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Understanding the Effectiveness of Emotion-Focused Therapy (EFT)

Emotion-Focused Therapy (EFT) is a well-established therapeutic approach developed by Leslie S. Greenberg and Robert Elliot. It has gained recognition for its effectiveness in treating a range of psychological conditions. This article introduces the empirical support for EFT, its therapeutic process and outcomes, and the core principles guiding emotional processing in this approach.

Empirical Support for EFT

Research Base and Development: EFT is grounded in contemporary psychological theories and was developed through empirical studies focusing on the process of change in psychotherapy. Recognized as an evidence-based treatment, EFT has consistently demonstrated its effectiveness across various psychological conditions, including depression, marital distress, trauma, eating disorders, anxiety disorders, and interpersonal problems.

Effectiveness in Randomized Clinical Trials: EFT's efficacy has been validated through numerous randomized clinical trials, the gold standard for evaluating therapeutic interventions. These trials have shown EFT to be effective in both individual and couples therapy settings.

EFT and Depression Treatment:

  • EFT has been particularly effective in treating depression. In three separate studies, EFT's manualized form was used, incorporating specific emotion activation methods within an empathic therapeutic relationship. The studies found that:

  • EFT was more effective than client-centered (CC) empathic treatment and cognitive-behavioral treatment (CBT) in reducing depression symptoms.

  • EFT was more effective in reducing interpersonal problems compared to both CC and CBT.

  • EFT promoted more significant changes in symptoms than CC.

  • EFT had a high effectiveness in preventing relapse, with 77% of patients not relapsing after treatment.

Other Conditions: Beyond depression, EFT has shown promise in treating other conditions. It has been effective in addressing anxiety, trauma, interpersonal problems, promoting forgiveness, and resolving issues related to abuse. Emotionally Focused Couples Therapy, a branch of EFT, is recognized as one of the most effective approaches for resolving relationship distress.

The Therapeutic Process and Outcomes

Process of EFT:

  • Emotion as Fundamental: EFT posits that emotion is a fundamental aspect of human experience and self-organization. Emotions are adaptive processes that help individuals make sense of their experiences and navigate their environment.

  • Types of Emotions: EFT distinguishes between primary adaptive emotions, primary maladaptive emotions, secondary reactive emotions, and instrumental emotions. This differentiation allows therapists to tailor interventions to specific emotional processes.

  • Emotion Schemes: Emotions are organized into emotion schemes, complex structures formed through personal experiences that influence emotional reactions to various situations.

  • Therapeutic Relationship: The therapeutic relationship in EFT is characterized by empathy, genuineness, and unconditional positive regard, providing a safe space for clients to explore and process their emotions.

  • Marker-Guided Interventions: EFT interventions are guided by specific markers indicating the client's emotional state and readiness for different types of therapeutic work.

Outcomes of EFT:

  • Reduction of Symptoms: EFT effectively reduces symptoms of depression, anxiety, and other psychological conditions by decreasing maladaptive emotions and increasing adaptive responses.

  • Improvement in Interpersonal Relationships: EFT helps clients resolve interpersonal problems, improve communication, and develop healthier relationships. EFCT is particularly effective in resolving relationship distress.

  • Prevention of Relapse: EFT's emphasis on long-term emotional resilience and coping strategies makes it effective in preventing relapse, particularly in depression.

  • Enhanced Emotional Awareness and Regulation: Clients develop greater emotional awareness and learn to regulate their emotions more effectively, leading to improved emotional well-being and a stronger sense of self.

Principles of Emotion Processing in EFT

EFT's effectiveness is guided by six major principles of emotion processing:

  1. Awareness and Expression:

  • Increasing emotional awareness is fundamental in EFT. Clients are encouraged to identify and name their feelings, which reconnects them with their needs and motivations.

  • Emotional expression involves overcoming avoidance to access and express core emotional experiences. This expression is not about venting but accessing primary emotions.

  1. Regulation

  • Emotion regulation involves managing emotional arousal. This includes techniques for down-regulating distressing emotions and developing self-soothing abilities. A safe, empathic therapeutic environment is essential for this process.

  1. Transformation:

  • Transforming maladaptive emotions with adaptive ones is crucial. For example, transforming core shame with self-compassion or empowerment. This transformation is achieved through the activation of opposing adaptive emotions.

  1. Corrective Emotional Experience:

  • Corrective emotional experiences involve new, emotionally meaningful experiences that disconfirm old, maladaptive patterns. These experiences typically occur within the therapeutic relationship and help clients develop new, healthier emotional responses.


Emotion-Focused Therapy (EFT) is a robust, empirically supported therapeutic approach that emphasizes the centrality of emotion in human functioning. Through a structured process of increasing emotional awareness, expression, regulation, reflection, transformation, and providing corrective emotional experiences, EFT leads to significant therapeutic outcomes. These include symptom reduction, improved interpersonal relationships, relapse prevention, and enhanced emotional well-being. The principles guiding EFT interventions ensure that clients can process and transform their emotions, leading to long-lasting, positive change.


Elliott, R., Greenberg, L., & Lietaer, G. (2004). Research on experiential psychotherapy. In M. Lambert (Ed.), Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (pp. 493-539). New York: John Wiley & Sons.


Goldman, R. N., Greenberg, L. S., & Angus, L. (2006). The effects of adding emotion-focused interventions to the client-centered relationship conditions in the treatment of depression. Psychotherapy Research, 16, 536-546.


Greenberg, L. S. (2010). Emotion-Focused Therapy: A Clinical Synthesis. Focus: The Journal of Lifelong Learning in Psychiatry, Winter 2010, Vol. VIII, No. 1, 32-41.


Greenberg, L., & Watson, J. (2006). Emotion-Focused Therapy of Depression. Washington, DC: American Psychological Association.

Grosse Holtforth, M., Krieger, T., Zimmermann, J., Altenstein-Yamanaka, D., Dörig, N., Meisch, L., & Hayes, A. M. (2019). A randomized-controlled trial of cognitive-behavioral therapy for depression with integrated techniques from emotion-focused and exposure therapies. Psychotherapy Research, 29(1), 30–44.


Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773-781.

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