Introduction

Emotion-Focused Therapy (EFT) is an evidence-based psychotherapeutic approach that emphasizes the role of emotion in human functioning and therapeutic change. Developed by Leslie Greenberg and colleagues, EFT integrates principles from humanistic, experiential, and emotion theory to support emotion processing, leading to lasting change and growth.

This blog delves into and briefly highlights the scientific foundations of EFT and its 50 years of empirical research, across four key areas: Change Process Research and Task Development, Emotion Transformation as a Psychotherapeutic Change Mechanism and Outcome-Based Research.

Change Process Research and Task Development

The foundation of Emotion-Focused Therapy (EFT) is deeply rooted in the pioneering task analysis work conducted by Leslie Greenberg and Laura North Rice during the 1970s and 1980s, later joined by Robert Elliott. Their collaborative efforts aimed to dissect and understand the micro-processes that facilitate emotional change within psychotherapy sessions.

Task analysis, as developed by Greenberg and Rice, involves a systematic examination of therapy sessions to identify specific tasks and steps of change that lead to resolution of client difficulties, such as a strong inner critic or interpersonal conflict. This method comprises two primary phases: a discovery-oriented phase (where researchers build observationally based models of therapeutic change), and a validation phase (testing hypotheses to confirm the efficacy of these models).

One of their notable early studies focused on the resolution of intrapersonal conflicts using the Gestalt two-chair technique. They found that in successful therapy sessions, clients moved from expressing opposing internal voices to a phase where these voices began to merge, culminating in an integration phase marked by negotiation and resolution.

Additionally, Rice’s work on evocative unfolding provided insights into how clients re-experience and make sense of puzzling personal reactions. This task involves clients vividly recalling specific events to uncover underlying emotions and meanings, facilitating emotional processing and change.

These early task analyses laid the groundwork for the development of EFT by providing empirically supported models of how specific therapeutic tasks can lead to emotional transformation.

Emotion Transformation as a Psychotherapeutic Change Mechanism

Emotion-Focused Therapy (EFT) is built on the principle that maladaptive emotions – those learnt through unmet needs early in life – are easily triggered in adulthood and can keep us stuck or impede therapeutic change. EFT argues that these maladaptive emotions cannot be changed by logic or cognition alone. Rather, Leslie Greenberg emphasises that change occurs when clients access those previously avoided or suppressed emotions and transform them by experiencing new, more adaptive emotions “in the moment.” For example, adaptive assertive anger can help counteract feelings of helplessness leading to self-agency, and self-compassion can begin to dissolve entrenched shame. This concept is central to the therapeutic process and distinguishes EFT from cognitive-based models that prioritize thought restructuring or models that focus on behavioural modification.

Antonio Pascual-Leone has made substantial contributions to the theoretical and empirical understanding of this process. His research, particularly the Sequential Model of Emotion Processing (Pascual-Leone, 2018), delineates the predictable stages clients move through when engaging in deep emotional work:

1. Awareness and Accessing – The client becomes aware of and accesses primary maladaptive emotions.
2. Expression and Regulation – The emotion is expressed and managed within the safe container of therapy.
3. Reflection and Meaning-Making – The client reflects on the emotion and associated unmet needs to derive new meaning or insight.
4. Transformation – A new emotional experience emerges that reorganizes the client’s emotional and cognitive schema.

This model was empirically supported through process-outcome research that showed clients who reached the “transformation” phase were more likely to experience significant therapeutic gains (Pascual-Leone and Greenberg, 2007; Pascual-Leone, 2018). The research also demonstrated that bypassing or prematurely pushing clients through these stages can hinder change, highlighting the importance of timing, responsiveness and therapist attunement, as well as the depth of work identified and achieved in EFT.

Therapists use techniques like chair work, focusing, and imagery to facilitate emotional access and change. Crucially, emotional transformation is not about catharsis or attenuation, but about constructing new meanings and shifting core self-evaluations through emotion-based insight (‘connecting the head and the heart’).

Clinical Trials and Outcome-Based Research

Although early empirical work in EFT focused most closely on change processes underpinning the approach, outcome-research now reinforces the effectiveness of Emotion-Focused Therapy (EFT) across diverse clinical populations and in real-world practice (Kramer et al., 2025). For example, a randomized controlled trial by Timulak et al. (2022) compared EFT with Cognitive Behavioural Therapy (CBT) for treating Generalised Anxiety Disorder in primary care. The study found that EFT was as effective as CBT in reducing anxiety symptoms. Moreover, EFT had significantly fewer therapy dropouts than CBT (10% versus 25%), suggesting that EFT is a viable alternative treatment for GAD.

EFT is a core component of person-Centred Experiential Counselling for Depression (PCE-CfD), a high intensity psychological therapy offered in the English National Health Service (NHS) Talking Therapies. It is the second most frequently offered individual therapy after cognitive behaviour therapy (CBT). In a pragmatic, noninferiority randomised controlled trial (PRaCTICED trial; Barkham et al. 2021) found that at 6-month post-randomisation outcomes for PCET-CfD were noninferior to those for CBT, again highlighting the comparability of EFT with CBT. Additionally, research has explored the integration of EFT components into other therapeutic modalities. For example, a randomized controlled trial by Berking et al. (2019) examined the impact of integrating EFT techniques into cognitive-behavioral therapy for depression. The study found that the integrated approach led to significant improvements in emotional processing and symptom reduction, highlighting the versatility and applicability of EFT principles across different therapeutic frameworks.

Collectively, these (and many other) studies underscore EFT’s versatility and effectiveness across various disorders and settings, highlighting its potential as a robust therapeutic approach for emotional and psychological well-being.

Summary

Emotion-Focused Therapy represents a robust, empirically supported approach to psychotherapy that emphasises the central role of emotion in human functioning and change. Through meticulous research on therapeutic processes, a focus on transforming maladaptive emotions, and a solid foundation of clinical trials, EFT offers a scientifically grounded, effective and comprehensive framework for facilitating emotional healing and personal growth.