Emotion-Focused Therapy - Training & Evolution

O convidado nesta nova gravação, em torno da Terapia Focada nas Emoções, é o Professor Leslie Greenberg, psicoterapeuta, investigador e Professor  da Universidade de York, Toronto .

A entrevista  teve lugar a 26 de Junho de 2011, em Lisboa, com contributos de J.Serra e J. Salgado, e segue a seguinte estrutura:

Part I - EFT Training
Part II - Evolution and final questions

PDF com transcrição disponível.

This Emotion Focused Therapy Interview with Leslie Greenberg took place in Lisbon the 26th June 2011. It's  structured in two parts:

Part I - EFT Training
Part II - Evolution and final questions

PDF Transcription available.

A.H.: Dear Professor Les Greenberg thank you so much for accepting to have this conversation. As a psychotherapist I have been learning from your books since decades – from your articles and video sessions and it’s an honor for me to host you here in Lisbon.
 
Emotion Focused Therapy (EFT) now has a new website – as much as I know – the Emotion Focused Therapy Clinic – dedicated to the training and the certification of EFT, right? Could you tell us a little bit about how this EFT training and certification program started?
 
L.G.: Firstly I should mention it’s not exactly dedicated to certification...
 
A.H.: OK.
 
L.G: … and this is quite a complicated issue because I have complex feelings about certification. But it is dedicated to training and then there’s a strong push from people to wan certification.
 
A.H.: Yes! They love certification! They do.
 
L.G.: Yes, yes. And my younger colleagues all think it’s important to certify people but I’m actually opposed to certification in principle. But I think it’s probably necessary.
But yes. So at York University we have a psychology clinic for the community at large, which was recently set up by the psychology department and within that we’ve created an Emotion Focused Therapy Clinic dedicated to training and ultimately - and it has only been going for two years and this whole work is at the second year. So we want to, also do an externship there so that people can come and actually get supervision and so on. But otherwise we do trainings based there but also I do trainings all around the world.
 
A.H.: All around the world, yes.
 
L.G.: And there we have three levels of training - level 1, 2 and 3. But, you know, my belief is that it takes many years to make a psychotherapist and to train and so on, so…
 
A.H.: I very much agree with you. So how do trainees progress in a EFT training usually? How long does this process takes and how many years on average does it takes to complete the training? Are there major difficulties or obstacles?
 
L.G.: Well, I mean the main group of people who I trained initially where all my students at the University and some colleagues and they really where with me for six to eight years and little longer. And then the trainings that we do - you see, it’s very different in different contexts. In North America training is done within a PhD program, in Europe it’s done outside and it’s actually a more intensive psychotherapy training. So it’s not possible in North America, we haven’t yet set up like a two-year training program. So in Canada what we have: a four day level 1, a four day level two, then supervision and then level three is a supervision, group supervision where people come and bring tapes. But I really recommend supervision as a very important part of the training process. But people are free to seek that as they choose, right? In Europe we’ve been setting up a two-year training programs. I think that’s more substantial. I mean, there are three difficulties: one is people generally need to be trained in empathy at a deep level but they don’t believe that they need to be trained in that. So there are some processes by which people come to learn that they need to. This is not true with students - when we start with students they do one or two years of training basically in empathy. I mean, when you say,  “are there difficulties” I think the issue is their training has to be experiential. You have to work with emotion and you have to work with yourself. So, I mean, that’s not a difficulty. Usually people are aware when they come in. So the training is personal where people are clients – they don’t role-play plans  - they’re actually working on their own issues.
 
A.H.: Their own selves…
 
L.G.: Their own selves. So, you know, that’s a complicated ..
 
A.H.: Process..
 
L.G.: .. form of training, yes.
 
A.H.: Yes. So as a more ambitious model promising a deeper and enduring change, could we say EFT is a model that is more difficult to practice and eventually is a model that is more difficult to teach and train?
 
L.G.: Yes, definitely. I mean, you see, it depends what’s there to contrast. There was psychoanalysis on the one hand which I think was complicated and required five years of analyses so… and then there was CBT on the other hand, which produced modules and people got this idea that we could train briefly and it was a set of strategies. So, I mean, I see EFT as much more complex than the modules but not as demanding as a psychoanalytic training. But I would say that two years is a sort of basic unit of time that you need to train. And yes, the skills are quite complex so that it takes a long… I mean, two years is a minimum and then you keep learning and developing.
 
A.H.: A minimum of two years, yes. EFT is structured around different tasks: process tasks, relational, empathy based tasks, experiencing tasks, process tasks, enactment tasks – the chair ones. From your experience are there fundamental principals or tasks that somehow are more complex and difficult to teach and train?
 
