Emotion Focused Therapy (EFT)
Overview
Emotion-focused therapy (EFT) was developed in the 1980s by psychologist Leslie Greenberg and co-developers Rhonda Goldman, Robert Elliot, Jeanne Watson, Laura Rice, and Sandra Paivio. EFT integrates psychologist Carl Rogers’ person-centered therapy and psychiatrist Fritz Perls’ Gestalt therapy, as both approaches share many philosophies of the humanistic approach.[1]
EFT is derived from the idea that our emotions are strongly linked to our identities and are absolutely crucial to understand when trying to help an individual resolve inner conflict. The primary target of intervention and therapeutic change in EFT are our “emotional schemes'' - the emotional memories that we hold onto from our lived experiences.[2] These emotional schemes guide our emotions in many scenarios, specifically ones that mirror a previous situation; therefore, in order to understand someone and the way that they react and interact with the world, we must understand their underlying emotions that have been built throughout their life and are influencing and controlling their current behavior.
Because EFT focuses on the contributions of emotion to the human experience, Greenberg (2017) explains that, “This focus leads therapist and client toward strategies that promotes the awareness, acceptance, expression, utilization, regulation, and transformation of emotion as well as corrective emotional experience with the therapist. The goals of EFT are strengthening the self, regulating affect, and creating new meaning ".[3] EFT therapists promote the development of emotional intelligence, which allow clients to be aware of and process their emotions, as well as understand and control how their emotions impact their behavior and decision-making. Clients are encouraged to confront their inner, most fearful or negative emotions, in order to fully understand and process through them. By doing so, an individual can become more at peace with these negative emotions and learn to more fully accept themselves.
Foundation
Much like person-centered therapy, gestalt therapy, and other variations of the humanistic approach, EFT is founded on the therapeutic relationship. Thus, EFT therapists emphasize the therapist’s empathy and unconditional positive regard, creating a safe space for their client. Greenberg noted that “EFT therapists are not afraid to show feelings for and with the client, although the client’s well-being must guide what and how much the therapist reveals and expresses''.[4] EFT therapists also greatly emphasize emotions in the “here and now”; therefore, during a session, an EFT therapist is primarily concerned with the client’s most immediate emotions and inner experiences. Another key element to EFT is the therapist’s attention to case formulation. In EFT, case formulation relies on process diagnosis, which attunes the therapist to the underlying determinants within the client’s life and the development of their client’s emotions.[5] Overall, an EFT therapist’s main focus is on the client’s emotions in order to help the client explore, express, raise awareness, and heal.
Techniques
Within emotion-focused therapy, therapists use the following techniques, often also referred to as “therapeutic tasks”, to help clients explore and understand their emotions. While other techniques may be used during emotion focused therapy, they must adhere to the values and philosophy of those practicing EFT.
Two-Chair Technique: Therapists will use the two-chair technique to bring a client’s inner conflicts and emotions into awareness. During the two-chair technique, the client moves back and forth between two chairs, representing different aspects of themselves in each chair. This dialogue between the two incongruent parts of oneself often reveals true emotions, create new perspectives, and help the client understand past events.[6]
Empty-Chair Technique: Therapists often use the empty-chair technique in situations where the client has unresolved feelings with a partner, family member, past self, or other person. When utilizing the empty-chair technique, clients assume the interval view of someone they are experiencing conflict with and express their unresolved feelings and needs. By doing this, the client’s perspective may shift and resolution can typically occur by holding each other accountable, understanding, or forgiving each other.[7]
Primary vs. Secondary Emotions: During EFT, therapists will often emphasize the difference between primary and secondary emotions, which help them better understand their client. Primary emotions are underlying, deep emotions that one has in response to an event, which many individuals often feel embarrassed or ashamed to share; therefore, people tend to share their secondary emotions more often. Secondary emotions are in response to our original thoughts and feelings and are typically shared more often because they seem “safer and more acceptable”. For example, if someone is upset at their significant other for not spending time with them, they might hide that they are upset and outwardly project feelings of anger or frustration toward their partner.
Greenberg (2010) notes there are six principles of emotional intervention that will help clients process and manager their emotions:[8]
Awareness: Increasing awareness of emotion is one of the most important principles of EFT because it helps clients understand what motivates their feelings and reconnect to their needs.
Emotional Expression: Encouraging clients to express, overcome, and confront their previously constricted emotions allows them to begin coping with them.
