Person-Centred-Experiential (PCE) Therapy for Social Anxiety (SA) following the Process-Experiential Model (3/09)

Entry for 30 March 2009:

As part of our planning for our next Social Anxiety study, I’m meeting with a couple of prominent Scottish CBT types this week to discuss a CBT comparison condition. As part of my preparation for the meeting, I put together the following summary of where I understand us to have gotten up to in describing a comprehensive PCE therapy for Social Anxiety.

A. Theoretical model: PCE Understanding of Social Anxiety:
1. Particularly interested in generalized SA/Avoidant Personality difficulties
•Commonly accompanied with clinical depression

2. Driven by emotion processes:
•Key emotions: primary maladaptive (overgeneralized) shame and fear
•Organized by core emotion schemes of self as socially defective (e.g., “rubbish”, “daft”, “not nice to look at”) and others as harshly judging/rejecting

3. Causal factors:
•Often grounded in early rejection/abuse by primary caregivers
•Results in harsh, shaming internal critic (introject of early rejection/abuse)
•Maladaptive shame/fear motivate social withdrawal/avoidance and emotional avoidance
•Recent life events (e.g., loss, rejection, conflict) activate core emotion schemes, lead to exacerbation of SA difficulties, interfering with life functioning, precipitating a SA episode or crisis

B. Treatment Model: Change Processes/Phases of therapy:
1. Establishing PCE working relationship
•Sessions 1 -3
•Offering adequate structure to allay initial client SA related to being therapy
•Communicating genuine empathy and unconditional caring
•Fostering mutual involvement in therapeutic goals/tasks

2. General exploration and initial narrative work
•Sessions 2 – 4
•Exploring nature and history of SA
•Making meaning
•Explicating and constructing life narrative

3. Initial exploration of key SA processes
•Sessions 3 – 8
•Systematic evocative unfolding of SA episodes
•Two chair work on SA and related self-criticism process

4. Strengthening the self
•Sessions 6 – 10
•Empathic affirmation/validation of sense of social defectiveness and desire for change
•Working on emotion regulation: clearing an internal space free of anxiety; experiential focusing on positive aspects of self; two chair dialog for self-soothing)

5. Work on changing core SA processes:
•Sessions 9 – 16
•Work on changing emotion with emotion and altering core self/other schemes: via two-chair work between emotional and SA critic aspects of self, and empty chair work with imagined rejecting/abusive significant others

6. Consolidation of changes
•Sessions 17 – 20 with decreasing frequency
•Additional narrative and other closure work as needed