Working With Traumatized Partners - EFT Couple Therapy Switzerland

How is relationship repair different for traumatized couples? (check all correct answers.)

Negative cycles and absorbing states of negative emotion are often more complex and more tenacious.

Distrust is higher in the survivor.

The nontraumatized partner may show signs of secondary PTSD from living in the shadow of the trauma, and so need additional support.

The alliance with the survivor is often more fragile and must be more actively monitored. The therapist is more explicitly collaborative and transparent, able to be seen.

Emotional storms, crises, and relapses must be expected and weathered.

Assessment must focus on possible violence and substance abuse and any risk of self-harm.

Emotion must be more actively contained at times; for example, flashbacks may occur as emotions are heightened in a session

A psychoeducational component on trauma is necessary.

In Step 2 the effects of trauma and how it is coped with are included in the description of the negative interactional cycle

Shame is a key part of complex PTSD and must be actively addressed. Survivors do not feel entitled to caring and often blame themselves for the traumatic abuse.

The destination is different and more unique to each couple. For example, sexual expression may be more limited even at the end of therapy.

Couple interventions must be coordinated with other therapies.

Therapy takes longer. Integration of new steps often takes longer.

Risks must be sliced thinner, defenses validated.

It is rare for PTSD to appear alone. It is often laced with depression, somatization, and negative coping responses, such as self-mutilation. Therapist must explicitly ask about how the person copes, so assessment is exceptionally thorough.

The therapist needs to take more care of his/her own needs for support and nurturing to work with the intense distress of trauma survivors.

How is emotion contained; for example, in a flashback that occurs in a session? (For an example, see the excerpt in JMFT, 1998, 24, p. 24.)

As in regular EFT, the therapist slowly tracks, reflects, and organizes the strong emotions/images as they occur.

The therapist validates, normalizes, and explicates strong emotional responses.

The therapist coaches the client in affect regulation skills.

The therapist can use grounding techniques, talking a client through a flashback and reflecting present realities, as in, “Can you feel your back against the chair, feet on the floor. Can you breathe slowly. This is what happened…”

How does the EFT therapist deal with recurring shame and self-blame responses? (Self-blame mediates adjustment in CAS survivors)

The therapist normalizes self-blame as often being the only coping mechanism open to the survivor and seeming preferable to complete helplessness.

The therapist frames self-blame as an alternative to the loss of an abusing or abandoning attachment figure and so experiencing isolation.

The therapist tracks the impact of self-blame and the hiding stance that goes with shame on the present relationship.

The therapist actively uses his/her acceptance and empathy to counter self-blame.

The therapist uses the compassion and acceptance of the other spouse in enactments to counter the survivor’s self-blame.

The therapist mainly works on extensive insight into the survivor’s past and the creation of his or her model of self.

With this couple in this session the EFT therapist is likely to:

Move to contain this loaded topic and help couple negotiate, increase their “skills,” and make a contract regarding the phone.

Help Ed talk about his limits and support the partners being more independent and having “boundaries” preventing future power struggles.

Frame the process of interaction in terms of attachment needs and fears and validate Jane’s experience (without blaming Ed).

Write out the text of the answer you have chosen above. What would you say?

As an EFT therapist give three responses you might make at this point:

At the end of Stage 2 of EFT, what kind of corrective emotional dialogue does the therapist want to help Ed and Jane structure? What will it look like? Write out the ideal dialogue/set of responses. Begin with the therapist structuring it, as in “Can you tell her/him…”

The fact that Ed, in a moment of doubt after questioning by the police, accused Jane of wanting sex with the rapist was an attachment injury—a moment that continues to define the relationship as dangerous. How might you frame this injury and its impact on the relationship to the couple (how might Ed found himself doing this—how would Jane have heard it, how does it constrain their present interactions?):

The EFT therapist views depression as:

A natural integral part of intense separation distress in an attachment relationship.

A natural response to loss and lack of connection.

A response to the sense of failure and unworthiness/inadequacy that often occurs in a distressed relationship

A response to self-criticism where the self is viewed as weak and dependent for needing others and being vulnerable to them.

A natural response to a sense of helplessness in sudden crises or transitions, such as the birth of a child, where attachment needs arise and are, in fact, not met.

A personal response that is best understood in the context of a cycle of interactions with key attachment figures, rather than in an “in the head” variable.

10.

The EFT therapist will then naturally put a partner’s depression in the context of __________ and __________.

11.

In the first stage of EFT, depressive responses are placed in the context of:

Models of self and how they were formed in childhood.

Negative interactional cycles, such as desperate pursuit and hopeless distancing.

Unmet attachment needs and fears.

Self-defeating patterns of cognition.

12.

In the second stage of EFT, depressive responses evolve into:

More explicit heightened emotional responses of grief or deprivation.

The ability to rationalize and replace dysfunctional cognitions.

Clear statements of longing and the assertion of needs to the spouse.

Fears of abandonment, rejection, and aloneness, the unworthiness of self, that can be processed and dealt with.

Acknowledgments of helplessness and vulnerability that can be legitimized and explored in the session

Emotional signals that pull the spouse closer and result in antidote events that empower the depressed partner and create a new connection with the other.

13.

By the end of the EFT process, the changes (expressed below in client statements) that will logically impact depression as we understand it are:

“I do not feel immature or crazy anymore. I just know how much I need to concentrate on my communication skills.”

“I have more of a sense of how scared and lost I was—we both were—and how alone I felt. It’s easier to name it. I can talk about it now.”

“I just used to see it that I was failing all the time, and she was always reminding me of that. Now I see she was trying to tell me how much she needed me. I feel valued, special.”

“I feel much closer, more connected to him. I can go to him when things get rough—we are a team.”

“Even when we get stuck in a fight, I don’t get into that sense of helplessness. I know we can connect, even when things go wrong.”

“Before, I used to just shut down and hide. I didn’t want anyone to see me, how small I felt. Now she is beside me. I can accept me more.”