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 Clinical Handbook of
Emotion-Focused Therapy

Clinical Handbook of Emotion-Focused Therapy, edited by L. S. Greenberg and R.

N. Goldman
Copyright © 2019 American Psychological Association. All rights reserved.
 Clinical Handbook of
Emotion-Focused Therapy
Edited by
Leslie S. Greenberg and Rhonda N. Goldman
Copyright © 2019 by the American Psychological Association. All rights reserved. Except
as permitted under the United States Copyright Act of 1976, no part of this publication may
be reproduced or distributed in any form or by any means, including, but not limited to, the
process of scanning and digitization, or stored in a database or retrieval system, without the
prior written permission of the publisher.

The opinions and statements published are the responsibility of the authors, and such
opinions and statements do not necessarily represent the policies of the American
Psychological Association.

Published by APA Order Department

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Library of Congress Cataloging-in-Publication Data

Names: Greenberg, Leslie S., editor. | Goldman, Rhonda N., editor. | American
Psychological Association, issuing body.
Title: Clinical handbook of emotion-focused therapy / edited by Leslie S. Greenberg
and Rhonda N. Goldman.
Description: First edition. | Washington, DC : American Psychological Association,
[2019] | Includes bibliographical references and index.
Identifiers: LCCN 2018015936 (print) | LCCN 2018017005 (ebook) |
ISBN 9781433829802 (eBook) | ISBN 1433829800 (eBook) |
ISBN 9781433829772 (hardcover) | ISBN 1433829770 (hardcover)
Subjects: | MESH: Emotion-Focused Therapy—methods | Mental Disorders—therapy
Classification: LCC RC489.F62 (ebook) | LCC RC489.F62 (print) | NLM WM 420.5.E3 |
DDC 616.89/14—dc23
LC record available at https://lccn.loc.gov/2018015936

British Library Cataloguing-in-Publication Data

A CIP record is available from the British Library.

Printed in the United States of America

First Edition

http://dx.doi.org/10.1037/0000112-000

10 9 8 7 6 5 4 3 2 1
 CONTENTS

Contributors................................................................................................... ix
Preface............................................................................................................ xi

I. Introduction to Emotion-Focused Therapy............................................ 1

Chapter 1. History and Overview of Emotion-Focused Therapy........ 3
Rhonda N. Goldman
Chapter 2. Theory of Functioning in Emotion-Focused Therapy..... 37
Leslie S. Greenberg
Chapter 3. Theory of Practice of Emotion-Focused Therapy............ 61
Leslie S. Greenberg and Rhonda N. Goldman

II. Integrating Research and Practice in Emotion-Focused Therapy...... 91

Chapter 4. Clinical Implications of Research
on Emotion-Focused Therapy.......................................... 93
Ladislav Timulak, Shigeru Iwakabe, and Robert Elliott

v
Chapter 5. Role of the Therapeutic Relationship
in Emotion-Focused Therapy......................................... 111
Jeanne Watson
Chapter 6. Therapeutic Presence: The Foundation
for Effective Emotion-Focused Therapy......................... 129
Shari M. Geller
Chapter 7. How Clients “Change Emotion With Emotion”:
Sequences in Emotional Processing
and Their Clinical Implications..................................... 147
Antonio Pascual-Leone and Ueli Kramer
Chapter 8. Relating Process to Outcome
in Emotion-Focused Therapy......................................... 171
Alberta E. Pos and Bryan H. Choi
Chapter 9. Facilitating Optimal Emotional Processing................... 193
Imke R. Herrmann and Lars Auszra
Chapter 10. Task Analyses of Emotional Change.............................. 217
Jason M. Sharbanee, Rhonda N. Goldman, and
Leslie S. Greenberg
Chapter 11. Narrative Change Processes and Client Treatment
Outcomes in Emotion-Focused Therapy....................... 243
Lynne Angus, Tali Boritz, Inês Mendes, and
Miguel M. Gonçalves
Chapter 12. Emotion Coaching in Action: Experiential Teaching,
Homework, and Consolidating Change........................ 261
Serine H. Warwar and Jennifer Ellison

