Emotional Freedom Techniques (EFT)

1. Introduction

Version followed: Clinical EFT as set out by Dawson Church (The EFT Mini-Manual, 2nd ed., 2012; The EFT Manual, 3rd ed., 2013, as cited by Church et al., 2018) and the Clinical EFT PTSD guidelines (Church et al., 2018), with the training and accreditation route of EFT International (formerly AAMET). Gary Craig's own current forms, Gold Standard EFT (the tapping method he introduced in 1995) and Optimal EFT (a later meditative approach), are named where they differ; their detailed protocols are [uncertain: not verified]. [source: Church 2012; Church et al. 2018; Blackwell's listing for Craig & Rutten 2023; EFT International accreditation page]

What it is. Emotional Freedom Techniques (EFT, "tapping") is a brief method in which the client brings a specific distressing memory, emotion or sensation to mind, names it in words that pair the problem with self-acceptance, and taps with the fingertips on a fixed series of acupressure points while rating distress on a 0–10 scale. EFT was derived from Roger Callahan's Thought Field Therapy and first described in The EFT Manual (Craig & Fowlie, 1995, as cited by Church et al., 2022). [source: Church et al. 2022]

How change is said to happen. In EFT's own theory, a negative emotion is linked to a disruption in the body's energy system, and tapping on meridian points while attending to the problem resolves it; the corrective setup step is described as addressing an "energy blockage" called psychological reversal (attributed to the method; not established as physiological fact). Clinical EFT authors describe the active ingredients in clinical terms as exposure, cognitive framing and acupressure, and say its 48 techniques draw on awareness building, imaginal exposure, cognitive reframing, preframing and systematic desensitisation. Progress is tracked as falling distress ratings on specific events, with a claimed "generalisation effect" in which related memories lose charge once enough similar events are cleared. [source: Church 2012; Church et al. 2022]

Status, in one line each. Evidence: developer-led reviews report benefit for anxiety, depression and PTSD and VA designation as a "generally safe therapy" (as reported by Church et al.); independent guideline endorsement (e.g. NICE) is [uncertain: not verified]. Physical-health claims: EFT is not a treatment for any physical disease; Church's own materials say real medical problems need medical care and that medication should not be changed without the prescriber. [source: Church et al. 2018, 2022; Church 2012]

2. Framework

EFT has no fixed session-by-session manual comparable to a CBT protocol; the Clinical EFT guidelines say they are "only guidelines" that clinicians adjust client by client and session by session. The sequence below follows the PTSD guidelines and the Mini-Manual; where the phases are ordered by clinical logic rather than stated by a source, it is marked [synthesis]. [source: Church et al. 2018]

Phase 1: Assessment and intake

Goals: establish diagnosis and risk, screen for developmental trauma (noted at intake as it predicts slower response), record baseline measures, and get a signed release to communicate with the client's primary-care doctor early. [source: Church et al. 2018]
Measures named in the guidelines: PCL (civilian, military or specific-trauma versions; PCL-5 as newer alternative) before and after sessions; CAPS-5 as the gold standard. Instruments are described, not reproduced here. [source: Church et al. 2018]
Move on when: risk is managed, the client understands EFT is a complementary method and has consented (including to any touch), and the treatment step is chosen. [synthesis]

Phase 2: Preparation and teaching the Basic Recipe

Goals: teach the 0–10 SUD scale, setup statement, points and reminder phrase on a low-intensity target; teach self-tapping for between-session arousal regulation. The Constricted Breathing exercise is the Mini-Manual's demonstration. [source: Church 2012; Church et al. 2018]
Move on when: the client can rate distress, complete a round, and stop or self-soothe when asked. [synthesis]

Phase 3: Target selection

Goals: translate global complaints (e.g. "low self-esteem") into specific events; list aspects. EFT International Level 2 teaches this with the metaphors of core issues as a tabletop supported by specific past events as table legs. [source: Church 2012; EFT International Level 1 & 2 course outline]

Phase 4: Processing

Goals: reduce distress on each specific event to 0 or near, starting with the gentlest technique that fits the intensity (Tearless Trauma, then Movie Technique, then Tell the Story), tapping on each aspect as it appears. Higher intensity calls for more distance (dissociation from the memory). [source: Church 2012; Roberts, EFT Universe; Llewellyn-Edwards, EFT Universe]
Move on from an event when: SUD is 0 or near, and the client can tell the whole story calmly or replay it with senses exaggerated without distress. [source: Church 2012; Roberts, EFT Universe]

