Flourish Clinical Exchange Week 10 | An Introduction to Emotion-Focused Therapy (EFT) with Dr. Bryan Choi
EFT Learning Resources:
EFT Learning Resources
Readings
Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. American Psychological Association.
Greenberg, L. S., & Goldman, R. N. (2018). The clinical handbook of emotion-focused therapy. American Psychological Association.
Pos, A. E., & Greenberg, L. S. (2006). Emotion-focused therapy: The transforming power of affect. Journal of contemporary Psychotherapy, 37(1), 25-31.
Choi, B. H., Pos, A. E., & Magnusson, M. S. (2016). Emotional change process in resolving self-criticism during experiential treatment of depression. Psychotherapy Research, 26(4), 484–499.
EFT training courses and workshops
Get supervision from a certified EFT supervisor
Dr. Bryan Choi – bchoi@emotionmatters.ca
Dr. Bryan Choi
So I'm passionate about EFT, so I really hope to just provide you with a good overview, a good introduction to EFT, and if it resonates with you, just also provide you with some next directions, if you want to learn more, you know. So I have a, of course, a PowerPoint prepared for today. So I want to do this didactic part. Please feel free to ask questions or like, I think, if it's like, right there, you know, relate to the content. I'm fine. You know, one of the moderators can just let me know if there's a question. But I will save space for like 10 minutes at the end for any questions as well. There's I also hope to show video. I think one of the best ways to learn any type of therapy is just to show video. So I want to show you a video of EFT in action. I just think that'll just be a nice compliment. Okay, so without further ado, maybe we can get started. So okay, so I believe you can, if you're not seeing my Presenter View, someone can unmute and tell me if that's not the case. So we're going to be giving you an intro to EFT today. But I'm informal, so please just call me Brian. My own practice is called emotion matters psychology and the International Society for EFT sort of just certifies training institutes, trainers, supervisors, and you can get certified as a therapist. There's different levels. Alright so I want to start with some history, just because this will kind of help you understand how EFT came to be. So, you know, someone mentioned Leslie Greenberg in the chat, and so I've been trained by several of his students who are experts in EFT. As well as Leslie Greenberg, there's many actual people who contributed to the initial development of EFT. Just Leslie Greenberg is the one most cited. He contributed significantly to the development of EFT. EFT is also known as process experiential because in therapy, we're focusing on what is the person's the client's experience, their process, moment to moment, what's what are they feeling and processing? It was developed in the late 1980s early 90s. It's with in the humanistic experiential tradition, right? Which, if you remember the waves of therapy, right? It came with the third wave humanistic, you know, with under Carl Rogers, we need to focus on the person again. You know, psychology became very dehumanizing, so let's value the person and everything that makes us special and human. So EFT is a synthesis of person of the person centered approach. There is an emphasis on providing a therapeutic relationship that's based on, you know, Carl Rogers, you know, being a congruent, genuine therapist, holding the client with unconditional positive regard, being empathic. Gestalt therapy is a influence in the sense that Gestalt therapy is all like it's how we are as organisms responding to an environment trying to get a need met. That will become clear as I go along, why that's really relevant to EFT. In Gestalt therapy, there's also parts of cells that, you know, we're not just one coherent whole like, well, that might be a goal, but there's still different parts of us, though. So maybe we have a part of ourselves that's very self critical, and then the part of us that's receiving the self criticism. So in Gestalt therapy, there was that emphasis EFT, kind of, you know, borrowed and integrated, that. There's a focus on making sense of our existence as seen in the existential approach. So we're focused on emotions in EFT, and we want to help clients access health care Emotions in therapy. How many of you have heard of Emotionally Focused Therapy? I should have emphasized emotionally, because this is one confusion that I guess if you if you know EFT like even that, it might not be clear there actually is a distinction between emotion and Emotionally Focused Therapy. Another like creator of EFT was Sue Johnson, who recently passed. That's her. She created and collaborated with Les to create a therapy that's couples oriented that's really focused on the attachment. Maybe some of you are trained in this, but it's all about the attachment and repairing, creating, you know, an attachment that's safe, empathic. And the idea is that when we can help change the couple relationship that helps people regulate on them, regulate themselves, and that's kind of the opposite, because so I will be referring to