III. Clinical Practice of Emotion-Focused Therapy

With Specific Client Populations.................................................... 291
Chapter 13. Emotion-Focused Therapy for Depression..................... 293
João Salgado, Carla Cunha, and Marina Monteiro
Chapter 14. Emotion-Focused Therapy for Generalized
Anxiety Disorder............................................................ 315
Jeanne Watson, Ladislav Timulak, and
Leslie S. Greenberg

vi       contents
Chapter 15. Emotion-Focused Therapy for Social Anxiety............... 337
Robert Elliott and Ben Shahar
Chapter 16. Emotion-Focused Therapy for Complex
Interpersonal Trauma..................................................... 361
Ula Khayyat-Abuaita and Sandra Paivio
Chapter 17. Emotion-Focused Therapy for Personality Disorders..... 381
Alberta E. Pos and Danielle A. Paolone
Chapter 18. Emotion-Focused Family Therapy
for Eating Disorders........................................................ 403
Joanne Dolhanty and Adele Lafrance
Chapter 19. Integrating Feminist-Multicultural Perspectives
Into Emotion-Focused Therapy..................................... 425
Heidi M. Levitt, William J. Whelton, and
Shigeru Iwakabe

IV. Emotion-Focused Therapy for Couples.......................................... 445

Chapter 20. Emotion-Focused Therapy for Couples.......................... 447
Catalina Woldarsky Meneses and
Jacqueline M. McKinnon
Chapter 21. Integrating Individual Tasks Into
Emotion-Focused Therapy for Couples.......................... 471
Charles Edwards and Jamie Levin-Edwards
Chapter 22. Mastering the Interventions of Emotion-Focused
Therapy for Couples....................................................... 493
Brent Bradley

V. Conclusions........................................................................................ 511
Chapter 23. Enduring Themes and Future Developments
in Emotion-Focused Therapy......................................... 513
Rhonda N. Goldman and Leslie S. Greenberg
Index.......................................................................................................... 521
About the Editors...................................................................................... 533

contents      vii
 contributors

Lynne Angus, PhD, York University, Toronto, Ontario, Canada

Lars Auszra, Dr. phil., German Institute for Emotion Focused Therapy,
Munich, Germany
Tali Boritz, PhD, Centre for Addiction and Mental Health, Toronto, Ontario,
Canada
Brent Bradley, PhD, The Couple Zone, Houston, TX
Bryan H. Choi, MA, York University, Toronto, Ontario, Canada
Carla Cunha, PhD, ISMAI—University Institute of Maia, Porto, Portugal
Joanne Dolhanty, PhD, EFT Clinic at York University, Toronto, Ontario,
Canada
Charles Edwards, PhD, Edwards Psychotherapy, Portland, OR
Robert Elliott, PhD, University of Strathclyde, Glasgow, Scotland
Jennifer Ellison, MA, Private Practice, Toronto, Ontario, Canada
Shari M. Geller, CPsych, PhD, Centre for MindBody Health, York University,
Toronto, Ontario, Canada
Rhonda N. Goldman, PhD, Illinois School of Professional Psychology–
Argosy University, Schaumburg, and The Family Institute at North-
western University, Evanston, IL

