Two-chair Dialogue Research Articles

Consensual Qualitative Analysis of Self-Criticizing Using the Two-Chair Technique

Level of self-criticism has a significant impact on people’s psychopathology because severe self-criticism activates the sympathetic nervous system, and that further stimulates the physiological and psychological stress response which lead to impairment of mental health and wellbeing (Singer & Klimecki, 2014). Therefore, self-criticism is widely studied, but authors use mainly quantitative approaches which allow generalisation of knowledge but do not allow in-depth insights into the phenomenon. Hence our research aim was to identify the kinds of statements individuals utter when self-criticizing using the two-chair dialogue technique which enable to expose inward dialogues people lead with their self-critical parts. Out of 80 participants, the 20 most expressive participants were selected for the analysis: 15 women and 5 men (M = 27.7; SD 7.60). The data were analysed using Consensual Qualitative Research (CQR; Hill et al., 1997) with three members of a core team and one auditor. We identified three domains of self-criticism – Emotional (mainly inadequacy, fear, contempt, and disgust), Behavioural (mainly hurting and neglecting others, stating one’s shortcomings and motivating oneself), and Cognitive (primarily generalized judgements about one’s negative traits and reactions, perceived judgements by others or based on comparisons with others, and judgements relating to criticized situations and the effects of these). Expanding on the qualitative knowledge in the area of self-criticism would make for better planning and the provision of better treatment for highly self-critical people by mental health professionals.

Two-chair dialogue: an emotion-focused technique applied to career counselling

ABSTRACT This article aims to show the applicability of two-chair dialogue techniques to solve intrapersonal conflicts underpinning career decision-making difficulties. Grounded in a dialectical constructivist perspective this technique evokes the dialogue between two conflicting self-position, each one in a different chair. It is sought that this dialogue fosters harmony between both sides of the conflict to facilitate career decision-making. An illustrative case is presented to describe the sequence of counsellor’s tasks during the process of facilitating conflict resolution. Next, critical aspects of the intervention are commented, namely the role of emotions and working alliance to foster client change. Finally, we refer to the advantages of this technique for flexible and dynamic practices, committed to abolishing frontiers between career and personal counselling.

Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder: A Pilot Study.

Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimuli based on false beliefs. For this pilot study, we assessed eight patients with BPD before and after a 3-month-long psychiatric treatment, using functional magnetic resonance imaging and behavioral tasks. We observed arousal increase within the session of the two-chair dialogue (d = 0.36), paralleled by arousal decrease between sessions (d = 0.80). We found treatment-associated trends for neural activity reduction in brain areas central for EP and TOM. Our exploratory findings using an integrative assessment procedure of changes in EP and TOM point toward evidence for treatment effects at the brain systems level related to behavioral modulation.

Does the two-chair dialogue intervention facilitate processing of emotions more efficiently than basic Rogerian conditions?

ABSTRACTProcessing difficult emotions is assumed to be of importance in therapeutic change. In this study, we examine whether a two-chair dialogue in Emotion-focused Therapy (EFT) is associated with a change in emotional processing, measured as changes in emotional arousal and emotional experiencing. In a multiple baseline design, 20 clients in treatment for depression or anxiety first received five, seven or nine weekly sessions of baseline treatment providing Rogerian conditions and affect attunement. In the second phase, two-chair intervention was added for the five consecutive sessions. All sessions were subdivided into 2 min segments which were rated using the Client Emotional Arousal Scale III and the Experiencing Scale. Analyses indicated a significantly higher number of high-arousal segment in the latter phase. Individual clients’ change trajectories were not significantly steeper in the second phase. Experiencing increased throughout both phases of treatment. However, after introducing the two-chair dialogue the Experiencing change trajectory was not significantly steeper than in the baseline phase. Findings suggest that both the two-chair dialogue and the Rogerian conditions with affect attunement focus are effective in facilitating emotional processing. Results are consistent with previous research, suggesting that the two-chair dialogue is an emotionally evocative intervention. Implications and limitations are discussed.

‘It’s heavy, intense, horrendous and nice’: clients’ experiences in two-chair dialogues

ABSTRACTIn this study, we conducted qualitative in-depth interviews to explore how clients experienced working with emotional processing and self-criticism in a two-chair dialogue intervention. Eighteen clients scoring high on self-criticism were interviewed upon completion of a short-term treatment (10–14 sessions) with Emotion-Focused Therapy (EFT), where the two-chair dialogue was used as the main intervention. A hermeneutic-phenomenological approach guided the research process, while a thematic analysis approach was used to analyze the interview transcripts. Our analysis revealed that clients who are asked to engage in the two-chair dialogue intervention often experience an embarrassment or awkwardness before they decide to engage. When engaged in the intervention, most clients found it intense and demanding, but also meaningful. A few clients found the intervention too intense to be of use. Many of those who participated reported that they became more aware of the fact that they were active agents who took part in their self-critical processes. The intensity and somewhat unusual nature of this intervention call for special attention to the working alliance before clients are invited to engage.

Does an emotion-focused two-chair dialogue add to the therapeutic effect of the empathic attunement to affect?

