Copyright American Psychological Association
PREFACE
Emotion-focused therapy (EFT) aims to help clients enhance their
emotional processing, which we define as approaching, accepting, tolerating,
symbolizing, making narrative sense of, and utilizing or transforming emo-
tions. This increases people’s ability to respond adaptively to situations as they
arise. EFT helps people face previously disclaimed, painful emotions; reflect on
them to create meaning; use them to inform adaptive action; and transform
those that are maladaptive. Developing this type of emotional competence
(Greenberg, 2015) then involves the ability to (a) experience emotions and
symbolize them in awareness, (b) tolerate and regulate dysregulated emotions,
(c) transform maladaptive emotions, and (d) develop positive identity and
relationship narratives on the basis of new emotions. Emotional competence
thus is seen as the ability to use adaptive emotional responses to guide a process
of becoming, and to transform emotions that have become maladaptive, to redirect
this process. This enhances people’s capacity to deal with problems in living
and promotes harmony within and among people.
The therapeutic relationship is the cornerstone of EFT, serving as an
essential reference point throughout the treatment and providing the stability
and structure for clients to grow and change. Growing out of the client-centered
and experiential traditions that emphasize the importance of the therapeutic
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attitudes of acceptance, prizing, congruence, and empathy, EFT similarly stresses
the importance of therapists’ attitudes toward their clients. Emotion-focused
psychotherapists are accepting of and empathically attuned to their clients’
inner worlds to facilitate changes in clients’ emotion schemes and emotional
processing as well as their relationship with self and others.
This volume provides a comprehensive review of the most current,
research-informed work on EFT in both individual and couple therapy. We
see this approach as highly comprehensive and relevant to a broad array of
clinical populations. The approach is the premier therapy model for address-
ing emotion at a deep, experiential level that is not psychoanalytic, nor cog-
nitive behavioral in orientation, although we believe that it can contribute
to these approaches. The chapters in the book provide systematic coverage
of theory, research, and practice of an emotion-focused perspective that has
emerged from the work of Greenberg and collaborators emphasizing emotion
as the fundamental datum of human experience.
This is a clinical handbook and as such, the focus is on clinical practice.
The contributors were all asked to emphasize clinical applications of their
work. Researchers and clinicians alike were asked to make their chapters
research informed and as clinically relevant as possible. The EFT authors
in this handbook are all both researchers and skilled clinicians, a neces-
sary aspect of doing meaningful research on how people actually change in
therapy. The chapters by these clinician researchers, therefore, are all highly
clinically focused. The chapters in the book follow a trajectory from the
developing theory, to current hypothesis testing, to practice.
The aim with this collection is to reach both professionals in the field
who are somewhat knowledgeable about EFT as well as established therapists
who are looking to learn about this approach. Advanced graduate students
looking to incorporate working with emotion into their approach will also
benefit. The goal of this book is to promote the emotion revolution, which
is rapidly gaining momentum.
EVOLUTION OF THE THERAPY APPROACH
Initially, Greenberg and colleagues called the individual therapy process
experiential therapy (Greenberg, Rice, & Elliott, 1993; Rice & Greenberg,
1984), while Greenberg and Johnson (1986, 1988) called the couple’s treat-
ment emotionally focused couple therapy. There was a seamless transition
between the name process experiential and emotion-focused therapy in the indi-
vidual model. In the couples model, however, although there are a lot of simi-
larities in an emotion-focused and an attachment-based, emotionally focused
approach to couples, the approaches have taken slightly different paths. As
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was originally conceptualized (Greenberg & Johnson, 1988), couples func-
tioning is seen as organized around both attachment and influence; however,
over time, Johnson dropped this differentiation, focusing solely on attach-
ment and increasingly viewing couple’s functioning primarily through the
lens of attachment theory (Johnson, 2004). Greenberg (2002), on the other
hand, stayed with emotion as the primary focus from the original version of
the emotionally focused approach to couples. All the individual and couple
work was then integrated under the name emotion-focused therapy (Greenberg,
2002) to accord with the term emotion-focused used more generally in the
psychology literature. Greenberg and Goldman (2008) presented an updated
view of EFT for couples (EFT-C) in which they viewed affect regulation as
the central force that organizes couples’ dynamics. The aim was to produce
an integrated volume with both approaches, but this effort did not succeed
because of Johnson’s desire to maintain the separate identity of emotionally
focused couple therapy. EFT for couples, grounded as it is in affective neuro-
science and empirical studies of how people change in therapy, is covered in
this volume.
