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Leslie S. Greenberg - One of the best experts on this subject based on the ideXlab platform.
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Neuroscience of Enduring Change - Emotion-Focused Therapy: Integrating Neuroscience and Practice
Neuroscience of Enduring Change, 2020Co-Authors: Antonio Pascual-leone, Leslie S. GreenbergAbstract:This chapter provides an overview of the theory and practice of Emotion-Focused Therapy (EFT), while giving special attention to the neuropsychological perspectives that help explain this approach to treatment. The authors elaborate how emotion theory is a fundamental part of the approach and discuss how this theory informs the treatment principles or ways of understanding emotional processing. They discuss how EFT focuses on accessing and utilizing adaptive emotions to promote transformation of maladaptive emotion structures and show how this promotes changing painful memories from the past by a process of memory reconsolidation. In addition, they refer to the outcome and process research of this approach and outline the principles of clinical practice.
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Where Are the Emotions? How Emotion-Focused Therapy Could Inspire Systemic Practice
Systemic Research in Individual Couple and Family Therapy and Counseling, 2020Co-Authors: Julika Zwack, Leslie S. GreenbergAbstract:The article explores theoretical premises as well as practical interventions of Emotion-Focused Therapy (EFT) and Systemic Therapy (ST). By outlining similarities as well as differences of both approaches, it is argued that EFT is both highly compatible and complementary to ST. Drawing on scientific evidence as well as case studies, implications for systemic practice are discussed.
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Emotion-Focused Therapy of depression
Person-Centered & Experiential Psychotherapies, 2017Co-Authors: Leslie S. GreenbergAbstract:ABSTRACTA review of Emotion-Focused Therapy (EFT) of depression including a discussion of its evidence base is provided. EFT aims within an affectively attuned empathic relationship to access and transform habitual maladaptive emotional schematic memories that are seen as the source of the depression. These memories often involve feelings of the shame of worthlessness, anxious insecurity and the sadness of abandonment. Through the therapeutic process, adaptive emotions are accessed to transform maladaptive emotions and to organize the person for adaptive responses. This process of changing emotion with emotion is aided by the use of specific therapeutic techniques that help stimulate arousal of emotion and its processing.
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Emotion-Focused Therapy for generalized anxiety disorder: An exploratory study.
Psychotherapy (Chicago Ill.), 2017Co-Authors: Ladislav Timulak, Daragh Keogh, James Mcelvaney, Elaine Martin, Peter Clare, Elena Chepukova, Leslie S. GreenbergAbstract:Among psychological therapies for generalized anxiety disorder (GAD), cognitive-behavioral Therapy has a dominant position as the most studied Therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive-behavioral Therapy models for GAD should be examined. The present study was an exploratory study, assessing pre-post outcomes and 6-month follow-up of Emotion-Focused Therapy for GAD, supplemented by qualitative postTherapy client accounts of helpful and unhelpful aspects of Therapy and changes reported since Therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre-post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing Emotion-Focused Therapy as a treatment for GAD in a randomized controlled trial. (PsycINFO Database Record
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Humanistic-experiential psychoTherapy in practice : Emotion-Focused Therapy
2016Co-Authors: Robert Elliott, Leslie S. GreenbergAbstract:In this chapter, we provide an overview of Emotion-Focused Therapy (EFT), a contemporary humanistic psychoTherapy that integrates person-centered, gestalt, and existential approaches. After sketching its history and main theoretical concepts, we outline a set of emotion change principles. These guide an emotional deepening process in which therapists help clients move from undifferentiated distress to secondary reactive emotions to primary maladaptive emotions to core pain and thence to primary adaptive emotions and emotional transformation. To do this, the therapist responds to key markers offered by clients, proposing appropriate therapeutic tasks such as unfolding problematic reaction points or two-chair work for internal conflicts. In addition, we briefly summarize the relevant outcome data, review the EFT case formulation process, lay out treatment principles, consider its application to diverse client populations, and provide a brief case example.
Ben Shahar - One of the best experts on this subject based on the ideXlab platform.
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New Developments in Emotion-Focused Therapy for Social Anxiety Disorder.
Journal of clinical medicine, 2020Co-Authors: Ben ShaharAbstract:Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral Therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-Focused Therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.
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Exploring the process of change in Emotion-Focused Therapy for social anxiety.
Psychotherapy research : journal of the Society for Psychotherapy Research, 2018Co-Authors: Ann Haberman, Ben Shahar, Eran Bar-kalifa, Sigal Zilcha-mano, Gary M. DiamondAbstract:Objective: This study examined purported change mechanisms in Emotion-Focused Therapy for social anxiety disorder. Methods: The sample included nine clients who had participated in a multiple-basel...
