NJ-ACT - Leslie Greenberg

Leslie Greenberg’s Master Lecture on

Emotion-Focused Therapy

By Lynn Mollick

On Sunday, March 28 Leslie S. Greenberg, Ph.D. presented “Emotion-Focused Therapy,” NJ-ACT’s 15^th annual Master Lecture. EFT is an empirically supported therapy that has proven effective in the treatment of depression, trauma, marital dysfunction, and eating disorders.

Dr. Greenberg began by explaining that emotion is fundamentally adaptive. It provides us with information about how our environment is treating us, and thus promotes survival and satisfaction.

Emotions are motivating. We seek positive emotions such as pleasure, calm, excitement, interest, and joy, and we avoid negative emotions such as fear, anxiety, pain, embarrassment and shame. Emotion also gives meaning to experience and prepares us for taking action.

Beginning in childhood, experience becomes organized into “emotion schemes” that always include feelings and action tendencies, and sometimes include beliefs. The purpose of EFT is to change dysfunctional emotion schemes, the habitual maladaptive ways patients experience and respond to the environment.

Types of Emotion Schemes

Emotion is evoked in lower areas of the brain, such as the amygdala -- cognition occurs in higher brain centers. Thus, emotion usually precedes cognition. EFT distinguishes among primary, secondary, and instrumental emotions:

1. Primary emotions are “gut responses” that are either adaptive -- fight, flight, or freeze for survival -- or maladaptive -- fight, flight, or freeze that interferes with survival as in PTSD. Patients seldom recognize primary emotions when they enter therapy.

2. Secondary emotions are reactions to primary emotions. For example, shame and anger are usually reactions to hurt. Patients usually present with secondary emotions because secondary emotions tend to be aversive and unwanted, and they interfere with effective functioning.

3. Instrumental emotions are attempts to manipulate the environment. Crying in order avoid expected punishment is an example of an instrumental emotion.

EFT asserts that primary, secondary, and instrumental emotions should be “processed” -- identified, fully experienced, and allowed to evolve and develop. EFT establishes different goals for each type of emotion:

Patients should work on becoming aware of their primary emotions. If a primary emotion is adaptive, awareness helps the patient understand what’s needed for survival and satisfaction. If the primary emotion is maladaptive, patients should work on transforming the primary emotion into a less distressing experience.

Since secondary emotions are reactions to primary emotions, patients should explore their secondary emotions in order to become aware of the underlying primary emotion. Therapists should not devote significant therapy time helping patients to express secondary emotions.

Patients should also work on becoming aware of instrumental emotions, which often cause interpersonal problems.

Five Steps in EFT

1) Become aware of emotions. Help patients to identify and name their emotions. Use imagery, music, or role playing to evoke emotions -- use reflection or modeling to identify them.

2) Express emotions, especially primary emotions and unexpressed emotions. (But avoid expression of dysregulated emotions.)

3) Regulate emotions. Teach patients to allow dysregulated emotions to surface and then dissipate. Use breathing, relaxation, & self-soothing skills to help patients develop distance from dysregulated emotions.

4) Make sense of emotions. Look for patterns and develop a narrative to explain the emotions of each particular patient in each particular situation.

5) Transform problem emotions in one of two ways:

a) Simultaneously evoke a competing emotion, ideally a primary adaptive emotion. Ask “what do you need [want] right now?” Or shift the patient’s attention by asking “what other emotions are you experiencing right now?”

b) Provide a new interpersonal experience. When patients receive warm, validating, or positive responses to emotional expression, they experience a corrective relationship that disconfirms pathological beliefs, provides soothing, and eventually creates a new, adaptive emotion scheme.

Successful “emotion processing” involves completely articulating 5 components of every emotion – situation, meaning/appraisal, sensation/feeling, need, and action tendency. According to EFT, the most common markers of inadequate emotional processing are: self-criticism, vague feelings, confused feelings, lingering negative feelings, and overreactions.

Double Chair Techniques in EFT

Although EFT incorporates many emotional processing techniques to transform emotion, it relies heavily on three variations of gestalt therapy’s “double chair” technique:

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

2. Patients enact a conversation with an imagined significant other who evokes maladaptive primary or secondary emotions. Patients express their feelings in one chair, then switch chairs and express the significant other’s imagined response. This process is useful for emotions that are blocked or not fully experienced.

3. Patients sit in one chair and speak to an imagined significant other in the empty chair, with no imagined response from the significant other. This form of the “double chair” helps clarify vague, confused or unexpressed emotions.

When To Use EFT

Like CBT’s third wave therapies, EFT does not use logic to challenge irrational beliefs. EFT seeks to evoke rational, forgiving emotion schemes to counteract habitual, dysfunctional emotion schemes. The goal of EFT is to make emotion schemes fully accessible to awareness. The more intensely an emotion scheme is experienced, the more thoroughly it can be expressed and processed, and the more rapid and complete the transformation of dysfunctional emotion schemes.

EFT should be used only when the therapist and patient have a good alliance, when the patient’s GAF is 50 or above, when the patient is not actively abusing drugs or being impulsive, and when the patient expresses too little or too much emotion. EFT is indicated when patients are struggling to diminish symptoms rather than trying to manipulate the therapeutic relationship.