ix
Miguel M. Gonçalves, PhD, University of Minho, Braga, Portugal
Leslie S. Greenberg, PhD, York University, Toronto, Ontario, Canada
Imke R. Herrmann, Dr. phil., German Institute for Emotion-Focused Therapy,
Munich, Germany
Shigeru Iwakabe, PhD, Ochanomizu University, Tokyo, Japan
Ula Khayyat-Abuaita, CPsych, PhD, Correctional Service of Canada,
Ottawa, Ontario
Ueli Kramer, PhD, University of Lausanne, Lausanne, Switzerland
Adele Lafrance, PhD, Laurentian University, Sudbury, Ontario, Canada
Jamie Levin-Edwards, PsyD, Edwards Psychotherapy, Portland, OR
Heidi M. Levitt, PhD, University of Massachusetts Boston
Jacqueline M. McKinnon, PhD, Private Practice, London, Ontario, Canada
Inês Mendes, PhD, Royal Holloway, University of London, Egham, United
Kingdom
Catalina Woldarsky Meneses, PhD, Private Practice, Geneva, Switzerland
Marina Monteiro, MS, ISMAI—University Institute of Maia, Porto, Portugal
Sandra Paivio, CPsych, PhD, University of Windsor, Windsor, Ontario,
Canada
Danielle A. Paolone, BA, Centre for Addiction and Mental Health, Toronto,
Ontario, Canada
Antonio Pascual-Leone, PhD, University of Windsor, Windsor, Ontario,
Canada
Alberta E. Pos, PhD, York University, Toronto, Ontario, Canada
João Salgado, PhD, ISMAI—University Institute of Maia, Porto, Portugal
Ben Shahar, PhD, Hebrew University of Jerusalem, Jerusalem, Israel
Jason M. Sharbanee, PhD, Edith Cowan University, Joondalup, Western
Australia
Ladislav Timulak, PhD, Trinity College, Dublin, Ireland
Serine H. Warwar, PhD, Private Practice, Toronto, Ontario, Canada
Jeanne Watson, PhD, University of Toronto, Ontario, Canada
William J. Whelton, PhD, University of Alberta, Edmonton, Alberta, Canada

x       contributors
 Preface

Emotion-focused therapy (EFT) aims to help clients enhance their

emotional processing, which we define as approaching, accepting, tolerating,
symbolizing, making narrative sense of, and utilizing or transforming emo-
tions. This increases people’s ability to respond adaptively to situations as they
arise. EFT helps people face previously disclaimed, painful emotions; reflect on
them to create meaning; use them to inform adaptive action; and transform
those that are maladaptive. Developing this type of emotional competence
(Greenberg, 2015) then involves the ability to (a) experience emotions and
symbolize them in awareness, (b) tolerate and regulate dysregulated emotions,
(c) transform maladaptive emotions, and (d) develop positive identity and
relationship narratives on the basis of new emotions. Emotional competence
thus is seen as the ability to use adaptive emotional responses to guide a process
of becoming, and to transform emotions that have become maladaptive, to redirect
this process. This enhances people’s capacity to deal with problems in living
and promotes harmony within and among people.
The therapeutic relationship is the cornerstone of EFT, serving as an
essential reference point throughout the treatment and providing the stability
and structure for clients to grow and change. Growing out of the client-centered
and experiential traditions that emphasize the importance of the therapeutic

xi
attitudes of acceptance, prizing, congruence, and empathy, EFT similarly stresses
the importance of therapists’ attitudes toward their clients. Emotion-focused
psychotherapists are accepting of and empathically attuned to their clients’
inner worlds to facilitate changes in clients’ emotion schemes and emotional
processing as well as their relationship with self and others.
This volume provides a comprehensive review of the most current,
research-informed work on EFT in both individual and couple therapy. We
see this approach as highly comprehensive and relevant to a broad array of
clinical populations. The approach is the premier therapy model for address-
ing emotion at a deep, experiential level that is not psychoanalytic, nor cog-
nitive behavioral in orientation, although we believe that it can contribute
to these approaches. The chapters in the book provide systematic coverage
of theory, research, and practice of an emotion-focused perspective that has
emerged from the work of Greenberg and collaborators emphasizing emotion
as the fundamental datum of human experience.
This is a clinical handbook and as such, the focus is on clinical practice.
The contributors were all asked to emphasize clinical applications of their
work. Researchers and clinicians alike were asked to make their chapters
research informed and as clinically relevant as possible. The EFT authors
in this handbook are all both researchers and skilled clinicians, a neces-
sary aspect of doing meaningful research on how people actually change in
therapy. The chapters by these clinician researchers, therefore, are all highly
clinically focused. The chapters in the book follow a trajectory from the
developing theory, to current hypothesis testing, to practice.
The aim with this collection is to reach both professionals in the field
who are somewhat knowledgeable about EFT as well as established therapists
who are looking to learn about this approach. Advanced graduate students
looking to incorporate working with emotion into their approach will also
benefit. The goal of this book is to promote the emotion revolution, which
is rapidly gaining momentum.

