Emotion-focused therapy for women with premenstrual dysphoric disorder: a randomized clinical controlled trial.

BACKGROUND: Premenstrual dysphoric disorder (PMDD) is a debilitating condition, affecting women of reproductive age. It is characterized by severe periodic physical and psychological symptoms, which end after the onset of menstruation. This study aimed to evaluate the effectiveness of emotion-focused therapy (EFT) for PMDD patients. METHODS: A total of 48 PMDD women, in the age range of 18-44 years, were randomly assigned to two intervention and control groups. The intervention group participated in 16 weeks of EFT treatment, while the control group was selected based on the waiting list (waitlist control group) and followed-up after three months. Forty-four patients finally completed this study. The participants completed the Premenstrual Syndrome Screening Tool (PSST), Difficulties in Emotion Regulation Scale (DERS), and Depression Anxiety Stress Scale-21 (DASS-21) in the first premenstrual period before treatment, the first premenstrual period after treatment, and the premenstrual period three months after treatment. RESULTS: Based on the repeated measure analysis of variances, the total score of DERS and the total score of PSST decreased significantly (P < 0.05). Also, in DASS-21, the scores of depression and stress subscales reduced significantly (P < 0.05), while there was no significant decrease in the score of anxiety subscale (P > 0.05). CONCLUSION: Based on the present results, EFT can be an effective treatment for alleviating the symptoms of PMDD. This treatment can reduce the emotion regulation difficulties of women with PMDD and alleviate the symptoms of depression and stress. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT ID: IRCT20220920055998N1, Registered on: 12/2/2023.

A qualitative meta-analysis of the clients' experiences of emotion-focused therapy.

OBJECTIVE: Client experience of psychotherapy is an important resource for our understanding of psychotherapy and deserves relevant attention in psychotherapy research. Emotion-focused therapy (EFT) is a relatively new adaptation of a humanistic therapy that has a tradition of giving a voice to the clients in therapy. Despite the number of qualitative studies looking at the experience of clients in EFT, there was no formal qualitative meta-analysis conducted synthesizing the existing qualitative research on the clients' experience of EFT. METHOD: A sample of 11 primary qualitative studies was selected through a systematic search of the literature. Primary studies were critically appraised, and data (findings) from them extracted and meta-analysed. RESULTS: All 11 studies featured experiences of helpful aspects of therapy, with difficult but helpful aspects reported in seven studies and unhelpful aspects reported in six studies. Most studies reported chair and experiential work and intense emotional work in EFT as helpful, with fewer reports and fewer clients finding them difficult but helpful or unhelpful. The multidimensional nature of the therapist and therapeutic relationship in EFT included emotional connection and support, validation and understanding and was commonly experienced as helpful to clients. Other client experiences reported included practical aspects of EFT such as session length, in-session outcomes such as clients' transformative experiences, and internal and external factors which were experienced by clients such as determination or reluctance to commit to therapy. CONCLUSIONS: Most clients experience EFT as an intense, challenging, but productive psychotherapy, but it appears a minority of clients experience aspects of EFT as challenging.

A comparison of emotion-focused therapy and cognitive-behavioral therapy in the treatment of generalized anxiety disorder: Results of a feasibility randomized controlled trial.

Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16-20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre-post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effect of stress management training on perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy.

The aim of this study was to investigate the effect of stress management training on the perceived stress, anxiety and hopelessness levels of women with high-risk pregnancy. The sample of this experimental study consisted of 206 high-risk pregnant women (intervention = 103; control = 103). Data were collected using a Personal Information Form, the Perceived Stress Scale, the Beck Hopelessness Scale and the State-Trait Anxiety Inventory. In the second follow-up after the training, there was a statistically significant difference amongst the Perceived Stress Scale, Beck Hopelessness Scale and State-Trait Anxiety Inventory mean scores in the intervention and control groups (p < .05). Perceived stress scores of the control group who did not receive training during discharge increased. The state and trait anxiety scores and hopelessness scores of the intervention group received training decreased compared with the control group.IMPACT STATEMENTWhat is already known on this subject? Mental problems such as anxiety and stress are more common in high-risk pregnancies compared with healthy pregnancies.What do the results of this study add? After the training 51.4% of women in the intervention group, 75.7% of women in the control group had stress. The state and trait anxiety and hopelessness scores of the intervention group having training decreased compared to the control group.What are the implications of these findings for clinical practice and/or further research? Health professionals should provide stress management training in high-risk pregnant women to reducing perceived stress, anxiety and hopelessness levels.

