Emotion-focused Therapy - a summary of an article by Greenberg

Emotion-focused Therapy
Greenberg, L.S. (2004)
Clinical Psychology and Psychotherapy, 11, 3-16

Abstract

In an emotion-focused approach, emotion is seen as foundational in the construction of the self and is a key determinant of self-organisation. People have emotions and live in a constant process of making sense of emotions. Personal meaning is seen as emerging by the self-organization and explication of one’s own emotional experience. Optimal adaptation involves an integration of reason and emotion.

Therapists are emotion coaches who work to enhance emotion-focused coping by helping people become aware of, accept, and make sense of their emotional experience.
Emotion coaching is based on two phases, arriving and leaving.

Emotion in human functioning

A major premise of Emotion-focused therapy (EFT) is that emotion is foundational in the construction of the self and is a key determinant of self-organisation. Emotions are an adaptive form of information-processing and action readiness that orients people to their environment and promotes their well-being. Emotional intelligence involves honing the capacity to use emotions as a guide, without being a slave to them.

Emotions are important because they inform people that an important need, value, or goal may be advanced or harmed in a situation. They indicate how individuals appraise themselves and their worlds. Different action tendencies correspond to different emotions.

Emotion is a primary signalling system that communicates intentions and regulates interaction.

Emotion makes an integral contribution to information processing.

The amygdala forms emotional memories in response to particular sensations that have become associated with physical threats.

Affect infusion model holds that infusion of affect into cognition depends on the type of processing that is occurring. When processing is substantive in ambiguous, open situations, affect is most likely to influence the construction of beliefs. More controlled processing in explicit problem-solving situations is most impervious to affect infusion effects.

Cognition and memory are mood dependent.

Positive emotion improves problem solving by making thought processes more flexible, creative and efficient. It also builds resilience by undoing the effects of negative emotions. A tendency to low positive affect confers a vulnerability to depression. A stable positive affective affective  style builds psychological resilience. The ability to recruit positive emotions in the face of stress is a crucial component of resilience.

Negative emotions are often useful. They draw people’s attention to matters important to their well-being. When the unpleasant emotions endure even when the circumstances that evoked them have changed, or are so intense that they overwhelm , or evoke past loss or trauma they can become dysfunctional. Healthy adaption necessitates learning to be aware of, to tolerate, and to regulate negative emotionality as well as to enjoy positive emotionality.

A dialectical-constructivist view: integrating biology and culture

We live in a constant process of making sense of our emotions.

In a dialectical-constructivist view personal meaning emerges by the self-organization and explication of one’s own emotional experience. Optimal adaptation involves an integration of reason and emotion. This is achieved by an ongoing circular process of making sense of experience by symbolizing bodily-felt sensations in awareness and articulating them in language, thereby constructing new experience. The person is seen as an agent who is in a constant process of symbolizing bodily-felt referents to create new meaning, and who creates new experience by the ways in which bodily-felt experience is organized. Attending to, and discovery of, pre-conceptual elements of experience, influences the process of meaning construction while the process of meaning construction influences what is experienced. Two streams of experience and knowing are embodied experiential stream and a social, conceptual linguistic stream.

With development, emotional experience is produced by highly differentiated structures, that have been refined through experience and bound by culture into emotion schemes (organized response- and experience-producing units stored in memory networks). Much adult emotional experience is of this higher order. Feeling an emotion involves experiencing body changes in relation to, and integrated with the evoking object or situations and one’s past emotional learning. The feeling of emotion allows the formation of emotion network or schemes. Consciously feeling something involves higher levels of the brain. It entails a syntheses of emotion-cognition-motivation and action into internal organizations.

Emotions become maladaptive through learning and socialisation, and especially to failures early on in the dyadic regulation of affect.

Change in emotional experience is brought about in therapy first by activating the maladaptive experience and then by accessing adaptive feelings. The adaptive emotions are attended to and validated, and are used to vitalize a more resilient sense of self to help transform the person’s maladaptive affects and to explicitly challenge maladaptive beliefs. The new self-experience and views are integrated with the existing negative experience and views to consolidate a new self-organisation.

Therapy involves changing both emotional experience and the narratives in which they are embedded.

EFT views bottom-up processing as essential in changing automatic emotional responding. The bottom-up element of the process consists of people learning to observe and follow the unattended to or avoided sensory-motor reactions that are activated in the present.

