Multicultural Realities and EFT Extra-CARE (Part One)

Author
Paul Guillory, Brandy Hall
Issue
68
Date
January 2026
Page
7 - 9

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Building on the CARE framework (e.g. Johnson & Campbell, 2021; Campbell et al., 2022), this article is intended to expand on the existing CARE literature, specifically with respect to multicultural realities and clinical interventions with people who are members of diverse groups in therapy. For example, how do we help a Black couple process the impact of racial
distress that results from a racially demeaning and targeted joke made by a supervisor at work when they have very different views as to what should have been the “right” reaction in the moment and what should be done in the aftermath. We hope to engage the reader in a clinical journey into the internal and interpersonal world of the culturally different who live in a larger cultural White context (Helm & Carlson, 2013). Our focus is outlining EFT clinical formations and interventions with the goal of enhancing psychotherapy for those clients who are culturally different and marginalized.

We suggest that therapists tune in with Extra CARE, i.e. extra Context, Attachment, Relationship/therapeutic alliance, and Emotion) when working with couples from marginalized groups impacted by cultural realities. By multicultural realities, we mean cultural, racial, and minority stress. These are extra stressors along with the extra psychology that marginalized couples cope with regularly, that those from the majority White culture do not typically face. This argument is based on the reported literature regarding historical oppression, current
discrimination and negative bias experiences, and the internalized cultural deficit model for people who are marginalized within cultures where there is a majority dominant cultural group (APA, 2021; Comas-Diaz, et al., 2019; Carter, 2007; Aponte & Wohl, 2000; Davis, et al., 2022).

These are not just cultural elements to be under stood within each cultural group but significantly emotional, reactive, stressful, multicultural experiences and an extra-psychological set of appraisals and internal view of self and others. These unique multicultural realities occur between the dominant group and marginalized groups, and impact lived experiences with unique internal psychological effects causing psychological stress and suffering (Meyer, 2003; Carter, 2007; Hardy, 2023; Edwards, Wittenborn, & Allan, 2025).

Consistent with the extra-stress and extra-psychological implications of the cultural realities of marginalized people, there have been several recommendations for adaptation of clinical models while maintaining the fidelity of the clinical approach. See Chu & Leino (2017), Hwang (2006), Sorenson & Harrell (2021), and Edwards, Wittenborn, & Allan (2025).

The Extra-CARE model suggests recognizing the in trapsychic depth of cultural realities, the resulting implication of the internalized deficit model on in terpersonal safety, and the potential emotional reactivity of multicultural identity. For example, a Latina client’s fear of rejection may not be rooted in early attachment experiences, but in multicultural negative narratives about Latinas’ women’s worth being tied to her cultural group, or simply being viewed in a negative way as an immigrant. Extra-CARE means extra-assessment of the unique experiences of multicultural people. Just as EFT therapists do not expect couples to be knowledgeable about attachment and emotion theory, we should not expect marginalized
people to be experts in cultural realities.

Broaching multicultural realities is about setting the foundation for intrapsychic clinical depth work on attachment and identity. Of course, marginalized persons who are highly reactive and rigid regarding their marginalized identity are likely to avoid engaging in any or limited discussion of race/culture according to Helms (1995). It is most clinically
productive to ask marginalized couples questions about their cultural realities, not as an isolated topic, but integrated into questions about their personal development and attachment relationships. For example, after asking about early attachment relationships (“Tell me about your relationship with your mother,” or, “Can you give me three adjectives to describe your relationship with your mom/dad when you were young?”), we might integrate cultural questions (“Do you strongly identify with a cultural group? What does that mean to you?” Or, “Do you think racism (or any ism) or discrimination impacted your parents’ lives in any way?” Or, “What has been the significances of race, skin color or hair?”). This allows cultural reflection to benefit from the psychological depth already activated by attachment questions.

This integrated process has two important reasons. First, individual development and attachment-related assessment inquiries invite partners to focus inward on their thoughts and memories about important milestones and relationships. According to Main, et al. (1985), as multiple attachment questions are asked sequentially, participants turn inward in greater psychological depth. Second, as cultural realities questions are integrated after a series of attachment questions, the cultural reflections of clients benefit from the depth exploration of attachment histories.

Stage One EFT Extra-CARE
Creating the Safety for Exploring Extra-Wounds

Stage One: Considerations

  • EFT clinical attitude.
  • Clinical interview that includes attachment and cultural questions that might provide emotional handles, i.e., emotional phases, images, or words to use with EFT interventions.
  • Listening for and understanding cultural stereo types embedded in the negative cycle.
  • Curiosity and understanding of harsh internal and interpersonal critic with attachment and cultural lens.
  • Processing race-based events with impact on emotions and view of self and others.
  • Encouraging the fight against the multicultural negative pattern on view of self and others.

Stage Two EFT Extra-CARE
Creating Safety for Intrapsychic Exploration of the Deficit Model

Stage Two: Considerations

  • EFT clinical attitude.
  •  Increased spontaneous discussion of view of self and other regarding cultural distress.
  • Accessing multicultural needs and longing for acceptance, being chosen, and worthiness.
  •  Increased tolerance of vulnerability to cultural deficit appraisals that in moments of crisis can promote cultural self-hate and internalized racism. Compassion.
  • Lingering longer with cultural identity triggers to explore view of self and others.
  • Use of dreams, images, culturally based messaging (cultural myths and affirmation scripts).
  • Promoting exploration of cultural strengths.
  •  Softening internal multicultural appraisals and defensiveness.

Just as EFT therapists use EFT interventions to process attachment distress and emotional experiences, they can also process cultural realities distress with EFT interventions and Tango moves. In the broader sense, the EFT model is a clinical model that can process emotional stress and attachment disconnections. The extra focus of the adapted EFT EXTRA-Care frame would include attachment distress and when present, distress cues from multicultural realities (i.e., experienced racial/multicultural bias, discrimination, or racial/multicultural assaults). This underscores the complexities of multicultural realities and psychotherapy. That is, the therapist would have to have dynamic considerations of attachment focus and a multicultural focus. As Hwang (2006) suggests, dynamic sizing, or the clinical skill of flexibility and agility to shift dynamically between or integrate attachment and/or cultural focus is needed. The therapist must also shift dynamically between two types of cultural appraisals. First, there are appraisals of the model of self (“I’m not good enough.”) Second, there are appraisals of the internalized cultural deficit (“Black people are seen as less than.”) For example, when Marcus said, “I’m always suspect,” he was expressing both a personal view of himself influenced by the relationship negative cycle and also influenced by the negative cultural view of Black men. This culturally influenced view of self is what Hardy (2023) refers to as the “invisible wounds.” Therapists need flexibility to be able to address both levels. An EFT Extra-CARE approach would include responsiveness to an internalized deficit model, cultural competency, and cultural humility. As in all EFT therapy, adapted Extra-CARE would prioritize attachment and emotional experience.

Paul Guillory, PhD
EFT Trainer

Brandy Hall, MA
EFCT, EFIT and EFFT Therapist

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