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The Therapeutic Relationship in Emotion-Focused Therapy
Leslie Greenberg
York University
Important qualities of the relationship that make it therapeutic are discussed. The relationship is seen
as both therapeutic in and of itself and as providing a facilitative environment from specific change
processes. The role of the relationship in emotion-focused therapy is discussed within this framework.
The relationship in emotion-focused therapy is seen as curative by serving an affect-regulation
function, which is internalized over time by the client. This function is accomplished by offering a
soothing affect-attuned bond characterized by the therapist’s presence and empathic attunement to
affect as well as acceptance and congruence. Second, the relationship is seen as functioning as a
means to an end by offering an optimal environment for facilitating specific modes of emotional
processing. In our view, affect is much more likely to be approached, tolerated, and accepted in the
context of a safe relationship.
Keywords: presence, affect regulation, empathic attunement, acceptance, emotion processing
Emotion-focused therapy (EFT; Greenberg, 2002, 2010; Greenberg
& Watson, 2006) views the relationship, characterized by the
therapist’s presence and the provision of empathy, acceptance, and
congruence, as an affect-regulating bond.1 Over time, this interpersonal
regulation of affect is internalized by the client as selfsoothing
and enhances the capacity to regulate his or her inner
states. In this view, the therapist’s overall attitude, not only his or
her techniques, is seen as influencing the client’s well-being.
Elements such as pacing and facial, tonal, and postural communication
of affect all create a therapeutic emotional climate. An
important goal of EFT is client enhanced self-soothing and emotional
transformation, and EFT sees the relationship as both a
direct predictor of this change and a context in which techniques
can be successfully used to reach this end.
In our view, the relationship thus serves a dual purpose in
psychotherapy (Greenberg & Watson, 2006). First, the relationship
is therapeutic in and of itself by serving an affect-regulation
function, which is internalized over time by the client. This function
is accomplished by offering a soothing affect-attuned bond
characterized by the therapist’s presence and empathic attunement
to affect as well as acceptance and congruence. Second, the relationship
functions as a means to an end. The relationship offers the
optimal environment for facilitating specific modes of emotional
processing. Affect is much more likely to be approached, tolerated,
and accepted in the context of a safe relationship.
In the most general terms, EFT is built on a genuinely positively
regarding, empathic relationship, and on the therapist being highly
present, respectful, and responsive to the client’s experience. Consistent
with this, an abundance of research points to the therapeutic
relationship as being central to client growth and change, given
that differential therapeutic outcomes may only be minimally
attributed to specific techniques (Norcross, 2011). Furthermore,
recent research has identified therapeutic presence as a core therapeutic
stance that contributes to the development of a positive
therapeutic relationship (Geller & Greenberg, 2012; Pos, Geller &
Oghene, 2011). Therapeutic presence is defined as the therapist’s
ability to be fully immersed in the moment, without judgment or
expectation, being with and for the client, which facilitates healing.
EFT therapists also assume that it is useful to use techniques to
guide the client’s emotional processing in different ways at different
times. The relationship thus is seen as curative in and of itself
and as a foundation for specific techniques to work and so is both
directly and indirectly related to outcome (Weerasekera, Linder,
Greenberg, & Watson, 2001)
Treatment Principles
EFT is based on two major treatment principles: The provision
of a therapeutic relationship and the facilitation of therapeutic
work (Greenberg, Rice, & Elliot, 1993). As their ordering implies,
the relationship principles come first and ultimately receive priority
over the task-facilitation principles. In the relationship with the
client, the overall therapeutic style combines what EFT therapists
call following with guiding. In following, the therapist enters
the client’s internal frame of reference, empathically following the
client’s experience and responding to it in an affectively attuned
manner. This is combined with a more guiding process-directive
style to deepen experience. The therapeutic relationship thus, as
well as being curative, also promotes the therapeutic work of
exploration, emotional transformation, and the creation of new
meaning. With safety, exploration deepens and the client is able to
say, “I just feel like I am sinking, sinking into a deep black hole,”
the therapist responds with “just feeling hopeless like I can try and
try but nothing works” (following) and the client responds, “Yes
1 Informed consent for purposes of research, training, and publishing
have been received for case material presented, and number of details of
the client and the situation have been changed to disguise the material for
reasons of confidentiality.
