Leslie S. Greenberg - Clinical Handbook of Emotion-Focused Therapy

RHONDA N. GOLDMAN

Fritz Perls and Carl Rogers did not likely ever sit down and have coffee together, but perhaps they should have. They might have shared a conversation after shooting the Gloria films. If they did, little of that conversation was ever recorded or published. Although both pioneers therapeutic approaches are associated with and emerge from the humanistic tradition, thus sharing a number of important common philosophical principles and assumptions, it is doubtful that they saw their therapies, gestalt and client centered, being integrated. This is in a sense what happened, however, in the creation of emotion-focused therapy (EFT).

In 1970, Leslie Greenberg, having recently immigrated to Canada from South Africa, entered graduate school to study clinical and counseling psychology at York University in Toronto. He had previously completed a masters in engineering but did not feel content to make a career of it. It was at York that he met his mentor, Laura Rice, a professor at the university and herself an immigrant from the United States, where, during the 1950s, she had studied under Carl Rogers before making her way to Canada. As a faculty member at York, she conducted research within the client-centered approach.

Over the next 20 years, Rice and Greenberg worked together to create the events-based paradigm that in many ways revolutionized the field of psychotherapy research. The debate over the Dodo Bird Verdict (Luborsky, Singer, & Luborsky, 1975) was raging. Some researchers claimed that all therapies were essentially equivalent and that change should be attributed to common factors across psychotherapy models, whereas others claimed that specific techniques used in specific therapies for different disorders accounted for change. Many were calling for an end to the horse races. Psychotherapy research was beginning to focus not just on outcome, specific disorders, and particular client groups, but also on the relationship between what happened during therapy and outcome (Orlinsky & Howard, 1978). In this endeavor, some thought it best to study the content of therapy (e.g., how many times in a therapy session do you mention your mother; Marsden, 1971), whereas others were advocating for a new paradigm to study the process in relation to outcome (Kiesler, 1973).

Rice and Greenberg were strong advocates for the study of psychotherapy process, not only in in relation to overall outcome, but also to small outcomes, which could themselves be broken down into in-session and postsession outcomes. In 1986, Greenberg published a seminal paper that advocated for the study of in-session change process research that took both in-session context and the therapeutic relationship into account. This was followed by a research handbook, coedited with William Pinsof, that spelled out how to conduct process research (Greenberg & Pinsof, 1986) and further emphasized the importance of change process research. This built on the ideas that Greenberg and Laura Rice articulated in the book Patterns of Change (Rice & Greenberg, 1984). The paradigm promoted more idiographic study of therapy as both a supplement and an alternative to existing outcome research approaches and integrated qualitative methods with quantitative methodologies to provide a rich picture of the therapy change process and its relationship to outcome.

Out of the events-based paradigm, task analysis emerged, a specific research methodology that Greenberg (Rice & Greenberg, 1984) in part imported from engineering and in part from cognitive science through an important academic collaboration with Juan Pascual-Leone (Greenberg, 1984). Task analysis represented a new, rationalempirical method for the intensive analysis of psychotherapy events and held the promise of providing greater understanding and specification of productive client performances and the interventions that facilitate them. It was with task analysis that EFT researchers were able to specify the many markers and therapy tasks interventions that occur in the course of EFT. This would become an important line of research for Greenberg and collaborators (Elliott, Watson, Goldman, & Greenberg, 2004; Greenberg & Pinsof, 1986; Greenberg, Rice, & Elliott, 1993), resulting in the development and refinement of a unique, integrative psychotherapy model called EFT.

In his tenure at the University of British Columbia (19751986), Greenberg built three important collaborative academic relationships that proved fruitful and productive. It was during these early years that Greenberg began to study emotion, originated the theory of EFT for couples, and developed the Working Alliance Inventory.

Building on the humanisticexistential principles inherent in the therapeutic approaches of Rogers, Perls, and Gendlin (Rogers, 1951; Perls, 1969, 1973; Gendlin, 1981, 1996), Greenberg became interested in the developing field of emotion theory (Arnold, 1960; Fridja, 1986; Izard, 1977; Tomkins, 1962). He intuitively understood and believed that emotion was a primary source of motivation and regulation in human functioning and saw this as implicit in the theories of Rogers, Perls, and other humanistic theories. He saw that emotional responses, not cognitions or beliefs, prompted primary evaluations of goal attainment success and signaled the personal significance of events for clients, and as such should be the focus of therapeutic intervention. Working with then-graduate student Jeremy Safran, Greenberg published Emotion in Psychotherapy (Greenberg & Safran, 1987), an initial articulation of the principles of working with emotion in therapy. A key development here was the distinction between different types of emotion. It was recognized that not all emotions serve the same function and that a differential model of emotion was needed. Thus, primary adaptive emotion responses were seen as direct reactions consistent with the immediate situation that help the person take appropriate action, whereas primary maladaptive emotions, although also direct reactions to situations, were seen as associated with negative learning experiences and no longer helping the person cope constructively with the situations that elicit them. Secondary reactive emotions are covers or defensive emotions that obscure or transform the original emotion and lead to actions which are, again, not entirely appropriate to the current situation. Instrumental emotions are emotions expressed to influence or control others.

Influenced by his time spent at the Mental Research Institute in Palo Alto studying and working with couples and families, Greenberg came to see emotion as a primary communication system in couples. At the same time, Greenberg was also impressed with the importance of cycles and the power dynamics in the relationship. His interest in studying couples had evolved mainly from his research, begun in his doctoral years on how individuals resolved intrapsychic conflict, in which he found that softening of the critic led to resolution. From his perspective, the EFT for couples process looked very much like intrapersonal conflict resolution, but now it was a critical or blaming partner who softened and a withdrawn partner who revealed. He received a grant from the Social Science and Humanities Research Council of Canada to study how couples resolved conflict, and it was from this that the EFT for couples therapy manual and the first outcome study were developed. It was the integration of his work on emotion with his training with Virginia Satir and his work at Palo Alto with systemic therapists that led to the innovative development of emotionally focused couples therapy that was later tested in his graduate student Susan Johnsons dissertation (Greenberg & Johnson, 1988; Johnson & Greenberg, 1985). At the heart of the theory was the revealing of underlying vulnerable primary feelings and circular interactions around closeness (attachment) and dominance (influence). Both emotion and interaction, and affiliation and influence, seemed important to help conceptualize, understand, and treat couples. As noted in the Preface, Susan Johnson later developed the therapy with a strong emphasis on the attachment piece (Johnson, 2004). Further theoretical developments in EFT for couples are outlined later in the chapter.