Reducing Experiential Avoidance
and Accessing Self-Soothing in EFTT
Sandra C. Paivio
York University Psychology Clinic
Toronto, ON, Canada
Creating Connections Conference
Washington DC
September, 2016
Complex Trauma
Definition:
• Repeated exposure to violence and betrayal at the hands of
caregivers and loved ones (attachment relationships)
• Type II versus Type I (single incident)
Prevalence:
• Exposure to violence in the home during childhood is more
common than single incident trauma in adulthood
• Increases risk of repeated victimization
• Estimates for child abuse history as high as 90% in clinical
samples
Need for effective treatments for long-term effects and training in
these approaches
Three Inter-related Sources
of Disturbance
• Exposure to trauma (experiences of terror and
powerlessness)
• Negative experiences in attachment relationships
(enduring perceptions of self and intimate others)
• Reliance on experiential avoidance as a coping
strategy (interferes with processing and integration)
Constellation of Long-term Effects
(Complex PTSD)
• Symptom Distress
– Posttraumatic stress disorder (PTSD), anxiety, depression
• Emotion Regulation Difficulties
– Under-regulation, over-control, alexithymia, maladaptive behaviors
(e.g., substance abuse, self-harm)
• Self and Interpersonal Problems
– Self-esteem, -awareness, -identity, -confidence; interpersonal
alienation, distrust; difficulties with intimacy, parenting
(transgenerational transmission of trauma); personality pathology
Disrupted narrative and affective processes are at the core of
this constellation
Psychological treatments address these disturbances
Emotion-Focused Therapy for Trauma*
(EFTT)
• Short-term (16 – 20 sessions), trauma-focused,
individual therapy for men and women dealing
with different types of childhood abuse
(emotional, physical, sexual, emotional neglect)
• Based on the general model and principles of EFT
applied to complex trauma
• Developed from 20+ years of process and
outcome research
* Paivio & Pascual-Leone, 2010
Common Factors in Therapies
for Complex Trauma
• Provision of safety
• Attention to emotion regulation (primarily underregulation)
• Emotional engagement with trauma memories
(exposure, emotional processing as change
process)
• Construction of more adaptive narratives and
meaning regarding self, others, traumatic events
• Stage models (safety and emotion regulation,
exposure and working through, integration and
connection to the present)
Distinguishing Features of EFTT
• Empathically responsive therapeutic relationship is the
foundation of therapy and primary vehicle for emotion
regulation (Paivio & Laurent, 2001)
• Subjective internal experience (feelings and associated
meanings) is the primary source of new information
used in the construction of new narratives and
meaning
• Draws on emotion theory and research, and current
affective neuroscience (e.g., Damasio, 1999; Ledoux, 1996)
• Focus on resolving past emotional injuries with
particular perpetrators
• Based on an empirically verified model of steps in the
interpersonal resolution process (Greenberg & Foerster, 1996
Core Tasks in EFTT
• Establish a safe and collaborative therapeutic
relationship
o Promote emotional experiencing – awareness,
exploration of feelings and meanings
o Promote self-development -- reduce
fear/avoidance, shame; access self-soothing
• Resolve issues concerning perpetrators
(attachment figures) – adaptive anger and
sadness as catalysts
Process Maps that Guide Intervention
• Revised Model of Resolution (Greenberg & Foerster, 1997,
Paivio & Pascual-Leone, 2010)
• Models of Emotional Experiencing
– Allowing Emotional Pain (Bolger, 1999; Greenberg & Paivio,
1997)
– Levels of Experiencing (Klein et al, 1986; Gendlin, 1997)
• Accessing Self-Soothing (Paivio & Pascual-Leone,
2010)
• Narrative-Emotion Quality Subtypes (Angus & Paivio,
2017)
Model of Resolution
Negative
other
Specific
negative
attributes
More
differentiated
view of other
Hurt,
blame,
complaint
Global
distress
Episodic
memories
Differentiate
feelings
Uninhibited
anger,
sadness
Work with fear, avoidance,
shame
Entitled
to
unmet
needs
Increased selfesteem,
empowerment,
separation from
other;
forgiveness
and/or holding
other
accountable for
harm
Markers of Avoidance
Over-control
