I am Chris Blazes, and on behalf of the American Academy of Addiction Psychiatry, welcome to today's webinar, which is part of a series on advanced addiction psychotherapy. This is a monthly series, and it's focused on evidence-based intensive psychotherapy training. The series is produced in partnership with Oregon Health and Science University, which is where I'm from, as well as NYU, which is where Dr. Stifler is from, as well as funding through a grant from SAMHSA. We're excited you could join us today, and that we can offer you these live trainings that are held on the second Wednesday of each month from 5.30 to 7 p.m. Eastern time. Please join us again on April 9th, where Dr. Donna Sudak will address cognitive behavioral therapy for suicidal behavior. She's one of my favorite speakers, and it's her encore appearance, and it's going to be a great talk next month. All right, so we're very excited today to be joined by Dr. Irina Wen, who will be discussing emotionally focused therapy theory and practice. Dr. Wen is a clinical psychologist and psychotherapist with a heartfelt passion for helping people build stronger, more secure connections with themselves, their loved ones, and their communities. Her work is rooted in attachment theory and a trauma-informed approach, creating a safe and supportive space for healing and growth. A certified emotionally focused couples therapy therapist and supervisor, Irina serves as the executive director of the NYC EFT, and is deeply committed to helping couples foster lasting closeness and understanding. She is the founder of Touchstone Psychology, a group practice dedicated to providing personalized care for couples, family, and individuals. Irina also loves mentoring and guiding the next generation of mental health professionals, offering teaching supervision and consultation, and as clinical associate professor at NYU Langone Health, she was honored to help establish the Stephen A. Cohen Military Family Center, creating impactful resources for military families. Irina brings warmth, expertise, and dedication to every aspect of her work, empowering her clients and colleagues to thrive. So I'll turn it over to you, Dr. Wen, and thank you again for agreeing to do this with us. Well, thank you so much for the introduction and for having me here. It's really an honor and my deep pleasure. One of the things I love most in life is to share my passion and my trust in the model that I'll be presenting today, which is emotionally focused therapy. And I am a certified EFT therapist and supervisor in emotionally focused therapy for couples and individuals. So I split my time working with couples and as well as using EFT in my individual work as well. So I'll be talking to you primarily today about individual aspect of the work within EFT, but I'll mention some work on couples. Probably most relevant to all of you will be the application of the EFT model to individual psychotherapy. But the model is an umbrella model that can be applied to different type of work with couples, individuals, and families. So I have no conflict of interest to disclose. And I always start because it's an attachment model and I want to honor my connection and relationships. I always start my presentations with paying homage and gratitude to my teachers who welcomed me into the journey of EFT and from whom I continue to learn. So of course, it's the founder of the model, Sue Johnson, who we tragically lost last summer, but the model lives on. And then many other trainers in EFT and supervisors, my mentor, Zoya Simochucka, George Fowler, Alana, Leanne Campbell, Paul Guillory, and many more, too many to mention here. And my greatest teachers in life, especially in attachment theory and practice and emotionally focused therapy is my family, my husband and my kids who continue to challenge me and to help me grow as a therapist and as well as a teacher, but also, of course, as a human in the relationship and in connections. These are the books I recommend to those of you who want to learn more about the model and want to go deeper in it. Thank you. Attachment Theory in Practice, this is the seminal psychotherapy book written by Sue Johnson in 2019, published. And it's a really dense, comprehensive text on how EFT is applied to couples, individuals, and families. Then more accessible text that I recommend to my couples, as well as people, individuals I work with, Hold Me Tight, which is more accessible layman, accessible book on relationships and attachment. And then more technical text, a primer for emotionally focused individual therapy, specifically. There are also many primers in couples therapy, but this one is how EFT is applied to individual work by Sue Johnson and Leanne Campbell. EFT as a model was originally formulated in 1980s. And in the beginning, it was the model of working with couples. So Sue and some colleagues in Canada, they worked with a lot of couples, they watched their tapes, and they were trying to categorize and understand and operationalize what is it that they're doing that works, that brings people closer, that and then ultimately fosters what we call secure attachment and secure bond. So they watch thousands of tapes, and they try to understand and kind of extract the interventions. And over the years, we've accumulated tremendous amount of evidence on not just efficacy and effectiveness of the EFT model with couples, but also on the mechanism of change. And as a clinical psychologist who is very much interested and based my own work in research, I do appreciate when psychotherapy not just tells me that it works, but also on how it works and why. So with EFT, we have that understanding, especially with couples and families. And it's also based, of course, on over 50 years of research on bonding, which is early bonding and attachment, as well as more adult partners in relationships. And most of the research available to date, and you can go to ISAF, International Center of Excellence for EFT, which is an international organizations of EFT therapists. We, you know, we have all the research published there or listed there rather. Most of the research is based on couples work and family work. The individual psychotherapy within the EFT model is a newer branch of the model, but the model has grown to be more of a psychotherapy approach rather than a specific intervention for a particular population. So right now there is the evidence, there is a randomized controlled trial underway that's being published by psychotherapy journal, and there are several case studies and theoretical papers that are written and published as well. And as I said, this is an umbrella model that is applied with couples, with families, and now with individuals. Today we will focus specifically on individuals, but I do want to say that the principles and the approach and what EFT has to offer and teach us is really, it's really the same across the board. And EFT also has been used with various specific patient populations with depression, chronic illness, children with illness, veterans, just to name a few, neurodivergence and other groups. I can't remember because I'm speaking with the audience that specifically works with addictions. We definitely work with couples with addiction and within the EFT approach will be case conceptualizing addiction in addition to neurobiology of it also as emotion regulation disorders, so to speak, through