Entry for 4 April 2008:
Full reference: R. Elliott. (April, 2008). Emotion Processes in First Sessions of Process-Experiential Therapy: An Interpretive Discourse Analysis of Clients’ Accounts of Significant Events. Paper presented at conference of the British Psychological Society, Dublin, Ireland.
Jutta Schnellbacher and I gave an earlier version of this paper at the Society for Psychotherapy Research conference last June. This time, without Jutta to present her parallel analyses of relational processes, I decided to concentrate on emotion processes. Last time, I presented only one of the five domains that I’d analyzed; this time I decided to go for broke and present the entire analysis, all five domains. This involved staying up rather later than I had anticipated the night before the presentation, but I think that the resulting presentation gave the audience a much more complete picture of the variety and depth of analyses that are possible with this method for really digging down in one’s data. The following is a text conversation of my powerpoint slides.
I. Introduction
A. First Sessions as Locus for Studying Key Client Experiences
1. Clients typically bring to first session of therapy salient concerns about:
-Nature of the therapy relationship they are entering
-Their emotions
2. These are key processes in Process-Experiential/ Emotion-Focused Therapy
3. Initial sessions = excellent site to study these
4. Here focus on emotion processes; Jutta Schnellbacher of KU Leuven did parallel analysis of relational talk
B. Helpful Aspects of Therapy (HAT) Form (Llewelyn, 1988)
1. Widely used for collecting client post-session accounts of significant therapy events
2. Asks client to describe most helpful or important event in session, including:
-What made it helpful
-How helpful (9-point scale)
-Other helpful or hindering events in session
3. Typically produces relatively thin research protocols of brief but information-dense statements
4. Sometimes difficult to analyze properly
5. Example: Client 6, Session 1 HAT:
-Helpful: Being able to vent without having anything negative be said.
-Slightly Helpful: 6; Where?: from middle to end; How long? 20 to 30 mins.
-Hindering: Nervousness (mine) at first. Nervousness talking to someone I didn’t know about things that have happened in the past and present. Slightly Hindering: 4
C. Qualitative Data Analysis Practices
1. Generic approach to qualitative data analysis:
-Set of common analytic practices that different analytic approaches draw on (Elliott & Timulak, 2006)
-Types of Practices: Pre-analysis; Translation; Categorization; Integration; Credibility checks
-Translation practices: Data Summary, Explicating Implicit Meaning, Interpretation Unconscious Meaning, Process Description
D. Interpretive Discourse Analysis
1. Emphasizes Explication and Interpretation practices
2. Deeper reading of the data than is typical for standard ÅgdescriptiveÅh qualitative analysis (e.g., GTA)
3. Requires theoretical framework that provides basis for interpretation of aspects of experience of out informantsÅf experience (e.g., psychodynamic or feminist theory):
4. Process-experiential emotion theory
5. Lakoff-Johnson metaphor theory
II. Method
-Parallel analyses of relational & emotion talk
-Series of steps:
A. Step 1. Highlight relevant talk that points to:
-Position of self or therapist in relationship
-Experiences of own emotions
1. Example: Client 6, Session 1 (Highlighted)
-Helpful: Being able to vent without having anything negative be said.
-Slightly Helpful: 6; Where?: from middle to end; How long? 20 to 30 mins.
-Hindering: Nervousness (mine) at first. Nervousness talking to someone I didn’t know about things that have happened in the past and present.
-Slightly Hindering: 4
Key: Relational talk; Emotion talk
B. Step 2: Interpreting the Text
1. Read HAT texts closely for explicit and implicit meaning
2. Dialogue with the data: Ask:
-Relational Talk: What is the client telling/ revealing about their understanding of their and the therapist’s position in the relationship?
-Emotion Talk: What is the client telling/ revealing about their experience of their emotions?
