3 Module 1 | Part 2: The EFT Model: An Attachment-Based Humanistic Experiential Therapy

Tuning In and Finding Focus in eFit

Roadmap for Trauma: Understanding trauma through the lens of attachment.
Safe Haven Alliance: Creating a secure base as temporary attachment figures.
Process-Based Assessment: Attachment-based experiential assessment; emphasizes joining with clients, not checklists.
Video Demonstration: Highlighting key principles of joining with clients.
CARE Model: A joining approach focusing on Context, Attachment, Relationship (therapeutic alliance), and Emotion.
Pacing the Process: Paying attention to pacing and charting the course of therapy.

Understanding Trauma

Definition of Trauma: Events falling outside the capacity to manage alone. Examples include car accidents, war, and developmental trauma.
Focus on Impact: Emphasizing the emotional and relational consequences, not the events themselves.
Emotional Management: Examining how clients manage trauma emotionally and relationally.
Safe Sharing: Assessing if clients were able to share the experience with a safe other.
Traumatic Experiences: Flood individuals with physical fear and helplessness, the very opposite of secure attachment.
Trauma's Effects: Colors the world as dangerous, promotes vigilance, and undermines affect regulation.

Attachment and Trauma

Attachment Security: Secure attachment promotes affect regulation and integration, the opposite of the dysregulation common in traumatic experiences.
Chaos and Storytelling: Trauma creates chaos, often scattered storytelling.
Cohesive Sense of Self: Trauma threatens a cohesive sense of self, while eFit aims for a felt sense of security.
Reclaiming Disowned Aspects: Goal is to help clients reclaim disowned aspects of self.
Protections as Prisons: When protections become prisons, clients feel lost and disconnected from themselves.
Finite Attachment Strategies: Shutting down, numbing out, or intensifying affect can impact personality development.
Finding Yourself: Connecting with emotional experience facilitates self-discovery.
Promoting Engagement: Encouraging engagement in the here and now and resonance with others, openness to experience, risk-taking, and new learning.
Being Fit for Life: Moving clients into "existential living".

Factors Influencing Trauma's Impact

Non-Interpersonal vs. Interpersonal: Differentiating between traumas that involve relationships and those that do not.
Multiple Exposures: Cumulative impact of repeated traumatic events.
Proximity to the Event: The closer one is to the trauma, the greater the impact.
Duration: Length of time exposed to trauma.
Age: Age at the time of trauma influences its effects.

Key Variables

Join with clients with a curious stance rather than making assumptions.
Model of Self: How clients describe themselves.
Model of Other: How clients relate to and describe others.
Affect Regulation: How clients manage emotions.
Prototypical Strategy: Typical methods for managing threat or distress.
Window of Tolerance: Capacity for managing emotions and flexibility of emotional strategies.

The Therapeutic Alliance and Safety

Voice and Presence: The way the therapist joins with clients impacts their sense of safety.
Mirroring: Reflecting clients' experiences helps them feel seen, heard, and understood.
Self-Compassion: Clients can begin to feel self-compassion as therapists reflect, track, and validate their experiences.
Predictability: Therapists should be predictable, accessible, responsive, and engaged.

Rationality, Not Pathology

Look past diagnoses.
Track, reflect, validate, and make sense of experiences.
Consider the rationality of behaviors (e.g., shutting down as a coping mechanism).
Address shame and help clients receive care and love.

UP Model and Attachment

Basic processes like vigilance, emotional awareness, and avoidance are critical.
Avoidance doesn't work in the long term.
Sensitivity to threat becomes a significant issue for people.

Pivotal Experiences

Developmental transitions that have shaped models of self and other for good and for bad.
Access and utilize client resources.
Remind them of moments of competence and success.
Attachment theory tells you what goes wrong and where the blocks are, but it's also an incredible source of resources.

Homework

Do not give clients homework.
Help clients emotionally become more flexible and move into different kinds of experiences.

Emotional Handles

Tune into poignant phrases and images that capture clients’ felt experiences.
Use these "emotional handles" to deepen and evoke experiences.

CARE Model Dimensions

Context

Identity
Environmental factors
Experiences
Temporary attachment figures
Intergenerational context.

Attachment

Pivotal experiences that have shaped models of self and other
Coherence of the narrative.

Relationship

Safe haven where clients can begin to explore and move through difficult experiences.

Emotion

Self-criticism, numbing, detachment
Facial cues, ways of sharing, emotional handles.

Understanding the CARE Model

The CARE model involves understanding the client's background (context), attachment history, therapeutic relationship (alliance), and emotional experience. It aids in joining with the client and making sense of their experience.

Context: Family origins, beliefs about safety, experiences with discrimination.
Attachment: Injuries, disappointments, and their impact on self-perception.
Alliance: Feeling safe with the therapist.
Emotion: Dancing with emotions, being receptive to them or suppressing them, and staying attuned to these four dimensions throughout the process of therapy.

