet and avoidance are natural responses to the lack of confidence in the parents' emotional availability. Drawing from zipper theory, the EFFT therapist conceptualizes distress in terms of zipper dilemmas in which ineffective responses to attachment needs fuel miscommunication, creating parenting dysfunctions and exacerbating symptoms associated with individual psychopathology [14]. The therapist must obtain a clear understanding of symptoms that generate distress in the family and furthermore, evaluate the parent(south) availability and their children's confidence in their availability. These observations will provide the therapist with data about the attachment quality in the parent–child relationship. Insecure attachment is evident when the parent's capacity for empathy is blocked, giving precedence to feelings of feet and anger, thus viewing the child as difficult, antagonistic or uncooperative. In such instance, parents tend to blame the boyish or child equally solely the identified patient and remain oblivious to the underlying emotions, of fear, or sadness that are at play [xv]. The EFFT therapist connects the child/boyish's symptoms to their perception that the caregiver is unavailable and detached. This perception increases a child's anxiety, anger and defensiveness that contributes to the presenting problem [9, xvi]. The goal of the EFFT therapist is to work through a series of interventions that reframe the family problem equally 1 arising out of an zipper crunch, and afterward works to normalize family difficulties without blaming anyone [17]. Key to the EFFT process is understanding and integrating these core theoretical principals.

3. EFFT procedure: Steps and stages

The procedure of EFFT is categorized into three stages and nine handling steps. In the initial 4 treatment steps, the therapist carefully focuses on assessing the interactive styles of the family and judiciously works to deescalate whatever conflicts equally they sally. In the middle phases of treatment (steps five, six, and vii), the therapist and family unit, work in concert to detect new ways to institute more than secure familial relationships. In the final two steps of treatment, the therapist highlights and validates new patterns of positive interaction. Equally importantly, the therapist reinforces family unit members conviction to handle future conflicts and problems now that they are armed with greater empathy and understanding for one some other. The stages and steps of EFFT are outlined and discussed below.

3.1 Stage one: Deescalating family distress

Stride 1: Forming an alliance and family cess.
Footstep 2: Identifying negative interactional patterns that maintain insecure zipper.
Stride 3: Accessing underlying emotions informing interactional positions/relational blocks.
Pace 4: Reframing the problem in light of relational blocks and negative interaction patterns.

The principal focus in stage 1 is for the therapist to place and runway behaviors and secondary emotions that fuel attachment insecurities. The therapist guides the family away from focusing on the content of their presenting conflicts, to developing a more attentive awareness about what underlies their expressed difficulties. The therapist accomplishes this task by tracking familial behaviors driven past intense emotion. As therapists empathise, in times of distress, family members commonly deal with their feelings and interpersonal behaviors in unproductive ways. Some may withdraw, argue, submit, explicate, or engage in other behaviors designed to minimize and distract from their emotional pain. In this stage, the therapist pays shut attention to the interactive behaviors of the family and reframes maladaptive or secondary emotional responses in efforts to bring into awareness their negative cycle of interactions. A negative cycle is defined every bit a predictable interactional pattern that gets repeated and organizes the family unit around insecurity, rather than vulnerability. Negative cycles are fatiguing and subversive for family functioning. Tracking the cycle interrupts the behavior and reveals for the commencement time to the family their truthful underlying emotions and how their electric current behaviors serve equally protective mechanisms to avoid discomfort and hurting. Accessing primary emotions such as fearfulness, hurt, and sadness creates empathy among family members, facilitates responsiveness, and helps the family deescalate [18]. During this phase of treatment, the therapist often returns to utilizing tracking interventions to reemphasize to the family the importance of agreement and dealing with the underlying issues of their discontent in order to enhance family stability and healthy performance.

3.2 Stage two: Restructuring family interactions

Step 5: Accessing and deepening a child'southward disowned aspects of self and attachment needs.
Pace 6: Fostering acceptance of kid's new experience and attachment related needs.
Pace 7: Restructuring family unit interactions focusing on sharing attachment needs and supportive caregiving responses.

