Emotionally focused therapy
Emotionally focused therapy and emotion-focused therapy (both EFT) are two related but distinct approaches to psychotherapy with individuals, couples, or families. Both EFT approaches include elements of experiential therapy (such as person-centered therapy and Gestalt therapy), systemic therapy, and attachment theory. EFT is usually a short-term treatment (8–20 sessions). Both EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. The approach now called emotion-focused therapy was originally known as process-experiential therapy, and it is still sometimes called by that name.
- 1 Shared beginnings
- 2 Similar terminology, different meanings
- 3 Divergence of the two EFT approaches
- 4 Comparison of the two EFT approaches
- 5 Differences in individual therapy
- 6 Differences in couples therapy
- 6.1 Stages and steps in emotion-focused therapy for couples
- 6.2 Stages and steps in emotionally focused therapy for couples
- 7 Differences in family therapy
- 8 Efficacy
- 9 Strengths
- 10 Criticism
- 11 See also
- 12 Notes
- 13 References
In spite of the divergent paths that emotionally focused therapy and emotion-focused therapy have taken (see § Divergence of the two EFT approaches below), EFT began in the mid-1980s as one approach for 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 combined 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 a within-individual phenomena, but also as part of the whole system that organizes the interactions between partners.
Further viewing of couples therapy videos revealed attachment themes of fears of loss and connection. Attachment theory became a foundational part of Johnson's expansion of the original three-stage, nine-step EFT model of how distress occurs in romantic relationships and of the process for how distressed relationships could be repaired (see § Stages and steps in emotionally focused therapy for couples below).
Similar terminology, different meanings
The terms emotion-focused therapy and emotionally focused therapy have different meanings for different therapists.
In Les Greenberg's emotion-focused 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. Emotionally focused therapy views attachment needs as a primary motivational system for mammalian survival. Emotionally focused therapy has expanded to be centered upon attachment theory as a theory of adult love wherein attachment, caregiving, 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, lovability and desire. Following attachment theory and emotion theory, emotionally focused therapy aims to reshape attachment strategies towards optimal interdependency and emotion regulation, for resilience and physical, emotional, and relational health.
Divergence of the two EFT approaches
Historically, emotionally focused therapy and emotion-focused therapy diverged into related but distinct approaches.
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. 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, 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, with detailed manuals of specific methods of therapeutic intervention. Goldman & Greenberg (2015) presents case formulation maps for this approach.
Greenberg & Goldman (2008) developed an emotion-focused approach for helping couples. This approach contains some elements from Greenberg and Johnson's original emotionally focused therapy approach but takes a different approach to attachment theory and adds several steps and stages. Greenberg and Goldman argue that there are three motivational dimensions—attachment, identity or power, and attraction or liking—that impact emotion regulation in intimate relationships. See § Differences in couples therapy below for more on this emotion-focused approach to couples therapy.
Emotionally focused therapy
Johnson continued to integrate attachment theory with systemic and humanistic approaches, explicitly expanding attachment theory's understanding of love relationships. 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. 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.
Comparison of the two EFT approaches
The following sections compare the two EFT approaches by examining their shared experiential focus, their different approaches to working with emotion (maladaptive emotions vs. negative patterns of interaction), differences in individual therapy, differences in couples therapy, and differences in family therapy.
Both EFT approaches have retained emphasis on the importance of Rogerian empathic attunement and communicated understanding. They both focus upon the value of engaging clients in emotional experiencing moment-to-moment in session. Thus, the experiential roots of the approach remain strong in both approaches. Both hold 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 both approaches since their inception. Both value emotion as the target and agent of change, honoring the intersection of emotion, cognition, and behavior. Both approaches posit that emotion is the first, often subconscious response to experience. Both also use the framework of primary and secondary (reactive) emotion responses.
Maladaptive emotions vs. negative patterns of interaction
Emotion-focused therapy categorizes emotion responses into four types (see § Emotion response types below) to help therapists decide how to respond to a client at a particular time: primary adaptive, primary maladaptive, secondary reactive, and instrumental. Emotion-focused therapy also has 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 is seen as a reliable guide for behavior, primary maladaptive emotion is seen as an unreliable guide.
Johnson's approach to emotionally focused therapy rarely distinguishes between adaptive and maladaptive primary emotions, and rarely distinguishes emotion responses as dysfunctional or functional. Instead, all primary emotional responses are usually construed as normal survival reactions in the face of what John Bowlby called "separation distress". Emotionally focused therapy, 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 emotions that are subconsciously driving the ineffective, negative reinforcing cycles of interaction. Validating reactive emotions and reprocessing newly accessed primary emotions is part of the change process.
Differences in individual therapy
Emotion-focused therapy with individuals
Within emotion-focused individual therapy there is a 14-step case formulation process that regards emotion-related dysfunction as stemming from at least four different possible causes: lack of awareness or avoidance of emotion, dysregulation of emotion, maladaptive emotion response, or a problem with making meaning of experiences. The theory features four types of emotion response (see § Emotion response types below), categorizes needs under "attachment" and "identity", specifies four types of emotional processing difficulties, delineates different types of empathy, has at least a dozen different task markers (see § Therapeutic tasks below), relies on two interactive tracks of emotion and narrative processes as sources of information about a client, and presumes a dialectical-constructivist model and an emotion schematic system.
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. For simplicity, we use the term emotion schematic process to refer to the complex synthesis process in which a number of coactivated emotion schemes coapply, to produce a unified sense of self in relation to the world.
Techniques used in "coaching clients to work through their feelings" include the Gestalt therapy empty chair technique, frequently used for resolving "unfinished business", and the two-chair technique, frequently used for self-critical splits.
Emotion response types
Although emotion-focused therapy posits that each person's emotions are organized into idiosyncratic emotion schemes that are highly variable both between people and within the same person over time, nevertheless emotion-focused theorists have posited that emotional responses can be classified into four broad types: primary adaptive, primary maladaptive, secondary reactive, and instrumental.
- Primary adaptive emotion responses are initial emotional responses to a given stimulus that have a clear beneficial value—for example, sadness at loss, anger at violation, and fear at threat. Sadness is an adaptive response when it motivates people to reconnect with someone or something important that is missing. Anger is an adaptive response when it motivates people to take assertive action to end the violation. Fear is an adaptive response when it motivates people to avoid or escape an overwhelming threat. In addition to emotions that indicate action tendencies (such as the three just mentioned), primary adaptive emotion responses include the feeling of being certain and in control or uncertain and out of control, and/or a general felt sense of emotional pain—these feelings and emotional pain do not provide immediate action tendencies but do provide adaptive information that can be symbolized and worked through in therapy. Primary adaptive emotion responses "are attended to and expressed in therapy in order to access the adaptive information and action tendency to guide problem solving."
- Primary maladaptive emotion responses are also initial emotional responses to a given stimulus; however, they are generally dysfunctional responses based on emotion schemes that are no longer useful (and that may or may not have been useful in the past) and that were often formed through previous traumatic experiences. Examples include sadness at the joy of others, anger at the genuine caring or concern of others, fear at harmless situations, and chronic feelings of insecurity/fear or worthlessness/shame. For example, a person may respond with anger at the genuine caring or concern of others because as a child he or she was offered caring or concern that was usually followed by a violation; as a result, he or she learned to respond to caring or concern with anger even when there is no violation. The person's angry response is understandable, and needs to be met with empathy and compassion even though his or her angry response is not helpful. Secondary maladaptive emotion responses are accessed in therapy with the aim of transforming the emotion scheme through new experiences.
- Secondary reactive emotion responses are complex chain reactions where a person reacts to his or her primary adaptive or maladaptive emotional response and then replaces it with another, secondary emotional response. In other words, they are emotional responses to prior emotional responses. ("Secondary" means that a different emotion response occurred first.) They can include secondary reactions of hopelessness, helplessness, rage, or despair that occur in response to primary emotion responses that are experienced (secondarily) as painful, uncontrollable, or violating. They may be escalations of a primary emotion response, as when people are angry about being angry, afraid of their fear, or sad about their sadness. They may be defenses against a primary emotion response, such as feeling anger to avoid sadness or fear to avoid anger; this can include gender role-stereotypical responses such as expressing anger when feeling primarily afraid (stereotypical of men's gender role), or expressing sadness when primarily angry (stereotypical of women's gender role). "These are all complex, self-reflexive processes of reacting to one's emotions and transforming one emotion into another. Crying, for example, is not always true grieving that leads to relief, but rather can be the crying of secondary helplessness or frustration that results in feeling worse." Secondary reactive emotion responses are accessed and explored in therapy in order to increase awareness of them and to arrive at more primary and adaptive emotion responses.
