Emotionally focused therapy
EFT was originally formulated and tested by Sue Johnson and Les Greenberg in 1985,[9] and the first manual for emotionally focused couples therapy was published in 1988.
[10] 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.
[11] 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.
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, Greenberg, Rice & Elliott (1993) created a treatment manual with numerous clearly outlined principles for what they called a process-experiential approach to psychological change.
Elliott et al. (2004) and Goldman & Greenberg (2015) have further expanded the process-experiential approach, providing detailed manuals of specific principles and methods of therapeutic intervention.
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.
"[23] 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.
[38] Instead, primary emotional responses are usually construed as normal survival reactions in the face of what John Bowlby called "separation distress".
[43] The emotion schematic system is seen as the central catalyst of self-organization, often at the base of dysfunction and ultimately the road to cure.
[34] Emotion-focused theorists have proposed that each type of emotion response calls for a different intervention process by the therapist.
Instrumental emotion responses need to be explored interpersonally in the therapeutic relationship to increase awareness of them and address how they are functioning in the client's situation.
In the 1970s and 1980s, researchers such as Laura North Rice (a former colleague of Carl Rogers) applied task analysis to transcripts of psychotherapy sessions in an attempt to describe in more detail the process of clients' cognitive and emotional change, so that therapists might more reliably provide optimal conditions for change.
[56] This kind of psychotherapy process research eventually led to a standardized (and evolving) set of therapeutic tasks in emotion-focused therapy for individuals.
[64] Attachment principles guide therapy in the following ways: forming the collaborative therapeutic relationship, shaping the overall goal for therapy to be that of "effective dependency" (following John Bowlby) upon one or two safe others, depathologizing emotion by normalizing separation distress responses, and shaping change processes.
"[68] Goldman and Greenberg justify their added emphasis on self-change by noting that not all problems in a relationship can be solved only by tracking and changing patterns of interaction: In addition, in our observations of psychotherapeutic work with couples, we have found that problems or difficulties that can be traced to core identity concerns such as needs for validation or a sense of worth are often best healed through therapeutic methods directed toward the self rather than to the interactions.
[80] Its primary focus is on strengthening parental responsiveness and care-giving, to meet children and adolescents' attachment needs.
[82] One group of clinicians, inspired in part by Greenberg's approach to EFT, developed a treatment protocol specifically for families of individuals struggling with an eating disorder.
[86] Johnson, Greenberg, and many of their colleagues have spent their long careers as academic researchers publishing the results of empirical studies of various forms of EFT.
[87] The American Psychological Association considers emotion-focused therapy for individuals to be an empirically supported treatment for depression.
[88] Studies have suggested that it is effective in the treatment of depression, interpersonal problems, trauma, and avoidant personality disorder.
[89] Practitioners of EFT have claimed that studies have consistently shown clinically significant improvement post therapy.
[91] Johnson et al. (1999) conducted a meta-analysis of the four most rigorous outcome studies before 2000 and concluded that the original nine-step, three-stage emotionally focused therapy approach to couples therapy[9] had a larger effect size than any other couple intervention had achieved to date, but this meta-analysis was later harshly criticized by psychologist James C. Coyne, who called it "a poor quality meta-analysis of what should have been left as pilot studies conducted by promoters of a therapy in their own lab".
[99] With regard to emotion-focused therapy, Purton argued that "the effectiveness of each of the 'therapeutic tasks' can be understood without the theory"[99]: 124 and that what clients say "is not well explained in terms of the interaction of emotion schemes; it is better explained in terms of the person's situation, their response to it, and their having learned the particular language in which they articulate their response.
[100] In a response accompanying the article, Bruce Ecker and colleagues (creators of coherence therapy) disagreed with this claim and argued that the key ingredient in therapeutic change involving memory reconsolidation is not emotional arousal but instead a perceived mismatch between an expected pattern and an experienced pattern; they wrote:[101] The brain clearly does not require emotional arousal per se for inducing deconsolidation.
Mismatch consists most fundamentally of a direct, unmistakable perception that the world functions differently from one's learned model.
[101]Other responses to Lane et al. (2015) argued that their emotion-focused approach "would be strengthened by the inclusion of predictions regarding additional factors that might influence treatment response, predictions for improving outcomes for non-responsive patients, and a discussion of how the proposed model might explain individual differences in vulnerability for mental health problems",[102] and that their model needed further development to account for the diversity of states called "psychopathology" and the relevant maintaining and worsening processes.