Leslie Greenberg's version of EFT in this talk, where we're focused on the individual. So there is a different emphasis in both therapies. Well, they started out differently. And in EFT Leslie Greenberg style, we don't just focus on the attachment, we focus on individual concerns like, how do you feel about yourself, your sense of self worth, right? How important or how? Yeah, there's sometimes we can feel like unimportant, like identity related concerns. Am I important to other people? Do I have value all that to say that today, both versions of EFT have individual and couples therapy formats, but there are some small distinctions between them. And as Megan was talking about, like, EFT is empirically support to treat, you know, different issues this is there's more adding to the list as more research is being done, the trauma anxiety, like GAD social anxiety, that's been a recent turf where EFT is making strides and treating that disordered eating is another one. Okay, so I hope that gives you an idea of just where we've come from. I want to talk about what's called process research. So EFT is heavily informed and continually updated by process research. Actually, I'll go to the second point first. So when we researched psychotherapy, I'm sorry feeling my throat a bit. So in outcome research, we are concerned, in therapy, does a client get better in therapy? So you can examine that with pre and post measures, right? So if it's the depression, give the Beck Depression Inventory, is there a score lower at the end indicating a reduction in depressive symptoms? That's outcome, research. Process research is concerned with answering the question, how does the client get better in therapy? What are the mechanisms by which in therapy, clients are getting better? And maybe wondering, what's this picture about? So it's from Alice in Wonderland, and there was a claim in early on in psychotherapy, you know, the field, that the dodo dodo bird verdict was proposed that, and it was quite controversial. Like all therapies are the same. They're providing like equivalent outcomes or just doing similar things. People are saying they're all different, but everyone has - there was a race in Alice in Wonderland, and you know, the verdict was, everyone has won, and everyone deserves prizes. So if all therapy is working right, and that's if you agree with you know, and at that time, then we need to actually show what's working in therapy, what is making your therapy unique. So there was a push for process research. So Bruce Wampler came and said, We need to demonstrate that the change we are saying is happening in therapy is actually occurring in the therapy and is associated with client improvement. So if I'm saying clients get better when they access healthy emotions in therapy, I need to show that clients are accessing those feelings in therapy, and those clients do better or that predicts good outcome. So that's process research. That's the evidence base EFT wants to ground itself in. And it's continuing, you know, to this day. And you know, I think it's important for all psychotherapy approaches to do this. So when I think about, you know, so I do also practice other modalities, but, you know, I think it's really a helpful framework for understanding any therapy approach. First, how does that therapy model understand human functioning? So an EFT, I mean, no surprises, the emotion is, is important and emphasize. The idea is, the emotion is the most basic unit of our experience. So I was talking about at the beginning. I have a seven month old baby, and I, the idea is, yeah, in EFT, we really do prize the value of emotion, that even before we learn speech, like babies learn speech, there's like, an emotional reaction. You can tell if a baby likes something or doesn't like something. Started solid foods with my baby does not like, Yes, I gave my my baby sushi the other day. We're trying baby led weaning. I love sushi. He does not love it, but loved risotto, another kind of creamy rice, so it but you can tell right by the sounds the baby is making, right their gestures. So the idea is that emotion is an organizing principle for understanding how we navigate moment to moment experience. We say emotion is at the core of it. We call these emotion emotions are synonymous with emotion schemes, which is a fancy word for just actually saying that in any given situation, we are receiving input from the environment, right? We are having sensation and perceptions of the environment. I then have a mental structure in my head that kind of organizes and makes sense of this information, and then I output something, right? I react or respond to my environment. So in an emotion scheme is then that process unfolding, right? So I am having sensations, perceptions. I have an emotional experience that tells me, that helps me make sense of what's happening. Cognitions are important. They are, you know, we are seeing them in EFT as linked to the emotion. So if I'm feeling sad, I'm going to have sad thoughts. Maybe it's tied to your learning history and memories, sad memories of the past. And the idea is that emotions are linked