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EFT for LGBTQ+ Relationships: Guidelines for Culturally Responsive Practice

Sun, Apr 27, 2025 . 3:07 PM44:27Owner: Amber Watkins

SUMMARY KEYWORDS

EFT, LGBTQ+ relationships, culturally responsive practice, Delphi study, Emotionally Focused Therapy, attachment theory, minority stress, therapist foundational knowledge, socio-cultural context, heteronormative biases, client experience, relationship dynamics, therapist training, EFT guidelines, mental health.

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Music.

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Speaker 1

0:09

Hello and welcome to the thoughtful counselor, a podcast dedicated to bringing you innovative and evidence based counseling and mental health content designed to enhance your life, whether you're a clinician, supervisor, educator, or a person wanting to learn more about the counseling process. We are here to demystify mental health through conversations with a wide range of counseling professional powerhouses. In each episode, you'll learn about current issues in the field, new science and real life lessons learned from the therapy room. Thank you for joining us on our journey through the wide world of counseling. There's a lot to explore here, so sit back, take a deep breath, and let's get started.

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Speaker 2

0:54

Welcome Caitlin. I'm excited to talk about your article, one of your many published articles that just came out this fall in 2020 through four. What year are we? Yeah, 2024 developing guidelines on EFT for same sex, gender relationships, recommendations from a from a Delphi study. This was published in the Journal of family process, which is an open access journal so everyone can get access to this. The link will be available to you in the show notes, so be sure to download it and read it and consume it, because it's so good.

1:29

Thank you. I'm super excited to be here. Yay.

1:33

Let's break it. Let's start what inspired the Delphi study.

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Speaker 3

1:37

So this is, this is a long time coming for several folks, and I just kind of happened to be in the right place at the right time. So one of my co authors, Dr Robert Allen, has been an EFT trainer, originally in Canada, now in both the United States and in the United Kingdom, and he identifies as a queer or gay man, depending on the context, and spent a lot of time thinking about how what he was learning, what he was implementing in EFT, was different because he identified as a gay man, and when he was working with LGBTQ plus clients, like, things were showing up that were not the same in heterosexual, cisgender relationships. And so this study is is really kind of his brain child from his original training, like a decade, over a decade ago, and then also my doctoral mentor, Dr Andrea wittenborn, who is a phenomenal EFT researcher, and she has also been She was talking to Robert for years prior to all three of us connecting about how EFT does look different for different identities, whether that be um, someone who identifies as African American, someone who identifies as pansexual, someone who identifies as transgender and so here I arrive on the scene loving to loving EFT, loving research, and identifying as a member of the LGBTQ plus community communities myself, and really kind of bringing all of that together to read this study. So it's, I'm I'm coming in on the tail end of it, and was incredibly happy to work with both Dr Allen and Dr win born. I love

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Speaker 2

3:50

that. For those of our listeners that don't know what EFT is, it's Emotionally Focused Therapy developed by Sue Johnson rip she passed earlier last year. Yeah, so for and just disclaimer, I'm also an EFT therapist, and so connect very deeply with EFT and everything to do with attachment theory. And so this was really essential, because when we look at what's available in relationship literature, yeah, it was a it's pretty shitty.

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Speaker 3

4:22

Yeah, I It's honestly kind of shocking how few couple and family therapy interventions, especially evidence based interventions, have been culturally adapted to meet the unique lived experiences and therapeutic preferences and needs of marginalized populations. And so when I was, you know, looking at the like to do this study, at the time, only cognitive behavioral couple therapy had been. Culturally tailored or adapted for same sex female couples, and that was it. And even though attachment based family therapy was developed in part using like in populations, like kind of urban Philadelphia, so with suicidal African American black teens, there has been, there have been clinical trials of ABFT with LGBTQ plus adolescents, but there hadn't been any kind of qualitative research on like asking people like, what are you actually doing in the room? What are you actually doing in the room when you are working with LGBTQ plus folks to ensure that the model that you're using is culturally responsive, and so there's just such a gap in couple and family therapy in particular, and so one of my many goals is to change that.

