[Hand-painted watercolor by my friend Roberta Giulia A.]
In our last article, The Eclipse of the Human, we explored together how the pursuit of hyper-technicization and fragmentation into “schemas” or “parts” often responds to a need for safety in us as therapists.
Faced with the vastness of human pain, protocols offer us the illusion of being able to control the storm. And yet, we have seen how this shield risks distancing us from the visceral connection with the person in front of us.
How, then, can we restore warmth and organicity to our practice, integrating technique without being overwhelmed by it?
The answer to this question leads us into an uncomfortable, but fertile territory: the clinician’s anxiety. That same anxiety which, in supervision, in WhatsApp groups, in the breaks of training courses, translates into a recurring question — “maybe I need another training?” — and invites us to look directly at our own attachment system while it is at work.
The White Rabbit’s Holes: clinical anxiety and the hunger for technique
In the text EFIT Primer, Sue Johnson and Leanne Campbell describe what they call rabbit holes — the White Rabbit’s burrows into which the therapist falls during the session. These are familiar places to anyone learning to work with emotions within the attachment model: remaining in the patient’s narrative without evoking emotional charge, out of fear of damaging the alliance. Talking about emotions instead of entering them, slipping into a fast and complex cognitive language that misses the mark. Giving up when the patient resists, without reflecting their difficulty, without validating the reluctance to enter unfamiliar territory (Johnson & Campbell, 2021, Box 4.1).
These falls are not errors of competence. They are responses of the therapist’s attachment system to threat. Johnson herself names this with disarming clarity: the tender-hearted therapist, the therapist who feels protective toward their patients, may find it difficult to allow them to come into contact with real pain (Johnson & Campbell, 2021, p. 70). That therapist — who slows down where they should deepen, who avoids where they should stay, who changes subject when the pain intensifies — is also protecting themselves.
And here a higher-level rabbit hole opens: the belief that what is missing is an external tool. A new model, a new certification, a new workshop. The question that we EFT therapists immediately recognize in our patients — “What should I do more, differently, better?” — is the same one that, in the form of enrolling in the next course, allows us not to remain with our clinical fear. It is an intelligent, protective, understandable movement. And it is, exactly like the pursuer’s move, an attempt to regulate anxiety by looking outside for what one fears cannot be found within.
The invisible roots of our practices: validation, attachment, regulation
A fascinating aspect of modern psychology is that many of the concepts we now consider cutting-edge rest on the solid foundations built by figures such as John Bowlby and Carl Rogers, even when their names are not explicitly cited on conference stages.
“Validation”, now an undisputed cornerstone of countless therapeutic approaches, finds its primary roots in Rogers’ unconditional positive regard. “Emotional regulation,” an omnipresent term in our discourse, is the beating heart of attachment theory. These insights have become the air we breathe in our consulting rooms, so pervasive that they risk being taken for granted, becoming invisible. And when a practice becomes invisible, it stops being inhabited and begins to be applied.
This shift requires our most vigilant attention. When we separate technique from its existential and relational matrix, we strip it of much of its vitality. A validating statement delivered in a surgical manner, without the authentic intention of meeting the other in their pain, is perceived by the patient’s nervous system as a formal gesture. The person’s body “knows,” through neuroception (Porges, 2011), when the connection is real and when it is a well-intentioned clinical performance. Bowlby left us far more than a theory of child development: he gave us a map for emotional survival, showing us how secure attachment is our primary physiological regulator.
The intelligence of suffering: reading the symptom as adaptation
At times, in our field, a subtle fear can emerge that speaking the language of humanism, of affection, and of attunement may make us appear insufficiently scientific. Contemporary research — interpersonal neurobiology, Panksepp’s affective neuroscience, Schore’s work on right-brain regulation — has provided solid empirical confirmation of what the pioneers of clinical work had intuited through their sensitivity.
The human brain is a deeply and exquisitely social organ, whose architecture is shaped and reshaped through lived experience with others. What we often hastily define as “dysfunctional beliefs” rarely arise as errors of logical calculation generated in a vacuum. They are, more often, affective crystallizations — vital adaptations that a person had to develop in order to survive in response to painful or frightening primary bonds.
A child who experiences neglect does not conclude they are “unlovable” because of an incorrect rational deduction to be corrected. They conclude it because that belief is the safest way they have found to adapt to an environment scarce in emotional resources. Treating this physically painful wound solely as a thinking error to be resolved through logical reasoning means depriving ourselves of the precious possibility of understanding the survival intelligence of that person.
The same mechanism operates in the therapist. The drive to accumulate models has its own emotional logic: in the face of overwhelming complexity, looking outside is a way to regulate the sense of inadequacy. It is an intelligent adaptation. Recognizing it as such allows us to stop judging it — and to ask whether another stance might be possible.