L.G.: That’s an interesting question and I mean, in some way empathy is probably the most difficult to train but the simplest to train in. I mean, because it’s just… but to actually develop this sort of, this capacity to truly be empathic is extremely complex and we don’t really know how to train in that. We can train in the enactment tasks and the other tasks because they’re all things that you do whereas… I mean I’ve written papers called ways of being and ways of doing and ways of being are much more complex…
 
A.H.: Of course.
 
L.G.: And ways of doing are easy to teach. But the chair dialogs are also… I mean, I do see the self critical work and unfinished business work as the most central and the most fundamental because I think they’re universal problems that people suffer from, regardless of the kind of problems that they come in. And those are complex to teach as well.
 
A.H.: As well, hum-hum. How do the training in EFT progresses in Europe? - I’ve heard that you are now training a lot in Europe too, as well as Elliott and others of your model. And what opportunities are there for the training?
 
L.G.: Well, I mean, we are doing trainings in different countries now and the model that I’m trying to develop is a two-year training program. So there’s one in Germany and there’s one in Norway. I’m doing a lot of variants Switzerland and Robert Elliott and Jeanne Watson are doing a training program in the Netherlands and they’re starting a two-year program in Italy, in Rome. Those are sort of training programs but the problem is that they’re in English but some of the training goes on in the language of their country. We’re not directly supervising people usually in a group.
 
A.H.: Oh, there are local supervisors.
 
L.G.: Or, no, even when we’re there sometimes they talk in their own language when I’m not directly with the group because we break into small groups, or I’m not in the room then they work in their own language. When the trainer comes into the room they turn in to it.
 
A.H.: OK. To English.
 
L.G.: So… Yeah but we are also trying to develop local supervisors in local languages and of course, there’s a possibility of trying to develop something here in Portugal.
 
A.H.: Hum-hum. And how has been your training experience in Portugal and Spain? - I know that you also visit Spain often - Do you find exactly the language somehow an obstacle for the training?
 
L.G.: I haven’t but, you know, because I do it in English and the people do it in English so it actually works quite well and in fact it seems to me - I mean, I think this is accurate – that Portuguese are more, have greater facility in English than I’ve experienced in Spain. And in Spain I’ve done some minimal training but there hasn’t been a major effort to get a training program of the ground so… there hasn’t been as much of a following in Spain.
 
A.H.: OK. As much as I know there is no institute or organization devoted to EFT training and promotion. Why is that? I know that somehow when you developed the EFT method you suffered the pressure to give it a name and that you would prefer not to add another model to the already crowded world of psychotherapy models…
 
L.G.: Right, right.
 
A.H.: … has anything to do with this?
 
L.G.: Yeah, I think so. I mean I started off studying how people change. I mean, I did have a commitment to a humanistic approach but I’m much more interested in really understanding how people change and develop in those kinds of methods. So the school wars are not attractive at all and then creating another school - EFT - was not what I really wanted. But then, there are a lot of political forces involved - this is very political. And then also when we created Emotion Focused Couples Therapy and we did an outcome study – because I didn’t believe in outcome studies as much as process studies – but I saw how quickly that became recognized and how much attention we’ve got because it was an outcome study and because it had a name. Eventually I decided that it was necessary to do that. Of course we first also called the individual therapy process Experiential Therapy, staying within the humanistic kind of framework but eventually I felt that it was very important to call it Emotion Focused Therapy because that’s what we were focusing on and also because that was a contrast with Cognitive Therapy.
 
A.H.: OK, so you don’t really feel that EFT needs an organization to facilitate…
 
L.G.: I mean I just was not organizationally motivated. I mean there where too many other things too much… so, we are now discussing and have decided that we will create an international society – I would like to call it the International Society For The Study of Emotion Focused Therapy.
 
A.H.: OK!
 
L.G.: And that will include people around the world who are studying or training in EFT. So, I mean, there is this evolving need to do that but there’s an interesting story, which is Rogers never wanted to form a Rogerian Society and Client Centered Therapy essentially died in North America. In the Netherlands, in Germany they created Client Centered organizations and Client Centered lived on there. So you do need organizations in order for people to organize essentially but it’s not where my talent or interest lies. 
 
A.H.: I see. OK, before we turn our topic into EFT evolution, do you want to add anything on this topic of training?
 
L.G.: No, no. No, thank you.
 
A.H.: Ok, so we turn our topic.

Part II - On EFT Evolution


A.H.: OK. Les when did you in your both personal and professional life did you start considering that emotion is in fact a central element on human functioning?
 
L.G.: Well, I came in to psychology in 1970 and I had been an engineer and I think… and psychology had hardly anything on emotion. I came in with an interest in the idea of tacit knowledge, of tacit knowledge. And my explorations there sort of led me to that we know more than we can say and what is this knowing and that somehow became emotion was an important part of that knowing. So, but I think clearly I had an intuitive  sense that emotions were important in my life. And that’s what probably led me into psychology.  But I think it would be in 1970 that I would say I really – that’s when I entered psychology – I started to see that nobody talked about emotion and I thought emotion was really important! And William James had written this that my experiences, what I select to attend to – when I was in graduate school I wrote a major paper with that just in the title and so, I was really first following tacit knowing and experience of selective attention. But eventually it became clear to me that emotion was at the center of human experience. But it was definitely in graduate school.
 