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Speaker 2

6:09

I love that, and it's essential, right? It's like we know that these relationships are being seen. We know they're being supported. We know that they may be having sometimes not the best experience, because we don't have enough we don't have a good model that breaks it down for them, lines it up for them. And so this Delphi study really speaks to gathering that information of what are therapists doing in the room, what are we doing? How are we doing it? What's informing their practice, based on the relation LGBTQ plus relationships they are serving, and what I loved about the breakdown. So for those of you who will read the article, on page 14, there's a table that breaks down categories, guidelines, and then after that, moves into stage one, two and three of the EFT process. For those of you familiar with Emotionally Focused Therapy, and those are just so essential, because you're providing us a lens and an addition, a framework within the model that hasn't been done yet. Well, one

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Speaker 3

7:08

of the one of the things that I really do appreciate about EFT is not only is it one of the most heavily researched couple and family therapy models, but it also is a model that distinctly breaks down both what the therapist should be doing in terms of the EFT tango and also where your clients should be if they are making progress, as defined by the model, yeah. And therefore allows for very specific cultural tailoring, as opposed to kind of these more vague guidelines that we get around working with LGBTQ plus folks like make sure to include options for pronouns on your paperwork,

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Speaker 2

7:54

yes, which for everyone to know, just do it Yes period. Yeah. No questions, no questions. That's that simple. And you know, it makes me reflect on some of just the training in a setting. So either kick crab, kicker kawaii, no, not quite, COVID, or social work, like those accredited accreditation bodies and how they train students to work with LGBTQ plus relationships and families. To me, it's like, it's

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Speaker 3

8:27

so they don't, yeah, so there's like, it's really fascinating. So one of the things that the literature says, like over several decades, is that therapists do not feel competent or confident in working with members of the LGBTQ plus communities, even though members of the LGBTQ plus communities seek therapy at higher rates than their cisgender heterosexual counterparts, and so you have clients that are in real need of people who know how to be a culturally responsive therapist and employ a culturally competent or culturally responsive framework when working with LGBTQ plus folks, and unfortunately, That training just doesn't exist in the context of K prep or COVID accredited programs,

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Speaker 2

9:25

true, which is wild. So wild, wild. I think about myself in my training and even my EFT journey. You know, none of that was discussed, none of that was explicit. All of the examples and models were from heteronormative, monogamous white relationships. Oh,

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Speaker 3

9:44

absolutely. I remember in my EFT externship, I was working with a supervisor, you know, who'd been practicing for EFT for quite a while, and I was discussing clients that I had with. With the female identified partner as the withdraw, and she didn't this supervisor didn't believe me that this female identified client was the withdraw in the relationship, and her male identified partner was the pursuer. And so even that kind of way that EFT has traditionally talked about gender roles and how influential they are in terms of pursue, withdraw dynamics. Um, really kind of prevents people from kind of seeing maybe more than what's there, or maybe more than what they expect, and also just sets clients up to be pigeon holed when they shouldn't be 100% so yeah, I think like part of the goal in doing this work is to kind of revise and kind of offer up alternative ways of using EFT and seeing how the model can be so useful when working with members of the LGBTQ plus communities, what

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Speaker 2

11:14

makes me think too, is it expands what we know what to do precisely. It gives us so much more to look at and consider. And the thing is, I find I don't know this, the sense of like, it's scary for folks that may not be part of the community and or understand the lived experience and so similar to other identities, right for like, disabled community and or maybe folks of color who are working with white therapists. They may the white therapist, may find themselves like, I don't know, you know, confusing or stuck or not sure what to do, and then they go seek an empty supervisor who may also have never, maybe, maybe not never, but may have served LGBTQ plus relationships in a very pin pigeon holed way. Yeah, it kind of leaves the that cycle could perpetuates itself in terms of it never expanding. Oh, we do the same treatment as usual for all folks, and we know that that's just not a reality. And we know that there's harm that can be done when relationships that are coming to us wanting support, get find therapists who maybe they've asked the questions and they feel like, okay, this is a good fit. And then find themselves encountering situations where they're being asked ridiculous questions and or being conceptualized in a very heteronormative way,

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Speaker 3

12:32

yeah, one of the this is not about the study that we're discussing, but one of the findings from my dissertation, which was a community engaged research project with LGBTQ plus clients who had been in at least six or so sessions of EFT, was that there was a lot of stereotyping even among LGBTQ plus identified therapists. Fascinating and so even though the vast majority of people who had therapists who had a kind of marginalized identity, kind of in any way, did report having a better experience than LGBTQ, plus folks who are working with therapists who did not hold a marginalized identity, you know, one of my participants really talked about their their second session of EFT, which is the whole, I want to get to know you as an individual before we go back to doing couples work. They talked about it being just tell me about your trans trauma, as opposed to tell me what is important for me to know about you and the work that you want to do in in this room. So even, like even as members of the LGBTQ plus communities, we need to be aware of our potential to perpetuate stereotypes and bias and so, yeah, really kind of focusing on, like, what, what is the most culturally responsive intervention for this client that also isn't perpetuating stereotypes and biases and prejudices? Yes,

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Speaker 2

14:15

yes. Well, yeah, I'm just struck by that because you're, you're so right and how, again, we go back to either training and or our own identity development as therapists, and how just those layered together, how they may, again, just perpetuate messages that are so rooted in heteronormativity and homophobia and transphobia transmission. It just, yeah. It's, it's interesting, yeah, so yeah, important for all of us to take a look at that and consider and so another reason why these this study is so wonderful and helpful in the in breaking it down for folks. So please read it, because it has some good stuff. Another, another thing I was curious. About was what? Well, you touched on this a little bit, but currently struggling with as mental health professionals supporting same sex and same gender relationships.