Emotion coaching

Emotion coaching is aimed at enhancing emotion-focused coping by helping people become aware of, accept and make sense of their emotional experience. Coaching involves a mutually accountable relationship in which both client and therapist collaborate actively in the creation of an educational experience for the client who is an active participant in the process. It entails both acceptance and change.
The goals of emotion coaching are acceptance, utilization and transformation of emotional experience

This involves awareness and deepening of experience, processing of emotion and the generation of alternative emotional responses.

In emotion coaching a safe, emphatic and validating relationship is offered throughout to promote acceptance of emotional experience. An accepting, emphatic relational environment provides safety learning to greater openness and provides people with the new interpersonal experience of emotional soothing and support that over time becomes internalized. This type of environment reduces interpersonal anxiety and frees up clients’ processing capacities enabling them to pay attention to their bodily-felt experience. People sort out their feelings, develop self-empathy and gain access to alternate resilient responses based on their internal resources.

The therapist follows where the client is moment by moment and coaches the client in new ways of processing experiential information. Change and novelty can be introduced into the emotional domain by guiding people’s attention and meaning construction processes and by helping people to become aware of their emotional processes.

The first phase of arriving at one’s emotions involves four steps focused on awareness and acceptance of emotion 1) Help people become aware of their emotions 2) People need to be coached to welcome their emotional experience and allow it. And people need to be coached in skills of regulation if needed to help tolerate emotions 3) Help people to describe their feelings in words in order to aid them solving problems 4) Help people to become aware of whether their emotional reactions are their primary feelings in this situation.

The second phase focuses on emotion utilization or transformation 1) Once the person has been helped to experience a primary emotion, the coach and client together evaluate if the emotion is a healthy or unhealthy response to the current situation. If healthy it should be used as a guide to action,if unhealthy it needs to be changed 2) If the person’s assessed primary emotions are unhealthy, the person has to be helped to identify the negative voice associated with these emotions 3) The person is helped to find and rely on alternate healthy emotional responses and needs 4) People need to be coached to challenge the destructive thoughts, in their unhealthy emotions, from a new inner voiced based on their healthy primary emotions and needs, and to learn to regulate them necessary.

Following provides acceptance and leading introduces novelty and the possibility of change. This provides direction for the exploration by guiding the type of processing in which they engage. Each therapist response is viewed as a processing proposal that guides the type of emotion in which the client engages. The types of proposals used in emotion coaching are those that help people symbolize their internal experience and make sense of them.
Coaching in the emotional domain involves helping verbally label emotions being felt, helping people accept the emotion, talking with the client about what it is like to experience the emotion, facilitating new ways of processing the emotion, and teaching ways of soothing or regulating the emotion

Principles of working with emotion

Emotion assessment

It is important to make distinctions between different types of emotional experiences and expression that require different types of in-session intervention. 1) Primary and secondary emotions. Primary emotions are the person’s most fundamental direct initial reactions to a situation. Secondary emotions are those responses that are secondary to other more primary internal processes and may be defences against these 2) Emotional experience that is adaptive or maldapative. Adaptive emotions are accessed for their useful information. Maladaptive emotions are those old familiar feelings that occur repeatedly and do not change.

Distinctions between different types of emotion provide clinicians with a map for differential intervention with emotion. Primary emotions need to be assessed for their adaptive information and capacity  to organize action. Maladaptive emotions need to be regulated and transformed. Secondary maladaptive emotions need to be reduced by exploring them to access their more primary cognitive or emotional generators.

Emotion-focused work involves accessing primary adaptive emotions in order to symbolize their adaptive information and evoking maladaptive emotions in order to make them amenable to change by exposing them to new information and experience.

Goals of emotion-focused intervention

Emotion-focused therapy relies on three major principles for enhancing emotion-processing. These principles are embedded within an overarching framework that emphasizes emotional/social support as important in the promotion of change. Emotional/social support is the provision of a relationship characterized by attunement to affect, validation of experience and emphatic responsiveness. Outside therapy it involves encouraging the acquisition of interpersonal support characterized by listening, validating relationships as well as instrumental support.

Emotional support inside therapy is the foundation for the therapeutic effectiveness of the three emotion processing principles. Increasing awareness of emotion, enhancing emotion regulation and transforming emotion.