- Instrumental emotion responses are experienced and expressed by a person because the person has learned that the response has an effect on others, "such as getting them to pay attention to us, to go along with something we want them to do for us, to approve of us, or perhaps most often just not to disapprove of us." Instrumental emotion responses can be consciously intended or unconsciously learned (i.e., through operant conditioning). Examples include crocodile tears (instrumental sadness), bullying (instrumental anger), crying wolf (instrumental fear), and feigned embarrassment (instrumental shame). When a client responds in therapy with instrumental emotion responses, it may feel manipulative or superficial to the therapist. Instrumental emotion responses are explored in therapy in order to increase awareness of their interpersonal function and/or the associated primary and secondary gain.
The therapeutic process with different emotion responses
Emotion-focused therapy posits that each type of emotion response calls for a different intervention process by the therapist. Primary adaptive emotions need be more fully allowed and accessed for their adaptive information. Primary maladaptive emotions need to be accessed and explored to help the client identify core unmet needs (e.g., for validation, safety, or connection), and then regulated and transformed with new experiences and new adaptive emotions. Secondary reactive emotions need empathic exploration in order to discover the sequence of emotions that preceded them. Instrumental emotions 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.
It is important to note that primary emotion responses are not called "primary" because they are somehow more real than the other responses; all of the responses feel real to a person, but therapists can classify them into these four types in order to help clarify the functions of the response in the client's situation and how to intervene appropriately.
A therapeutic task is an immediate problem that a client needs to resolve in a psychotherapy session. 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. This kind of psychotherapy process research eventually led to a standardized (and evolving) set of therapeutic tasks in emotion-focused therapy for individuals.
The following table summarizes the standard set of these therapeutic tasks as of 2012. The tasks are classified into five broad groups: empathy-based, relational, experiencing, reprocessing, and action. The task marker is an observable sign that a client may be ready to work on the associated task. The intervention process is a sequence of actions carried out by therapist and client in working on the task. The end state is the desired resolution of the immediate problem.
In addition to the task markers listed below, other markers and intervention processes for working with emotion and narrative have been specified: same old stories, empty stories, unstoried emotions, and broken stories.
|Task marker||Intervention process||End state|
|Empathy-based tasks||Problem-relevant experience (e.g., interesting, troubling, intense, puzzling)||Empathic exploration||Clear marker, or new meaning explicated|
|Vulnerability (painful emotion related to self)||Empathic affirmation||Self-affirmation (feels understood, hopeful, stronger)|
|Relational tasks||Beginning of therapy||Alliance formation||Productive working environment|
|Therapy complaint or withdrawal difficulty (questioning goals or tasks; persistent avoidance of relationship or work)||Alliance dialogue (each explores own role in difficulty)||Alliance repair (stronger therapeutic bond or investment in therapy; greater self-understanding)|
|Experiencing tasks||Attentional focus difficulty (e.g., confused, overwhelmed, blank)||Clearing a space||Therapeutic focus; ability to work productively with experiencing (working distance)|
|Unclear feeling (vague, external or abstract)||Experiential focusing||Symbolization of felt sense; sense of easing (feeling shift); readiness to apply outside of therapy (carrying forward)|
|Difficulty expressing feelings (avoiding feelings, difficulty answering feeling questions)||Allowing and expressing emotion (also experiential focusing, systematic evocative unfolding, chairwork)||Successful, appropriate expression of emotion to therapist and others|
|Reprocessing tasks [situational-perceptual]||Difficult/traumatic experiences (narrative pressure to tell painful life stories)||Trauma retelling||Relief, validation, restoration of narrative gaps, understanding of broader meaning|
|Problematic reaction point (puzzling over-reaction to specific situation)||Systematic evocative unfolding||New view of self in-the-world-functioning|
|Meaning protest (life event violates cherished belief)||Meaning creation work||Revision of cherished belief|
|Action tasks [action tendency]||Self-evaluative split (self-criticism, tornness)||Two-chair dialogue||Self-acceptance, integration|
|Self-interruption split (blocked feelings, resignation)||Two-chair enactment||Self-expression, empowerment|
|Unfinished business (lingering bad feeling regarding significant other)||Empty-chair work||Let go of resentments, unmet needs regarding other; affirm self; understand or hold other accountable|
|Stuck, disregulated anguish||Compassionate self-soothing||Emotional/bodily relief, self-empowerment|
Emotion-focused therapy for trauma
The interventions and the structure of emotion-focused therapy have been adapted for the specific needs of psychological trauma survivors. A manual of emotion-focused therapy for individuals with complex trauma (EFTT) has been published. For example, modifications of the traditional Gestalt empty chair technique have been developed.
Emotionally focused therapy with individuals
The approach of Johnson and colleagues maintains an emphasis on attachment, while integrating the experiential focus of empathic attunement for engaging and reprocessing emotional experience and tracking and restructuring the systemic aspects and patterns of emotion regulation. The EFT therapist follows the attachment model by addressing deactivating and hyperactivating strategies. Individual therapy is seen as a process of developing secure connections between therapist and client, between client and past and present relationships, and within the client. Attachment principles guide EFT 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. The change processes are: identifying and strengthening patterns of emotion regulation, and creating corrective emotional experiences to transform negative patterns into secure bonds.
The relevance of attachment theory to understanding change in adult psychotherapy, whether individual or couple therapy, has become clearer because of the enormous amount of research applying attachment theory to adults in the last two decades (Cassidy & Shaver, 2008). Attachment theory is now used explicitly to inform interventions in individual therapy (Fosha, 2000; Holmes, 1996), and... the attachment perspective helps the humanistic experiential therapist address individual problems such as anxiety and depression, as well as the relationship distress that accompanies and maintains these problems.
Differences in couples therapy
There are two primary differences between emotion-focused and emotionally focused therapy for couples. Both differences revolve around the different prominence that attachment theory has in each approach. In Greenberg and Goldman's emotion-focused approach, although they "fully endorse" the importance of attachment, attachment is not considered to be the only interpersonal motivation of couples; instead, attachment is considered to be one of three aspects of relational functioning, along with issues of identity/power and attraction/liking. In Johnson's emotionally focused approach, attachment theory is considered to be the defining theory of adult love, subsuming other motivations, and it guides the therapist in processing and reprocessing emotion.
In emotion-focused therapy the emphasis is on working with core issues related to identity (working models of self and other) and promoting both self-soothing and other-soothing for a better relationship, in addition to interactional change. In emotionally focused therapy the primary goal is to reshape attachment bonds and create "effective dependency" (including secure attachment).
A systemic perspective is important in both approaches, but tracking conflictual patterns of interaction, often referred to as a "dance" in Johnson's popular literature, has been a hallmark of the first stage of Johnson's emotionally focused therapy for couples since its inception in 1985. In Goldman and Greenberg's newer approach to emotion-focused therapy for couples, therapists help clients "also work toward self-change and the resolution of pain stemming from unmet childhood needs that affect the couple interaction, in addition to working on interactional change." 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. For example, if a person's core emotion is one of shame and they feel "rotten at the core" or "simply fundamentally flawed," soothing or reassuring from one's partner, while helpful, will not ultimately solve the problem, lead to structural emotional change, or alter the view of oneself.
Stages and steps in emotion-focused therapy for couples
Deviating from the original three-stage, nine-step EFT framework developed by Johnson and Greenberg, Greenberg and Goldman's emotion-focused therapy for couples has five stages and 14 steps. It is structured to work on identity issues and self-regulation prior to changing negative interactions. It is considered necessary, in this approach, to help partners experience and reveal their own underlying vulnerable feelings first, so they are better equipped to do the intense work of attuning to the other partner and to be open to restructuring interactions and the attachment bond.
