Therapy approaches, explained

Emotion-focused therapyEFT

Emotion itself isn't the problem: it carries information about what we need. Trouble tends to come from not hearing it, being swamped by it, or being stuck in an old emotion that no longer fits.^[2,3]

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What was that anger a signal of? How emotion-focused therapy sees emotion

Have you ever been through this: you arranged dinner with your partner at seven, and they turn up at half past. The moment you see them you blurt out, "You're always late!", and the whole evening goes stiff. Yet that was never the thing you most wanted to say. That flash of anger came so fast: what was it actually saying? And why does saying it leave you further from what you wanted?

1The worldview

That anger is a signal: three principles, awareness, regulation, transformation

To answer the opening question, start with how this approach understands emotion. Emotion-focused therapy (EFT) was developed by Leslie Greenberg and colleagues at York University in Canada, and was first called process-experiential therapy. It has three sources: the warm, empathic, accepting relationship of person-centred therapy is the foundation of everything; the chair dialogues of gestalt therapy and Gendlin's focusing (attending to bodily feeling) are two ways of working; and contemporary emotion theory ties them together.^[1,3,4]

EFT's central view is that emotion is fundamentally adaptive: a tool that helps us deal with our situation. In an instant it processes a great deal of information, tells us what matters and which needs are unmet, and moves us to act. So the therapist works like an emotion coach, helping you become aware of, accept and make sense of your emotions. As Greenberg puts it, you cannot leave a place until you have arrived at it: to change an emotion, you first have to really feel it. And once you have felt it, how does it change?^[2,3]

EFT's answer is "changing emotion with emotion": when an old, stuck emotion such as shame or fear is fully felt and the unmet need beneath it is reached, newer, more empowering emotions such as assertive anger, compassion for oneself or grief for what was lost can emerge, sit alongside the old one and gradually change it. Research has observed this order in productive sessions: from global distress, through fear and shame, to voicing needs, and on to the more developed emotions above.^[5,6]

So on that evening, "You're always late!" led only to a standoff: the anger was spoken before it had been heard. You have to arrive at an emotion before you can leave it, and Greenberg divides work with emotion into two phases, arriving and leaving. Arriving rests on the first two principles: become aware of the emotion and put it into words, then feel it at a level that doesn't overwhelm. Leaving rests on the third: let a new emotion transform the old one. They aren't done once in order; therapy moves back and forth between them.

AwarenessPut into words what you are really feeling now
RegulationFeel it, without being swamped or going numb
TransformationLet a new emotion change the old one

What is under that anger? Telling secondary emotion, primary emotion and need apart

The first step of awareness is telling which kind of emotion you are feeling, because EFT doesn't treat every emotion the same. The feeling that shows first often has an earlier one underneath, and that one points to a need. The therapist listens carefully for which kind it is before deciding how to respond. The three layers below go back to that opening evening: you are waiting for your partner at dinner, and they arrive half an hour late.^[3,7,23]

One more type of emotion: instrumental emotion, shown in order to influence others (tears to win sympathy, for example), whose role in the relationship the therapist explores. And anger isn't always secondary: anger at being violated is the primary emotion that protects us. So the name of an emotion alone doesn't tell you which kind it is. Research found that fewer secondary and more adaptive primary emotions in the working phase of therapy predicted better outcomes.

1Secondary emotion
A reaction to another feeling that covers the one that came first, such as anger over hurt, or anger at yourself for being afraid. The therapist explores it with you to find what lies beneath.
Anger: "You're always late!"
2Primary emotion
The first, most direct reaction to a situation, of two kinds. An adaptive primary emotion is a useful signal, to be accessed and used. A maladaptive one is an over-learned response from past, often painful experience that no longer fits, such as shame left by years of being put down; it has to be felt first, and then transformed.
Hurt: "It's like I don't matter to you."
3Need
The unmet need a primary emotion points to, such as to matter, to be safe or to be connected. Voicing the need is often the turning point.
To matter

2The method

Once you can tell them apart, how does therapy proceed? Marker, task, resolution

Telling the layers apart is so that the therapist can decide what to do. EFT has no fixed session-by-session steps; what makes it systematic is that it is marker-guided. The therapist follows you empathically while listening for a particular kind of difficulty you show in the moment (a marker), then offers a task to match it, such as two-chair dialogue when they hear harsh self-criticism. Each task has research-mapped steps and a recognisable end point (the resolution). These three parts map onto the three principles above: the marker is the difficulty you become aware of that most needs attention now; the task lets the emotion be felt without swamping you (regulation) and begin to change (transformation); the resolution is what transformation looks like once it has happened. Back in that evening, "You're always late!" is the marker. The therapist proposes; you decide.^[3,4]

1MarkerA difficulty you show in the moment, such as a harsh self-criticism or lingering resentment towards someoneAwareness
2TaskThe way of working that fits it: two chairs, the empty chair, focusing, self-soothing…RegulationTransformation
3ResolutionA recognisable end point, such as the critic softening, letting go of resentment, more self-acceptanceTransformation

That opening evening: one late arrival, from anger to need

1You arranged dinner with your partner at seven. They turn up at half past.

