Process-Experiential /

Emotion Focused Psychotherapy /

EFT

L. S. Greenberg
 What is EFT?
• Process-Experiential / Emotion-Focused Therapy (PE-EFT)
is an empirically-supported, neo-humanistic approach that
integrates and updates person-centered, Gestalt, and
existential therapies.
• EFTs have been shown to be effective in:
– both individual and couples forms of therapy in a number of
randomized clinical trials,
– equally or more effective than a Client Centered (CC) empathic
treatment, and a Cognitive Behavioral treatment (CBT) in the
treatment of depression. EFT was found to be more effective
in reducing interpersonal problems than both the CC and CBT,
– treating abuse,
– resolving interpersonal problems and promoting forgiveness,
– one of the most effective approaches in resolving relationship
distress.
 What is EFT
Similarly with 3rd wave CB approaches (DBT & ACT),
EFT relies on emotions in the process of change,
rather than on congnitions.

EFT has more research than any other approach on

the process of change, having demonstrated a
relationship between outcome and:
– empathy,
– the alliance,
– depth of experiencing,
– emotional arousal,
– making sense of aroused emotion,
– productive processing of emotion and
– particular emotions sequences.
 Emotion
• Premise: emotion is fundamental to the construction
of the self and is a key determinant of self-
organization:
– Emotions are an adaptive form of information-processing
and action readiness that orient people to their
environment and promote their well being,
– Emotions are seen by contemporary emotion theorists as
significant because they inform people that an important
need, value, or goal may be advanced or harmed in a
situation,
– Emotions are motivating. We seek positive emotions such
as pleasure, calm, excitement, interest, and joy, and we
avoid negative emotions such as fear, anxiety, pain,
embarrassment and shame,
– Emotion also gives meaning to experience and prepares us
for taking action.
 Emotion
• Emotional memories of lived emotional
experience are seen as being formed into
emotion schemes:
– internal organizations or neural programs making
people react automatically from their emotion
systems
– always include feelings and action tendencies, and
sometimes include beliefs.
• Changing the emotion schematic memory
structures is one of the main goals in therapy:
• The purpose of EFT is to change dysfunctional emotion
schemes, the habitual maladaptive ways patients experience
and respond to the environment.
 Emotion
• A Dialectical Constructivist View: Integrating Biology and Culture
• Integration of reason and emotion is based on an ongoing circular
process of making sense of experience by symbolizing bodily-felt
sensations in awareness and articulating them in language,
thereby constructing new experience:
– How emotional experience is symbolized influences what the
experience becomes in the next moment.
• Emotion Assessment
• A system of process diagnoses in which it is important to make
distinctions between different types of emotional experiences
and expression that require different types of intervention:
– Primary emotions are the person’s most fundamental, initial reactions
to a situation, such as being sad at a loss.
– Secondary emotions are responses to one’s thoughts or feelings, such
as feeling angry in response to feeling hurt,
– Maladaptive emotions are those old, familiar feelings that occur
repeatedly and do not change, such is a core sense of lonely
abandonment, the anxiety of basic insecurity.
 EFT
• EFT asserts that primary, secondary, and instrumental
emotions should be “processed”:
– identified, fully experienced, and allowed to evolve and develop.

• EFT establishes different goals for each type of emotion:

– Patients should work on becoming aware of their primary
emotions.
• If a primary emotion is adaptive, awareness helps the patient understand
what’s needed for survival and satisfaction.
• If the primary emotion is maladaptive, patients should work on
transforming the primary emotion into a less distressing experience.
– Since secondary emotions are reactions to primary emotions,
patients should explore their secondary emotions in order to
become aware of the underlying primary emotion.
• Therapists should not devote significant therapy time helping patients to
express secondary emotions.
– Patients should also work on becoming aware of instrumental
emotions, which often cause interpersonal problems.
 What is EFT?
• 2 fundamental treatment principles:
• Provision of a therapeutic relationship, &
– Person centered, empathetic,
– Combined with a more guiding, directive Gestalt style of
engaging in experiments to deepen experience.
• Facilitation of therapeutic work:
– the therapist guides clients emotional processing in different
ways at different moments
• EFT is marker guided and process directive.
– Markers = specific problematic emotional processing states that
are identifiable by in-session performances that mark underlying
affective problems, as well as client’s current readiness to work
on the problem,
– therapists are trained to identify markers of different types of
problematic emotional processing problems and to intervene in
specific ways
 Markers
• 1) Problematic reactions expressed through puzzlement
about emotional or behavioral responses to particular
situations,
• 2) An unclear felt sense in which the person is on the surface
of, or feeling confused and unable to get a clear sense of
his/her experience
• 3) Conflict splits in which one aspect of the self is critical or
coercive towards another aspect,
• 4) Self-interruptive splits arise when one part of the self
interrupts or constricts emotional experience and
expression,
• 5) An unfinished business marker involves the statement of a
lingering unresolved feeling toward a significant other such
as the following said in a highly involved manner,
• 6) vulnerability is a state in which the self feels fragile,
deeply ashamed, or insecure.
 Principles of Emotional Intervention
• Awareness
– increasing awareness of emotion is the most fundamental overall
goal of treatment,
• Emotional Expression
– has been shown to be a unique aspect of emotional processing
that predicts adjustment to things such as breast cancer,
interpersonal emotional injuries, and trauma
• Regulation
– training in the capacity for emotional down-regulation must
precede or accompany utilization of emotion
• Reflection
– helps people make narrative sense of their experience
• Transformation
– of primary maladaptive emotions
• Corrective emotional experience
– have a new lived experience that changes an old feeling
 Steps in EFT intervention
• 1) Become aware of emotions. Help patients to identify
and name their emotions.
– Use imagery, music, or role playing to evoke emotions,
– use reflection or modeling to identify them.
• 2) Express emotions, especially primary emotions and
unexpressed emotions.
– But avoid expression of dysregulated emotions.
• 3) Regulate emotions. Teach patients to allow
dysregulated emotions to surface and then dissipate.
– Use breathing, relaxation, & self-soothing skills to help
patients develop distance from dysregulated emotions.
• 4) Make sense of emotions.
– Look for patterns and develop a narrative to explain the
emotions of each particular patient in each particular
situation.
 Steps in EFT intervention
• 5) Transform problem emotions in one of two ways:
• a) Simultaneously evoke a competing emotion, ideally a
primary adaptive emotion. Ask “what do you need [want] right
now?” Or shift the patient’s attention by asking “what other
emotions are you experiencing right now?”
• b) Provide a new interpersonal experience. When patients
receive warm, validating, or positive responses to emotional
expression, they experience a corrective relationship that
disconfirms pathological beliefs, provides soothing, and
eventually creates a new, adaptive emotion scheme.
• Successful “emotion processing” involves completely
articulating 5 components of every emotion:
– 1. situation, 2. meaning/appraisal, 3. sensation/feeling, 4. need, and
5. action tendency.
– According to EFT, the most common markers of inadequate emotional
processing are: 1. self-criticism, 2. vague feelings, 3. confused
feelings, 4. lingering negative feelings, and 5. overreactions.
 Chairs work as main technique
• Although EFT incorporates many emotional processing techniques to
transform emotion, it relies heavily on three variations of gestalt therapy’s
“double chair” / “empty chair” technique:

• 1. Patients enact a conversation between a dysfunctional emotion scheme,

usually critical and self-damning, and a forgiving, reasonable scheme.
– Patients express one side of the conflict in each chair, and switch chairs as the
conversation progresses.

• 2. Patients enact a conversation with an imagined significant other who

evokes maladaptive primary or secondary emotions.
– Patients express their feelings in one chair, then switch chairs and express the
significant other’s imagined response.

– This process is useful for emotions that are blocked or not fully experienced.
• 3. Patients sit in one chair and speak to an imagined significant other in
the empty chair, with no imagined response from the significant other.
– This form of the “double chair” helps clarify vague, confused or unexpressed
emotions.