Stages and steps in emotionally focused therapy for couples
Emotionally focused therapy for couples retains the original nine-step model of restructuring the attachment bond between partners. In this approach, the aim is to reshape the attachment bond and create more effective co-regulation and "effective dependency", increasing individuals' self-regulation and resilience. In good-outcome cases, the couple is helped to respond and thereby meet each others' unmet needs and injuries from childhood. The newly shaped secure attachment bond may become the best antidote to traumatic experience from within and outside of the relationship.
Johnson (2008) summarizes the nine treatment steps in Johnson's model of EFT for couples: "The therapist leads the couple through these steps in a spiral fashion, as one step incorporates and leads into the other. In mildly distressed couples, partners usually work quickly through the steps at a parallel rate. In more distressed couples, the more passive or withdrawn partner is usually invited to go through the steps slightly ahead of the other."
Stage 1. Stabilization (assessment and de-escalation phase)
- Step 1: Identify the relational conflict issues between the partners
- Step 2: Identify the negative interaction cycle where these issues are expressed
- Step 3: Access attachment emotions underlying the position each partner takes in this cycle
- Step 4: Reframe the problem in terms of the cycle, unacknowledged emotions, and attachment needs
During this stage the therapist creates a comfortable and stable environment for the couple to have an open discussion about any hesitations the couples may have about the therapy, including the trustworthiness of the therapist. The therapist also gets a sense of the couple's positive and negative interactions from past and present and is able to summarize and present the negative patterns for them. Partners soon no longer view themselves as victims of their negative interaction cycle; they are now allies against it.
Stage 2. Restructuring the bond (changing interactional positions phase)
- Step 5: Access disowned or implicit needs (e.g., need for reassurance), emotions (e.g., shame), and models of self
- Step 6: Promote each partner's acceptance of the other's experience
- Step 7: Facilitate each partner's expression of needs and wants to restructure the interaction based on new understandings and create bonding events
This stage involves restructuring and widening the emotional experiences of the couple. This is done through couples recognizing their attachment needs, and then changing their interactions based on those needs. At first their new way of interacting may be strange and hard to accept, but as they become more aware and in control of their interactions they are able to stop old patterns of behavior from reemerging.
Stage 3. Integration and consolidation
- Step 8: Facilitate the formulation of new stories and new solutions to old problems
- Step 9: Consolidate new cycles of behavior
This stage focuses on reflection of new emotional experiences and self-concepts. It integrates the couple's new ways of dealing with problems within themselves and in the relationship.
Styles of attachment
Johnson & Sims (2000) described four attachment styles that affect the therapy process:
- People who are secure and trusting perceive themselves as lovable, able to trust others and themselves within a relationship. They give clear emotional signals, and are engaged, resourceful and flexible in unclear relationships. Secure partners express feelings, articulate needs, and allow their own vulnerability to show.
- People who have a diminished ability to articulate feelings, tend not to acknowledge their need for attachment, and struggle to name their needs in a relationship. They tend to adopt a safe position and solve problems dispassionately without understanding the effect that their safe distance has on their partners.
- People who are psychologically reactive and who exhibit anxious attachment. They tend to demand reassurance in an aggressive way, demand their partner's attachment and tend to use blame strategies (including emotional blackmail) in order to engage their partner.
- People who have been traumatized and have experienced little to no recovery from it vacillate between attachment and hostility.
Differences in family therapy
Emotion-focused family therapy
Greenberg and colleagues have not produced a manual for emotion-focused therapy with families, but they have mentioned that emotion-focused therapy can be combined with family-based treatments, implying that their emotion-focused approach is not appropriate for families by itself, but it can be combined with other treatments appropriate for families.
One group of clinicians, inspired in part by emotion-focused therapy, developed a treatment protocol specifically for families of individuals struggling with an eating disorder. The treatment is based on the principles and techniques of four different approaches: emotion-focused therapy, behavioral family therapy, motivational enhancement therapy, and the New Maudsley family skills-based approach. It aims to help parents "support their child in the processing of emotions, increasing their emotional self-efficacy, deepening the parent–child relationships and thereby making ED [eating disorder] symptoms unnecessary to cope with painful emotional experiences". The treatment has three main domains of intervention, four core principles, and five steps derived from Greenberg's emotion-focused approach and influenced by John Gottman: (1) attending to the child's emotional experience, (2) naming the emotions, (3) validating the emotional experience, (4) meeting the emotional need, and (5) helping the child to move through the emotional experience, problem solving if necessary.
Emotionally focused family therapy
Emotionally focused family therapy (EFFT) aims to promote secure bonds among distressed family members. It is a therapy approach consistent with the attachment-oriented experiential–systemic emotionally focused model in three stages: (1) de-escalating negative cycles of interaction that amplify conflict and insecure connections between parents and children; (2) restructuring interactions to shape positive cycles of parental accessibility and responsiveness to offer the child or adolescent a safe haven and a secure base; (3) consolidation of the new responsive cycles and secure bonds. Its primary focus is on strengthening parental responsiveness and caregiving, to meet children and adolescents' attachment needs. It aims to "build stronger families through (1) recruiting and strengthening parental emotional responsiveness to children, (2) accessing and clarifying children's attachment needs, and (3) facilitating and shaping caregiving interactions from parent to child". Some clinicians have integrated EFFT with play therapy.
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.
The American Psychological Association considers emotion-focused therapy for individuals to be an empirically supported treatment for depression. Studies have suggested that it is effective in the treatment of depression, interpersonal problems, trauma, and avoidant personality disorder.
Studies have suggested that emotionally focused therapy for couples is an effective way to restructure distressed couple relationships into safe and secure bonds with long-lasting results. 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 had a larger effect size than any other couple intervention had achieved to date. 70 to 73% of couples reported recovery from relationship distress, according to the Dyadic Adjustment Scale measure of relationship satisfaction, and 86% reported significant improvement over controls. Studies have consistently shown clinically significant improvement post therapy and excellent follow-up results. A study with an fMRI component suggested that emotionally focused couples therapy reduces the brain's response to threat in the presence of a romantic partner.
Some of the strengths of both EFT approaches can be summarized as follows:
- EFT aims to be collaborative and respectful of clients, combining experiential person-centered therapy techniques with systemic therapy interventions.
- Change strategies and interventions are specified through intensive analysis of psychotherapy process.
- EFT has been validated by 30 years of empirical research. There is also research on the change processes and predictors of success.
- EFT has been applied to different kinds of problems and populations, although more research on different populations and cultural adaptations is needed.
- EFT for couples is based on conceptualizations of marital distress and adult love that are supported by empirical research on the nature of adult interpersonal attachment.
In a 2015 article in Behavioral and Brain Sciences on "memory reconsolidation, emotional arousal and the process of change in psychotherapy", Richard D. Lane and colleagues summarized a common claim in the literature on emotion-focused therapy that "emotional arousal is a key ingredient in therapeutic change" and that "emotional arousal is critical to psychotherapeutic success". 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:
The brain clearly does not require emotional arousal per se for inducing deconsolidation. That is a fundamental point. If the target learning happens to be emotional, then its reactivation (the first of the two required elements) of course entails an experience of that emotion, but the emotion itself does not inherently play a role in the mismatch that then deconsolidates the target learning, or in the new learning that then rewrites and erases the target learning (discussed at greater length in Ecker 2015). [...] The same considerations imply that "changing emotion with emotion" (stated three times by Lane et al.) inaccurately characterizes how learned responses change through reconsolidation. Mismatch consists most fundamentally of a direct, unmistakable perception that the world functions differently from one's learned model. "Changing model with mismatch" is the core phenomenology.
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", and that their model needed further development to account for the diversity of states called "psychopathology" and the relevant maintaining and worsening processes.