to needs. When I'm having an emotion, it's telling me what I really need in the in this situation to feel better, and that mobilizes me to act on my environment to get that need met. So let me give you some examples of that. So the idea is that these are adaptive responses. These these responses help us. The idea with anger is that we feel in situations where we're sorted from a goal or we're violated, like our rights or boundaries are violated, we feel anger. We say it's actually healthy to feel angry, because angry anger leads to separation from the source of offense leads to healthy boundary setting. So if you know you're being mistreated in any kind of relationship, how can I set a boundary with someone so they stop hurting me when there is a loss of some like a person, maybe even you know transition. You know, you know life transition. We feel sad because we've lost something, right or losing an object that means something to us. Sadness motivates us to seek connection and comfort, and that's what helps us feel better. We can also self soothe, right? Learn that's a skill. So here's an example of soothing by someone else. I won't go into this too much, but interestingly, when we look around, when we think of a someone who's sad or depressed or overwhelmed, there's a lot of withdrawing that happens. And I think that's actually very societal in nature. Why that happens? That we get messages around, you know, kind of chin up Chuck deal like, you know, don't, don't burden others, cope, get with it. Just keep going. So I think that's actually it goes against some biological programming, which actually tells us when you feel sad, we actually need comfort, right? Like, what would you do with the crying baby, right? Um, fear is felt when we are in danger, and it leads to seeking safety. So that's fight or flight, right? So in response to a threat, what can I do to ensure my survival protection? These are all healthy emotion. When you are feeling these things, your emotions are working for you. So in EFT, we see that emotion schemes. Emotions fall into four categories. So I'll let's go through it. So primary, adaptive emotions are survival based. They mobilize us in ways to get important needs met in a situation. Sounds like the emotions I just talked about. What does this term? What do these terms mean? Primary means it is a first occurring emotional response. I'll go into secondary emotions in a moment. But think about any relationship where you got frustrated, maybe your partner, a friend, whoever, and think about was that really what you were feeling inside? Was there a more vulnerable feeling maybe this person hurt you, or you were really scared, or maybe you felt belittled or shamed by someone. The frustration is secondary. The first occurring feeling was actually you felt hurt like when someone you know said, Oh, why didn't you? This is not necessarily from my life, but you know, oh, the Okay, why not? My partners just said, said to me earlier, oh, did you? Did you cut the like, like, I've asked you multiple times to cut the baby's nails. I felt a bit shamed at that moment, right? That would be my primary emotional response. But then frustration was kind of what I felt, and that would be the emotion on top, right? I use my own examples, because, you know, we're all human, right? We're not immune to this. We all have primary and secondary emotions. Adaptive is a key word here, because that means it's when you feel this adaptive emotion. It's giving you helpful, good information about the situation. The emotion is helping you get through the situation in a helpful way. So these are all the examples I just shared. Those are all examples just, I don't know, some of these are from movies. So in the top right is adaptive anger, right? That's from the movie about Norma Ray, who stood up against poor working conditions and factories. And you know, that led to development of unions. This was an assertion right against, you know, being mistreated, you know that's feeling sad and being comforted is the picture in the middle. And I think, I think I found this just, you know, the running from a storm or something. I forget which movie this is from, but maybe, you know, but now, now I'm forgetting so we're seeking safety. Is running with this child seeks shelter. So what do we do with adaptive emotions? We want to encourage and facilitate clients in helping to access them. We function very much like an emotion coach. One thing like EFT is not like a it's not a didactic approach. We are not like teachers. Saying that is a good emotion. You need to feel this. You need to know it's a very experiential we're very much feeling with our clients. So even though I say Coach, we are trying to create an environment that helps clients come to these emotions on their own, okay? And the idea is that when they do this, they start to be in touch with their feelings and get their needs met, and life is good. Primary maladaptive emotions, or is the second category, sometimes we call this the core pain. The the core pain is an unpleasant emotion one felt either intense, intensely or frequently earlier in life, often