Correspondence concerning this article should be addressed to Leslie
Greenberg, Department of Psychology, York University, 510 St. Clements
Avenue, Toronto, Canada M5N1M4. E-mail: lgrnberg@yorku.ca
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Psychotherapy © 2014 American Psychological Association
2014, Vol. 51, No. 3, 350–357 0033-3204/14/$12.00 http://dx.doi.org/10.1037/a0037336
350
and I can see the light but just can’t quite reach up it.” Here, we see
facilitated by the therapist’s validation of this painful state, the
client enters a domain of emotional processing of painful feelings
that would never have been reached without the safety and empathy
in the relationship. He allows the client to reach the painful
emotion that needs to be processed to move on. Subsequently, in
response to the therapist’s reflection that the client needs the
support of a mother that she never received (guiding), the client
both grieves the loss and accesses a sense of having deserved more
and begins to reorganize.
Purely following, without a contribution from the therapist and
without the sense of direction emerging from a dialogue, can result
in therapy not progressing efficiently or just going in circles. At the
same time, leading by the therapist without following is ineffective
and may be counterproductive, undermining the client’s efforts to
develop as an empowered, self-organizing person. When disjunction
or disagreement occurs, the client is viewed as the expert on
his or her own experience, and the therapist always defers to the
client’s experience. Thus, therapist interventions are offered in a
nonimposing tentative manner, as conjectures, perspectives, “experiments,”
or offers, rather than as pronouncements, lectures, or
statements of truth.
Relationship Principles
The relationship is built on the following three subprinciples: (a)
Empathic attunement: being fully present, enter the client’s internal
frame of reference and track the client’s immediate and evolving
experiencing; (b) Therapeutic bond: genuinely communicate
empathy, caring, and warmth to the client; and (c) Task collaboration:
facilitate involvement in goals and tasks of therapy.
In EFT, the relationship is seen as being curative in and of itself
in that therapists’ empathy and acceptance promotes breaking of
isolation, validation, strengthening of the self, and self-acceptance.
The relation with the therapist also provides a powerful buffer to
the client’s distress by the coregulation of affect. A relationship
with an attuned, responsive, mirroring therapist is essential in
developing interpersonal soothing and emotion regulation. This
type of relationship helps clients regulate their overwhelming
disorganizing emotions by breaking the sense of isolation and the
unbearable aloneness of emotional pain. Over time, the interpersonal
regulation of affect becomes internalized into self-soothing
and the capacity to regulate inner states (Stern, 1985). When an
empathic connection is made with the therapist, affect-processing
centers in the brain are affected and new possibilities open up for
the client. This type of relationship creates an optimal therapeutic
environment that both contributes to clients’ self-acceptance and to
affect regulation and also helps the client feel safe to fully engage
in the process of self-exploration and new learning. Another important
aspect of a helping relationship is establishing collaboration
on the goals and tasks of therapy. This is essential to developing
the experience that the two of us are working together to
overcome the problem. Getting agreement on goals and tasks is
dependent on understanding the client and what might be helpful
to the client and so it is an enactment of empathy. Goal agreement
in EFT often is achieved by being able to capture the chronically
enduring underlying pain with which the client has been struggling
and establishing an agreement to work on resolving the pain rather
than setting a behavioral change goal.
The Relationship and Affect Regulation
It is important to explore how affect regulation occurs to understand
the important affect-regulating role of the relationship. In
our view, emotion regulation is an integral aspect of the generation
of emotion and coterminates with it (Campos, Frankel, &
Camras, 2004) rather than involving self-control of emotion. The
type of implicit affect regulation that results from a good therapeutic
relationship occurs through right hemispheric processes, is
not verbally mediated, is highly relational, and is most directly
affected by such things as emotional communication, facial expression,
vocal quality, and eye contact (Schore, 2003).
The therapists’ facial, postural, and vocal expression of emotion
clearly set very different emotional climates and are aspects of
their ways of being. Clients’ right hemispheres respond to therapists’
micro affective communication as well as to their explicit
words, and all these influence clients’ processes of dynamic selforganization.
The therapist who conveys genuine interest, acceptance,
caring, compassion, and joy, and little anger, contempt,
disgust, and fear creates the environment for a secure emotional
bond. In the analysis of the classic film, Three Psychotherapies, by
Rogers, Perls, and Ellis with Gloria, Magai and De Haviland
(2002) studied the emotional climate created by the therapists. This
analysis revealed that each of these therapists, in their behavior in
the film, in their theories, and more generally in their personalities
and personal lives, expressed and focused on very different emotions.
Rogers showed interest, joy, and shame. Perls showed contempt
and fear and Ellis anger and fear. Anyone who has seen this
film can see that they created very different therapeutic environments.
