Emotion-Focused Therapy – Theory of Anxiety Difficulties
EFT (Elliott et al., 1998; see also Paivio & Pascual-Leone, 2010) conceptualises anxiety difficulties first in terms of anxiety splits, internal conflicts in which the person makes themselves anxious. A process involving critical and experiencing self-aspects very similar to McGavin and Cornell’s (2008) controlling and compromised partial-selves. The controlling aspect takes the form of an internal critic, while the compromised aspect is a “collapsed experiencer“, who gives in to the anxiety and retreats from situations and experiences, while still longing to have its needs met. Furthermore, the presenting anxiety split overlays a deeper anxiety split in which the coach/critic aspect fears what will happen if the experiencing aspect makes itself vulnerable by pursuing its unmet needs for self-assertion or closeness. For example, Carol’s critical aspect feared her experiencing aspect’s deep hunger for social connection and therefore tried to get her to avoid weddings and parties by telling her that people would reject her once they saw she really was: “old and grumpy”.
In EFT these self-aspects are seen as organised around emotion schemes, consisting of networks of key stuck emotions, the perceptions and memories that the emotions refer to, associated bodily experiences and expressions, verbal-symbolic representations of the emotional state, and finally the wishes/needs and action tendencies motivated by the emotion. Different forms of anxiety difficulty are organised around specific types of core emotion scheme:
- Vulnerability-related fear (phobias, PTSD, panic, generalised anxiety)
- Guilt/shame (Obsessive-compulsive, social anxiety)
- Worried hyper-responsibility (generalised anxiety)
- Overwhelming loss of control (panic)
These are either secondary reactive or primary maladaptive emotion responses, that is, either reactions to other more primary emotion response, or else automatic, overgeneralised and no longer useful emotion responses (Elliott et al., 2004). Such emotion responses are typically grounded in early attachment injuries, including abuse, rejection/bullying, or neglect/abandonment by primary caregivers, siblings or peers. These early injuries are internalised as anxiety splits between a vulnerable self experiencer and a harsh internal critic/coach self-aspect. The latter is the introject of early rejection, abuse, or neglect, but continues to prime the person to monitor for dangers in order to protect them from various kinds of harm. For example, Carol’s social anxiety emotion scheme consisted of a secondary reactive emotion deriving from a deep, highly general sense of primary maladaptive shame; this emotion scheme stemmed from multiple forms of early abuse by her mother and brother, was symbolised by words like “ugly” and “clumsy”, and made her want to hide her face and retreat to her bed.
Anxiety splits are driven by a deeper protective split in the Critic: When cued, primary maladaptive emotion schemes highlight the vulnerability of the Experiencer aspect (e.g. Carol’s shame at being defective, but also her fear of abandonment and her emotional pain from deprivation), which frightened the critical/coaching self-aspect, so that the latter attacked the experiencer aspect (i.e. secondary reactive anger), thus creating the surface anxiety split. Over time, anxiety splits lead to chronic psychological pain and avoidance of both feared situations and painful emotions (experiential avoidance), Current loss, rejection, threat, or interpersonal conflicts re-activate these core emotion schemes and split processes, exacerbating the anxiety difficulties, interfering with important life projects, and leading to a sense of stuckness and depression. For Carol, this involved a traumatic job loss several years earlier and a more recent threat of a loss of her disability benefits.
EFT’s general theory of the change process with anxiety difficulties (Elliott et al., 1998; Elliott et al., 2004; Paivio & Pascual-Leone, 2010) proposes that therapeutic change begins with a genuinely empathic and caring therapeutic relationship. The therapist first offers the client genuine, caring empathy for their current life situation, interrupted life projects, and life story; this is soothing in itself and contributes directly to reducing the client’s anxieties about starting therapy, while also creating safety for the client to work on their inner experiences and difficult emotions. Client and therapist then work through at least two layers of anxiety splits beginning with the presenting anxiety split, then proceeding to the underlying protective split in critic/coach self-aspect. This is a critical step; EFT therapists hold that the surface anxiety split will not resolve without accessing the underlying fear that drives the critic. As they proceed, client and therapist track the core maladaptive emotion schemes back to vulnerabilities that originated in the person’s unresolved relationships with developmentally significant others (most often parents or siblings). After helping the client to resolve this unfinished business, client and therapist return to the experiencer’s need for self-assertion or contact in their current life.
Although this formulation sounds rather prescriptive, EFT therapists find that the specifics vary substantially first across the different types of anxiety difficulty and second across different clients with the same presenting anxiety difficulty. Although there are many common elements, every client has a unique configuration of emotion schemes, conflict splits, unresolved relationships, and change processes.