Somatic experience of emotion in emotionally focused couple therapy : Experienced trainer therapists' views and experiences

This is a self-archived version of an original article. This version may differ from the original in pagination and typographic details. Author(s): Title: Year: Version: Copyright: Rights: Rights url: Please cite the original version: CC BY 4.0 https://creativecommons.org/licenses/by/4.0/ Somatic experience of emotion in emotionally focused couple therapy : Experienced trainer therapists' views and experiences © 2021 the Authors Published version Kailanko, Sari; Wiebe, Stephanie A.; Tasca, Giorgio A.; Laitila, Aarno A.; Allan, Robert Kailanko, S., Wiebe, S. A., Tasca, G. A., Laitila, A. A., & Allan, R. (2022). Somatic experience of emotion in emotionally focused couple therapy : Experienced trainer therapists' views and experiences. Journal of Marital and Family Therapy, 48(3), 677-692. https://doi.org/10.1111/jmft.12543 2022 J Marital Fam Ther. 2021;00:1–16. | 1 wileyonlinelibrary.com/journal/jmft Received: 11 March 2021 | Accepted: 13 July 2021 DOI: 10.1111/jmft.12543 ORIGINAL ARTICLE Somatic experience of emotion in emotionally focused couple therapy: Experienced trainer therapists' views and experiences SariKailanko MA1 | Stephanie A.Wiebe PhD2 | Giorgio A.Tasca PhD3 | Aarno A.Laitila PhD1 | RobertAllan PhD4 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2021 The Authors. Journal of Marital and Family Therapy published by Wiley Periodicals LLC on behalf of American Association for Marriage and Family Therapy 1University of Jyväskylä, Jyväskylä, Finland 2University of Saint Paul, Ottawa, ON, Canada 3University of Ottawa, Ottawa, ON, Canada 4University of Colorado Denver, Denver, Colorado, USA Correspondence Sari Kailanko, University of Jyväskylä, PO Box 35, Jyväskylä 40014, Finland. Email: [email protected] Funding information Grant for this research to Kailanko was given by the University of Jyväskylä. Abstract In general, arousal of emotions is often felt and expressed as a somatic experience in the body. In Emotionally Focused Couple Therapy (EFT), the deepening of emotional experiencing enables therapeutic change. This research explores the experiences of eight experienced EFT trainer therapists regarding their somatic experiences in their work with couples. Using interpretative phenomenological analysis of transcribed indepth interviews, this research data yielded three core themes that captured therapists' experiences of using their own and couples' somatic experiences in therapy: (1) the importance and relevance of somatic experiences, (2) therapists' use of their own somatic experiences, and (3) working with clients' somatic experiences. The findings suggest that therapists do focus on their own and couples' somatic experiences in their work with couples, and that EFT therapists could benefit from a map to guide therapists how to focus on felt, somatic experiences as a way of maintaining an emphasis on emotional experience. KEYWORDS couple therapy, EFT, emotionally focused therapy, experiencing, somatic 2 | KAILANKO et AL. SOMATIC EXPERIENCE OF EMOTION IN EMOTIONALLY FOCUSED COUPLE THERAPY: EXPERIENCED TRAINER THERAPISTS’ EXPERIENCES Emotionally Focused Couple Therapy (EFT; Johnson, 2004, 2020) is an experiential and systemic therapy that focuses on each partners’ emotional attachmentrelated experiences in a couple. It aims to create a deep emotional experience for each partner in the session, thus enabling change and sharing of experience through enactments to foster couple's interaction and feelings of a secure emotional bond between partners (Palmer & Johnson, 2002). Even though the somatic experience of emotion is a key part of emotional experience, it has received limited examination in the EFT literature (e.g., Allan et al., 2015). The purpose of this study is to explore how experienced EFT trainer therapists describe their experiences and views on somatic phenomena in their therapeutic work. This research may provide new insight to the somatic experience of emotion in EFT couples' therapy to support therapists in facilitating partners' somatically felt, deeper emotions. Somatic experience of emotion In experiential therapies, moderate to high emotional arousal is seen as necessary in the change process. Therefore, the therapist's aim is to facilitate emotional arousal, however not so much that it is dysregulating (Greenberg, 2015). When psychotherapy clients experience emotions, they have corresponding physiological reactions within the body (Jung et al., 2017). Selfawareness of one's internal bodily states, or interoception, plays an important part in experiencing emotions. Research by Jung and his colleagues (2017) identified significant patterns of bodily sensation for each emotion, such as fear, anger, and sadness. Hence, emotion is a person's subjective internal state of being accompanied by involuntary physiological responses. Concurrently, some psychotherapy researchers have moved from focusing exclusively on linguistic modes of communicating, to incorporating affective and somatic modes of communicating, including in couples' therapy (Laitila et al., 2018; Nyman- Salonen et al., 2020; Seikkula et al., 2018). The roots of somatically oriented therapeutic interventions can be found in Gendlin's research (Gendlin, 1961, 1964, 1969), and his concept of “felt sense” that refers to experiencing emotions in the body (Gendlin, 1961). The phenomenological philosopher Merleau- Ponty stated that understanding of our life and world starts as an embodied experience, and further that “It is through my body that I understand