Gloria at points becomes defensive with both Ellis and Perls but
not with Rogers whom she sees as a warm father. The categorical
emotions such as interest, anger, sadness, fear, and shame, expressed
by the therapist are important and strongly influence the
relational environment. The vitality aspects of the therapists’ emotional
expression, such as rhythm, cadence, and energy, are also
important in affective attunement.
In clinical work, regulation is thus not easily achieved through
the conscious system alone. A validating relationship is crucial to
affect regulation. People with underregulated affect have been
shown to benefit both from interpersonal validation as much as
from the learning of explicit emotion regulation and distresstolerance
skills (Linehan et al., 2002). Problems in vulnerable
personalities arise most from deficits in the more implicit forms of
regulation of emotion and emotional intensity. Although deliberate
behavioral and cognitive forms of regulation—more left hemispheric
process—are useful for people who feel out of control to
help them cope, over time, it is the building of implicit or automatic
emotion regulation capacities that is important to achieve
transformation for highly fragile, personality disordered, clients
(Schore, 2003). Implicit forms of regulation often cannot be
trained or learned as a volitional skill. Directly experiencing
aroused affect, being soothed by relational or nonverbal means—a
more right hemispheric process (Schore, 2003)—is one of the best
ways to build the implicit capacity for self-soothing. Being able to
soothe the self develops initially by internalization of the soothing
functions of the protective other (Stern, 1985). Soothing then most
centrally comes interpersonally in the form of empathic attunement
and responsiveness to one’s affect and through acceptance
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RELATIONSHIP IN EFT 351
and validation by the therapist. The provision of a safe, validating,
supportive, and empathic environment in therapy helps soothe
automatically generated underregulated distress. Internalizing the
soothing of the therapist is one of the best ways of developing
implicit soothing. Empathy from the other over time is internalized
and becomes empathy for the self and this leads to a strengthening
of the self (Bohart & Greenberg, 1997; Bohart, Elliott, Greenberg,
& Watson, 2002; Elliott, Bohart, Watson, & Greenberg, 2011).
Over time, this interpersonal regulation of affect is internalized
into self-soothing or the capacity to regulate inner states. These
optimal therapeutic relational qualities thus facilitate the dyadic
regulation of emotion through provision of safety, security, and
connection. This breaks the client’s sense of isolation, confirms
self-experience, and promotes both self-empathy and selfexploration.
When an empathic connection is made with the therapist, affectprocessing
centers in the client’s brain are effected and new
possibilities open up for the client (Schore, 2003). This creates an
optimal therapeutic environment that not only contributes to clients’
affect regulation by providing interpersonal soothing but also
helps them to feel safe to fully engage in the process of selfexploration
and new learning. Effective therapeutic work is only
possible when the client feels safe and secure with the therapist.
Developing a sense of safety and security for the client emerges
through therapists’ ability to be fully present and empathically
engaged, in a genuine validating manner (Geller & Greenberg,
2012). When the therapist is fully in the moment with a client, his
or her receptive presence sends a message to the client that he/she
is going to be heard, met, felt and understood, which elicits a
feeling of safety in the client. Current neuroscience research is
beginning to reveal the neurological underpinnings of client safety
through therapists’ presence and affective attunement. Porge’s
(2011) Polyvagal Theory explains that when clients feel met and
felt by the therapist, they not only feel aligned with the therapist,
but the brain likely establishes a state of “neuroception” of safety
(Porges, 2011). This creates a feeling of security in clients, which
allows them to trust the therapist and to open and engage in the
necessary therapeutic work. Neuroception is a novel construct
created to describe how neural circuits discern safety, danger, or
life threat outside the realm of awareness. Neuroception takes
place in the primitive parts of the brain as an unconscious process
that is manifested in our autonomic nervous system as an adaptive
mechanism to prepare us for defensive strategies of fight–flight or
shutdown.
For instance, clients with trauma backgrounds may have autonomic
nervous systems that preclude the down-regulation of defense
strategies and predisposes them to feel unsafe even when
there is no observable risk. Hence, challenges in the social world
of these clients occur, as they respond defensively even when there
is no risk. Hence, in the Polyvagal Theory, the regulators of
emotions and physiology are embedded in relationship. The core
of the social engagement system in mammals is reflected in the
bidirectional neural communication between the face and the heart
(Porges, 2011). From this perspective, arousal can be physiological
arousal or emotional dysregulation and can be stabilized through
social interaction that includes warm facial expression, open body
posture, vocal tone, and prosody (rhythm of speech). The therapist’s
presence and overall safety providing attitude thus influence
the client’s well-being. Therapists’ pacing, facial, tonal, and postural
communication of affect all create a therapeutic emotional
climate that leads to physiological soothing.
