Sunday, May 22, 2011

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

Reference: Elliott, R. (May, 2011). Emotion-Focused Therapy and the Person-Centred Approach: Past, Present, Future. Paper presented at Counselling Unit Twentieth Anniversary Conference, University of Strathclyde, Glasgow, Scotland.

1. A Personal Journey…
1.1. Five years ago: Invited to join the Counselling Unit
1.1.1. Walked into a place with a deep sense of culture and history built up over many years; but also, deeply counter-cultural
1.1.2. Complex web of: Courses and projects; relationships and traditions; large team of talented trainers and counselors; highly committed students, past and present
1.1.3. Fear & trembling: Questions raised:
• Will I be able to do meaningful work in this new setting?
• Will I be accepted?
• Is there space for my way of working with clients here?
• Will I change it?
• Will it change me?

1.2. Crucial Issue: What is the relationship between Process-Experiential/Emotion-Focused Therapy and the Person-Centred Approach?
1.2.1. In the early 1990’s, Barbara Brodley and John Shlien had both said to me: (Process)-Experiential therapy, Focusing, Emotion-Focused Therapy is not Person-centred
1.2.2. But Laura Rice, Les Greenberg & I had all started from a Person-Centred base, and felt we were Person-Centred
1.2.3. So, coming here, I began a five-year Evolving Dialogue with colleagues: •Classical/nondirective Person-Centred Therapy (PCT)
• Broadly relational PCT
• Pluralistic
1.2.4. My position has varied: Curiosity & puzzlement; awe & skepticism; frustration & excitement
1.2.5. Will present what I’ve learned so far from this dialogue: Past, Present & Future

2. The Past: A Brief History of Person-Centred-Experiential (PCE) Therapy
2.1. PCE Time-line:
• Roots/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…
• 1970’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 research
• 2000’s: World Association founded; Journal: Person-Centered and Experiential Psychotherapies; Struggles for recognition; Research continues rapid development; EFT books & training emerge

2.2. Legacy of this Past: The Great Divide:
2.2.1. Continuing dialogue between different parts of the tradition, especially from 1970 on
• One 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
2.2.2. “Pluralistic Approach” fits in there somewhere… perhaps at a 90 degree to the Great Divide

2.3. Examining the Legacy: Dialoging Across the Great Divide
2.3.1. Counselling 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
2.3.2. 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
2.3.2. Which takes us to …

3. The Present: Have PCT vs EFT differences been exaggerated?
•As a result of recent history of dialogue over our differences, can now ask this question.
Two recent efforts to look at this…

3.1. The EFT Translation Project
3.1.1. EFT jargon can put PCT therapists off: Makes 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 Principles
3.1.2. PCT-Friendly EFT Principles
• Research Clinic therapists examined the 6 EFT principles; decided the following 3 need no translation: Empathic Attunement: Always start by entering, attending to & tracking the client’s immediate experiencing Therapeutic Bond: Offer genuine, empathic, caring presence to client Self-development: Foster client growth, empowerment & choice
•Three EFT Principles Need Translation into PCT Language; involve different kinds of therapeutic work (=“tasks”) “Task Collaboration”:
•EFT: Offer and facilitate involvement in therapeutic work
•PCT Translation:
(a) Listen for and engage with what client wants to work on
(b) Offer orienting information about nature of therapy and particular ways of working in the session, particularly when the client asks or is puzzled “Task Completion/Emotional Change”:
• EFT: Facilitate reorganization of core maladaptive emotion schemes by helping client resolve key therapeutic tasks
• PCT Translation:
(a) Listen for and engage with key issues clearly or repeatedly presented by client
(b) Help client contact, explore and clarify core, growth-oriented emotions and views of self/others
(c) Keep helping client work on their key issues until they feel they have resolved these or decide they want to stop
(d) … and the client decides what is key, core, or resolved “Process Guiding”:
• EFT: Help client work in different ways at different times; foster relevant client micro-processes/ modes of engagement (e.g., experiential search, active expression)
• PCT Translation:
(a) Be aware of and respond helpfully to common kinds of client experiences and process
(b) E.g, Empathic Refocusing response: allow C to step back from difficult emotions before offering opportunity to return to them
(c) Respond to client-presented issues by offering opportunities for potentially useful kinds of therapeutic work
(d) Always accept client’s decision about whether or not to accept a process offer

3.2. Comparing PCT & EFT: The PCEPS study (Freire, Elliott & Westwell, 2011)
3.2.1. 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+
3.2.2. The PCEPS study – Method: Just 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)
3.2.3. The PCEPS study: Summary PCEPS is reliable (across items and raters) In general, PC and Exp items correlate very highly with each other We also found a Nondirectiveness factor: Empowering Presence, Content Nondirectiveness, Clarity/brevity Student therapists scored lower on all items 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 differences

4. The Future: Some concluding thoughts about avenues for continuing the dialogue & an agenda for the future
•Where does this leave us?
4.1. 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 process

4.2. A Pluralistic community of practice: Using our different strengths as therapists to complement each other
4.2.1. Most of us are never going to be effective therapists across a range of different therapy approaches
4.2.2. 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 therapy

4.3. 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:
(a) What are these moments? (=client markers)
(b) How can I maintain nondirectivity at these moments? (=therapist processes)
(c) What are the immediate and ongoing effects of these moments? (=micro-outcomes)

4.4. Conclusion: Living with the creative tension between nondirectivity and process guiding
4.4.1. It’s so difficult to live in the middle: Between dichotomies/unresolved differences/ ambiguity/ complexity (David Rennie’s “rocky middle road”)
4.4.2. However, I strongly suspect: Nondirectivity and Process Guiding might actually need each other: Can be a source of moderation and creativity for each other
4.4.3. 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 Guiding

5. Coda: 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

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