A view of human functioning is presented in which functioning is seen as integrating head and heart, emotion and reason, in a process by which people are constantly making sense of their lived ...emotional experience to form narratives of told experience. Because much of the processing involved in the generation of emotional experience occurs independently of and prior to conscious thought, therapeutic work on a purely cognitive level of processing is unlikely to produce enduring emotional change. The questions especially relevant to psychotherapy are how we can best facilitate change in emotions rather than only changes in cognition or behavior. A theory of emotional change is presented in which change in emotion is seen as requiring that first emotions be felt and then they both be exposed to new emotional experience and be reflected on to create new meaning. The process of emotional change thus involves both new experience and new understanding. At times, people also need to protect themselves from being overwhelmed by emotions. They need to be helped to tolerate and regulate them so that emotions inform their lives rather than control them. The importance of both emotion awareness and emotion regulation in therapeutic change is thus highlighted. The article ends by reviewing research on the role of emotional processing in therapeutic change and presents six empirically based principles of emotional processing that will help move the field toward psychotherapy integration in a manner that clearly recognizes emotion as a key component of functioning and change.
Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what ...is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components - autobiographical (event) memories, semantic structures, and emotional responses - supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed.
Emotional Processing in Experiential Therapy Pascual-Leone, Antonio; Greenberg, Leslie S
Journal of consulting and clinical psychology,
12/2007, Letnik:
75, Številka:
6
Journal Article
Recenzirano
The purpose of this study was to examine observable moment-by-moment steps in emotional processing as they occurred within productive sessions of experiential therapy. Global distress was identified ...as an unprocessed emotion with high arousal and low meaningfulness. The investigation consisted of 2 studies as part of a task analysis that examined clients processing distress in live video-recorded therapy sessions. Clients in both studies were adults in experiential therapy for depression and ongoing interpersonal problems. Study 1 was the discovery-oriented phase of task analysis, which intensively examined 6 examples of global distress. The qualitative findings produced a model showing: global distress, fear, shame, and aggressive anger as undifferentiated and insufficiently processed emotions; the articulation of needs and negative self-evaluations as a pivotal step in change; and assertive anger, self-soothing, hurt, and grief as states of advanced processing. Study 2 tested the model using a sample of 34 clients in global distress. A multivariate analysis of variance showed that the model of emotional processing predicted positive in-session effects, and bootstrapping analyses were used to demonstrate that distinct emotions emerged moment by moment in predicted sequential patterns.
Empathy Elliott, Robert; Bohart, Arthur C; Watson, Jeanne C ...
Psychotherapy,
03/2011, Letnik:
48, Številka:
1
Journal Article
Recenzirano
Odprti dostop
After defining empathy, discussing its measurement, and offering an example of empathy in practice, we present the results of an updated meta-analysis of the relation between empathy and ...psychotherapy outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted
r
= .31 (
p
< .001; 95% confidence interval: .28-.34), for 59 independent samples and 3599 clients. Although the empathy-outcome relation held equally for different theoretical orientations, there was considerable nonrandom variability. Client and observer perceptions of therapist empathy predicted outcomes better than therapist perceptions of empathic accuracy measures, and the relation was strongest for less experienced therapists. We conclude with practice recommendations, including endorsing the different forms that empathy may take in therapy.
The primary purported change process in emotion-focused therapy for couples (EFT-C) involves partners accessing and revealing their underlying vulnerable emotions and responding empathically when ...their partners disclose their vulnerable emotions. One main intervention to facilitate vulnerability sharing is enactment - guiding partners to interact directly with each other. The objective of the current study was to identify interventions therapists can use to help partners share vulnerability in the context of enactment. The primary hypothesis of this study was that promoting these interventions would lead to more vulnerability expressions during enactments.
One hundred and five vulnerability enactment events were identified from videod therapy sessions of 33 couples dealing with a significant emotional injury who received 12 sessions of EFT-C. Four therapists' interventions were coded: setting a meaningful systemic context, promoting the revealing partner's emotional engagement, preparing the revealing partner for enactment, and promoting the listening partner's emotional engagement in the enactment. In addition, vulnerability expression was coded.
