Accuracy and Bias in Vulnerability Perceptions of Partners Undergoing Emotion-Focused Therapy for Couples.

The primary mechanism of change in emotion-focused couples therapy (EFT-C) is described as one partner accessing and expressing vulnerability, with the other partner responding affiliatively, with compassion, acceptance, validation, and support. These interactions are assumed to restructure the negative, rigid interactional cycle that usually brings couples to therapy and helps build a positive emotional bond. The primary aim of this study was to test whether for this process to occur, partners need to accurately perceive their spouse's experiences of vulnerability during therapy. Specifically, it examined the factors (i.e., tracking accuracy, assumed-similarity bias, and directional bias) shaping partners' perceptions of their spouse's vulnerability and whether accurate perceptions predict positive session outcomes during EFT-C. Data from 36 couples who took part in the York Emotional Injury Project were analyzed. Following each session, clients reported their own experience of vulnerability as well as their perceptions of their partners' vulnerability. Session outcome was defined as the extent to which clients reported resolution. Using a multilevel Truth and Bias model, the results indicated that partners accurately perceived changes in their spouses' expressions of vulnerability (i.e., significant tracking accuracy). Interestingly, partners' perceptions were also tied to their own expressions of vulnerability (i.e., significant assumed-similarity bias) and tended to underestimate the level of their partners' vulnerability expressions (i.e., significant negative mean-level bias). Using a multilevel Response Surface Analysis, we found that accuracy regarding partners' vulnerability was associated with higher levels of resolution.

El principal mecanismo de cambio en la terapia de pareja centrada en las emociones (EFT-C, siglas en inglés) se describe como un integrante de la pareja que accede a la vulnerabilidad y la expresa, y el otro integrante de la pareja que responde afiliativamente; con compasión, aceptación, validación y apoyo. Se supone que estas interacciones reestructuran el ciclo interactivo negativo y rígido que generalmente lleva a las parejas a terapia y ayuda a construir un vínculo emocional positivo. El principal objetivo de este estudio fue evaluar si, para que ocurra este proceso, las parejas necesitan percibir con exactitud las experiencias de vulnerabilidad de su cónyuge durante la terapia. Específicamente, analizó los factores (p. ej.: precisión del seguimiento, sesgo de similitud asumida y sesgo direccional) que determinan las percepciones de las parejas de la vulnerabilidad de su cónyuge y si las percepciones exactas predicen resultados positivos en las sesiones durante la EFT-C. Se analizaron datos de 36 parejas que participaron en el Proyecto de York sobre Daño Emocional (York Emotional Injury Project). Después de cada sesión, los pacientes informaron su propia experiencia de vulnerabilidad así como sus percepciones de la vulnerabilidad de sus parejas. El resultado de la sesión se definió como el grado en el que los pacientes informaron la resolución. Utilizando un modelo multinivel de verdad y sesgo, los resultados indicaron que las parejas percibieron con exactitud los cambios en las expresiones de vulnerabilidad de sus cónyuges (p. ej.: precisión considerable del seguimiento). De modo interesante, las percepciones de las parejas también estuvieron ligadas a sus propias expresiones de vulnerabilidad (p. ej.: sesgo considerable de similitud asumida) y tendieron a subestimar el nivel de las expresiones de vulnerabilidad de sus parejas (p. ej.: sesgo considerable de nivel medio negativo). Utilizando un análisis superficial de respuesta multinivel, descubrimos que la exactitud con respecto a la vulnerabilidad de las parejas estuvo asociada con niveles más altos de resolución.

Working with identity and self-soothing in Emotion-Focused Therapy for Couples.

This paper will outline new developments in Emotion-Focused Therapy for Couples (EFT-C) (Greenberg & Goldman, Emotion-focused couples therapy: The dynamics of emotion, love, and power, Washington, DC, American Psychological Association, 2008). People are seen as primarily motivated by their affective goals and the regulation of emotional states. The three motivational systems of attachment, identity, and attraction/liking, viewed as reflective of the core concerns people bring to therapy, are briefly outlined and elaborated. The five-stage model of EFT-C is briefly described. The paper will then provide two illustrations, one that demonstrates how EFT-C therapists work with core issues related to identity, and the other that shows how therapy can promote self-soothing. In the first example, annotated transcripts taken from therapy sessions illustrate how an EFT therapist addresses issues of identity in a highly distressed couple. The second example demonstrates how to facilitate work with individuals within the couples' context to engender and develop capacities for self-soothing, seen as fundamental for the promotion of healthy emotion regulation and couples' overall health.

Emotional processing during experiential treatment of depression.

This study explored the importance of early and late emotional processing to change in depressive and general symptomology, self-esteem, and interpersonal problems for 34 clients who received 16-20 sessions of experiential treatment for depression. The independent contribution to outcome of the early working alliance was also explored. Early and late emotional processing predicted reductions in reported symptoms and gains in self-esteem. More important, emotional-processing skill significantly improved during treatment. Hierarchical regression models demonstrated that late emotional processing both mediated the relationship between clients' early emotional processing capacity and outcome and was the sole emotional-processing variable that independently predicted improvement. After controlling for emotional processing, the working alliance added an independent contribution to explaining improvement in reported symptomology only.

Maintenance of gains following experiential therapies for depression.

Follow-up data across an 18-month period are presented for 43 adults who had been randomly assigned and had responded to short-term client-centered (CC) and emotion-focused (EFT) therapies for major depression. Long-term effects of these short-term therapies were evaluated using relapse rates, number of asymptomatic or minimally symptomatic weeks, survival times across an 18-month follow-up, and group comparisons on self-report indices at 6- and 18-month follow-up among those clients who responded to the acute treatment phase. EFT treatment showed superior effects across 18 months in terms of less depressive relapse and greater number of asymptomatic or minimally symptomatic weeks, and the probability of maintaining treatment gains was significantly more likely in the EFT treatment than in the CC treatment. In addition, follow-up self-report results demonstrated significantly greater effects for EFT clients on reduction of depression and improvement of self-esteem, and there were trends in favor of EFT, in comparison with CC, on reduction of general symptom distress and interpersonal problems. Maintenance of treatment gains following an empathic relational treatment appears to be enhanced by the addition of specific experiential and gestalt-derived emotion-focused interventions. Clinical and theoretical implications of these findings are presented.

Depth of emotional experience and outcome.

Abstract The relationship between theme-related depth of experiencing (EXP) and outcome was explored in experiential therapy with depressed clients. The study sought to investigate whether depth of EXP predicts outcome, whether change in depth of EXP over therapy predicts outcome, and how these factors compare with the therapeutic alliance as predictors of outcome. The sample consisted of 35 clients, each of whom received 16 to 20 weeks of therapy. Themes that had emerged across therapy were identified. Depth of EXP was measured in relation to themes in one early session and in three sessions sampled from blocks across the last half of therapy. Analyses revealed that EXP on core themes in the last half of therapy was a significant predictor of reduced symptom distress and increased self-esteem. EXP did not correlate significantly with changes on the Inventory of Interpersonal Problems. EXP on core themes also accounted for outcome variance over and above that accounted for by early EXP and alliance.