Transcript Emotion-Focused Therapy and the Person-Centred

Robert Elliott
University of Strathclyde
Five years ago: Invited to join the Counselling
Unit
Walked into a place with a deep sense of culture
and history built up over many years
But also, deeply counter-cultural
Complex web of:
Courses and projects
Relationships and traditions
Large team of talented trainers and counsellors
Highly committed students, past and present
Fear & trembling: Questions raised:
Would I be able to do meaningful work in this new
setting?
Would I be accepted?
Is there space for my way of working with clients
here?
Would I change it?
Would it change me?
What is the relationship between
Process-Experiential/Emotion-Focused Therapy
And the Person-Centred Approach?
In the early 1990’s, Barbara Brodley and John
Shlien had both said to me:
(Process)-Experiential therapy, Focusing, EmotionFocused Therapy ≠ Person-centred
But Laura Rice, Les Greenberg & I had all started
from a Person-Centred base
Felt we were Person-Centred
So, coming here, I began…
With colleagues:
Classical/nondirective Person-Centred Therapy (PCT)
Broadly relational PCT
Pluralistic
My position has varied:
Curiosity & puzzlement
Awe & scepticism
Frustration & excitement
Will present what I’ve learned so far from this
dialogue
Past, Present & Future
Roots/Sources: Humanism (The Renaissance,
The Enlightenment, existentialism, Third force
Humanistic psychology)
1940’s: Nondirective therapy: Rogers
1950’s: Classical approach: Chicago
Relationship conditions: unconditional positive
regard, empathy, genuineness
1960’s: Focus on client process: Wisconsin
Late Rogers, Gendlin
The dialogue begins…
1970’s: Experiential therapy:
Gendlin: Focusing
Rice, Greenberg: task analysis
1980’s: Partial eclipse period
Dismissed in North America
Further development of PCA in Europe
1990’s: Beginning of PCE revival
Training centres established: Counselling Unit
Process-Experiential (PE)/Emotion-Focused
Therapy (EFT)
Explosion of research
2000’s:
World Association founded
Journal: Person-Centered and Experiential
Psychotherapies
Struggles for recognition
Research continues rapid development
EFT books & training emerge
Continuing dialogue between different parts of the
tradition, especially from 1970 on
One end: “Classical” approaches
Emphasize Nondirectivity, Unconditional Positive Regard,
the centrality of the relationship
Other end: Emotion-Focused Therapy
Emphasize client process, process guiding, the work of
therapy
“Pluralistic Approach” fits in there somewhere…
Counselling Unit: One of few places in the world where
it would have been possible to carry out this dialogue
Over an extended period of time
And with reference to actual practice
Most importantly, this has allowed exploration of the
deeper issues of personal and professional identity:
Need to hang onto what is essential vs. need to escape
oppressive restrictions
Need to establish self vs. feeling threatened or excluded
Which takes us to …
As a result of recent history of
dialogue over our differences, can
now ask:
Have PCT vs EFT differences been
exaggerated?
Two recent efforts to look at this…
EFT jargon can put PCT therapists off
Makes it sound like EFT therapists are pulling levers
and controlling clients
Have been trying to translate into PCT Friendly
language
Many discussions with Beth Freire, Brian
Rodgers, Graham Westwell, and others
Example: The Six EFT Therapy Principles
 Research Clinic therapists examined the 6 EFT
principles.