Phase 5: Testing, generalisation and self-help

Goals: test results, check for related events, and set up the Personal Peace Procedure or other self-tapping between sessions. [source: Church 2012]

Phase 6: Review and stepped care

Re-administer measures; a 10–20 point PCL fall is described as clinically significant. Non-responders move to the next step. [source: Church et al. 2018]

Session count and format

Trials summarised by Church et al. used 1–6 sessions for anxiety and 4–10 for PTSD; veteran trials used six one-hour sessions. [source: Church et al. 2022]
Stepped care for PTSD (Church et al. 2018): Step 1 (subclinical) = treatment as usual plus about 5 individual EFT sessions, an instructional consultation on online self-help, optional Borrowing Benefits groups; Step 2 (PTSD range) = treatment as usual plus about 10 sessions and the same supports; Step 3 (developmental trauma or no response) = intensive psychotherapy, inpatient care where suicidality requires, and/or psychiatric medication review by a prescriber. EFT is delivered in addition to usual treatment, not instead of it. [source: Church et al. 2018]
Formats reported: individual, group, telephone, video, self-help and online programmes. In one comparison, in-person delivery outperformed telephone. [source: Church et al. 2018, 2022]

Training, certification and scope

EFT International (a charity registered in England and Wales; formerly AAMET) runs Level 1 (personal use; does not confer practitioner status), Level 2 (foundational practitioner training) and Level 3 (advanced practitioner). Certification follows attendance plus mentoring, case studies and session notes (one Level 2 listing names 50 session notes); accredited members keep annual CPD and mentoring and follow the EFTi Code of Conduct and Ethics. [source: EFT International accreditation page; EFT International Level 1 & 2 course outline]
Clinical EFT (EFT Universe) has offered a one-year certification covering the 48 techniques since 2010. No central body owns EFT's intellectual property. [source: Church et al. 2022]
The guidelines say licensed psychotherapists, allied health professionals or qualified coaches may apply EFT after certification, that training for non-licensed practitioners must cover recognising serious psychiatric disorders, referral and scope, and that membership of an EFT body with an ethics code is strongly advised. They warn that uncertified practitioners have used EFT without psychiatric assessment, sometimes with poor outcomes. [source: Church et al. 2018]
For a psychotherapist, EFT sits inside existing scope: the professional's own licensing rules, ethics code and supervision continue to apply, and the method is documented as a complementary technique within therapy. [synthesis]

3. Guiding principles

Be specific. Target concrete events, not labels; the Mini-Manual calls tapping on generalities the commonest beginner error. Practical meaning: ask "when did you last/first feel this, and what exactly happened?" [source: Church 2012]
Find and clear every aspect. Sights, sounds, smells, emotions, beliefs and body sensations within an event are tapped separately. Practical meaning: when SUD stalls, look for a missed aspect before changing technique. [source: Church 2012]
Measure every round. SUD before and after each round, with body location noted. Practical meaning: write the numbers down; decisions follow the numbers. [source: Church 2012; Church et al. 2018]
Use the client's own words. EFT International teaches reflecting the client's exact words as a rapport skill. Practical meaning: build setup and reminder phrases from the client's language, not your interpretation. [source: EFT International Level 1 & 2 course outline]
Self-acceptance in the setup. The setup pairs the problem with an acceptance statement, said even if not yet believed. Practical meaning: the client need not feel the acceptance for the round to proceed. [source: Church 2012; Church et al. 2018]
Safety before processing; avoid re-traumatisation. The guidelines name re-traumatisation as the core dilemma and describe a graduated approach that lowers arousal at each step. Practical meaning: begin with the gentlest technique and the least intense event the client can tolerate. [source: Church et al. 2018; Roberts, EFT Universe]
More intensity, more distance. Higher distress calls for more dissociative techniques. Practical meaning: guess-rate before imagining, use a screen or third person, stop at peaks. [source: Roberts, EFT Universe; Llewellyn-Edwards, EFT Universe]
Never suggest abuse. The practitioner must not suggest that trauma or abuse occurred. Practical meaning: work only with material the client brings; no leading questions about hidden memories. [source: Roberts, EFT Universe]
"Do not go where you don't belong." A named EFT International Level 2 topic; its full content is [uncertain: not verified]. Practical meaning: stay within your clinical competence and refer when a presentation exceeds it. [synthesis]
The problem is rarely the presenting problem. Present triggers often echo earlier events; tapping on the earlier event can reduce the present reaction. Practical meaning: ask "what does this remind you of?" [source: Church 2012]
Persistence and testing. Keep going until 0 or near, then test by vividly replaying or retelling; EFT International teaches persistence and testing as core skills. [source: Church 2012; EFT International Level 1 & 2 course outline]
The practitioner's own work. Practitioners are advised to address their own unresolved trauma and use EFT on themselves to prevent burnout and interference. [source: Roberts, EFT Universe; EFT International Level 1 & 2 course outline]
Adjunct, coordinated care. EFT is added to usual treatment, with early, open communication with the client's doctor and referral of non-responders. Practical meaning: get a release at intake; never present EFT as replacing medical or psychiatric care. [source: Church et al. 2018; Church 2012]
Consent for touch, every time. If the practitioner taps on the client, it is with permission; self-tapping is always available as the hands-off alternative, consent is checked during the session, the client may stop at any time, and touch is never sexual. [source: Llewellyn-Edwards, EFT Universe (permission); synthesis (remaining safeguards)]