3. Example of Emotion Talk Analysis:
Text: "Being able to vent without having anything negative be said"
Analysis: Read as description of:
-Emotion regulation process: heat/steam metaphor (Lakoff & Johnson)
-Action tendency(emotion as source of action/wish/need): Express/vent/get emotion out in the open
-Consequence of emotion expression or work: lack of negative interpersonal consequences
-Folk concept of problematic emotion process: In general, emotional expression is interpersonally risky -- a rule noted by virtue of an exception being remarked upon here
-Folk concepts of helpful processes re: emotions:
-(a) "It is helpful to express emotions" "Venting metaphor";
-(b) "The therapist’s acceptance/non-negative response to emotional expression is helpful”
C. Step 3: Developed general analytic framework (domain structure)
-Emerged from the analysis
-Rough correspondence to key elements of Process-Experiential emotion theory
I. Type of mention or nonmention
II. Type of emotion
III. Emotion regulation processes
IV. Emotion Scheme elements
V. Folk emotion theory concepts
D. Step 4: Open Coding within Domains
1. Within each domain, classified different different types of emotion talk (ÅgdomainsÅh)
2. Often used subdomains
3. Constructed categories within domains/subdomains (= Open Coding)
III. Results:
Domain I: Type of mention or nonmention
A. When clients didn’t talk about their experience of their emotions in their accounts:
1. No event description at all (n=5)
2. Emotion not mentioned or implied (n=13)
3. Report of therapistÅfs understanding of clientÅfs emotions (n=1)
B. When clients did talk about their emotions: n= 40 (74% of 54 event descriptions)
1. Talked about only in abstract or general terms (no specific emotions or emotion scheme elements) (n=5)
2. Remaining events (n = 35) involved additional information about emotions (described in further analyses)
Domain II: Type of Emotion
A. Distressing emotions re: Client’s life/ problems (n= 22 clients)
1. Anxiety/Fear: (10)
-Nervous/anxious (4); Overwhelmed (2); Fear (4)
2. Sadness/Depression/emotional pain: (12)
-Sadness/hurt/isolation (8); Depression (5); Emotional pain (1)
3. Dislike/disappointment/frustration/anger (5)
-Anger/hate (2); Confused/frustrated (1); Dislike (1); Disappointed (mild) (1)
B. Positive (attachment) emotions re: Relationship with therapist (21)
1. Relieved/relaxed/refreshed/comfortable/less overwhelmed/ unguarded: (9)
2. Secure/safe/trusting/grateful: (7)
3. Generally Good: (7)
-Hopeful (3); Globally positive: It feels good (4)
4. Understood/Validated/in rapport with therapist: (5)
-Understood (3); Validated/affirmed/cared for (1); Sense of rapport with therapist (1)
C. Other emotions: (2)
-Surprise (1); Avoidant comfort (1)
Domain III: Emotion regulation processes
A. Soothing/Containing/distancing (n=16)
1. Relational soothing (5):
a. being listened to/understood (2)
b. being (re)assured (1)
c. being validated/affirmed (1)
d. sense of rapport (1)
-160: To confirm a “rapport” with the therapist-that the likelihood is strong that progress and “personal” revelations will result over time
2. Venting/expressing (4):
-06: venting
3. Distancing/“extracting” uncomfortable emotion (3):
-24: Being able to “empty” all my feelings. I can put all my feelings aside and feel safe and comfortable doing it.
4. Focusing on positive aspects (1):
-67: Focusing on the positive aspects of my life. Getting positive reinforcement from my therapist.
5. Planning strategy for controlling emotions (2):
-143: When I talked about knowing that I have to take control of my own feelings (writing a journal).
6. Dissolving sources of distress (1):
-63: Dissolving some reasons for sadness.
B. Hindering Loss of regulation/unhelpful accessing (3):
1. Difficult realization (1):
-39: Realizing how frightened I am to be an adult [help neutral]
2. Stuck in distressing feelings (1):
-147: what do you do for a child trapped in a closet, alone fearing for her life?… but my feelings got “stuck” there
3. Continuing confusion/frustration (1):
-54: I was confused throughout the whole session, frustrated.
Domain IV. Emotion Scheme elements
-Emotion Scheme Model; Elliott et al., 2004
A. Perceptual-situational: [referent of emotion]
1. Life situation (14)
-51: I have been on the outside of the World looking in. She made a direct connection to my feelings of isolation and understood it.
2. Therapy context:
-11: She’s trying to understand what I’m going through and this makes me feel secure.
3. Research context:
-52: The pre-session form I filled out stated my problems in print this surprised me.
B. Bodily-Expressive: [How emotion is experienced or expressed in the body] (7)
1. Decreased bodily tension (3)
-14: Relaxing, cool, relieved
2. Crying (3)
-21: I don’t like to cry.