other people” (1962, p. 186). In this vein, a recent study by Sleater and Scheiner (2019) applied interpretative phenomenological analysis to the therapy transcripts of six experienced clinicians working with individual clients. Their findings suggested that “embodiment” was a prominent theme of therapists’ “use of self” in the therapy (Sleater & Scheiner, 2019). In the present study, we were interested in couple therapists' views on somatic phenomena, including their own and couples' somatic experiences. Therapist presence Therapist presence has been defined by Greenberg et al., (1993) as not only showing empathy, but also including therapists' awareness of therapists' present moment experience of what is taking place in the session. Greenberg and colleagues highlighted that therapists' manner and style, including tone of voice and nonverbal expression play an essential role in communicating the therapist's presence. | 3JOURNAL OF MARITAL AND FAMILY THERAPY Couples therapy researchers recognize that therapists' emotional presence is an important part of EFT for couples (Furrow et al., 2012). The practice of EFT, as articulated by Johnson (2004, 2020), includes empathic attunement, validation, empathic conjectures, evocative questions and responses, addressing deactivating and hyperactivating strategies, heightening, reframing, and enactments (Johnson, 2004, 2020). Johnson (2004) highlighted the therapists' access to their own emotional experience as an important source of empathy, empathic attunement, and responsiveness. However, Palmer and Johnson (2002) noted that novice therapists may be more mechanical in their execution of EFT for couples until the model is fully integrated into their way of working through the process of clinical supervision. In a study investigating pursuer softening, which is a key change event in EFT, Furrow and colleagues (2012) reported that therapists' emotional presence predicted higher levels of client emotional experiencing. That is, when EFT therapists focused explicit attention on partners' current experiences by conveying a sense of personal presence and involvement, partners demonstrated deeper emotional experiencing (Furrow et al., 2012). Specifically, when EFT therapists softened their voice during an intervention, partners were 2.2 times more likely to have a heightened level of emotional experiencing. Higher therapist emotional responsiveness also predicted a greater likelihood of heightened partner emotional experiencing (Furrow et al., 2012). Therefore, therapists' capacity to tune into their own and clients' somatic experience may facilitate deeper engagement and an experiential therapeutic process. Working with clients' somatic experience Most of the time EFT interventions involve deepening of emotion (Johnson, 2009). Those EFT interventions that involve deepening of emotion and likely a somatic component are linked to significant change events in EFT such as accessing, exploring, and heightening attachmentrelated fears and longings that are first experienced by one partner, and then shared through enactment between partners. Furthermore, the experience of sharing is explored with each partner (Bradley & Furrow, 2004, 2007). Understanding how therapists use heightening and evocative interventions effectively in EFT may improve our understanding of how to facilitate change for couples. Gaining a greater understanding of how therapists engage with the somatic aspect of heightening and evocative interventions may be one avenue toward this goal. In order to better understand the role of EFT interventions involving somatic experience, Kailanko and colleagues (2020a; 2020b) studied interventions focusing on clients' somatic experiences during EFT sessions for couples. They found that experienced EFT trainer therapists used interventions that focused on partner somatic experiences, and that somatically focused interventions were significantly associated with greater depth of couples' emotional experiencing. In the present qualitative study using the interpretative phenomenological methodology, we explored how experienced EFT trainer therapists themselves view somatic phenomena and their experiences, if and how they report paying attention to it, and how they describe their experiences of working with their own and partners' somatic experiences. Understanding the views from EFT therapists on somatic phenomena is important for two reasons. First, this kind of knowledge can help to bring a missing piece of research within the EFT framework with the goal of better understanding how the somatic aspect of experience in EFT sessions facilitates emotional change for partners. Second, this knowledge may contribute to the development of a map to guide therapists to focus on felt, somatic experiences as a way of maintaining a focus on emotional experience during EFT. 4 | KAILANKO et AL. METHOD Participants We recruited eight certified EFT trainers of 56 listed on the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) website as of October 2018. We contacted 12 of them directly by email and 8 expressed their interest to participate in the study. Prior to the interview, the therapists were informed about the study procedure and provided a privacy notice, and they provided informed consent to participate in the study. The interviews took place between July and November, 2019. The eight participants, seven females and one male, were from three different continents and had an average of more than 25years (18– 40) of clinical experience in the area of couple therapy. All were White, between 50 and 70years of age. Experienced EFT trainer therapists