Context Example

Naz talked about growing up with God and Allah, her father came from Iraq and her mother from South America.

She talked about letters to God hoping that somebody would save her and understand her.
She talks about growing up in a predominantly white community when we talk to her about the goals of therapy or what brought her there.
She talks about being on the verge of entering a marriage with a person she describes as a white male and not sure about how to manage that and noting that for years and she's in her late twenties, early thirties, she has done everything she can to remove herself from her history.
She has memories associated with parental violence and abuse.

Client Strengths

Nas is resourceful, she has a successful business, she has a fiance who loves her and supports her, she has a lot of stability in her current context. She has the capacity to then move into,to use the Tango both as a means of assessment and as a way of joining with her and introducing the model essentially.

Client Weaknesses

With other clients, it may not be so. As we were alluding to earlier, some of our clients come to us with addictions or with very limited capacity, and we need to spend lots of time in stage one of the process, resourcing them.

Assessment & Structuring the Process

It's important to know whether clients are able to manage what we're going to ask of them emotionally and relationally.

Tuning In and Finding Focus in eFit

Roadmap for Trauma: Understanding trauma through the lens of attachment theory, focusing on how early attachment experiences shape responses to trauma.
Safe Haven Alliance: Creating a secure base with the therapist acting as a temporary attachment figure to provide safety and support.
Process-Based Assessment: Utilizing attachment-based experiential assessment to deeply understand the client’s experiences; this involves joining with clients empathetically rather than using standardized checklists.
Video Demonstration: Illustrating and highlighting key principles of effectively joining with clients to build rapport and trust.
CARE Model: Implementing a joining approach that emphasizes: Context (understanding the client's background), Attachment (exploring past relationships), Relationship (building a strong therapeutic alliance), and Emotion (addressing emotional experiences).
Pacing the Process: Carefully managing the therapeutic process by paying close attention to pacing and thoughtfully charting the course of therapy to avoid overwhelming the client.

Understanding Trauma

Definition of Trauma: Defining trauma as events that exceed an individual's capacity to manage alone, encompassing experiences such as car accidents, war, and developmental trauma.
Focus on Impact: Prioritizing the emotional and relational consequences of trauma over the specific details of the events themselves, emphasizing the subjective experience.
Emotional Management: Analyzing how clients manage trauma emotionally and relationally, examining coping mechanisms and emotional regulation strategies.
Safe Sharing: Evaluating whether clients were able to share their traumatic experiences with a safe and supportive person, and the impact of that sharing on their healing process.
Traumatic Experiences: Recognizing that traumatic experiences flood individuals with intense physical fear and helplessness, which directly opposes the sense of security fostered by secure attachment.
Trauma's Effects: Acknowledging that trauma colors the perception of the world as dangerous, leading to heightened vigilance and impaired affect regulation, impacting daily functioning.

Attachment and Trauma

Attachment Security: Understanding that secure attachment promotes affect regulation and integration, serving as a buffer against the dysregulation commonly triggered by traumatic experiences.
Chaos and Storytelling: Recognizing that trauma often results in chaotic and fragmented storytelling, reflecting the disorganized nature of traumatic memories.
Cohesive Sense of Self: Highlighting that trauma can threaten an individual's cohesive sense of self, whereas eFit aims to restore a felt sense of security and integration.
Reclaiming Disowned Aspects: Establishing a therapeutic goal to help clients reclaim disowned aspects of themselves, fostering self-acceptance and wholeness.
Protections as Prisons: Addressing how protective mechanisms can become prisons, leading clients to feel lost and disconnected from themselves, limiting their ability to engage fully in life.
Finite Attachment Strategies: Exploring how shutting down, numbing out, or intensifying affect can impact personality development, creating rigid patterns of behavior.
Finding Yourself: Emphasizing that connecting with emotional experiences facilitates self-discovery, allowing clients to gain deeper insights into their identities and needs.
Promoting Engagement: Encouraging engagement in the here and now and resonance with others, fostering openness to experience, willingness to take risks, and embracing new learning opportunities.
Being Fit for Life: Facilitating clients' movement into "existential living," where they can live authentically and purposefully.

Factors Influencing Trauma's Impact

Non-Interpersonal vs. Interpersonal: Differentiating between traumas that involve relationships (interpersonal) and those that do not (non-interpersonal), recognizing the unique impact of each.
Multiple Exposures: Understanding the cumulative impact of repeated traumatic events, considering the effects of compounding trauma.
Proximity to the Event: Recognizing that the closer one is to the trauma, the greater the potential impact, accounting for direct exposure versus indirect exposure.
Duration: Considering the length of time exposed to the trauma, as prolonged exposure can exacerbate its effects.
Age: Recognizing that age at the time of trauma significantly influences its effects, with considerations for developmental stage and vulnerability.

