Emotion-Focused Couples Therapy: The Dynamics of Emotion, Love and Power


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Emotion-based work highlighted in impressively researched book
(August/September 2009 Issue)

“Emotion-Focused Couples Therapy:
The Dynamics of Emotion, Love and Power”
By Leslie S. Greenberg and
Rhonda N. Goldman
American Psychological Association
Washington, D.C., 2008

By Paul Efthim, Ph.D.

It's a little odd to encounter a school of couple therapy that calls itself "emotion-focused." The label feels too generic. Shouldn't any good treatment approach focus on emotion, especially when working with couples in conflict? On the other hand, not all psychotherapies place affect at the center of couples work. Cognitive-behavioral therapy, for instance, steers warring partners away from the fight toward more constructive behaviors. Narrative and solution-focused therapies also seek to extricate couples from the emotional maelstrom to cool things down and construct a new story. (See James Donovan's superb 2003 book on couple therapy for much more on these points). More than many approaches, emotion-focused couples therapy (EFT-C) seeks to evoke the "heat" of emotion in the treatment session. Since emotion fuels conflicts, therapists can use EFT-C to help couples gain access to hidden feelings that drive conflict cycles and transform these emotions into more adaptive ones. Psychologist Les Greenberg of York University in Toronto began developing EFT-C about 20 years ago with his then-graduate student Susan Johnson. Since that time, the two have parted ways, both continuing to develop EFT for couples, families and individuals. Greenberg, meanwhile, has gone on to work with a number of other scholar-practitioners, most recently Rhonda Goldman, who teaches and practices in the Chicago area. Together, they have published a hefty (400-page) manual that artfully and thoroughly describes their approach, linking it with recent research on emotion, affect regulation, attachment and neuroscience. For Greenberg and Goldman, most couple problems do not result from deficits in communication skills but, rather, stem from undisclosed and unresponded-to emotions: fear of opening up, fear of rejection and abandonment, anticipation of shame and diminishment. These are primary emotions activated in the normal context of intimate relating. However, these feelings get hidden underneath defensive secondary emotions such as anger and contempt which are what we usually encounter in the first sessions with a couple. The core change principle in EFT-C involves using emotion to change emotion. Entrenched maladaptive patterns of relating are seldom altered by insight, ra-tionality or even penetrating interpretations. Instead, the therapist needs to evoke the affective storm (which usually consists of defensive, secondary emotions) and then help each partner access underlying vulnerable feelings and needs. In this way, emotion changes emotion: the maladaptive emotion state is transformed by a new experience of having one's deepest fears and needs met with empathic attunement and validation by the partner, therapist and self. Of course, this process can unfold only after a strong alliance with both partners has been formed and after a fair amount of work to help partners increase their abilities to become more aware of, regulate, express and reflect on emotion. The first third of the book presents the theoretical basis for the model. This section, although somewhat long and repetitive, is impressively detailed. The second section consists of a manual-type framework that breaks the approach into five stages and 14 steps, illustrated by numerous transcripts. Finally, a series of chapters are devoted to the specific emotions of anger, sadness, fear, shame and positive feelings. To their credit, Greenberg and Goldman see their approach as a work in progress. One recent development has been to highlight the role of shame as a master emotion in interpersonal relations. Shame - and efforts to protect the self against it - lurks beneath many fights and negative interaction cycles. The authors teach therapists to identify different flavors of shame and other emotions, as well as different motives that drive emotion sequences, so they can develop more accurate conjectures about patients' underlying pain. At times the book lacks nuance in its approach to the dynamics of emotion. For example, partners are labeled statically as "pursuers" or "distancers" without noting that these roles are fluid and can shift depending on the context. Emotional phenomena are described as arising entirely within an individual when in fact there is much evidence that emotion is co-constructed and can be evoked with or without the consent of the other. There is a lack of reference to the therapist's own emotions and use of self in the treatment. Perhaps these minor shortcomings arise from an effort to keep the model from becoming too complex and unwieldy. Blending experiential, systems and psychodynamic approaches, Greenberg and Goldman also have amassed impressive research evidence to support the ef-ficacy of EFT-C. The model is adaptable to a variety of therapeutic styles and can be used for both short- and long-term treatment. Given the chaotic and fre-quently "hot" nature of couples work, this book is a superb contribution to the field and will serve as a solid base for practitioners and researchers who want to deepen their facility with emotion-based work.

Paul Efthim, Ph.D. is a licensed psychologist in full-time practice in Brookline, Mass. He holds faculty appointments at the Massachusetts School of Professional Psychology and the Boston Institute for Psychotherapy.