In phase two, the focus is on deepening and expanding primary emotions and unmet zipper needs, in society to reshape attachment bonds betwixt family unit members that are more than secure and connected. The change event in stage two involves the therapist accessing the needs embedded in the newly expanded principal emotions that drive the negative family bike; and helping family members acquire to place and asking that previously unexpressed core attachment needs be addressed. The therapist intentionally structures interventions known as enactments that function to restructure attachment bonds between family members [fourteen]. Typically, these requests are for straight care, contact, or comfort and the shift is premised on the parent(s) ability to respond to their children's vulnerability. It is very mutual in this stage to find parents having the desire to answer in a more than emotionally continued manner to their child, but their empathy may exist restricted. In such instances, the EFFT therapist will work with the parents to develop their capacity and ability to answer in a way that shifts family relationships toward more secure bonds, replacing negative and harmful cycles of interactions.

iii.three. Stage three: Consolidation

Step eight: Exploring new solutions to past bug from more secure positions.
Step 9: Consolidating new positions and strengthening positive patterns.

Finally, in stage three of EFFT, positive cycles of bonding are consolidated and integrated into the life of the family. At the end of this phase, the family is best able to integrate new ways of engaging in discussions and investing in greater security [18]. Discussions are characterized by more openness, responsiveness, and engagement amid family unit members. It is imperative for the family to learn how to repair failed attempts to connect outside of sessions. Before termination, the therapist affirms that the family is now able to handle its issues and conflicts by examining and resolving them in new and more constructive means. The therapist also focuses on amplifying the family'south vision to include more than mindfulness of positive affect, vulnerable reaching, and connection.

Advert

four. Core interventions

There are two primary sets of interventions utilized by EFFT clinicians to help families navigate through the diverse stages of the treatment process. These cadre interventions are designed to direct families toward developing relational bonds that enhance their security, advice and forcefulness. The outset set are interventions for accessing, expanding and reprocessing of emotional experience. The 2nd set are interventions for restructuring the family unit interactions.

The EFFT techniques used within these categories are described below, followed by an case of a therapist's response to highlight and reinforce a more concrete understanding of the techniques deployed. For a more detailed explanation the reader is referred to the EFT manual [three].

4.1 Accessing, expanding and reprocessing emotional experience

four.ane.1 Empathic reflection

Reflect (proper name, order, or distill) emotional processing as it occurs. Slows down the process, directs and focuses attending inwards, helps the therapist modulate to the client experience, thus carrying understanding and helps in creating brotherhood. Empathic reflections need to be specific and bright in order to motility the client into a deeper awareness of their emotional experiencing.

Therapist: "I retrieve I hear you say that you become so anxious well-nigh his future that you find yourself wanting to control, wanting to know what he has in mind because non knowing or not having 'a say' is so overwhelming. Is that it? And then you become very disquisitional with your son. Is that correct?"

four.1.2 Validation

Conveys that the client is entitled to their experience. Such statements part to affirm, and legitimize, the client's experience as understandable, given the attachment relationship context. Validating statements showtime with, "it makes sense that y'all would feel this way, given (state specific context)".

Therapist : " That makes sense to me, that when yous experience that things are most to escalate betwixt yous and your mom, you go away, and yous avoid whatever chat. Is that right?"

4.1.3 Evocative responding

Through the use of questions, evocative linguistic communication, and metaphors the therapist opens up the client's experience and encourages them to take another step toward information technology

Therapist: "What'southward happening right now equally yous hear him say that?" "What's it like for you when she follows you effectually the house, pushing for your attending?"

4.i.4 Heightening

This intervention intensifies, clarifies, and deepens an emotion through persistent focus, reflection or enactments. Thus, allowing the client to identify and accept their emotional experience. The therapist'south pacing, tone and timing are meaning. The acronym RISSSC, implying emotional risk [iii], represents how this intervention is washed: with repetition, images, speaking only, softly, slowly, and using client'south words. The soft tone heightens vulnerability and sooths the dysregulated brain, so the client can procedure clearly.

Therapist: "This sounds really important, tin we stay here for a flake, I think I hear you say that deep downwardly yous actually go to a bad place, a place where you get the message that you lot are nothing but a failure in their eyes. A real disappointment for a son, and that makes you feel so sad, then hurt inside."

4.1.5 Empathic conjecture

Therapist offers an interpretation of client's feel, or a hunch seen through the attachment lens. This facilitates a more intense experiencing from which new meanings may arise and an expanded awareness. Information technology is important to convey tentativeness when offering a conjecture and to check if what is communicated matches the client's experience.