The Therapeutic Alliance
Numerous studies have shown that a positive therapeutic alliance
is associated with good outcome (Horvath, Del Re, Fluckiger,
& Symonds, 2011). The alliance reflects three important aspects of
therapeutic work, the bond or the feelings the participants have
toward each other, the level of agreement that exists between them
about the goals of therapy, and the ways in which they will go
about meeting those goals (Bordin, 1979). A recent study that
looked at clients who were being treated for depression in
cognitive– behavioral and emotion-focused psychotherapy found
that clients’ perceptions of the Rogerian relationship conditions
were highly correlated with clients’ ratings of the therapeutic
alliance in both approaches and that presence and empathy were
correlated (Watson & Geller, 2005) and were associated with
changes in clients’ level of self-esteem, and their self-report of
interpersonal difficulties, while therapists’ acceptance of their clients
was predictive of changes in depression.
The development of collaboration also has been established as
an important, empirically supported aspect of the therapeutic relationship
(Horvath & Greenberg, 1994). Thus, as well as creating
the emotional climate that secures a warm trusting bond, it is also
important to foster a collaboration on tasks and goals through the
course of therapy, wherein client and therapist agree to work with
both avoided emotions and underregulated emotions. With research,
we (Horvath & Greenberg, 1989) came to see the client’s
perceived task relevance and task collaboration as more predictive
of outcome than empathy. In fact, perceived task collaboration
emerged from an enactment by the therapist of his or her empathic
understanding of the client. This enactment might occur by making
a suggestion that helped deepen the client’s exploration or experience.
For example, a response like “if your father was here what
would you like to say to him from your anger” enacts an understanding
of what the client needed and would be experienced as
more helpful than a verbal communication of an understanding of
the client’s inner world such as “so that left you feeling so angry
at him.” Proposals thus were enactments of empathy. Collaboration
thus became an important foundational principle of an EFT
approach and a core ingredient of our theory of relationship.
From this, we have identified a number of ways to assist in the
development and maintenance of the task agreement dimension of
the alliance when working with emotions. The first of these involves
conveying that the primary focus of treatment is the client’s
concerns and underlying painful feelings. The therapist conveys
that a central intention of therapy is to help clients to open up and
reveal their inner feelings, meanings, and fears—to risk being
vulnerable with their therapists in the hope that together they can
come to a better understanding of the clients’ inner and outer
worlds and effect meaningful change that will ameliorate clients’
sense of despair. Without this exploratory goal being adequately
negotiated between the parties, the therapy will likely end prematurely
or not progress. From the start, the client is implicitly being
trained, by the therapist’s consistent empathic focuses on the
client’s internal experience, to attend to this internal experience.
Therapists in the early phase of therapy convey understanding,
acknowledge client’s pain, validate his or her struggles, and focus
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352 GREENBERG
on the emotional impact of events in the client’s life. By the
therapist’s attentive listening, presence, and caring and by the
attitude conveyed by the therapist’s face, body, hands, and eyes
that validates the client specialness, the client comes to feel seen,
valued, and respected and is thereby more inclined to trust and be
open. By attending to clients’ core humanness and expressing
unconditional confidence in clients’ strengths and capacities for
growth, the therapist helps reveal clients’ uniqueness and strength.
It is by seeing the possibility of growth in another being that this
possibility is stimulated. This is an important aspect of the relationship
in all approaches. The deeply held therapeutic stance of
presence and the attitude of empathy, positive regard, and a focus
on strengths and resources help create an emotional bond of trust
and respect and help develop the safe environment and a secure
base for the exploration that will take place as the therapy progresses.
This is a relational principle that is universal to all helping
relationships. In addition to creating a bond, a rationale is provided,
right from the start, that the goal of treatment is for the
person to access and become aware of underlying feelings and
needs involved in their difficulties. If, however, their emotions are
underregulated, the goal becomes finding better ways of coping
with feelings that seem overwhelming. People are told that their
feelings provide important information about how they are reacting
to situations and that it is important to get clear on what their
emotions are telling them. There is a strong emphasis from the start
on validating and accepting the pain that people feel. When people
come to therapy they do so because they are suffering and feel
some form of pain—it feels like something in their life or inside of
them is broken. It is with the quickness and sureness with which
the therapist can grasp the nature of the client’s chronic enduring
pain that an emotional bond and collaboration to work on it will be
created. Once the chronic enduring pain has been articulated, the
person’s sense of isolation is broken. There is a sense of relief that
it has been spoken, that someone understands, and that the person
now is not so alone in the struggle. Hope is created and agreeing
to work on resolving the chronic enduring pain creates an alliance,
spurred by this hope. Resolving the articulated enduring pain
becomes the goal of treatment and the basis for the working
alliance.