Multilevel regression models showed that two interventions were significantly associated with greater levels of expressed vulnerability: setting a meaningful systemic context, and preparing the revealing partner for enactment.
These findings suggest that therapists can facilitated vulnerability sharing using specific preparatory interventions.
Objective: To investigate the pattern of change in emotional states over a course of emotion-focused therapy using the model of sequential emotional processing as an initial framework for analysis. ...Method: This was a single case study observational design examining 15 sessions of therapy with one client. A qualitative analysis of moment-to-moment shifts in client emotional events was conducted. This conceptualised the interplay between experienced emotions using the sequential emotional processing model as an interpretative framework. The analysis was triangulated by using existing observer-based rating scales and reliability assessed with an independent rater. Results: The sequential emotional processing model was found to be an effective means to explain the sequence of expressed emotional events, although some emotional events and emotion scheme change processes pertaining to this particular case required additional explanation than provided in the original model descriptions. Conclusions: Observed nuances in this specific case included highlighting triggers to emotional experience and avoidance processes fuelled by anticipatory fear. The observations included a process of change through accessing core feelings of shame, fear, and loneliness and their transformation through the generation of self-compassion and assertive anger. Implications for practice are discussed in terms of case conceptualisation and therapeutic strategy.
Spinocerebellar ataxia type 7 (SCA7) is an inherited neurodegenerative disease caused by a polyglutamine repeat expansion in the ATXN7 gene. Patients with this disease suffer from a degeneration of ...their cerebellar Purkinje neurons and retinal photoreceptors that result in a progressive ataxia and loss of vision. As with many neurodegenerative diseases, studies of pathogenesis have been hindered by a lack of disease-relevant models. To this end, we have generated induced pluripotent stem cells (iPSCs) from a cohort of SCA7 patients in South Africa. First, we differentiated the SCA7 affected iPSCs into neurons which showed evidence of a transcriptional phenotype affecting components of STAGA (ATXN7 and KAT2A) and the heat shock protein pathway (DNAJA1 and HSP70). We then performed electrophysiology on the SCA7 iPSC-derived neurons and found that these cells show features of functional aberrations. Lastly, we were able to differentiate the SCA7 iPSCs into retinal photoreceptors that also showed similar transcriptional aberrations to the SCA7 neurons. Our findings give technical insights on how iPSC-derived neurons and photoreceptors can be derived from SCA7 patients and demonstrate that these cells express molecular and electrophysiological differences that may be indicative of impaired neuronal health. We hope that these findings will contribute towards the ongoing efforts to establish the cell-derived models of neurodegenerative diseases that are needed to develop patient-specific treatments.
The epistemological and methodological underpinnings of task analysis are discussed and the steps and concrete procedures for its implementation are described and exemplified in a task analysis of ...the resolution of unfinished business. Task analysis, a method for studying the process of change, consists of two main phases: a discovery-oriented phase based on rational-empirical model building and a validation phase based on hypothesis testing. The goals of the approach are to (a) build an observationally based model of how therapeutic change occurs for a particular type of affective-cognitive problem, (b) validate the model of change, and (c) relate the process of change to outcome. Benefits and strengths of the approach are presented and factors that have impeded the use of this approach in the study of change processes are discussed.
Objective:
To determine the relationship between length of time spent expressing highly aroused emotion and therapeutic outcome.
Method:
Thirty-eight clients (14 male, 24 female) between the ages of ...22 and 60 years (
M
= 39.5,
SD
= 9.71), treated for depression with experiential therapy, were rated on working alliance and expressed emotional arousal (with the Client Expressed Emotional Arousal Scale) in their three highest arousal sessions. Among the clients, 34 were of European ethnicity, 2 were of Asian ethnicity, 1 was of Latino ethnicity, and 1 was of Caribbean-Canadian ethnicity. Clients were administered the short form of the Working Alliance Inventory following their 4th therapy session and also completed, pre- and posttherapy, the Beck Depression Inventory (BDI), the Global Severity Index (GSI) of the Symptom Checklist-90-Revised (SCL-90-R), the Inventory of Interpersonal Problems, and the Rosenberg Self-Esteem Scale.