Therapist: "As I listen to you, I hear you proverb that you are angry about her lack of business organization for y'all, but I see the tears in your eyes and I wonder if you are also saying that you are hurt by her lack of concern. Does that seem to fit?"

4.ii Restructuring interventions

The following interventions are used in EFFT to address the restructuring task:

4.2.1 Tracking, and reflecting interactions

Reflections that track family members behaviors tiresome down and clarify the interactional process.

Therapist: "And so, when Alex gets frustrated and walks away ignoring what you lot say, you get angry too and follow him. You need him to mind to you. And, when your mom follows you lot around wanting your attention it makes you shut down fifty-fifty more."

4.2.2 Reframing

Reframing interactions in the context of the negative cycle, and attachment needs. An attachment reframe functions to access a positive pregnant or intention for a seemingly negative response. It shifts the view of the member to a positive portrayal.

Therapist: "You don't experience that the louder she gets, the more desperately she is trying to find you. It sounds as if she is upset with you, just she is doing everything she tin to become shut to you lot."

four.2.3 Creating enactments

The therapist requests direct sharing of a clearly distilled message from ane family member to another. Enactments, the almost powerful intervention in EFFT, their role is to heighten emotional experience and reshape new interactions among family members which atomic number 82 to positive cycles of accessibility and responsiveness.

Therapist: "Can you tell her, 'I become away because I don't want things to get worse between the two of u.s..' Can you tell her this?"

5. Example analogy

To assistance illustrate EFFT handling in action, a case study of a family recently seen past the author is provided below:

The Aldo Family unit: Presenting Business organisation and Relevant History

The family unit is composed of James and Penny (names and identifying data take been contradistinct), a professional person couple in their early 50s, married for 28 years. They take two children; Ellie (23) and Alex (19). The couple has been on and off in couple therapy for a year. The presenting trouble described by the parents focused on their son Alex, who had told them at the end of his third semester in college that he wanted to drop out because "this kind of education" was not for him, and he did not see how it would help him become a chore. Both parents were very upset and later much give-and-take, hesitantly agreed to allow him to take a "gap year." Information technology was their understanding that after the year break, Alex was to resume his studies. During that fourth dimension Alex worked equally a waiter, earning spending coin while living at dwelling. His work hours provided him with the flexibility to develop an online business that in the long run became a source of income. Alex enjoyed being contained and learning virtually the world through travel, reading and much You Tube video viewing. A year later, his goal was to be an entrepreneur and not re-enroll in university. Both parents were extremely upset with Alex and had tried to talk "some sense" into him, simply to no avail. It was at this signal that Penny- the mom requested a family session.

During the first two sessions the therapist met once with the entire family unit in gild to assess they viewed the problem; and one time individually with Alex, in order to develop an brotherhood and get to know him better. Alex, was a slender fellow with short blond pilus, and green optics. He appeared younger than his years and was soft spoken as he stated that he was eager to start the process. Alex perceived his mother every bit critical, with potent opinions about a college education and persistent virtually him returning to school. This made him angry and he said that he frequently avoided conversations with her because they ever ended upward on the topic of his hereafter. Mom viewed her son as unreasonable, and disrespectful because he ignored her questions and refused to appoint with her. She experienced him every bit spoiled, entitled and selfish; this made her experience frustrated. James agreed with his wife and said that the tension betwixt Alex and his mother stressed him, but he did not know what to do to resolve the issue.

Right from the start the EFFT therapist aims to understand the ways family members react to each other and tracks their interaction design. As family members discuss how they each perceive their concerns, reactive emotional responses are expressed or suppressed, thus assuasive the therapist to witness the negative interaction pattern firsthand. The therapist tracks and reflects the behaviors that elicit the negative response and begins to identify the family unit pattern that is associated with the problem [3, four]. It was obvious that this family was defenseless in a reactive pattern of defensiveness, which escalated with increasing acrimony and frustration. The family's escalation included mom trying to advise Alex and Alex fugitive the chat. The more mom insisted in engaging him the more Alex ignored her and she would become so upset that she would turn to her husband for help. James, not knowing what to do would try to calm her by promising he would talk to Alex. Nonetheless, his approach was not successful either. The more they tried to talk to him or present him with consequences for his actions, the more Alex pulled away. The more he pulled away, the less valued they felt. It appeared to be a hopeless state of affairs.

