Emotion-Focused Therapy: A Transdiagnostic Formulation

Phenomenological considerations on empathy and emotions in psychotherapy

In this article we will present a phenomenological approach to empathy and its relationship with emotions in the context of psychotherapy, highlighting the importance of empathy as a key element of the therapist-client relationship and therapeutic process, regardless of the therapist’s approach. We will use a consensus definition of empathy taken from phenomenologically oriented philosophy to analyze therapist’s empathy, as well as client’s self-empathy and client’s empathic communication with others. We will discuss emotions as they usually manifest in the context of psychotherapy, specifically describing how certain emotions can disturb empathic communication in close personal relationships and how it is possible to reestablish empathic communication in psychotherapy. This article it is not only based on evidence from scientific literature but also incorporates the authors’ practical knowledge of psychotherapy.

Qualitative Analysis of Chair Tasks in Emotion-Focused Therapy Video Sessions

One of the key elements of Emotion-Focused Therapy (EFT) is decreasing self-criticism as a secondary, maladaptive emotion within two-chair interventions while simultaneously increasing self-compassion and self-protection as primary, adaptive emotions. Though the concepts of self-compassion, self-protection, and self-criticism are highly acknowledged within psychotherapy research, the verbal articulation of these constructs within therapy sessions is underinvestigated. Thus, this qualitative study aims to examine how self-criticism, self-protection, and self-compassion are articulated by clients in EFT video sessions. Consensual qualitative research was used for data analysis performed by two core team members and one auditor. Three similar domains were considered for all three concepts: behavioural, emotional, and cognitive aspects. The number of self-protection statements was the highest among the states. The behavioural aspect was the most dominant domain for self-protection with the major subdomain 'I tell you what I need'. For self-compassion, the cognitive aspect was the most significant domain containing eight subdomains, such as 'I see your bad circumstances'. The most frequent domain for self-criticism was the behavioural aspect consisting of the two subdomains 'I point out your wrong behaviours and I give you instructions'. The findings demonstrate the significance of promoting both self-compassion and self-protection to combat self-criticism. More studies of categorising a broader number of cases among various therapy approaches are necessary to develop a more detailed understanding of clients' verbalisation of self-compassion, self-protection, and self-criticism within therapy.

Emotion-focused group therapy among women with premenstrual dysphoric disorder: A randomized clinical trial

OBJECTIVE

Premenstrual Dysphoric Disorder (PMDD) contributes to couple burnout, reduced quality of life, sexual dysfunction, and social isolation. The present study aimed to investigate the effectiveness of emotion-focused group therapy (EFGT) in pain perception, self-compassion, sexual function, and couple burnout in women with PMDD. Method: Among married females with PMDD, 72 participants were selected and randomly assigned to experimental and waitlist control groups. EFGT was performed in 10 sessions for the subjects in the experimental groups. The McGill Pain Questionnaire, Self-Compassion Scale, Female Sexual Function Index and Couple Burnout Measure were used to collect data in the pre-test and post-test. To analyze the data, an analysis of covariance test was applied. Results: The findings demonstrated that EFGT was effective in pain perception (p < .001, η²=.80), self-compassion (p < .001, η²= .86), sexual function (p < .001, η²= .38), and couple burnout (p < .001, η²= .70). Participants of EFGT improved well, were satisfied with treatment, and had a good therapeutic relationship. Conclusion: Implementing EFGT increased the components of self-compassion and sexual function, and reduced the components of pain perception and couple burnout. It seems that EFGT could be effective in women with PMDD.

The perceptual control model of psychopathology

Perceptual control theory states that behaviour controls perception; we act against disturbances in the environment to align hierarchically organised perceived aspects of the self and the world with neurally specified reference values. The diverse symptoms of psychopathology are each examples of loss of control, which are maintained by conflicting control systems, and effective interventions shift and sustain awareness to the source of the conflict to allow trial-and-error changes (reorganisation) in the parameters of the superordinate system to the conflict, until control is restored. Experimental, phenomenological, therapeutic and computational research has examined its mechanisms, and its mode of delivery has extended it from a client-led psychotherapy (method of levels) to brief training, group interventions and computerised modalities.