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Speaker 3

15:09

So I think the thing that I kind of see when I'm doing a lot of consultation right now around working with LGBTQ plus folks, and then also consensually, non monogamous and polyamorous relationships. Have not I have an article on that shameless plug, and I think the two things that I'm really seeing are kind of this fear, like fear of asking. And I think that one of the best things that we can do as therapists is name that, like, I'm not going to get it right all the time. I'm going to make mistakes. I want to create a relationship where we can't, where you can call me out when I make a mistake, and you feel comfortable doing that in the moment, and so if I'm not actively working to make that type of relationship with my clients, I'm not doing my job as a therapist and as Someone who really comes from a, oh my gosh, what is the term deliberate practice lens? I am doing that both from a measurement based place around providing my clients with the most accurate and updated measurements. So for example, the session rating scale, or the couple relationship, couple relationship scale, and then also in checking in with my clients every session, do you feel like I really heard and understood you in our last session? Was there something that I got wrong or misunderstood, and that really provides a vehicle? Both of those methods provide a vehicle to making sure that I am creating a safe relationship for my clients. So when I do mess up, or when I do when I am afraid to ask, I can be like, Hey, I'm not sure about this. I might get something like a little off or a little wrong here, and I really want you to help me figure this out. Like, what's going on with this over here? Yeah, and just being that direct and that, I mean, that's a very neat thing. I'm a very direct therapist. I'm just going to say the things. And so just being able to do that with my clients, because it is a safe relationship, because I've worked to establish that and and prevent that, like, fear from coming up in me, around like I'm too afraid to ask this question, right? And then I think the second thing is, and I think we mistake, we make this mistake in EFT a lot is only looking at the dynamics between the folks that are in front of you, and not taking a broader picture lens around, how do the how do the identities that my clients have that they are moving through the world with impact them in relationship, and that is on a biological level. So for example, testosterone, higher level of testosterone, you're just happier. You just are not as problem focused. And so, like, you have all of these, like, you know, cis men walking around actually doing better in their relationships than their cis female partners, because hormonally, that's what's normal for them. And if you don't know that you're coming in with, like, an assumption that, like, they could be missing something, or they're, like, biased in some way, or they're not seeing the problems. And then also that. I mean, if we look specifically with like, LGBTQ plus relationships, we're in a we're in a cultural context in which we are under threat, especially if you identify as a member of the trans and gender non conforming, non binary communities, you are politically under threat. And so how does that socio cultural context impact you on a relational level. And I think we miss that moving from the macro to the micro in EFT, because we are often so focused on the micro of the interactions between the two partners. And so unless we're taking a step back and asking our clients and actively integrating the socio cultural context, we are missing some really important ways that their dynamics are impacted by what is going on in their lives, even if it might not necessarily be between two people,

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Speaker 2

19:55

right? I appreciate you mentioning that because you know, if we're talking about. But the way in which we frame it in EFT as their cycle? Well, yeah, that's, that's part of the cycle. It's like, how are we how are they showing off for each other? When these moments happen within the social, social, cultural context, when they're they're experiencing a moment where of threat and or of worry and or scarcity, and we just completely miss it because we're so we have a singular focus,

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Speaker 3

20:25

and we know that like clients respond to minority stress, which is a theory developed by frosted Meyer, which essentially postulates that LGBTQ plus folks experience additional stressors, so distal stressors like external experiences of rejection, prejudice or discrimination, and then also proximal stressors, so the thoughts and feelings that are maintained because of the direct and indirect experience of prejudice. And so we know that LGBTQ plus relationships respond to minority stress as a dyad. And so unless we are considering both the external prejudice events and then the internal response to those even if they're not direct. And so, for example, internalized homophobia, internalized trans phobia, those are things that show up in relationship that we need to be attending to, or else we're really missing a huge part of our clients experience. And in the EFT context, we can help them create a like secure attachment, because there is a part of self that is unacceptable to both the individual and to their partner, because it is unacceptable to themselves.

