Emotionally focused therapy and emotion-focused therapy (EFT) are related humanistic approaches to psychotherapy that aim to resolve emotional and relationship issues with individuals, couples, and families. These therapies combine experiential therapy techniques, including person-centered and Gestalt therapies, with systemic therapy and attachment theory.Examples of psychotherapy survey textbooks that have covered one or more EFT approaches include: ; ; ; ; ; ; . Examples of texts on EFT for individuals include: ; ; . Texts on EFT for couples (sometimes called EFT-C) include: ; ; ; ; . Examples of texts on EFT for families (sometimes called EFFT) include: ; ; . The central premise is that emotions influence cognition, motivate behavior, and are strongly linked to needs.The connection between human needs and emotions is explored in, for example: ; ; ; ; ; ; The goals of treatment include transforming maladaptive behaviors, such as emotional avoidance, and developing awareness, acceptance, expression, and regulation of emotion and understanding of relationships. EFT is usually a short-term treatment (eight to 20 sessions).;
Emotion-focused therapy for individuals was originally known as process-experiential therapy,; examples of early texts using the term process-experiential include: ; and continues to be referred to by this name in some contexts.For example: EFT should not be confused with emotion-focused coping, a separate concept involving coping strategies for managing emotions.Emotion-focused coping is typically contrasted with problem-focused coping and relationship-focused coping, for example: ; ; ; EFT has been used to improve clients' emotion-focused coping abilities.For example: ; ;
History EFT began in the mid-1980s as an approach to helping couples. EFT was originally formulated and tested by Sue Johnson and Les Greenberg in 1985,; ; ; and the first manual for emotionally focused couples therapy was published in 1988.
To develop the approach, Johnson and Greenberg began reviewing videos of sessions of couples therapy to identify, through observation and task analysis, the elements that lead to positive change. They were influenced in their observations by the humanistic experiential psychotherapies of Carl Rogers and Fritz Perls, both of whom valued (in different ways) present-moment emotional experience for its power to create meaning and guide behavior. Johnson and Greenberg saw the need to combine experiential therapy with the systems theoretical view that meaning-making and behavior cannot be considered outside of the whole situation in which they occur. In this "experiential–systemic" approach to couples therapy, as in other approaches to systemic therapy, the problem is viewed as belonging not to one partner, but rather to the cyclical reinforcing patterns of interactions between partners. Emotion is viewed not only as an intra-individual fact, but also as a part of the whole system that organizes the interactions between partners.
In 1986, Greenberg chose "to refocus his efforts on developing and studying an experiential approach to individual therapy". Greenberg and colleagues shifted their attention away from couples therapy toward individual psychotherapy.The major books that they published during this period include: ; They attended to emotional experiencing and its role in individual self-organization. Building on the experiential theories of Rogers and Perls and others such as Eugene Gendlin, as well as on their own extensive work on information processing and the adaptive role of emotion in human functioning, created a treatment manual with numerous clearly outlined principles for what they called a process-experiential approach to psychological change. and have further expanded the process-experiential approach, providing detailed manuals of specific principles and methods of therapeutic intervention. presented case formulation maps for this approach.
Johnson continued to develop EFT for couples, integrating attachment theory with systemic and humanistic approaches, and explicitly expanding attachment theory's understanding of love relationships.Attachment theory of love relationships is outlined in, for example: ; Johnson's model retained the original three stages and nine steps and two sets of interventions that aim to reshape the attachment bond: one set of interventions to track and restructure patterns of interaction and one to access and reprocess emotion (see below).; Johnson's goal is the creation of positive cycles of interpersonal interaction wherein individuals are able to ask for and offer comfort and support to safe others, facilitating interpersonal emotion regulation.
developed a variation of EFT for couples that contains some elements from Greenberg and Johnson's original formulation but adds several steps and stages. Greenberg and Goldman posit three motivational dimensions—(1) attachment, (2) identity or power, and (3) attraction or liking—that impact emotion regulation in intimate relationships.; ; ;
Similar terminology, different meanings The terms emotion-focused therapy and emotionally focused therapy have different meanings for different therapists.