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The Development of the Working Alliance and Its Ability to Predict Outcome in Emotion-Focused Therapy for Social Anxiety Disorder.
The Journal of nervous and mental disease, 2018Co-Authors: Gilad Adler, Ben Shahar, Tohar Dolev, Sigal Zilcha-manoAbstract:The study focuses on the alliance of 12 patients receiving Emotion-Focused Therapy for social anxiety. Anxiety symptoms and patient perception of the working alliance were examined weekly. The first eight sessions of each patient were coded for within- and between-sessions alliance levels (1008 segments were coded). At the sample level, the alliance shows linear development over time but high variability between individuals. More than half the patients showed alliance development consistent with the rupture-resolution pattern. Without accounting for the temporal relationship between alliance and symptoms, alliance significantly predicted symptoms across treatment. When we accounted for the temporal relationship between alliance and symptoms, we found that symptoms can predict alliance but alliance cannot predict symptoms. We obtained the same findings using patient-rated and coded alliance.
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Emotion-Focused Therapy for social anxiety (EFT-SA)
Person-Centered & Experiential Psychotherapies, 2017Co-Authors: Robert Elliott, Ben ShaharAbstract:Social anxiety (SA) is a common, disabling difficulty characterized by persistent fear of other people. After a brief clinical description, we present an Emotion-Focused Therapy (EFT) theory of SA:...
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Emotion-Focused Therapy for social anxiety disorder: Results from a multiple-baseline study.
Journal of consulting and clinical psychology, 2017Co-Authors: Ben Shahar, Eran Bar-kalifa, Eve AlonAbstract:OBJECTIVE The purpose of the present study was to evaluate the efficacy of Emotion-Focused Therapy (EFT) for adults suffering from social anxiety disorder (SAD). METHOD Using a nonconcurrent multiple-baseline design, 12 patients (mean age = 26.75 years, SD = 5.15; 7 males) meeting criteria for SAD were treated with up to 28 sessions of EFT. EFT was based on an empathic relationship, 2-chair work for self-criticism, empty-chair work for unresolved feelings, and focusing. Patients were randomized to wait 4, 8, or 12 weeks between the intake and the first Therapy session. Intake assessment included the MINI International Neuropsychiatric Interview (MINI; Sheehan et al. 1998), the clinician-administered Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987), and various self-report questionnaires. The LSAS was also administered at the end of the baseline period and at posttreatment. The MINI was administered again at posttreatment. Self-reports were administered throughout the baseline, before each Therapy session, and at 6-month and 12-month follow-ups. RESULTS One patient dropped out prematurely. Of the 11 completers, 7 did not meet criteria for SAD at the end of treatment. Intent-to-treat analysis showed that LSAS scores did not change during baseline, significantly improved during treatment (Cohen's d = -2.37), and remained improved during follow-up. Mixed regression models showed that SAD symptoms and self-criticism did not change during baseline, significantly improved during treatment, and remained improved during follow-up. Self-reassurance improved significantly during the follow-up phase. CONCLUSION This study provides initial evidence supporting the efficacy of EFT for SAD. (PsycINFO Database Record
Sandra C. Paivio - One of the best experts on this subject based on the ideXlab platform.
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Emotional processing of trauma narratives is a predictor of outcome in Emotion-Focused Therapy for complex trauma.
Psychotherapy (Chicago Ill.), 2019Co-Authors: Ula Khayyat-abuaita, Sandra C. Paivio, Antonio Pascual-leone, Shawn J. HarringtonAbstract:This study tested a model of emotional processes over the course of Emotion-Focused Therapy for trauma. The model of emotional processing (Pascual-Leone & Greenberg, 2007) proposes a sequential order of shifting from "early expressions of distress" to "primary adaptive emotion" that aid in adaptive functioning. Thirty-eight participants were taken from a randomized clinical trial to examine in-session process from video recordings of treatment. The sample had an average age (M = 44.3 years) and the majority was female (55.3%) and of European descent (89.5%). The Classification of Affective Meaning States was used to examine changes in emotional processes during trauma narratives in both early and late sessions. Processes were related to treatment outcome as measured by the Impact of Event Scale and the Resolution Scale. Sessions later in treatment showed a higher frequency of primary adaptive emotions compared with early sessions (p < .001, r = .76). Primary adaptive emotions were also more frequent in good-outcome cases (p = .017). Using emotional processes as predictors correctly classified 67% of poor-outcome cases and 80% of good-outcome cases. Increases in primary adaptive emotions from early to late treatment sessions more than doubled the odds (2.2) of having a good treatment outcome. The order of emotion was concordant with the sequential model in early sessions and partially concordant in late sessions. Findings have implications for guiding therapeutic process in a productive manner that leads to trauma recovery. Changes in discrete emotions were related to good treatment outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Emotion-Focused Therapy for complex trauma
Person-Centered & Experiential Psychotherapies, 2017Co-Authors: Ashley E. Mlotek, Sandra C. PaivioAbstract:ABSTRACTThis article describes Emotion-Focused Therapy for complex trauma (EFTT). EFTT is an evidence-based, short-term treatment for childhood abuse and neglect that posits the therapeutic relationship and emotional processing of trauma material as key mechanisms of change. This paper outlines sources of disturbance and long-term effects of complex trauma. It reviews the theoretical framework on which EFTT is based, mechanisms of change and phases of treatment, as well as supporting research. Primary interventions are demonstrated using a case example from a published video of a single session.