the attachment lens. So we would approach that that way as well. I'm going to read you a quote by Sue just to lay a foundation of how through EFT we approach health and the goals of psychotherapy. The model of healthy adaptation from attachment framework is a felt sense of connection with others, either through mental models in which you engage with others on a mental level or actual positive interactions. And that felt sense of connection fosters emotional balance and regulation, right? So it's from connection to emotion regulation. And this balance then potentiates the exploration and construction of coherent, adaptive in the world of positive models of self and other. It also promotes full open and flexible engagement with self, other, and environment, which then becomes the norm. Responsiveness in relationships meaning fosters safe connection with others that renders the tasks of living manageable and constructs a sense of self, that's a typo, that is competent to handle those tasks. Emotional regulation and engagement with others are at the core of this continually cycling process that occurs at a micro level in a daily interaction and a macro level across developmental phases. So here it's a mouthful, but it introduces the idea that it is through a relationship that a healthy sense of self emerges and healthy emotion regulation is promoted. And if we look specifically at the emotionally focused individual therapy, it is an approach to growing and expanding the self in its capacity, grounded in attachment science and the power of transforming core emotional experiences. Core chaotic, foreign, or denied emotional experience is evoked, ordered, and regulated to share emotional balance and integration in each client. Client moves from chaos to order, reactivity to balance, from self-abnegation to self-acceptance, and from helplessness to agency. So that is the north star of EFIT and EFD in general, right? So we understand pathology as a constriction and health and well-being as flexible adaptation. And one of the things that I really appreciate, especially as a clinical psychologist who is, you know, educated and taught to identify, diagnose, categorize, identify pathology and different manifestations of it and symptomatology, I really appreciated the model's focus on actually healthy adaptation. So I wanted to know what is it that we're actually after, aside from reduction of symptoms that we're trying to promote in psychotherapy model. And over the years, after being trained in psychodynamic approaches, as well as lots of CBT and CBT derivative approaches of psychotherapy, I found my clinical home in EFT. EFT, Sue Johnson set a conversation between Carl Rogers, Salvador Mnuchin, and John Balbi, attachment theory of John Balbi, of course, humanistic and experiential framework of Carl Rogers and systemic approach of Salvador Mnuchin. And if we look specifically at EFIT, which is emotionally focused individual therapy, we see that it has deep roots in person-centered psychotherapy, gestalt therapy, focusing oriented psychotherapy, specifically with working with deepening emotion and humanistic non-pathologizing perspective of Maslow of unhealthy functioning. Some basic principles of EFT is growth oriented. So at the core, we assume that we all are capable of growth and have the innate desire and ability to do so. So part of what EFT is trying to do is to create an optimal environment for a natural growth potential to unfold. And it's deep pathologizing focus on even ineffective maladaptive behavior. So we say that people are not sick, but stuck in habitual ways of dealing with emotions and engaging with others. So those stuck places can be due to, of course, earlier experiences or different survival adaptive strategies that people were relying on at some point in their lives that perhaps saved their life. And then of course, those strategies are hard to let go off and they pursue even when they're not effective anymore. I'm going to review a few basic EFT principles, and then we'll move more towards interventions and how it actually unfolds. So the main principle of EFT is based on empathic, authentic responsiveness of therapists in the room. So more than anything, EFT really teaches us therapists, psychotherapists is how to be with human experience, right? So this is a very open, transparent, genuine stance where, you know, you learn. And of course we are kind of educated in different traditions of psychotherapy and our role as a therapist. So EFT invites us to actually be quite emotionally available, accessible, responsive, and engaged in the room, right? So for me, for example, that was a really beautiful permission where I could actually be emotionally myself in the room. And it doesn't mean I'm bringing my, you know, my life into the room, but I can present and respond in a way that I'm feeling touched and that feels authentic. The most basic EFT intervention is empathic reflection that allows us to, again, be with another person's emotional and human experience that creates safety, that focuses and flows emotional processing and helps our clients to organize and distill experience. And the goal is to guide our individual clients or our couples clients to connection and responsiveness within themselves and each other. So we're helping them, if we work with individuals, to really be open and be able to process and to be in touch with those emotional experiences that perhaps were not accessible or fragmented before. And in EFT, we call it ARE, as a five pillars of secure attachment, accessible, responsive, and engaged. And as a therapist, you want to embody that because as a therapist, you are a surrogate attachment figure in the room. And EFT works with emotions very experientially. I teach a lot across different settings. I have many supervisees who are either in private practice or different organizations or in academic institutions. And that part is one of the hardest for usually for psychotherapists to shift, especially if prior training or personal stance was slightly different before. Being able to lean into true emotional experiences is hard for us, right? Because maybe we're not trained or allowed to do that as psychotherapy professionals, or maybe as people, we're not sure how to do that. And so that part is usually growing edge for a lot of newer EFT therapists. I'm gonna give you a quick overview of attachment theory. I'm very well aware that I'm talking to a very educated audience. I know that you know these basics, but I want to prime our brain to and focus us on the foundational premise of the EFT. And that's based on attachment theory of John Balby, who wrote that all of us from cradle to grave are happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figures. And then we go on exploring in life. And the propensity to make strong emotional bonds to particular individuals is a basic component of human nature. So attachment behavior and ability to form deep bonds and attachments is our survival mechanism, right? As human species, we survive for as long as we have, not because we run the fastest, or we have sharpest nails or teeth. We survive because we're able to form communities. And at the core of those communities is our ability to bond and to form relationships. So part of what EFT is doing is also destigmatizing our nature that at the core of it is interdependence, that we're not separate, individuated