Staying on the surfaceAfter reaching the feeling underneath

Awareness: what you feel

Staying on the surfaceOnly anger

After reaching the feeling underneathUnder the anger, hurt: "It's like I don't matter to you."

Need

Staying on the surfaceFor them to admit they're wrong

After reaching the feeling underneathTo know that you matter

Transformation: what you say

Staying on the surface"You're always late!"

After reaching the feeling underneath"Waiting that half hour, I felt like I didn't matter. If you're going to be late, could you tell me first?"

Afterwards

Staying on the surfaceThey get defensive and you argue

After reaching the feeling underneathThey can hear you more easily, and know what to do next time

That is the answer to the opening question: the anger was speaking for hurt, but what came out was the anger, not the hurt. Set against the method above, "You're always late!" is the marker; the task is to explore what lies beneath the anger (the first dialogue below shows how that moment goes); and the "after reaching the feeling underneath" column is the resolution. Here the anger is secondary, covering hurt. Voicing the hurt and the need reveals rather than blames, and the other person is more likely to respond with care than to withdraw or hit back. Find your own layer with the emotion-awareness exercise

3The skills

What does therapy actually do? Six tasks, serving the three principles

The tasks described above are these six ways of working. They aren't a fixed sequence: when you show a particular marker, the therapist offers the one that fits best, so each entry says when it is used. They are grouped by the principle each mainly serves. The two chairs have different jobs: two-chair work is for a split inside you (the critic and the criticised self), empty-chair work for unfinished business with a particular person.

Awareness: finding the emotion and naming it

Start from the body and the experience of the moment, and slowly put a vague feeling into words.

Finding the feeling underneath
This is the groundwork for every other task, and useful at any point. EFT's most basic work is empathic exploration. Rather than analyse or advise, the therapist uses tentative reflections and questions ("what does it feel like inside right now?", "where is it in your body?") to go with you to the edge of the feeling, telling the secondary layer from the primary one and finding what it needs. Every guess comes with "is that right?", and you correct it.^[2,3]
Try the emotion-awareness exercise
Hear it in a session
1. Client
  He was half an hour late again. As soon as I saw him I said, "You're always late!" and the whole evening was tense.
2. Therapist
  The moment you saw him, the anger just came out.
3. Client
  Yes. I think I have a right to be angry.
4. Therapist
  Mm, of course you can be angry. Talking about that moment now, what does it feel like inside?
5. Client
  …My chest is tight.
6. Therapist
  Tight in your chest. Can you stay with that tightness for a moment? If it could speak, what would it say?
7. Client
  Something like… "Here we go again."
8. Therapist
  "Here we go again"… I wonder if, under the anger, there's some hurt too? I might be wrong.
9. Client
  Not exactly hurt… more like fear. Scared that I come pretty low on his list.
10. Therapist
  Scared that you don't matter to him. Is that it?
11. Client
  (Pause) Yes. Saying it, I don't want to shout at him so much, but I feel a bit like crying.
12. Therapist
  Underneath that fear, what do you most want from him?
13. Client
  To know I matter to him. Though I'm still a bit angry.
14. Therapist
  The anger and the fear are both there, and both are real. This week, if that anger rises again, would you be willing to pause and see whether there's another feeling underneath?
15. Client
  OK, I'll try.
Notice: This is that opening evening, replayed in session, showing awareness: from anger (secondary) to fear (primary) to need. The therapist never explains "what you're really feeling is…"; they reflect, ask about the body, then offer a guess that can be turned down. The client corrects it (not "hurt" so much as "scared I don't matter"), and the therapist takes up her words. The anger isn't treated as wrong; it is still there. The session ends with something to notice, not advice.
Method based on^[2,3]
Focusing: listening to the felt sense
When a feeling is vague and hard to name (like the anger at the start, with no words yet for what lay beneath), EFT borrows Gendlin's focusing: bring attention to the chest or stomach, sense how the whole matter feels in the body (the felt sense), let a fitting word or image arise, and check it back against the body. When the word fits, there is often a small bodily release, a felt shift.^[3,8,9]
Unfolding a puzzling overreaction
When you react to something small far more than you can explain (like that opening evening: why did half an hour's lateness stiffen the whole night?), the therapist asks you to slow down and go through the moment again as if in slow motion: what you saw and heard, what happened in your body, what that trigger meant to you. The aim is to see the meaning behind your reaction, not to prove it unreasonable.^[3,10]

Regulation: feeling without drowning

Steady yourself when the emotion is too strong, draw closer when it is too faint, and find a distance you can work at.