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Narrative and emotion integration processes in Emotion-Focused Therapy for complex trauma: an exploratory process-outcome analysis
Person-Centered & Experiential Psychotherapies, 2016Co-Authors: Naomi Carpenter, Sandra C. Paivio, Lynne Angus, Emily BryntwickAbstract:ABSTRACTThe Narrative-Emotion Process Coding System (NEPCS) is a behavioral coding system that identifies eight client markers: Abstract Story, Empty Story, Unstoried Emotion, Inchoate Story, Same Old Story, Competing Plotlines Story, Unexpected Outcome Story, and Discovery Story. Each marker varies in the degree to which specific narrative and emotion process indicators are represented in one-minute time segments drawn from videotaped Therapy sessions. As enhanced integration of narrative and emotional expression has previously been associated with recovery from complex trauma, the purpose of the present pilot study was to examine the contribution of within session NEPCS markers to treatment outcomes for clients undergoing Emotion-Focused Therapy for Trauma (EFTT). The NEPCS was applied to two early, two middle, and two late videotaped Therapy sessions selected from two recovered and two unchanged complex trauma EFTT clients. Exploratory statistical analyses established that unchanged clients expressed s...
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Essential processes in Emotion-Focused Therapy.
Psychotherapy (Chicago Ill.), 2013Co-Authors: Sandra C. PaivioAbstract:Emotion-Focused Therapy is an evidence-based approach grounded in current experiential Therapy theory and research which, in turn, draws on emotion theory and research. Fundamental assumptions are that (1) emotions are associated with a multimodal network of information, (2) accessing emotion in Therapy accesses this information, and (3) attention to, and exploration of, subjective internal experience (feelings and meanings) is the primary source of new information used in construction of new meaning. The two primary mechanisms of change are thought to be the therapeutic relationship and emotional processing of problematic material. Emotional change processes include awareness, regulation, reflection, and transformation of emotion. Four intervention principles that are essential to every session are as follows: (1) collaborating on a focus for the session, (2) empathically responding to client struggles and pain, (3) responding to the emergence of adaptive emotion and associated healthy resources, and (4) promoting client experiencing (i.e., attention to, and exploration of, feelings and meanings). These in-session intervention principles are consistent with posited change process.
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Characteristics of client-identified helpful events in Emotion-Focused Therapy for child abuse trauma
Psychotherapy research : journal of the Society for Psychotherapy Research, 2011Co-Authors: Karen A. M. Holowaty, Sandra C. PaivioAbstract:This study investigated the characteristics of client-identified helpful events (n=29) in Emotion-Focused Therapy for child abuse trauma (EFTT). Helpful events (HE) were identified on the Helpful Aspects of Therapy Questionnaire and in Post Therapy Interviews, located in video-taped Therapy sessions, and compared to researcher-defined control events (CE) for each client. Results indicated a greater focus on childhood abuse (particularly during the imaginal confrontation procedure), higher levels of emotional arousal, and comparable alliance quality in HE compared to CE. HE contained deeper levels of experiencing compared to CE, but only for clients who achieved the greatest depth of experiencing. Client perspectives converged with theory and research on change processes in EFTT and have implications for practice and training.
Robert Elliott - One of the best experts on this subject based on the ideXlab platform.
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Relational dialogue in Emotion-Focused Therapy.
Journal of clinical psychology, 2020Co-Authors: Robert Elliott, James MacdonaldAbstract:OBJECTIVES In Emotion-Focused Therapy (EFT) relational processes between the therapist and client are not normally an explicit focus unless the therapist and client encounter difficulties that interfere with therapeutic work. When this does happen, however, relational dialogue (including meta-communication) becomes necessary. We present the principles and stages of the EFT task Relational Dialogue for Alliance Difficulties. METHODS AND RESULTS After describing this little-known task, we illustrate its application in the successful treatment of a severely socially anxious female client with complex trauma and emotional fragility. Using transcripts and detailed descriptions we highlight the alliance difficulty marker subtype, relational dialogue principles and the stages of EFT alliance difficulty work.