EVOLUTION OF THE THERAPY APPROACH

Initially, Greenberg and colleagues called the individual therapy process

experiential therapy (Greenberg, Rice, & Elliott, 1993; Rice & Greenberg,
1984), while Greenberg and Johnson (1986, 1988) called the couple’s treat-
ment emotionally focused couple therapy. There was a seamless transition
between the name process experiential and emotion-focused therapy in the indi-
vidual model. In the couples model, however, although there are a lot of simi­
larities in an emotion-focused and an attachment-based, emotionally focused
approach to couples, the approaches have taken slightly different paths. As

xii       preface

was originally conceptualized (Greenberg & Johnson, 1988), couples func-
tioning is seen as organized around both attachment and influence; however,
over time, Johnson dropped this differentiation, focusing solely on attach-
ment and increasingly viewing couple’s functioning primarily through the
lens of attachment theory (Johnson, 2004). Greenberg (2002), on the other
hand, stayed with emotion as the primary focus from the original version of
the emotionally focused approach to couples. All the individual and couple
work was then integrated under the name emotion-focused therapy (Greenberg,
2002) to accord with the term emotion-focused used more generally in the
psychology literature. Greenberg and Goldman (2008) presented an updated
view of EFT for couples (EFT-C) in which they viewed affect regulation as
the central force that organizes couples’ dynamics. The aim was to produce
an integrated volume with both approaches, but this effort did not succeed
because of Johnson’s desire to maintain the separate identity of emotionally
focused couple therapy. EFT for couples, grounded as it is in affective neuro-
science and empirical studies of how people change in therapy, is covered in
this volume.

HOW THIS BOOK IS ORGANIZED

This volume is organized into five parts. Part I offers an introduction by

the volume editors, with Chapter 1 covering the history and development of
EFT theory and research in further detail. It covers the development of EFT
from its origins in the 1980s through the present. Chapter 2 then elaborates
EFT’s theory of emotion and its dialectical constructivist theory of function-
ing. Chapter 3 presents the theory of EFT practice and describes the four
compasses that guide it.
Part II follows the theme of integrating research and practice in EFT. In
Chapter 4, Timulak, Iwakabe, and Elliott present a summary of quantitative,
qualitative, and case study research on EFT to illuminate the evidence base of
the approach and discuss the clinical implications of the research. Chapters 5
and 6 present the relationship foundations of the approach based predomi-
nantly on empathy (Watson) and therapeutic presence (Geller). These are
the cornerstones of EFT practice. The next three chapters focus on clinical
applications of the process research done over the last decades. Chapter 7
by Pascual-Leone and Kramer provides an empirically based model of the
sequence of emotions in therapeutic change. In Chapter 8, Pos and Choi look
at research relating process to outcome with an emphasis on depth of experi-
encing in EFT. Herrmann and Auszra, in Chapter 9, define and give examples
of productive emotional processing. In Chapter 10, Sharbanee, Goldman,
and Greenberg review task analyses of emotional change, some of which

