The Importance of Therapeutic Presence in Emotion-Focused Therapy

The American psychologist Les Greenberg, the father of the emotion-centered treatment approach, was deeply influenced during his clinical and theoretical development by Carl Rogers, about whom I have written extensively in the past. In recent years, it seems that the Rogerian aspect that Greenberg has emphasized is the importance of therapeutic presence.

He believes that therapeutic presence means giving empathy and unconditional positive regard to the patient, along with presenting an attitude of mental openness. This openness allows the therapist to contain the client's experience and absorb it without judgment, enabling them to grasp what the patient brings at any given moment.

The Role of Self-Awareness

Another layer of therapeutic presence, according to Greenberg, is the therapist's self-awareness. The therapist uses their own body as a kind of barometer or GPS, allowing them to echo what is happening in the patient's mind and respond accordingly. When therapeutic presence is fully maintained, the therapist conveys two essential messages to the patient: "I hear you," and "I am open to whatever you want to express."

In Greenberg's EFT, therapeutic presence reflects the therapist's ideal of openness to the experience created in the room and the importance of a deep connection with the patient. In his writings, Greenberg explains that therapeutic presence is about being with the patient more than treating them. This term emphasizes that the therapist's role is not to look over the patient or peer into their soul but to be open to their experience in a compassionate and non-judgmental way.

Influence and Guidance

Therapeutic presence indicates the therapist's willingness to be influenced by the patient's experiences and be moved by them, while maintaining their center and ability to respond in a coordinated manner to the patient's experience and needs. When this ideal is achieved, therapists are in touch with the patient's experience and their own, and can understand what is happening between the patient and themselves.

However, there is a significant difference between EFT and the Rogerian approach. In emotion-based therapy, the therapist not only follows the patient in a deeply empathic way but also directs the patient to observe and enhance their feelings, something Rogers would never have accepted. The fourth part of Greenberg's interview is dedicated to this difference:

Why is Rogerian Empathy Not a Satisfactory Therapeutic Tool?

"In the Rogerian view, the therapist should focus on the patient's words and should not influence or direct them. The problem is that this is impossible. When two people meet, they automatically begin to influence each other. Therefore, at the root of the difference between EFT and Rogers' approach is the understanding that it is impossible to avoid influencing another person, especially in an encounter between therapist and patient.

"But the difference between the approaches is deeper. Empathy in its Rogerian sense, focusing on the patient without directing them, is not effective enough. If the patient is with me in the room and is looking for a way to feel better, and I know which path they need to take for their ambition to come true, it makes sense that I would direct them there.

"My knowledge does not come from knowing better than the patient what they are feeling, but from knowing how to help people connect with their deep feelings and process them effectively, which will ultimately help them feel better. So, in EFT, empathy is a necessary condition, but empathically following the client's feelings as Rogers established is simply not effective enough."

Can You Give an Example?

"Let's imagine that we are sitting in a room with a patient who feels anger and sadness. Let's say I notice that the patient is stuck in their anger more than in their pain. If we stick to pure Rogerian empathy, only tracing their emotional process, they will stay stuck in anger for a long time. On the other hand, once an EFT therapist notices the patient's sadness, they can direct their attention to it. Once they do this, the patient will be able to connect with their sadness in a more explicit way, building together the emotional process and learning from it."

When Greenberg talks about directing the process, he doesn't mean an interpretation along the lines of "You say you're angry at your mother, but I guess in your subconscious you're sad." Nor does he mean directing the process in a way that takes the focus somewhere else, like "You say you're angry with your mother, but we both know that this anger only complicates things, so let's see how you can control it next time."

Instead, he means something different: when a patient says "I'm angry with my mother" but looks and sounds sad, I can draw their attention to this and say, "You know, I hear you're angry with your mother, but when I look at you, it seems you might also be a little sad?"

The Need for Validation and Guidance

Greenberg explains that the Rogerian position, which considers empathy the necessary and sufficient condition of the therapeutic process, misses two important things: "First, the patient needs not only empathy but also validation or confirmation. Within a close relationship, people need validation of their identity. Secondly, patients need gentle guidance.

"These two things are just as important in therapy as they are in parenting. As a parent, you know that you have to recognize the spark of interest in the child's eyes so that the spark will develop into the flame of curiosity. In other words, to fulfill my potential, I need someone to see that potential. If I'm stuck but want to get out of the rut, I need someone who sees me, understands the process I'm going through, and helps me focus on the right thing."