Emotion-Focused Therapy and the Person-Centred Approach - PowerPoint Presentation

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Emotion-Focused Therapy and the Person-Centred Approach: Past, Present & Future

Robert

Elliott

University of

StrathclydeSlide2

A Personal Journey…Five years ago: Invited to join the Counselling UnitWalked into a place with a deep sense of culture and history built up over many years

But also, deeply counter-cultural

Complex web of:

Courses and projects

Relationships and traditions

Large team of talented trainers and

counsellors

Highly committed students, past and presentSlide3

A Personal Journey…Fear & trembling: Questions raised: Would I be

able to do meaningful work in this new setting

?

Would

I be accepted?

Is there space for my way of working with clients here?

Would I change it?

Would it change me?Slide4

Crucial Issue…What is the relationship between Process-Experiential/Emotion-Focused Therapy

And the Person-

Centred

Approach?

In the early 1990’s, Barbara

Brodley

and John

Shlien

had both said to me:

(Process)-Experiential therapy, Focusing, Emotion-Focused Therapy ≠ Person-

centred

But Laura Rice, Les Greenberg & I had all started from a Person-

Centred

base

Felt

we were Person-

Centred

So, coming here, I began…Slide5

… Five-year Evolving DialogueWith colleagues:Classical/nondirective Person-Centred

Therapy (PCT)

Broadly relational PCT

Pluralistic

My position has varied:

Curiosity & puzzlement

Awe &

scepticism

Frustration & excitement

Will present what I’ve learned so far from this dialogue

Past, Present & FutureSlide6

The Past: A Brief History of Person-Centred-Experiential (PCE) Therapy Slide7

Time Line of PCE Therapy -1Roots/Sources: Humanism (The Renaissance, The Enlightenment, existentialism, Third force Humanistic psychology)

1940’s: Nondirective therapy: Rogers

1950’s: Classical approach: Chicago

Relationship conditions: unconditional positive regard, empathy, genuineness

1960’s: Focus on client process: Wisconsin

Late Rogers,

Gendlin

The dialogue begins…Slide8

Time Line of PCE Therapy -21970’s: Experiential therapy:Gendlin

: Focusing

Rice, Greenberg: task analysis

1980’s: Partial eclipse period

Dismissed in North America

Further development of PCA in Europe

1990’s: Beginning of PCE revival

Training

centres

established:

Counselling

Unit

Process-Experiential (PE)/Emotion-Focused Therapy (EFT)

Explosion of researchSlide9

Time Line of PCE Therapy -32000’s:

World Association founded

Journal:

Person-Centered and Experiential Psychotherapies

Struggles for recognition

Research continues rapid development

EFT books & training emergeSlide10

Legacy of this Past: The Great DivideContinuing dialogue between different parts of the tradition, especially from 1970 onOne end: “Classical” approaches

Emphasize

Nondirectivity

, Unconditional Positive Regard, the centrality of the relationship

Other end: Emotion-Focused Therapy

Emphasize client process, process guiding, the work of therapy

“Pluralistic Approach” fits in there somewhere…Slide11

Examining the Legacy: Dialoging Across the Great DivideCounselling

Unit: One of few places in the world where it would have been possible to carry out this dialogue

Over an extended period of time

And with reference to actual practice

Most importantly, this has allowed exploration of the deeper issues of personal and professional identity:

Need to hang onto what is essential vs. need to escape oppressive restrictions

Need to establish self vs. feeling threatened or excluded

Which takes us to …Slide12

The PresentAs a result of recent history of dialogue over our differences, can now ask: Have PCT

vs

EFT differences been exaggerated?

Two recent efforts to look at this…Slide13

1. The EFT Translation Project EFT jargon can put PCT therapists offMakes it sound like EFT therapists are pulling levers and controlling clients

Have been trying to translate into PCT Friendly language

Many discussions with Beth

Freire

, Brian Rodgers, Graham

Westwell

, and others

Example: The Six EFT Therapy PrinciplesSlide14

PCT-Friendly EFT Principles

Research Clinic therapists examined the 6 EFT principles.

Decided the following 3

need no translation:

1.

Empathic Attunement

: Always start by entering, attending to & tracking the client’s immediate experiencing

2.

Therapeutic Bond

: Offer genuine, empathic, caring presence to client

3.

Self-development

: Foster client growth, empowerment & choiceSlide15

Three EFT Principles Need Translation into PCT Language -1

Involve different kinds of therapeutic work (=“tasks”)

4. “

Task Collaboration”

:

Listen for and engage with what client wants to work on

Offer orienting information about nature of therapy and particular ways of working in the session, particularly when the client asks or is puzzledSlide16

EFT Principles that Need Translation into PCT Language -2

5. “

Task Completion/Emotional Change”

:

Listen for and engage with key issues clearly or repeatedly presented by client

Help client contact, explore and clarify core, growth-oriented emotions and views of self/others

Keep helping client work on their key issues until they feel they have resolved these or decide they want to stop

… and the client decides what is key, core, or resolvedSlide17

EFT Principles that Need Translation into PCT Language -3

6. “

Process Guiding”