in childhood. So those adverse childhood experiences are what contribute to the development of core pain. It's simply the feeling that you felt a lot as a kid. I I mean, we do do some didactic, didactics. I usually say to a client like, you know, a core pain is like an armpit. Everyone has one and it sticks, because no one has the perfect childhood. We all felt some negative emotion despite parents trying their best or the environment. You know, you know that things were out of our control, and something may have caused a negative emotion. What it means is that, because we felt it a lot earlier in life, we develop a sensitivity and vulnerability to feeling that way. It's like an old emotion network or bruise that we learned, and it's like it can get triggered or activated in the present moment. I think it's important to emphasize it was actually adaptive and realistic at this at the in childhood, right when it first occurred, but it becomes maladaptive in the present moment, because it's giving you poor information. It's not actually matching. There's one kind of idea, like you're not reacting fully to the present moment. You're actually reacting with your previous learning history or trauma, and others experience us as overreacting. Let me give you an example to clarify so individuals who had critical caregivers, or who were bullied, they often felt shamed, right? Like you're not good enough, a fear of failure and so now, well, actually, I want to say, like some, some people have asked me, well, why is that adaptive to feel as a child? If that kid didn't feel shame, like, you know by this can be, like, super, like, unrealistic, like, oh, like, you got like, 90% on this test, why isn't it 100% or it can be so subtle, I've worked with clients where it's like, they brought home a report card to their parents and even when it was like, they didn't necessarily get something negative when they didn't enjoy as well, but they got like, oh, okay, well, maybe next time it'll be better. It's so subtle. But that kind of lack, like, with like, less warmth and validation contributed to, like, a feeling of shame, like, I'm not as good when I don't perform as well. So now as an adult, it can lead to some false positives, in the sense that like you get, I don't know, like I feel like, sometimes this can happen to many of us. You get feedback on your performance, on something, and like those couple lines of like negatives, like everything, like so many positives, but then we dwell on the negatives that might be activating a core shame actually.Really the core pains really fall into like three categories, shame, fear and lonely abandonment. So lonely abandonment speaks to attachment. This is usually resulting from caregivers who are unavailable. You know, if there was, you know, trauma where boundaries were violated, people feel a sense of mistrust and like, I'm not safe with other people. And you know, this can come out like in the present moment, like, you know, oh, like your partner is on your phone and is on their phone, and then you feel like neglected or unimportant. So in EFT, we're trying to actually help people understand, is there a core pain that's actually underlying the presenting difficulties? Because if so, we want to actually help them become aware of it and actually understand the origin, where does this come from. And essentially we're feeling it to heal it, because when you start to understand where it comes from, we can start to shine a light on it and start to change it. And I always say, like, will you ever feel that vulnerable feeling again? Probably, but we can help you feel it less intensely and less often, so you become less reactive. And one point, I just want to say it can also come about in adulthood, like, you know, if someone's been cheated on, infidelity in a relationship that usually is a, you know, a powerful experience of, you know, be a betrayal, your trust being broken. So then you walk into your next relationship with that baggage, right? You're becoming less less trustful. And the way in EFT is that we need to address the infidelity of how your trust was broken. That's that's the way forward, okay, um, secondary emotions I was alluding to earlier. It's the response that comes after the primary emotion. They're not helpful because they cover or obscure our access to the underlying what we're really feeling. And if we're not really in touch with what we feel, then we don't really know what we truly need to feel better. So secondary emotions give give us superficial information. There's two kinds, really. So one is learned rules about feeling, or emotions, and you reflect on yourself, like, what kinds of rules around emotions did you grow up with? Are any of them like shame based? Like, you know, it's weak to show feelings like working as long as I have, I've heard so many things like, chin up Chuck, pull yourself up by the bootstraps. You know, we're ex name. We don't get, you know, sad we get mad. That's like the like, the family name, like, these are all messages that we receive in our families, cultures. There's gender rules. Boys Don't Cry, right? This is when