Clearing a space and self-soothing
When there is too much going on, the therapist may first help you clear a space: name each thing weighing on you and imagine setting it at a comfortable distance, so you can focus. When anguish is strong enough to get stuck in, the therapist helps you practise meeting your own pain with compassion, which brings bodily relief and a sense of strength. The therapist's steady, empathic presence is part of regulation too.^[3,5]

Transformation: changing emotion with emotion

In chair dialogues, let the old emotion meet a new emotion and need.

Two-chair dialogue: answering the inner critic
When you criticise yourself harshly ("I'm useless"), the therapist may invite you to use two chairs so the critic and the criticised self can talk: say the criticism from one chair, then move to the other and say how it feels to hear it and what you need. The criticised side often moves from hopelessness and shame towards standing up for itself; the critic sometimes softens, showing care or revealing what it is afraid of. A dialogue can last tens of minutes and usually recurs over several sessions.^[11,13,14]
Hear it in a session
1. Client
  My report got sent back again. I'm so useless; everyone at work does better than me.
2. Therapist
  It sounds like there's a voice in you scolding you, and another part of you taking it. Shall we try something a bit different? Two chairs, so the two parts can talk. It may feel odd at first, and you can stop any time.
3. Client
  …OK, let's try.
4. Therapist
  Sit in this chair and be the critical voice. Across from you is you. What do you say to him?
5. Client
  (Critic) You've messed it up again. You're lazy. You'll never catch up with anyone.
6. Therapist
  Be more specific. Tell him how you see him.
7. Client
  (Critic) Everything you do is half-done. Sooner or later people will see through you.
8. Therapist
  OK, now come and sit over here. Hearing all that, what do you feel?
9. Client
  (Self) …I want to curl up. Like I can't lift my head.
10. Therapist
  Wanting to curl up, head down. Where do you feel that in your body?
11. Client
  (Self) My shoulders are heavy, my chest too.
12. Therapist
  Being spoken to like that, what do you need from him? You can tell him directly.
13. Client
  (Self) I've been trying really hard. I need you to stop, and not tear into me every time.
14. Therapist
  Say it once more, and notice your voice as you do.
15. Client
  (Self, voice steadier) I've been trying really hard. Stop tearing into me like that.
16. Therapist
  Back to the critic's chair. Hearing him say that, how do you respond?
17. Client
  (Critic, after a pause) …I'm just scared you'll fail, that people will look down on you. Still, you need to try harder.
18. Therapist
  So you're scared he'll fail. Let's stop here and come back to your own chair. How do you feel now?
19. Client
  A bit lighter. The voice is still there, but it doesn't feel quite so loud.
Notice: This is two-chair work, showing transformation. The marker is the self-critical voice: the therapist hears it, asks consent and says the client can stop at any time. The critic is asked to be specific; the criticised side moves from bodily feeling to need and says it to the critic. The critic softens only partly, showing the fear underneath while still demanding "more effort": one dialogue rarely resolves it, and the work usually recurs over sessions.
Method based on^[3,11,12]
Empty-chair work: unfinished business
A lingering resentment or hurt towards someone important (a parent, an ex, someone who has died) is what EFT calls unfinished business. The therapist may ask you to imagine them in an empty chair and say what was never said: often complaint first, then gradually the sadness, hurt and unmet needs beneath it. Research found that people who voiced those needs and came to see the other person differently had better outcomes. It doesn't require forgiveness, or the other person to be there.^[3,15,16]
Hear it in a session
1. Client
  My mum always compared me with my sister. Even now, thinking about it, I feel awful.
2. Therapist
  That feeling seems never to have settled. Would you be willing to imagine your mum in this empty chair and speak to her directly? If it gets too hard, we can stop.
3. Client
  …OK.
4. Therapist
  Can you see her sitting there? What does she look like?
5. Client
  Yes. She's got that frown again.
6. Therapist
  Tell her what you want to say.
7. Client
  You only ever saw what I did wrong. Whatever my sister did was right.
8. Therapist
  Tell her what you felt inside all those years.
9. Client
  (Voice dropping) I was so lonely. I tried so hard, wanting you to see me.
10. Therapist
  What did you need from her?
11. Client
  I needed you to say, just once, that you were proud of me.
12. Therapist
  Could you sit over there and be your mum for a moment? Hearing your daughter say that, how do you respond?
13. Client
  (As her mother) …I thought if I was strict with you, you'd make something of yourself. I was brought up being scolded like that too.
14. Therapist
  Come back to your own chair. Hearing her say that, how are you?
15. Client
  I understand a bit more… but the hurt of those years is still real.
16. Therapist
  Yes, both can be true at once. You don't have to forgive her today. Today you said what you always wanted, and that matters.
Notice: This is empty-chair work; the marker is lingering resentment towards her mother. The therapist asks whether the client is willing and keeps checking. The client voices complaint first (a secondary emotion), and the therapist helps her reach the feeling and need beneath. Then she speaks as her mother from the other chair and comes to understand her a little more; the therapist doesn't push for forgiveness, and affirms that the years of hurt were real. This work is done with a therapist.
Method based on^[3,12,16]

The dialogues are illustrative composites, not real clients; skills that stir strong emotion or touch on trauma should be done with a trained therapist.

