Integrating EFT with Traditional Counseling: Pilot Study for Proposed Theoretical Model

Christine C. Berger, PhD, LCPCOld Dominion University

EFT Scientific Symposium 2015July 4, Staffordshire University

IntroductionAs complementary therapies (CT) become more widely

used (Clarke et al., 2015), it would benefit counselors and other mental health professionals to better understand their effects on mental health treatment

The principal investigator has observed that there are 2 emerging models combining CT and counseling: an integrative counseling model and a team treatment approach

The goal of this study is to explore, inform, and encourage counselors who practice using conventional counseling methods to include complementary therapies: integrative counseling model

IntroductionCurrently in the counseling field “integrative

counseling” refers to the combination of multiple types of conventional counseling or including cultural issues in counseling (Corey, 2012; LaFramboise et al., 1990; Leong, 1996)

However, psychiatrist James Lake has coined the term “integrative mental health” which focuses on the inclusion of integrative therapies with conventional counseling (Lake, 2009).

In counseling this integrative term may need modification but the label refers to mental health professionals who integrate a CT into their practice

IntroductionThe PI met with a professional counselor who practices

this integrative model using Emotional Freedom Techniques (EFT) as her CT and that was the impetus for this pilot study.

There is a large body of research demonstrating the effectiveness of EFT on a variety of mental disorders (Boath, Stewart & Rolling, 2014, etc.) but there have not been in-depth studies about the experience of such a model from the client and counselor perspective

A grounded theory approach is exploratory and seeks to understand a phenomenon from the ground-level up.

Research QuestionsResearch question 1: What attracted you to

this holistic/integrative model of counseling?Research Question 2: Can you describe

how this experience has differed from other counseling or mental health treatments you may have received previously?

Research Question 3: How has EFT/EP specifically affected your mental health and overall well-being?

Research QuestionsResearch Question 4: How has the

counseling relationship and process affected your mental health and overall well-being?

Research Question 5: How has counseling and EFT/EP for your issues (trauma) impacted your spirituality, if at all?

MethodSetting

Setting was a private mental health counseling practice run by a licensed professional counselor

ParticipantsFive outpatient clients seeking treatment for a variety of

mental health disorders (alcohol use, other substance abuse, anxiety, depression, grief and trauma). These clients were all receiving counseling and EFT 2 males, 3 females Ages ranged from 25 to 55 4 were Caucasian and one was biracial

1 Professional CounselorWe wanted to interview clients who disliked or refused EFT

but none were interested in participating

MethodData Collection

Data were collected by principal investigator and two graduate students who were learning qual methods

Consents were obtained and data were collected through audiotaped semi-structured interviews. Interviews lasted about an hour and were subsequently transcribed

Data was collected over two monthsAnalysis

The transcribed interviews were entered into NVIVO which is a software program designed to manage narrative data

The primary investigator coded each participant transcription at two levels: open coding and axial coding

MethodAnalysis

After axial coding themes emerged from the data which created the initial foundation of theory of an integrative counseling model

This study stopped short of generating a relational model as we have not yet achieved theoretical saturation

TrustworthinessIn the data collection process each

interviewer was trained in qualitative interviewing methods by the PI

Bracketing and Memos: the training encouraged the use of memos to bracket biases for accurate data collection. The PI used the memo process at this stage

Codes were combined and compared to each other to refine themes and dynamics in the model.

One graduate student also coded at an open level for across-interviewer comparisons.

ResultsOpen coding rendered 113 unique codes for all

participant transcriptionsAxial Coding produced 7 themes:

The role of motivation and readiness may improve openness to a CT

Integrative model preferredIntegrative model effective (accomplishes goals,

reduces sx)EFT is calming/focusing/groundingEFT is a key coping toolMechanism is not a client concernCounselor provides a safe space

Motivation and readiness may improve openness to modelEFT2:” I am a more motivated person I think. I when

I want to do something I’m going to do it, and I had decided that I was not going to be dealing with the depression any more, I was going to find a way to fix it.

EFT3: “I think if it had been an earlier time frame for me, like if I wasn’t ready to kind of delve into all the things, I wanted to at that point. I wanted to delve into the depths of myself because I know that was really the only way that I was gonna move forward. I just didn’t, I really just didn’t know how to do it.”

Integrative Model PreferredSome participants had previous counseling and

clearly preferred the integrative modelEFT2:. “And so I like this technique so much more

because, with him it was like I would see him once a week, then I would kind of have to wait for another week for anything to happen, I would just wait for the next week. Whereas, this was something I could do every day as many times a day as I wanted and I could experience immediate relief as opposed to having to wait a full week just to talk to someone. So, I liked that I was in control of it as opposed to needing him to help me through something.”