you learn a rule like this, you actually learn to feel shamed in response to having a primary feeling, feeling feelings, I'm sad, but you know, that's a shameful feeling to have. So if I'm just in touch with my shame, I'm actually not in touch with what I really feel, which is the sadness. The other type of secondary emotion is when the second, sorry, sorry, the second emotion you feel is easier to feel than the primary emotion. This is super common because the primary emotion is usually a more vulnerable or painful emotion. So inside you're really feeling afraid and on but on the outside you you show anger, right? It's like, imagine a parent and the kid comes home late past curfew, and it's like, Where were you? I was worried sick. It's in a frustrated, angry manner, but inside they're actually the parent is feeling was terribly afraid. So in the top right, actually, it's a cute video, it's Alfred in the shadow. It's a video about EFT. So that's where it's from. So it's like, that armor is the anger or being tough. It speaks to also, like, you know, having that those those rules around emotion, right? But inside this owl is actually feeling fear. If the feeling's really painful, right, then I avoid it. I'm afraid of feeling, you know, my core, that bad relationship breakup. I don't want to feel that betrayal hurt. A lot of my research in graduate school was on self criticism, and the self critical person really feels shame underneath, but how it comes out is this anger itself. But really, the real feeling we need to work through is the anger, sorry, the shame underneath. So when the goal for an EFT therapist is to validate, you know, you'd want to dismiss, just validate secondary motion, but then try to get under it. What's the primary feeling? It's helpful to look at where did, where did these rules come from? Like, like, where did these secondary emotions come from? That can also just unravel and support the client's growth? Um, just also, my full time instrumental emotions, I'll just say briefly, these are unconscious or conscious ways we use emotion to get a desired outcome. It's like crocodile tears to get support, or giving someone the evil eye to get them to leave or do something you want. I think a parents again, you know? It's like giving your kid like you know, the you know, like you know, don't, don't you know, you better, do you know? And then giving the you know evil eye, or whatever it's called, these don't come up, frankly, as much in therapy, if they do, it's just good to understand what is it that you're really wanting, and then trying to find more helpful ways to actually communicate this. So we have these four categories. So one way you can think about it is we have these emotion category words like fear, shame and anger. And then what happens is we create a whole plethora of emotion categories of, you know, you know, fear can actually look any one of these four ways. Shame can look any one of these four ways, and so on. This is overwhelming. When we learn EFT if, as an EFT learner, we don't like we're not learning categorically like this. It's just a way to understand that any emotion can present differently. And the most important thing for an EFT therapist is just to follow the feelings and to help the client change, right? So I want to get to that, let me just say with theory of dysfunction. So problems come about because we're either we're not in touch with our adaptive, our primary adaptive emotions, so then we don't get our needs met. Really, there's like and my research supervisor helps me really understand this. We usually have one of two problems, or both. If you're unlucky, you're either cut off from your feelings or you're stuck in unhelpful feelings all the time, like secondary emotions or maladaptive emotions. So oftentimes presenting issues are secondary issues like emotions and problems like someone has an addiction, they're angry, depression and anxiety, these all cover probably the primary maladaptive emotions inside. They really just feel lonely, right? They're really dealing with feelings of shame and worthlessness, or there's unprocessed pain like trauma. Okay, so that's why we want to get to what is the real emotional issue at the core? Because the idea is, I mean, that's kind of what I said. So I just want to get to this slide. There's, this is the emotion change path in EFT. We start by with the client, secondary emotions we get underneath what are the primary maladaptive emotions mean to transform what do they need and that and the idea is that accessing needs leads to primary adaptive emotions. So, and my research was on self criticism, so when a client comes in, they're really angry and frustrated. They have a lot of like, performance anxiety, right? That could be social anxiety, too, test anxiety. We feel that in EFT, the real issue is the core maladaptive shame. There's some historical pain of feeling worthless that we need to process, like, what was, what were those core memories where you know that were formative, and you feeling this deep sense of like, unlovable, worthless, defective. And when we start to process that pain, we start to