4. Intervention inventory

All example language is illustrative wording for the therapist, not quoted from any manual. Risks are flagged within each item.

4.1 Informed consent and touch agreement

Purpose: make the complementary status, the procedure and any touch explicit before any tapping. [synthesis, built on Church et al. 2018 (physician coordination) and Llewellyn-Edwards (tapping on the client with permission)]
Steps: (1) Explain that EFT is a complementary technique used within therapy, not a replacement for medical or psychiatric care. (2) Describe what happens: naming a problem, rating it 0–10, tapping lightly with two fingertips on the side of the hand, face, collarbone and side of the body. (3) Give the evidence status in one line (developer-led studies report benefit; independent guideline status is limited). (4) Ask whether the client prefers to tap on themselves (default), or whether the therapist may tap on named points; agree specific points. (5) Agree a stop signal and confirm the client may stop or withdraw consent for touch at any moment. (6) Record consent and any touch agreement in the notes. [synthesis]
Example language (illustrative): "Tapping is something we can add to our work; it doesn't replace any medical care. You'll do the tapping on yourself, and I'll follow along. If at any point you'd rather I tapped for you, we can talk about which points, and you can say stop at any time."
Watch for: agreement given to please; history of abuse making touch or face-touching triggering; cultural or religious views on touch or on energy concepts. Hands-off alternative: self-tapping, or tapping without words. Touch is never sexual and never near intimate areas; the under-arm point is self-tapped. Follow your professional body's chaperone and documentation guidance [uncertain: not verified for any specific body]. [synthesis]

4.2 Assessment, SUD and outcome measures

Purpose: baseline, risk, choosing a treatment step, and session-by-session monitoring. [source: Church et al. 2018; Church 2012]
Steps: (1) Standard clinical intake and risk assessment. (2) Note developmental trauma. (3) Administer a validated measure such as the PCL-5 for trauma presentations. (4) Teach the 0–10 SUD scale (0 = no distress, 10 = maximum) and record SUD plus the body location of the feeling before and after each round. [source: Church et al. 2018; Church 2012]
Example language (illustrative): "When you think of that moment now, how strong is the feeling, from 0 to 10? And where do you notice it in your body?"
Watch for: a client who cannot give a number (possible dissociation or numbing, see 4.17); ratings given quickly to end the exercise. It is working when SUD falls across rounds and measures fall between sessions. [synthesis]

4.3 The Basic Recipe (Clinical EFT form)

Purpose: the core round used inside every other technique. [source: Church 2012; Church et al. 2018]
Steps: (1) Pick one specific issue and take the SUD. (2) Compose a setup statement that names the problem and pairs it with self-acceptance, in the form "Even though I [problem], I deeply and completely accept myself"; the halves may be reversed, and the client says it whether or not they believe it. (3) While continuously tapping the Karate Chop point (fleshy outer edge of the hand), the client says the setup three times; the Mini-Manual describes this as correcting psychological reversal (EFT's concept). (4) Tap roughly seven times on each point in order while saying a short reminder phrase (one or two words drawn from the setup): start of the eyebrow; side of the eye (outer eye socket); under the eye (bony ridge); under the nose; chin (crease between lower lip and chin); collarbone point; under the arm (on the side of the body, about a hand-width below the armpit). Church et al. (2018) also list the top of the head as an eighth point; the Mini-Manual sequence of seven omits it. (5) Take a deep breath and re-rate. A round takes one to two minutes. [source: Church 2012; Church et al. 2018]
Example language (illustrative): "Let's put it into words: 'Even though my chest goes tight when I think about that phone call, I deeply and completely accept myself.' Say it three times while tapping the side of your hand… now just 'that phone call' as we go round the points."
Watch for: wording that is too global; the client tapping hard (light tapping is enough); rising SUD (a new aspect has appeared, not failure; see 4.8). Working when SUD drops by several points per round. [source: Church 2012; synthesis for interpretation]