 Decided the following 3 need no translation:
 1. Empathic Attunement: Always start by
entering, attending to & tracking the client’s
immediate experiencing
 2. Therapeutic Bond: Offer genuine, empathic,
caring presence to client
 3. Self-development: Foster client growth,
empowerment & choice
Involve different kinds of therapeutic
work (=“tasks”)
4. “Task Collaboration”:
Listen for and engage with what client
wants to work on
Offer orienting information about nature of
therapy and particular ways of working in
the session, particularly when the client
asks or is puzzled
5. “Task Completion/Emotional Change”:
Listen for and engage with key issues
clearly or repeatedly presented by client
Help client contact, explore and clarify core,
growth-oriented emotions and views of
self/others
Keep helping client work on their key issues
until they feel they have resolved these or
decide they want to stop
… and the client decides what is key, core,
or resolved
6. “Process Guiding”:
Be aware of and respond helpfully to
common kinds of client experiences and
process
Eg, Empathic Refocusing response: allow C
to step back from difficult emotions before
offering opportunity to return to them
Respond to client-presented issues by
offering opportunities for potentially useful
kinds of therapeutic work
Always accept client’s decision about
whether or not to accept a process offer
Freire, Elliott & Westwell, 2011
Developed quantitative process rating measure of PCE
therapist adherence/competence
Person-Centred and Experiential Psychotherapy Scale
(PCEPS)
Two subscales:
Person-Centred (PC): 10 items
Eg Client frame of reference; content nondirectiveness
Experiential Process (Exp): 5 items
Eg Experiential specificity, emotion focus
1 – 6 descriptively-anchored scales
Passing = 3.5+
Just finished test of measure on 120
segments:
Research Clinic data
10-15 min segments
60 sessions, 20 clients, 10 therapists
5 student therapists (general client sample)
5 post-training therapists (clients with social
anxiety)
2 PCT, 3 EFT (2 fully trained)
1. PCEPS is reliable (across items and raters)
2. In general, PC and Exp items correlate very highly
with each other
3. We also found a Nondirectiveness factor
Empowering Presence, Content Nondirectiveness,
Clarity/brevity
4. Student therapists scored lower on all items
5. No difference between fully trained PCT and EFT
therapists on: PC, Exp, and nondirectiveness subscales
Conclusion: Therapist and training effects much
more important than PCT vs EFT differences
N Segments
Mean
score
Student
therapists
PCT
therapists
EFT
therapists
60
3.1*
% “passing” Range
(at least
3.5)
17%
0 – 33%
24
4.4
92%
83-100%
36
4.2
75%
33-100%
EFT fully trained
24
4.6
96%
92-100%
*P<.001 vs. SA protocol therapists (PCT + EFT); all other effects nonsignificant
PC
Scale:
Mean
PC
Scale:
% pass
Exp
Scale:
Mean
Exp
Scale:
% pass
NDir Ndir
Scale Scale %
Mean pass
PCT
4.5
therapists
EFT
4.2
therapists
92%
4.2
96%
4.6
78%
4.2
75%
4.0* 72%
EFT fully
trained
96%
4.7
96%
4.4
4.6
*P<.01 vs. PCT therapists; all other effects
nonsignificant
87%
83%
Where does this leave us?
Some concluding thoughts about avenues for
continuing the dialogue
Provides an agenda for the future
Is it worth continuing to argue at an ideological
level over nondirectivity and process guiding?
Like Psychology, we have been neglecting study
of concrete behavior in favor of the ease of selfreport data
Both quantitative questionnaires & qualitative
interviews
PCEPS study illustrates value of following the
example of early Carl Rogers and colleagues
We need to return to the study of therapy
process
Most of us are never going to be effective therapists
across a range of different therapy approaches
But: We can do a better job of listening to and learning
from each other within the PCE tradition:
Classical, nondirective therapists
Broadly relational person-centred therapists
Focusers and EFT therapists
Person-centred-based pluralistic experimenters in other
approaches
Near neighbors in 4th generation CBT (eg Schema therapy)
and contemporary relational psychodynamic therapy
Here in the Counselling Unit, I have found myself
fascinated by rigorous nondirectivity in therapy
Personally, I could never adopt a sustained, rigorously
nondirective stance
Nevertheless, it is clear to me that there are clients and
moments when this is absolutely the best thing to do
I want to know:
What are these moments? (=client markers)
How can I maintain nondirectivity at these moments?
(=therapist processes)
What are the immediate and ongoing effects of these
moments? (=micro-outcomes)
It’s so difficult to live in the middle:
Between dichotomies/unresolved differences/ ambiguity/
complexity
David Rennie’s “The rocky middle road”
However, I strongly suspect: Nondirectivity and Process
Guiding might actually need each other
Can be a source of moderation and creativity for each other
My dream for the next 20 years of the CU:
That as a community, we learn how to effectively
live with and grow from from the creative tension
between Nondirectivity and Process Guiding
Those questions I asked five years when I
walked into this place…
About doing meaningful work, being accepted,
finding space, changing things, and being
changed…
The Answer is … Yes
Email: [email protected]
Blog: http://pe-eft.blogspot.com