Insight in Psychotherapy: A Conversation with Les Greenberg

Understanding the Limitations and Transformative Power of Emotion-Focused Therapy

"Insight is the siren song of treatment," said writer Assaf Shur in one of his interviews. "The mermaids of psychotherapy sing their sweet voices, offering different insights, and often tempt me—both as a therapist and as a patient—to jump off the therapeutic ship, lose direction, and drown." Although psychology's initial gift to humanity was insight, anyone familiar with psychodynamic therapy knows that insight rarely leads to deep and lasting psychological change.

This frustration ended for me last week when I had the privilege of undergoing advanced training in emotion-focused therapy (EFT) with Les Greenberg, a Canadian psychologist born in Johannesburg, and one of the world's leading psychotherapy researchers.

Greenberg is one of the main and original developers of EFT. I can confidently say that I have never learned so much in such a short time as in Greenberg's training.

Before Greenberg boarded a plane to train other fortunate therapists worldwide, he agreed to sit down with me for an interview. I will use this interview in the following series of articles to present his revolutionary therapeutic approach, starting with the research insight that insight is not the ultimate goal in psychotherapy.

What do we not understand about insight?

"Well, our biggest mistake is thinking that insight leads to change. Insights are indeed useful, but they are not the ultimate form of creating change in the patient."

Can you give me an example?

"A person may be aware that he is sensitive to criticism because his father was very critical, or he may know that he is sensitive to situations where he feels lonely and abandoned because he lost his mother when he was young. Within a relationship, he may suddenly feel lonely and abandoned because of a comment from his partner, and he may believe that he feels this way because of his partner and blame her. But coming to the insight that the pain is based on sensitivity from childhood, and that the pain is not rooted in the partner's actions, can help them manage these situations in a more regulated way. The psychological insight is beneficial to them.

"The limitation is that even if you understand the historical origin of your reactions and learn to manage them better, the real problem remains: you are still extremely sensitive to situations where you feel alone and abandoned or to criticism. That is, the basic emotional response still exists, and the insight you gained didn't really lead to changing this emotional reaction."

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What is the change model in emotion-focused therapy?

"The goal of emotion-focused therapy is to change the unhelpful, or excessive, emotional response that haunts patients and makes it difficult for them to live their lives normally. The best way to do this is to feel this ancient pain; you need to feel it to heal it. The change model of EFT has been extensively studied, and we see that to achieve a deep and consistent change in patients' emotional states, they need help to feel the ancient painful feeling that has not been fully experienced.

"But we help them experience this pain in a structured process that yields a new emotional experience, changing the brain's coding of the old emotional experience. According to our model, the best way to change a difficult and painful emotion is to create a process in which the painful emotion is experienced in a way that naturally and immediately generates another emotion.

"What needs to be done is to understand that some emotions move us to approach another person or move toward a goal, while others make us retreat. For example, fear and shame organize us to run away or shrink so that the earth swallows us up. When we are angry, on the other hand, anger pushes us forward to protect our boundaries. Sadness influences us to reach out for help. This means we cannot run away from fear and shame and also reach out for help, so the formation of a new emotion changes the previous emotion."

What will happen to the patient you mentioned in the first example, the one who is sensitive to criticism?

"In emotion-focused therapy, we will understand that we have to work on the fact that he had a very critical father, but we will not stay with only insight. The therapist will go back with the patient to the memories of how the father shamed and humiliated him and will help him re-experience the desire to disappear and the constricted feeling of shame inside the body. After activating this burned memory, we will ask the patient what he needs when he feels this pain, or what this painful feeling needs. If the feeling is shame, the patient may feel he needed validation or to feel appreciated as a child.

Prof. Les Greenberg Photo: Les Greenberg

"The point is that the moment you feel truly worthy, that you deserve to be valued—and often you need a therapist by your side to feel worthy—your emotional brain starts to act: 'I deserve to feel validation, and I actually didn't get what I deserved.' Then a new stage in the process begins, where you no longer feel the trapped pain but anger.

"The structured and safe process in which you experienced the original pain led your emotional brain to create a healthy assertive anger, which is not a blaming or aggressive anger but a healthy anger that you did not receive the validation you needed as a child, let's say, and that you deserved. If this anger is born out of a therapeutic process that led you earlier to feel the shame or sadness that haunted you all your life, this fresh anger will change your original shame, and in the end, you will come out of this process with a genuinely new sense of yourself."

What would this change look like in the case of the patient who felt terrible every time his wife criticized him?

"He will stop experiencing a harsh internal reaction to his partner's criticism and will begin to feel higher self-worth and greater internal resilience. When his partner asks, 'Did you take care of this chore today?' he will no longer feel the familiar knot in his stomach, nor will he feel the same powerful initial anger. It will not be a slow process that goes through thought and interpretation; he simply won't feel anything special, certainly not with the intensity he used to know. Therefore, he will be able to say to his partner simply, 'I haven't gotten to it yet.'"