Emotion-Focused Counselling in Action

Robert Elliott, Leslie Greenberg

• Publisher: SAGE Publications Ltd
• Year: 2021
• ISBN:
  9781529737806
• Edition: 1
• Topic: Psychologie
• Subtopic: Santé mentale en psychologie

This is the definitive introduction to the theory and practice of emotion-focused counselling. Starting with an introduction to the main theory and concepts, it then guides you through the counselling phases from beginning to end. The final chapter extends your learning by examining different client populations, process research, and ways of monitoring your practice.

Chapters include features such as case studies and transcripts, further reading sections and reflective exercises that help you to enhance your understanding of the approach.

1 Emotion-Focused Counselling and the Person-Centred-Experiential Approach

Chapter Outline

• Introducing Emotion-Focused Counselling
• What is Emotion-Focused Counselling?
• The Evolution of Emotion-Focused Counselling
• Practising Emotion-Focused Counselling: Pre-flight Checklist
• Emotion-Focused Counselling Practice Principles
• Common Concerns Raised about Emotion-Focused Counselling
• The Evidence on the Effectiveness of the Approach
• Suggestions for Helping with the Process of Learning
• Introducing Our Two Case Examples
• Further Exploration

Introducing Emotion-Focused Counselling

Robert’s new client is sitting nervously in the waiting room when he goes out to meet her at the beginning of their first session. ‘Bethany?’ he says, tentatively. She rises; they shake hands, exchange greetings, and he ushers her into the therapy room, letting her pick which of the three chairs she wants to sit in. She sits down a bit awkwardly, wrapping herself into a kind of human pretzel by twisting her arms and legs over each other. Robert is struck by her body position, feeling it as a kind of expression of her fear of others, and finds himself resonating with a sense of her fearful uncertainty about what will happen in the work they are about to start. He deliberately fusses a bit with the recording equipment and papers to give her a bit of space.

Bethany: Where are you from?

Robert (realizing that she is trying to take the focus off herself, he smiles to himself): So you want to know a bit about me. From my accent you’ll be able to tell that I’m American, but I’ve been in Scotland for 10 years. (He sits down, turns on the recorder.) I’ve been doing counselling for a while, but that doesn’t stop me from being a bit nervous when I start with a new person. I wonder what you’re experiencing, right now, as we start counselling?

Bethany (hesitantly): Er… kind of, er, apprehensive?

This gives them a starting point, and they go into a small Focusing task by asking her a series of exploratory questions that help her explore where and how in her body she feels this ‘apprehensive’ (a tightness in her upper chest and throat), what it’s about (meeting new people), what word or image might capture this feeling (‘a bomb’), and what it is telling her (‘to leave’: the room or the subject of how she feels). After this, he offers a brief piece of experiential teaching, explaining that fear and anxiety are part of our evolutionary heritage, and are useful for warning us about dangers and can help us prepare for dealing with them.

This way of starting therapy with a highly socially anxious client doesn’t fit the stereotype of person-centred counselling. First, there are three chairs (because in later sessions they will need the extra chair for two chair and empty chair work; see Chapters 6 and 7); second, the therapist asks a series of questions, clearly directing the process (we prefer to call this process guiding); third, there is a little bit of Focusing (borrowed and adapted from Gendlin, 1981; see Chapter 5), an example of what is called a task in the emotion-focused approach, where they collaborate with the client in working in a particular way with a particular issue in the session. Finally, they even talk a little bit about emotion theory with the client (see Chapter 2), which is part of creating a working alliance in EFC (see Chapter 4).

At the same time, the therapist in this vignette is clearly offering the Person-Centred therapeutic conditions (Rogers, 1957). Empathy is most clearly present, including the therapist using his body to empathically resonate with the client’s anxiety at their first encounter, but he also offers a process reflection (‘So you want to know a bit about me’), and carefully reflects each bit of the client’s experience during the Focusing as well as offering empathic conjectures about as-yet unspoken aspects of what the client may be experiencing. Genuineness or congruence is easy to see as well, for example in the process disclosure that like the client he too is anxious about meeting a new person, but also in the evident pleasure he takes in beginning to learn about the client’s experience of starting therapy. This gentle, warm curiosity is also evidence of unconditional positive regard (UPR), as is his nondefensive acceptance of the client’s attempt to shift the conversational burden onto him by asking him about himself and her confession that her apprehension is telling her to leave the counselling room. Above all, this little bit of therapeutic work conveys the therapist’s foremost desire to enter into a relationship with this client, to shift the power balance away from himself, and to encounter her as a fellow human being.