4.4 Follow-up rounds and "remaining" wording

Purpose: continue when SUD is above 0 after a round. [source: Church 2012]
Steps: (1) Re-rate. (2) Adjust the setup to acknowledge what is left (e.g. "this remaining tightness"). (3) Repeat rounds until SUD is at or near 0. (4) If the quality of the feeling changes (e.g. from fear to anger), treat the new feeling as a new aspect with its own setup. [source: Church 2012]
Example language (illustrative): "It's gone from 8 to 4. Let's do 'Even though I still have some of this fear about the call…'."
Watch for: plateaus at the same number for several rounds, which usually means the target is still too global or an aspect is missed. [source: Church 2012]

4.5 Full Basic Recipe with the Nine Gamut procedure

Purpose: the original, longer recipe from The EFT Manual; the Mini-Manual omits it from the standard Basic Recipe but says it has value for certain conditions and keeps it in Appendix A of The EFT Manual. [source: Church 2012]
Steps: the component steps of the Nine Gamut procedure are [uncertain: not verified]; consult the Manual's appendix or Craig's Gold Standard EFT materials directly before using it.
Example language (illustrative): "There's a longer version of this routine; for now we'll use the short one and see how far it takes us."
Watch for: confusion about which version a client learned elsewhere; name the version in the notes. [synthesis]

4.6 Constricted Breathing demonstration

Purpose: a low-stakes first experience of EFT and a way to surface emotional contributors. [source: Church 2012]
Steps: (1) The client takes three deep breaths and rates how fully the lungs expand, 0–10. (2) Tap rounds on setups about the breathing (e.g. "this constricted breathing"). (3) Re-rate. (4) Ask what emotional contributors might be tied to the tightness and tap on those. [source: Church 2012]
Example language (illustrative): "Take a few deep breaths; how full do your lungs feel, out of 10, where 10 is completely full?"
Watch for: respiratory illness, panic with breath-focused tasks; stop and use grounding instead. Breathing problems need medical assessment; this is a demonstration, not a treatment for any breathing condition. [synthesis]

4.7 Specific events: from global issue to tabletops and table legs

Purpose: convert a global complaint into tappable specific events; EFT International teaches core issues as a tabletop supported by specific past events (table legs), and limiting beliefs as "writing on the wall". [source: Church 2012; EFT International Level 1 & 2 course outline (metaphor names only)]
Steps: (1) Name the global issue. (2) Ask for specific events that are evidence for it: when, where, who, what was said. (3) Give each event a short title and a SUD. (4) Work events one at a time, usually the highest-charged first once the client is stable enough. [source: Church 2012; synthesis for ordering by stability]
Example language (illustrative): "You've said you've never been good enough. If that belief were a tabletop, what specific moments would be the legs holding it up?"
Watch for: the client offering repeated events as one block ("all of my childhood"); help them choose one moment. Working when tapping several legs leads related events to lose charge (generalisation). [source: Church 2012]

4.8 Aspects

Purpose: clear the separate components of an event. [source: Church 2012; EFT International Level 1 & 2 course outline ("shifting aspects")]
Steps: (1) As the client describes the event, note each charged element: an image, sound, smell, words, body sensation, emotion, belief or decision. (2) Rate and tap each separately. (3) When SUD rises or the feeling changes, name the new aspect and tap on it. (4) Return to the whole event and re-test. [source: Church 2012]
Example language (illustrative): "The look on his face is down to a 1. What's the next part of that moment that still has a charge: the sound, what you said, how your body felt?"
Watch for: the event "coming back" later, which usually means an aspect was missed rather than that EFT failed. [source: Church 2012]