preface      xiii
are published here for the first time. In Chapter 11, Angus, Boritz, Mendes,
and Gonçalves focus on the relationship between narrative change processes
and treatment outcome. Part II ends with Chapter 12 in which Warwar and
Ellison discuss the role and process of experiential teaching in EFT with a
focus on homework.
Part III focuses on EFT with specific client populations. In Chapter 13,
Salgado, Cunha, and Monteiro review EFT of depression, including their
recent randomized clinical trial comparing the effects of EFT and cognitive–
behavioral therapy on depression. In Chapter 14, Watson, Timulak, and
Greenberg present their recently published manualized approaches to EFT for
generalized anxiety disorder. Elliott and Shahar then cover in Chapter 15 EFT
for social anxiety coming from both their research programs. Following in
Chapter 16 by Khayyat-Abuaita and Paivio is EFT for complex inter-
personal trauma. In Chapter 17, Pos and Paolone present an EFT approach
to the treatment of personality disorders and emotion dysregulation. In
Chapter 18, Dolhanty and Lafrance present their novel approach to emo-
tion-focused family therapy for eating disorders. Part III ends with a focus
on cultural populations rather than populations with a disorder. In Chapter
19, Levitt, Whelton, and Iwakabe discuss integrating feminist-multicultural
perspectives into EFT.
In Part IV, the focus is on EFT for couples. In Chapter 20, Woldarsky
Meneses and McKinnon present the updated theory and practice of emotion-
focused couple therapy, whereas in Chapter 21, Edwards and Levin-Edwards
present strategies for integrating individual tasks into EFT for couples. Part IV
ends with Chapter 22, in which Bradley presents a detailed description of
specific interventions that can be used with couples.
The editors provide in Part V a review of the themes that emerged from
the chapters and offer some future perspectives.
In many of the chapters the authors provide examples from clinical
cases as a way of illustrating how EFT works in practice. To protect the confi­
dentiality of therapy clients, authors have disguised names and other details,
or used composites with details drawn from multiple cases. The contributors
hope readers will take away clinically useful suggestions that span setting up
therapeutic relationships and facilitating productive emotional processing and
will apply these to specific populations and different disorders. The hope is that
this volume will help readers see the important role of emotion in therapeutic
change and understand how to work effectively with clients who have too little
emotion of the right kind and those who have too much emotion of the wrong
kind. If you are already trained in EFT, hopefully this handbook adds a more
differentiated understanding on how to work with emotion. If you are new to
this approach, hopefully it will encourage you to pursue further EFT training so
that you can help your clients engage in deeper emotional work.

xiv       preface

 I
Introduction to
Emotion-Focused
Therapy
many involved in the development of process-experiential therapy, includ-
ing Jeanne Watson, Rhonda Goldman, Sandra Paivio, as well as those deeply
involved with the World Association movement (i.e., Germain Lietaer, Art
Bohart, Mia Leissjen), led to a reexamining of the core principles from which
the therapy had emerged. The conclusion was that the therapy was directive
in process (or “process guiding”) but not directive in content. This meant,
for instance, that therapists maintained an empathic attitude at all times but
were selectively responding on a moment-by-moment basis to core aspects
of what clients were understood to be communicating. Empathy was seen as
both an attitude and a technique, and empathic responding was understood
as a multidimensional process (Bohart & Greenberg, 1997; Greenberg &
Goldman, 1988; Rice, 1974). Different forms of empathic responding were
defined (Goldman, 1991; Watson, Goldman, & Vanaerschot, 1998). In terms
of training, this meant therapists could specify how and what to listen for
in the client’s communication. Similarly, the therapy was understood to be
marker driven. Markers were verbal and nonverbal in-session indicators that
therapists could respond to with invitations to engage in different types of
tasks designed to facilitate certain types of emotional processing. This initial
framework and focus on specification organized much of the thinking going
forward, and although debate continued within the World Association,
process-experiential therapy, later known as EFT, settled and became com-
fortable with these theoretical developments, descriptions, and distinctions.

EMPIRICAL VALIDATION

As mentioned earlier, having been instrumental in the promotion of the

events paradigm, Greenberg and Rice were at heart process researchers who
had devoted much academic energy to the endeavor. In the early 1990s, how-
ever, the field of psychotherapy research was moving rapidly in the direction
of empirically supported treatments. There was, at the same time, a strong
appreciation that conducting randomized, controlled treatment trials using
standardized treatment outcome measures had the potential to demonstrate
the power of the therapy that they were creating. The generation of data from
the psychotherapy studies also promised to allow further study of key client
process variables in relation to both session and final outcomes. It was in
this vein that in 1992, Greenberg and Rice received a National Institute of
Mental Health grant in support of a randomized, controlled trial comparing
brief client-centered and brief process-experiential therapy (16–20 weeks)
for depression.
When completed, results of the comparative study showed that both
client-centered and process-experiential therapy were effective treatments

14       rhonda n. goldman

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