Emotion-focused Therapy For Depression Research Articles

Emotion-focused therapy for depression: Canadian contributions.

Emotion-focused therapy for depression: Canadian contributions.

Fluctuation in the assimilation of problematic experiences: A comparison of two contrasting cases of Emotion Focused Therapy

The assimilation model suggests that therapeutic change occurs through a gradual assimilation of problematic experiences. Previous case studies have suggested that both good- and poor-outcome cases exhibit a fluctuating pattern of assimilation progress, characterized by advances and setbacks. Our study examined more closely how this fluctuating pattern is related to symptom change across therapy. We analyzed the longitudinal relations among assimilation ratings, instability (fluctuation) in assimilation ratings, and clinical symptom intensity in two contrasting cases of emotion-focused therapy for depression, one good and one poor outcome. We used the assimilation of problematic experiences scales (APES) to measure assimilation and the outcome- questionnaire (OQ-10) to measure clinical symptom intensity. To assess assimilation instability, we used a fluctuation measure that calculated the amplitude and the frequency of changes in assimilation levels. The results showed that in the good-outcome case, assimilation levels and instability tended to increase and symptom intensity tended to decrease, particularly in the final phase of treatment. In the poor-outcome case, assimilation levels and instability did not change much across sessions.

How and when immersion and distancing are useful in emotion focused therapy for depression

Objective: The potential benefit or harm of immersion (egocentric perspective) and distancing (observer perspective) on negative experiences are unclear and have not been empirically investigated in therapy. This is a first exploratory study aimed to analyze and compare the perspectives adopted on reflection (immersion and distancing) of negative experiences across therapy and the relationship between them and depressive symptoms in contrasting therapeutic outcomes of emotion-focused therapy (EFT). Method: Three good-outcomes cases and three poor-outcomes cases of EFT, diagnosed with mild to moderate depression at the beginning of therapy, were randomly selected. Immersion and distancing on negative experiences were analyzed using the measure of immersed and distanced speech. The depressive symptoms were assessed by the Beck Depression Inventory-II. Results: Significant differences across sessions were only found in the good-outcome cases which showed a significant decrease of immersion and an increase of distancing, and this evolution pattern was found related to the reduction of symptoms. Moreover, at the beginning of therapy, distancing was higher in the poor-outcome cases rather than in the good-outcome cases. Conclusion: The progressive and significant evolution from higher immersion at the initial phase to higher distancing in the final phase may be helpful in EFT for depression.

Emotion-focused therapy of depression

ABSTRACTA review of emotion-focused therapy (EFT) of depression including a discussion of its evidence base is provided. EFT aims within an affectively attuned empathic relationship to access and transform habitual maladaptive emotional schematic memories that are seen as the source of the depression. These memories often involve feelings of the shame of worthlessness, anxious insecurity and the sadness of abandonment. Through the therapeutic process, adaptive emotions are accessed to transform maladaptive emotions and to organize the person for adaptive responses. This process of changing emotion with emotion is aided by the use of specific therapeutic techniques that help stimulate arousal of emotion and its processing.

Therapeutic collaboration and the assimilation of problematic experiences in emotion-focused therapy for depression: Comparison of two cases

Objective: The Assimilation model argues that therapists should work responsively within the client’s therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES). Method: Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not. Results: As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client’s TZPD. However, Julia’s therapist used a balance of supporting and challenging interventions, whereas Afonso’s therapist used mainly supporting interventions. Setbacks were common in both cases. Conclusions: This study supports the theoretical expectation that EFT therapists work mainly within their client’s TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.

Immersion and distancing during assimilation of problematic experiences in a good-outcome case of emotion-focused therapy

Objective: Some studies have suggested that a decrease in immersion (egocentric perspective on personal experiences) and an increase in distancing (observer perspective on personal experiences) are associated with the resolution of clinical problems and positive outcome in psychotherapy for depression. To help clarify how this change in perspectives relates to clinical change, the present study compared changes in immersion and distancing across therapy with progress in one client’s assimilation of her problematic experiences. Method: We analyzed all passages referring to the central problematic experience in a good-outcome case of emotion-focused therapy for depression using the Measure of Immersion and Distancing Speech and the Assimilation of Problematic Experiences Scale. Results: Results showed that immersion and distancing were associated with different stages of assimilation. Immersion was associated with stages of emerging awareness and clarification of the problem and in the application of new understandings to daily life. Distancing was associated with problem-solving and attaining insight. Conclusion: The decrease of immersion and increase of distancing associated with therapeutic improvement should not be taken as a recommendation to avoid immersion and encourage distancing. Immersion and distancing may work as coordinated aspects of the processes of psychotherapeutic change.