- Accelerated experiential dynamic psychotherapy
- Affectional bond
- Attachment in adults
- Attachment in children
- Attachment-based psychotherapy
- Compassion focused therapy
- Emotional reasoning
- Human bonding
- Inner Relationship Focusing
- Interpersonal attraction
- Interpersonal communication
- Intimate relationship
- Object relations theory
- Schema therapy
- Occasionally both approaches are called by the same name, even when they are differentiated from one another; for example, Fromme (2011) calls both by the same name but still clearly differentiates between two approaches. Examples of psychotherapy survey textbooks that have covered one or both EFT approaches include: Fromme 2011, pp. 233–261, 385–389; Corey 2013, pp. 83–92; Goldenberg & Goldenberg 2013, pp. 267–272; Wedding & Corsini 2013, pp. 102–103; Gehart 2014, pp. 449–465; Prochaska & Norcross 2014, pp. 161–168; Corey 2015, pp. 167–168, 480. Examples of texts on EFT for individuals include: Elliott et al. 2004; Greenberg 2011; Greenberg 2015. Texts on EFT for couples (sometimes called EFT-C) include: Greenberg & Johnson 1988; Johnson 2004; Greenberg & Goldman 2008; Johnson 2008; Ruzgyte & Spinks 2011. Examples of texts on EFT for families (sometimes called EFFT) include: Heatherington, Friedlander & Greenberg 2005; Sexton & Schuster 2008; Stavrianopoulos, Faller & Furrow 2014.
- Johnson & Greenberg 1992, pp. 220–221, 223; Goldenberg & Goldenberg 2013, p. 267
- The connection between human needs and emotions is explored in, for example: Greenberg & Safran 1987; Safran & Greenberg 1991; Greenberg, Rice & Elliott 1993; Greenberg & Paivio 1997; Greenberg 2002a; Johnson 2004; Flanagan 2010
- Prochaska & Norcross 2014, p. 162; examples of early texts using the term process-experiential include: Rice & Greenberg 1990, p. 404; Greenberg, Rice & Elliott 1993
- For example: Wedding & Corsini 2013, pp. 102
- Emotion-focused coping is typically contrasted with problem-focused coping and relationship-focused coping, for example: Folkman et al. 1986, p. 571; Greenberg & Goldman 2007, p. 391; Morgan 2008, p. 185; Cormier, Nurius & Osborn 2013, p. 407
- For example: Baker & Berenbaum 2008, p. 69; Baker & Berenbaum 2011, p. 554; Stanton 2011, p. 370, 378
- For example: Johnson 2004; Johnson 2008; Ruzgyte & Spinks 2011; Johnson & Brubacher 2016
- For example: Greenberg, Rice & Elliott 1993; Greenberg & Goldman 2008; Prochaska & Norcross 2014, pp. 161–168
- Johnson & Greenberg 1985a; Johnson & Greenberg 1985b; Johnson & Greenberg 1987; Johnson & Greenberg 1988
- Greenberg & Johnson 1988
- Johnson et al. 2005, p. 13
- Fromme 2011, pp. 367–400
- Johnson 1998
- Johnson 1986; Goldenberg & Goldenberg 2013, pp. 267–272
- Greenberg & Goldman 2008, p. x
- Greenberg 2002b; Greenberg 2008; Thoma & McKay 2015, p. 240
- Greenberg 2011, p. 141
- Boswell et al. 2014, p. 117
- Johnson 2004; Gehart 2013, pp. 449–465; Goldenberg & Goldenberg 2013, pp. 267–272
- Shaver & Mikulincer 2006; Fromme 2011, pp. 384–390; Cassidy & Shaver 2016
- Johnson, Lafontaine & Dalgleish 2015
- Greenberg & Goldman 2008, p. viii
- The major books that they published during this period include: Greenberg, Rice & Elliott 1993; Elliott et al. 2004
- Greenberg & Goldman 2008, pp. 4–7; Woldarsky Meneses & Greenberg 2011; Goldman & Greenberg 2013, pp. 64–67; Woldarsky Meneses & Greenberg 2014
- Johnson 2004
- Attachment theory of love relationships is outlined in, for example: Mikulincer & Shaver 2016; Cassidy & Shaver 2016
- Johnson 2009a
- Client experiencing can be measured, for example, by the Client Experiencing Scale (Klein, Mathieu-Coughlan & Kiesler 1986), the Levels of Emotional Awareness Scale (Lane et al. 1990), or the Assimilation of Problematic Experiences Scale (Honos-Webb et al. 1998).
- For example: Goldman, Greenberg & Pos 2005; Johnson 2009a; Johnson 2009b; Elliott et al. 2011
- Greenberg & Safran 1987; Greenberg & Johnson 1988; Greenberg, Rice & Elliott 1993
- Greenberg & Safran 1987; Greenberg & Johnson 1988; Greenberg 2012
- Greenberg & Safran 1987, pp. 62–64, 127–128; Johnson 2004, p. 22; Johnson et al. 2005, p. 46; Lane et al. 2015, pp. 4–6
- Fromme 2011, pp. 233–261; Gehart 2014, pp. 449–465
- Greenberg & Paivio 1997, p. 35; Elliott et al. 2004, pp. 28–32; Fromme 2011, pp. 236–237; Elliott 2012, p. 111; Goldman & Greenberg 2015, pp. 25–27
- Greenberg 2010, pp. 35–38
- Goldman & Greenberg 2015, pp. 22–24
- For example: Johnson & Greenberg 1994, pp. 13–19
- For example: Johnson 2004, pp. 206-207
- For example: Johnson 1986; Johnson & Greenman 2006, p. 599; Johnson, Lafontaine & Dalgleish 2015, p. 414; Cassidy & Shaver 2016, pp. 29, 417–423
- Johnson 2004, pp. 45-46
- Goldman & Greenberg 2015, p. 5
- Goldman & Greenberg 2015, pp. 8, 27, 50, 139
- Goldman & Greenberg 2015, pp. 3–42
- Goldman & Greenberg 2015, p. 92
- Greenberg 2015
- Elliott et al. 2004, pp. 219–241; 295–296; Goldman & Greenberg 2015, pp. 36–38
- For example: Greenberg, Rice & Elliott 1993, p. 65; Greenberg & Paivio 1997, p. 117; Thoma & McKay 2015, p. 240–241
- Elliott et al. 2004, pp. 31
- Greenberg & Paivio 1997, p. 38
- Elliott 2012, p. 111
- Greenberg & Paivio 1997, p. 41
- Greenberg & Paivio 1997, p. 43
- Greenberg & Paivio 1997, p. 42
- Greenberg & Paivio 1997, p. 44
- Greenberg & Paivio 1997, p. 85
- Rice & Greenberg 1984
- Adapted from: Elliott 2012, p. 118; Fromme 2011, pp. 242–243
- Angus & Greenberg 2011, pp. 59–79; Baljon & Pool 2013
- Fosha et al. 2009
- Pavio & Pascual-Leone 2010
- Gehart 2014, pp. 449–465
- Johnson 2009a; Johnson 2009b
- Johnson 2009a, p. 410
- Greenberg & Goldman 2008, p. 4
- Johnson 2004; Johnson 2008; Greenman & Johnson 2013; Johnson & Brubacher 2016
- Greenberg & Goldman 2008; Goldman & Greenberg 2013
- Woolley et al. 2016, p. 329
- Johnson & Greenberg 1987; Best & Johnson 2002
- Goldman & Greenberg 2013, p. 62
- Goldman & Greenberg 2013, p. 77
- Greenberg & Goldman 2008, pp. 137–170
- Goldman & Greenberg 2013, pp. 68–70
- Johnson 2004, p. 17
- Johnson et al. 2013; cf. Mikulincer & Shaver 2016
- Johnson 2008, p. 116
- Johnson 2008, pp. 116–117; Jordan 2011
- Goldman & Greenberg 2015, p. 66
- Lafrance Robinson, Dolhanty & Greenberg 2015; Lafrance Robinson et al. 2016
- Lafrance Robinson, Dolhanty & Greenberg 2015, pp. 75–76; Lafrance Robinson et al. 2016, pp. 15–17
- Lafrance Robinson, Dolhanty & Greenberg 2015, p. 77
- Lafrance Robinson et al. 2016, pp. 15–16
- Early publications on EFFT include: Johnson, Maddeaux & Blouin 1998; Johnson & Lee 2000; Palmer & Efron 2007. A key text for emotionally focused therapy includes a chapter on EFFT titled "Emotionally focused family therapy: restructuring attachment" (Johnson 2004, pp. 243–266).