5.1 EFFT therapeutic interventions

5.1.1 Phase i: Family unit De-escalation

What follows is an actual dialog from the initial sessions with the family. This excerpt highlights the goal of stage one treatment to rail the bike betwixt Alex and his mom and attempt to deescalate the tensions between family unit members.

ALEX: Well, yeah… she is unbelievable. She asks me questions, a lot of questions about what I am going to exercise with my life and I do answer her merely a few days after she is asking me the same questions!

THERAPIST: all these questions coming your fashion, regarding your time to come and you answer them, then she asks again. Is that correct?

ALEX: Aye, it's and then frustrating because it's like, does she not call back? What's going on?

THERAPIST: I can understand your frustration- considering, you wonder 'isn't what I say important enough to remember' Is that right?

ALEX: yes, that'southward exactly correct.

THERAPIST: When your mom asks the same question, what happens inside you? What do you say to yourself?

ALEX: I hear myself maxim, what is the point? I get frustrated.

THERAPIST: Are you feeling frustrated right at present?

ALEX: Yes!

THERAPIST: Would you be willing to stay curious with me for a moment about this office that feels frustrated? Do you notice it somewhere in your body? ( staying with emotion in his torso slows him down and intensifies the feeling).

ALEX: I feel tightening in my breast and my shoulders.

THERAPIST: you hear your mom request another question about your plans, you lot get frustrated, which you notice equally a tightening in your breast and shoulders, is that right?

ALEX: yes.

THERAPIST: And then what does this frustrated function desire to do or say to mom?

ALEX: It wants to avoid her.

THERAPIST: How do you exercise that?

ALEX: Past ignoring her and eventually leaving the room.

THERAPIST: What would happen if you lot did non ignore her and did not exit; if you stayed and talked with her?

ALEX: Nothing good would come out of that. I volition only disappoint her again. In that location is no point.

THERAPIST: So, if talking makes it worse and you lot worry that yous will disappoint her, so it makes sense that you practise non want to engage. It sounds like when these fights happen there is nothing more than to exercise merely exit. Is that correct?

ALEX: That seems to be the best option, right and then and there.

THERAPIST: It makes sense to me that you leave the conversation to avoid making things worse between the 2 of you and, non disappoint your mom. Do you think your mom knows this? Can you tell her that you lot leave in gild to not escalate things between the two of y'all?

ALEX: (turning to mom) I do not get into it with you and I walk away considering I do not want the states to fight and I do not want to disappoint you.

MOM: I had no idea.

THERAPIST: Yep (nodding). This is something new you are learning about Alex.

The therapist also works with mom to place her behaviors, thoughts and feelings as they relate to the negative bike.

THERAPIST: And when he walks away what happens to you?

MOM: I get fired up and I follow him, and I ask again. I insist that he listens to me and not ignore me.

THERAPIST: Would y'all be willing to stay curious with me for a moment nearly this function that gets all fired up? Exercise y'all notice it somewhere in your body?

MOM: I feel tense all over.

THERAPIST: you run across Alex walk away, y'all become very angry, which y'all notice as a tension all over your body, is that right?

MOM: Yes.

THERAPIST: And and so what does this aroused part do or say to Alex?

ALEX: It gets very focused, very energized, and follows him relentlessly to become his attention.

THERAPIST: What would happen if you lot did not exercise that?

ALEX: I would not know what he is upward to and I would not be able to help him. I have proficient advice- I have been where Alex is now, and I can maybe spare him the heartache if he would talk with me. I worry that he volition make a mistake, just he does not value my input.

THERAPIST: You want Alex to value your advice. So, you go angry and you insist on engaging in a conversation in the hopes that you can assist him come across the value in what you say. Is that right?

MOM: That'due south correct.

THERAPIST: What does it experience like when y'all think that Alex does not value you?

MOM: (deep sigh) It feels distressing.

THERAPIST: You want him to value y'all and your input and when he does not that makes yous feel sad. Is that right?

MOM: (in soft voice) yes.