Therapeutic Presence
Therapeutic presence involves therapists being fully in the moment
on a multitude of levels, physically, emotionally, cognitively,
spiritually, and relationally (Geller & Greenberg, 2002, 2012;
Geller, Greenberg, & Watson, 2010). The experience of therapeutic
presence involves (a) being in contact with one’s integrated and
healthy self, while (b) being open and receptive, to what is poignant
in the moment and immersed in it, (c) with a larger sense of
spaciousness and expansion of awareness and perception. This
grounded, immersed, and expanded awareness occurs with (d) the
intention of being with and for the client, in service of his or her
healing process (Geller & Greenberg, 2002, 2012). A more detailed
description of our empirically validated model of therapeutic
presence can be found in other publications (see Geller & Greenberg,
2002, 2012). Presence is a relational stance that is fundamental
to evoking an experiential and neuro-physiological sense of
safety in the client, which in turn can promote a positive therapeutic
alliance and effective clinical work across different therapeutic
approaches.
To establish a positive alliance, it is important for therapists first
to be present to their clients. A question often asked by trainees is:
What does one need to do to help a constricted client access
feeling? But this implies that it is something one needs to do to the
client. My answer is that the ability to access emotions depends
first and foremost on the type of relationship created. It is the
therapist’s ability to be present that will help the client access
emotion. A qualitative analysis of therapists’ experience of presence
revealed that therapeutic presence involves being receptively
open and sensitive to one’s own moment-by-moment changing
experience, being fully immersed in the moment, feeling a sense of
expansion and spaciousness, and being with and for the client
(Geller & Greenberg, 2002). It is these qualities that will help
create the climate that will lead clients to attend to their momentby-
moment affective experience. It is important that therapists are
able to be receptive and open to their clients’ emotional experiences.
The kind of “presence” that seems to be therapeutic is the
state of mind in which there is an awareness of moment-bymoment
emotional reactions as well as thoughts and perceptions
occurring in the client, in the therapist, and between them in the
therapeutic relationship. This means that therapists need to let go
their own specific concerns, the quarrel with their spouse this
morning, the falling value of the dollar, or an upcoming vacation
and truly show up in the session. To be present for clients is to
empty oneself, to clear a space inside so as to be able to listen
clearly in the moment to the narratives and problems that clients
bring. Therapists need to see their clients’ faces and hear their
voices. It is through the therapist’s undivided and focused attention
that clients feel valued and are able to clearly discern their own
concerns and difficulties. By giving clients their full attention,
therapists are able to more fully resonate with their clients’ feelings
and their experience of events and provide the level of
empathic responding that will be most optimal at different points
during the session.
Dialogue of this type often leads to heightened moments of
meeting or what Buber (1958) referred to as I-Thou contact. In
these moments, people share living through an emotional experience
together. Here an intersubjective experience is lived while it
is occurring: It is a shared experience of attending to and experiencing
the same thing at the same time and knowing that the other
is coexperiencing the same thing. Each person experiences something
of the other’s experience and knows that this is occurring.
This creates a strong bond, a sense of togetherness that breaks any
sense of existential isolation and promotes trust and openness. It
also is a lived moment of experience that remains indelibly
stamped in memory. These moments produce therapeutic change
both in the people’s sense of self and their way of relating.
We see the Rogerian conditions of empathy, positive regard or
acceptance, and congruence (Rogers, 1957) as part of a single
therapeutic way of that of being fully present with the other.
Empathy has been established as one of the three empirically
supported aspects of the relationship, one that correlates moderately
(e.g., r .32) with outcome (Bohart et al., 2003; Elliott,
Bohart, Watson, & Greenberg, 2011). The sense that another is
accepting and can be trusted, to the extent that one perceives the
other as congruent and sincere, is important to the sense that one
is valued and liked by the other. Through sensing the therapist’s
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RELATIONSHIP IN EFT 353
unconditional acceptance of their experience, clients lose their
preoccupation with the therapist and their energy becomes available
to turn inward and contact their own experience. Reduction of
interpersonal anxiety leads to capacity for tolerance of more intrapersonal
anxiety. Clients are able to face and accept more of
their experience with the unconditional acceptance of another.