- Brassard & Johnson 2016
- Palmer 2015, pp. 5–6
- Hirschfeld & Wittenborn 2016
- See, for example, the literature reviews in: Elliott et al. 2013; Wiebe & Johnson 2016
- APA 2013; Lebow 2008, p. 87; Greenberg 2011; Wedding & Corsini 2013, pp. 103
- For example: Paivio & Nieuwenhuis 2001; Watson et al. 2003; Greenberg & Watson 2005; Goldman, Greenberg & Angus 2006; Paivio & Pascual-Leone 2010; Pascual-Leone et al. 2011; Pos 2014
- For example: Johnson et al. 1999; Dessaulles, Johnson & Denton 2003; Najafi et al. 2015; Wiebe & Johnson 2016
- Ruzgyte & Spinks 2011, p. 347
- Wiebe & Johnson 2016
- Johnson et al. 2013
- Elliott et al. 2004, pp. 7–14; Furrow, Johnson & Bradley 2011, p. 20
- Rice & Greenberg 1984; Pascual-Leone, Greenberg & Pascual-Leone 2009; Elliott 2010
- Greenberg 2011; Elliott et al. 2013
- Johnson 2008; Ruzgyte & Spinks 2011; Cassidy & Shaver 2016
- Lane et al. 2015, pp. 1, 8
- Ecker, Hulley & Ticic 2015; see also Patihis 2015 for a similar criticism from a cognitive behavioral therapy perspective
- Kimbrel, Meyer & Beckham 2015
- Mancini & Gangemi 2015
- "Website on research-supported psychological treatments". American Psychological Association, Division 12. 2013. Retrieved 30 October 2014.
- Angus, Lynne E.; Greenberg, Leslie S. (2011). Working with narrative in emotion-focused therapy: changing stories, healing lives. Washington, DC: American Psychological Association. ISBN 9781433809699. OCLC 698451460.
- Baker, John P.; Berenbaum, Howard (February 2008). "The efficacy of problem-focused and emotional approach interventions varies as a function of emotional processing style". Cognitive Therapy and Research. 32 (1): 66–82. doi:10.1007/s10608-007-9129-y.
- Baker, John P.; Berenbaum, Howard (December 2011). "Dyadic moderators of the effectiveness of problem-focused and emotional-approach coping interventions". Cognitive Therapy and Research. 35 (6): 550–559. doi:10.1007/s10608-011-9386-7.
- Baljon, Marijke; Pool, Grieteke (June 2013). "Hedgehogs in therapy: empathy and insecure attachment in emotion-focused therapy". Person-Centered & Experiential Psychotherapies. 12 (2): 112–125. doi:10.1080/14779757.2013.804652.
- Boswell, James F.; Sharpless, Brian A.; Greenberg, Leslie S.; Heatherington, Laurie; Huppert, Jonathan D.; Barber, Jacques P.; Goldfried, Marvin R.; Castonguay, Louis G. (2014) . "Schools of psychotherapy and the beginnings of a scientific approach". In Barlow, David H. The Oxford handbook of clinical psychology. Oxford library of psychology (Updated ed.). New York: Oxford University Press. pp. 98–127. ISBN 9780199328710. OCLC 874118501.
- Corey, Gerald (2013) . The art of integrative counseling (3rd ed.). Belmont, CA: Brooks/Cole/Cengage Learning. ISBN 9780840028631. OCLC 794271531.
- Corey, Gerald (2015) . Theory and practice of counseling and psychotherapy (10th ed.). Boston: Cengage Learning. ISBN 9781305263727. OCLC 914290570.
- Cormier, L. Sherilyn; Nurius, Paula; Osborn, Cynthia J. (2013) . Interviewing and change strategies for helpers (7th ed.). Belmont, CA: Brooks/Cole/Cengage Learning. ISBN 9780840028570. OCLC 796953120.
- Ecker, Bruce (January 2015). "Memory reconsolidation understood and misunderstood". International Journal of Neuropsychotherapy. 3 (1): 2–46. doi:10.12744/ijnpt.2015.0002-0046.
- Ecker, Bruce; Hulley, Laurel; Ticic, Robin (January 2015). "Minding the findings: let's not miss the message of memory reconsolidation research for psychotherapy" (PDF). Behavioral and Brain Sciences. 38: e7. PMID 26050698. doi:10.1017/S0140525X14000168.
- Elliott, Robert (March 2010). "Psychotherapy change process research: realizing the promise" (PDF). Psychotherapy Research. 20 (2): 123–135. doi:10.1080/10503300903470743.
- Elliott, Robert (2012). "Emotion-focused therapy" (PDF). In Sanders, Pete. The tribes of the person-centred nation: an introduction to the schools of therapy related to the person-centred approach (2nd ed.). Ross-on-Wye: PCCS Books. pp. 103–130. ISBN 9781906254551. OCLC 859577725.
- Elliott, Robert; Bohart, Arthur C.; Watson, Jeanne C.; Greenberg, Leslie S. (2011). "Empathy". In Norcross, John C. Psychotherapy relationships that work: evidence-based responsiveness (2nd ed.). Oxford; New York: Oxford University Press. pp. 132–152. ISBN 9780199737208. OCLC 663370182. doi:10.1093/acprof:oso/9780199737208.003.0006.
- Elliott, Robert; Greenberg, Leslie S.; Watson, Jeanne C.; Timulak, Ladislav; Freire, Elizabeth (2013). "Research on humanistic-experiential psychotherapies" (PDF). In Lambert, Michael J. Bergin and Garfield's handbook of psychotherapy and behavior change (6th ed.). Hoboken, NJ: John Wiley & Sons. pp. 495–538. ISBN 9781118038208. OCLC 808006668.
- Elliott, Robert; Watson, Jeanne C.; Goldman, Rhonda N.; Greenberg, Leslie S. (2004). Learning emotion-focused therapy: the process-experiential approach to change. Washington, DC: American Psychological Association. ISBN 9781591470809. OCLC 52554018.
- Flanagan, Catherine M. (March 2010). "The case for needs in psychotherapy". Journal of Psychotherapy Integration. 20 (1): 1–36. doi:10.1037/a0018815.
- Folkman, Susan; Lazarus, Richard S.; Gruen, Rand J.; DeLongis, Anita (March 1986). "Appraisal, coping, health status, and psychological symptoms". Journal of Personality and Social Psychology. 50 (3): 571–579. PMID 3701593. doi:10.1037/0022-35220.127.116.111.
- Fosha, Diana; Paivio, Sandra C.; Gleiser, Kari; Ford, Julian D. (2009). "Experiential and emotion-focused therapy". In Courtois, Christine A.; Ford, Julian D. Treating complex traumatic stress disorders: an evidence-based guide. New York: Guilford Press. pp. 286–311. ISBN 9781606230398. OCLC 234176147.
- Fromme, Donald K. (2011). Systems of psychotherapy: dialectical tensions and integration. New York: Springer-Verlag. ISBN 9781441973078. OCLC 696327398. doi:10.1007/978-1-4419-7308-5.
- Goldman, Rhonda N.; Greenberg, Leslie S. (2015). Case formulation in emotion-focused therapy: co-creating clinical maps for change. Washington, DC: American Psychological Association. ISBN 9781433818202. OCLC 878667783.
- Goldman, Rhonda N.; Greenberg, Leslie S.; Angus, Lynne E. (October 2006). "The effects of adding emotion-focused interventions to the client-centered relationship conditions in the treatment of depression". Psychotherapy Research. 16 (5): 537–549. doi:10.1080/10503300600589456.
- Goldman, Rhonda N.; Greenberg, Leslie S.; Pos, Alberta E. (July 2005). "Depth of emotional experience and outcome". Psychotherapy Research. 15 (3): 248–260. PMID 22011154. doi:10.1080/10503300512331385188.
- Greenberg, Leslie S (2002a). "Evolutionary perspectives on emotion: making sense of what we feel". Journal of Cognitive Psychotherapy. 16 (3): 331–347. doi:10.1891/jcop.16.3.331.52517.
- Greenberg, Leslie S. (June 2002b). "Integrating an emotion-focused approach to treatment into psychotherapy integration". Journal of Psychotherapy Integration. 12 (2): 154–189. doi:10.1016/S1053-0479(02)00013-0.