You will have also noticed that we’ve used quite a bit of EFC jargon to talk about what is going on in the session. EFC is big on process differentiation, that is to say, in this approach we like to carefully distinguish different aspects of things (what the client and counsellor do in the session, different aspects and kinds of emotions, different kinds and stages of emotion work, and so on). We don’t do this to make ourselves powerful experts who speak a special, difficult-to-understand language to impress people with how clever we are. On the contrary, we want to honour the cleverness of our clients, to reveal and bring out their unstated expertise. EFC uses lots of different terms for what the client and counsellor do and experience in the session to help counsellors be as responsive as possible to their clients.

In this book, we want to introduce you to the Emotion-Focused approach to counselling or psychotherapy. In the relatively brief space we have here, our goal is to present this approach in a clear, accessible way. We start here in this chapter by describing where the approach came from and providing an overview of its essential features. In the following chapters we present its underpinning theory of emotion (Chapters 2 and 3), its opening phase of relationship building and beginning the work of therapy (Chapter 4), its early and late working phases of using therapeutic tasks to help clients deepen and transform their stuck emotions (Chapters 5–8), and the ending phase of consolidating and bringing therapy to a close (Chapter 9). We conclude with a discussion of how you can go further with this approach, should you be inspired to do so (as we hope you will be!) (Chapter 10).

What is Emotion-Focused Counselling?

As the initial case example shows, Emotion-Focused Counselling (EFC), more commonly called Emotion-Focused Therapy (EFT), is a contemporary form of the Person-Centred-Experiential (PCE) Approach, and has as its most important sources Carl Rogers’ and Fritz Perls’ deeply humanistic visions of therapeutic change.

EFC is, as its label clearly says, focused on emotion, not emotion as an abstract entity, but emotions in all their concrete, embodied, messy confusion, including the range of our immediate, moment-by-moment emotions: the small, subtle ones as well as the big, powerful ones. Emotions fill our lives and give them meaning, flavour and direction. Without emotions, we strongly believe, life would be colourless, empty and without meaning.

EFC is a humanistic therapy, embodying centuries of humanistic values, such as authenticity, growth, self-determination, creativity, equality, and pluralism. These values have often put humanists at odds with authority and power structures, but in their hearts humanistic therapists want to help their clients live fuller, more meaningful lives of mature interdependence with others (Fairburn, 1952; Lewin, 1948).

EFC is an integrative approach, pulling together key forms of practice from across the humanistic therapy tradition, including not just the Person-Centred approach of Carl Rogers (1951, 1957, 1961), but also the dramatic, active approach of Psychodrama (Moreno & Moreno, 1959) and Perls’ Gestalt therapy (1969; Perls, Hefferline, & Goodman, 1951). Other key humanistic influences are existential psychotherapy (e.g., Schneider & Krug, 2017), with its focus on what is most important in lived, human existence, and narrative therapy (Angus & Greenberg, 2011), which recognizes the key role of context, story, and story-telling for human beings.

Finally, EFC is evidence-based. As we explain later in this chapter, it emerged out of the careful study of how clients change in sessions and is supported by a strong and growing base of outcome research, both quantitative and qualitative (see reviews by Elliott, Watson, Greenberg, Timulak, & Freire, 2013; Elliott, Watson, Timulak, & Sharbanee, in press; Timulak, Iwakabe, & Elliott, 2019). This also includes the development of a wide range of useful research tools that can be used to support practice and evidence-based models of how clients accomplish specific kinds of work in sessions (see Chapter 10).

The Evolution of Emotion-Focused Counselling

As noted, the roots of EFC lie firmly in the western humanistic tradition, which goes back ultimately to various ancient Greek philosophers (e.g., Aristotle, Epicurus), who focused their attention on humans rather than the gods and who advocated using human reason to understand the world. During the eighteenth-century Enlightenment period this tradition sought first to free itself from religious authority, then in the nineteenth century emphasized freedom and emotion as part of the Romantic movement (Coates, White, & Schapiro, 1966). In the twentieth century, humanism took the form of phenomenology, the study of direct human experience (Spinelli, 1989), and existentialism, which grounded itself in the fundamental human experiences of freedom, death, loneliness, responsibility, and meaning (Schneider & Krug, 2017; Yalom, 1980).