Walking into the room: how does a course of EFT run?

Now you know how it sees a person and how it works. The next questions: what is it actually like, does it work, and what is it not for?

If you wanted to bring that evening into a therapy room, EFT can be brief or longer-term; in research it is typically weekly for 16 to 20 sessions, though the length varies. Unlike CBT (cognitive behavioural therapy) it has no fixed agenda each session: the therapist follows what you feel in the moment and proposes tasks when they fit. A course broadly runs like this.^[3,18,24]

1Build a safe relationship firstEFT's rule is "contact before contract", meaning relationship first, agreed work second: the therapist first offers empathic company so you feel safe, before touching more painful experiences. This is what the person-centred relationship is for.
2Find a focusTogether, identify the core pain that keeps you stuck, what usually triggers it, and how you tend to avoid it. The focus runs through the whole course; markers are the difficulties that show up within each session, usually related to the focus.
3Work with emotion as it arisesWhen a marker shows up in session, the therapist offers a task to match it, such as two-chair or empty-chair work, which you can accept or decline.
4Arrive, then leaveOnce the core emotion and need are felt (arriving), let newer, more empowering emotions emerge and slowly change the old response (leaving, which is transformation).
5Carry the new meaning into lifeReflect on what happened, form a new understanding of yourself, and notice how it shows up day to day.

Lateness is one case among many: what can EFT help with?

EFT has been studied most for depression, then anxiety, trauma, self-criticism and unresolved hurt with important people. Humanistic-experiential therapies as a group appear especially effective for interpersonal and relationship difficulties.^[17,23]

Depression
Generalised anxiety
Self-criticism and shame
Unfinished business with parents, partners and others
Childhood abuse
Interpersonal problems

Everyone is different. If you are thinking of hurting yourself or ending your life, please don't face it alone: call The Samaritans' 24-hour line on 2896 0000, or 999 in an emergency. If emotions easily overwhelm you, talk with a therapist about building steadiness first.

How much evidence is there for these ways of working? What the research says

EFT has a run of randomised trials (participants are randomly assigned to groups, then different approaches are compared), but far fewer and smaller than CBT's. Some test a whole course of therapy, others only a single task such as two-chair or empty-chair work. Below, from firmer to more preliminary, is what the research found on each question, and what limits it.

For depression: much better than no treatment
Compared with people given no active treatment, EFT shows a clear benefit, and depression is the most-studied problem. In one trial, adding emotion work helped more than empathic support alone, and over 18 months fewer people relapsed. But most of these studies are small and of limited quality.^[17,18,19]
Against other therapies: not shown to be better
In a few small trials comparing EFT with CBT (for depression and for generalised anxiety), the two did about equally well, with a larger drop in interpersonal problems with EFT. EFT came out slightly ahead on paper, but not by enough to be sure, so "no worse" is fair and "better" is not.^[17,20,21]
For unfinished business and childhood abuse
Empty-chair studies have positive results: people improved more than those in a psychoeducation group and kept their gains a year later, and adults abused as children improved markedly with either of two versions. But each study had only a few dozen people, and several were run by the method's developers.^[15,16,22]
Does it last?
A few studies followed people for 6 to 18 months, and gains mostly held. But few studies follow up at all, and an analysis of the whole humanistic-experiential family found results slightly weaker at follow-up than at the end of treatment.^[19,21,25]
For self-criticism
After two-chair work, people were less self-critical and kinder to themselves, but this rests on one pilot of 9 people and one trial of people without a clinical diagnosis, compared with a waiting list. Promising, but early.^[13,14]

To be honest, though. The latest meta-analysis (which pools many studies) finds most studies are of poor quality: small samples, weak randomisation, dropouts not accounted for, and signs of publication bias (studies with good results being more likely to get published); participants were mostly women and White or Iranian; and many trials were led by EFT's developers. The American Psychological Association's Society of Clinical Psychology rates EFT for depression as having "modest" research support (1998 criteria), now pending re-evaluation. An analysis of 17 trials of humanistic-experiential therapies as a whole in depression reached a similar conclusion: comparable to other treatments at the end of therapy but slightly behind at follow-up, again with risk-of-bias concerns. So EFT looks effective, but hasn't been shown to beat other established therapies.^{[17,18,24,25]}

