Emotionally Focused Therapy

Posted on by Wendy E. Smith, MA, LMHC

After getting further training, I have been using Emotionally Focused Therapy, or “EFT”, in my work with both couples and individuals.

When working with couples, I help each partner to sink below the surface emotions he/she may be feeling and begin to get in touch with the “primary” emotions and relationship, or “attachment”, needs that underlie his/her reactions to his/her partner. An attachment need may be something like, “I need to know that you accept me, even when I screw up”, or “I need to know that I won’t lose you”.

Once I have helped the partners understand how their surface, or “secondary”, emotions have been driving the cycle of negative interactions which has brought them to therapy, I help them learn to communicate on the level of their primary emotions, a level on which their deepest needs are much more likely to be met. Via this process, partners are often learning to speak to each other in a way that is completely new in their experience of each other, and likely in their experience as a whole as well.

Although EFT is not the only, or sometimes not even the primary, technique I use with individual clients, it is clear to me that EFT is also extremely helpful in individual therapy. Once individuals have become aware of their secondary and primary emotions and the unmet needs that are associated with the latter, they can use this awareness to direct their decisions and communication in the world much more effectively than when their unseen emotions were (seemingly mysteriously) driving them.

Furthermore, in individual work, there is more time for developing understanding of complex patterns involving the interplay of emotions. For example, a person may be feeling deeply sad, but not able to experience and move through his/her pain or grief because shame regarding feeling sad blocks that exploration.

Additionally, while some primary emotions, such as primary anger, can be extremely motivating and helpful, other primary emotions are “maladaptive” and, when deeply examined, show themselves as hindrances to the client. An example of a maladaptive emotion might be fear of certain people or situations that was adaptive in childhood but no longer makes sense in the life of the adult, even though it is still felt very deeply. In such a situation, once the client has felt safe enough to dip into that fear in the therapy session, and the brain circuit related to that experience is open, the therapist can guide the client in transforming the maladaptive fear with a another emotion, say pride or curiosity, that is also present for the client but has so far been overshadowed by his/her maladaptive fear. The therapist can, thus, assist the client in physically (on the level of neural pathways) making a change in the way his/her habitual thought and feeling processes actually work.

EFT is a well-researched, effective and safe mode of therapy, but it is not for the meek. It involves being willing to experience deep, difficult emotions directly in session, with the therapist present as a trained and compassionate guide. (Thus, a solid, trusting relationship between therapist and client is definitely a prerequisite.) The payoff is that the client’s inner experiences, as well as his/her experiences out in the world, can be gradually and profoundly changed in a way that leads to greater authenticity and fulfillment.

If it’s worth doing, it’s worth doing half-assed

Posted on by Wendy E. Smith, MA, LMHC

Some years ago I read an anecdote in one of Rachel Naomi Remen’s books about a woman with a chronic illness who embroidered the above phrase into a wall hanging that she used as a personal reminder. As a person living with Fibromyalgia, I’ve found it a very useful slogan indeed.

Case in point: I love to go hear/watch Flamenco at a trendy late night club on Capitol Hill. One time I had a longstanding plan to go experience Flamenco on a certain date with three of my friends. When the night in question rolled around, I realized I was really quite sick. I thought about cancelling, but I love Flamenco, and the friends are not too shabby either. I went. We ordered drinks and snacks and, finding myself basically unable to eat due to severe GI discomfort, I pretty quickly surrendered my fork. The performance started, and I was still acutely aware of my physical pain. But, soon, my soul, like the dancer that night, was on fire. By the end of the evening, I was so exhausted from fighting back pain that I could barely stand up; at the same time, I felt filled with inspiration. Physically, I was stumbling, but, emotionally and spiritually, I was in flight.

Sometimes, it appears, the Buddhists are right: It is possible to separate pain from suffering. Furthermore, if it’s worth doing, it may well be worth doing half-assed.

If and When to Tell Other People about Disability and Illness

Posted on by Wendy E. Smith, MA, LMHC

So, you are corresponding with a man on an online dating site and he asks if you’d like to meet in a part of town that is awkward to get to by bus. Is this the time to tell him you are legally blind and can’t drive, or should you make some other excuse for wanting a different meeting location and tell him about your disability when you and he know each other better? Experience suggests that many people are not educated about what it is like to live with a disability and harbor prejudices that would cut off prospects of a date with this man right there. On the other hand, why should you have to hide who you are? And would you want a date with this guy anyway, if it turns out he can’t take in this piece of information in an open-minded manner?

With the huge and important exception of job interviews, I usually err on the side of straightforwardness when it comes to such matters. In my more defiant moments, I tell my friends that talking about illness and disability is a good screening device that helps eliminate the closed-minded in one fell swoop.