and isolated entities, but we live in a web of relationships. And of course, the core for all of us is the relationship with our loved ones. In the beginning of our lives, these are our caretakers and parents or other caretakers, and later on, these are our partners. And so, attachment becomes the primary motivational force from cradle to grave with Baldy said, and longing for self connection becomes the primary need. We all know that isolation is inherently traumatizing. We all are very aware of how at the core of our growth, our brain growth, right, on a very neurobiological level, physical growth, and thriving is us being taken care of. And we know from research and studies of Romanian orphans, and many others across the world, what happens, and how we fail to thrive, or we die, if that type of care is not available. So, when we have the safe haven of connection, connections on nervous system, together with our minds and our psychology and emotional world will learn that emotions are more manageable. Right when we learn emotion regulation in the most optimal environment where we first are co regulated by our caretakers. And these pieces are very adaptable. So even, of course, not everyone has secure attachment in the beginning, and so we can compensate, we're resilient, and we can learn it later through different strategies for medications through going to programs, EFT, psychotherapy, and so forth. But in the most optimal trajectory, we'll learn that self regulation through being mirrored and responded to by the other. And through that relationship we develop, we can develop coherent articulated positive sense of self. We'll call it dependency paradox, right, the more securely attached, we are, the more in a way courageous and brave and confident we are to explore the world, and to have autonomy. So, from that standpoint attachment system becomes a working model of self, others, and relationships. It is also emotion regulation model, right so oftentimes when I sit with my clients and I tune in to their attachment stories. I tune in to how they regulate their own in the world. So, the attachment model offers us a developmental theory of personality and that's why the psychotherapist who practices from that model, we pay specific attention to pivotal moments in people's histories that define who they are, and also define their coping. And that becomes potentially a pattern, right from state to trait. And, of course, attachment systems also inform how we perceive and respond to intimacy and romantic relationships. Is it safe? Do we expect to feel safe and embraced and accepted? Do we expect that intimacy is dangerous and we want to avoid it, and so on. Usually we talk about three or four attachment styles, right, secure, when we feel comfortable with intimacy, and usually warm and loving, those folks usually have easier time communicating their feelings and needs in the relationship. With anxious attachment, people crave intimacy, and often are preoccupied with their relationships and also with a sense of self, which may lack security avoidant attachment tends to equate intimacy with loss of independence, it tends to feel dangerous, unsafe, and there is a tendency to avoid relationships and that's what we see also with avoidance style, avoiding intense feelings and emotions in general, tending to keep them at bay, and then there's a disorganized anxious avoidance style as well. So, as I mentioned before, attachment is very related to our ability to emotion regulate, and in EFT we make specific emphasis on co-regulation as most optimal way to regulate emotions. If it's not available, of course, we can self-regulate, right, or, which also is relying on maybe co-regulation with internalized attachment figures. What we know from various research with humans, but not only, that in all primates, loss of connection with an attachment figure induces a particular kind of fear, a primal panic, what we call heightening attachment needs, and evoking proximity seeking behavior or some other behavior that tends to protect an individual from that panic. Right, so a sense of connection with a loved one is a primary build in emotion regulation device, and if that connection is lost, we all tend to be distressed. Right, so I work a lot with couples, and so what we see, couples who show up in conflict or disconnection, they're, and you probably, those of you who were or are in a relationship, when we don't feel balanced and in harmony and in connection with our partners, if there's tension, if there's conflict, it's unsettling, right, it induces anxiety or some sort of other tension and distress, and so on a neurobiological level, our brain detects that this connection is threat, and when we're threatened, we have very limited options. These are stress response, right, that then maybe could also mimic trauma response in some way, but stress response kicks in, fight, flight, and potentially freeze. And for some people, it can activate fight response, hyper, hyper activation of the nervous system, where people tend to pursue, criticize, maybe be flooded with anxiety, and for some it's deactivation, which would be shutting down, minimizing, avoiding, and so on. I'm not going to show this, it will take too much of our time right now, but if you have not seen this still face experiment, I would highly recommend that you watch it, because it is demonstrating in a very short snapshot, right, what happens to the baby, but the baby doesn't disappear as we grow. The baby doesn't have the same longing to connect. And here, what happens with the baby when mom is attuned and responsive to the baby, and then mom is instructed for just two minutes or something like that to stop responding, and she has this still unresponsive face. The baby decompensates, right, first she squeaks, and then she points, and when nothing works, she loses control of her body, she starts kind of wailing and have a little emotional tantrum. And finally, for this baby, mom comes back online and starts responding and they repair. But I think this beautiful experiment, painful experiment beautifully demonstrates what happens to our attachment and emotional system, when we lose that sense of connection. And it also demonstrates what happens to some of our clients who grow up in chronically unresponsive environments, right, and what they have to do to survive in those environments and that's what EFT teaches us to tune into and correct in some way, to learn to become responsive to your own needs. Johnson also writes that effective affect regulation is a process of moving with and through an emotion, rather than reactively intensifying or suppressing it, and then being able to use this emotion to give direction to one's life. When we work with our clients and patients within the EFT framework, our goal is to help them have expanded self sense of self versus constricted, right. The ideal outcome of attachment based therapy is an individual who is balanced, emotionally and mentally open, flexible in terms of action, deeply engaged and alive, and is able to learn and grow. We want to cultivate that felt sense of security, of being able to access affect, be with their emotions, regulating their emotions, which then leads to better information processing, our brain works better, better communication and sense of self and so on. And EFT, whether you work with couples or families or individuals, it