To be honest: the evidence is still thin, and some doors need company

The latest meta-analysis concludes that EFT is "modestly effective", not that it outperforms. Beyond the still-thin evidence, a few things are worth knowing:^{[17,22,23,26]}

1Emotional intensity has to be judged

EFT needs emotion to be stirred, but too much for too long doesn't help, which is what regulation is there to judge. For people who are easily overwhelmed, the therapist has to help them steady first; in a childhood-abuse trial, people with more severe personality difficulties did less well on some outcomes.

2Chair work needs a safe frame

Empty-chair and two-chair work can stir very deep feelings, and belong in a trusting therapeutic relationship with someone trained. The same holds in reverse: discussion of how cults manipulate people shows what happens when similar guiding techniques are borrowed without a professional, safe frame, which is deeply irresponsible.

3Narrow research samples

In the trials the latest meta-analysis reviewed, participants were mostly women, and White or Iranian, so how well the findings carry over to Chinese communities such as Hong Kong has not been well studied. EFT encourages expressing emotions and needs directly; whether it suits people used to more reserved expression just as well is still to be studied.

So EFT is a good road to hearing that opening anger and then transforming it, but not the only one; a good therapist adjusts to where you are and what you need.

Take this with you

The next time that anger rises, you needn't push it away or simply say what it says: pause, ask what is underneath it, then decide what to say. The deeper doors are easier to open with someone beside you.

Free EFT exercises

Want to try it yourself first? These free exercises are simpler versions of the skills above, with you step by step.

About 8 minToo emotional? Find the feeling underneathFind the feeling under the surface one, and what it needs.Start

A self-guided EFT path

Not ready to see a therapist yet? Start with these three steps at your own pace. Deeper work such as chair dialogues is best kept for therapy.

Courses

Therapists who practise EFT

TreeholeHK's counsellors and clinical psychologists use EFT to fit what you need, alongside other approaches.

Book therapy

Other ways into the same emotion: approaches beyond EFT

EFT stands on the person-centred relationship, and sits next to other approaches to emotion, self-criticism and relationships.

Person-centred therapyEFT's root: an empathic, accepting, genuine relationship. EFT adds tasks that guide emotional processing on top of it.^[3]
Cognitive behavioural therapy (CBT)Changes emotion through thought and behaviour; EFT works on the emotion directly. In one depression trial the two did about equally well.^[5,20]
Compassion-focused therapy (CFT)Also works with self-criticism and shame, centred on building compassion for oneself, and borrows a good deal from humanistic-experiential practice.^[23]
Emotionally focused couple therapyThe couples version Greenberg and Sue Johnson developed in the 1980s, also called EFT; Johnson later built it around attachment theory, working with the negative cycles couples get stuck in.^[27,28]

Other therapy approaches

FAQ

Is EFT about letting all your emotions out?

No. EFT tells kinds of emotion apart: a secondary emotion, such as anger covering hurt, is explored for what's beneath rather than vented again and again; an adaptive primary emotion is accessed; an old maladaptive one is felt and then transformed. Research also found that reaching intense arousal (how strongly emotion is stirred) in moderation helps most, while being highly aroused too often or for too long does not.^[3,23]

What's the difference between EFT and CBT?

CBT mainly changes emotion by working on thoughts and behaviour; EFT works with emotion directly, holding that you must feel an emotion before you can change it, and that a new emotion transforms an old one. In one depression trial the two did about equally well.^[5,20]

Are 情緒取向治療, 情緒導向治療 and EFT the same thing?

Both Chinese names translate emotion-focused therapy, the individual EFT developed by Greenberg (first called process-experiential therapy). Note that the couples therapy Greenberg and Sue Johnson developed, emotionally focused therapy, is also abbreviated EFT. And the tapping method Emotional Freedom Techniques shares the acronym but has nothing to do with the therapy described here.^[3,27]

How many sessions does EFT take?

In research, EFT is usually weekly for 16 to 20 sessions. The real length depends on what you bring and is agreed with your therapist; more complex difficulties may take longer.^[18,24]

Won't talking to an empty chair feel awkward? Can I say no?

Feeling odd at first is normal. An EFT therapist offers this kind of exercise only once a relationship is in place, without pressure, explains why, and leaves the choice to you; you can stop at any point. The chairs are a tool, and the same work can be done in other ways.^[3,22]

How do I find an EFT therapist in Hong Kong?

Look for specific EFT training and membership of a professional body. Further down are TreeholeHK's therapists who use EFT; read their backgrounds before you book.