HOW THIS BOOK IS ORGANIZED
This volume is organized into five parts. Part I offers an introduction by
the volume editors, with Chapter 1 covering the history and development of
EFT theory and research in further detail. It covers the development of EFT
from its origins in the 1980s through the present. Chapter 2 then elaborates
EFT’s theory of emotion and its dialectical constructivist theory of function-
ing. Chapter 3 presents the theory of EFT practice and describes the four
compasses that guide it.
Part II follows the theme of integrating research and practice in EFT. In
Chapter 4, Timulak, Iwakabe, and Elliott present a summary of quantitative,
qualitative, and case study research on EFT to illuminate the evidence base of
the approach and discuss the clinical implications of the research. Chapters 5
and 6 present the relationship foundations of the approach based predomi-
nantly on empathy (Watson) and therapeutic presence (Geller). These are
the cornerstones of EFT practice. The next three chapters focus on clinical
applications of the process research done over the last decades. Chapter 7
by Pascual-Leone and Kramer provides an empirically based model of the
sequence of emotions in therapeutic change. In Chapter 8, Pos and Choi look
at research relating process to outcome with an emphasis on depth of experi-
encing in EFT. Herrmann and Auszra, in Chapter 9, define and give examples
of productive emotional processing. In Chapter 10, Sharbanee, Goldman,
and Greenberg review task analyses of emotional change, some of which
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are published here for the first time. In Chapter 11, Angus, Boritz, Mendes,
and Gonçalves focus on the relationship between narrative change processes
and treatment outcome. Part II ends with Chapter 12 in which Warwar and
Ellison discuss the role and process of experiential teaching in EFT with a
focus on homework.
Part III focuses on EFT with specific client populations. In Chapter 13,
Salgado, Cunha, and Monteiro review EFT of depression, including their
recent randomized clinical trial comparing the effects of EFT and cognitive–
behavioral therapy on depression. In Chapter 14, Watson, Timulak, and
Greenberg present their recently published manualized approaches to EFT for
generalized anxiety disorder. Elliott and Shahar then cover in Chapter 15 EFT
for social anxiety coming from both their research programs. Following in
Chapter 16 by Khayyat-Abuaita and Paivio is EFT for complex inter-
personal trauma. In Chapter 17, Pos and Paolone present an EFT approach
to the treatment of personality disorders and emotion dysregulation. In
Chapter 18, Dolhanty and Lafrance present their novel approach to emo-
tion-focused family therapy for eating disorders. Part III ends with a focus
on cultural populations rather than populations with a disorder. In Chapter
19, Levitt, Whelton, and Iwakabe discuss integrating feminist-multicultural
perspectives into EFT.
In Part IV, the focus is on EFT for couples. In Chapter 20, Woldarsky
Meneses and McKinnon present the updated theory and practice of emotion-
focused couple therapy, whereas in Chapter 21, Edwards and Levin-Edwards
present strategies for integrating individual tasks into EFT for couples. Part IV
ends with Chapter 22, in which Bradley presents a detailed description of
specific interventions that can be used with couples.
The editors provide in Part V a review of the themes that emerged from
the chapters and offer some future perspectives.
In many of the chapters the authors provide examples from clinical
cases as a way of illustrating how EFT works in practice. To protect the confi-
dentiality of therapy clients, authors have disguised names and other details,
or used composites with details drawn from multiple cases. The contributors
hope readers will take away clinically useful suggestions that span setting up
therapeutic relationships and facilitating productive emotional processing and
will apply these to specific populations and different disorders. The hope is that
this volume will help readers see the important role of emotion in therapeutic
change and understand how to work effectively with clients who have too little
emotion of the right kind and those who have too much emotion of the wrong
kind. If you are already trained in EFT, hopefully this handbook adds a more
differentiated understanding on how to work with emotion. If you are new to
this approach, hopefully it will encourage you to pursue further EFT training so
that you can help your clients engage in deeper emotional work.
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