were selected as the sample of therapists in order to gain collective wisdom as broadly and deeply as possible about how EFT is prototypically or ideally practiced, that is, the espoused theory of EFT practice. Thus, the selection of trainer therapists was done to see if they recognized the somatic phenomena in their work, and if they did, how they described utilizing such phenomena. All the therapists reported using only the EFT therapy approach in their practice, and they were active in providing training and supervision to new EFT therapists locally and internationally. Procedures We collected data from participants in face- to- face semistructured interviews. The goal of the interview was to capture a rich, indepth understanding of participants' experiences of somatic phenomena in couples therapy. Topics of the semistructured interview included: (a) participants' views of the relevance or importance of somatic phenomena to their own clinical work (b) participants' experiences of paying attention to the somatic aspect during therapy (c) participants' experiences of the use of somatic experience, if any (d) participants' examples of using somatic experiences from their own clinical work, and (e) participants' conscious awareness of using somatic experience in clinical work. We used openended questions, such as: How do you see the somatic phenomena in EFT? How do you use it in your work with couples? Could you give me an example, please? How consciously are you using it? How do you see the importance of somatic aspect in your work? Would you have some additional examples how you use it? in order to explore therapists' verbally reported views and experience on somatic phenomena. Interviewers followed up with additional questions such as “how”, so that participants could elaborate on their views, experiences, and examples while interviewers tried to gain a deeper understanding and make sense of participants' experience. Analytical method The length of the interviews was from 40 to 90min. One interview was conducted for each therapist. Transcribed interviews were analyzed using interpretative phenomenological analysis (IPA; Smith, 1996; Smith et al., 2009, 1999; Smith & Osborn, 2008). IPA is a qualitative method of analysis that has roots in phenomenology in exploring subjective experience, and it aims to provide detailed examinations of personal lived experience. We applied a double hermeneutic method (Smith & Osborn, 2015), that refers to a way of working, when we, as researchers, try to account for how the experienced | 5JOURNAL OF MARITAL AND FAMILY THERAPY TABLE 1 Compositional structure and illustrative quotations for core theme 2 Core theme Code Superordinate theme Emergent theme Quotations Therapists' use of their own somatic experiences 2.1 Therapists' own body as a tool in therapy work Consists of 15 emergent themes Based on my own experience I put out bodily reaction tentatively for the client I pay attention to the client, not me I signal to clients nonverbally I tune into myself and what happens inside of me as it guides me, helps to understand, describe, validate, and get the meaning I use my bodily experience to guide my interventions, but I never share it with the client I use my body throughout the process I use my body to deepen clients' inner experience I use my own body to create energetic shift I use my physical presence My different bodily sensations My somatic experiencing as a resource as clients may have a block My use of somatic aspect in the early stage My ways of tuning myself into clients' experience Therapists feeling emotion in their body To facilitate therapists emphatic attunement Including 75 quotations I'll say I feel tense right now. I'm wondering, if that's what you're feeling (T1 L 350) No, no, I pay attention to them, not me in that moment (T3 L 62) I may… close my folder on the book just some indication of we got 10minutes we're winding down (T4 L 440) I tuned into myself, and really noticed my own…what was happening inside of me that that was a real guide into what was happening over there with my client too (T1 L 96) If I can hear their voice constricting or they're breathing, so I use my attunement in those moments to guide my questioning and my interventions (T3 L 65) I never share my bodily experience or anything like that. I just use it to guide my interventions. Some therapists say I feel X Y C (T3 L 139) I use my body throughout the whole process for sure (T3 L 82) I'm especially aware of how much I use it in move two our surrounding deepening (T3 83) I'll actually use my body to energetically shift, so that I can get more engaged and start to help them to get more engaged (T2 L 291) I roll out, whenever I am ready to hand the session back over to the…when I see affect or something or see a entry, I'll roll in and I lean in, I mean, I'm physically lean in my chair toward them (T4 L 321) As my client is speaking and as I'm listening to my own responses, I'm scanning my body… in my heart and in my chest (T1 L 143) So this touches me when he's telling that story … with the more of a blank voice…I let him see my tears. I tell it makes me sad and I turned to him and say so what's happening. So I'm using my kind of their sensory reactions to to to help him to connect with his pain (T6 L 434) As my client is speaking… I'm scanning my body, right, or my own responses, so I would be reflecting, what I'm seeing. And as I say those words, I can feel myself starting to feel, what I'm saying (T1 L 143) Note: N=8 therapists. 