RISSSSC and trust as a clinical stance
In the Epilogue of the EFIT Primer, Johnson poses a question to the therapist that deserves to be taken seriously: Am I afraid of asking the client to risk and reach? If so, what am I afraid will happen? The answer she offers does not concern technique. It is trust in the attachment framework — as a model of the therapeutic relationship and as a map of human vulnerability — that helps the therapist manage their own anxiety in relation to the apparently destabilizing power of emotion (Johnson & Campbell, 2021, p. 191).
Consider what happens in the room when a therapist rests in their model. The rhythm changes. Voice slows. Words become fewer and more precise. The therapist stops searching for the next intervention and begins to follow the process: to trust that if they stay with the patient’s primary emotion, if they reflect accurately, if they slow down enough to allow the experience to emerge, change has the conditions to occur.
This is the clinical stance that EFT calls RISSSSC: slowing down, softening, using images, making it simple, making it specific, repeating, and keeping the connection real (Johnson, 2019). It is the opposite of accumulation. It is subtraction — the courage to do less and stay more. RISSSSC tells the therapist that therapeutic power does not reside in the arsenal, but in the quality of human presence — and that presence is cultivated through the discipline of simplicity, not through the expansion of repertoire.
When Carl Rogers, in 1957, formulated the necessary and sufficient conditions of therapeutic change, he identified the quality of the relationship as the factor that determines clinical effectiveness — and decades of research on common factors have confirmed that intuition (Wampold, 2015). The effectiveness of our work vibrates in the quality of what we are able to be with the person in the here-and-now of the room.
The clinic of the Face and the courage of specialization
We have a vital need to return to the clinic of the Face, to use the expression of Emmanuel Levinas: a space in which the Other is not a diagnostic enigma to be solved through a protocol, but a human being engaged in the difficult and courageous attempt to find a sense of safety amid the storms of life. The Face, in Levinas, is that which resists objectification, that which calls the clinician to a responsibility that precedes any technique. And responding to that call requires, on the part of the therapist, a presence that no acronym can provide.
We need therapists who are able to deconstruct symptom dynamics, and who feel sufficiently secure to remain in the sacred silence of grief, to navigate the emotional storm of a partner seized by terror, to receive the gaze that lowers in shame — without feeling the urgency to consult a reassuring checklist. This security is not purchased at the next workshop. It is built through deliberate practice within a solid model, through supervision, through the time we allow ourselves to become masters of one craft rather than apprentices of many.
Fidelity to the model, research reminds us, is directly associated with better clinical outcomes (Wampold, 2015; Burgess Moser et al., 2015). Every serious training is demanding. It requires time, practice, supervision, and the willingness to be personally engaged. The shortcut of accumulation is, ultimately, a way to avoid that demand — remaining on the surface across many territories instead of going deep into one.
Simplicity on the other side of complexity
The most profound innovation in our field will not lie in the invention of yet another protocol for a specific phobia, but in the continuous rediscovery of the transformative power of connection. It is within that shared space, when threat gives way to the safety of being seen and received, that the resources blocked by fear can begin to flourish again.
The therapist’s anxiety in the face of the patient’s emotion is something to be known, inhabited, and brought into supervision. Johnson explicitly asks therapists in training to identify their greatest fear regarding evoking and deepening emotion in session (Johnson & Campbell, 2021, p. 70). Therapists who knows their own fear can choose to remain with it. The one who avoids it, by accumulating tools, continues to fall into the same White Rabbit hole, one level higher.
The simplicity we arrive at through deep specialization is not the simplicity of the starting point — that of naivety or slogans. It is the simplicity that lies on the other side of complexity. It is the therapist who has stopped searching for the right tool because they have learned to trust their own hands. And it is those hands, grounded in trust, that can finally rest on the patient’s shoulder — without trembling, without searching for something else, without eclipsing themselves behind technique.
If you think back to the last time you felt that urge to look for one more tool, what was your clinician attachment system really asking for?
What might have supported you in that moment — more than a new technique?
References
- Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Basic Books.
- Burgess Moser, M., Johnson, S. M., Dalgleish, T. L., Lafontaine, M.-F., Wiebe, S. A., & Tasca, G. A. (2015). Changes in relationship-specific attachment in Emotionally Focused Couple Therapy. Journal of Marital and Family Therapy, 42(2), 231–245.
- Johnson, S. M. (2019). Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families. Guilford Press.
- Johnson, S., & Campbell, L. (2021). Emotionally Focused Individual Therapy (EFIT): An Attachment-Based Primer. Routledge.
- Levinas, E. (1980). Totalità e infinito. Saggio sull’esteriorità. Jaca Book.
- Panksepp, J., & Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotions. W. W. Norton & Company.
- Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. W. W. Norton & Company.
- Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103.
- Schore, A. N. (2019). Right Brain Psychotherapy. W. W. Norton & Company.
- Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.