- Greenberg, Leslie S. (February 2008). "Emotion and cognition in psychotherapy: the transforming power of affect". Canadian Psychology / Psychologie canadienne. 49 (1): 49–59. doi:10.1037/0708-5518.104.22.168.
- Greenberg, Leslie S. (January 2010). "Emotion-focused therapy: a clinical synthesis". Focus: The Journal of Lifelong Learning in Psychiatry. 8 (1): 32–42. doi:10.1176/foc.8.1.foc32.
- Greenberg, Leslie S. (2011). Emotion-focused therapy. Theories of psychotherapy series. Washington, DC: American Psychological Association. ISBN 9781433808579. OCLC 655301581.
- Greenberg, Leslie S. (November 2012). "Emotions, the great captains of our lives: their role in the process of change in psychotherapy". American Psychologist. 67 (8): 697–707. PMID 23163464. doi:10.1037/a0029858.
- Greenberg, Leslie S. (2015) . Emotion-focused therapy: coaching clients to work through their feelings (2nd ed.). Washington, DC: American Psychological Association. ISBN 9781433819957. OCLC 903873710.
- Greenberg, Leslie S.; Goldman, Rhonda N. (2007). "Case formulation in emotion-focused therapy". In Eells, Tracy D. Handbook of psychotherapy case formulation (2nd ed.). New York: Guilford Press. pp. 379–411. ISBN 9781593853518. OCLC 65617415.
- Greenberg, Leslie S.; Paivio, Sandra C. (1997). Working with emotions in psychotherapy. The practicing professional. New York: Guilford Press. ISBN 9781572309418. OCLC 36705776.
- Greenberg, Leslie S.; Rice, Laura North; Elliott, Robert (1993). Facilitating emotional change: the moment-by-moment process. New York: Guilford Press. ISBN 9780898629941. OCLC 27897484.
- Greenberg, Leslie S.; Safran, Jeremy D (1987). Emotion in psychotherapy: affect, cognition, and the process of change. The Guilford clinical psychology and psychotherapy series. New York: Guilford Press. ISBN 9780898620108. OCLC 14214819.
- Greenberg, Leslie S.; Watson, Jeanne C. (2005). Emotion-focused therapy for depression. Washington, DC: American Psychological Association. ISBN 9781591472803. OCLC 57514665.
- Honos-Webb, Lara; Stiles, William B.; Greenberg, Leslie S.; Goldman, Rhonda N. (September 1998). "Assimilation analysis of process-experiential psychotherapy: a comparison of two cases". Psychotherapy Research. 8 (3): 264–286. doi:10.1093/ptr/8.3.264.
- Kimbrel, Nathan A.; Meyer, Eric C.; Beckham, Jean C. (January 2015). "A clinician's perspective on memory reconsolidation as the primary basis for psychotherapeutic change in posttraumatic stress disorder (PTSD)" (PDF). Behavioral and Brain Sciences. 38: e8. PMC . PMID 26050699. doi:10.1017/S0140525X1400017X.
- Klein, Marjorie H.; Mathieu-Coughlan, Philippa; Kiesler, Donald J. (1986). "The experiencing scale". In Greenberg, Leslie S.; Pinsof, William M. The psychotherapeutic process: a research handbook. New York: Guilford Press. pp. 21–71. ISBN 089862651X. OCLC 13003288.
- Lane, Richard D.; Quinlan, Donald M.; Schwartz, Gary E.; Walker, Pamela A.; Zeitlin, Sharon (1990). "The Levels of Emotional Awareness Scale: a cognitive-developmental measure of emotion". Journal of Personality Assessment. 55 (1-2): 124–134. PMID 2231235. doi:10.1080/00223891.1990.9674052.
- Lane, Richard D.; Ryan, Lee; Nadel, Lynn; Greenberg, Leslie S. (2015). "Memory reconsolidation, emotional arousal and the process of change in psychotherapy: new insights from brain science" (PDF). Behavioral and Brain Sciences. 38: e1. PMID 24827452. doi:10.1017/S0140525X14000041.
- Lebow, Jay L., ed. (2008). Twenty-first century psychotherapies: contemporary approaches to theory and practice. New York: John Wiley & Sons. ISBN 9780471752233. OCLC 123332183.
- Mancini, Francesco; Gangemi, Amelia (January 2015). "The relevance of maintaining and worsening processes in psychopathology" (PDF). Behavioral and Brain Sciences. 38: e14. PMID 26050677. doi:10.1017/S0140525X14000375.
- Morgan, Robin K. (2008). "Coping skills". In Davis, Stephen F.; Buskist, William. 21st century psychology: a reference handbook. 2. Los Angeles: Sage Publications. pp. 184–191. ISBN 9781412949682. OCLC 228071381.
- Paivio, Sandra C.; Nieuwenhuis, James A. (January 2001). "Efficacy of emotion focused therapy for adult survivors of child abuse: a preliminary study". Journal of Traumatic Stress. 14 (1): 115–133. doi:10.1023/A:1007891716593.
- Paivio, Sandra C.; Pascual-Leone, Antonio (2010). Emotion-focused therapy for complex trauma: an integrative approach. Washington, DC: American Psychological Association. ISBN 9781433807251. OCLC 429588844.
- Pascual-Leone, Antonio; Bierman, Ralph; Arnold, Robert; Stasiak, Eugene (May 2011). "Emotion-focused therapy for incarcerated offenders of intimate partner violence: a 3-year outcome using a new whole-sample matching method". Psychotherapy Research. 21 (3): 331–347. PMID 21506046. doi:10.1080/10503307.2011.572092.
- Pascual-Leone, Antonio; Greenberg, Leslie S.; Pascual-Leone, Juan (July 2009). "Developments in task analysis: new methods to study change". Psychotherapy Research. 19 (4): 527–542. PMID 20183405. doi:10.1080/10503300902897797.
- Patihis, Lawrence (2015). "Let's be skeptical about reconsolidation and emotional arousal in therapy" (PDF). Behavioral and Brain Sciences. 38: e21. PMID 26050685. doi:10.1017/S0140525X14000272.
- Pos, Alberta E. (June 2014). "Emotion focused therapy for avoidant personality disorder: pragmatic considerations for working with experientially avoidant clients". Journal of Contemporary Psychotherapy. 44 (2): 127–139. doi:10.1007/s10879-013-9256-6.
- Prochaska, James O.; Norcross, John C. (2014) . Systems of psychotherapy: a transtheoretical analysis (8th ed.). Australia; Stamford, CT: Cengage Learning. ISBN 9781133314516. OCLC 851089001.
- Rice, Laura North; Greenberg, Leslie S., eds. (1984). Patterns of change: intensive analysis of psychotherapy process. New York: Guilford Press. ISBN 9780898626247. OCLC 8762790.
- Rice, Laura North; Greenberg, Leslie S. (1990). "Fundamental dimensions in experiential therapy: new directions in research". In Lietaer, Germain; Rombauts, Jan; Balen, Richard van. Client-centered and experiential psychotherapy in the nineties. Studia psychologica. Leuven, Belgium: Leuven University Press. pp. 397–414. ISBN 9061863643. OCLC 24954596.
- Safran, Jeremy D.; Greenberg, Leslie S., eds. (1991). Emotion, psychotherapy, and change. New York: Guilford Press. ISBN 9780898625561. OCLC 22665279.
- Stanton, Annette L. (2011). "Regulating emotions during stressful experiences: the adaptive utility of coping through emotional approach". In Folkman, Susan. The Oxford handbook of stress, health, and coping. Oxford library of psychology. Oxford; New York: Oxford University Press. pp. 369–386. ISBN 9780195375343. doi:10.1093/oxfordhb/9780195375343.013.0018.
- Thoma, Nathan C.; McKay, Dean, eds. (2015). Working with emotion in cognitive-behavioral therapy: techniques for clinical practice. New York: Guilford Press. ISBN 9781462517749. OCLC 881362948.
- Watson, Jeanne C.; Gordon, Laurel B.; Stermac, Lana; Kalogerakos, Freda; Steckley, Patricia (August 2003). "Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression". Journal of Consulting and Clinical Psychology. 71 (4): 773–781. PMID 12924682. doi:10.1037/0022-006X.71.4.773.