References

1.Murphy, D. (2017). Person-centred experiential counselling psychology. In D. Murphy (Ed.), Counselling psychology: A textbook for study and practice (BPS Textbooks in Psychology). Wiley. (Section: Emotion Focused Therapy.)
2.Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy, 11(1), 3–16. doi.org/10.1002/cpp.388
3.Elliott, R. (2012). Emotion-focused therapy. In P. Sanders (Ed.), The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach (2nd ed., pp. 103–130). PCCS Books. strathprints.strath.ac.uk
4.Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment-by-moment process. Guilford Press.
5.Greenberg, L. S. (2006). Principles of emotional change [Presentation slides]. www.emotionfocusedtherapy.org (hosted by the Institut für Emotionsfokussierte Therapie). ieft.de
6.Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional processing in experiential therapy: Why "the only way out is through." Journal of Consulting and Clinical Psychology, 75(6), 875–887. doi.org/10.1037/0022-006X.75.6.875
7.Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy. Guilford Press.
8.Gendlin, E. T. (1981). Focusing (2nd ed.). Bantam Books.
9.British Focusing Association. (n.d.). An introduction to Focusing. focusing.org.uk
10.Rice, L. N., & Saperia, E. P. (1984). Task analysis and the resolution of problematic reactions. In L. N. Rice & L. S. Greenberg (Eds.), Patterns of change (pp. 29–66). Guilford Press.
11.Greenberg, L. S. (n.d.). Two-chair technique. Common Language for Psychotherapy (CLP) Procedures. commonlanguagepsychotherapy.org
12.Bailey, G., Halamová, J., & Gablíková, M. (2022). Qualitative analysis of chair tasks in emotion-focused therapy video sessions. International Journal of Environmental Research and Public Health, 19(19), 12942. doi.org/10.3390/ijerph191912942
13.Shahar, B., Carlin, E. R., Engle, D. E., Hegde, J., Szepsenwol, O., & Arkowitz, H. (2012). A pilot investigation of emotion-focused two-chair dialogue intervention for self-criticism. Clinical Psychology & Psychotherapy, 19(6), 496–507. doi.org/10.1002/cpp.762
14.López-Cavada, C., Jódar, R., Timulak, L., & Corbella, S. (2025). Emotion-focused treatment for self-criticism in a nonclinical population: A randomized controlled trial. Journal of Counseling Psychology, 72(1), 56–68. doi.org/10.1037/cou0000768
15.Paivio, S. C., & Greenberg, L. S. (1995). Resolving "unfinished business": Efficacy of experiential therapy using empty-chair dialogue. Journal of Consulting and Clinical Psychology, 63(3), 419–425. doi.org/10.1037/0022-006X.63.3.419
16.Greenberg, L. S., & Malcolm, W. (2002). Resolving unfinished business: Relating process to outcome. Journal of Consulting and Clinical Psychology, 70(2), 406–416. doi.org/10.1037/0022-006X.70.2.406
17.Whittington, D. D., Jafari, M., & Borgogna, N. C. (2026). Emotion-focused therapy for distress-based psychopathology in adults: A systematic review and meta-analysis. Psychotherapy Research. Advance online publication. doi.org/10.1080/10503307.2026.2650152
18.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(5), 537–549. doi.org/10.1080/10503300600589456
19.Ellison, J. A., Greenberg, L. S., Goldman, R. N., & Angus, L. (2009). Maintenance of gains following experiential therapies for depression. Journal of Consulting and Clinical Psychology, 77(1), 103–112. doi.org/10.1037/a0014653
20.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(4), 773–781. doi.org/10.1037/0022-006X.71.4.773
21.Timulak, L., Keogh, D., Chigwedere, C., Wilson, C., Ward, F., Hevey, D., Griffin, P., Jacobs, L., Hughes, S., Vaughan, C., Beckham, K., & Mahon, S. (2022). A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial. Psychotherapy, 59(1), 84–95. (Correction published 2023, Psychotherapy, 60(4), 547.) doi.org/10.1037/pst0000427
22.Paivio, S. C., Jarry, J. L., Chagigiorgis, H., Hall, I., & Ralston, M. (2010). Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma. Psychotherapy Research, 20(3), 353–366. doi.org/10.1080/10503300903505274
23.Elliott, R., Watson, J., Timulak, L., & Sharbanee, J. (2021). Research on humanistic-experiential psychotherapies: Updated review. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield's handbook of psychotherapy and behavior change (7th ed., pp. 421–467). Wiley. strathprints.strath.ac.uk
24.Society of Clinical Psychology (APA Division 12). (n.d.). Emotion focused therapy for depression. Psychological treatments. societyofclinicalpsychology.org
25.Duffy, K. E. M., Simmonds-Buckley, M., Haake, R., Delgadillo, J., & Barkham, M. (2024). The efficacy of individual humanistic-experiential therapies for the treatment of depression: A systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research, 34(3), 323–338. doi.org/10.1080/10503307.2023.2227757
26.樹洞香港. (n.d.). 邪教特徵與定義：洗腦組織如何用認知失調操控你 [Podcast episode]. TreeholeHK. treehole.hk
27.Greenberg, L. S., & Johnson, S. M. (1988). Emotionally focused therapy for couples. Guilford Press.
28.Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). Brunner-Routledge.