4.9 Testing your work

Purpose: confirm an event is resolved before moving on. [source: Church 2012; Roberts, EFT Universe]
Steps: (1) Re-rate the event title. (2) Ask the client to replay the event vividly with senses exaggerated, or to tell the whole story aloud (see 4.10), stopping to tap on any part that still has charge. (3) Optionally test in the real world by approaching the trigger as part of planned exposure work. (4) Record the before-and-after numbers. [source: Church 2012; Roberts, EFT Universe; synthesis for step 3]
Example language (illustrative): "Let's really try to get it back: make the picture brighter, the sound louder. What number comes up now?"
Watch for: "testing" before the client is stable; residual body sensations; a client reporting 0 but avoiding the memory. Working when the client can tell the whole story calmly from beginning to end. [source: Roberts, EFT Universe; synthesis]

4.10 Tell the Story (Tell-a-Story) technique

Purpose: process a specific event narratively; used early in therapy and as a final test. Trauma-safety note: it is the least distancing of the three event techniques, so use it for moderate charge or after Tearless Trauma or the Movie Technique have lowered intensity. [source: Llewellyn-Edwards, EFT Universe; Roberts, EFT Universe; Church 2012]
Steps: (1) Agree the event and its start and end points. (2) The client tells the story aloud while tapping continuously through the points (or the therapist taps, with consent); a formal setup, reminder phrase or SUD is often unnecessary in this variant. (3) Keep tapping if the client becomes emotional or stops talking. (4) Note the parts the client rushes over. (5) Afterwards ask how they feel; if charge remains, take a SUD, retell, or return to rushed sections using Tearless Trauma. (6) In the testing form, stop and tap whenever distress appears, then have the client retell that section; finish when the whole story can be told calmly. [source: Llewellyn-Edwards, EFT Universe; Roberts, EFT Universe]
Example language (illustrative): "Tell me what happened from the moment just before it started, and keep tapping as you talk. If you need to pause, just keep tapping; you don't have to say anything."
Watch for: speeding up, glossing, flat voice or gaze fixing (signs of approaching overwhelm or dissociation); stop and use the Movie or Tearless Trauma approach. Working when retelling becomes slower, more detailed and calmer. [source: Llewellyn-Edwards, EFT Universe; synthesis for dissociation signs]

4.11 Movie Technique

Purpose: a more distanced way of processing a specific event, usually silently, so the client need not disclose details. [source: Church 2012; Llewellyn-Edwards, EFT Universe]
Steps: (1) Choose a specific event lasting minutes rather than hours. (2) Give the "movie" a title and rate the title. (3) Optional distancing: project it onto an imaginary screen, cast an actor as "you", narrate in third person. (4) Identify a neutral starting scene. (5) Run the movie in the mind (or narrate it); stop at each point where emotion rises, take the SUD, tap until it drops, then continue. (6) Re-run from the start until the whole movie can be watched calmly. (7) Test by replaying with senses exaggerated. [source: Church 2012; Llewellyn-Edwards, EFT Universe]
Example language (illustrative): "If this were a short film, what would you call it? … Start the film just before anything happened. Raise a finger the moment you feel it build and we'll pause the film there."
Watch for: intensity too high to watch at all, in which case switch to Tearless Trauma; the therapist should also watch for signs of rising emotion and pause the client. Used once rapport is established. [source: Roberts, EFT Universe; Llewellyn-Edwards, EFT Universe]

4.12 Tearless Trauma technique

Purpose: reduce a highly distressing memory with minimal re-experiencing; described as a double-dissociation approach that limits abreaction. [source: Church, EFT Universe tutorial; Roberts, EFT Universe]
Steps: (1) Choose one specific incident; the tutorial suggests one at least three years old so recent events do not complicate the work. (2) Ask the client to guess, without imagining the event, how intense it would be 0–10 if they did imagine it; record the guess. (3) Build a short phrase naming the emotion (or, in Roberts' version, title the incident as a mini-movie kept out of sight) and tap a round. (4) Ask for a new guess, again without imagining. (5) Repeat rounds until the guess is low. (6) Do one further round, then for the first time ask the client to imagine the incident and rate it. (7) If charge remains, use the Movie Technique or Tell the Story on remaining aspects, in stages. [source: Church, EFT Universe tutorial; Roberts, EFT Universe]
Example language (illustrative): "Don't go into the memory; keep it on the shelf. Just guess: if you did picture it, what number do you think it would be?"
Watch for: clients who picture it anyway (remind them gently to guess); keeping the redirect to the original incident if other issues surface. Working when guesses fall across rounds and the first real imagining is low. [source: Church, EFT Universe tutorial]