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Ethical Considerations in Emotion-Focused Therapy
The Oxford Handbook of Psychotherapy Ethics, 2019Co-Authors: Ueli Kramer, Robert ElliottAbstract:This chapter discusses ethical principles underlying Emotion-Focused Therapy (EFT). It shows that the six intervention principles of EFT—empathic attunement, therapeutic bond, task collaboration, differential emotional processing, emotional deepening through work on therapeutic tasks, and self-development—are grounded in the more basic ethical requirements of psychoTherapy and counseling, in particular beneficence and non-maleficence. There is an overall tension in EFT between providing a productive therapeutic relationship and task facilitation. As examples, this chapter discusses three specific key ethical dilemmas of EFT: (a) necessary emotion arousal versus risks on the path to core pain, (b) transient emotional dysregulation versus protection of the self, and (c) freedom to choose versus process-guiding or control. It illustrates with clinical examples, and discusses research implications.
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Emotion-Focused Therapy for clients with autistic process
Person-Centered & Experiential Psychotherapies, 2017Co-Authors: Anna Robinson, Robert ElliottAbstract:ABSTRACTThe person-centered approach has paid little attention to persons with autistic process, in spite of their often experiencing high levels of psychological distress. We present the main arguments for a group Therapy adaptation of Emotion-Focused Therapy for people on the autistic spectrum (EFT-AS). The principles of this approach are described here. A novel form of interpersonal process recall as a process guiding method is presented. The primary change processes include improving access to and symbolizing one’s own and others’ painful emotional experiences. EFT-AS uses video playback of social–emotional interpersonal reciprocity difficulty task markers to help clients activate, deepen and transform emotions via accessing core pain and associated unmet needs, which in turn point to adaptive emotions such as compassion for self and others. The beginning, middle and ending phases of treatment, showing shifts in client emotion processing, are presented with illustrative session transcripts. EFT-AS app...
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Emotion-Focused Therapy for social anxiety (EFT-SA)
Person-Centered & Experiential Psychotherapies, 2017Co-Authors: Robert Elliott, Ben ShaharAbstract:Social anxiety (SA) is a common, disabling difficulty characterized by persistent fear of other people. After a brief clinical description, we present an Emotion-Focused Therapy (EFT) theory of SA:...
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Humanistic-experiential psychoTherapy in practice : Emotion-Focused Therapy
2016Co-Authors: Robert Elliott, Leslie S. GreenbergAbstract:In this chapter, we provide an overview of Emotion-Focused Therapy (EFT), a contemporary humanistic psychoTherapy that integrates person-centered, gestalt, and existential approaches. After sketching its history and main theoretical concepts, we outline a set of emotion change principles. These guide an emotional deepening process in which therapists help clients move from undifferentiated distress to secondary reactive emotions to primary maladaptive emotions to core pain and thence to primary adaptive emotions and emotional transformation. To do this, the therapist responds to key markers offered by clients, proposing appropriate therapeutic tasks such as unfolding problematic reaction points or two-chair work for internal conflicts. In addition, we briefly summarize the relevant outcome data, review the EFT case formulation process, lay out treatment principles, consider its application to diverse client populations, and provide a brief case example.
Ladislav Timulak - One of the best experts on this subject based on the ideXlab platform.
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Emotion-Focused Therapy for Anxiety and Depression in Women with Breast Cancer
Journal of Contemporary Psychotherapy, 2020Co-Authors: Allison Connolly-zubot, Ladislav Timulak, Natalie Hession, Niamh ColemanAbstract:Emerging evidence supports the efficacy of transdiagnostic approaches in the treatment of comorbid conditions. Given that both depression and anxiety disorders have been consistently noted as the most common psychological presentation across site and stage of illness in patients with cancer, psycho-oncology as a specialty may benefit from approaches that implement transdiagnostic approaches to treatment. This paper presents an adaptation of Emotion-Focused Therapy for comorbid anxiety and depression in women with breast cancer. The described approach outlines how the chronic problematic emotion schemes are triggered by the experience of cancer and its medical treatment as well as transformation of those schemes through a sequence of steps. A process of change occurs through overcoming emotional avoidance and demoralization, increasing distress tolerance, differentiation of core painful feelings, articulation of unmet needs; and generation of adaptive emotions such as boundary setting anger and self-compassion. Implications for practice in a cancer context are discussed in terms of case conceptualisation and therapeutic strategy. Further investment in the clinical development and research of Emotion-Focused Therapy in psycho-oncology may prove informative and supportive in efforts to widen the evidence base and the choice of clinical treatment available to patients with cancer and comorbid anxiety and depressive disorders.