Want someone alongside you?

You can do the exercises on your own. When you're stuck, a trained therapist can take you further.

Book therapy

Two-chair dialogue: answering the inner critic

When you criticise yourself harshly ("I'm useless"), the therapist may invite you to use two chairs so the critic and the criticised self can talk: say the criticism from one chair, then move to the other and say how it feels to hear it and what you need. The criticised side often moves from hopelessness and shame towards standing up for itself; the critic sometimes softens, showing care or revealing what it is afraid of. A dialogue can last tens of minutes and usually recurs over several sessions.^[11,13,14]

Hear it in a session

Client
My report got sent back again. I'm so useless; everyone at work does better than me.
Therapist
It sounds like there's a voice in you scolding you, and another part of you taking it. Shall we try something a bit different? Two chairs, so the two parts can talk. It may feel odd at first, and you can stop any time.
Client
…OK, let's try.
Therapist
Sit in this chair and be the critical voice. Across from you is you. What do you say to him?
Client
(Critic) You've messed it up again. You're lazy. You'll never catch up with anyone.
Therapist
Be more specific. Tell him how you see him.
Client
(Critic) Everything you do is half-done. Sooner or later people will see through you.
Therapist
OK, now come and sit over here. Hearing all that, what do you feel?
Client
(Self) …I want to curl up. Like I can't lift my head.
Therapist
Wanting to curl up, head down. Where do you feel that in your body?
Client
(Self) My shoulders are heavy, my chest too.
Therapist
Being spoken to like that, what do you need from him? You can tell him directly.
Client
(Self) I've been trying really hard. I need you to stop, and not tear into me every time.
Therapist
Say it once more, and notice your voice as you do.
Client
(Self, voice steadier) I've been trying really hard. Stop tearing into me like that.
Therapist
Back to the critic's chair. Hearing him say that, how do you respond?
Client
(Critic, after a pause) …I'm just scared you'll fail, that people will look down on you. Still, you need to try harder.
Therapist
So you're scared he'll fail. Let's stop here and come back to your own chair. How do you feel now?
Client
A bit lighter. The voice is still there, but it doesn't feel quite so loud.

Notice: This is two-chair work, showing transformation. The marker is the self-critical voice: the therapist hears it, asks consent and says the client can stop at any time. The critic is asked to be specific; the criticised side moves from bodily feeling to need and says it to the critic. The critic softens only partly, showing the fear underneath while still demanding "more effort": one dialogue rarely resolves it, and the work usually recurs over sessions.

Method based on^[3,11,12]

FAQ

Is EFT about letting all your emotions out?

What's the difference between EFT and CBT?

Are 情緒取向治療, 情緒導向治療 and EFT the same thing?

How many sessions does EFT take?

In research, EFT is usually weekly for 16 to 20 sessions. The real length depends on what you bring and is agreed with your therapist; more complex difficulties may take longer.^[18,24]

Won't talking to an empty chair feel awkward? Can I say no?

How do I find an EFT therapist in Hong Kong?

Look for specific EFT training and membership of a professional body. Further down are TreeholeHK's therapists who use EFT; read their backgrounds before you book.