6 | KAILANKO et AL. EFT trainer therapists were viewing and making sense of somatic phenomena in their clinical work with couples. We chose IPA because it provides a framework for exploring novel research areas, like in this study of somatic phenomena of EFT couple therapy, and for gaining an understanding of participants’ personal experiences. We used purposive homogeneous sampling (Smith & Osborn, 2008) in this study. The participants were similar as all were experienced EFT trainer therapists for couples, yet they had their own experiences of somatic phenomena in their own clinical work with couples. We were committed to explore the detailed experience of each therapist, while capturing their shared experience. IPA is a dynamic process recognizing the researcher's own conceptions while the researcher is making sense of what appears during the analysis. Two of the authors (Kailanko & Wiebe) acted as interviewers and coders of the data. They are psychologists, trained in EFT at the basic level, and also trained in somatic psychotherapy. They kept a notebook to record their own preconceptions and theme development during the study as suggested by Giorgi (1985). The analytical process of this study followed a similar process as outlined by Smith and his colleagues (2009). That is, a series of analytical stages where emerging themes were first identified and then grouped into clusters of themes. Then, a core theme structure or table of themes was created as an outcome that captures and describes the shared experiences of participants. The description of the analytic procedure for this study is provided in the Appendix. Validity and reliability The trustworthiness and validity of the present study's findings were assessed against validity criteria by Smith (2011b), such as coherence and transparency. The EFT therapists who took part in the interview had the option of receiving a copy of the transcribed interview. They were free to amend the transcript as they deemed necessary. Furthermore, the two authors (Kailanko & Wiebe) carried out and analyzed the interviews using a process of consensual validation. In this study, we applied the theoretical aspects of IPA (phenomenological, idiographic, and hermeneutic) as described in the analytical method section. The validity criteria addressing sampling for a study of eight interviews indicate having extracts from at least three participants for each theme (Smith, 2011b). This study meets this set criteria by having a minimum of three and up to six quotations for each emerging theme under each core theme. However, in addition, negative statements even by a single participant referring to the somatic aspect of emotional experience, such as “I don't use or do …” was intentionally marked separately in order to clearly pay attention to them. For the reader to be able to transparently follow how we conducted the analysis, we provide an example, a part of the compositional structure of core theme 2 with some direct quotations from data for the emerging themes that are building blocks for core theme 2 in Table 1. Therapists (T) and transcript lines (L) for extracts are noted to ensure the audit trail. The participants of the study are very experienced, which provided interesting and plausible research material to be analyzed. We used respondent validation in which we provided findings to a participant therapist in order to seek her views of our interpretation for the data (Dallos & Vetere, 2005). That is, we discussed the findings of the current research with one experienced EFT trainer therapist in order to understand the relevance, importance, interesting areas, and potential clinical impact of the findings. Working on the transcribed interview texts, making preliminary markings, highlights of themes and interpretations, is a continuous reflective practice used by coders to note their own preconceptions (Smith et al., 2009). However, one may not be conscious of one's own attitudes and views (Smith et al., 2009). Therefore, to achieve consensual validity, all interview material was reviewed by the | 7JOURNAL OF MARITAL AND FAMILY THERAPY two coders to verify what was marked as interesting or important. From the reflexive validity point of view, the two authors acting as interviewers and coders note that their own understanding of the somatic experience in EFT has changed pre- to post interviews. RESULTS The analysis of interview transcripts yielded three core themes. They were as follows: (1) the importance and relevance of somatic experiences, (2) therapists' use of their own somatic experiences, and (3) working with clients' somatic experiences. The findings of this study, the core and superordinate themes, are presented as an overview in Table 2, and then each core theme is discussed in separate sections. Smith (2011a) recommends sampling extracts from half of the sample for each theme. In this study, each of the superordinate themes is supported by verbatims from at least half of the participants. In the text below, we show the audit trail of verbatims by referencing transcripts with therapists’ number (T1) and transcript lines (L111) for each extract. Core theme I: Importance and relevance of somatic experiences This core theme reflects the importance and relevance of somatic experience of emotion that participants associated with their clinical work with couples. All eight therapists viewed the somatic aspect as important to their therapeutic work. Verbatim descriptions of this theme included: “Absolutely. Yeah. I couldn't do without it” (T4, L 458); “Totally 100 percent” (T5, L418); “Definitely” (T1, L 484); “I can't imagine not working somatically in EFT”. One therapist stated that “I think emotions show themselves somatically. I