Developing Process-Experiential and Person-Centred Therapies for Social Anxiety

Entry for 15 September 2006:

One of the several things I am trying to get started here is a research project on developing Process-Experiential and Person-Centered approaches to working with clients with Social Anxiety. Beth Freire, my Brazilian colleague here at Strathclyde, and Mick Cooper, the other professor, have both been pushing me on this. I have been collecting articles on the topic for a couple months. Here are a few of my initial thoughts:

To begin with, as I said in an earlier entry (see entry for 10 September), there seems to be a potentially very nice fit between Person-Centered therapy and social anxiety. Person-centered therapists have been working with clients with social anxiety for decades and I think that a person-centered approach makes a lot of sense with this problem, starting with ideas about social anxiety being a form of incongruence/social disempowerment based on conditions of worth. I think that being deeply listened to and understood has got to be very powerful for socially anxious people. Also, of course, being affirmed by the therapist and the therapist revealing self as fellow human being is potentially healing for clients whose relationship to their social environment is broken by their fear of being judged.

At the same time, I am very interested in developing a process-experiential formulation and therapy for social anxiety. I have some ideas about what this may look like, which I will outline here. These ideas will be developed a bit further for my new professors bid and it now looks like I may try for additional funding for this work.

I think a PE/EFT approach makes a lot of sense also, starting with the same empathic/prizing/genuineness processes as are key in person-centered therapy, but then using various PE tasks, such as:
-Particularly difficult episodes of social anxiety (Narrative Retelling)
-Anxiety splits (Two Chair Dialogues in which critical/shaming others are addressed in the other chair)
-Attachment failures with significant others (Empty Chairwork)
-Pulling for therapist expertise (Relationship Dialogue)
-Poor experiential access (Focusing)
-Hyper-arousal or anxiety episodes or states (Clearing a Space)

From a PE/EFT perspective, we expect a common set of emotion schemes around emotions of shame and fear (also secondary sadness, i.e., depression), defective/weak self, and judgemental/harsh/rejecting others.

But in either case, part of the work on a project like this is a research team investing a number of months reading the literature on the clinical problem, meeting to discuss emerging ideas, beginning to develop formulations, then working with clients in order to learn more. Then we move into an open clinical trial (i.e., one-group pre-post design), perhaps with 2 strands (person-centered and process-experiential), all before we would even consider doing a randomized clinical trial.

Mick suggests that the work he and Dave Mearns have been doing on working at relational depth might be highly relevant to social anxiety. I think it would be very interesting, to develop relational depth as a therapeutic task. Actually, this is close to the interpersonal dialog work that Germain and the KUL group have been working on. Doing this research might be a way forward to developing this task more fully.

In any case, I'd still like to see a rigorously-developed person-centered approach to social anxiety developed, thought; I think it would be very interesting and could illuminate some important points.