THERAPIST: Do y'all think Alex knows that? What would information technology exist similar to share a little bit of that with him? That underneath your anger yous feel distressing considering y'all think that he does non value you? Tin yous tell him that?

five.1.i.1 Treatment focus and progress in stage one

In the above excerpt the therapist looks at the design every bit information technology unfolds in the room between Alex and his mom. Family de-escalation occurs equally Alex and his mom begin to understand their part in the negative interaction blueprint and how their attachment-driven behaviors trigger anticipated responses in each other. In this instance every fourth dimension mom needed to be assured that Alex was on the correct path regarding his future, she asked questions which in turn triggered Alex and made him feel that an statement was imminent and he would disappoint his mother. He and so pulled away to avoid the argument, leaving mom to feel pitiful and not valued and fearful that she was declining equally a mother. This triggered mom and she then followed Alex around the firm insisting that he engage with her. Alex would get more frustrated and somewhen would get out the room thus confirming mom'due south fear of non beingness valued. The therapist helps both uncover these deeper emotions and so invites them to do an enactment. In other words, to turn toward each other and engage in a different chat. Until now, neither was enlightened how they protected themselves in their relationship nor had they been able to talk most their underlying feelings. The enactment is successful, and both Alex and mom accept a new understanding near each other's behavior. He expresses that he values her and wants to be able to talk with her without arguing because information technology does not feel practiced to either of them. They both share in the new experience of staying engaged. This sensation shifts the focus from blaming each other to attributable their contribution in the negative cycle. In turn, this begins to alter their experience; they feel calmer and more open. A level of safety is created that will let us to get deeper into vulnerabilities in the next stage.

5.1.two Stage two: Restructuring family unit interactions

What follows beneath is an example of actual dialog used to illustrate the process of restructuring family dynamics:

THERAPIST: A few sessions ago you talked about feeling sad considering you lot come across yourself as a thwarting for your parents. Practice yous recall?

ALEX: Mhmm.

THERAPIST: I guess, I am curious to know, more than about this place that yous go to… when you lot feel that… you are a thwarting. Is it okay for us to go to that place?

ALEX: Sure. (pause) It's pretty bad. I try not to think nigh it. Instead, I just try to focus and piece of work harder.

THERAPIST: It's so bad that y'all try to not remember about information technology? Correct now as we are thinking most it, talking about, notice what happens in your body.

ALEX: I feel flushed and I feel tightness in my pharynx. It's a bad feeling. That'southward why I practice not like to call up near information technology.

THERAPIST: Sure, information technology makes sense. And… who sees you in that place? Who knows about that?

ALEX: Nobody knows. Nobody sees how much I endeavor to make them proud of me. Instead I am told that everything I exercise is wrong. My whole approach is wrong, I am all wrong! (eyes airtight).

THERAPIST: That's actually painful—it'southward hard for you.

(Long Interruption)

ALEX: Sometimes information technology feels that I might exist running out of time… yous know… my dad had problems with his heart final year. (At this point Alex, with his optics airtight and tears running downwardly his cheeks, can hardly speak. Afterward a long pause he continues). I am afraid that I might non accept the take chances to evidence myself and it volition exist too late. And that peradventure I should give upwardly on my ideas and heed to theirs considering information technology will exist faster, but then I become conflicted and I think that, it's not right to do something that I do not believe in. And I really believe in this. I do not want to disappoint them but I do not want to disappoint myself either.

THERAPIST: Wow! It feels like you are running against time and yous accept to choose - your parents or yourself. Neither is a good choice; and so you go here and y'all struggle, and you are confused and scared and lone trying to effigy things out.

Alex is sobbing, and his dad reaches over and hugs him. His mom moves over and she too, sits beside him and hugs him.

THERAPIST: Alex, your parents are right abreast you. They want to understand. Can you let them in to that place where you lot are alone and sad?

ALEX: I am scared when I recollect that something suddenly might happen to dad or to you (mom) like last year- and then you would not accept the chance to come across what I accomplished and be proud of me. Then you will never know that I am capable and that it's ok to do it my manner.

THERAPIST: That is scary, to think that something might happen to either of your parents and trying to evidence yourself, trying to get information technology correct and non disappoint while yous nevertheless have time.

DAD: I am so distressing that you are so injure. I am, we are not disappointed in y'all and nosotros do not desire to "set yous" or "change y'all". Nosotros love you no matter what you lot practise and at present that I know I will do anything to be there for y'all. I am deplorable that our pushing- our mode of trying to help you caused y'all so much pain. Nosotros love you and want to back up y'all, in a way that is best for y'all.