get out, what did they need at that time? What do they need? Now, that's what I call existential needs. It's like if we're dealing with a critical parent. We call it unfinished business, sometimes where we're like, resolving old feelings with past others. You know, it's like you needed, I needed to be praised. I needed to be told I was also lovable. I had good qualities, right? You know, for, you know, reward not to be based off just having good report card, right? I need to be seen from my character. You know, all these kinds of, you know, emotional processing happens in EFT. And so what we found in the research was that when clients can access a place of self compassion, asserting yourself, sorry, assertive anger. So like holding others accountable who may have criticized you this idea of a self critic, that the part that beats us down when we can stand up to that part when we can self accept ourselves, these are the things that predicted resolution of not just depression, but self criticism in the long term. So that's that's the process research behind to support what we're doing in EFT. This is an important slide. So many therapies see releasing emotions as the core change mechanism. So in psychoanalytic therapy, catharsis, it's like that, Eureka, Aha, I know why I'm I'm so self critical, like my parents are so hard on me. So that release is thought to, you know, lead to change. You know, habituation, we do like exposure, like getting used to like your fear, extinguishing. In EFT, you may have heard this line or not before. We're changing emotion with emotion information. So specifically, if you draw, I don't think I have a pointer right now, but look at the graph. The yellow emotion that's over time. That's why it's a hump. So the like. So the primary maladaptive emotion in yellow is shame. So if we activate that feeling, okay, okay, you felt shamed, effective, worthless as a kid. This is your parents made you feel this way, and then we start to access concurrently, well or subsequently, an adaptive emotion like that wasn't right, like adaptive anger holding like, you know, that wasn't right that you treated me like that, you know, parent or teacher, I deserve to feel like I was worthy. I was I still had internal worth. Maybe it's an abuser a bully, right? So then what happens is you have a synthesis, that primary maladaptive emotion, the core pain, is not in its original form, okay? It's actually lines up with memory reconsolidation research. We can't change what happened, but we can change how we feel about what happened. So if our memories like envelopes, and you know, in our memory bank, we take out that feeling, you know, take out an envelope with the shame, process it, we put it back into that envelope with these new feelings like assertive anger, self compassion, self acceptance, so it goes back into the envelope and it's no longer the same. And you have to I'm just going a bit quicker. I want to get to my video, it's important to build the therapeutic alliance. We work a lot with emotion each this could have been the whole talk today is, how do you increase the client's level of experiencing of their emotions, labeling feelings, validating feelings, feelings are embodied. So going to the body is often a good the it's even like, you know, sometimes for clients who are very rational, who aren't good about have the language for emotions. You know, it's like, okay, well, in that situation or right now, like, what do you feel in your body? Okay, you feel some tenseness in your chest. Okay, just, just be that tense chest place. Now, what's this part feeling or wanting? You can always conjecture that, you know, there's actually some really painful feeling here, episodic memories. So that takes the client back to when these emotions first took place. In EFT, so a lot of these so we I've talked about the change process, and then we know there's some common problems, like self criticism, anxiety, self interruption. We facilitate tasks like so maybe, and that's why I want to show you as a chair work task, we are marker guided. When there's a marker for self criticism, we respond right? We're not coming in saying, Here's a protocol, and we have to do this in session one two. We're responding to what comes up in the therapy moment to moment. We have a task for unfinished business with others, soothing oneself, who's vulnerable, problematic reaction points, unclear, felt sense. Okay, so I want to stop sharing and go to the video now. So if we could pause the recording, please. [VIDEO BREAK] Okay, so I sorry. I wish I had more time so, but I'm happy to also stay like I don't know if it's a hard end at one but happy. You to answer. I'll send my slides. The last slide was just as a next step. If you're interested in learning more about EFT, I can circulate some readings, like the names for the books it is, taking a workshop and getting supervision. That's like most other therapies, right? So
Megan W
someone's just wondering if there's any resources that you can share as well with the slides, and then we can send them along to to everybody, if you have them.
Dr. Bryan Choi
Yep. Happy, too.
