Tuesday, July 15, 2008

Relational Change Processes in Process-Experiential/Emotion-Focused Therapy

Paper presented Person-Centred/Experiential Therapy Conference,
Norwich, UK, July 2008

Relational Change Processes in Process-Experiential/Emotion-Focused Therapy
Robert Elliott
University of Strathclyde

I. Therapeutic Relation and the Change Process in PE-EFT
A. Two functions (from Rice & Greenberg)
1. Primary: Fosters change directly as a corrective relational experience
2. Secondary: Fosters change by facilitating emotion change processes

B. Therapeutic Relation as a Primary Change Process
1. Client enters therapy with Negative Other emotion schemes, e.g.:
Uncaring, judging, misunderstanding, phony, exploitive, abusive
2. Therapist violates these expectations by acting differently, often in the opposite manner: Caring, accepting, understanding, genuine, putting client’s needs first, present in a healing way
3. Provides client opportunity to revise interpersonal emotion schemes into positive ones (therapeutic reaction: Positive Other
4. Also promotes revising Self Emotion Schemes to complement new Other Emotion Schemes (therapeutic reaction: Positive Self)

C. Therapeutic Relation as a Secondary Change Process
1. Enables the client to trust the therapist and the therapeutic process enough to risk entering into the difficult, often painful emotional experiences that are change processes in themselves.
2. Emotions are source of agency: helps client find own direction

II. Reflections on Deference in Therapy
A. General considerations:
1. Definition of Deference: Submission to the judgment, wishes or opinion of another person
2. Can be negative/interferring or positive/facilitative

B. Complexities of Deference
1. Universality
2. Types
3. Nonlinear relational regulation processes
4. Paradoxical deference in PCT

C. Universality of Deference
1. All relationships involve some degree of mutual deference
2. In talking, we take turns giving the floor to each other
3. We expect the other to listen to us when we speak
4. We design our responses to be responsive to the other

D. Types of Deference
1. Content deference: Topic/issue/task/goal; Meaning, commentary
2. Process deference: How a topic/task/issue will be worked with
3. Content deference can allow process nondeference

E. Feedback Processes in Deference:
1. When we defer, we follow the other person
2. But this often reveals to both people that the direction proposed doesn’t work, so they reverse direction and go a different way
3. This argues against simple linear deference models
4. What we should worry about is when deference defeats the natural self-correcting process in therapy

F. Paradoxical Deference in Person-Centred Therapy
1. Client asks for guidance from therapist
2. Therapist declines to provide guidance
3. Client defers to therapist by withdrawing request for guidance
4. So: Nondirectivity doesn’t eliminate the power differential, and may risk being experienced as a power play in which the therapist withholds valuable information in order to retain power over the client

G. Paradoxical Deference in Person-Centred Therapy
1. Gloria is a counter-example: She doesn’t really defer: She continues to ask Rogers for direction and finally extracts an answer to her question from her reading of his responses to her:
Gloria: Example of Client Nondeference:
C49 But then there's also a conflict there because I am not really positive what I want to do. ... Like when I bring a man to the house. I am not sure I want to do that. If I feel guilty afterward, I must not have really wanted to.
T49 ... I'm not just sure which words you used - but ... you don’t like yourself or don't approve of it when you do something against yourself.
C50 Yes. You know, this is so different. Now this kind of thing we are talking about now, it isn't just knowing whether you want to do something or not. ... when I find myself doing something I don't feel comfortable with, I automatically say, "If you’re not comfortable Gloria, it’s not right. Something’s wrong." All right now. What I want to ask you is, how can I know which is the strongest? Because I do it, does that mean that’s the strongest? And yet, if I disapproved, that's just part of the thing that’s got to go along with it? You see, it sounds like you... I'm picking up a contradiction...
2. But: What about less resilient clients? How often do we silence their request for help in resolving their tasks?
-Example of Possible Deference by a client:
-Is this an example of a client celebrating his new-found power…
-Or: attempting to self-persuade that it is OK to give up his desire for guidance from the therapist?
-Socially Anxious client in Nondirective Therapy:
… sometimes I want to ask you [for] advice and say: ‘what would you do?’ but I know that is not the purpose of this… and has been hard to get used to sit here and coming up with solutions myself… but I’m starting to see… we have only met for four or five times, but I can see the benefits of doing that and sitting here and doing that… just speaking and thinking… because the solutions are all in my brain! but sometimes there is so much mess in my brain I can’t see them. I have never in my life would have thought this would work, just me talking and … because you are the only person in my life who doesn’t offer me advice (laugh) and that is bizarre! But I’m coming to realize that I don’t need you to advise… yeah it would be lovely for you to turn and say: ‘I think you should this and this’, but the actual fact is that this is far healthier than.”
III. More Differentiated View of Deference needed
A. Interfering Deference:
1. Being silenced from expressing important, pressing concerns or feelings
2. Going along with something that goes against our values
3. Allowing ourselves to be put down or lowered in value
4. Being exploited for an other’s benefit

B. Facilitating Deference (for both client and therapist:
1. Holding back for a bit to make space for the other to finish
2. Trusting the other that something painful or difficult can be helpful

C. Conclusion:
1. Vital not to abuse client’s trust
2. With this warning, critical point is to be clear about what kind of deference we are using.

Acknowledgements to Bill Stiles, Beth Freire for the transcripts and to Art Bohart for general inspiration.

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