4.13 Continuous tapping and practitioner tapping

Purpose: lower arousal when a client is already flooded or needs to talk immediately, without setup wording. [source: Roberts, EFT Universe; Llewellyn-Edwards, EFT Universe]
Steps: (1) Explain at the start that tapping may continue while they talk. (2) The client taps continuously through the points (or the therapist taps, with consent agreed in advance and checked again in the moment). (3) Return to structured rounds with SUD once arousal falls. [source: Roberts, EFT Universe; synthesis for consent check]
Example language (illustrative): "Just keep tapping round the points as you talk; you don't need any words for it."
Watch for: touch becoming unwelcome when distress rises; switch to self-tapping instantly if the client hesitates. Some EFT writers recommend tapping on the client wherever possible; within psychotherapy, default to self-tapping. [source: Roberts, EFT Universe; synthesis]

4.14 Following associations (Tsunami Technique)

Purpose: follow an earlier event or emotion that surfaces while working on a memory. [source: Roberts, EFT Universe]
Steps: (1) When a new memory or feeling arises, note it. (2) Follow and tap on each association as it appears. (3) Test both the new event and the original memory. [source: Roberts, EFT Universe]
Example language (illustrative): "Something else just came up. Let's give that a number and tap on it, then check the first memory again."
Watch for: chains of associations moving toward material the client is not ready for; contain and park items on a list. [synthesis]

4.15 Core issues: earlier events behind present triggers

Purpose: reduce a present reaction by clearing the earlier event it echoes ("the problem is never the problem", Church's maxim). [source: Church 2012]
Steps: (1) Ask what the current trigger reminds the client of, or when they first felt this way. (2) Title the earlier event and work it with the techniques above. (3) Re-test the present trigger. [source: Church 2012]
Example language (illustrative): "When you feel that hot shame in meetings, what's the earliest time you remember feeling exactly that?"
Watch for: pressing for early memories; do not suggest events the client does not report. [source: Roberts, EFT Universe]

4.16 Psychological reversal and secondary gain

Purpose: address lack of progress that EFT attributes to reversal (an energy blockage, in the method's terms) and to hidden benefits of keeping a problem. [source: Church 2012; EFT International Level 1 & 2 course outline]
Steps: (1) Always include the Karate Chop setup, which the Mini-Manual says corrects reversal. (2) When progress stalls, explore what the problem protects or provides (e.g. income, avoiding attention, loyalty). (3) Tap on the fears or losses involved in letting go, in the client's words. [source: Church 2012; synthesis for steps 2–3]
Example language (illustrative): "Even though part of me isn't sure it's safe to let this go, I accept myself."
Watch for: real practical stakes (benefits, litigation, safety); explore these openly rather than tapping them away. [synthesis]

4.17 When the client cannot rate or recall

Purpose: proceed safely with dissociation or partial recall. [source: Church 2012]
Steps: The Mini-Manual suggests tapping repeated rounds on each aspect the client can recall when an event cannot be rated. In therapy, first check for dissociation, ground, and use Tearless Trauma rather than pushing recall. [source: Church 2012; synthesis]
Example language (illustrative): "We don't need the whole memory. Let's just work with the bit you do have, and keep your feet on the floor while we do."
Watch for: absent numbers, glazed affect, time loss; stop processing and ground. [synthesis]

4.18 Personal Peace Procedure

Purpose: structured self-help that works systematically through a person's specific troublesome events; EFT International also teaches it for practitioner self-care. [source: Church 2012; EFT International Level 1 & 2 course outline]
Steps: (1) The client lists specific troublesome events (the Mini-Manual suggests at least fifty), each with a short title. (2) Rate each. (3) Tap on the biggest first, working through one to three a day over about three months, per the Mini-Manual. (4) Bring stuck or highly charged items to session. [source: Church 2012]
Example language (illustrative): "Between sessions, try listing specific moments that still sting, give each a title, and tap on one at a time. Mark any that feel too big and we'll do those together."
Watch for: trauma survivors listing and approaching high-charge events alone; agree that items above a set level of distress or involving trauma are only worked in session. [synthesis]