References

1.Murphy, D. (2017). Person-centred experiential counselling psychology. In D. Murphy (Ed.), Counselling psychology: A textbook for study and practice (BPS Textbooks in Psychology). Wiley. (Section: Emotion Focused Therapy.)
2.Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psychology & Psychotherapy, 11(1), 3–16. doi.org/10.1002/cpp.388
3.Elliott, R. (2012). Emotion-focused therapy. In P. Sanders (Ed.), The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach (2nd ed., pp. 103–130). PCCS Books. strathprints.strath.ac.uk
4.Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment-by-moment process. Guilford Press.
5.Greenberg, L. S. (2006). Principles of emotional change [Presentation slides]. www.emotionfocusedtherapy.org (hosted by the Institut für Emotionsfokussierte Therapie). ieft.de
6.Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional processing in experiential therapy: Why "the only way out is through." Journal of Consulting and Clinical Psychology, 75(6), 875–887. doi.org/10.1037/0022-006X.75.6.875
7.Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy. Guilford Press.
8.Gendlin, E. T. (1981). Focusing (2nd ed.). Bantam Books.
9.British Focusing Association. (n.d.). An introduction to Focusing. focusing.org.uk
10.Rice, L. N., & Saperia, E. P. (1984). Task analysis and the resolution of problematic reactions. In L. N. Rice & L. S. Greenberg (Eds.), Patterns of change (pp. 29–66). Guilford Press.
11.Greenberg, L. S. (n.d.). Two-chair technique. Common Language for Psychotherapy (CLP) Procedures. commonlanguagepsychotherapy.org
12.Bailey, G., Halamová, J., & Gablíková, M. (2022). Qualitative analysis of chair tasks in emotion-focused therapy video sessions. International Journal of Environmental Research and Public Health, 19(19), 12942. doi.org/10.3390/ijerph191912942
13.Shahar, B., Carlin, E. R., Engle, D. E., Hegde, J., Szepsenwol, O., & Arkowitz, H. (2012). A pilot investigation of emotion-focused two-chair dialogue intervention for self-criticism. Clinical Psychology & Psychotherapy, 19(6), 496–507. doi.org/10.1002/cpp.762
14.López-Cavada, C., Jódar, R., Timulak, L., & Corbella, S. (2025). Emotion-focused treatment for self-criticism in a nonclinical population: A randomized controlled trial. Journal of Counseling Psychology, 72(1), 56–68. doi.org/10.1037/cou0000768
15.Paivio, S. C., & Greenberg, L. S. (1995). Resolving "unfinished business": Efficacy of experiential therapy using empty-chair dialogue. Journal of Consulting and Clinical Psychology, 63(3), 419–425. doi.org/10.1037/0022-006X.63.3.419
16.Greenberg, L. S., & Malcolm, W. (2002). Resolving unfinished business: Relating process to outcome. Journal of Consulting and Clinical Psychology, 70(2), 406–416. doi.org/10.1037/0022-006X.70.2.406
17.Whittington, D. D., Jafari, M., & Borgogna, N. C. (2026). Emotion-focused therapy for distress-based psychopathology in adults: A systematic review and meta-analysis. Psychotherapy Research. Advance online publication. doi.org/10.1080/10503307.2026.2650152
18.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(5), 537–549. doi.org/10.1080/10503300600589456
19.Ellison, J. A., Greenberg, L. S., Goldman, R. N., & Angus, L. (2009). Maintenance of gains following experiential therapies for depression. Journal of Consulting and Clinical Psychology, 77(1), 103–112. doi.org/10.1037/a0014653
20.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(4), 773–781. doi.org/10.1037/0022-006X.71.4.773
21.Timulak, L., Keogh, D., Chigwedere, C., Wilson, C., Ward, F., Hevey, D., Griffin, P., Jacobs, L., Hughes, S., Vaughan, C., Beckham, K., & Mahon, S. (2022). A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial. Psychotherapy, 59(1), 84–95. (Correction published 2023, Psychotherapy, 60(4), 547.) doi.org/10.1037/pst0000427
22.Paivio, S. C., Jarry, J. L., Chagigiorgis, H., Hall, I., & Ralston, M. (2010). Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma. Psychotherapy Research, 20(3), 353–366. doi.org/10.1080/10503300903505274
23.Elliott, R., Watson, J., Timulak, L., & Sharbanee, J. (2021). Research on humanistic-experiential psychotherapies: Updated review. In M. Barkham, W. Lutz, & L. G. Castonguay (Eds.), Bergin and Garfield's handbook of psychotherapy and behavior change (7th ed., pp. 421–467). Wiley. strathprints.strath.ac.uk
24.Society of Clinical Psychology (APA Division 12). (n.d.). Emotion focused therapy for depression. Psychological treatments. societyofclinicalpsychology.org
25.Duffy, K. E. M., Simmonds-Buckley, M., Haake, R., Delgadillo, J., & Barkham, M. (2024). The efficacy of individual humanistic-experiential therapies for the treatment of depression: A systematic review and meta-analysis of randomized controlled trials. Psychotherapy Research, 34(3), 323–338. doi.org/10.1080/10503307.2023.2227757
26.樹洞香港. (n.d.). 邪教特徵與定義：洗腦組織如何用認知失調操控你 [Podcast episode]. TreeholeHK. treehole.hk
27.Greenberg, L. S., & Johnson, S. M. (1988). Emotionally focused therapy for couples. Guilford Press.
28.Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). Brunner-Routledge.

Emotion-focused therapyEFT

What was that anger a signal of? How emotion-focused therapy sees emotion

That anger is a signal: three principles, awareness, regulation, transformation

What is under that anger? Telling secondary emotion, primary emotion and need apart

Once you can tell them apart, how does therapy proceed? Marker, task, resolution

That opening evening: one late arrival, from anger to need