Results:
Hierarchical regressions showed that a nonlinear pattern of expressed emotional arousal predicted outcome significantly above the alliance. This combination predicted 30% of outcome variance on the BDI and 24% on the GSI (
p
< .01). An optimal frequency (25%) of highly aroused emotional expression was found to relate to outcome, with deviation from this optimal frequency predicting poorer outcome.
Conclusions:
Too much or too little emotion was found to be not as helpful as a moderate amount. It was concluded that expressed emotional arousal in experiential therapies has a more intricate relationship with therapeutic outcome than has previously been shown and that it is moderate amounts of heightened emotional arousal that improve predictions of therapeutic outcome.
The theory and research on emotion-focused therapy (EFT) for depression is reviewed to highlight Canadian contributions to research in depression. We describe how depression is understood within EFT ...and review studies that examined its effectiveness in the treatment of depression and illuminate the important role of working with emotion to facilitate change. EFT initially known as process-experiential therapy is an empirically supported treatment for depression. In EFT, emotions are seen as fundamental to the construction of the self, providing an immediate source of information by means of a preconscious, automatic evaluation of stimuli. This system provides information and action tendencies and a gut response that helps people discriminate among competing options, adapt to environments, and promote well-being. In this article, we present three randomized clinical trials that examined the efficacy of EFT in the treatment of depression and review research on the processes and mechanisms of change in this form of treatment. Our review provides empirical support for the underlying mechanisms of change in EFT including optimal emotional processing, how clients make sense of their experiences by integrating cognition and emotion, the therapeutic relationship conditions, as well as specific emotion-focused techniques used in the treatment of depression.
Les travaux sur la théorie et la recherche sur la thérapie centrée sur les émotions (TCE) pour le traitement de la dépression sont examinés afin de mettre en relief les contributions de chercheurs du Canada dans ce domaine. Les auteurs décrivent la façon dont est comprise la dépression dans le contexte de la TCE et passent en revue les études qui ont examiné l'efficacité de cette méthode dans le traitement de la dépression et mis en lumière le rôle important du travail avec les émotions en vue de favoriser les changements. La TCE, au départ connue en tant que processus thérapeutique expérientiel, est un traitement de la dépression validé par des données concrètes. Dans le cadre de la TCE, les émotions sont perçues comme des éléments fondamentaux pour la construction du soi, lesquels constituent une source immédiate d'information par l'entremise d'une évaluation automatique de stimuli préconscients. Ce système fournit de l'information et des tendances quant aux actions ainsi qu'une réaction instinctive qui aident les gens à faire la distinction entre des options concurrentes, à s'adapter à des environnements et à promouvoir leur mieux-être. Dans cet article, les auteurs présentent trois essais cliniques randomisés qui ont examiné l'efficacité de la TCE dans le traitement de la dépression, et ils examinent la recherche sur les processus et les mécanismes du changement dans ce type de traitement. Cette revue fournit un appui empirique aux mécanismes qui sous-tendent les changements dans la TCE, y compris le traitement optimal des émotions, la façon dont les clients comprennent leurs expériences en assimilant cognitions et émotions, les conditions de la relation thérapeutique, ainsi que les techniques précises axées sur les émotions qui sont utilisées dans le traitement de la dépression.
Public Significance Statement
This article presents a review of the research on emotion-focused therapy (EFT) in the treatment of depression that has been conducted in Canada, including studies of its effectiveness and the mechanisms of change. This research is important as its highlights that EFT is an effective treatment for depression and reveals the important role of emotional processing and relational factors in the process of change. An increased understanding of the mechanisms of change in EFT is vital to enhance therapeutic outcomes.
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