Emotion awareness

The goal of EFT treatment is for clients to become aware of their primary (adaptive) emotions. Increased emotional awareness is therapeutic because becoming aware of and symbolizing core emotional experience in words provides access to both the adaptive information and action tendency in the emotion and awareness helps people make sense of their experience and promotes assimilation of it into their ongoing self-narratives.

Acceptance of emotional experience as opposed to its avoidance is the first step in awareness work. Having accepted the emotion the therapist then helps the client in the utilization of emotion. Clients are helped to make sense of what their emotion is telling them and to identify the goal/need/concern that it is organizing them to attain.

Emotional awareness are physical sensations, action tendencies, single emotions, blends of emotions and blends of blends of emotional experience (the capacity to appreciate complexity in the experiences of self and other).

The dynamic interaction between phenomenal experience, establishing a representation of it, elaborating that representation and integrating it with other cognitive processes are the fundamental processes involved in the cognitive elaboration of emotion.

Greater emotional awareness is associated with greater self-reported impulse control. Individual differences in emotional awareness predict recovery of positive mood and decrements in ruminative thoughts following a distressing stimulus.

Awareness of emotion involves overcoming avoidance of emotional arousal and the promotion of emotional processing. Normal cognitive processes often distort or interrupt emotion and transform adaptive unpleasant emotions into dysfunctional behaviour designed to avoid feeling. To overcome emotion avoidance, clients must first be helped to approach emotion by attending to their emotional experience. Then clients must allow and tolerate being in live contact with their emotions. Optimum emotional processing involves the integration of cognition and affect. Once contact with emotional experience is achieved, clients must cognitively orient to that experience as information, and explore, reflect on, and make sense of it.

Emotional expression appears to be a therapeutic aspect of emotional processing.

Symbolizing emotion in awareness promotes reflection on experience to create new meaning and this helps people develop new narratives to explain their experience. Putting emotion into words allows previously un-symbolized experience in emotion memory to be assimilated into people’s conscious, conceptual understanding of self and world where it can be organized into a coherent story. Once emotions are in words they allow people to reflect on what they are feeling, create new meanings and evaluate their own emotional experience.

Emotion regulation

Emotions that require regulation generally are either secondary emotions or primary maladaptive emotions.

Emotion regulation skills involve identifying and labelling emotions, allowing and tolerating emotions, establishing a working distance, increasing positive emotions, reducing vulnerability to negative emotions, self-soothing, breathing and distraction

Emotion regulation involves not only the restraint of emotion, but at times its maintenance and enhancement.

Emotion transformation

Changing emotion with emotion suggests that a maladaptive emotional state can be transformed best by undoing it with another more adaptive emotion. In time the co-activation of the more adaptive emotion along with or in response to the maladaptive emotion helps transform the maladaptive emotion.

The right hemispheric, withdrawal-related, negative affect system might be able to be transformed by activation of the approach system in the left prefrontal cortex.

Bad feelings are able to be replaced by happy feelings by the evocation of meaningfully embodied alternate experience to undo the negative feeling.

The expression of even the muscular expressions of one emotion can change another emotion. The experience of an emotion to some degree can be induced or intensified by putting one’s body into its expression. There are individual differences in this capacity.

Emotional arousal, and the attendant replacement of emotion with emotion, occurs more in good than in poor outcome cases.

Emotional transformation often occurs by a process of dialectical synthesis of opposing schemes. When opposing schemes are co-activated they synthesize compatible elements from the co-activated schemes to form new higher level schemes.

Shift attention

Shifting people’s focus of attention to pay attention to a background or subdominant feeling is a key method of helping them change their states. The subdominant emotion is often present in the room non-verbally in tone of voice or manner of expression.

Access needs/goals

Raising a need or a goal to a conscious self-organizing system opens a problem space to search for a solution. At the affective level it conjures up a feeling of what it is like to reach the goal and opens up neural pathways both the feeling and the goal.

Positive imagery

Imagination is a means of bringing about an emotional response.

Expressive enactment of the emotion

Ask people to adopt certain emotional stances and help them deliberately assume the expressive posture of that feeling and then intensify it.

Remember another emotion

Remembering a situation in which an emotion occurred can bring the memory alive in the present.

Cognitively create a new meaning

Changing how one views a situation or talking about the meaning of an emotional episode often helps people experience new feelings.

The therapist expresses the emotion for the client

The therapist might express the emotion the client is unable to express

Utilizing the therapy relationship to generate new emotion

A new emotion is evoked in response to new interactions with the therapist