gives us a very clear map, right, and I'm just going to present the map for individuals, for couples, it's similar but slightly different. But we start with stabilization, you know, several models introduced that term, right, that first, if you work with trauma, I work a lot with complex trauma, complex PTSD and PTSD folks, stabilization in different models means different things. What we mean here is that when we start working with our clients, we kind of start walking into their, in the world, right, we're going to walk into the world and get to know it, get to know the landscape. We want to understand how their symptoms work, what they're a function of, how do they get stuck, what causes their distress, how is that distress maintained by the internal patterns that they're stuck in, so what is that internal cycle of distress that we are wanting to break free from. And so the stabilization phase is, of course, thorough assessment, we identify treatment goals, and we begin to tune in to, Sue calls them negative music and dance moves, right, that kind of pattern of emotional experience, cognitive interpretations and behaviors with significant others and also within yourself. That causes this repetitive cycling of distress, that then shows up as symptoms of depression, anxiety, and other spectrum of symptoms that we can categorize as emotion regulation disorders, arguably substance abuse and addictive behaviors included. We, part of that stabilization phase is that we begin to access and make sense of this deeper core, what Balbi called frightening, alien, and unacceptable emotion, right, so then that was fragmented or exiled somehow, that is driving the behavior, so we begin to increase the window of tolerance that people can actually become aware of. People can become more aware of it, tolerate it, be in touch with it, befriend their own inner world in some way, and begin to create new steps of moving through it. And then, once we get a very clear picture of that cycle, and we begin to not just look at the surface level how it shows up as a behavior but on the deeper level of attachment fears of core experiences of self, we're going to stage two, which is in a way, it's a slow progression to deeper work. And with that comes more deeper emotional engagement EFT very much turns to a body of work and research in psychotherapy on how the depths of emotional engagement and psychotherapy room is linked to greater outcome. So it's not just we're talking about concepts and intellectual thoughts and so on, but we really work with affect and the deeper we can work with it, the better the outcome. And so, in stage two. Okay, I see. Okay, the problem is sound know loud and clear. I hope everyone can hear me. So, we begin to go to help our clients to connect to these core fears about themselves and their relationships or insecurities and vulnerabilities and set up emotional encounters, it's like a particular term we use that helps facilitate corrective emotional experience within themselves, right so that we shift from insecure to secure attachment within your own self, acceptance and understanding of those different parts of yourself. And stage three is called consolidation where we celebrate the gains and we make plan to maintain progress. There was a quick question about, if you can go back for one second what what's the up model at the top of step one. It's the. It's the processing model for that would you. Yeah, it's a tuning into emotional processing and emotion regulation, and how people construct their emotional experience. So this is a map for for the whole course of treatment of our work with a client. We also have a map for session to session. It's not linear, so you don't have to go 12345 and 12345. This is what's called EFT tango. So Sue Johnson was a big fan of tango dance it's an improvised dance as many of you may know, and a lot of terminology in the model borrows from the music right and so here with dance the tango with the emotional experience, a person's emotional experience. And, and it helps guide the process, so you don't have to take it as a very specific and rigid progression, but it's more the trajectory of what we're trying to do right and move one, it's what's called mirroring reflecting on the present process, where we reflect. This is what I'm hearing this is what happens for you this is where you stop my getting this right, then in move to will go a little deeper, let's stay here. Tell me more. What happens for you and your friend doesn't call for example or when your husband turns away. What's that like and so we step a little bit deeper into and helping people unpack that experience. And that tango is true for individual work and also couples work and family work as well. It's just slightly different how it unfolds in couples therapy, our choreographed encounters that was structured based on deeper exploration of affect is between the therapist right maybe we discovered that when I get angry and frustrated what I'm feeling underneath I'm, I'm really I'm feeling abandoned I'm lonely. And so a therapist will help the partner, turn to their partner and say can you share that with your husband or wife or partner, right that you see me angry and what you don't see is how lonely I get. So that type of direct, more vulnerable, more distilled conversation over time promotes more secure bonding and more deeper understanding of yourself and each other in individual psychotherapy, that type of an encounter is within yourself. So here's an imaginary encounter with on the left you can see that in a fit, the encounter could be with between you and the therapist, or sorry, your client and you right if you're the therapist, or within yourself with different parts of yourself like often we work with more child and wiser older self part, or maybe with that vulnerable part, and some attachment figure from the past or present that can show up for it so that choreographed encounter. So here's an imaginary encounter. When we, when it comes to individual EFT, and then we process that encounter, what's that like for you to be there with that part of you that feels so alone, right, if we talk about if it, and we move five is integrating validating. Usually, you don't even access that feeling. It came alive, you're able to stay with it. You're able to really share it with me. What's that like for you, right, it's so we celebrate we make sense of it. So, if you, if you think about it as kind of like a dip in the dive from one right we catch the experience, we process it emotionally, we set up an encounter. And then we pop up again, and we integrate and validate. It's on a more cognitive level. And so it's an integration of that cognitive processing, but the meat of the work is happening on a deeper emotional level. The EFT therapist mindset is non-pathologizing, growth-oriented and our ultimate goal is always trying to facilitate that what we call corrective emotional experience, right? That choreographed encounter that is often present in our sessions is our way to facilitate this deeper emotional connection within that person. And a therapist, as I mentioned before, is a temporary attachment figure in the room. So the creation and maintenance of Therapeutic Alliance is the foundation of the work. Of course, Therapeutic Alliance, we know that it's present across different modalities. There's tons of research on the fact that it's