Dynamic Emotion Focused Therapy (DEFT), developed by Susan Warren Warshow, is based on decades of clinical observation of the effects of dysregulated shame reactions on the therapeutic alliance and outcome. DEFT seeks to access and help integrate affects that are blocked by toxic forms of shame, anxiety, guilt and defensive process (including defense mechanisms and defense driven affects). To accomplish this, DEFT interventions place shame-sensitivity at the forefront and highlight therapeutic elements and therapist qualities that support an egalitarian partnership and strengthen an individuated sense of self. It also delves deeply into how the therapist helps to generate compassion for self through embodied as well as verbal responses, sustains hopefulness, and co-creates an ongoing therapeutic alliance, as all are catalysts for change. DEFT gives special attention to the indicators that the therapist is neurobiologically attuned. It emphasizes the use of language (how an intervention is worded) and employs metaphor to bring interventions to life, making them clearer and more memorable. Prosody (voice inflection and tone) is also a key factor in the approach. The DEFT training also places great importance on the therapist’s non-shaming self-reflection, compassion towards self and community support. Intuition, creativity and appropriate play are are also valued and encouraged in DEFT.
As with ISTDP, treatment involves:
- Processing of unconscious complex feelings towards past and current figures and consolidating the insights that result; exploring practical application.
- Distinguishing self-limiting from self-enhancing parts of the self and developing capacity for self-care.
- Moment-to-moment tracking of physiological sensations, including careful attention to manifestations of anxiety. DEFT also emphasizes physiological manifestations of shame and guilt.
- Mobilization of will to attend to the self.
- Resolving toxic forms of guilt over feelings.
Signature features of DEFT:
- Embraces attachment theory. All interventions seek to convey compassion, sense of safety and respect through verbal and non-verbal, embodied responses. The authentic quality of the therapeutic relationship is given primary importance.
- Emphasizes building an individuated sense of self and therefore adopts a non-authoritarian, collaborative therapeutic stance.
- Highlights client strengths over deficits.
- Views all new and difficult types of self-disclosure as “breakthroughs to intimacy.” DEFT encourages therapists to see great therapeutic value in enhanced awareness of internal process and causality, as well as any new levels of emotional engagement. Full breakthroughs to complex feeling are not seen as the only path for healing to occur, although these are regarded as highly valuable for many clients.
- Distinguishes between the therapist’s ability to feel compassion and the ability to convey and express compassion in a palpable way, which is believed to increase the client’s ability to internalize self-compassion.
- Values and encourages therapist spontaneity and creativity.
- Sees the therapist’s willingness to self-reflect, be vulnerable and participate in the growth process as central to the most effective therapeutic relationship.
- Utilizes play and humor, which can help reduce defense and form connection.
- Uses vivid language and metaphor to enhance therapeutic impact (e.g., the perpetrator system might be described to a client as a “parasitical vine wrapped around a healthy tree trunk.”)
- Relies on clinical intuition and “instinctive knowing” alongside theoretical grounding.
DEFT regards shame as a primary inhibitory affect that is often neglected or poorly responded to in treatment.
- Shame often has similar manifestations to anxiety and needs to be recognized and titrated in similar ways. Shame is frequently evoked through attention to internal process.
- Prosody, body language, facial expression and eye gaze carry important implicit communication regarding acceptance, safety and empathy.
- Subtle relational factors impact the reduction of shame, for example:
- Therapist self-disclosure of shared vulnerability.
- Use of play and humor.
- Eschewing the role of expert, e.g. collaboratively seeking choice of focus and making meaning of the therapeutic experience.
- To reduce their own shame, therapists are urged to remember that they are only one half of the therapeutic partnership and that all humans suffer from trauma. Growth is a shared journey.
In dealing with defenses, DEFT recommends the following:
- Present defenses in developmental context, i.e. as protective and resourceful mechanisms/habits learned in childhood. Rather than “turn against” defenses, clients are encouraged to release them as a vestige of childhood no longer serving their purpose.
- Avoid “you” language, e.g. “You’re digressing again!” which can more readily be perceived as shaming and blaming, especially depending on tone. The sad cost of defenses is highlighted with appropriate inflection.
- Frame defenses as neither intentional nor fixed parts of self.
- Instill hope. Strengths are typically commented upon alongside defense interruption, e.g.: “You’ve successfully broken other habits in your life.”
- Emphasizes the attachment relationship: “You no longer need to be alone with these intense feelings. Do you recognize that I am here with you? How is it for you to feel my presence?”
DEFT, like ISTDP, recognizes the existence of the punitive superego rising from guilt over rage towards primary figures. DEFT also holds the view that trauma, symptom formation and self-damaging behaviors can derive from modeling and internalizing shaming treatment originating not only from family of origin but also from cultural, religious, peer group, educational experiences and others (e.g. gang cultures, severe childhood bullying, abusive institutions, poverty, the horrors of war, irresolvable medical conditions, physical disabilities and abnormalities). In DEFT, the therapist is advised to remain open to the origins of the individual’s suffering.
DEFT resists strict adherence to any model, including its own. The complex mystery of the human psyche is never to be fully known and therefore, DEFT embraces a state of humility. The response to intervention is believed to provide the therapist with the information that matters the most.