EMOTION FOCUSED THERAPY
Contemporary Emotion theory posits that emotion, at its core, is an innate and adaptive system that has evolved to help us survive and thrive. Emotions are connected to our most essential needs. They rapidly alert us to situations important to our well-being. They also prepare and guide us in these important situations to take action towards meeting our needs.
According to Greenberg, emotion is a brain phenomenon that is vastly different from thought. It has its own neurochemical and physiological basis and is a unique language in which the brain speaks. The emotional brain however, is not capable of analytic thought or reasoning and its rapid evaluations are imprecise, so, one needs to attend to, and reflect on, one’s emotions to use this information most effectively. EFT aims to support clients as they experience, make sense of, and make decisions informed by their emotions and the important information contained therein.
The limbic system is responsible for all emotional responses. LeDoux (1996) identified two different paths for producing emotion. The first pathway, via the amygdala, is shorter and faster and sends automatic emergency signals to the brain and body and produces gut responses. The second pathway, via the neocortex, is longer and slower and produces emotion mediated by thought. In some situations it is necessary to respond quickly but at other times better functioning requires the integration of cognition into an emotional response. Significantly, emotion makes fundamental contributions to information processing, and EFT can help clients to make this process more conscious.
EMOTION FOCUSED THERAPY (EFT) THEORY IN A NUTSHELL
Two basic principles underlie the Emotion-Focused Therapy (EFT) model. The first principle is to create a genuine empathic valuing relationship which is seen as curative in its own right and the second is deepening the client’s experiencing in therapy. The sequence of activation, exploration, expression and reflection on emotion expression is central to EFT.
An important task of EFT is to bring emotions and their associated action tendencies into awareness. EFT practitioners differ from their more traditional client-centred counterparts in using more questions and conjectures to explore and stimulate the client’s inner experience. In addition, attention is given to specific client statements or markers that indicate a client is struggling with a particular issue and is ready to work with it. The work of the EFT therapist is characterised by the recognition of these distinctive markers that inform the therapist of the need for a specific task or intervention.
The tasks of EFT are intended to heighten the client’s inner experiencing, so that this can be more easily symbolised into awareness and thus processed consciously .Different interventions pursue particular types of exploration suited to different types of issues and promote different types of resolutions. Some tasks are focused on the intra-psychic processes, others indirectly facilitate interpersonal functioning. For example, an intra-psychic conflict within a person, or in Gestalt terms a split, is seen as two voices in one person, which can be worked with using the Two-Chair task. Evoking an emotional response can help the client to identify the impact of the events that gave rise to the emotion, to symbolise their relationship to the events, to discover their own needs and goals, and to recognise the action tendencies inherent in their emotional responses. This emotional activation and processing allows clients to become aware of the links between their inner experience, the external world and their behaviour. Once these links are available to awareness and integrated through their emotional and rational systems, clients can reflect on them and make choices about alternative ways of acting that might enhance their adaption and growth, and facilitate their achievement of life goals.
Briefly, the EFT therapist tracks or follows the client’s internal experience as it evolves moment by moment within the session, offering processing proposals to guide or facilitate meaning construction. The therapist seeks active client collaboration and works in the creative tension between “following” the client’s experience and “leading” the therapeutic process. The EFT interventions are regarded as particular ways of relating rather than technical treatments dealing with the client as an object. This marker-guided task strategy is combined with a genuinely prizing, empathic working relationship to foster a shared, engaging, safe environment that enables the client to express and explore personal difficulties and emotional pain. An EFT therapist, therefore, needs to follow the client through focused responsiveness, or attunement, in order to track their process, as well as assess whether to propose the use of more specific interventions or tasks. However, the clients remain the experts and final arbitrators, and may reject the therapist’s process directives to a task. The therapist is then encouraged to follow the client’s direction.
EMPATHY AS A TASK
A simple definition of empathy might be where one person understands, identifies and imaginatively enter into another person's feelings or experience. It could also be described as the ability to assume another’s internal frame of reference. Empathy is an active, immediate and continuous process that has both affective and cognitive aspects. There is the presence of warm acceptance and regard for the other that includes profound interest, curiosity and presence. Being truly present involves being fully aware of the moment by directly encountering the client's experience, physically, emotionally, mentally and viscerally. The therapist is intimately engaged whilst maintaining a sense of centre and grounding within his or herself in that shared space.