4.19 Self-tapping for between-session regulation

Purpose: manage elevated emotion between sessions; the guidelines describe acupoint tapping as safe for clients to use on their own. [source: Church et al. 2018]
Steps: (1) Teach the Basic Recipe on a mild target. (2) Agree specific situations to use it. (3) Ask for a brief log of situation, before and after SUD. [synthesis]
Example language (illustrative): "If the panic starts on the train, tap the side of your hand and go round the points with 'this panic'. Jot the number before and after."
Watch for: tapping used to avoid feelings or situations (safety behaviour); review the log for this. [synthesis]

4.20 Borrowing Benefits (groups)

Purpose: group delivery in which members each pre-select a personal issue and tap along while the therapist guides one member; members' own ratings are reported to drop. [source: Church et al. 2018]
Steps: (1) Each member privately chooses and rates a personal issue. (2) The therapist works with one volunteer while everyone taps along. (3) Members re-rate their own issue. [source: Church et al. 2018]
Example language (illustrative): "Pick something of your own and give it a number; you don't need to share it. Tap along as I work with our volunteer, then check your number."
Watch for: vicarious distress from the volunteer's material; screen members, keep volunteer content contained, offer individual follow-up. [synthesis]

4.21 Telephone, video and online delivery

Purpose: remote delivery, which EFT International covers in Level 2 and Clinical EFT studies evaluated; self-guided programmes (e.g. the veterans' Battle Tap) build custom setups and follow recorded sessions. [source: EFT International Level 1 & 2 course outline; Church et al. 2018]
Steps: (1) The client self-taps while mirroring the therapist on camera. (2) Agree a crisis plan and location before processing trauma. (3) Prefer in person for high-intensity trauma, since in-person delivery outperformed telephone in one comparison. [source: Church et al. 2018; synthesis for steps 1–2]
Example language (illustrative): "Mirror me as I tap; if the connection drops, keep tapping and I'll call you straight back."
Watch for: limited view of dissociation signs remotely. [synthesis]

4.22 Children, surrogate tapping and other named Level 2 topics

Purpose: EFT International Level 2 lists tapping with children, surrogate tapping (a practitioner tapping on themselves on behalf of someone else, an energy concept attributed to the method), animals, reframes, pre-framing, cravings, aches and pains with "emotional contributors", and the Apex Effect. [source: EFT International Level 1 & 2 course outline (topic names only)]
Steps: [uncertain: not verified]. With children, obtain parental consent and the child's assent and follow safeguarding procedures. Physical pain is medically assessed first, and EFT is not presented as treating its cause. [synthesis]
Watch for: claims about physical illness; refer to the medical team. [synthesis]

4.23 Named techniques not described here

Sneaking Up on the Problem, Chasing the Pain, the Imagination Technique, Gary Craig's Optimal EFT and the Nine Gamut steps appear in EFT literature, but their protocols are [uncertain: not verified] and are not given here. Learn them from the originating trainer before use.

4.24 Combining EFT with psychotherapy

Purpose: place EFT inside a treatment plan. Practitioners surveyed often combined EFT with cognitive therapy; the guidelines add EFT to usual treatment and escalate to intensive psychotherapy or psychiatric review for non-responders. [source: Boath et al. 2017; Church et al. 2018]
Steps: (1) Formulate as usual. (2) Use EFT for specific-event desensitisation and arousal regulation within that formulation. (3) Follow processing with cognitive work on meanings and beliefs that shift. (4) Monitor with standard measures and review the step at set points. [synthesis]
Example language (illustrative): "Now that memory is at a 1, what do you make of it now? What does it say about you?"
Watch for: EFT crowding out formulation, relationship work or risk management. [synthesis]

5. Handling problems

Sources address abreaction, re-traumatisation, stalled SUD, missed aspects, reversal, secondary gain, non-response and practitioner wellbeing. Guidance marked [synthesis] is general clinical practice added for psychotherapists.

Overwhelm and abreaction

Sources: avoid re-traumatisation and abreaction; use more distancing as intensity rises; address memories in graduated steps that lower arousal at each one. EFT International Level 2 covers abreactions and the Gentle Techniques. [source: Roberts, EFT Universe; Church et al. 2018; EFT International Level 1 & 2 course outline]
Response: stop narrative, keep tapping continuously (client self-taps), ground with orientation to the room, and return later with Tearless Trauma on a smaller piece. Close the session only when SUD is back to a tolerable level and the client is oriented. [synthesis]

Dissociation

Signs: inability to rate, numbness, glazed or far-away look, time loss. Respond by stopping processing, grounding, and switching to guess-rating (Tearless Trauma) on a small fragment. Clients with frequent dissociation or developmental trauma belong at the intensive step of stepped care, with stabilisation before processing. [source: Church et al. 2018 (developmental trauma, Step 3); Church 2012 (unable to rate); synthesis (signs and stabilisation)]