Genuineness and Congruence
The positive real relationship, composed of what Gelso and
colleagues term congruence and realism, is an important aspect of
the therapeutic relationship that enhances the alliance and client
progress (Gelso, 2011; Gelso & Hayes, 1998; Kolden, Klein,
Wang & Austin, 2011) Congruence or authenticity can be broken
into two separate components (Lietaer, 1993): Awareness of one’s
own internal experience and the willingness to communicate to the
other person what is going on within (transparency). The deeper
level intentions include the intentions to facilitate the others’
development, to be accepting and noncritical of the other, to
confirm the others’ experience, to focus on their strengths, and
above all to do the other no harm. These intentions, and more, are
what determine whether congruence is therapeutic. The case of
transparency or the communication component of congruence is
much more complicated than the self-awareness component. Being
facilitatively transparent involves many interpersonal skills
(Greenberg & Geller, 2001). This component involves not only the
ability to express what one truly feels but to express it in a way that
is facilitative. Transparency thus is a global concept for a complex
set of interpersonal skills embedded within a set of therapeutic
attitudes. These skills appear to depend on three factors: first, on
therapist attitudes, second, on certain processes such as facilitativeness,
discipline, and comprehensiveness, and third, on the
interpersonal stance of the therapist.
The set of skills involved in facilitative congruent communication
is best explicated by looking at congruent interaction in terms
of the interactional stance taken by therapists as described by a
circumplex grid of interpersonal interactions (Benjamin, 1996).
This grid is based on the two major dimensions of autonomy/
control and closeness/affiliation. Consistent with interpersonal theory,
this grid outlines a set of complementary responses that fit
each other and that interactionally “pull” for each other. Thus,
attack pulls defensiveness or withdrawal, and affirmation pulls for
disclosure and revelation. The skill of congruent responding involves
not reacting in a complementary fashion to a negative
interpersonal “pull” of the client, like recoiling when attacked; but
rather, to act in such a way as to “pull” for a more therapeutically
productive response from one’s client, such as clear expression.
This would be achieved by an empathic understanding response to
an attack rather than by recoiling.
What to do when the therapist is not feeling affirming but is
feeling angry, critical, and rejecting and cannot get past this
feeling, to something more affiliative? As we have said, an interactional
response to be facilitatively congruent involves first connecting
with the fundamental attitudes or intentions of trying to be
helpful, understanding, valuing, respecting, and nonintrusive or
nondominant. This will lead to these feelings being expressed as
disclosures. If the interpersonal stance of disclosing the difficult
feeling is adopted, rather than the complementary stances of expressing
it by attacking, or rejecting, or seducing then this congruent
response is more likely to be facilitative. It is not the content
of the disclosure that is the central issue in being facilitative; rather
it is the interpersonal stance of disclosure in a facilitative way that
is important. What is congruent is the feeling of wanting to
disclose in the service of facilitating, and the action of disclosing.
The different ways of being facilitatively congruent in dealing with
different classes of difficult feeling thus are to some degree specifiable.
They all involve adopting a position of disclosing. Expressing
a feeling that could be perceived of as negative, in a stance that
is disclosing, rather than expressing it in the stance that usually
accompanies that feeling, will help make it facilitative because
disclosing is an affiliative and nondominant form of interaction
whereas being angry is clearly nonaffiliative and may be dominant.
Disclosure, implicitly or explicitly, involves willingness to, or an
interest in, exploring with the other what one is disclosing. For
example, when attacked or feeling angry therapists do not attack
the other but rather disclose that they are feeling angry. They do
not use blaming “you” language. Rather they take responsibility
for their feelings and use “I” language that helps disclose what
they are feeling. Above all they do not go into one up, escalatory,
positions in this communication, but rather openly disclose feelings
of fear, anger, or hurt. When the problem is one of the
therapists experiencing nonaffiliative rejecting feelings or loss of
interest in their clients’ experience, the interactional skill involves
being able to disclose this in the context of communicating congruently
that the therapist does not wish to feel this. Or therapists
disclose these feelings as problems getting in the way and that they
are trying to repair so that they will be able to feel more understanding
and closer. The key in communicating what could be
perceived as negative feelings in a congruently facilitative way is
to communicate it in a nondominant affiliative disclosing way with
appropriate nonverbals. Both timing and type of client need to be
considered in deciding whether or not to disclose.