In EFT the degree of empathy might be best described as advanced attunement where the therapist tunes into the client's internal frame of reference. The client feels the therapist is “empathically present” to them whilst they process their pain and/or trauma. There is a process of resonating with the clients experience. This conveys to client a sense of being really “heard” and being non-judgmentally valued.
From a therapeutic perspective empathy is an active ingredient of change and a key process in assisting clients to develop a greater understanding of themselves. Its presence assists clients to feel safe and enables them to explore and deconstruct their worldviews and assumptions. Clients feel heard, understood and supported. Empathy promotes and enhances clients’ capacity to regulate their emotions. It generates deeper and deeper appreciation for the client. Empathy is not just a therapeutic skill, it is a basic relationship process.
In Emotion-Focused therapy (EFT) the first task is to develop a safe working alliance. Such a therapeutic relationship is considered inherently curative and the attitudes offered by Carl Rogers of empathy, unconditional positive regard and genuineness are understood as central change-producing aspects. The working alliance serves two functions. First, it promotes growth by helping clients to understand and accept themselves. Second, it assists clients to develop trust in the therapist and in the therapeutic process so the client can engage in the often difficult work of self-exploration and active expression. Whilst the first function is considered vital in EFT, the task-facilitative function of the working alliance is also emphasised. A safe empathic working environment is considered essential when introducing and facilitating the active interventions or tasks of EFT.
SYSTEMATIC EVOCATIVE UNFOLDING
Systematic evocative unfolding is especially appropriate when clients are puzzled or confused by a particular personal reaction. The marker for this reprocessing task is when a client describes an unexpected, puzzling personal problematic reaction. The primary approach is helping clients to bring problematic scenes alive in session with the use of vivid, concrete, colourful, and expressive language. This intervention also involves slowing the storytelling right down and incrementally retracing the events sequentially. This is intended to increase body awareness of the events. By having clients describe scenes in great detail therapists are helping them to recall episodic memories and allowing them to re-experience their feelings at the time. In unfolding, the goal is to establish a link between a stimulus situation and the client’s emotional and behavioural response to it, thus generating access to underlying emotional patterns so that they can be re-examined. The promoting of the re-experiencing of the situation and the reaction to it allows an opportunity to arrive at the implicit meaning of the situation that then in turn assists in making sense of the reaction. Resolution involves a new view of one’s reaction in that situation.
FOCUSING GENDLIN STYLE AND A BROADENED VERSION TO PROCESS TRAUMA
Eugene Gendlin’s style of psychotherapy involved directing clients’ attention to their present experience and this then influenced their physiological responses and meaning creation. He termed this process focusing. Focusing involves checking words against experience and finding a fit that generated the feeling of certainty. Experiential focusing was developed in the late 1960s as a way of helping clients access their experience by having them attend to their bodily felt-sense. Through the different stages of clearing the space, attending to, and symbolising their felt-sense, clients are encouraged to form a trusting relationship with themselves and their own inner experiencing. Therapists are encouraged to listen actively through attunement (advanced empathy) and to stay with the internal experience of their clients. Choosing to reflect present feeling in those inarticulate moments can assist the client to stay with, and explore, their experience rather than moving into self-analysis or criticism. Making the implicit explicit was the process goal of therapy.
Gendlin’s model has a dual intention. Attending to the immediately felt sense of experience combined with empathic understanding leads to deepening that experience. The integration between the feeling process and the attention brought to it generates a specifiable felt-sense and symbolising it enables a carrying forward to some sort of action. The therapist’s task is to carry the client’s experiencing forward and to remain in-touch experientially with what is occurring in their client. The skilful facilitation of process encourages exploration of the edge of the client’s awareness of their experience. Deepening of that experience as it occurs in the present moment can potentially lead to new understanding and change. A full resolution manifesting as a felt-shift leads to new thoughts, meanings, awarenesses and feelings.