arguably one of the main factors that contribute to therapeutic effectiveness, right? But in EFT, we put a specific heightened emphasis on that and do a lot of work to try to facilitate, maintain, and then repair if breaches happen. And that comes from deep empathic attunement. So we're really, you know, one of my mentors, Leanne Campbell, says you have to let your clients break your heart, which means you have to be really emotionally available to their experience and not shield yourself. Because if I don't feel that experience, it will be harder for me to reflect back, to validate, to be with. And of course, it doesn't mean that we get swept away. We still maintain our therapeutic framework and grounded, centered position, but becoming emotionally available is key. Acceptance, genuineness, and constant active alliance monitoring. As a trauma therapist and working with couples with trauma, I expect breaches and ruptures in our lives, right? That people may feel misunderstood by me or dropped by me because of their profound, you know, wounds in their attachment histories. And so I have to be very mindful and open to repair and model healthy repair, right? So for me, it's not uncommon if, you know, the person may get activated and then maybe the session doesn't feel like I fully got them or caught them. Next week, we had conversations when I come back into the session and I said, yeah, I've been thinking about you last week. I don't think, I'm afraid you walked away with a feeling misunderstood by me. Can we try again? And so I'm open to hearing their, you know, their feelings, their experiences, their pain in a way that I'm not gonna just write it off as counter, as a transference, but I'm gonna be open to hearing and maybe repairing in a way that they've never had a chance to in maybe their earlier attachment figures. So I wanna be accessible, responsive, and engaged to that experience. So, you know, questions in the beginning, how can I help you feel safe in the session with me? Or if they had prior experience with other therapists where it didn't feel good, we can talk about that. What didn't feel right? How can I, will you let me know when we feel disconnected? Would that be all right for you to let me know? I wanna know that, it's important for me to know that, right? So that's something that I wanna facilitate that transparency and curiosity about their experience. And I wanna name and highlight a few EFT interventions that we use throughout different modalities of EFT, whether it's an individual or couples or family model. And the basic one is reflection, which allows us to name, clarify, and order emotions. You can name it, you can tame it, right? If we can name it, we can begin to transform it, but we need to name it first. And reflection is really active reflecting back. I hear what you say, that you get very angry in this no-win situation. Or you help me, you start, you're saying that there is a kind of panic when he turns his back, is that right? You start feeling very anxious and wonder if he cares. So I'm not trying to change anything. I'm just trying to reflect and it signals, I hear you. It also helps them see, kind of experience their feelings and emotions in the mirror, helps them sink into that deeper, so we can work with those experiences on a deeper level. And another very key intervention is validation. on another level, it's really scary. And so you protect yourself. So your protection makes sense, right? So I'm giving them validation of whatever those experiences internally are for them. It's almost like giving them permission and feeling really seen, really seen by me. And so the rule of thumb here, correct, sorry, connect before correcting, connect before redirecting. Reflecting and validating helps us connect and make people feel really seen, really non-pathologized, that their experiences make sense even though they're not working for them. And then we can introduce different possibilities, but that foundation of connection first is really important. We also use evocative questions, which involves questions and prompts to call up emotions into conversation. So for example, what's going on for you when she turns to you and she says that she wants to feel that she's important? Or what's going on for you right now when you look at your partner and see his disappointment? What was that like for you when you tried to talk to your mom and she just walked away, right? So we're opening up, what's that like? What is it, what's going on for you? And that's called evocative questions, heightening when we help crystallize and deepen a particular emotional experience by repetition, by maybe our voice presentation, by using images and metaphors. We reframe the emotional experience through attachment lens, right? So if I work with a couple, I'm not just saying, well, you get angry because you have anger issues or it's really hard for you to regulate your anger. You will get angry when you can't reach your partner. So anger is a protest behavior against disconnection. We put it in the cycle and the pattern of interaction, right? It's the behavior and the emotions that look through attachment lens at the core of which is an attempt to healthy adaptation and connection or protection from pain. And we also use empathic conjecture or interpretation where a lot of our clients or patients may not have words yet to describe their experience, right? When we say like, what happens for you? They say, I don't know. Where do you feel it? I don't know. And it's not because they're trying to be difficult. They may be, you know, maybe they don't have fully trust yet to let you know, or maybe they truly don't know. And so that's where empathic conjecture helps us maybe advance the exploration by us offering tentatively some possibilities. So for example, when someone says, well, I don't know, I just get frustrated. And then maybe I'll say, right, I get that. You get frustrated as if like, it's almost like you can never get it right, right? No matter what you do, you still fail. Is that what your frustration is about? So again, to be able to suggest that I have to step into that person's world and kind of feel around. And so then intuitively you begin feeling what that frustration may be about, then you can help with empathic conjecture. And if it doesn't land, we abandon it and we go someplace else. We don't have to be offended if our empathic conjecture doesn't land. A few more is risk, right? Repeat, use images, use simple words for describe affect, use slow pace, especially if we go into a deeper emotional engagement, soft voice, use somatic explorations, what happens in your body and use client's words. So oftentimes in my notebook, when I sit with my clients and I write, I write their words so I can come back to it and say, it's this experience of feeling on the edge, isn't it? Tell me more about it, right? So I'm gonna, it's like an emotional handle that helps us understand deeper from what's happening for them. Just to come back to the tango, in our session with sitting with clients as we move through sessions and treatment, we'll help them at first make sense of that experience of where they're stuck, right? We're naming and tracking internal cycle of distress. And so move one of the EFT tango could sound something like, I hear what you're saying, Sam. You're very upset and angry at your boss. You feel unfairly treated and