Emotion-focused parenting interventions for prevention and treatment of child and adolescent mental health problems: a review of recent literature.

PURPOSE OF REVIEW: To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families. RECENT FINDINGS: A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains. SUMMARY: Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.

Goal-Focused Emotion-Regulation Therapy (GET) for young adult survivors of testicular cancer: a pilot randomized controlled trial of a biobehavioral intervention protocol.

BACKGROUND: Testicular cancer diagnosis and treatment, especially given its threat to sexuality and reproductive health, can be distressing in the formative period of young adulthood and the majority of young survivors experience impairing, distressing, and modifiable adverse outcomes that can persist long after medical treatment. These include psychological distress, impairment in pursuit of life goals, persistent physical side effects, elevated risk of secondary malignancies and chronic illness, and biobehavioral burden (e.g., enhanced inflammation, dysregulated diurnal stress hormones). However, few targeted interventions exist to assist young survivors in renegotiating life goals and regulating cancer-related emotions, and none focus on reducing the burden of morbidity via biobehavioral mechanisms. This paper describes the methodology of a randomized controlled biobehavioral trial designed to investigate the feasibility and preliminary impact of a novel intervention, Goal-focused Emotion-Regulation Therapy (GET), aimed at improving distress symptoms, emotion regulation, goal navigation skills, and stress-sensitive biomarkers in young adult testicular cancer patients. METHODS: Participants will be randomized to receive six sessions of GET or Individual Supportive Therapy (ISP) delivered over 8 weeks. In addition to indicators of intervention feasibility, we will measure primary (depressive and anxiety symptoms) and secondary (emotion regulation and goal navigation skills, career confusion) psychological outcomes prior to (T0), immediately after (T1), and 12 weeks after (T2) intervention. Additionally, identified biomarkers will be measured at baseline and at T2. DISCUSSION: GET may have the potential to improve self-regulation across biobehavioral domains, improve overall cancer adjustment, and address the need for targeted supportive care interventions for young adult cancer survivors. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04150848. Registered on 28 October 2019.

EFT and Intimate Partner Violence: A Roadmap to De-escalating Violent Patterns.

This article aimed to extend and refine the existing roadmap of emotionally focused therapy (EFT) in cases of situational couple violence (SCV). SCV is a common problem with couples who seek out couple therapy. Based on attachment theory, academic research, EFT, and our clinical experience, we argue that SCV can be safely treated using EFT. Through a detailed case description of stage 1 of EFT with a violent couple, we demonstrate how EFT can help to reduce violence. We also discuss safety-related matters, specific therapeutic interventions, and potential limitations of the proposed method.

Este artículo tiene como finalidad ampliar y perfeccionar la hoja de ruta actual de la terapia centrada en emociones (TCE) en casos de violencia situacional de pareja (VSP). La VSP es un problema común en las parejas que buscan terapia de pareja. Sobre la base de la teoría del apego, la investigación académica, la TCE y nuestra experiencia clínica, sostenemos que la VSP puede tratarse de manera segura usando la TCE. Mediante una descripción detallada de un caso de etapa 1 de TCE con una pareja violenta, demostramos cómo la TCE puede contribuir a reducir la violencia. También comentamos asuntos relacionados con la seguridad, las intervenciones terapéuticas específicas y las posibles limitaciones del método propuesto.

Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma.

This study tested a model of emotional processes over the course of emotion-focused therapy for trauma. The model of emotional processing (Pascual-Leone & Greenberg, 2007) proposes a sequential order of shifting from "early expressions of distress" to "primary adaptive emotion" that aid in adaptive functioning. Thirty-eight participants were taken from a randomized clinical trial to examine in-session process from video recordings of treatment. The sample had an average age (M = 44.3 years) and the majority was female (55.3%) and of European descent (89.5%). The Classification of Affective Meaning States was used to examine changes in emotional processes during trauma narratives in both early and late sessions. Processes were related to treatment outcome as measured by the Impact of Event Scale and the Resolution Scale. Sessions later in treatment showed a higher frequency of primary adaptive emotions compared with early sessions (p < .001, r = .76). Primary adaptive emotions were also more frequent in good-outcome cases (p = .017). Using emotional processes as predictors correctly classified 67% of poor-outcome cases and 80% of good-outcome cases. Increases in primary adaptive emotions from early to late treatment sessions more than doubled the odds (2.2) of having a good treatment outcome. The order of emotion was concordant with the sequential model in early sessions and partially concordant in late sessions. Findings have implications for guiding therapeutic process in a productive manner that leads to trauma recovery. Changes in discrete emotions were related to good treatment outcome. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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.