Megan W
Um, or even, like other workshops that you might be aware of,
Dr. Bryan Choi
sure, yeah, I can put together, okay, so, like a list of book resources or trainings, yeah.
Megan W
I'm wondering if you could talk more about like, the like, obviously, like, it's sort of broken down into the really helpful steps of like, the adaptive emotions and then the secondary and primary. But what's what sort of might happen in as people are transitioning between them, like in actual practice, in therapy, what that might look like?
Dr. Bryan Choi
Yeah, I really think people are coming in often, in the frustration, the overwhelm in their secondary emotions, if, especially if they're dealing with like substance use or alcohol use. So really, what it would look like is really trying to, you know, validate their feelings, just create that safe space, and then starting to explore, you know, what? What's the real feeling underneath? And you'll see what's often like a, you know, a breaking down or tearing up, right? Really, at the heart of this, it's just you. It's not, it's not really depression. It's just I feel so worthless, or I feel like no one's ever going to love me for just me, right? And then, you know, we get historical because we feel like these are often historical pains. And, you know, it's, it's tremendous growth work that can come from this work, and people feel more healed. Notice, just at the end of the video, she already felt so, so much softer with herself, right?
Megan W
Definitely, I don't know, we have a question in the chat, but I don't know, Sean, if you want to go first,
Dr. Bryan Choi
sure, go for it. Sean,
Sean
sure. Thanks, Dr Choi for sharing. And as you said, the video was really powerful. And for me, personally, I could speak to stir it up some emotions for me just watching that and just learning from your experience and your point of view. Like, what do you find as a practitioner or therapist delivering this kind of support? Like, what do you take away that really strengthens you? And what do you take away as like, the challenging part of being there to support the person in such a difficult time
Dr. Bryan Choi
just having understanding it's almost like, the impact, almost like, kind of the better and worse on you as a therapist, yeah, taking
Sean
yeah, our perspective from our like, often, we're focused on the patient or The client, and here focus more on us as like providers, and how I can see this being a very challenging therapy to deliver sometimes, because there's so much emotion you're supporting. So just would love to hear your perspective. Yeah,
Dr. Bryan Choi
no, that's a lovely question. I think, I mean, I gravitate to it because and I live my life, you know, it's not like once I leave and I work from home, there's no therapy door. But, you know, it's like, because I wholeheartedly believe in, you know, the importance of feeling our emotions communicating. You know, I brought this into my relationship. So I think the impact is, I really think you need to drink the Kool Aid, right? When I did a session of just CBT or DBT. I actually feel like not as tired like this really does draw on your empathy. You know, life experience cup where for me to feel, and we don't have to go through everything what a client does. But if someone is feeling, somehow to feel your pain. I feel like I'm kind of quoting Brene Brown a bit, but like to feel your pain, I need to tap into my own pain. My supervisor used to say we're like, you know, an emotional thermometer. So I do think the impact on us as therapists is that it does. It is more emotionally draining, right? But also incredibly rewarding, because then you have people who work through stuff that you know they never even thought they would Right, yeah, thanks for that.
Megan W
Um, and then just a couple questions from the chat, I think. Um, someone's asking. So you mentioned using other modalities as well. How do you manage switching between modalities? Is it a fluid process, or do you know more about the presenting issue to do so, yeah,
Dr. Bryan Choi
yeah, that's a great question. I think it will look all kind I think, I mean, ultimately, EFT is my home base. But, I mean, if someone is, you know, but like, also, it's not, it's contraindicated. Someone is, like, you know, actively suicidal. If someone is dealing with severe substance use, like, you know, I'm going to bring in some DBT stuff, right? So I think they're actually like opposites. DBT is about containing emotion, and EFT is about evoking and transforming emotion. But both can kind of come up depending on the context. So if someone is, yeah, more and I don't know how else do it like less stable or they have more like, dysregulated behaviors, I will bring DBT skills like I, I used to, I was at CAMH, the BPD clinic, and I actually continued with, you know, a couple clients, and we did EFT work, but still focus on skills. You know, assertiveness skills can sometimes help, because EFT isn't about training like this is what you should say to your partner, right? So I draw DBT, interpersonal, interpersonal skills. And I just think, you know, you're flexible, right? And you know clients might, you know, I just want to do what's like a tool I can do, right? Maybe then I'll draw reach into my CBT bag. So that's how you can integrate.