In Les Greenberg's approach the term emotion-focused is sometimes used to refer to psychotherapy approaches in general that emphasize emotion. Greenberg "decided that on the basis of the development in emotion theory that treatments such as the process experiential approach, as well as some other approaches that emphasized emotion as the target of change, were sufficiently similar to each other and different from existing approaches to merit being grouped under the general title of emotion-focused approaches." He and colleague Rhonda Goldman noted their choice to "use the more American phrasing of emotion-focused to refer to therapeutic approaches that focused on emotion, rather than the original, possibly more English term (reflecting both Greenberg's and Johnson's backgrounds) emotionally focused." Greenberg uses the term emotion-focused to suggest assimilative integration of an emotional focus into any approach to psychotherapy.; ; He considers the focus on emotions to be a common factor among various systems of psychotherapy: "The term emotion-focused therapy will, I believe, be used in the future, in its integrative sense, to characterize all therapies that are emotion-focused, be they psychodynamic, cognitive-behavioral, systemic, or humanistic." Greenberg co-authored a chapter on the importance of research by clinicians and integration of psychotherapy approaches that stated:
In addition to these empirical findings, leaders of major orientations have voiced serious criticisms of their preferred theoretical approaches, while encouraging an open-minded attitude toward other orientations.... Furthermore, clinicians of different orientations recognized that their approaches did not provide them with the clinical repertoire sufficient to address the diversity of clients and their presenting problems.
Sue Johnson's use of the term emotionally focused therapy refers to a specific model of relationship therapy that explicitly integrates systems and experiential approaches and places prominence upon attachment theory as a theory of emotion regulation.; ; Johnson views attachment needs as a primary motivational system for mammalian survival; her approach to EFT focuses on attachment theory as a theory of adult love wherein attachment, care-giving, and sex are intertwined.; ; Attachment theory is seen to subsume the search for personal autonomy, dependability of the other and a sense of personal and interpersonal attractiveness, love-ability and desire. Johnson's approach to EFT aims to reshape attachment strategies towards optimal inter-dependency and emotion regulation, for resilience and physical, emotional, and relational health.
Features
Experiential focus All EFT approaches have retained emphasis on the importance of Rogerian empathic attunement and communicated understanding. They all focus upon the value of engaging clients in emotional experiencing moment-to-moment in session.Client experiencing can be measured, for example, by the Client Experiencing Scale (), the Levels of Emotional Awareness Scale (), or the Assimilation of Problematic Experiences Scale (). Thus, an experiential focus is prominent in all EFT approaches.For example: ; ; ; All EFT theorists have expressed the view that individuals engage with others on the basis of their emotions, and construct a sense of self from the drama of repeated emotionally laden interactions.
The information-processing theory of emotion and emotional appraisal (in accordance with emotion theorists such as Magda B. Arnold, Paul Ekman, Nico Frijda, and James Gross) and the humanistic, experiential emphasis on moment-to-moment emotional expression (developing the earlier psychotherapy approaches of Carl Rogers, Fritz Perls, and Eugene Gendlin) have been strong components of all EFT approaches since their inception.; ; EFT approaches value emotion as the target and agent of change, honoring the intersection of emotion, cognition, and behavior.; ; EFT approaches posit that emotion is the first, often subconscious response to experience.; ; ; All EFT approaches also use the framework of primary and secondary (reactive) emotion responses.;
Maladaptive emotion responses and negative patterns of interaction Greenberg and some other EFT theorists have categorized emotion responses into four types (see below) to help therapists decide how to respond to a client at a particular time: primary adaptive, primary maladaptive, secondary reactive, and instrumental.; ; ; ; Greenberg has posited six principles of emotion processing: (1) awareness of emotion or naming what one feels, (2) emotional expression, (3) regulation of emotion, (4) reflection on experience, (5) transformation of emotion by emotion, and (6) corrective experience of emotion through new lived experiences in therapy and in the world. While primary adaptive emotion responses are seen as a reliable guide for behavior in the present situation, primary maladaptive emotion responses are seen as an unreliable guide for behavior in the present situation (alongside other possible emotional difficulties such as lack of emotional awareness, emotion dysregulation, and problems in meaning-making).
Johnson rarely distinguishes between adaptive and maladaptive primary emotion responses,For example: and rarely distinguishes emotion responses as dysfunctional or functional.For example: Instead, primary emotional responses are usually construed as normal survival reactions in the face of what John Bowlby called "separation distress".For example: ; ; ; EFT for couples, like other systemic therapies that emphasize interpersonal relationships, presumes that the patterns of interpersonal interaction are the problematic or dysfunctional element. The patterns of interaction are amenable to change after accessing the underlying primary emotion responses that are subconsciously driving the ineffective, negative reinforcing cycles of interaction. Validating reactive emotion responses and reprocessing newly accessed primary emotion responses is part of the change process.
Individual therapy