An increasing amount of research suggests that it is beneficial to work explicitly with emotions in psychotherapy. Emotion-focused therapy (EFT) utilizes interventions that are thought to enhance the evocativeness of emotional processing and facilitate explorations of new meaning. The purpose of this study was to examine the effect of such an intervention on therapeutic outcome. The intervention, a two-chair dialogue drawn from emotion-focused therapy, was added to the treatment conditions that consisted of empathically following the clients' emotional processes. The treatment comprised 2 phases. Using a multiple baseline design, 21 self-critical clients (15 women and 6 men) with clinically significant symptoms of depression and/or anxiety first received 5, 7, or 9 sessions of a baseline treatment focused on alliance building, empathic attunement to affect, and therapeutic presence and genuineness. A two-chair dialogue intervention was then added for 5 sessions. The symptoms were measured before each session using Beck's Depression Inventory, Beck's Anxiety Index, and Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. An analysis using Hierarchical Linear Modelling revealed that the phase with the two-chair dialogue had a larger impact on symptoms of anxiety and depression when compared to the baseline phase. On BDI-II, there was a greater impact on somatic-affective components than cognitive components. Self-criticism was reduced when we used time as a predictor for both phases but not significantly more after introducing the intervention. The results corroborate that the two-chair dialogue intervention is associated with change beyond what is shown when relationship conditions alone are being provided. Implications and limitations are discussed.

La chaise vide en psychothérapie : origines et développements

Working with the empty chair or the two-chair dialogue techniques is used in experiential techniques. The latter are practiced in various psychotherapy forms. The present article demonstrates the origins of these techniques in the Gestalt and Person-centered models of psychotherapy, as well as presents their current developments in experiential psychotherapy approaches. The techniques presented are classified according to their objectives, namely: clarification and meaning construction, and modification of internal determinants of the presenting problem. The following techniques are briefly presented, illustrated with clinical examples and discussed: treatment of internal conflict split; treatment of self-interruptive process; unfinished business dialogue; self-soothing dialogue; cognitive elements in the one-person role-play; affective elements in the one-person role-play. We discuss the empirical evidence of these techniques, by referring to efficacy and effectiveness studies, as well as process studies, and conclude with a reflection on the differential indication of the techniques, in the context of novel clinical and research perspectives.

Healing the research–practice split: Let's start with me.

This article highlights many of the major issues that separate the researcher from the clinician and then suggests some possible solutions. The format involves an enacted two-chair dialogue between my researcher side and my therapist side. The dialogue involves three phases. Phase 1 involves each side presenting a straw man of the other's position. In Phase 2, the two sides engage in a creative dialogue regarding many of the issues that divide them. Phase 3 eventuates in a series of synthetic solutions that honors the concerns and core values of each side. The solutions include: (a) broadening the definition of clinically useful research, (b) researcher-practitioner collaboration, (c) appropriate dissemination of user-friendly research findings, (d) translating research findings into experience-near procedures such as the systematic case studies, and (e) providing clinicians with easy access to a video archive of research therapies.

A Pilot Investigation of Emotion‐Focused Two‐Chair Dialogue Intervention for Self‐Criticism

Self-criticism plays a key role in many psychological disorders and predicts poor outcome in psychotherapy. Yet, psychotherapy research directly targeting self-critical processes is limited. In this pilot study, we examined the efficacy of an emotion-focused intervention, the two-chair dialogue task, on self-criticism, self-compassion and the ability to self-reassure in times of stress, as well as on depressive and anxiety symptoms among nine self-critical clients. Results showed that the intervention was associated with significant increases in self-compassion and self-reassuring, and significant reductions in self-criticism, depressive symptoms and anxiety symptoms. Effect sizes were medium to large, with most clients exhibiting low and non-clinical levels of symptomatology at the end of therapy, and maintaining gains over a 6-month follow-up period. Although preliminary, these finding suggest that emotion-focused chair work might be a promising intervention addressing self-criticism. Self-criticism is an important process in a variety of clinical disorders and predicts poor outcome in brief therapy for depression. Yet, little is known about how self-criticism can be effectively addressed in psychological treatment. Practitioners can benefit from increasing their awareness of self-critical processes in their clinical work, and from directly working with emotions in addressing self-criticisim. Emotion-focused two-chair dialogue intervention can be effective in reducing self-criticism, increasing self-compassion, and decreasing depressive and anxiety symptoms, and these improvements are largely maintained six months after therapy.

The Use of Cognitive and Experiential Techniques to Treat Depression

Treatment of a young woman for symptoms of depression and adjustment problems incorporated cognitive and experiential techniques. Cognitive techniques were used to identify beliefs in incompetence and unlovability of self, and uncontrollability of situations; but logical analysis and challenge of these beliefs proved ineffective. The therapist hypothesized that these core beliefs were not altered by cognitive challenge because they were not fully activated. An obstacle to treatment was the client’s reluctance to fully engage these painful beliefs. Several months into treatment, as depression symptoms increased, a Gestalt two-chair dialogue helped the client make contact with a constellation of beliefs and emotions surrounding vulnerability and competence. Through this work, the client’s belief in her incompetence and unlovability appeared to be dislodged and her belief in the uncontrollability of her situation reduced.

Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome.

Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome.

Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome.

Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome.

Specific effects of Gestalt two-chair dialogue on intrapsychic conflict in counseling.

Specific effects of Gestalt two-chair dialogue on intrapsychic conflict in counseling.

Specific effects of Gestalt two-chair dialogue on intrapsychic conflict in counseling.

Specific effects of Gestalt two-chair dialogue on intrapsychic conflict in counseling.

Effects of two-chair dialogue and focusing on conflict resolution.

Effects of two-chair dialogue and focusing on conflict resolution.

Effects of two-chair dialogue and focusing on conflict resolution.

Effects of two-chair dialogue and focusing on conflict resolution.