• Explicit statements (I don’t want to cry)
• Self-interruption (suppressing tears, resignation)
• Minimizing harm, pain
Intervention involves allowing
Limited Access
• External focus on behavior and events
• Flat affect, numbing
Intervention involves accessing
Allowing Emotional Pain
Steps in the Process
• Approach
• Allow
• Tolerate
• Explore meaning (causes, effects, needs)
• Acknowledge those responsible for the pain
Intervention
• Gradual exposure
• Affirm vulnerability
• Encouragement and support
• Evocative empathy
Depth of Experiencing
Levels
• Low – external focus on behavior, events
• Moderate – personal, affective
• High – explore meaning and construct new meaning
(pose and begin to answer questions about self)
Intervention
• Deepen experiencing step-by step
• Explicit emotion coaching and guidance
• Focus on personal values and concerns
• Focus on feelings and needs
• Explore meaning
Narrative-Emotion Quality Subtypes
Problem Markers
• Same Old Story – stuck (core maladaptive emotion scheme)
o Empty Story – absence or minimal emotion and/or arousal
• Unstoried Emotion – overwhelming emotion or
dissociation, incoherent content
• Superficial - impersonal, external focus, low experiencing
Intervention
• Direct attention to internal experience
• Explicit emotion coaching and guidance
• Emotion regulation
• Focus on personal values and concerns
• Then feelings and needs
N-E Quality Subtypes
(cont’d)
Transition Markers
o Competing Plot Lines – conflicted, dominant
maladaptive versus healthy experiencing self
• Reflexive Story – some exploration of meaning
• Experiential Story – higher levels of experiencing
Intervention
• Support less dominant healthy experiencing self
• Access specific episodic memories – sensorial detail
• Deepen experiencing
Steps in the Process
of Accessing Self-Soothing
• Evoke self as a vulnerable needy child
• Direct attention to feelings of child (e.g., sad,
lonely, unwanted, worthless, afraid)
• Identify unmet needs of child (e.g., love,
protection)
• From adult perspective, respond to needs –
compassion for suffering, nurturing, comforting
• Experience effect of soothing response
• Carry into the present
Clinical Examples
“Little Girl in a Dungeon”
• Exposure to extreme family violence from
father up to age 5, past and current
symptoms of PTSD, requested no chair work
“I’m So Damaged”
• Repeated victimization into adulthood,
multiple types of trauma, multiple
perpetrators, long history of depression
“Little Girl in a Dungeon”
Task Markers and Intervention
Emotional over-control
Interventions help her allow suppressed feelings – affirm
vulnerability, encouragement and support, evocative
empathy, imagine self as a child, access healthy needs and
self-soothing
Moderate depth of experiencing
Interventions explore available feelings and meanings –
evocative empathy, imagine self as a child, explore
metaphors, access healthy needs and self-soothing
Competing plot lines narrative
Interventions support experiencing self – desire to let go
over-control, be free
“Little Girl in a Dungeon”
Video Clips
Quality of Emotional Processing
• Suppressing, then approaching and allowing
emotional pain
• ..\Desktop\EFT(T) workshop Video Clips with
Subtitles\SEPI13 APA video clips\APA Client 3
allowing.mp4
Accessing Self-soothing.
.\Desktop\EFT(T) workshop Video Clips with
Subtitles\SEPI13 APA video clips\APA client 3 selfsoothe.mp4
Discussion
“I’m So Damaged”
Task Markers and Intervention
Limited access to emotion
Interventions access emotion – emotion coaching, evocative empathy ,
imagine self as a child
Low level experiencing
Interventions focus on core values and concerns, then feelings –
evocative empathy, imagine self as a child, explicit guidance to access
unmet needs and self-soothing
Empty story
Interventions access personal meaning and feelings – evocative empathy,
focus on core values and concerns, imagine self as a child, explicit
guidance to access unmet needs and self-soothing
“I’m So Damaged”
Video Clip
Initially limited access to emotional experience
followed by accessing sadness, unmet needs,
and self-soothing
EFT(T) workshop Video Clips with Subtitles\APA
video clips\APA Client2 self-soothe long.mp4
Discussion
Slides and Reference List
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