think the body doesn't lie. You can say you're feeling something, but the body really, I think, manifests your emotions” (T2, L 386). Furthermore, participants stated that the somatic aspect needs to be explicitly recognized within EFT, as indicated in these verbatim accounts: “I think one of the S's in the RISSSC acronym (i.e., repeatimages- softslow- simpleclient's words), … needs to stand for somatic or sensations, in my opinion” (T5, L 418); “I think it's interesting and great that you're focusing on this (somatic experience) in your study, because I think we do use a somatic aspect in EFT quite a bit, but we're not necessarily always explicit about it” (T3, L 250). The participants discussed the benefits of working with the somatic experience, as indicated in these verbatim accounts: “I know that it's a fruitful venue for explore” (T3, L 57); “I do think that nonverbal expression of emotion is often the entry point” (T2, L 77); ”It's the channel for lasting change” (T1 L 485); “The body sensations help lots of people tune in, and other people just deepen, what's going on” (T1, L437). Therapists reported that they consciously use the somatic aspect: “I'm very aware of it, and it's something that I trust. It's probably my biggest resource” (T1, L 190); “By this kind of focusing, my eyes are even more onto their sensorymotor process. So, I'm more precise, I'm more aware of it all, and I have much more information” (T6, L 56). The EFT therapists viewed the somatic aspect throughout the therapy process as highly relevant. For example, one participant noted that “I would focus on the body throughout the process, and also use myself in that way through the process” (T3 L 138). Working with somatic experiences was viewed as rewarding by some therapists, and they reported that it allowed them and clients to work on a deeper level: “It's what makes the work meaningful and deep, otherwise it's an intellectual exercise” (T1, L 485). The participants also discussed the reasons and needs for their interest in somatic experience. All of the therapists mentioned how challenging it is to work with withdrawing partners: “With a withdrawer, when they're in their heads and that's where they're comfortable speaking from, … I'm 8 | KAILANKO et AL. wanting to work experientially, and then I will do EFT interventions, and I won't get very far… nothing really will come of them. And I'll say, ‘how is it for (you that I ask) about your inner world, and can you help me know what sensations are coming alive when I try to get focused on your inner world?’ People often report discomfort or tension, so I'll linger there because that tension, that discomfort, is something I want to then bring alive experientially” (T5 L 93); “I felt like I had no access as there were no words, no emotions. There was really nothing happening in them in the sessions…, so I felt like I have to find another route to make sense of what is going on and get into the connection” (T6 L 26). The participants had different experiences of working with pursuers’ somatic experience. Some reported that “The pursuers are usually so much more verbal, and yet also struggle to get in touch with what's happening somatically, … as they're maybe sharing a bunch of reactive emotions.” (T5 L 113). Therefore, some therapists suggested that somatic experience may help the pursuer to slow down and get their focus inside of themselves instead of outside: “One of the primary ways we know to slow pursuers down is to help them slow down enough to connect to their somatic experience, so they're not just reacting emotionally and then getting caught in their own reactivity, which makes it bigger and brings them further from their intrapsychic experience” (T5 L 118). One therapist reported that they may say to pursuing clients: “Help me know what you feel on the inside, what sensations are you aware of. I see your hand making a fist, or I see your legs shaking, so you are feeling what on the inside” (T5 L 115). However, another therapist viewed working with pursuers differently saying: “I wouldn't want to say, where do you feel that in your body, especially, if it's a dysregulated pursuer, because they already feel in their body, and we don't want to draw attention to it. It's already hot and we want to kind of get in calm, sort of regulated enough that they can sort of be still in and feel something that they can talk about what they feel, and how this person (their partner) makes them feel that way” (T4 L 645). The participants explained that the somatic experience of emotion came from a need to be able to work with clients, such as withdrawers or the need to go deeper into the felt experience. They discussed their own developmental paths toward using somatic experiences as a therapist that might have taken several years since their training as a counseling or family therapist did not include a focus on the therapists’ somatic or emotional experience. Some reported that the traditional role of a therapist was to be “blank slate.” Therefore, using somatic experience of emotion was learned by copying or imitating colleagues, or by seeking external training that focused on somatic experience. Core theme II: Therapists' use of their own somatic experiences This core theme of therapists using their own body as a tool in the therapeutic encounters had the highest number of quotations from participants. Moreover, all therapists brought up this aspect: “Yes. I noticed when my body responds to the process with the partners, and I pay attention to my somatic responses, my somatic experience” (T5 L 53). 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