ALEX: I could go out the house, but I really desire to piece of work on our human relationship, because it is of import that I, take both of your "blessings" as I move on. It is important, that I leave "the nest" every bit you say, knowing that you are proud of me and you love me, fifty-fifty if I failed. It's like, the baby bird trying to fly out of the nest. The parents have to trust that he can practise it- although they may not know for sure. If the baby bird falls, he needs his parents to lovingly encourage him to attempt over again. Sometimes, he flops around for a petty bit before the parents rush in to assistance, and that is ok. The trivial bird is learning even if he falls, even if he breaks a wing. Keeping the bird in the nest or constantly giving him directions how to wing is constraining—he will not find his way. I guess what I am request is… do you retrieve you tin can be in that location every bit I try to figure things out? I want to find my mode and can yous trust that I will exist okay–without flying in to assist me or endeavour to alter my path?

DAD: "I had no thought that you lot felt this mode; that you take been trying to fly out of the nest. I didn't see all this as your effort in figuring things out. What I thought I saw, was a little bird taking advantage of the safety provided by our nest and unless we pushed, you were not going to wing. I see now how that hurt you and how it made you experience that we didn't trust you. I love yous and want to back up you and it's pretty incredible to hear what has been going on for you."

At this point Alex is weeping in his begetter'southward arms. Mom joins in the hug and subsequently a small break, with tears in her optics says:

MOM: "I am so deplorable I hurt you. I get scared and I rush in to assistance you, to relieve you, to show you and that makes you feel that I don't believe in y'all. I want to exist at that place for yous. I don't desire you to experience this way."

5.1.2.1 Treatment focus and progress in stage two

In the above extract, Alex begins to talk virtually how scary it is to feel that he disappoints his parents and how he wants to make them proud before he loses either of them. His parents remain open up hearted and open up minded every bit he engages with them from a vulnerable place. They meet his pain, hurt and fearfulness. Dad not only sees from afar this terrible place that his son struggles in but tin can stand side past side with him at that place. His presence is felt, and his apology makes a huge difference to Alex. For the first fourth dimension, Alex feels seen and feels understood at a much deeper level and therefore, this allows Alex to conspicuously articulate his attachment needs. Mom and dad worked together to answer to Alex. Often parents cannot empathize because they get defenseless upward in their own secondary responses of fear. Staying nowadays with Alex in his vulnerability allowed both parents to experience how Alex'southward problematic beliefs was related to the family unit'southward negative cycle of interaction. In a afterward session, both parents were able to clear their fear of failure and Alex was able to hear this and understand much of their stress as parents. He then reassured them, "y'all have been cracking parents, given me so much. I hope to exist able to offer my kids what y'all have offered me. I love you both and I don't want you to experience that y'all have failed equally parents." Additionally, he expressed regret for his past behavior toward his mother. Alex began to ask for contact, and this continued in following sessions which helped to bring them closer together.

5.ane.iii Stage three: Consolidation

What follows below is an instance of actual dialog used to illustrate the process of consolidation:

MOM: Things are good. Alex initiated a conversation before this week where he confided in me and asked for my advice. He was telling me about an incident that happened at work and how he handled it. Then asked for my opinion–how I would have handled it.

ALEX: (smiling) "That was nice, and dissimilar than times in the past. She did non practise anything, other than only listen.

(Turning toward his mom) You did not try to set up or problem solve with me the way you used to with all the questions. You listened to me for a long time and then I think that I asked you for advice. You lot said that you agreed with how I handled the matter and you would take washed the same. Information technology really felt good to talk to you lot like an developed without running away or avoiding y'all. I want to say, thank you for that because I feel less tense and more relaxed.

THERAPIST: That'due south really great Alex that you felt practiced to approach your mom and discuss something that was of import to yous and inquire for her input. And it sounds that you both had this conversation in a different way than before. In a style that even feels different in your body.

ALEX: Yep. Growing up and doing things differently than the way your parents wait is hard and tin can exist kind of scary. Knowing that they are open and that my mom is in that location without judging me feels dandy.

MOM: I am so glad that we turned a corner. I am e'er here for you, no matter what and I want to be the mom you want me to be.

