I love teaching and supervising the act of psychotherapy! It is such a rich, vulnerable, and important learning journey that clinicians undertake. There is something so energizing about working with clinicians to assist in facilitating shifts from the tentative anxiety of the novice stages of learning, through to surprise and wonder as interventions begin to flow and clients experience benefits, into a sense of confidence and joy as a clinician comes to firmly understand and work systematically and creatively from a deep understanding of a human change process.
What I Iove most of all is teaching Emotion Focused Therapy. It’s not because I believe it’s a better model than all the rest – the contemporary evidence base just does not support superiority of any one model over others. It’s because it has an impressive evidence base, is consistent with what we know and continue to learn from affective neuroscience and, well, because it’s the right fit for me. I have learned that it is also the right fit for many others who believe that the foundation of change in psychotherapy involves empathy, respect, the centering and exploration of client lived experience, and helping clients to work directly with feared or blocked emotions to alleviate symptoms and suffering.
In this three-blog series, I’m going to unpack lessons I have learned as a practitioner, supervisor, and teacher of Emotion Focused Therapy (EFT) for individual clients, breaking learning down into the beginning, intermediate and advanced stages.
Where to Start?
Which EFT I am Learning???
It’s important to know that there are two primary schools of thought when it comes to learning EFT for individual clients. Dr. Leslie Greenberg and Dr. Robert Elliot, along with Dr. Jeanne Watson and others have been researching, supervising, and teaching Emotion Focused Therapy for individual clients since the 1970s. This is a robust model and is recognized by the American Psychological Association as an evidence-based model for the treatment of depression.
Dr. Sue Johnson, also a prolific researcher, writer, and trainer has spent much of her career over the past 35 years researching, supervising, and teaching what has come to be known as Emotionally Focused Therapy for couples. More recently, attention has turned to applying Emotionally Focused Therapy to individual psychotherapy treatment, identified in 2022 as a newly emerging therapy.
While both use the term EFT to describe their models, they look quite different when applied to individual cases. Dr. Greenberg’s model is grounded in a combination of empathy, experiential chairwork and over 40 years of research into the underlying mechanisms of change. Dr. Johnson’s model is grounded solidly in empathy and attachment theory, typically without use of experiential chairwork and with attention recently being turned to researching this variation of the therapy. These models do spring from a common base as both Emotion Focused Therapy for couples and Emotionally Focused Therapy for couples originated from the working relationship of Leslie Greenberg and Sue Johnson when he was her supervisor during her doctoral degree in psychology. Their work has slowly diverged over time. While I am curious about Dr. Johnson’s model, my own training and experience have occurred through trainers including Dr. Leslie Greenberg, Dr. Robert Elliott, and Dr. Jeanne Watson in Toronto, Canada.
Learning a New Language
If you are new to EFT, the first thing to know is that learning EFT involves learning a new language grounded in different types of emotions and in emotion theory. When learning anything new, we can’t skip or fast track the beginning stages: encountering new concepts, learning new words, experiencing new ways of perceiving the world (e.g. deeply attending to emotions as processes, as well as to narrative content), and developing new ways of understanding human experience.
At the beginning, I recommend reading or, if you prefer structured learning, taking an intensive workshop or course that has the added benefit of working with a teacher and with peers. Some great places to begin include:
Written Materials:
- Learning Emotion-Focused Therapy (2004) by Elliott, Watson, Goldman, and Greenberg (Note – a new edition is currently in the works so it may be worth your while to wait a bit longer)
- Emotion-Focused Counselling in Action (2021) by Elliott and Greenberg.
- For a gentler start, check out my blog series, Focus on Emotions¸ which includes a number of articles focusing on concepts and language helpful when learning the foundational principles of EFT.
- A variety of online resources can be found here.
Courses:
- In a North American context, and in particular if you want to earn your certification as an Emotion Focused Therapist, check out the International Society for Emotion Focused Therapy to find a Level 1 training in your time zone. These four-day training institutes offer a great introduction to the theory and practice of Emotion Focused Therapy including facilitating opportunities to practice new therapy skills. Through the same website, you can find trainings specifically in the use of empathy in psychotherapy. If you have not previously received formal training or supervision in the use empathy as a therapeutic intervention, I recommend this as a starting point that will pay dividends in the long run!
- If you learn better at a slower pace, or by spreading the learning out over multiple sessions with time to consolidate and deepen knowledge between lessons, check out my Emotion Focused Therapy for Busy Professionals course. This 30-hour workshop offers an opportunity for a comprehensive introduction to EFT, or an opportunity to further consolidate emerging skills. We will cover both theory, and opportunities for facilitated skills practice.
- If you’re a graduate student in psychology, see if your program offers a course in Emotion Focused Therapy. If not, talk to your program advisor and request one! When looking for practicums, take a look for placements that offer access to an EFT supervisor.
I’m Learning the Language, but What Do I Do??
After you have completed an introduction to EFT terminology, theory, and technique, it’s time to start digging into the technical skills of the model.
