Emotion Focused Therapy for Avoidant Personality Disorder: Pragmatic Considerations for Working with Experientially Avoidant Clients

Emotion-focused therapy (EFT), an empirically supported treatment for depression and interpersonal difficulties, is now being directed towards clients with personality disorders, such as borderline and avoidant personality disorder. In this paper, both the value of, but also potential difficulties therapists can encounter while engaging in, active EFT chair interventions with clients with avoidant personality disorder (AVPD) are described. While EFT interventions can effectively transform emotion schemes at the heart of both intra and interpersonal difficulties, avoidant clients may have difficulties engaging in EFT interventions that activate core maladaptive emotion schemes related to self and negative/unaccepting representations of ‘others’. Alliance ruptures, intransigent experiential avoidance, or ‘unresolvable stand-offs’ may result. To avoid these problems, the importance of working with a more refined and content based case conceptualization of the particular avoidant client is highlighted. Guidance in optimal emotional processing in order to transform layers of maladaptive emotion schemes present within the client with AVPD is provided. Supporting these clients’ full striving for life, and their capacity to self-soothe is also discussed. A case example illustrates application of the model and principles.