Identifying and developing therapeutic principles for trauma‐focused work in person‐centred and emotion‐focused therapies

David Murphy,Robert Elliott,Lorna Carrick

doi:10.1002/capr.12235

David Murphy, Robert Elliott + Show 1 more

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https://doi.org/10.1002/capr.12235

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Abstract

AbstractBackgroundThe aim of this research was to identify facilitative therapeutic principles in person‐centred and emotion‐focused therapy for working with traumatised clients in the early stages of therapy.MethodsFour cases were selected from the Strathclyde Experiential Therapy for Social Anxiety archive: one good and one poor outcome case from each therapeutic approach. Outcomes were considered good and poor based on quantitative outcome measures. Each case met DSM‐IV‐TR diagnostic criteria for both PTSD and social anxiety. We developed a new method for the identification of therapeutic principles that offers an alternative to current approaches to competency identification. Our method uses a qualitative, bottom‐up inductive process analysis. The first three sessions from each case were transcribed and independently analysed by two researchers (one blinded to the outcomes); the third researcher acted as consultant. The transcripts were analysed by focusing on session episode structure and treatment principles.FindingsFour trauma‐focused therapist principles were identified: (a) support early relationship building/alliance formation; (b) facilitate client identification and recognition of past events as trauma experiences; (c) facilitate work on traumatic sources of current experiential and interpersonal difficulties; and (d) offer self‐agency focused empathy.ConclusionsWe conclude that our approach identifies and provides a new method for establishing person‐centred experiential therapy principles for early trauma‐focused work. Further research is recommended, and limitations are discussed.

Highlights

Traumatic events can lead people to feel anxious; it is not surprising that post‐traumatic stress and social anxiety difficulties frequently co‐occur in both research and naturalistic samples (Collimore, Carleton, Hofmann, & Asmundson, 2010). Collimore et al (2010) suggest that experiencing both post‐ traumatic stress and social anxiety will make clients more clini‐ cally distressed, potentially making them more difficult to help
We have been able to identify four key common thera‐ peutic principles that are present in good outcome cases of PCT and Emotion‐focused therapy (EFT) for traumatised clients
These principles relate to early relation‐ ship/alliance formation, identification and acknowledgement of past events as traumatic, facilitation of past traumatic events locating these in the client's present process orientation, and thera‐ pists using self‐agency focused empathic responses to support the self‐direction and self‐healing capacities of clients

Summary

Introduction

Traumatic events can lead people to feel anxious; it is not surprising that post‐traumatic stress and social anxiety difficulties frequently co‐occur in both research and naturalistic samples (Collimore, Carleton, Hofmann, & Asmundson, 2010). Collimore et al (2010) suggest that experiencing both post‐ traumatic stress and social anxiety will make clients more clini‐ cally distressed, potentially making them more difficult to help. Notwithstanding the large body of evidence underpinning NICE treatment recommendations for CBT and EMDR for PTSD, research with traumatised clients within the humanistic‐experiential psychotherapies (HEPs) shows promising results (Elliott et al, 2013). This is especially the case for more complex relational and interpersonal difficulties that clients are experiencing as responses to childhood abuse and trauma (Paivio, Hall, Holowaty, Jellis & Tran, 2001). Findings: Four trauma‐focused therapist principles were identified: (a) support early re‐ lationship building/alliance formation; (b) facilitate client identification and recognition of past events as trauma experiences; (c) facilitate work on traumatic sources of current experiential and interpersonal difficulties; and (d) offer self‐agency focused empathy.

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