The EFT marker for the task of focusing, typically for processing an unclear felt sense has been broadened to include the reprocessing of painful or traumatic events. Recent neuroscience findings have stated that reactivating a previously “stored” memory can lead to the creation of a new version of that memory. This according to Greenberg suggests that emotion schematic memory can be changed by new emotional experience. Automatic dysfunctional emotional processes arising from traumatic childhood experiences can be altered by activating the problematic memories, generating new adaptive emotional responses, and then storing the changed memories in stable fashion. Reconsolidation is an important mechanism for understanding plasticity, potentially explaining how organisms build on prior experience while incorporating new information.
According to Greenberg the degree to which emotional responses become disorganized and resistant to change by alternative life experiences depends on how early they were experienced, how intensely, and how frequently they and the situations activating them occurred. In addition, the more highly aroused the emotion, the more the evoking situation is remembered. Reactivation of a long-term memory returning it to a fragile and labile state, initiates a restabilisation process termed reconsolidation, which allows for updating of the memory. Memories are malleable and constantly undergoing revision because of the process of retrieval or recollection. When a person engages in recollection, the memory goes into an unstable state, so at that moment there’s the possibility of adding information. This is not just laying down a new memory but actually changing in fundamental ways the original memory. This reprocessing of the traumatic event is more than a desensitising of that traumatic experience.
It is important to note that in order to process painful or traumatic events it is essential that the client be equipped to manage it. Part of this management involves clients being grounded in their bodies and not exhibiting dissociative symptoms. Grounding is achieved by creating body awareness. Clients need to be confident that their flow of anxiety, emotion, memories and body sensations can be contained at will and have the ability to move in and out of distressing states. Also creating a safe place is useful as it acts as a grounding mechanism and a location the client can return to if she becomes overwhelmed or hyper-aroused.
DIALECTICAL CONSTRUCTIVISM AND TWO-CHAIR ENACTMENT TASKS
The developers of EFT have proposed a dialectical-constructivist view of human functioning to explain how people make sense of their emotions. From the perspective of dialectical constructivism, the self is a constantly changing but organised multiplicity, seen as a dynamic self-organising system that is influenced by interaction with the environment moment by moment. The multilevel organisation of the self emerges from a dialectical interaction of many component elements. Integration is achieved by an ongoing circular process of making sense of experience by symbolising bodily-felt sensations in awareness and articulating them in language, thereby constructing new experience.
Stability is experienced because people regularly re-create themselves out of the same basic component-elements as they interact with their situation. Such stability arises from repeated constructions of the same state from multiple, constituent elements that are constructed, afresh, each time. These characteristic organisations impart character to the person, and are responsible for the more enduring aspects of personality. Adding or subtracting elements from the process of construction can alter these traits, making character change possible. Dialectical synthesis of emotion and reflection are the key to therapeutic change of this nature.
Dialectical constructivism has several implications for understanding how people change in therapy. Much of the therapeutic work for the client involves various internal dialectical processes where separation and contact between different aspects are facilitated. Evocation and explication of the various implicit self aspects and facilitation of psychological contact with those aspects results in a new integrative experience of self. Previously overlooked or silenced voices are encouraged to emerge so that the more dominant voices can hear those previously ignored voices and an internal self-challenge is created. Assimilation and accommodation occur with both aspects undergoing change. Dialectical processes can be observed in the conceptualising versus experiencing domains of the client, and in the “splits” between the dominant voice that reiterates negative views of self versus a less dominant, more change-orientated voice of life and growth.
The Enactment Tasks in EFT, particularly the two-chair work, are a means in which to work with these dialectical processes. Greenberg and colleagues have adapted and developed the two-chair dialogue for working with a variety of internal conflicts. Conflicting aspects of self are frequently verbalised and expressed as two parts in conflict. These conflicts often represent internalised standards set up in the early formative years. These incorporated standards, or introjected voices impress on the person how they “ought” to be and interrupt the process of attending to and selecting what fitsand what would lead to a greater satisfaction of needs being met. As a result important needs get ignored, minimised or lost.