CBT at the Crossroads: The Rise of Transdiagnostic Treatments

Transdiagnostic treatments span a heterogeneous group of interventions that target a wider range of disorders and can be applied to treat several disorders simultaneously. Several meta-analyses have highlighted the evidence base of these novel therapies. However, these meta-analyses adopt different definitions of transdiagnostic treatments, and the growing field of transdiagnostic therapies has become increasingly difficult to grasp. The current narrative review proposes a distinction of “one size fits all” unified and “my size fits me” individualized approaches within transdiagnostic therapies. Unified treatments are applied as “broadband” interventions to a range of disorders without tailoring to the individual, while individualized treatments are tailored to the specific problem presentation of the individual, e.g., by selecting modules within modular treatments. The underlying theoretical foundation and relevant empirical evidence for these different transdiagnostic approaches are examined. Advantages and limitations of the transdiagnostic treatments as well as future developments are discussed.

New Developments in Emotion-Focused Therapy for Social Anxiety Disorder

Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.

Emotion-focused therapy as a transdiagnostic treatment for depression, anxiety and related disorders: Protocol for an initial feasibility randomised control trial

Background: Depression, anxiety and related disorders, including obsessive-compulsive disorders and trauma/stressor related disorders, have high prevalence, chronic courses and cause significant impairment. These disorders are also highly co-morbid, and appear to share etiology and maintenance factors. Recent developments have seen the emergence of transdiagnostic approaches that systematically address the common/shared features of these disorders. A key advantage of transdiagnostic approaches is that they can reduce the pressure on mental health professionals to be proficient in a plethora of single-disorder focused treatments. Currently almost all transdiagnostic approaches come from cognitive-behavioural therapy (CBT). However, not all clients prefer or benefit from CBT. Emotion-focused therapy (EFT) represents an evidence-based alternative to CBT. This study aims to examine a transdiagnostic adaptation of EFT (EFT-T) as a treatment for depression, anxiety and related disorders.

Method: The current study is a randomised controlled trial that aims to establish the efficacy of EFT-T vs. wait-list control in the treatment of depression, anxiety and related disorders. Up to 40 clients presenting in a psychology/counselling service will be randomly assigned to two conditions: EFT-T (n=20) and wait-list control, with delayed intervention (n=20). Primary outcome measures will be the Overall Anxiety Severity and Impairment Symptoms, the Overall Depression Severity and Impairment Symptoms, and the Clinical Outcome in Routine Evaluation – Outcome Measure. Disorder specific self-report measures will also be used to assess the main symptomatology of respective primary diagnoses. Clients will be assessed prior to therapy, at week 16, at end of therapy, and at 6 months follow-up.

Discussion: This study aims to provide an initial test of EFT-T as a transdiagnostic treatment for depression, anxiety and related disorders. It will provide estimates of effects sizes that can inform power calculations for a comparative trial, comparing EFT-T to a standard transdiagnostic treatment, CBT.

Registration: ISRCTN11430110; registered on 07 January 2019.

Enhancing Empathy in Emotion-Focused Group Therapy for Adolescents with Autism Spectrum Disorder: A Case Conceptualization Model for Interpersonal Rupture and Repair

Adolescents with autism spectrum disorder (ASD) are vulnerable to trauma-related experiences due to difficulties in emotion recognition, including recognising their own and others’ emotions, leading to interpersonal conflict and problems in making and maintaining friendships. There are limited intervention methodologies of how to work with interpersonal conflict and relational repair. This paper presents, for the first time, a case conceptualization model of relational rupture and repair as a clinical strategy to guide therapists working therapeutically with clients with ASD. The model is constructed from a task analysis applied to dyads of therapy and Interpersonal Process Recall sessions of Emotion-Focused Group Therapy with autistic adolescents (EFGT-AS). This model shows that when therapists use Interpersonal Process Recall of shared trauma-related experiences and misempathy encounters as a process-guiding method, it leads to a deepening of emotional processing in both cognitive and affective empathy. Autistic adolescents are able to use EFGT-AS to explore self-agency within interpersonal ruptures and enhance self and other cognitive-affective empathy within a relational repair process. This rational-empirical model for working with relational rupture and repair stands as a hypothesis for future testing.