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach.

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.

Building emotional resilience over 14 sessions of emotion focused therapy: Micro-longitudinal analyses of productive emotional patterns.

OBJECTIVE: Pascual-Leone and Greenberg's sequential model of emotional processing has been used to explore process in over 24 studies. This line of research shows emotional processing in good psychotherapy often follows a sequential order, supporting a saw-toothed pattern of change within individual sessions (progressing "2-steps-forward, 1-step-back"). However, one cannot assume that local in-session patterns are scalable across an entire course of therapy. Thus, the primary objective of this exploratory study was to consider how the sequential patterns identified by Pascual-Leone, may apply across entire courses of treatment. METHOD: Intensive emotion coding in two separate single-case designs were submitted for quantitative analyses of longitudinal patterns. Comprehensive coding in these cases involved recording observations for every emotional event in an entire course of treatment (using the Classification of Affective-Meaning States), which were then treated as a 9-point ordinal scale. RESULTS: Applying multilevel modeling to each of the two cases showed significant patterns of change over a large number of sessions, and those patterns were either nested at the within-session level or observed at the broader session-by-session level of change. DISCUSSION: Examining successful treatment cases showed several theoretically coherent kinds of temporal patterns, although not always in the same case. Clinical or methodological significance of this article: This is the first paper to demonstrate systematic temporal patterns of emotion over the course of an entire treatment. (1) The study offers a proof of concept that longitudinal patterns in the micro-processes of emotion can be objectively derived and quantified. (2) It also shows that patterns in emotion may be identified on the within-session level, as well as the session-by-session level of analysis. (3) Finally, observed processes over time support the ordered pattern of emotional states hypothesized in Pascual-Leone and Greenberg's (2007) model of emotional processing.

Fotografía y discapacidad intelectual: estudio sobre el reconocimiento emocional a través de talleres de fotografía en personas con discapacidad intelectual / Photography and intellectual disability: a study on emotional recognition through photography workshops for people with intellectual disabilities

El presente estudio busca explorar el reconocimiento de emociones en personas con discapacidad intelectual. El reconocimiento de emociones es importante para una correcta interacción social. Esto hace que la estimulación y desarrollo de estas habilidades sea in-dispensable para generar vínculos nuevos, comprender el medio en el cual se encuentra el sujeto y la adquisición de un conocimiento positivo gracias al aprendizaje social. En esta investigación se empleó la fotografía como un medio de expresión y de mejoramiento de habilidades cognitivas y sociales. La evaluación fue realizada mediante un test previamente creado para población ecuatoriana. Los objetivos de este estudio intentan comprobar si: a. Las personas con discapacidad intelectual presentan mayores problemas en el reconocimiento de emociones que la población general, y: b. Aprender fotografía mejora el reconocimiento de emociones en personas con discapacidad intelectual. En lo que respecta al método, esta investigación utiliza un diseño pre-experimental con medidas pre-post, contando con una intervención que fue realizada en un periodo de 4 meses y medio, mediante capacitaciones de dos horas de duración dirigidas a cincuenta personas con discapacidad leve y moderada. Se obtiene como principales resultados que: a. Existe diferencia significativa (X2= 37.29 P < 0,001) entre grupo control y personas con discapacidad intelectual para reconocer emociones. b. Hay una mejoría significativa en el factor de reconocimiento emocional, lo que a su vez permite concluir que la fotografía es una herramienta alternativa para estimular el reconocimiento de emociones en la discapacidad intelectual.

