Abstract
Background: The therapeutic relationship is regarded as an important source of change in emotion-focused therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have specifically investigated how clients experience the role of the relationship in EFT.Aim: The purpose of the present study was to explore what clients experienced as helpful or hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety, and severe self-criticism.Methods: We interviewed 18 clients after a clinical trial of time-limited EFT, to explore their experiences of the relationship with their therapist during treatment. The interviews were analyzed using hermeneutic-phenomenological thematic analysis (Braun and Clarke, 2006; Binder et al., 2012).Results: We identified four main themes: (1) Forming a trusting relationship or finding it hard to connect, (2) Collaborating and struggling to find new ways to relate to painful feelings, (3) Alliance ruptures and needs for repair when working with distressing emotions, and (4) The significance of new relational experiences.Conclusion: Clients described therapists’ genuineness and the establishment of trust in the relationship as important preconditions to open up to vulnerability and painful feelings, and engaging fully in specific EFT interventions. The findings also indicate that the therapists need to be mindful of different client preferences and monitor potential alliance ruptures when working to change distressing emotions in therapy.
Highlights
What is it like to open up and reveal your most vulnerable and painful feelings to another person when you are struggling with depression, anxiety, and self-criticism? How do clients experience the role of the relationship with their therapist when undergoing a time-limited emotion-focused therapy (EFT)? The therapeutic relationship is considered by many leading clinicians and theorists
We identified four main themes through the analytic process: (1) Forming a trusting relationship or finding it hard to connect; (2) Collaborating and struggling to find new ways to relate to painful feelings; (3) Alliance ruptures and needs for repair when working with distressing emotions; and (4) The significance of new relational experiences
The themes have a chronological structure, where the two main first themes describe both the helpful and challenging experiences the participants described within the initial phase or working phase of the therapeutic process, and the final main themes illustrate how the participants subsequently described these experiences as leading to the challenging experiences and the positive experiences in the therapeutic relationship as therapy progressed
Summary
What is it like to open up and reveal your most vulnerable and painful feelings to another person when you are struggling with depression, anxiety, and self-criticism? How do clients experience the role of the relationship with their therapist when undergoing a time-limited emotion-focused therapy (EFT)? The therapeutic relationship is considered by many leading clinicians and theoristsExploring the Therapeutic Relationship in EFT to be the main vehicle for client change (Rogers, 1951/2012; Sullivan et al, 1955/2003; Mitchell, 1993; Greenberg, 2007). How do clients experience the role of the relationship with their therapist when undergoing a time-limited emotion-focused therapy (EFT)? In a meta-analysis of 109 qualitative studies of clients’ experiences of psychotherapy, Levitt et al (2016) found that authentic caring from the therapist allowed clients to feel validated and engage in vulnerable discussion, but that overinvolvment could hinder client’ sense of agency. We investigate what clients experience as helpful and hindering aspects of the therapeutic relationship when undergoing EFT for depression, anxiety, and severe self-criticism. The therapeutic relationship is regarded as an important source of change in emotion-focused therapy (EFT) (Greenberg, 2014; Watson, 2018), but few qualitative studies have investigated how clients experience the role of the relationship in EFT
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