see this as leaving you in the dark fog of depression. If I have it right, you get caught in this space and become more and more angry, more and more down till the spiral takes over your life. You didn't wanna come and talk to me about this reality, isn't it? It feels safer to just shut it out, yes? So I'm describing their experiences, what the pain is and what's the coping with the pain is to avoid to shut down. So we're just kind of saying, this is what's happening. We mirror the present process. And then in move two, we're gonna go and explore deeper. So tell me more about that fog or when your boss shuts you down or whatever the trigger may be. So how we explore it, then maybe that's something you can take as a tool for deeper emotional exploration is oftentimes used in other models as well, right? You may find it familiar, but T is trigger, right? So you present the cue when you were at your family holiday and again, no one even acknowledged you were there. That was painful. So that's the trigger. Then we're gonna go and explore what's that like for you? What was coming up for you emotionally? What meaning did you make of that, right? How did you make sense of their behavior? And what did you do? Well, I just went to sleep or I started yelling at my parents or whatever it may be. So we explore the trajectory and the pattern, trigger the emotional, cognitive, somatic response and then the protection action, protective action. And as we explore and make sense and befriend those emotional experience, we go slow, right? In EFT, the slower we go, the faster we get there. And the emotional processing requires us to slow down and really track micro steps and micro movements. In EFT, it's not just enough to just label the emotions. Sometimes we could use feeling wheels and so on, but it's not about necessarily labeling. It's more about like Catherine Green, one of the EFT trainers says, we help them name it, associate with it, make a little contact with it because it's in the contacting experientially their own emotion, their own in the world is when the revision happens, limbic revision of emotional experience she needs. And so in EFT, we actually have to walk them to their pain and fear and sadness, because that's the only way to shrink it and to get limbic revision is to contact it experientially. And that's what EFT helps us do. And once we contact experientially that experience, we can set up corrective emotional experience or choreographed encounter. And in EFT, we often say that's the mechanism of change. And as I mentioned before, that encounter can be with part of yourself, with a therapist or real or imagined attachment figure that can be also evoked in the room. So let me give you a little bit of an example of how it may look like, and then maybe we'll fast forward for a moment. So this is from the primer of EFT. And here's the therapist is helping client to make contact with their emotional experience. So what do you see, Chris? Can you see him? What do you see? So here, therapist is trying to help the client contact their own younger self at the time of very difficult emotional traumatic experiences, right? So make contact with it. And usually it's very hard for folks because it's really disowned and fragmented. So Chris says, I see somebody who is a bit lost, confused. Sorry, he wants to lash out. I want to do some damage here. I'm just very angry. That kid's angry. Can you see his eyes? They're like lasers. They're not crying eyes, they're fighting eyes. Are you able to stay with him for a minute? What do you feel in your body, Chris, as you stay there with him in that room, in that space? Therapist, stay there, Chris. Stay really still with him right there in that moment, in his despair, in his eyes. What happens inside of you? Just need help. I need help. Yeah, that's what he'd say. That's good, Chris. Stay with him. I need help. Can you say that again? I need help. That's good, Chris. Let yourself feel that. You're there with him. It's going to be okay. Let him say it again, to speak again. I need help. And he says, I need help. I just feel invisible. Good for you, Chris. You're able to stay there. I feel invisible. Is that in your gut, Chris, or your chest? Where does it sit? It's here, he points. You know, thalaplexus kind of thing. Yes, so focus on that, Chris, and let it grow and develop and really make space for it. And if there's a space that you couldn't have made at that time, of course you wouldn't. It wouldn't have been safe, too. So now you can. You can make space for it. What happens as you allow that grow and build? Breathe and let yourself feel whatever you feel. It's okay to do that now, to feel what you couldn't have felt back then. Right, so under, what's happening here? We're coming in contact with very painful, vulnerable, hurt experience that lives inside of him still, right? But it's not just catharsis, because it happens with a very active presence of the therapist. I'm sure this is not their first session. There's a very active alliance built, and she's staying very involved. She uses his name many times to maintain the connection and guide him through, right? So oftentimes we evoke that courage in our patients because it's almost like cheerleader. We can do this. You can do this hard work. Let's go. I'm coming with you. So there is the attachment framework that happens and present throughout this, the active presence of the therapist. And then as they continue to work together, they're gonna be making contact more with that part of themselves. Let's see. I'm gonna say a couple of words about assessment. And then in my slides, I do include a few questions that can reflect some of the assessment process and some of the examples of that. So maybe I won't stay for too long. I'm trying to make sure that we leave enough time for question and answer, but just a couple of words on EFT assessment. In EFT, we focus on relationship and attachment histories, and we take them as a window into understanding the repetitive strategies that our clients use to respond to threats of security. Assessment is very process oriented, right? Attuned to the process of emotion regulation and moving through emotional experience. And we also make a lot of space and tune into client story with cultural humility and curiosity. We do know that attachment longings are universal, but there is a lot of differences and diversity in how it's expressed across cultures, across families, across ethnic and racial backgrounds. So as therapists, we want to be sensitive and attuned and name it, name it and welcome it in the room as well. A few principles here, be open, curious, focus on process and content, focus on developmental narrative of the client's experience, tune into their attachment strategies, tune into how they coped with adversity in their lives, likelihood those strategies probably stuck with them and they still cope that way. Focus on safety and capacity, so we do do risk assessment and see if we can do this type of work with our clients and establish an agenda for therapy and collaboration with clients, treatment plan. Let's see, I here include a few sample questions from attachment history questionnaire, adult attachment questionnaire, sorry, these are certainly not exhaustive list, these are just a few questions that I often ask my clients, but you can look up the adult attachment questionnaire and pull some more or