Megan W
And then somebody's also asking if you can explain more about shame, like, why the first adaptive emotion? Like, in the example of a kid bringing the report card and not getting the validation, why the shame is the first emotion that they're experiencing? Yeah?
Dr. Bryan Choi
Well, yeah, if shame is all about a core sense of yourself as being, you know, defective, unlovable, so unworthy, right? And and part of my words less sometimes, like you get the credit to really flesh out, you know, you fat, ugly pig, no one's ever going to touch you or want to be with you. It's like, it's that nasty, right? So when there are childhood experiences of you not measuring up in some way, and depending on how it's handled, it can really create an experience of, like, you know, I mean, that's what like the I mean, it keep going to like parenting stuff, but like, you know, using less evaluative words, right? Like, somehow your performance is going to determine your sense of worthiness in the eyes of others, like your parents. I mean, they're the biggest ones, but like, you know, teachers, you know, that really sets up someone to be either feel like they're constantly not good enough, or they become perfectionistic, anxiously driven to always, you know, you know my, my worth is determined in the eyes of others, right? So it's the primary emotion, because that's the first occurring feeling. I hope I answered that person's question.
Megan W
I think so, just in terms of that, like the trajectory that it occurs. I don't know if anybody has some other questions. Oh, somebody just is following up on that. How can shame be adaptive as an adult, um,
Dr. Bryan Choi
shame, yeah, if you notice I said input adaptive shame. Shame is adaptive. Shame is when it's about your standing in a society or group, like, if, just like, if I commit a crime I have violated the code of conduct in a society. So adaptive shame is when you take corrective action to repair your status or standing with others. Guilt is kind of like a cousin. So if I wronged you, you know, I, you know, told my partner, you know, how could you be so stupid you left the trash, you know, oh my gosh, I was so frustrated at such a long day. I feel terribly about what I said to you. That's, that's adaptive shame, right? When we can make shame and guilt relational, it actually has the power to repair. I just watched inside out too, and they did not have shame. Still, it's a great movie because I think Marie posted those, you got the dolls in and shame. They're forgetting about a really, really important they have embarrassment, which I guess is their version of it.
Megan W
That's really powerful, though. Like the like being able to see it as like, the opportunity. Or that window. It's very powerful stuff. And I appreciate you also going over a little bit just to connect and answer some of these questions.
Sara
Can I ask just one more. Sorry.I just saw a few people mention, how does this work? Sort of from a pediatric perspective, when you're talking about teens and adolescents, is there, is there anything you would adapt when working with that, you know, cohort, or that populations where this could still be effective but maybe adjusted slightly.
Dr. Bryan Choi
Yeah, um, it's a good question. It's not my area of expertise, because I work with adults, but I do know, like, like, someone like Mirisse Foroughe is like, definitely trying to, I think you can do EFT with teens and adolescents again, with the same caveats. If someone is really dysregulated, right? We don't, you don't want to turn up the emotional temperature for someone who's going to get dysregulated and harm themselves, or their safety risks, and then you just need to make it more developmentally appropriate, right in the sense like, you know, like you know, just kind of tailoring the intervention so that they kind of make sense, right? For your audience. I feel like that's a general statement, but yeah, I you know, it is being done, so I think that's, you know, Mirisse is now doing like workshops for that emotion focused family therapy was intended to support parents and parenting, right? More emotion focused ways, so they might also have some real a lot of recommendations working, because I imagine a lot of you work with kids and teens. I do think you can, you can integrate EFT principles, yeah.
Megan W
Thank you so much. Yeah, everybody will be we'll be back next week, just from the comments in the chat. Brian, it just seems like everyone really has taken a lot away from this talk today. So thank you so so much. You.
