Abstract
Recent years have seen the emergence of transdiagnostic psychotherapeutic treatments, typically targeting depression, anxiety and related disorders. The rationale for developing transdiagnostic protocols is based on a number of factors; shared etiology and maintenance mechanisms, high co-morbidity, hypothesising that discrete disorders may be underpinned by common psychological vulnerabilities, and the burden currently placed on clinicians to master multiple disorder-specific interventions. This paper describes a transdiagnostic model of emotion-focused therapy (EFT-T), which combines modular (targeting specific clusters of symptoms) and shared mechanisms (targeting underlying vulnerability) approaches to the treatment of depression, anxiety and related disorders such as obsessive–compulsive and trauma/stressor related disorders. The model proposes that clients’ core vulnerabilities are linked to specific chronic painful feelings, and that these chronic feelings are constellations of sadness/loneliness, shame, and fear-based emotions, idiosyncratically shaped by personal history. The paper describes how EFT-T addresses problematic symptoms but primarily focuses on transforming emotion vulnerability, or Core Pain, by activating adaptive emotional responses, such as compassion and protective anger, to embedded unmet needs. As all hitherto presented transdiagnostic protocols have emanated from within the cognitive behavioural paradigm, the aim of the described model is to increase the choice of evidence-based transdiagnostic interventions available to clinicians and clients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., et al. (2017a). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry,74(9), 875–884. https://doi.org/10.1001/jamapsychiatry.2017.2164.
Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Latin, H., Ellard, K. K., Bullis, J., et al. (2017b). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.
Caspi, A., Houts, R. M., Belsky, D. W., Goldman-Mellor, S. J., Harrington, H., Israel, S., et al. (2014). The p factor: one general psychopathology factor in the structure of psychiatric disorders? Clinical Psychological Science. https://doi.org/10.1177/2167702613497473.
Dillon, A., Timulak, L., & Greenberg, L. S. (2018). Transforming core emotional pain in a course of emotion-focused therapy for depression: A case study. Psychotherapy Research,28, 406–422. https://doi.org/10.1080/10503307.2016.1233364.
Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. Washington, DC: American Psychological Association. https://doi.org/10.1037/10725-000.
Goldman, R. N., & Greenberg, L. S. (2015). Case formulation in emotion-focused therapy: Co-creating clinical maps for change. Washington, DC: American Psychological Association. https://doi.org/10.1037/14523-000.
Goldman, R., Greenberg, L., & Angus, L. (2006). The effects of adding emotion-focused interventions to the therapeutic relationship in the treatment of depression. Psychotherapy Research,16, 537–549. https://doi.org/10.1080/10503300600589456.
Greenberg, L. S. (2015). Emotion-focused therapy: Coaching clients through their feelings. Washington, DC: American Psychological Association.
Greenberg, L. S. (2016). Emotion-focused therapy (2nd ed.). Washington, DC: American Psychological Association.
Greenberg, L. S., & Elliott, R. (2012). Corrective experience from a humanistic–experiential perspective. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 85–101). Washington, DC: American Psychological Association. https://doi.org/10.1037/13747-006.
Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment by moment process. New York, NY: Guilford Press.
Greenberg, L. S., & Safran, J. D. (1989). Emotion in psychotherapy. American Psychologist,44, 19–29. https://doi.org/10.1037/0003-066X.44.1.19.
Greenberg, L. S., & Warwar, S. H. (2006). Homework in an emotion-focused approach to experiential therapy. Journal of Psychotherapy Integration,16, 178–200.
Greenberg, L. S., & Watson, J. (1998). Experiential therapy of depression: Differential effects of client-centred relationship conditions and process-experiential interventions. Psychotherapy Research,8, 210–224. https://doi.org/10.1093/ptr/8.2.210.
Greenberg, L. S., & Watson, J. (2006). Emotion-focused therapy for depression. Washington, DC: American Psychological Association. https://doi.org/10.1037/11286-000.
Kennedy, K. A., & Barlow, D. H. (2018). The unified protocol for transdiagnostic treatment of emotional disorders: An introduction. In D. H. Barlow & T. J. Farchione (Eds.), Application of the unified protocol for transdiagnostic treatment of emotional disorders (pp. 1–16). New York: Oxford University Press.
Lahey, B. B., Krueger, R. F., Rathouz, P. J., Waldman, I. D., & Zald, D. H. (2017). A hierarchical causal taxonomy of psychopathology across the life span. Psychological Bulletin,143, 142–186.