develop your own arsenal of favorite questions to ask. And with the ear towards culture and race, these are Paul Guillory, who is a wonderful EFT trainer, he wrote EFT with African-American couples and he introduces this model of really attuning to culture and especially within African-American families, but not only and introducing the questions that we can ask our clients, for example, has there been any way your race culture been a challenge to review of self? Do you think racism and discrimination impacted your parents' life or your life? Do you strongly identify with a religious faith or group and so on? Okay, so let me pause here, we can come back if we have time, but I just want to check in. I've said a lot, I've shared a lot, I just want to check in with everyone and see how people are doing, if any questions are coming up, let's check in with the audience. So there's some questions, please put your questions in the question and answer, but I'm going to start off with a question of my own, which is that, you know, it seems like in the treatment of our demographic, people with addictions that, you know, I believe that attention to kind of limbic interventions have the potential to be really, really powerful. And so this is why this is exciting. And I also suspect that it requires a certain degree of stability in the patient and a continuity of care in order for this to be effective. So can you comment on that? Yes, absolutely. I think we have to be mindful that this is an emotionally involved work. I think it has potential to be very helpful for our clients who struggle with addiction, just given how we can understand addiction as through attachment lens. And in my couples, for example, I work with couples with addiction, but not active and out of control. Right. So that's where we have to be judicious and make sure that we attend to risk. So creating buffers, for example, when I work with my clients with addiction, they are typically in groups and individual treatment that's pretty intensive. And then my couple's work becomes sort of this. It has this buffers and it creates safety for us to engage in this deeper level. And same with individuals as well. And then monitoring, right, like we're in titrating. We don't want to go too deep. Similar probably with complex trauma, which of course with addiction, we'll see a lot of that too. Maybe the stabilization phase will be longer, right? Maybe we're not going to go too deep, of course, too fast. And we're going to help them really understand how addiction becomes a part of their internal cycle of distress as a coping strategy. Right. You turn to that. It's like we in this field say that everyone is talking about drinking. No one is talking about the thirst. So EFC precisely invites us to talk about the thirst. What is that thirst that leads to the use of substance, whatever that substance may be? So I think it can be used or at least a sprinkle, right? Like for example, my mentor always says a little EFT is better than none. So we can use the framework, perhaps it's not going to be full on EFT treatment. But at least in through case conceptualization and opening up these parts of the person to facilitate their insight and connecting how that pattern of addiction unfolds, I think it can be very helpful. We have a couple of other questions. However, I wanted to maybe also, if I can take Dr. Blais' prerogative and ask one. Just quickly, I do a lot of training for motivational interviewing and we talk about things that are sort of core counseling skills and you illustrated several of them in here with the reframe and other things like that, asking these evocative questions. I think what's different is how do we use those in service to the underlying sort of theory that informs or frames what we're asking about and kind of what pathway we're going down to. So in motivational interviewing, we talk about reflecting back underlying motivations for change or change talk, right? In here you're reflecting back more sort of attachments or the feelings involved in things. And so I was just curious if you could talk a little bit more about how we sometimes, what we do in therapy might be very similar, but how do we use the sort of theoretical framework and our understanding of that to guide? That's a great question. Yeah, no, you're right. The technique could be similar, but depending on our orientation, we will be reflecting different things. You're absolutely right. Being an attachment therapist, I will be reflecting and focusing on emotions that are attachment related, right? And construct, but for me, even their inner world is all around attachment and their sense of self, for example. So when people say, let's say they're depressed, I don't know what that means for that particular person. So we'll be unpacking that or anxious, right? What is it in relation to how do they move through that? So I have to kind of lean into that and of course, my ear would be picking up attachment themes of disconnection, loneliness, feeling unworthiness, right? Or some fears that are within the interrelational framework. So that's very true. As a behavioral therapist, maybe we'll be reflecting and attuning to different things, but as an attachment theorist, for sure, we're guided by the framework. Yeah. Next question. Go ahead, Carla. Yeah, so we have a lot of different questions. I'll start at the beginning and then switch to the hands raised because there's quite a few, but the first question was right back at the very beginning, but the idea of addiction as a kind of attachment and your thoughts on that. Yeah. So I think the EFT framework and being a process oriented attachment model, attachment based model and emotion regulation model, we will understand addiction as through that attachment framework, right? People turn to, and I don't want to simplify things because I'm fully aware that there are different layers and at some point it becomes very biological, very kind of physiological as well, but on the emotional level, typically, right, when we sit with our addicted clients, we find histories that shape them and that substance fills a hole. It becomes a relationship in a way, that's what we talked about on the even molecular level early on, but it's also on all levels, probably on the very granular level, but also on the emotional level, there is something that we're seeking with addictive behavior. And also it's part of, becomes part of emotion, dysregulation and regulation. And so looking through that lens, it offers us kind of deepening conversation about what it means for the person, the origins of a developmental trajectory of it and so on. And so I think it offers a huge layer of exploration that otherwise may not be accessible. I'm a big fan of the yes and approach thing. Yeah, exactly. There is a biological, molecular, and there's a relational aspect, even if you think about it on those terms, and there's all these other aspects of it. So I agree with that. So before I switch to, go ahead. I was just going to say, I was just going to do the next question, but go, go ahead. Before I switch to hands raised, I think the first question was the, can you share an example of depathologizing using this model? Absolutely. Yeah. I love that. That's one of my favorite EFT principles, like I was sharing before, right? There's many of you, I'm not a medical doctor, but I'm a clinical psychologist who