Humanistic psychotherapies expanded rapidly in the 1950s and 1960s. Based on extensive, careful observation and research on counselling sessions, Carl Rogers published Client-centered therapy in 1951, followed by his famous ‘necessary and sufficient conditions’ paper (1957) and On becoming a person in 1961, providing the main source of EFC. He saw the client as an expert on themselves and the counsellor as a facilitator of the client’s actualizing tendency (the tendency of all living things to grow, adapt, and differentiate in order to prosper). This focus on the development of the client as a whole person led to the later rebranding from Client-Centred to Person-Centred Therapy (PCT), or more broadly as the person-centred approach (PCA).

During the 1960s and 1970s, however, students and colleagues of Rogers, including Gene Gendlin, David Wexler, and Laura Rice (eg, Wexler & Rice, 1974), continued to look more deeply at the client’s process during therapy, along with specific ways that therapists could facilitate productive client process. This led to the Experiential Therapy branch of the broader Person-Centred Approach, including among others Gendlin’s Focusing (1981) and Miller and Rollnick’s Motivational interviewing (2012). At the same time, Laura Rice, one of the founders of EFC, began looking at what she called the evocative function, involving the client and therapist using vivid, metaphoric language and lively manner (Rice, 1974). In the early 1970s, after she moved to York University in Toronto, Rice also began to develop an understanding of clients as bringing particular kinds of therapeutic work to sessions, which she and her then-student Les Greenberg called therapeutic tasks, a reference to work on expert problem-solving in cognitive science (Greenberg, 1984b). They decided to take seriously the idea that clients are the experts on their experiences by studying how clients accomplish different kinds of therapeutic work in sessions, such as understanding puzzling personal reactions or internal conflicts. This was the seed from which the emotion-focused approach grew.

In parallel to these developments in the person-centred approach was the evolution within the broader humanistic psychology tradition of dramatic methods of psychotherapy and counselling from Psychodrama (Moreno & Moreno, 1959) and Gestalt therapy (Perls, 1969; Perls et al., 1951). Colourful and influential psychotherapists such as Jacob Moreno and Fritz Perls found that vivid enactments of aspects of self or important others could bring client experience to life and deepen therapeutic work, often more so than with words alone. In the early 1970s Les did Gestalt therapy training in Toronto and began studying transcripts of Fritz Perls’ use of chair work as he and Rice developed therapeutic task analysis, a research method for describing the steps by which clients accomplish two kinds of therapeutic work in counselling: first, figuring out why they had a puzzling reaction to a specific situation, such as getting unexpectedly angry at a child for knocking over a cup; and, second, resolving internal conflicts, such as criticizing oneself for not being strong. These lines of research were later published in the first book to present key elements of EFT: Patterns of change (Rice & Greenberg, 1984).

In 1975 Les moved to the University of British Columbia and began working with his then-student Jeremy Safran to develop the emotion theory that underlies EFC; together, they published a series of influential articles (e.g., Greenberg & Safran, 1984) that culminated in their 1987 book Emotion in psychotherapy. Les also became interested in couples therapy, and worked with his then-student Sue Johnson to develop what they called emotionally-focused therapy for couples (Greenberg & Johnson, 1988; Johnson & Greenberg, 1985), one of the main variant forms of EFC.

The third founder of EFC, Robert Elliott, met Laura Rice and Les Greenberg in 1976. His first therapy trainer at UCLA was Jerry Goodman, from whom he learned Person-Centred Counselling. His early research was on counsellor response modes and the intentions behind them. After hearing Laura and Les present their work on therapeutic tasks at a conference in Wisconsin in 1977, he immediately began incorporating their approaches to client puzzling reactions and internal conflicts into his practice, subsequently adding and adapting Gendlin’s Focusing, which easily fit into Laura and Les’s task analysis framework.

In 1985, Greenberg, Rice, and Elliott began working together to develop an integrated form of psychotherapy that would incorporate different aspects of the broader humanistic tradition into a new, evidence-based approach based on the emerging emotion theory of Greenberg and Safran. At first they called this approach to counselling experiential, and later process-experiential; however, beginning with Greenberg and Paivio (1997), it was rebranded as emotion-focused.

Greenberg, Rice, and Elliott began by describing the principles that governed their practice with clients; these were refined into a set of six practice principles (to be described later in this chapter). This was followed by descriptions of a basic set of therapeutic tasks: systematic evocative unfolding (see Chapter 5) and empathic affirmation (Chapter 8) were based on person-centred practice; two chair work (Chapter 6) and empty chair work (Chapter 7) were based on psychodrama/Gestalt therapy; and focusing (Chapter 4) was adapted from Gendlin’s (1981) and Cornell’s (1996) writings. Elliott carried out the first study of an integ...