The present study aims to explore emotion recognition in people with intellectual disabilities. Emotion recognition is an important skill to generate adequate social interactions. Thus, the stimulation and development of these skills are essential to build new relations-hips, understand the environment in which the subject develops and acquire a positive knowledge through social learning. In this re-search, photography was used as a tool for expression and improvement of cognitive and social skills. The evaluation was carried out through a test previously created specifically for the Ecuadorian population. The purposes of this study attempt to confirm if: a. People with intellectual disabilities have more difficulties in recognizing emotions than the general population, and: b. Studying photography improves emotion recognition skills in people with intellectual disabilities. Regarding the method, this study uses a pre-experimental design with pre-post measurements, with an intervention of 4 months and a half through two-hour training aimed at fifty subjects with minor and moderate intellectual disabilities. The main results show that: a. There is a significant difference (X

A comparison of emotion-focused therapy and cognitive-behavioural therapy in the treatment of generalised anxiety disorder: study protocol for a randomised controlled trial.

BACKGROUND: Generalised anxiety disorder (GAD) is a chronic and debilitating condition characterised by high co-morbidity. Alongside pharmacological treatment, cognitive behavioural therapy (CBT) is an established psychological therapy for GAD. Its effectiveness is limited, however, with only an estimated 50% of clients presenting in the non-clinical range after a course of treatment. Furthermore, not all clients prefer CBT as a psychological therapy. Recently, emotion-focused therapy (EFT) was developed for GAD and was tested in an open trial with promising results. METHODS/DESIGN: The present research project is a feasibility testing randomised controlled trial (RCT) that compares the efficacy of EFT with an established treatment for GAD, CBT. Sixty clients presenting in a primary care psychology/counselling service will be randomly assigned to one of two conditions: EFT or CBT. Outcomes will be assessed using several measures (Generalised Anxiety Disorder-7, Generalised Anxiety Disorder Severity Scale, Patient Health Questionnaire-9, and Clinical Outcome in Routine Evaluation - Outcome Measure). Clients will be assessed prior to and at the end of therapy, as well as at 6-month follow-up. On the basis of findings from the initial open EFT trial with regard to the optimal length of therapy, it is proposed that therapy last between 16 and 20 sessions. DISCUSSION: This study aims to test the feasibility of a full comparison RCT. It will test subject recruitment, therapist adherence to manualised treatment, and client retention rates. It will also provide estimates of comparative outcomes that can inform power calculations for a definitive trial. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN52689081 . Registered on 24 October 2017.

Emotional processing and therapeutic change in depression: A case study.

The association between clients' higher capability of emotional processing and good therapeutic outcome has been consistently observed in different therapeutic approaches. Despite previous studies that have reported an association between emotional processing and pre- to posttherapy change in symptoms, the session-by-session relation between emotional processing and therapeutic change needs further research. The current study explored, in a good-outcome case of depression, the session-by-session longitudinal association of the level of emotional processing with (a) clinical symptoms and (b) type of emotions aroused (adaptive or maladaptive). Using a time-series analysis, we observed a strong negative association between the intensity of clinical symptoms and the level of emotional processing in the same session, r = -.71, p < .001, but a nonsignificant association between emotional processing and the symptoms in the preceding session, r = -.37, p = .101, and the next session, r = -.29, p = .180. During the increase in the level of emotional processing, we observed a change in the type of emotions aroused, from maladaptive to more adaptive. The results support that emotional processing is associated with therapeutic change, although not necessarily precedes such change, at least from one session to the next. As it is an exploratory study, the results must be interpreted carefully. (PsycINFO Database Record

Emotion-focused therapy for binge-eating disorder: A review of six cases.

OBJECTIVE: This study aimed to provide preliminary evidence of the usefulness of emotion-focused therapy (EFT) for binge-eating disorder (BED). METHODS: We used a single-subject design in which 12 weeks of individual EFT were applied nonconcurrently to six female adult participants with BED, following three weekly baseline sessions. Participants were assessed for binge-eating psychopathology and emotion regulation difficulties on a weekly basis during baseline and treatment. They were assessed on a 2-, 4-, and 8-week basis during posttreatment, and they were assessed for binge-eating episodes, eating disorder attitudes, alexithymia, and psychiatric comorbidity at pretreatment and posttreatment. RESULTS: All cases experienced reliable recovery from binge-eating psychopathology and a significant decrease in binge-eating frequency. For all cases, there was reliable improvement or recovery on eating and shape concerns, and there was improvement on weight concern for the majority of cases. For all cases, reliable recovery or improvement occurred in overall emotion regulation. Most cases that were in the clinical range pretreatment recovered for anxiety, and reliable improvement in or recovery from depression occurred for all cases. There was reliable recovery or improvement in alexithymia for half of the cases; however, the other half experienced no change or deteriorated. There were no treatment dropouts. CONCLUSION: Individual EFT demonstrates potential as a psychological treatment for BED. The current study provides preliminary evidence to guide the development of a more extensive trial to test the efficacy of individual EFT for BED as well as to identify possible mechanisms of change.