A.H: You said we are wired to have emotions and we are also wired to be afraid of emotions because emotions can be very painful. Emotion avoidance is a significant problem as you know and write that is in part resolved in a safe relationship, right? So I don’t resist this question: how can feeling bad lead to feeling good?
 
L.G.: Right so I think that in order to change emotion we have to first experience it – it is to say you have to feel fear in order to change fear; you have to feel shame in order to change shame. So we really do have to arrive at it and then we have to become aware of it, to symbolize it, make sense of it. But then we need to change it and as I have proposed I think the best way to change emotion is with other emotion. So, the point is that you have to feel bad in order to feel good because you’ve got to get to the emotion in order to make it accessible to transformation or to new input. And you can’t just get to it and then quickly move away from it! You actually have to accept it – I think that’s a very first thing. But acceptance is not enough. You ordinary need to change it and that you need to bring in other things. But, I mean, that’s why I think feeling bad or how feeling bad leads to feeling good. And I think in every emotion is embedded a need – a need or a goal. I mean emotions really are goals towards something because each emotion is designed to achieve some sort of aim that aided survival. And so to get to the need of yours you have to go into the bad feeling and really eliminate what the need is.
 
A.H.: Yes. So, yesterday at your workshop you have said that you don’t see attachment styles in clients - that you see emotions and needs. Could we assume that you don’t believe that attachment needs or styles have such a central role in our lives and are there any clinical implications from this assumption?
 
L.G.: I think attachment needs are important and, I mean, they’re certainly important in children. But what an attachment need is, is a very complex thing and I’m arguing that emotion is more… at emotion regulation or the motivation to regulate your affect is more fundamental than is the attachment need. So, attachment styles have never been that of greate interest to me - I don’t believe in trait theories and major characterization of styles because I think people are complex person-situation-interaction organizations. So it’s just an over simplification of the complexity that’s really there. I mean, sometimes it acts has  organizing principles at a high level to say you’re insecurely attached but, as I say– I’m securely attached, I’m insecurely attached, I’m dismissively attached, I’m anxiously attached. I mean, I’m a different thing at different times.  So, I think that, I mean, the implications for practice for me are that I think emotions are more concretely available and sort of visible and therefore  you can work with them. So I can work that you are anxious that you’re sad, that you’re angry and I don’t really need an idea that this is attachment as such! But I do believe people need people and that we’re highly interpersonal and that is a motivation to want to be connected. So, I was introduced to object-relations theory where’s the basic drive was to be related to others. I think that’s slightly different than to be attached to others.
 
A.H.: OK, hum-hum.
 
L.G.: So I would say I believe strongly in an interpersonal motivation. But still, I think emotion is the most fundamental process in human nature.
 
A.H.:  How do you see the future of EFT in the next years? What would you desire EFT to be in the next decades? Are there more therapeutic tasks to be mapped or validated? And for instance EFT applied to children or EFT self-help books? How do you see these developments?
 
L.G.: You know, in a long future I would hope that emotion was studied as a process as well as cognition, behavior, interaction, motivation and so that EFT wouldn’t really need to exist has EFT.  But I think that the realistic context, as it is right now it does need to exist as a… and, I think, yeah, one of the other things that I would really like to see is more tasks being identified and studied with task analysis. When I developed task analysis I thought it was the best thing in the world, lets say (laughs). It’s never really been picked-up and used and I still think it has very great potential as a way of truly studying what happens in psychotherapy. And qualitative analysis sort of became very popular, task analysis includes some qualitative analysis but I’m not that impressed with it as a way of truly trying to study how people change. So, I would like to see much more of that going on but not to deemphasize the importance of the empathic relationship. So, there’s always to carry those two.
 
A.H.: Yeah, to keep the balance. Hum-hum.
 
L.G.:  I think the application of how to work with emotion with different populations is an important direction. Right now there are different groups studying anxiety and different anxiety disorders and then I’m also working on developing a preventive program - emotional competence, emotional literacy training programs. But that’s difficult because it’s hard to psycho educate in experiential domains where people really need to experience. I think its application to children and adolescents will be very good – we haven’t developed that. So, these are all future directions but I think my hope is that more people will train and then more people will get supervised by people who have been trained so that there will be a proliferation of therapists that are working with emotion in an informed manner.
 
A.H.: Good. Well Les Greenberg, thank you so much for your time. It was wonderful. Thank you so much again.
 
L.G.: Thank you, thank you.