Coaching as an Aspect of the Relationship
In addition to presence and being with the client, EFT therapists
also lead and guide client processing—an activity that we have
termed coaching. In EFT, certain client in-session problem states
are seen as markers of underlying emotional processing difficulties
that offer opportunities for differential interventions best suited to
help facilitate productive work on that problem state. Thus, if a
client enters a self-critical state, this is an opportunity to intervene
with a two-chair dialogue to resolve splits. The therapist is thereby
seen as setting a task for the client to work on. Therapeutic work
thus involves engaging clients in particular tasks suitable to states
that the clients enter into in the session.
We have come to view a therapist who works in this way as
emotion coaches (Greenberg, 2002). Coaches provide guidance on
how to process emotions and emotion-related problems in adaptive
ways. The therapist both promotes and validates awareness and
acceptance of emotional experience and coaches clients to engage
in tasks that promote new ways of processing emotion. Coaching
entails both acceptance and change. The nondirective following
style provides change toward acceptance of what is while the more
leading style provides guidance, introduces novelty and the possibility
of change.
Emotion coaching involves a partnership of coexploration in a
growth-promoting process aimed at helping people achieve goals
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354 GREENBERG
of emotional awareness, regulation, reflection, and transformation
(Greenberg, 2002). It involves facilitating awareness of emotions,
new ways of processing the emotion, and provides guidance in
ways of soothing or regulating the emotion. Awareness in turn
involves helping clients verbally label emotions while they are
being felt, helping them accept the emotion and talking with clients
about what it is like to experience an emotion. In addition, coaching
clients involves facilitating the utilization of adaptive emotions,
usually anger and sadness, to guide action and transform
maladaptive emotions usually fear, shame, or anger. It is important
to note that people often cannot simply be taught new strategies
conceptually for dealing with difficult emotions, but rather have to
be facilitated experientially to engage in the new process and only
later explicitly taught what to do. For example accessing anger or
a getting to an emotionally experienced need or goal may be very
helpful in overcoming a sense of depressive hopelessness or defeat.
However, explicitly teaching people that this is what they
should do is not nearly as helpful as interpersonally facilitating this
by asking them at the right time in the right way what it is they feel
or need.
Some clients, however, are extremely externally focused and
helping them contact their feelings can be challenging. A persistent
gentle pressure to focus on current internal experience is required
by means first, of empathic responding and emotion inquires, and
later, by process directives that focus the client’s attention on
internal experience. The client is encouraged to become aware of
internal experience and to develop mindful awareness (Perls, Hefferline,
& Goodman, 1951). Later process directives like suggesting
the client repeat key phrases that stimulate emotion in the
session can be used to intensify experience and make it more vivid.
A balance needs to be struck between allowing clients to tell their
story and tracking their reactions, and explicitly directing their
attention internally. Questions that are used in this phase and
throughout therapy are: What are you aware of as you say this?
What is happening in your body? What is it like inside right now?
Using empathic exploratory responses and emotion awareness
questions, the therapist therefore coaches clients to approach,
tolerate, regulate, and accept their emotional experience. Acceptance
of emotional experience as opposed to its avoidance is the
first step in emotion awareness work. Having facilitated the acceptance
of emotion rather than its avoidance, the therapist then
helps the client in the utilization of emotion. Here clients are
helped to make sense of what their emotion is telling them and to
identify the goal/need/concern which it is organizing them to
attain. Emotion is used both to inform and to move.
In addition, believing that clients cannot leave a place before
they have arrived at it, the focus in the relational dialogue is on
acceptance and validation of emotion rather than on modification
of cognition or awareness of, or insight into, interpersonal patterns.
It is only after validation of what is being experienced as shown in
the transcript below that transformation via accessing new affect
and creation of new meaning comes into play. The relational
emphasis is more on facilitation of strength than correction of
error.
Case Example
An example of a therapist responding to a client’s sense of
isolation after the loss of her father is given below to exemplify
the type of empathic attunement and exploration characteristic
of the relational style in EFT. A number of details of the client and
the situation have been changed for confidentiality.
T53: Do you think you could put your friend in the chair and
talk to her?
C54: No [pause]
T54: It’s really hard a one for you. [Pause] What are you feeling
right now?
C55: [small voice:] Scared. [ Vulnerability begins to emerge]
T55: [gently: ] Scared. [Pause] Uh-huh. Just so scared about . . .
C56: What will happen to the little [rueful laugh: ] relationship
that we have.
T56: Uh-huh, scared that if you assert yourself here, you could
lose her.