5.1.three.i Treatment focus and progress in stage iii

In the above excerpt mom discovers during treatment that she could help her son by her attentive presence. She understands that she did non have to solve Alex'southward problems or get "hole-and-corner" to find out what he was doing and, every bit a result, this helped her stay more connected with him. The relationship became safer, closer, and more equal. Both were able to confide in and support each other which is the desired result for stage three handling.

six. Conclusions

Treating families in distress is extremely challenging for family therapists. Professionals working with families, especially neophytes, usually experience uncertain and discouraged equally they attempt to navigate the vast landscape of family dynamics encompassing multiple, circuitous interpersonal processes betwixt members. Every bit a issue, family unit therapists find themselves negotiating or offering solutions to presenting issues, rather than focus on the underlying issues that are at the root cause of the dysfunction. Unfortunately, they soon realize the techniques used are not effective, and before long the family members bike dorsum where they started from. This makes the therapists feel inefficient and ineffective and therefore may shy abroad from doing family work.

Having access to a practical, organized and effective model for working with families is pivotal if practitioners are to make meaningful differences in the lives of people they serve. EFFT arose from the realization that the modify principles used in EFT could be applied to family relationships thus irresolute the cycles of interaction [iii]. EFFT is a powerful and efficient way to assess and create positive change within the family unit system. At its core, EFFT views family distress as a result of attachment insecurity where family unit members fail to go their attachment needs met. Such families do not possess the skills necessary in expressing their zipper needs and protect themselves by becoming defensive, get-go a negative bike of interaction which prevents good for you family functioning and stability. Accessing underlying attachment-related emotions and the needs associated with these emotions opens the family to address needs in new means [three]. Corrective emotional experiences create safety that change family relationships and most likely touch hereafter generations. Tapping into parents' unconditional love is powerful; information technology offers families great hope and holds tremendous promise in revitalizing the field of family therapy.

References

1. Bloch L, Guillory PT. The attachment frame is the thing: Emotion-focused family therapy in adolescence. Journal of Couple & Relationship Therapy. 2011;10(3):229-245
2. Stavrianopoulos K, Faller G, Furrow JL. Emotionally focused family therapy: Facilitating change within a family system. Periodical of Couple & Human relationship Therapy. 2014;13(i):25-43
3. Johnson SM. The Do of Emotionally Focused Couple Therapy: Creating Connection. second ed. New York (NY): Brunner-Routledge; 2004
4. Johnson SM. The Practice of Emotionally Focused Marital Therapy: Creating Connection. New York (NY): Brunner/Mazel; 1996
5. Rogers CR. Client-Centered Therapy. Boston: Houghton-Mifflin; 1951
6. Minuchin S, Fishman HC. Family Therapy Techniques. Cambridge (MA): Harvard University Press; 1981
7. Bowlby JA. Secure Base of operations. New York (NY): Basic Books; 1988
8. Karen R. Becoming Fastened: Commencement Relationships and how they Shape our Capacity to Beloved. New York (NY): Oxford University Press; 1994
9. Bowlby J. Attachment and Loss: Separation. Vol. 2. New York (NY): Bones Books; 1973
10. Johnson SM. Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Zipper Bonds. New York (NY): Guildford Press; 2002
11. Kobak R. The emotional dynamics of disruption in zipper relationships: Implications for theory, enquiry, and clinical intervention. In: Cassidy J, Shaver P, editors. Handbook of Attachment: Theory, Research, and Clinical Applications. New York: Guildford Press; 1999. pp. 21-43
12. Shaver PR, Mikulincer M. Attachment-related psychodynamics. Attachment & Human being Evolution. 2002;four:133-161
13. Mikulincer K, Shaver PR. Attachment in Machismo: Construction, Dynamics, and Change. 2nd ed. New York: Guildford Printing; 2016
14. Johnson SM. Listening to the music: Emotion as a natural part of systems theory. Journal of Systemic Therapies. 1998;17:1-17
15. Kobak R, Mandelbaum T. Caring for the caregiver: An attachment arroyo to cess and treatment of kid problems. In: Johnson South, Whiffen V, editors. Zipper Procedure in Couple and Family Therapy. New York: Guildford Printing; 2003. pp. 144-164
xvi. Miccuci JA. The Adolescent in Family Therapy: Breaking the Cycle of Conflict and Control. New York: Guildford Press; 1998
17. Palmer 1000, Efron D. Emotionally focused family unit therapy: Developing the model. Journal of Systemic Therapies. 2007;26:17-24
18. Johnson SM, Bradley B, Furrow J, et al. Becoming an Emotionally Focused Couple Therapist; the Workbook. New York: Brunner-Routledge; 2005

Written Past

Katherine Stavrianopoulos