Setbacks in the process of assimilation of problematic experiences in two cases of emotion-focused therapy for depression

Objective: Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression. Method: Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches. Results: In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T. Conclusions: As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.

Emotion categories and patterns of change in experiential therapy for depression

Objective: This investigation examined the relationship between in-session types of emotional experience operationalized by the emotion category coding system and the reduction of depressive symptoms in emotion-focused therapy (EFT). Method: Segments of videotaped sessions were coded and the different emotion categories were related to reduction in depressive symptoms in a sample of 30 clients who received EFT for depression. Results: Both fewer secondary and more primary adaptive emotions, in the working phases of therapy, were found to significantly predict outcome. Moderate levels of primary maladaptive emotion in the middle working session were associated with outcome and the frequency with which clients moved from primary maladaptive to primary adaptive emotions in this session-predicted outcome. Conclusions: Results of this study support a transformational model of changing emotion with emotion.

Ambivalence in emotion-focused therapy for depression: The maintenance of problematically dominant self-narratives

Objective: Ambivalence can be understood as a cyclical movement between an emerging narrative novelty—an Innovative Moment (IM)—and a return to a problematically dominant self-narrative. The return implies that the IM, with its potential for change is devalued right after its emergence. Our goal is to test the hypothesis that the probability of the client expressing such form of ambivalence decreases across treatment in good-outcome cases but not in poor-outcome cases. Method: Return-to-the-Problem Markers (RPMs) signaling moments of devaluation of IMs were coded in passages containing IMs in six clients with major depression treated with emotion-focused therapy: three good-outcome cases and three poor-outcome cases. Results: The percentage of IMs with RPMs decreased across therapy in good-outcome cases, whereas it remained unchanged and high in the poor-outcome cases. Conclusions: These results were consistent with the theoretical suggestion that therapeutic failure may be associated with this form of ambivalence.

Assessing client self-narrative change in emotion-focused therapy of depression: An intensive single case analysis.

Personality researchers use the term self-narrative to refer to the development of an overall life story that places life events in a temporal sequence and organizes them in accordance to overarching themes. In turn, it is often the case that clients seek out psychotherapy when they can no longer make sense of their life experiences, as a coherent story. Angus and Greenberg (L. Angus and L. Greenberg, 2011, Working with narrative in emotion-focused therapy: Changing stories, healing lives. Washington, DC: American Psychological Association Press) view the articulation and consolidation of an emotionally integrated self-narrative account as an important part of the therapeutic change process that is essential for sustained change in emotion-focused therapy of depression. The purpose of the present study was to investigate client experiences of change, and self-narrative reconstruction, in the context of one good outcome emotion-focused therapy dyad drawn from the York II Depression Study. Using the Narrative Assessment Interview (NAI) method, client view of self and experiences of change were assessed at three points in time--after session one, at therapy termination, and at 6 months follow-up. Findings emerging from an intensive narrative theme analyses of the NAI transcripts--and 1 key therapy session identified by the client--are reported and evidence for the contributions of narrative and emotion processes to self-narrative change in emotion-focused therapy of depression are discussed. Finally, the implications of assessing clients' experiences of self-narrative change for psychotherapy research and practice are addressed.

Toward an integrative understanding of narrative and emotion processes in Emotion-focused therapy of depression: Implications for theory, research and practice

This paper addresses the fundamental contributions of client narrative disclosure in psychotherapy and its importance for the elaboration of new emotional meanings and self understanding in the context of Emotion-focused therapy (EFT) of depression. An overview of the multi-methodological steps undertaken to empirically investigate the contributions of client story telling, emotional differentiation and meaning-making processes (Narrative Processes Coding System; Angus et al., 1999) in EFT treatments of depression is provided, followed by a summary of key research findings that informed the development of a narrative-informed approach to Emotion-focused therapy of depression (Angus & Greenberg, 2011). Finally, the clinical practice and training implications of adopting a research-informed approach to working with narrative and emotion processes in EFT are described, and future research directions discussed.

Therapist interventions and client innovative moments in emotion-focused therapy for depression.