A conflict split involves an aspect of self that is coercive or critical towards another aspect of self. The critical aspect often carries hostility, disgust, or contempt that feeds into feelings of hopelessness, powerlessness, and subsequent depressive and anxious states. Various forms of conflict splits are seen in clinical depression where the negative evaluative critic evokes a need for perfectionism or emotional blocking. In anxiety disorders the critical aspect of self persistently frightens a vulnerable experiencing aspect as a maladaptive protective strategy. Conflict splits are also central to substance abuse, eating disorders and other habit disorders where conflict typically exists between a distressed, weak self aspect that engages in persistent self harming behaviour as a means of distracting itself from emotional pain and a healthier aspect of the self that is concerned about the self harm but unable to stop it. In practical terms, the two parts are put in contact by dialoguing with each other. Thoughts, feelings and needs within each part of the self are explored and communicated in a dialogue to achieve a softening of the critical voice. Resolution involves a integration between sides and self acceptance.
A variation of the Two-chair task is the Self-interruptive processes where emotional expression is blocked, suppressed or interrupted. The experiencing or healthy part of the person begins to express a primary adaptive emotion or associated need or action but is interrupted by a self-censoring part that attempts to prevent the person from doing so. Self-interruptive splits tend to be more nonverbal in nature and can have a significant bodily component of expression, such as sudden headaches or choking sensations. Self-interruptive processes are formed at key developmental stages and generally re responses to environments that did not allow for the full expression of emotions and needs. Although these processes are no longer adaptive they continue into adult life and can become automated. They are learned responses designed to cope with an unsafe environment or an internalised lack of entitlement. They prevent emotional or verbal expression and experiencing.
Two-chair enactments are used to make the interrupting part of the self explicit. Clients are guided to become aware of how they interrupt and to enact the ways they do it, whether by physical act, metaphorically or verbally, so that they can experience themselves as an agent in the process of shutting down. They are then invited to react to and to challenge the interruptive part of the self. Growth in this context involves expression of the previously blocked experience.
EMPTY CHAIR TASK FOR UNFINISHED BUSINESS
The empty chair task is used for unresolved issues with a significant other where the client has experienced neglect, abandonment, abuse or trauma. The representation of the other in the chair serves a function that is integral to the resolution of the dialogue. The significant other may be someone who is developmentally important. In addition, unfinished business from current relationships with partners, bosses or authority figures is often symbolically related to past unfinished business. In some trauma-related cases, unfinished business is counterindicated especially where there is likelihood of retraumatisation and self or other harming behaviour.
Using an empty chair dialogue, clients activate their internal view of a significant other and experience and explore their emotional relations to the other and make sense of them. Access to unmet needs and shifts in views of both the other and self occur. Resolution involves holding the other accountable or understanding the other or forgiving the other.
A number of other tasks such as vulnerability, trauma and narrative retelling, alliance rupture and repair, self contempt and compassion, emotional suffering and self soothing, anxiety and depressive splits are also included in the suite of tasks in EFT.
There are a number of concerns related to the using of EFT with some clients. Emotions can sometimes have a disorganising or overwhelming effect but EFT promotes the experience of adaptive emotional resources and these are far from destructive. Working with emotions can be painful for our clients and an EFT therapist is sensitive to the need for sufficient internal and external support before accessing emotions. The ability to internally sooth and therapist/client dyadic emotion regulation skills need to be in place before emotion is activated in therapy.
People who are highly rational may not respond to EFT. However, all people have emotions and need to learn healthy emotional expression. It may take longer for such clients to feel comfortable with the emotional expression promoted in EFT. Whilst there are some limitations EFT has achieved the momentum to be recognised as a effective approach to therapy.
EFT invites people to approach, attend to, regulate, make effective use of and transform emotions. EFT also recognises the power of human relationships to heal. EFT therapists offer an opportunity for healing and transformation through not only the genuine person-centred therapeutic relationship but also with appropriate use of the powerful tasks within EFT.
Elliott, R. K., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. Washington, DC: American Psychological Association.
Greenberg, L. S. (2011). Emotion focused therapy. Washington DC: APA.
LeDoux, J. (1996). The emotional brain: The mysterious underpinnings of emotional life. New York: Simon & Schuster.