Stuck SUD

Check: is the target specific? Is there an unnamed aspect? Has the feeling changed into a different emotion? Is there an earlier core event? Is there reversal or secondary gain? [source: Church 2012; Roberts, EFT Universe]
Response: narrow to one moment, ask what part still has a charge, ask what it reminds them of, explore the cost of change. If still stuck after several sessions, review the formulation and treatment step. [source: Church 2012; synthesis]

"It didn't work" or the problem returns

Usually a missed aspect or a related event not yet cleared; test more thoroughly and use the Personal Peace Procedure on related events. EFT International teaches troubleshooting and "tail-enders" (doubts voiced about the goal) as Level 1–2 topics. [source: Church 2012; EFT International Level 1 & 2 course outline]

Scepticism, embarrassment and resistance

Clients may find tapping odd or object to energy concepts. Present the method transparently: EFT's own explanation is energy-based, while Clinical EFT authors describe exposure, cognitive framing and acupressure as its ingredients; the client can try a single low-stakes round (e.g. Constricted Breathing) and decide. Never pressure; offer other evidence-based options. [source: Church et al. 2022; Church 2012; synthesis]

Discomfort with the acceptance statement

The setup may be said without believing it. Alternative wordings in the client's language (e.g. "I'm OK" or "I'm willing to consider accepting myself") are reasonable adaptations. [source: Church 2012 (said without believing); synthesis (alternatives)]

Non-adherence to self-tapping

Simplify to one situation, a short round and a brief log; review barriers (embarrassment, forgetting, fear of stirring memories). Restrict trauma targets to sessions. [synthesis]

Ruptures, including around touch

If the client stiffens, withdraws or goes quiet when being tapped, stop touch immediately, acknowledge it, and return to self-tapping or no tapping. Repair openly; document. Do not resume touch without fresh consent. [synthesis]

Suggestibility and false memory risk

Practitioners must not suggest that trauma or abuse occurred. Work only with material the client reports; avoid leading questions about hidden memories, especially with associations or core-issue searching. [source: Roberts, EFT Universe; synthesis]

Non-response and escalation

After the planned 5 (subclinical) or 10 (PTSD-range) sessions without adequate change, step up: more intensive psychotherapy, other evidence-based trauma treatment, psychiatric review by a prescriber, or inpatient care where suicidality requires. Clients who do not improve should be referred for further care. [source: Church et al. 2018; Boath et al. 2017]

Medical symptoms and medication

EFT is not a treatment for any physical disease. Physical symptoms are assessed medically; medication decisions stay with the prescriber. Church's materials say real medical problems need good medical care and that medication doses should not be changed without consulting a physician. [source: Church 2012]

Risk and suicidality

Use standard risk assessment and safety planning; do not begin trauma processing during acute risk. [synthesis]

Commerce and conflicts of interest

Certification and trainings are fee-based and some EFT sites make strong marketing claims. Do not sell trainings, books or programmes to clients; disclose any affiliation. Several guideline authors disclose income from EFT publications and training. [source: Church et al. 2018 (conflict-of-interest disclosure); EFT International Level 1 & 2 course outline (fees); synthesis]

Practitioner vicarious distress

Sources advise practitioners to clear their own unresolved trauma and use EFT and the Personal Peace Procedure on themselves; supervision applies as normal. [source: Roberts, EFT Universe; EFT International Level 1 & 2 course outline; synthesis (supervision)]

Sources

Sources consulted:

Books cited as reported in the sources above:

Church, D. (2013). The EFT Manual (3rd ed.). [as cited in Church et al., 2018]
Craig, G., & Fowlie, A. (1995). The EFT Manual. [as cited in Church et al., 2022]
Craig, G., & Rutten, G. (2023). Official EFT from A to Z: How to Use Both Forms of Emotional Freedom Techniques for Self-Healing.

Not verified: Gary Craig's Gold Standard EFT tutorial (emofree.com) [uncertain: not verified]; APA Division 12 listing of EFT [uncertain: not verified; the 2022 review states Clinical EFT meets APA efficacy criteria]; NICE position on EFT [uncertain: not verified]; Nine Gamut, Sneaking Up on the Problem, Chasing the Pain and Optimal EFT protocols [uncertain: not verified].

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