C57: What change will it bring in her, toward me. I don’t think
I could handle it. (T: mhm)
T58: “If I assert my feelings or if I express my true feelings of
anger toward her, will it ruin the shred of a relationship that we do
have? (C: mhm) Will it ruin the little bit of contact I do have.” It
might destroy even those little threads, and it’s so scary to think
about not having that relationship. (C: mhmm mhm)
C59: Yeah. It is such a risk. I don’t know if I can bear the loss.
Without her it’s like I would have nothing.
T59: Just a feeling that, “Without that connection I will be left
totally alone.”
C60: Yes, that’s how I would feel, totally alone, not anything to
anybody.
T 60: Uh-huh, without any value to anyone.
C61: Yes, it’s like feeling that I could die without anyone
knowing.
T62: No one would even know.
C62: Yes. I feel tight in my throat (T: mhm). My stomach hurts.
In the above segment, the therapist responds empathically to the
client’s vulnerability in a prizing and congruent manner. This helps
the client’s vulnerability emerge at C55, when she reports feeling
scared. The therapist validates the scared feelings, and in C59 the
client begins to articulate the unbearable sense of loss. This leads
her toward focusing on a bodily felt sense of pain and the therapist
as shown below guides her to regulate the feeling and to explore it
to access the implicit meanings.
T64: That’s good. [Pause] Good calming breaths [Pause] [Whispers:
] Take a minute, just to relax. Quiet down inside [long pause].
So there’s this feeling inside. What’s it like?
C65: Sometimes it’s just like I want to go crawl in my bed and
just stay in there and nobody bother me [ vulnerability emerges
further]
T65: Mhm, mhm. “I just want to shut my eyes and shut all the
pain shut out (C: Mhm, mhm) And shut all the people out. Yeah
(C: mhm). I just want to make all the pain go away.”
After a deepening to get to core vulnerability, the acceptance
and validation by the therapist helps the client stay with the painful
vulnerable feelings, while the therapist listens for what is worst or
most painful about the whole thing.
T68: What hurts the most right now? I know it’s really hard
(Pause). What part of it is hardest?
C69: It’s like I’m drowning, (T: [whispered:] drowning) and I
keep reaching up, and I’ve been struggling since I was a kid.
T69: [whispering:] Like you’re drowning, and a little piece of
you, one hand, one arm just keeps reaching up.
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RELATIONSHIP IN EFT 355
At the same time as witnessing and receiving the helpless
aspects of her experience and making vivid the depths of the
client’s despair, the therapist is listening for the genuine emergence
of adaptive emotions and for the wants and needs in the
personality. This begins to emerge above in the image of reaching
up and is developed through exploring feelings tied to an episodic
memory of a time in her childhood when she nearly drowned. She
then reorganizes into a more resilient state and begins to access her
need for contact and comfort and safety from others and begins to
reach out for it by saying “I would like to hold onto my relationships
with them (friends and siblings). There are moments when I
know I can make it. It’s just sometimes it feels so overwhelming
and I go to that place.”
Conclusion
People develop from infancy to their demise in relationships.
Relationships are crucial to healthy human development, and therapeutic
relationships are a major vehicle for personal growth and
development. In this article, I have argued that the relationship is
first and foremost an affect-regulating bond, one that is, in and of
itself, facilitative of psychological change and conducive to growth
and well-being. Second, the therapeutic relationship, characterized
by presence, empathy, acceptance, and congruence, helps clients to
feel safe enough to face dreaded feelings and painful memories.
These I have argued are universal principles of all therapeutic
relationships.
Empathic responding by therapists helps clients become aware
of their emotional experience, label it in awareness, and modulate
it so that it is not overwhelming or excessively muted so that its
message is lost. Empathic exploration facilitates the client turning
inward to explore and unpack their inner subjective world views
and feelings about events (Elliott, Watson, Goldman, & Greenberg,
2004). In addition acceptance in the mind of valued person
can have profound effects on physiological processes. Warmth,
compassion, openness, and respect toward the client’s experience,
caring for the client as a separate person, with permission to have
his or her own feelings and experiences, is a crucial aspect of a
therapeutic relationship. Warm, accepting, empathic relationships
with a genuine therapist lead to greater self-acceptance and cure
the pain of isolation.
In EFT, once an alliance, consisting of a warm bond and
collaboration between client and therapist, has been consolidated
and safety established, the therapist guides clients toward new
ways of processing emotion, coaching them to become aware of,
regulate, reflect on, and transform their emotions. It is in the
blending of these various elements of a curative relationship with
the facilitation of specific change processes that successful therapy
emerges.
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Received February 7, 2014
Revision received March 10, 2014
Accepted March 12, 2014
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