1/5 I get weekly coaching with Alex Vaz. Here's what I learned on 11/10/23.
About once a week I get coaching from the worlds best therapist coach - Alex Vaz [1].
For long-time readers, that won't come as a surprise. I've written before about getting coaching with Alex Vaz.
I get coaching from Alex because, well, therapy is hard on me. Most of the therapists I meet assume they are helping their clients. That's their baseline. They (seemingly) walk around feeling wonderful because of all the good they feel they are doing in the world.
I was the opposite. I walked around feeling like no matter how hard I tried I wasn't making a difference.
I couldn't keep working as therapist like that. So, I started getting coaching from Alex.
Once a week we sit down, watch my therapy tapes, and use deliberate practice role plays to rehearse stuck points with clients.
It's been sooo useful. Not only do I feel better and more empowered when working with clients, I also have seen my metrics improve. So I know I'm getting better.
I want to pass along what I'm learning.
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2/5 Why Emotionally Focused Therapy (EFT) is the best model.
A few years ago I went though the full Emotionally Focused Therapy (EFT) training. It was, and still is, hands down the best clinical training that I've been through.
I'm not saying their model is more effective. I'm saying their training process is more clear. Most trainings simply aren't that clear on what you actually do. EFT has a huge advantage simply because it's more concrete and actionable.
Now of course there are other actionable models, but many of those models still have a problem - the interventions are often more behavioral. For instance in Bowen theory you ask clients to create a genogram between sessions. Or in exposure therapy you might attempt to help a client resolve anxiety by facing the things which make them anxious.
This leads to therapists burning out.
In these models we try and get clients to do the intervention. That's part of how we know we're succeeding. But, clients oftentimes don't want to do the behavioral intervention, so we never get cues that we're succeeding. We walk around feeling like we're failing.
EFT is different. In EFT you work with emotion. So as long as the client is crying you feel like you're working on the "right" thing, all of which feels more rewarding to the clinician.
That's great model design. Trouble is this focus on emotion can be a red herring.
3/5 The problem with focusing on emotion.
When I was taught EFT I was told, repeatedly by trainers, that my job was to keep the client talking about their emotion. In fact, I was told to prompt them to talk more about their emotions and ask that they, "add one more emotion word to their experience."
This is simply wrong.
What the trainers were alluding to is research which shows that the depth of experiencing is predictive of change in therapy. Many clients come to therapy talking about problems from the past, in vague ways, that are external to them. Client experiencing is the idea is that the more clients talk about their specific, present, and internal experience the more likely they are to have a clinically significant change.
In the research there are 7 levels of experiencing.
So where did the EFT trainers go wrong?
An emotion is NOT the same as experiencing. A client can be crying deeply but not be talking about their experience.
For instance, this "client" is not at a deep level of experiencing.
So what's the alternative?
4/5 Caching with Alex Vaz gave me an alternative to focusing on emotion in therapy.
Alex (my coach) prefers the idea of schemas to emotions. Schemas are connections of emotion as well as negative beliefs about our selves and the world.
Hearing him talk about schemas really changed how I see client experiencing. Yes, he gave me a rationale for what a schema was and why it was more encompassing than simply focusing on emotion but that idea did more than create a cognitive distinction in my mind.
It broadened my focus.
Before when I was listening to the advice of the EFT trainers my focus had narrowed. I simply wanted the client to add one more emotion word to how they felt. If they said "I feel sad." I'd say, "You feel sad. Is that like sad hopeless? Sad scared? Something else?"
If they responded with something that wasn't an emotion word ("I just feel like I'm on an island and no one's coming to help me,") I dismissed it.
But, that statement, feeling like you're on an island, can be a wonderful description of your inner world, even without using a single emotion word.
Now, thinking about how I'd dismissed clients, I cringe.
5/5 How focusing less on emotion makes me a better counselor.
Now of course, this isn't just a problem with some EFT circles. I suspect this is a problem for our field in general. For example I suspect some therapists make the same mistake when using the emotion wheel.
The two millimeter shift is to remember we're not looking only for words. Of course, having the client speak about their present internal experience in a concrete way is helpful, but it's not just about the worlds. It's also about how the words are said.
Did the client slow down?
Did their voice become soft?
Does their response sound less rehearsed and more like they are stretching for their words?
All of these things are signs of clients speaking more from their experience.
Personally, I think this has made me a better listener. I'm not trying as hard, but I'm also listening more effectively. I'm listening better while using less effort.
Which, for me, is much more sustaining.
Best,
Jordan (the counselor)
-Fin-
Notes
[1] Alex Vaz is the co-author of literally dozens of books on deliberate practice, has written academic papers on therapeutic change, has trained with the best trainers in half a dozen different models, is now the Director of Training at Sentio, ran a popular YouTube series interviewing therapy experts, and at one point had some of the highest clinical outcomes of any therapist on record.
If you liked this post, consider reading this next. I think you'll like it ;) It's about gamifying deliberate practice to make it more engaging.
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com.