Integrative Model PreferredEFT3: “Where before in traditional therapy I would

cry and I would just kind of stop talking about it, because that was the only way for me to kind of regroup myself was to not talk about it when what you really want to do is talk about it but you can’t, you know and that was kind of my roadblock with traditional therapy was like I can’t get past this point of anxiety or I can’t get past you know, this roadblock of I’m not gonna feel any emotion about that so it’s kind of been twofold in that 1) it calms me down so that I can keep talking and 2) it has removed that wall that I had up and it kind of sneak attacks you”

Integrative Model EffectiveEFT5: “Oh no I could drink like three bottles

of wine, I went from 3 to about 1 too even skipping a couple days…I would say the counseling with Dr. T and the tapping have both helped. Yes, and probably the yoga, they are all holistic. “

EFT is calming/focusing/groundingEFT2: “It’s definitely been positive. I still like

two nights ago I was stressing about something, I don’t remember what but I am definitely not feeling the way I felt when I was meeting with Dr. T but like even minor stressors it’s just it’s calming and it’s something that once you learn it you kind of remember it forever I feel like at least at this point.

EFT is a key coping toolEFT1: “It’s just very important. If I couldn’t

do that, I couldn’t get through half of what we’ve been going through”.

EFT2: (EFT has been)Tremendously positively like I said I couldn’t focus on anything I was kind of just laying around and not doing anything, but it kind of lets me put the stressing to the side and get back to whatever I need to do or stop stressing and actually be productive.

Mechanism is not a client concernIs the energy of EFT creating an outcome or is it a

distraction or focusing technique? Mixed resultsEFT4: “Like I don’t know I think it is cool the whole idea

of chi and the energy source stuff and everything and I don’t know exactly how it works if it is just distracting me or if that is doing something when I am doing this and talking through the problem and all of that. But it has proved helpful like when I have gone through a couple weeks stint where I have been doing that every day”.

EFT3: “When you do it yourself it’s a little bit different. Umm, when I tap myself, I don’t know how to describe it, it’s almost like a distraction and a focus at the same time”

Counselor Creates a Safe SpaceEFT5: “Yes it was new, the 3rd session I

noticed the poster of EFT tapping points and asked about it and she said well let’s do it. I told her I had started yoga and she encouraged me to do yoga. A man at yoga who had lost his son 20 some years ago had healed through yoga, I told him about it and he told me to keep seeing her because he felt it could help me. Today I have tapped twice. I did not know how I feel about coming in and opening up to another person”

Professional Counselor PerspectiveEFT is especially useful for traumaPeople “literally change before my eyes”Use of audio-recorder to “take counselor

home with them”.Gentle introduction of EFT offered as a toolDiscussion of ethics and trainingImportant for counselor to practice for

experiential knowledge/credibility and self-care

Professional Counselor PerspectiveExploration of improvement from 10 to 5 and

the challenges of going from 5 to 0“And when I say, I see people change in front

of my eyes, I don’t mean that. I mean that I see people shift from an intensity of a nine or 10down to a five, and pretty quickly. And then often, in my experience, there’s more work to get it from a five to a zero. So, in my experience, that’s where it can take some time. And focus.”

DiscussionStrengths

Sample included both gendersThere was adequate data to begin to understand the

experience of this integrative model (rich data)Certain suppositions were confirmed but there were

more avenues to exploreLimitations

Sample did not achieve theoretical saturation for adequate theory-building

Not a culturally representative sampleOne mental health professionalLimited to one CT

DiscussionInitiation or Seeking out of an Integrative ModelMechanism: the How of EFTPotential specific functions for EFT and

counseling that create the wholeEFT alone or in the counseling relationshipIM allows access to deeper emotionsReduction in anxiety over timeEFT as intuitiveValues did not attract people to EFT, counselor

did

DiscussionEFT and counseling seem to be tapping into

different things. Some participants described EFT as managing anxiety well enough to be more productive with talk therapy. Others view counseling as addressing specific issues (reduction of depressive symptoms) and EFT as helping him manage character defect issues (shame? On his own).

DiscussionGender was interesting as the males in the

study seemed to appreciate EFT as a self-help tool whereas the females discussed it more in relationship/holistic context. Could be related to ease of learning EFT as well.

Next PhaseWe will connect with other mental health

professionals who are integrating a complementary therapy into their traditional counseling practice

After increasing our numbers in this grounded theory qualitative study we hope to create quantitative studies of this model. Examples include studies comparing conventional counseling to integrative counseling across disorders (efficacy, efficient resolution of symptoms, satisfaction, etc.)

Next PhaseTrustworthiness

Theoretical Saturation: We intend to interview about 10-15 more participants or the amount required to achieve theoretical saturation

Member Checks: We will conduct member checks where we hand the transcripts back to the participants for verification or clarification

We will increase the use of memos for bracketing of biases and more refined questioning