- Wedding, Danny; Corsini, Raymond J. (2013) . Current psychotherapies (10th ed.). Belmont, CA: Cengage Learning. ISBN 9781285083711. OCLC 807032677.
EFT for couples
- Best, Marlene; Johnson, Susan M. (2002). "A systemic approach to restructuring adult attachment: the EFT model of couples therapy". In Erdman, Phyllis; Caffery, Tom. Attachment and family systems: conceptual, empirical, and therapeutic relatedness. Family therapy and counselling. New York: Brunner-Routledge. pp. 165–189. ISBN 1583913513. OCLC 49704975.
- Cassidy, Jude; Shaver, Phillip R., eds. (2016) . Handbook of attachment: theory, research, and clinical applications (3rd ed.). New York: Guilford Press. ISBN 9781462525294. OCLC 918616436.
- Dessaulles, Andre; Johnson, Susan M.; Denton, Wayne H. (October 2003). "Emotion-focused therapy for couples in the treatment of depression: a pilot study". The American Journal of Family Therapy. 31 (5): 345–353. doi:10.1080/01926180390232266.
- Furrow, James L.; Johnson, Susan M.; Bradley, Brent A., eds. (2011). The emotionally focused casebook: new directions in treating couples. New York: Brunner-Routledge. ISBN 9780415998758. OCLC 694172112.
- Goldman, Rhonda N.; Greenberg, Leslie S. (March 2013). "Working with identity and self-soothing in emotion-focused therapy for couples". Family Process. 52 (1): 62–82. PMID 25408090. doi:10.1111/famp.12021.
- Greenberg, Leslie S.; Goldman, Rhonda N. (2008). Emotion-focused couples therapy: the dynamics of emotion, love, and power. Washington, DC: American Psychological Association. ISBN 9781433803161. OCLC 163614069.
- Greenberg, Leslie S.; Johnson, Susan M. (1988). Emotionally focused therapy for couples. New York: Guilford Press. ISBN 9780898627305. OCLC 17413289.
- Greenberg, Leslie S.; Warwar, Serine; Malcolm, Wanda (January 2010). "Emotion-focused couples therapy and the facilitation of forgiveness". Journal of Marital and Family Therapy. 36 (1): 28–42. doi:10.1111/j.1752-0606.2009.00185.x.
- Greenman, Paul S.; Johnson, Susan M. (March 2013). "Process research on emotionally focused therapy (EFT) for couples: linking theory to practice". Family Process. 52 (1): 46–61. PMID 25408089. doi:10.1111/famp.12015.
- Johnson, Susan M. (July 1986). "Bonds or bargains: relationship paradigms and their significance for marital therapy". Journal of Marital and Family Therapy. 12 (3): 259–267. doi:10.1111/j.1752-0606.1986.tb00652.x.
- Johnson, Susan M. (June 1998). "Listening to the music: emotion as a natural part of systems theory". Journal of Systemic Therapies. 17 (2): 1–17. doi:10.1521/jsyt.1922.214.171.124.
- Johnson, Susan M. (2004) . The practice of emotionally focused couple therapy: creating connection. Basic principles into practice series (2nd ed.). New York: Brunner-Routledge. ISBN 9780415945684. OCLC 54408228.
- Johnson, Susan M. (2008). "Emotionally focused couple therapy". In Gurman, Alan S. Clinical handbook of couple therapy (4th ed.). New York: Guilford Press. pp. 107–137. ISBN 9781593858216. OCLC 213008213.
- Johnson, Susan M. (2009a). "Attachment theory and emotionally focused therapy for individuals and couples: perfect partners" (PDF). In Obegi, Joseph H.; Berant, Ety. Attachment theory and research in clinical work with adults. New York: Guilford Press. pp. 410–433. ISBN 9781593859985. OCLC 245512258.
- Johnson, Susan M. (2009b). "Extravagant emotion: understanding and transforming love relationships in emotionally focused therapy". In Fosha, Diana; Siegel, Daniel J.; Solomon, Marion Fried. The healing power of emotion: affective neuroscience, development, and clinical practice. Norton series on interpersonal neurobiology. New York: W. W. Norton & Company. pp. 257–279. ISBN 9780393705485. OCLC 319209081.
- Johnson, Susan M.; Bradley, Brent A.; Furrow, James L.; Lee, Alison C.; Palmer, Gail; Tilley, Doug; Woolley, Scott R. (2005). Becoming an emotionally focused couple therapist: the workbook. New York; London: Routledge. ISBN 9780415947473. OCLC 65645168.
- Johnson, Susan M.; Brubacher, Lorrie L. (2016). "Emotionally focused couple therapy: empiricism and art". In Sexton, Thomas L.; Lebow, Jay. Handbook of family therapy (2nd ed.). New York: Routledge. pp. 326–348. ISBN 9780415518017. OCLC 900684525.
- Johnson, Susan M.; Greenberg, Leslie S. (April 1985a). "Differential effects of experiential and problem-solving interventions in resolving marital conflict". Journal of Consulting and Clinical Psychology. 53 (2): 175–184. PMID 3998245. doi:10.1037/0022-006X.53.2.175.
- Johnson, Susan M.; Greenberg, Leslie S. (July 1985b). "Emotionally focused couples therapy: an outcome study". Journal of Marital and Family Therapy. 11 (3): 313–317. doi:10.1111/j.1752-0606.1985.tb00624.x.
- Johnson, Susan M.; Greenberg, Leslie S. (Fall 1987). "Emotionally focused marital therapy: an overview". Psychotherapy: Theory, Research, Practice, Training. 24 (3S): 552–560. doi:10.1037/h0085753.
- Johnson, Susan M.; Greenberg, Leslie S. (April 1988). "Relating process to outcome in marital therapy". Journal of Marital and Family Therapy. 14 (2): 175–183. doi:10.1111/j.1752-0606.1988.tb00733.x.
- Johnson, Susan M.; Greenberg, Leslie S. (1992). "Emotionally focused therapy: restructuring attachment". In Budman, Simon H.; Hoyt, Michael F.; Friedman, Steven. The first session in brief therapy. New York: Guilford Press. pp. 204–224. ISBN 0898621380. OCLC 25676421.
- Johnson, Susan M.; Greenberg, Leslie S., eds. (1994). The heart of the matter: perspectives on emotion in marital therapy. New York: Brunner/Mazel. ISBN 9780876307410. OCLC 30318897.
- Johnson, Susan M.; Greenman, Paul S. (May 2006). "The path to a secure bond: emotionally focused couple therapy". Journal of Clinical Psychology. 62 (5): 597–609. PMID 16523499. doi:10.1002/jclp.20251.
- Johnson, Susan M.; Hunsley, John; Greenberg, Leslie S.; Schindler, Dwayne (March 1999). "Emotionally focused couples therapy: status and challenges". Clinical Psychology: Science and Practice. 6 (1): 67–79. doi:10.1093/clipsy.6.1.67.
- Johnson, Susan M.; Lafontaine, Marie-France; Dalgleish, Tracy L. (2015). "Attachment: a guide to a new era of couple interventions". In Simpson, Jeffry A.; Rholes, W. Steven. Attachment theory and research: new directions and emerging themes. New York: Guilford Press. pp. 393–421. ISBN 9781462512171. OCLC 880462179.
- Johnson, Susan M.; Moser, Melissa Burgess; Beckes, Lane; Smith, Andra; Dalgleish, Tracy L.; Halchuk, Rebecca; Hasselmo, Karen; Greenman, Paul S.; Merali, Zul; Coan, James A. (November 2013). "Soothing the threatened brain: leveraging contact comfort with emotionally focused therapy". PLOS ONE. 8 (11): e79314. PMC . PMID 24278126. doi:10.1371/journal.pone.0079314.
- Johnson, Susan M.; Sims, Ann (2000). "Attachment theory: a map for couples therapy". In Levy, Terry M. Handbook of attachment interventions. San Diego: Academic Press. pp. 169–191. ISBN 9780124458604. OCLC 42622207.
- Jordan, Karin (July 2011). "Counselors helping service veterans re-enter their couple relationship after combat and military services: a comprehensive overview" (PDF). The Family Journal. 19 (3): 263–273. doi:10.1177/1066480711406689.