:

Be aware of and respond helpfully to common kinds of client experiences and process

Eg

, Empathic Refocusing response: allow C to step back from difficult emotions before offering opportunity to return to them

Respond to client-presented issues by offering opportunities for potentially useful kinds of therapeutic work

Always accept client’s decision about whether or not to accept a process offerSlide18

2. Comparing PCT & EFT: The PCEPS study

Freire

, Elliott &

Westwell

, 2011

Developed quantitative process rating measure of PCE therapist adherence/competence

Person-

Centred

and Experiential Psychotherapy Scale

(PCEPS)

Two subscales:

Person-

Centred

(PC): 10 items

Eg

Client frame of reference; content

nondirectiveness

Experiential Process (

Exp

): 5 items

Eg

Experiential specificity, emotion focus

1 – 6 descriptively-anchored scales

Passing = 3.5+Slide19

The PCEPS study - MethodJust finished test of measure on 120 segments:

Research Clinic data

10-15 min segments

60

sessions,

20 clients, 10 therapists

5 student therapists (general client sample)

5 post-training therapists (clients with social anxiety)

2 PCT, 3 EFT (2 fully trained)Slide20

The PCEPS study: Summary1. PCEPS is reliable (across items and raters)2. In general, PC and

Exp

items correlate very highly with each other

3. We also found a

Nondirectiveness

factor

Empowering Presence, Content

Nondirectiveness

, Clarity/brevity

4. Student therapists scored lower on all items

5. No difference between fully trained PCT and EFT therapists on: PC, Exp, and

nondirectiveness

subscales

Conclusion: Therapist and training effects much more important than PCT

vs

EFT differencesSlide21

The PCEPS study – Mean PCEPS Scores

N

Seg-ments

Mean score

%

“passing”

(at least 3.5)

Range

Student therapists

60

3.1*

17%

0 – 33%

PCT therapists

24

4.4

92%

83-100%

EFT therapists

36

4.2

75%

33-100%

EFT fully trained

24

4.6

96%

92-100%

*P<.001 vs. SA protocol therapists (PCT + EFT); all other effects

nonsignificantSlide22

The PCEPS study – PCEPS Subscale Results for Social Anxiety Clients

PC Scale: Mean

PC Scale:

%

pass

Exp

Scale:

Mean

Exp

Scale:

% pass

NDir

Scale

Mean

Ndir

Scale

% pass

PCT therapists

4.5

92%

4.2

96%

4.6

87%

EFT therapists

4.2

78%

4.2

75%

4.0*

72%

EFT fully trained

4.6

96%

4.7

96%

4.4

83%

*P<.01 vs. PCT therapists; all other effects

nonsignificantSlide23

The FutureWhere does this leave us?Some concluding thoughts about avenues for continuing the

dialogue

Provides an agenda

for the

future Slide24

1. Beyond ideology, Or: Back to the Process Itself

Is it worth continuing to argue at an ideological level over

nondirectivity

and process guiding?

Like Psychology, we have been neglecting study of concrete behavior in favor of the ease of self-report data

Both quantitative questionnaires & qualitative

interviews

PCEPS study illustrates value of following the example of early Carl Rogers and colleagues

We need to return to the study of therapy processSlide25

2. A Pluralistic community of practice: Using our different strengths as therapists to complement each other

Most of us are never going to be effective therapists across a range of different therapy approaches

But: We can do a better job of listening to and learning from each other within the PCE tradition:

Classical, nondirective therapists

Broadly relational person-

centred

therapists

Focusers and EFT therapists

Person-

centred

-based pluralistic experimenters in other approaches

Near neighbors in 4th generation CBT (

eg

Schema therapy) and contemporary relational psychodynamic therapySlide26

3. Toward a deeper understanding of nondirectivity via Task Analysis Here in the Counselling

Unit, I have found myself fascinated by rigorous

nondirectivity

in therapy

Personally, I could never adopt a sustained, rigorously nondirective stance

Nevertheless, it is clear to me that there are clients and moments when this is absolutely the best thing to do

I want to know:

What are these moments? (=client markers)

How can I maintain

nondirectivity

at these moments? (=therapist processes)

What are the immediate and ongoing effects of these moments? (=micro-outcomes) Slide27

4. Conclusion: Living with the creative tension between nondirectivity and process guiding

It’s so difficult to live in the middle:

Between dichotomies/unresolved differences/ ambiguity/ complexity

David

Rennie’s

“The rocky middle road”

However, I strongly suspect:

Nondirectivity

and Process Guiding might actually need each other

Can be a

source of moderation and creativity

for each other

My dream for the next 20 years of the CU:

That as a community, we learn how to effectively live with and grow from from the creative tension between

Nondirectivity

and Process GuidingSlide28

And by the way…Those questions I asked five years when I walked into this place…About doing meaningful work, being accepted, finding space, changing things, and being changed…

The Answer is … Yes

Email:

robert.elliott@strath.ac.uk

Blog:

http://pe-eft.blogspot.com

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