According to the narrative approach, change in self-narratives is an important part of successful psychotherapy. In this view, several authors have highlighted the usefulness of narrating new experiences (like actions, thoughts, and stories) during therapy in contrast with maladaptive client self-narratives. These new experiences are termed here innovative moments (IMs), and different types can be specified: action, reflection, protest, reconceptualization, and performing change. With the aim of understanding which therapist skills are related to client IMs, we analyzed the association between exploration, insight, and action skills and IMs in two initial, two middle, and two final sessions of three good outcome (GO) and three poor outcome (PO) cases of emotion-focused therapy (EFT) for depression. IMs occurred more often in GO than PO cases. Furthermore, in GO more than PO cases, exploration and insight skills more often preceded action, reflection, and protest IMs in the initial and middle phases of EFT, but more often preceded reconceptualization and performing change IMs in the final phase. Action skills were more often associated with action, reflection, and protest IMs across all phases, especially in the final phase, of GO EFT.

Contrasting Two Clients in Emotion-Focused Therapy for Depression 1: The Case of "Tom," "Trapped in the Tunnel"

The objective in this paper is to present a case drawn from a series of randomized clinical trials (RCT) comparing brief (16-20 sessions), emotion-focused therapy (EFT) the process experiential approach with client-centered therapy and cognitive-behavioral therapy in the treatment of depression. A case comparison method that triangulates data from clients’ histories, in-session process, post-session questionnaires, and post-therapy outcome measures was used to increase understanding of those factors that contribute to successful and unsuccessful outcomes. The case comparison method examines the role of the working alliance, clients’ emotional processing, clients’ and therapists’ interpersonal processes, and clients’ cognitive processing, as well as the specific changes that clients report immediately following their sessions that have been found to be related to therapeutic outcomes. The method is illustrated with two examples one a poor outcome case and the other a good outcome case The poor outcome case of "Tom" is presented in this article, and the good outcome case of "Eloise" is presented in the next article by Goldman, Watson, and Greenberg (2011). These two cases extend and build on the cases presented by the authors in their book Case Studies in Emotion-Focused Treatment of Depression: A Comparison of Good and Poor Outcome (Watson, Goldman, & Greenberg, 2007), in which six clients, three good outcome and three poor outcome, were compared and contrasted using the case-comparison method.

Extending Systematic Case Study Method: Generating and Testing Hypotheses About Therapeutic Factors Through Comparisons of Successful and Unsuccessful Cases

This commentary focuses on two case comparison studies, one by Burckell and McMain (2011) on Dialectical Behavior Therapy for borderline personality disorder, and one by Watson et al. (2011) and Goldman et al. (2011) on Emotion-Focused Therapy for depression. The associated case comparison method, which evaluates and contrasts one successful case against one unsuccessful case that are both conducted in similar conditions, provides a unique opportunity for deepening our understanding of therapeutic change. Both therapies are integrative approaches that are clinically state-of-the art and empirically supported, and that have been drawing considerable attention from practitioners and researchers. In this commentary, I first discuss the case comparison method by reviewing previous such approaches, I then examine each pair of case studies with a focus on (a) findings on factors influencing success and limited success, and (b) methodological issues associated with the application of this unique method. Finally, I end my commentary with a suggestion for conducting case comparison studies.

Contrasting Two Clients in Emotion-Focused Therapy for Depression 2: The Case of "Eloise," "It's Like Opening the Windows and Letting the Fresh Air Come In"

This paper presents a good-outcome case of "Eloise," an individual drawn from the York II Depression study and treated with emotion-focused therapy (EFT) (Goldman, Greenberg, & Angus, 2006). Using the case comparison method, this study considers data from an observer-rated measure of emotional processing during therapy, the client's perceptions of change as measured by post-session and post-therapy questionnaires, the therapist's perceptions of change as measured by post-session reports, and post-therapy interview data, to form an understanding of factors that contributed to change. Eloise's case study is designed to compare and contrast with Watson, Goldman, and Greenberg's (2011) case study of Tom, a poor-outcome case drawn from a similar RCT. The Eloise and Tom case studies extend and build upon the cases presented by the authors of Case Studies in Emotion-Focused Treatment of Depression: A Comparison of Good and Poor Outcome (Watson, Goldman, & Greenberg, 2007), which consist of three good outcome and three poor outcome clients compared and contrasted using the case-comparison method.

Introduction. One case, multiple measures: An intensive case-analytic approach to understanding client change processes in evidence-based, emotion-focused therapy of depression

There is an emerging consensus in the psychotherapy research literature (Kazdin, 2008; Moras, 2006; Westen, Novotny, & Thompson-Brenner, 2004) that a more differentiated and specific understanding ...