Mapping patterns of change in emotion-focused psychotherapy: Implications for theory, research, practice, and training.

An important objective in humanistic-experiential psychotherapies and particularly emotion-focused psychotherapy (EFT) is to map patterns of change. Effective mapping of the processes and pathways of change requires that in-session processes be linked to in-session resolutions, immediate post-session changes, intermediate outcome, final therapy outcome, and longer-term change. This is a challenging and long-term endeavour. Fine-grained descriptions of in-session processes that lead to resolution of specific interpersonal and intrapersonal issues linked with longer-term outcomes are the foundation of EFT, the process-experiential approach. In this paper, evidence in support of EFT as a treatment approach will be reviewed along with research on two mechanisms of change, viewed as central to EFT, clients' emotional processing and the therapeutic relationship conditions. The implications for psychotherapy research are discussed. Given the methodological constraints, there is a need for more innovative methodologies and strategies to investigate specific psychotherapy processes within and across different approaches to map patterns and mechanisms of change to enhance theory, research, practice, and training.

Ambivalence resolution in brief psychotherapy for depression.

Ambivalence in the process of psychotherapeutic change should be addressed and resolved if we are to avoid psychotherapeutic failure and promote sustained change. In this context, ambivalence can be defined as the cyclical conflictual relation between two opposed positions of the self: one expressed as an innovation, and a subsequent one expressed in a trivialization or rejection of the innovation (problematic position). This conflict may be resolved in two different ways: (a) the dominance of the innovative position and the consequent inhibition of the problematic one and (b) the negotiation between the innovative and the problematic positions. In this study, we sought to study the evolution of the dominance and the negotiation processes in recovered and unchanged cases; to analyse if different therapeutic models produce different results on the evolution of the dominance and negotiation processes, and finally, to study if these processes are predictive of ambivalence resolution. The complete sessions of 22 clinical cases of depression (6 cognitive-behavioural therapy, 10 narrative therapy, and 6 emotion-focused therapy cases) were independently coded for innovative moments, ambivalence, and ambivalence resolution. Results revealed that recovered cases had a progressively higher proportion of negotiation along treatment, whereas in unchanged cases, negotiation was virtually absent throughout treatment. Both dominance and negotiation were significant predictors of ambivalence reduction, however, negotiation had a higher impact than dominance. Overall, these results did not significantly differ for the 3 therapeutic models. The theoretical implications of these findings are discussed, and theoretical derived suggestions for clinicians are presented.

Attachment Versus Differentiation: The Contemporary Couple Therapy Debate.

This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories-as well as the two "pure form" example models-and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration-particularly between the broader theories of attachment and differentiation-are offered for therapists to consider.

Transforming core emotional pain in a course of emotion-focused therapy for depression: A case study.

OBJECTIVE: To investigate the pattern of change in emotional states over a course of emotion-focused therapy using the model of sequential emotional processing as an initial framework for analysis. METHOD: This was a single case study observational design examining 15 sessions of therapy with one client. A qualitative analysis of moment-to-moment shifts in client emotional events was conducted. This conceptualised the interplay between experienced emotions using the sequential emotional processing model as an interpretative framework. The analysis was triangulated by using existing observer-based rating scales and reliability assessed with an independent rater. RESULTS: The sequential emotional processing model was found to be an effective means to explain the sequence of expressed emotional events, although some emotional events and emotion scheme change processes pertaining to this particular case required additional explanation than provided in the original model descriptions. CONCLUSIONS: Observed nuances in this specific case included highlighting triggers to emotional experience and avoidance processes fuelled by anticipatory fear. The observations included a process of change through accessing core feelings of shame, fear, and loneliness and their transformation through the generation of self-compassion and assertive anger. Implications for practice are discussed in terms of case conceptualisation and therapeutic strategy.

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.