Thus, a few years ago, when I read Rhoda Olkin’s excellent book, What Psychotherapists Should Know about Disability, I was interested to discover that she made a point, on her first date with her future husband, to arrive at the restaurant first and get seated, so that he would not see that she had trouble walking as a result of Polio until after they had had the opportunity to converse during dinner. That made me think. After all, Rhoda is married and I’m single! Additionally, I thought of one of my very close friends and how, long after we had gotten to know each other very well, we were able to have some frank conversations about disability experiences and rights in which, he admitted, he may not have been able to participate so fully earlier on in our relationship. And he is a very thoughtful and open-minded guy.

I know that when I see men online who are wanting to date women of certain races and not of others, I eliminate them from my consideration immediately. I don’t want to date a racist, even an honest one. However, almost every guy states that he is looking for a woman who is young (or young looking) and fit as heck and “healthy”. As a person with many wonderful qualities and a chronic illness (which is, in fact, the source of some of those terrific traits), that offends me too; but, if I eliminated all those men, I’d be out of the dating business completely. Realistically, men might have to meet me first before they realize what is really attractive and important to them. Society is still in the dark ages when it comes to disability and illness.

So, “if and when to tell” is a tricky business. I still prefer to tell early and take my chances (What can I say? I’ve just got to be me!) but I keep a more open mind now when I help my clients with disabilities and illnesses consider their options in making these difficult choices. Perhaps every such choice must be made both on an individual and a case by case basis.

Chronic Illness as a Management Task

Posted on by Wendy E. Smith, MA, LMHC

I’m going to spend a little time on my blog, starting now, talking about different aspects of my own experience with a chronic illness, Fibromyalgia. This may give readers some insight into how I think about living well with a chronic illness when working with clients.

Aspect number one: It’s a Management Task

I’ve had Fibromyalgia for over a decade now and I’ve learned something about its mysterious ways. In my case, the illness results in sleep difficulties, digestive problems (including occasionally incapacitating abdominal pain), muscle aches over most of my body, and fairly severe headaches. Luckily, all these symptoms usually do not manifest themselves at once. Today, for example, I am tired because I didn’t sleep well last night and I have significant aches in the lower half of my body due to spending a good chunk of Sunday working in the garden. Working and socializing with only fatigue and muscle aches is manageable, so I can continue on with my schedule as planned, with the addition of stretching (for the muscle aches) and making sure to hit the sack early (for the fatigue). If I judged the situation to be unmanageable, then I would have to start cancelling things.

So, each morning, and throughout the day, I do this little assessment. I check how my body is doing and whether it needs something that I can supply (water, ibuprofen, a nap, to eat only yogurt, etc.). I don’t take things for granted. I pay attention to all the different subsystems and try to keep them running as well as possible. And, on those occasions when my ministrations fail, I put the whole system to bed.

In a way, managing an illness is like running a household, or a company. It’s just a different kind of multitasking that goes on constantly in the background while the person with the illness is doing her job, pursuing her hobby, socializing, attending to her family, and so on. Part of running that company well is making smart plans (e.g., not over-scheduling and making sure the highest priorities are attended to first) and, then, being willing to change those plans if and when necessary.

Falling Down the Rabbit Hole: The Chronic Illness Experience

Posted on by Wendy E. Smith, MA, LMHC

The other day, one of my chronically ill clients said to me, “My goal is no longer to get better; it’s to learn how to live well the way I am.” This was a big moment.

In the first years of a chronic illness, people spend a lot of time working with doctors, trying to figure out what is wrong with them and how to understand it and fix it. This makes sense. Sometimes when we get sick, medicine can help us get better. On the other hand, sometimes what has happened is that our body and our life has changed forever. Five years into her illness, one of my clients said, “I can’t believe that this is the life I have now. It’s like I fell down the rabbit hole and entered a whole new world that doesn’t even seem real.”

When people become ill, they are faced with a cascade of changes and losses that can be utterly overwhelming and very difficult to face. They may lose body parts and functionality, friends, career, their old lifestyle, financial and social status, independence and mobility, a sense of efficacy. Even writing this list feels overwhelming.

On the bright side, once a chronically ill person gets to the point of wanting “to learn to live well the way I am,” he/she is on the way to less suffering, anguish, unrest, and self-loathing, and more authentic relationships and life satisfaction, and a greater sense of contribution and meaning.

Some things from a chronically ill person’s “old life” still remain–like certain friends and family members who have had the guts to stick around and certain core personality characteristics–but a lot of the task of the chronically ill person adjusting to his/her new situation truly ends up being a process of saying, “okay, it appears that I now live in this completely different world down the rabbit hole; let me figure out how best to get on in this strange new world.”

If you find yourself in this position, there will be no denying everything you have lost. It can be heartbreaking acknowledging it all.

On the other hand, once you learn how to live in Wonderland, you may find that you can understand things, enjoy things, and do things that you simply wouldn’t have had any idea about in your old life above ground.