- Mikulincer, Mario; Shaver, Phillip R. (2016) . Attachment in adulthood: structure, dynamics, and change (2nd ed.). New York: Guilford Press. ISBN 9781462525546. OCLC 945884888.
- Najafi, Maryam; Soleimani, Ali Akbar; Ahmadi, Khodabakhsh; Javidi, Nasirudin; Kamkar, Elnaz Hoseini (July 2015). "The effectiveness of emotionally focused therapy on enhancing marital adjustment and quality of life among infertile couples with marital conflicts". International Journal of Fertility & Sterility. 9 (2): 238–246. PMC . PMID 26246883.
- Ruzgyte, Edita; Spinks, Donald (2011). "Emotionally focused therapy". In Metcalf, Linda. Marriage and family therapy: a practice-oriented approach. New York: Springer Publishing. pp. 341–364. ISBN 9780826106810. OCLC 663951666.
- Shaver, Phillip R.; Mikulincer, Mario (2006). "A behavioral systems approach to romantic love relationships: attachment, caregiving, and sex". In Sternberg, Robert J.; Weis, Karin. The new psychology of love. New Haven: Yale University Press. pp. 35–64. ISBN 9780300116977. OCLC 70399332.
- Wiebe, Stephanie A.; Johnson, Susan M. (September 2016). "A review of the research in emotionally focused therapy for couples". Family Process. 55 (3): 390–407. PMID 27273169. doi:10.1111/famp.12229.
- Woldarsky Meneses, Catalina; Greenberg, Leslie S. (October 2011). "The construction of a model of the process of couples' forgiveness in emotion-focused therapy for couples". Journal of Marital and Family Therapy. 37 (4): 491–502. PMID 22007782. doi:10.1111/j.1752-0606.2011.00234.x.
- Woldarsky Meneses, Catalina; Greenberg, Leslie S. (January 2014). "Interpersonal forgiveness in emotion-focused couples' therapy: relating process to outcome". Journal of Marital and Family Therapy. 40 (1): 49–67. PMID 25059412. doi:10.1111/j.1752-0606.2012.00330.x.
- Woolley, Scott R.; Faller, George; Palmer-Olsen, Lisa; Vitoria, Angela DeCandia (2016). "Training the emotionally focused therapist". In Jordan, Karin. Couple, marriage, and family therapy supervision. New York: Springer Publishing. pp. 327–346. ISBN 9780826126788. OCLC 921141306.
EFT for families
- Brassard, Audrey; Johnson, Susan M. (2016). "Couple and family therapy: an attachment perspective". In Cassidy, Jude; Shaver, Phillip R. Handbook of attachment: theory, research, and clinical applications (3rd ed.). New York: Guilford Press. pp. 805–823. ISBN 9781462525294. OCLC 918616436.
- Gehart, Diane R. (2014) . Mastering competencies in family therapy: a practical approach to theories and clinical case documentation (2nd ed.). Belmont, CA: Brooks/Cole. ISBN 9781285075426. OCLC 809029553.
- Goldenberg, Irene; Goldenberg, Herbert (2013) . Family therapy: an overview (8th ed.). Belmont, CA: Brooks/Cole/Cengage Learning. ISBN 9781111828806. OCLC 770864539.
- Heatherington, Laurie; Friedlander, Myrna L.; Greenberg, Leslie S (March 2005). "Change process research in couple and family therapy: methodological challenges and opportunities" (PDF). Journal of Family Psychology. 19 (1): 18–27. PMID 15796649. doi:10.1037/0893-3126.96.36.199.
- Hirschfeld, Mara R.; Wittenborn, Andrea K. (February 2016). "Emotionally focused family therapy and play therapy for young children whose parents are divorced". Journal of Divorce & Remarriage. 57 (2): 133–150. doi:10.1080/10502556.2015.1127878.
- Johnson, Susan M.; Lee, Alison C. (2000). "Emotionally focused family therapy: restructuring attachment". In Bailey, C. Everett. Children in therapy: using the family as a resource. New York: W. W. Norton & Company. pp. 112–136. ISBN 0393702898. OCLC 43845598.
- Johnson, Susan M.; Maddeaux, Cindy; Blouin, Jane (Summer 1998). "Emotionally focused family therapy for bulimia: changing attachment patterns". Psychotherapy: Theory, Research, Practice, Training. 35 (2): 238–247. doi:10.1037/h0087728.
- Lafrance Robinson, Adèle; Dolhanty, Joanne; Greenberg, Leslie S. (February 2015). "Emotion-focused family therapy for eating disorders in children and adolescents". Clinical Psychology & Psychotherapy. 22 (1): 75–82. PMID 23913713. doi:10.1002/cpp.1861.
- Lafrance Robinson, Adèle; Dolhanty, Joanne; Stillar, Amanda; Henderson, Katherine; Mayman, Shari (February 2016). "Emotion-focused family therapy for eating disorders across the lifespan: a pilot study of a 2-day transdiagnostic intervention for parents". Clinical Psychology & Psychotherapy. 23 (1): 14–23. PMID 25418635. doi:10.1002/cpp.1933.
- Palmer, Gail (July 2015). "Emotionally focused family therapy—EFFT" (PDF). iceeft.com. EFT Community News. Retrieved 24 January 2017.
- Palmer, Gail; Efron, Don (2007). "Emotionally focused family therapy: developing the model" (PDF). Journal of Systemic Therapies. 26 (4): 17–24. doi:10.1521/jsyt.2007.26.4.17.
- Sexton, Thomas L.; Schuster, Rachael A (June 2008). "The role of positive emotion in the therapeutic process of family therapy". Journal of Psychotherapy Integration. 18 (2): 233–247. doi:10.1037/1053-04188.8.131.52.
- Stavrianopoulos, Katherine; Faller, George; Furrow, James L (January 2014). "Emotionally focused family therapy: facilitating change within a family system". Journal of Couple & Relationship Therapy: Innovations in Clinical and Educational Interventions. 13 (1): 25–43. doi:10.1080/15332691.2014.865976.
- Greenberg, Leslie S.; Carlson, Jon (2004). Emotion-focused therapy for depression (DVD). Washington, DC: American Psychological Association. ISBN 9781591478133. OCLC 85815267.
- Greenberg, Leslie S.; Carlson, Jon (2007). Emotion-focused therapy over time (DVD). Washington, DC: American Psychological Association. ISBN 9781591474470. OCLC 85851969.
- Greenberg, Leslie S.; Carlson, Jon (2007). Emotionally focused therapy with couples (DVD). Washington, DC: American Psychological Association. ISBN 9781591474418. OCLC 82236088.
- Greenberg, Leslie S.; Beck, Judith S; McWilliams, Nancy (2012). Three approaches to psychotherapy with a female client: the next generation (DVD). Washington, DC: American Psychological Association. ISBN 9781433810299. OCLC 747586695.
- Greenberg, Leslie S.; Beck, Judith S.; McWilliams, Nancy (2012). Three approaches to psychotherapy with a male client: the next generation (DVD). Washington, DC: American Psychological Association. ISBN 9781433810305. OCLC 754964955.
- Johnson, Susan M.; Carlson, Jon (2011). Emotionally focused couple therapy for clients dealing with infidelity (DVD). Washington, DC: American Psychological Association. ISBN 9781433809880. OCLC 742669013.
- Johnson, Susan M.; Shoai, Shirin (2011). Emotionally focused therapy with same-sex couples: the EFT path to secure connection (DVD). Mill Valley, CA: Produced by Reel Concepts for Susan Johnson. OCLC 871556623.
- Johnson, Susan M. (2005). An externship in emotionally focused couple therapy (DVD). Ottawa: Ottawa Couple and Family Institute. OCLC 62154636.
- Johnson, Susan M. (2009). Re-engaging withdrawers: two live sessions in emotionally focused couple therapy (DVD). Ottawa: Ottawa Couple and Family Institute. OCLC 498574556.
- Paivio, Sandra C.; Tullos, Jon M. (2014). Emotion-focused therapy for trauma (DVD). Washington, DC: American Psychological Association. ISBN 9781433815607. OCLC 859399573.