worked in different psychiatric settings and love pathologizing in a way because it's just an interesting theory and so on and so forth. And when I met Sue in 2012 and I went to this big training, I was intrigued because in that training, I remember she was presenting and then someone in the audience raised the hand and they were talking about their clients and they were sharing something about like, what do you do when the partner in a couple is borderline? And by the way, as I was, I had deep interest. I worked in forensic settings with psychopathy and was very interested in personality disorder. And Sue at that point paused and said, you know, we don't talk about people like that in this model. And so I was really intrigued. And since then, I'm totally sold over time because I didn't understand what that means first, right? Give me an example. And so what does it mean? We don't talk about people like that. In AFT, we kind of move away from categorizing. It's not like I forget DSM or ACD-10, I can certainly fit people in some diagnostic categories, but it's about expansion of our understanding of what that behavior or whatever, however ineffective it shows up, what is it trying to accomplish? So for example, in our trainings, in our supervision, in our work with clients, we try not to use negative pathology-driven basis. For example, I don't want to, I would probably at this point never call my patients manipulative. I used to, but I don't anymore. I don't even think that way anymore because when I see, for example, a behavior that can present that way, my curiosity goes to what need are they trying to fill? How do I connect with that? Yeah. Where is it coming from? So that's an example, I hope. Yeah. So I'm going to jump in here. There's another question. Would you modify EFT for youth in any way or use it in the same manner for adults and as an adjunct to that group? That's a good question. It seems like that the nature of attachment seems to be changing, especially in the era of social media. And so has that affected your practice? Yeah, I think the faces of a change, but we haven't changed for many thousands of years, I would say. I don't know if that's going to quickly change. The way maybe it shows up, but the longing to belong is still there and the deep pain from isolation is still there and it's always going to be there. So I think there is maybe a way how it shows up, changes the faces of the change, but we can still tune into the same music. Regarding youth, I think that's the work with EFFT, the family therapy does change. And there it's like when we work with families, for example, with kids and parents, the idea is not to create reciprocal, horizontal relationship of responsiveness and engagement, but to empower and support the parent to show up for their child. And that's actually doesn't change through lifetime. Sometimes we work with dyads of older parents and already grown children, and it's still the same. So the nature of attachment bond changes a bit. I'm going to unmute Olivia Futter, and so she had typed a question in here, but maybe I'll just let you ask it, Olivia. Okay. Sure. I was, can you hear me okay? So I was just going to ask if you were to compare an approach like CBT, that's typically more like patients will come in with a particular concern and there will be behavioral interventions to target that. I mean, not always, but generally speaking. And then on the other side, you have more of a psychodynamic approach, which tends to be longer and has more of a focus at understanding underlying causes of symptoms and like self exploration. Would you say that EFT can be used for the former, or is it more closely aligned with a psychodynamic approach? In the depth oriented way, it's more aligned with psychodynamic approach. But we tend to think about it as more time limited. I don't know if you're familiar, let's say with accelerated experiential dynamic psychotherapy, ADP. Right. So that's, I would say cousin model in many ways, because it really honored neurobiology of attachment as well, and depth oriented emotional processing that we also favor in EFT. CBT is more top down approach, meaning more kind of from cognitive processing, prefrontal cortex to behavior. EFT is more bottom up, even though of course we talk enough about meaning making and we kind of pop back up and make sense of things, but we'll work and favor working in more of a limbic level. But we tend to think about it as a time limited, how long that depends. Couples therapy research was from eight to 12, 20 sessions, but then those of us who work with trauma can be 40 sessions. I never embark on my journey with my clients thinking that's for life. I'm hoping they at some point won't need me anymore, but that in that sense, maybe it's different from psychoanalysis. Some folks would like to know where they can go for EFT training. Fantastic question. I love that question. Depends on where you are, go to ISAF.com, I-C-E-E-F-T.com. It's an organization. Now we have almost a hundred different affiliate organizations across the world. It's amazing. We grew so tremendously far. We have folks in Africa, Iran, Asia, all over Europe. Of course, United States and Canada is where ISF is based. On that website, they post all the essential trainings. I am executive director of our local New York organization. We host official trainings for EFT. If you're in New York, please connect with me. In general, feel free to share my contact. I'll be very happy. You can reach out to me and I'll direct you and connect you with different EFT practitioners. It's a very vibrant community of wonderful therapists across the world. It's been really fun to be a part of it. It's a live and living model. It's also exciting because we're learning about it. We're still developing and learning, so that's been really interesting as well to think about that. ISAF.com, if you go to find a training, I think for therapists, something like that. There's a question that says, would you recommend being licensed or getting a certificate in order to practice this? Sure, I would, but you don't have to. You can dip your toes and try. I agree. A little EFT is better than none. It's a range. I have folks who study with me and they don't want to pursue certification. I feel like certification gives a sense of accomplishment, but it also just, for me, it's a lifelong journey at this point. The longer I'm in the model, the horizon just keeps opening up and the depths, but I'm a bit of an EFT nerd. I love it and it just never ceases to inspire me. Well, on that note, we're at the hour and we're going to have to end. Thank you very much, Dr. Nguyen. I feel smarter for having attended the session and thank you for spending the time with us. We could have gone on. It seems like for hours more with the questions. Just to remind everybody that next month is Dr. Donna Sudak talking about CBT in the setting of suicidal ideation. She's also a wonderful speaker, so we look forward to seeing everybody next month and thank you again, Dr. Nguyen. Thank you. It's my pleasure to be here. Thank you so much, all of you.

Emotionally Focused Therapy

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Attachment Theory

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Emotional Regulation

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Addiction

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