McNally, S., Timulak, L., & Greenberg, L. S. (2014). Transforming emotion schemes in emotion focused therapy: A case study investigation. Person-Centered & Experiential Psychotherapies,13, 128–149. https://doi.org/10.1080/14779757.2013.871573.
Murphy, J., Rowell, L., McQuaid, A., Timulak, L., O’Flynn, R., & McElvaney, J. (2017). Developing a model of working with worry in emotion-focused therapy: A discovery-phase task analytic study. Counselling and Psychotherapy Research,17, 56–70. https://doi.org/10.1002/capr.12089.
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review,40, 91–110. https://doi.org/10.1016/j.cpr.2015.06.002.
Norton, P. J. (2012). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford Press. https://doi.org/10.1080/16506073.2013.871329.
O’Brien, K., O’Keeffe, N., Cullen, H., Durcan, A., Timulak, L., & McElvaney, J. (2017). Emotion-focused perspective on generalized anxiety disorder: A qualitative analysis of clients’ in-session presentations. Psychotherapy Research. https://doi.org/10.1080/10503307.2017.1373206.
Paivio, S. C., & Nieuwenhuis, J. A. (2001). Efficacy of emotion-focused therapy for adult survivors of child sexual abuse: A preliminary study. Journal of Traumatic Stress,14, 115–134. https://doi.org/10.1023/A:1007891716593.
Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An integrative approach. Washington, DC: American Psychological Association. https://doi.org/10.1037/12077-000.
Pascual-Leone, A. (2009). Emotional processing cycles in experiential therapy: “Two steps forward, one step backward”. Journal of Consulting and Clinical Psychology,77, 113–126. https://doi.org/10.1037/a0014488.
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, 875–887. https://doi.org/10.1037/0022-006X.75.6.875.
Pearl, S. B., & Norton, P. J. (2017). Transdiagnostic versus diagnosis specific cognitive behavioural therapies for anxiety: A meta-analysis. Journal of Anxiety Disorders,46, 11–24. https://doi.org/10.1016/j.janxdis.2016.07.004.
Roy-Byrne, P. (2017). Transdiagnostic cognitive behavioral therapy and the return of the repressed. JAMA Psychiatry,74, 867–868. https://doi.org/10.1176/appi.ajp.2008.08040608.
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017). Current definitions of “transdiagnostic” in treatment development: A search for consensus. Behavior Therapy,48, 128–138. https://doi.org/10.1016/j.beth.2016.09.004.
Shahar, B., Bar-Kalifa, E., & Alon, E. (2017). Emotion-focused therapy for social anxiety disorder: Results from a multiple-baseline study. Journal of Consulting and Clinical Psychology,85, 238–249. https://doi.org/10.1037/ccp0000166.
Timulak, L. (2015). Transforming emotional pain in psychotherapy: An emotion-focused approach. Howe, Sussex: Routledge.
Timulak, L. (2018). Humanistic-experiential therapies in the treatment of generalised anxiety: A perspective. Counselling and Psychotherapy Research,18, 233–236. https://doi.org/10.1002/capr.12172.
Timulak, L., & McElvaney, J. (2017). Transforming generalized anxiety: An emotion-focused approach. Hove, Sussex: Routledge.
Timulak, L., McElvaney, J., Keogh, D., Martin, E., Clare, P., Chepukova, E., et al. (2017). Emotion-focused therapy for generalized anxiety disorder: An exploratory study. Psychotherapy,54, 361–366. https://doi.org/10.1037/pst0000128.
Timulak, L., & Pascual-Leone, A. (2015). New developments for case conceptualization in emotion-focused therapy. Clinical Psychology & Psychotherapy,22, 619–636. https://doi.org/10.1002/cpp.1922.
Warwar, S. H., & Ellison, J. (2018). Emotion coaching in action: Experiential teaching, homework, and consolidating change. In L. S. Greenberg & R. N. Goldman (Eds.), Clinical Handbook of emotion-focused therapy (pp. 61–90). Washington, DC: American Psychological Association.
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. https://doi.org/10.1037/0022-006X.71.4.773.
Watson, J. C., & Greenberg, L. S. (2017). Emotion-focused therapy for generalized anxiety. Washington, DC: American Psychological Association. https://doi.org/10.1037/0000018-000.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Timulak, L., Keogh, D. Emotion-Focused Therapy: A Transdiagnostic Formulation. J Contemp Psychother 50, 1–13 (2020). https://doi.org/10.1007/s10879-019-09426-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-019-09426-7