Regulation: Emotional regulation is a skill that frequently accompanies emotional expression and awareness because it allows for emotions to be expressed in ways that are healthy and appropriate. This could be seen as self-soothing, identifying and avoiding triggers, labeling emotions, and various coping practices for emotionally-charged situations.
Reflection: By reflecting on their emotional experiences, clients can make more sense of their emotions by creating new meaning for situations and understanding how and why these experiences may have triggered various emotions.
Transformation: The fifth principle of emotional intervention involves transforming negative maladaptive emotions (e.g., fear, shame, insecurity) into adaptive emotions (e.g., self-compassion, empathy). Greenberg explains that “It is important to note that the process of changing emotion with emotion goes beyond ideas of catharsis, completion and letting go, exposure, extinction, or habituation, in that the maladaptive feeling is not purged, nor does it simply attenuate by the person feeling it. Rather, another feeling is used to transform or undo it”.[9]
Corrective Experience of Emotion: A new lived experience that changes an old feeling serves as a corrective experience of emotion, in that it can correct patterns set in earlier situations. In this principle, a client will revise an emotion they had tied to an old experience with a new, healthier emotion. By doing so, a client can rethink the way they relate to others, how they view themselves, and how they view past emotional trauma.
Efficacy
Emotion focused therapy is considered highly effective and has been empirically proven through a variety of studies and deemed effective for those struggling with depression, anxiety, trauma, relationship issues, and personality disorders.[10] While EFT is used in individual therapy and family therapy, it is most commonly used in couples therapy. In one particular study, Johnson and Greenberg (1985) compared couples who were randomly selected to either receive EFT, a cognitive-behavioral approach which focused on teaching problem-solving skills, or a control group. They found that those who received EFT reported higher relationship satisfaction and intimacy and greater target complaint reduction than those who received the cognitive-behavioral approach.[11] Dandeneau and Johnson (1994) also found in a randomized clinical trial that those who received EFT had higher empathy and self-disclosure after therapy, and higher observed intimacy and greater stability at a follow-up than those who received cognitive-based therapy (CBT).[12] Furthermore, Johnson and Talitman’s research (1997) showed that 50% of couples found significant improvement in relationship satisfaction and were classified as recovered at post-therapy, which increased to 70% at a 3-month follow-up.[13] Wiebe and Johnson (2016) conclude that emotion-focused therapy has longer lasting effects than those of other methods, particularly for couples who report continued improvements after completing therapy.[14]
If you are interested in exploring Emotion Focused Therapy, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for additional guidance and support.
Contributed by: Kendall Hewitt
Editor: Jennifer (Ghahari) Smith, Ph.D.
references
1 Gelso, Charles J. & Williams, Elizabeth Nutt. (2022). Counseling Psychology. American Psychological Association, 4th edition, 337-339.
2 Greenberg, L.S. (2010). Emotion-Focused Therapy: A Clinical Synthesis. Focus, The Journal of Lifelong Learning in Psychiatry, Winter Edition, 8(1), 33-37. https://doi.org/10.1176/foc.8.1.foc32.
3 Greenberg, L.S. (2017). Emotion-Focused Therapy. American Psychological Association, Revised Edition, page 3. http://dx.doi.org/10.1037/15971-001.
4 Gelso & Williams (2022)
5 Ibid.
6 Pugh, M. (2017 June 08). Pull Up a Chair. The British Psychological Society. https://www.bps.org.uk/psychologist/pull-chair
7 Greenberg, L.S. (2010)
8 Ibid.
9 Ibid.
10 Gelso & Williams (2022)
11 Johnson, S. M., & Greenberg, L. S. (1985). The differential effectiveness of experiential and problem solving interventions in resolving marital conflict. Journal of Consulting & Clinical Psychology, 53(2), 175–184. https://doi.org/10.1037/0022-006X.53.2.175
12 Dandeneau, M. L., & Johnson, S. M. (1994). Facilitating intimacy: Interventions and effects. Journal of Marital and Family Therapy, 20(1), 17–33. https://doi.org/10.1111/j.1752-0606.1994.tb01008.x
13 Johnson, S. M., & Talitman, E. (1997). Predictors of success in Emotionally Focused Marital Therapy. Journal of Marital and Family Therapy, 23(2), 135–152. https://doi.org/10.1111/j.1752-0606.1997.tb00239.x
14 Wiebe, S.A. & Johnson, S.M. (2016 June 08). A Review of the Research in Emotionally Focused Therapy for Couples. Family Process, 55, 390–407. https://doi.org/10.1111/famp.12229