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Speaker 2

21:53

That's good. That's good stuff, right there. Because you're right. We can be spinning our wheels and doing trans thing. We're working. We're working the cycle. We're in this we're in stage one, we're in trying to get to stage two. And it's like, yeah, you might stay there forever because you're missing a vital component. Exactly, yeah, yeah. And I think the the especially right now, on our geopolitical context, it's like, we there. It's scary for a lot of our folks, scary. And the thing is, they might get what we might see them presenting as is maybe the arguments they had for the week or whatnot. But how much of that is compounded by the global context that they're having to navigate, the societal context they're having to navigate

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Speaker 3

22:38

well, and they might not even be aware 100% that's something that they're just kind of carrying around, you know, just and I think about like African American black clients who are at higher risk for cardiovascular disease, at higher risk for heart disease, at higher risk for diabetes and overweight and Obesity. LGBTQ plus clients are in similar higher risk situations, especially if clients identify as bisexual, bisexual women in particular, at the highest risk for same sex, intimate partner violence and as well as substance use disorders. And so that context can be internalized to a point that people aren't necessarily aware of them, and often people don't take the time to ask. Whenever I've asked my LGBTQ plus clients about, yeah, like, how are you doing? You know, in the context of this, in the context of the club Q shooting, in the context of the Donald Trump's re election, in the context of Roe versus Wade being overturned, like there are things that they're walking around with that they haven't explicitly been able to name or talk about. And so one of the things that really came out of this article in particular is really overtly talking about those experiences of minority stress and integrating them into how folks respond to their part.

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Speaker 2

24:10

I love that because it's one of those things where in the moment, therapists may assume, or make an assumption, well, they're not talking about it. So I didn't ask, I didn't bring it up precisely, and it's we do harm in those ways. Yes. And so to that point, it's like, yeah, bringing making that explicit, making space for it, and naming what's what's up, what's there, yeah, yeah.

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Speaker 3

24:33

And sometimes, you know, I do this a lot, I am, I think my clients sometimes are like, yeah, we're talking about this really big picture stuff, Kate, and you know, we're still struggling with this one dynamic that way that happened last week. And I'm like, okay, great. What was going on in your in the context that you arrived to in that dynamic? Tell me about what. Going, what did you see? Not what did you see on the news? Because I know y'all pay attention. What has happened in your community recently. How safe were you feeling that week in terms of walking around as a trans man like tell me about your context, and so we can arrive to talking about this dynamic in a way that has awareness for all of the things that we are actually bringing to this particular moment.

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Speaker 2

25:26

I love that and incorporating, and potentially could directly incorporate it into the cycle, Yep,

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Speaker 3

25:31

yeah, I do that all the time around. Yeah. I was feeling some, you know, sort of stress or fear or pressure as a result of this larger sociocultural context, and that stress or fear or pressure makes me more reactive when my partner, you know, kind of, kind of goes away and shuts down, or it makes me more likely to go away and shut down because I'm so stressed about this larger sociocultural context, right?

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Speaker 2

26:01

Yeah. And what I appreciate about the article too, is it, it makes it digestible and understanding how to just incorporate certain aspects of questions and or just considerations expanding thought by you provide like numbered bullet points, kind of breakdown for each category. And the thing about it too, because we know education lacks and how to support these relationships, you break down a you give you provide six different ways to just consider our own foundational knowledge and development. Because the the reality is I know this. So no liars out there. I know this. A lot of marriage and family therapists don't get trained in sex therapy. And guess what? I don't need you to be a sex therapist, but I need you to know something. Do some fucking research, right? There's many resources available at this point to really just understand when we're working with relationships that are are consensually, non monogamous, or polyamorous, or open, or whatnot, whatever structure that they may have in place. There's ways to ask questions where you're not coming off, like, you're not sure what what you're asking, and then also you're not sure how to respond to what you receive. One of

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Speaker 3

27:15

that, I mean, one of the things that came out of my dissertation was really asking, like, okay, great. This is a word that you're using. What does that mean to you? Yeah, love that. Yeah. Me that simple, like, I have a, I have a general understanding, you know, of what an open relationship means. And I want to understand exactly what that looks like for

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Speaker 2

27:34

you, exactly. I love that and, but again, what, what's beautiful about the from an EFT context, is it's it's so adaptable in incorporating a lot of this, where it it all will inform how we do the work that we do. It all helps, not none of this takes away from the work. It actually makes it a lot more meaningful, impactful, and creates the change that we are working to create.

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Speaker 3

27:58

Yeah, one of the things that we really aimed for this article is like, we're keeping it true to EFT. We're keeping it true to the EFT interventions. We're keeping it true to the framework of attachment. We are keeping it true to the focus on emotion and deepening emotion and increasing emotional coherence. And so I think even though these kind of guidelines can be applied in other they know therapy models kind of as a lens, like, it does get really specific around like, how do we as EFT therapists work with LGBTQ plus clients in a culturally responsive way?

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Speaker 2

28:38

Yeah, and within that, something about that that I was really struck with, that that stayed with me was this idea about what we provide our really, our clients with to consume, in terms of articles or books or media