Get Really Good at Empathic Attunement
Start with a firm grounding in how to empathically attune to your clients. While most therapists I meet believe that they are highly empathically attuned, in my experience, the majority of therapists have growth opportunities in this area. Top areas for improvement that I see include:
1. Differentiating compassion from empathy.
Compassion is characterized by a sense of kindness and a genuine concern for another’s suffering, often with a desire to help someone feel better. Every therapist who has sought me out as a supervisor has been very compassionate. Empathy is the ability to emotionally connect with and understand another person’s feelings or perspective, characterized by a sense of deeply being with another’s experience. This one takes more work.
2. Learning the language of empathic attunement
Learning the language of empathic attunement, including the various forms, channels, and functions of empathy statements. This type of learning can supercharge your capacity for empathic attunement! Dr. Robert Elliott offers great trainings in this area and trainings are listed here under “Advanced EFT Empathy”.
3. Understanding the difference between cognitive empathy, embodied empathy, and empathic distress.
- (a) Cognitive empathy relies on intellectually understanding your client’s point of view. To do this, you may look for clues to what your client may be feeling by learning to recognize patterns in vocal tone, facial expressions, and muscle tension in the body that are reflective of different emotion states. You may also ask yourself what you might feel if you were in a similar situation (watch out for implicit bias when taking this route), or work to more fully intellectually understand your client’s point of view through the application of curiosity while withholding any judgement or evaluation of their experience.
- (b) Embodied empathic attunement is a bit like being a human tuning fork. When a still tuning fork comes close to an identical but vibrating tuning fork, the still fork begins to vibrate at the same frequency. Some therapists, when exposed to emotion expression in their client, will begin to feel sensations and feelings in their own body. These feelings can be a great foundation for making educated yet tentative guesses about what the client may be feeling (this is called “empathic conjecture,” if you have already learned your empathy vocabulary).
- (c) Super-feeling therapists must beware empathic distress – a reaction in which empathic attunement to another’s deep pain or distress leads to personal feelings of emotional turmoil, pain, or helplessness in response. This can feel like drowning with your client rather than acting as a lifeguard on dry, stable land, helping your client return to safety from emotional pain.
4. If you are working with embodied empathy, therapist know thyself!
You will need to be able to stably differentiate the following:
- (a) Feelings stemming from empathic attunement to a client – when the therapist is literally feeling with the client and coming to better understand the client’s inner experience. These feelings are a great guide for experiential interventions.
- (b) Feelings that are stemming from a therapist’s reaction to the client – when the therapist is feeling responses that may be common reactions to the client’s interpersonal style, providing valuable information about how the client’s words and actions might be perceived and responded to more generally by others. These feelings can be helpful in understanding a client, their interpersonal style, and any changes that may be of benefit in this realm.
- (c) Feelings stemming from the therapist’s own triggered responses to the client’s words or actions – when something the client says or does lands close to home and triggers a secondary or problematic emotion response in the therapist based on the therapist’s own prior lived experience. These feelings are not a good guide to intervention. They do provide a great growth opportunity for the therapist via self-reflection, supervision, or the therapist’s own therapy.
Learn the Basic Markers and Tasks
Once you are confident in your empathy skills, you are ready to dive into the work of explicit emotion transformation. In EFT, we work with emotion processes that are stuck, including working to unblock these processes in real time. This means that we must first be able to recognize productive emotion processes in a client and have tools to teach these basic processes to clients when needed.
Productive Emotion Process
These include clients:
- Knowing how they feel: noticing sensations that tell them that a particular emotion is alive and being able to name different emotions.
- Saying how they really feel: being able to express their primary emotions (more on that in a moment)
- Feeling their emotions in a regulated way (not too little or too much emotion!)
- Being able to reflect on what they are feeling to understand the information conveyed by their emotions.
In my opinion, the last learning goal that characterizes the beginner stage is learning to recognize signs or “markers” that client emotion processes are stuck in front us in the therapy room. Each time we encounter a stuck process, we have a set of steps we can follow (a therapeutic “task”) to help us to work with and ‘unstick’ the client’s process.
Tasks and Markers
A “marker” is simply a sign that a client’s core emotional pain or stuck emotion process has been activated in session. Examples are illustrated in the following Table[1].
Sample Emotion Focused Therapy Markers and Tasks.
Copied with permission from Thompson, S. & Greenberg, L. (2023). Emotion Focused Therapy: An Overview in Foroughe, M. (Ed.), The Clinical Manual of Emotion Focused Therapy for Youth and Caregivers. Routledge.
To recap the beginning stages of learning to be an Emotion Focused Therapist:
- Learn the language of EFT.
- Develop your skills in empathic attunement.
- Learn to listen for and identify markers.
- Learn the basic structures of EFT tasks to help your clients ‘unstick’ emotion processes.
Stay tuned for more on the intermediate stages of learning Emotion-Focused Therapy in the next installment.
Want to learn more about practicing Emotion Focused Therapy with your individual clients? Come join us for EFT Fundamentals for Busy Professionals!
