Deep Dive: Emotionally-Focused Therapy for Trauma

Most research-informed treatment modalities for trauma use similar mechanisms to encourage symptom reduction and growth in clients (Pierce & Black, 2023). Elements such as psychoeducation, prolonged exposure to a trauma trigger or memory of traumatic event, relaxation techniques, and modeling copings strategies are all fairly widely used as components of trauma focused treatment (Pierce & Black, 2023). Emotionally-Focused therapy for trauma uses many of these components but includes their own unique practices and emphasis (Harrington et al., 2021). As a general modality, Emotionally Focused Therapy is an experiential approach that melds attachment science with structural and narrative therapy components to create an integrative treatment modality which seeks to help clients more deeply understand and communicate their emotional experiences so that they are better able to respond to themselves and those they are in relationship with in genuine and emotionally connected ways (Harrington et al., 2021). When applied to the treatment of trauma, Emotionally-Focused Therapy for Trauma uses the same basic blueprint, but place additionally emphasis on the therapeutic relationship which is developed between the therapist and client and the client’s ability to deepen their experience of their emotions — as well as the emotions of others (Harrington et al., 2021; Cardona et al., 2022).

One of the core hypotheses within an emotionally-focused perspective is that the normal function of primary emotions — namely to help the person experiencing get what they need in a given situation — gets adapted, through past experiences that are invalidating, traumatic, or harmful in some way, and becomes maladaptive (Cardona et al., 2022; Harrington et al., 2021). Treatment then is largely focused on helping clients to create a relational context (first with the therapist and then with important people outside of the therapy relationship) in which they can practice rediscovering their emotional experiences safely (Cardona et al., 2022; Harrington et al., 2021). Once emotions are able to be experienced more deeply and freely, they can be integrated into how a client makes decisions and self-advocates thereby often reducing many of the stereotypical symptoms associated with past trauma (CirqueLodge, 2023; Ganz et al., 2022). 

As a modality, Emotionally-Focused Therapy is particularly amenable to working with clients from a variety of cultural backgrounds and with a variety of different needs (Young et al., 2022; Cardona et al., 2022). This is due, in large part, to the individualized nature of the therapeutic relationship which is emphasized within the treatment model (Young et al., 2022). The therapist practicing from an Emotionally-Focused perspective is encouraged to relate to their clients with genuine curiosity and warmth, to respond to their clients in authentic ways, and to welcome the unique experience of the client on the client’s own terms instead of attempting to fit it into a particular theory or diagram (Ganz et al., 2022; Young et al., 2022). In fact, the driving push of this form of therapy is to attempt to create space for the client to own their own experience and be able to feel confident in their own perspective, so to invalidate it or question it in some way is antithetical to the experiential and attachment focus of the work (Young et al., 2022; Cardona et al., 2022). These guiding principles do not mean that therapist bias and systemic factors do not influence the therapy, the therapist, or the clients however. Even working from a model that encourages adaptation to the client’s unique context and needs, therapists must be mindful to invite clients into the therapeutic work and into genuine relationship thoughtfully (Young et al., 2022; Cardona et al., 2022). Research continues to show us, for example, that even a well-meaning attempt at communicating love or belonging can miss important emotional information and result in a form of emotional invalidation (Cardona et al., 2022). Clients are also likely to have a variety of beliefs about what emotions are, how those emotions should or shouldn’t be expressed, and what a “safe” or “secure” relationship may look like which need to be explored explicitly and not assumed to align with the therapist’s views (Young et al., 2022). 

It is also imperative for therapists to maintain a wide enough vision so that they are able to keep an eye on how therapy is progressing — paying special attention to the quality of the therapeutic relationship and emotional safety — while also attending to specific interactions and the process of communication and connection (Harrington et al., 2021). The therapist working with clients who have experienced trauma should be mindful of the pace of treatment and attend to the emotional experiences that develop as therapy progresses (Harrington et al., 2021; Young et al., 2022). Especially when working from an experiential modality, the therapist should feel empowered to follow the client’s lead and focus less on a particular treatment sequence or particular intervention and model a kind of playful flexibility which allows genuine emotional expression to be found, expressed and deepens (Cardona et al., 2022). This flexibility should be met with careful reflection and treatment planning which helps the therapist to track changes in the clients and ensure treatment is progress towards the clients’ goals (Cardona et al., 2022; Harrington et al., 2021). Working with the clients in a collaborative way can also allow for co-creation of the therapy experience, goal setting, and pace setting so the therapist can share their perspective with the clients and work together to address any areas that are not working well (Harrington et al., 2021). 

Research

Cardona, N. D., Madigan, R. J., & Sauer-Zavala, S. (2022). How minority stress becomes traumatic invalidation: An emotion-focused conceptualization of minority stress in sexual and gender minority people. Clinical Psychology: Science and Practice, 29(2), 185–195. https://doi.org/10.1037/cps0000054

CirqueLodge. (2023, March 20). Stages of trauma recovery. Cirque Lodge. https://www.cirquelodge.com/blog/stages-of-trauma-recovery/

Ganz, M. B., Rasmussen, H. F., McDougall, T. V., Corner, G. W., Black, T. T., & De Los Santos, H. F. (2022). Emotionally focused couple therapy within VA healthcare: Reductions in relationship distress, PTSD, and depressive symptoms as a function of attachment-based couple treatment. Couple and Family Psychology: Research and Practice, 11(1), 15–32. https://doi.org/10.1037/cfp0000210

Harrington, S., Pascual-Leone, A., Paivio, S., Edmondstone, C. and Baher, T. (2021). Depth of experiencing and therapeutic alliance: What predicts outcome for whom in emotion-focused therapy for trauma?. Psychology Psychotherapy Theory, Research and Practice, 94 (4), 895-914. https://doi.org/10.1111/papt.12342

Pierce, Z. P., & Black, J. M. (2023). The neurophysiology behind Trauma-Focused Therapy modalities used to treat Post-Traumatic Stress Disorder across the life course: A systematic review. Trauma, Violence, & Abuse, 24(2), 1106-1123. https://doi.org/10.1177/15248380211048446

Young, J., Taros, E., & Gregorash, A. (2022). Cultural considerations for using Emotionally Focused Therapy with African American couples. International Journal of Systemic Therapy, 34(2), 63-82. https://doi.org/10.1080/2692398X.2022.2159299