3. Panic sensations:
-147: I spoke about feeling trapped in my body, scared, fear not being able to breathe,
C. Verbal-Symbolic: [What the person thinks, says to themselves in accompaniment with the emotion; how they picture or classify self]
1. Cognitive/thinking errors (1):
2. Powerful mental image (2):
3. Verbalized thoughts (2)
-165: I don’t believe anyone would/should stand by me during my months of depression
4. Internal emotion attribution: Seeing self as responsible for one’s own emotions:
D. Action tendency [Actions, wishes, needs generated by and thus seeming to come from the emotion] (14)
1. Express/vent/get out in the open: (8)
2. Open self to other, let guard down (2)
3. Be free, move out into the world/contemplate possible action: (3)
4. Withdraw: (1)
E. Action tendency: toward [Actions, wishes, needs generated in response to or back toward the emotion] (12)
1. Approach/accessing:
a. Searching (for) emotions: (2)
b. Insight/realization/awareness of an emotion process: (5)
2. Distancing/containing: (6)
a. Setting aside/emptying/extracting emotions/pushing emotions away: (3)
b. Hiding emotions from others: (2)
F. Consequences of emotional expression or work (7):
1. Absence of expected negative response from other (2)
2. Relief (4)
3. Get stuck/stay with painful experience (1)
-147: ...what do you do for a child trapped in a closet, alone fearing for her life? …but my feelings got “stuck” there.
Domain V: Folk Concepts for Emotions
A. Problematic/Hindering aspects/processes re: emotions (7):
1. Emotion expression can be problematic (3)
a. Emotional expression is interpersonally risky (2)
b. Expressing distressing emotions burdens others (1)
2. Emotional experiencing can be problematic (4):
a. Uncontrolled/stuck emotions cause problems (2)
b. Being confused and frustrated is not helpful (1)
c. Unwanted emotional pain is unhelpful(1)
3. Hiding or pushing away emotions can cause you problems:
B. Folk theories of helpful processes re: emotions:
1. Managing/containing emotions can be helpful (5):
a. Distance from distressing/overwhelming emotions can be helpful (1)
b. Controlling one’s emotions can be helpful (1)
c. Emotions are things that can the removed or separated from other things (2)
d. Focusing on the positive can be helpful (1)
2. Approaching/accessing emotions can be helpful (10):
a. It is helpful to express emotions (venting) (8)
b. Emotions are hidden things to be carefully sought after (1)
c. It is helpful to sort out true emotions from false ones (1)
d. Emotion access can be life-changing (1)
3. Understanding emotions can be helpful (6)
a. Feeling unblamed for distressing emotions can be helpful (1)
4. The therapeutic relationship is important for helping clients work with their emotions (7):
a. The therapist’s acceptance of emotional expression is helpful (1)
b. Being able to trust/have rapport with the therapist is helpful (3)
c. The therapist’s non-negative response to one’s emotions is helpful (3)
C. Causal concepts involving emotions: (9)
1. Emotions are normal, common effects caused by events (6)
-30: It feels good having another human being understand my experiences
2. Emotions can be causes of symptomatic behavior: (2)
-39: It made me feel like crying.
3. Emotions have reasons: (1)
-63: Dissolving some reasons for sadness. I found that there were reasons you were depressed.
IV. Conclusions:
1. At first, it appeared that emotion processes were not particularly prevalent in session 1 HATs
2. However, by learning to look carefully at implicit meaning, found substantial emotion talk, in about 75% of accounts
3. Types of emotion talk in session 1 HAT were quite complex, covering the range of PE-EFT emotion theory, and in addition explicating clients’ folk theories about emotion and emotion work
4. Emotion processes and relational processes turned out to be more closely connected than we had anticipated.
5. Types of emotion reveal balance between
-Distressing emotions about clients’ lives and problems brought into first sessions and
-Attachment-related emotions emerging in early alliance formation
-Illustrates the central work vs. relationship dialectic in therapy, played out by on the stage of human emotions
6. The method and findings appear to be promising and merit further exploration
7. Raises many unanswered questions:
-Specific to Emotion-focused Therapy?
-Specific to first sessions?
-How do relational and emotion process connect to each other?
-Gender differences in how men and women describe significant events in general, and emotion more specifically?
-Relationships between types of HAT emotion talk and alliance; therapy incompletion; outcome, etc.?
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