Key Variables

Join with clients with a curious stance rather than making assumptions, demonstrating openness and a desire to understand their unique perspective.
Model of Self: Assessing how clients describe themselves, exploring their self-perception and self-esteem.
Model of Other: Evaluating how clients relate to and describe others, examining their interpersonal patterns and expectations.
Affect Regulation: Understanding how clients manage emotions, including their ability to modulate and cope with emotional experiences.
Prototypical Strategy: Identifying typical methods for managing threat or distress, recognizing common coping mechanisms and defense mechanisms.
Window of Tolerance: Assessing the capacity for managing emotions and flexibility of emotional strategies, determining the range of emotional experiences a client can handle without becoming overwhelmed.

The Therapeutic Alliance and Safety

Voice and Presence: Recognizing that the way the therapist joins with clients directly impacts their sense of safety, emphasizing the importance of a calm and reassuring demeanor.
Mirroring: Reflecting clients' experiences to help them feel seen, heard, and understood, fostering empathy and validation.
Self-Compassion: Facilitating clients' ability to feel self-compassion as therapists reflect, track, and validate their experiences, promoting self-acceptance and kindness.
Predictability: Ensuring that therapists are predictable, accessible, responsive, and engaged, creating a consistent and secure therapeutic environment.

Rationality, Not Pathology

Look past diagnostic labels to understand the individual's unique experiences and behaviors.
Track, reflect, validate, and make sense of experiences to promote insight and understanding.
Consider the rationality of behaviors (e.g., shutting down as a coping mechanism) in the context of the client's history and circumstances.
Address shame and help clients receive care and love, fostering self-worth and emotional healing.

UP Model and Attachment

Basic processes like vigilance, emotional awareness, and avoidance are critical components of understanding clients' responses.
Avoidance doesn't work in the long term, leading to increased distress and dysfunction.
Sensitivity to threat becomes a significant issue for people who have experienced trauma, contributing to hypervigilance and anxiety.

Pivotal Experiences

Developmental transitions that have shaped models of self and other for good and for bad, influencing attachment patterns and relational expectations.
Access and utilize client resources to build resilience and promote coping skills.
Remind them of moments of competence and success to reinforce positive self-perception and self-efficacy.
Attachment theory tells you what goes wrong and where the blocks are, but it's also an incredible source of resources for promoting healing and growth.

Homework

Do not give clients homework, as it can be counterproductive and may increase distress.
Help clients emotionally become more flexible and move into different kinds of experiences to promote adaptability and resilience.

Emotional Handles

Tune into poignant phrases and images that capture clients’ felt experiences, paying attention to the nuances of their emotional expression.
Use these "emotional handles" to deepen and evoke experiences, facilitating emotional processing and insight.

CARE Model Dimensions

Context

Identity: Exploring the client's sense of self and how it is shaped by various factors.
Environmental factors: Assessing the impact of the client's surroundings on their well-being.
Experiences: Understanding the client's life experiences and their influence on their current functioning.
Temporary attachment figures: Recognizing the importance of supportive individuals in the client's life.
Intergenerational context: Exploring the impact of family history and patterns on the client's current situation.

Attachment

Pivotal experiences that have shaped models of self and other, influencing attachment patterns and relational expectations.
Coherence of the narrative: Assessing the client's ability to create a coherent and meaningful narrative of their life experiences.

Relationship

Safe haven where clients can begin to explore and move through difficult experiences, fostering trust and security in the therapeutic relationship.

Emotion

Self-criticism, numbing, detachment: Addressing negative emotional responses and coping mechanisms.
Facial cues, ways of sharing, emotional handles: Paying attention to nonverbal cues and emotional expression.

Understanding the CARE Model

Context: Family origins, beliefs about safety, experiences with discrimination, cultural background, and socio-economic status.
Attachment: Injuries, disappointments, and their impact on self-perception, attachment style, and relationship patterns.
Alliance: Feeling safe with the therapist, trust in the therapeutic process, and the strength of the therapeutic bond.
Emotion: Dancing with emotions, being receptive to them or suppressing them, and staying attuned to these four dimensions throughout the process of therapy, recognizing and validating emotional responses to promote emotional processing.

Context Example

Naz talked about growing up with God and Allah, her father came from Iraq and her mother from South America. The CARE model emphasizes the crucial need of understanding family origins, safety beliefs, discrimination experiences, cultural contexts, and socioeconomic status as vital aspects of a client's background.

She talked about letters to God hoping that somebody would save her and understand her.
She talks about growing up in a predominantly white community when we talk to her about the goals of therapy or what brought her there.
She talks about being on the verge of entering a marriage with a person she describes as a white male and not sure about how to manage that and noting that for years and she's in her late twenties, early thirties, she has done everything she can to remove herself from her history.
She has memories associated with parental violence and abuse.

Client Strengths

Client Weaknesses

Assessment & Structuring the Process

It's important to know whether clients are able to manage what we're going to ask of them emotionally and relationally, ensuring that the therapeutic approach is tailored to their individual needs and capacities.