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Learning Emotion-Focused Therapy: Certified Emotion-Focused therapists' perspectives.
Person-Centered & Experiential Psychotherapies, 2020Co-Authors: Suyi Qiu, Daragh Keogh, Barbara Hannigan, Ladislav TimulakAbstract:Emotion-Focused Therapy (EFT) is an increasingly popular form of humanistic Therapy that is spreading internationally through standard training curricula. The empirical investigations of training i...
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Emotion-Focused Therapy: A Transdiagnostic Formulation
Journal of Contemporary Psychotherapy, 2019Co-Authors: Ladislav Timulak, Daragh KeoghAbstract:Recent years have seen the emergence of transdiagnostic psychotherapeutic treatments, typically targeting depression, anxiety and related disorders. The rationale for developing transdiagnostic protocols is based on a number of factors; shared etiology and maintenance mechanisms, high co-morbidity, hypothesising that discrete disorders may be underpinned by common psychological vulnerabilities, and the burden currently placed on clinicians to master multiple disorder-specific interventions. This paper describes a transdiagnostic model of Emotion-Focused Therapy (EFT-T), which combines modular (targeting specific clusters of symptoms) and shared mechanisms (targeting underlying vulnerability) approaches to the treatment of depression, anxiety and related disorders such as obsessive–compulsive and trauma/stressor related disorders. The model proposes that clients’ core vulnerabilities are linked to specific chronic painful feelings, and that these chronic feelings are constellations of sadness/loneliness, shame, and fear-based emotions, idiosyncratically shaped by personal history. The paper describes how EFT-T addresses problematic symptoms but primarily focuses on transforming emotion vulnerability, or Core Pain, by activating adaptive emotional responses, such as compassion and protective anger, to embedded unmet needs. As all hitherto presented transdiagnostic protocols have emanated from within the cognitive behavioural paradigm, the aim of the described model is to increase the choice of evidence-based transdiagnostic interventions available to clinicians and clients.
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Emotion-Focused Therapy for generalized anxiety disorder: An exploratory study.
Psychotherapy (Chicago Ill.), 2017Co-Authors: Ladislav Timulak, Daragh Keogh, James Mcelvaney, Elaine Martin, Peter Clare, Elena Chepukova, Leslie S. GreenbergAbstract:Among psychological therapies for generalized anxiety disorder (GAD), cognitive-behavioral Therapy has a dominant position as the most studied Therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive-behavioral Therapy models for GAD should be examined. The present study was an exploratory study, assessing pre-post outcomes and 6-month follow-up of Emotion-Focused Therapy for GAD, supplemented by qualitative postTherapy client accounts of helpful and unhelpful aspects of Therapy and changes reported since Therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre-post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing Emotion-Focused Therapy as a treatment for GAD in a randomized controlled trial. (PsycINFO Database Record
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Developing a model of working with worry in emotion‐focused Therapy: A discovery‐phase task analytic study
Counselling and Psychotherapy Research, 2016Co-Authors: Jennifer Murphy, Ladislav Timulak, Lucy Rowell, Anne Mcquaid, Rosie O'flynn, James McelvaneyAbstract:Background Generalised anxiety disorder (GAD) is an anxiety disorder characterised by excessive anxiety and worry. Worry is seen as a key-defining feature of GAD. Several cognitive-behavioural models of working with worry in GAD exist. More recently, there have been efforts to adapt Emotion-Focused Therapy (EFT) for GAD. This study focused on task analysis, observing therapist and client processes (using qualitative observations as well as observer-used measures) in the clinically developed, two-chair dialogue for worry (an intervention inspired by a similar EFT task of working with self-criticism in depression). Method A task analysis methodological approach was applied to 34 worry dialogues from eight clients. The worry dialogues were qualitatively analysed, focusing on therapist and client processes in the task and also using observer-based measures such as Classification of Affective-Meaning States, Client Emotion Arousal Scale and Client Emotion Productivity Scale. Results A tentative model of worry transformation using the two-chair dialogue for worry is presented. The model consists of marker identification, enactment of the worry, deepening the toll of the worry, articulation of the need towards the worry and the worry softening or the client's standing up to the worry. The results also focus on the progression in the dialogues across the series of dialogues. Implications The model has an immediate practical application as it can inform therapists' actions when working with worry processes in GAD clients. Implications for future research are also discussed.