Emotion-Focused Therapy and the Person-Centred Approach: Past, Present & Future Robert ElliottUniversity of Strathclyde

A Personal Journey…

Five years ago: Invited to join the Counselling UnitWalked into a place with a deep sense of culture and history built up over many years

But also, deeply counter-culturalComplex web of:

Courses and projectsRelationships and traditions Large team of talented trainers and counsellorsHighly committed students, past and present

A Personal Journey…

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?

Crucial Issue…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, Emotion-Focused Therapy ≠ Person-centred

But Laura Rice, Les Greenberg & I had all started from a Person-Centred base

Felt we were Person-CentredSo, coming here, I began…

… Five-year Evolving Dialogue

With colleagues:Classical/nondirective Person-Centred Therapy (PCT)Broadly relational PCTPluralistic

My position has varied:Curiosity & puzzlementAwe & scepticismFrustration & excitement

Will present what I’ve learned so far from this dialogue

Past, Present & Future

The Past: A Brief History of Person-Centred-Experiential (PCE) Therapy

Time Line of PCE Therapy -1

Roots/Sources: Humanism (The Renaissance, The Enlightenment, existentialism, Third force Humanistic psychology)1940’s: Nondirective therapy: Rogers1950’s: Classical approach: Chicago

Relationship conditions: unconditional positive regard, empathy, genuineness

1960’s: Focus on client process: WisconsinLate Rogers, GendlinThe dialogue begins…

Time Line of PCE Therapy -2

1970’s: Experiential therapy:Gendlin: FocusingRice, Greenberg: task analysis

1980’s: Partial eclipse periodDismissed in North AmericaFurther development of PCA in Europe

1990’s: Beginning of PCE revivalTraining centres established: Counselling UnitProcess-Experiential (PE)/Emotion-Focused Therapy (EFT)Explosion of research

Time Line of PCE Therapy -3

2000’s: World Association foundedJournal: Person-Centered and Experiential PsychotherapiesStruggles for recognitionResearch continues rapid developmentEFT books & training emerge

Legacy of this Past: The Great DivideContinuing dialogue between different parts of the tradition, especially from 1970 onOne end: “Classical” approaches

Emphasize Nondirectivity, Unconditional Positive Regard, the centrality of the relationship

Other end: Emotion-Focused TherapyEmphasize client process, process guiding, the work of therapy

“Pluralistic Approach” fits in there somewhere…

Examining the Legacy: Dialoging Across the Great Divide

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 restrictionsNeed to establish self vs. feeling threatened or excluded

Which takes us to …

The PresentAs 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…

1. The EFT Translation Project

EFT jargon can put PCT therapists offMakes it sound like EFT therapists are pulling levers and controlling clients

Have been trying to translate into PCT Friendly languageMany discussions with Beth Freire, Brian Rodgers, Graham Westwell, and others

Example: The Six EFT Therapy Principles

PCT-Friendly EFT 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

Three EFT Principles Need Translation into PCT Language -1

Involve different kinds of therapeutic work (=“tasks”)

4. “Task Collaboration”: Listen for and engage with what client wants to work onOffer orienting information about nature of therapy and particular ways of working in the session, particularly when the client asks or is puzzled

EFT Principles that Need Translation into PCT Language -2

5. “Task Completion/Emotional Change”: Listen for and engage with key issues clearly or repeatedly presented by clientHelp client contact, explore and clarify core, growth-oriented emotions and views of self/othersKeep 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

EFT Principles that Need Translation into PCT Language -3

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 workAlways accept client’s decision about whether or not to accept a process offer

2. Comparing PCT & EFT: The PCEPS study

Freire, Elliott & Westwell, 2011Developed 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 nondirectivenessExperiential Process (Exp): 5 items

Eg Experiential specificity, emotion focus

1 – 6 descriptively-anchored scales Passing = 3.5+

The PCEPS study - Method

Just finished test of measure on 120 segments:

Research Clinic data10-15 min segments60 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)

The PCEPS study: Summary1. PCEPS is reliable (across items and raters)2. In general, PC and Exp items correlate very highly with each other3. We also found a Nondirectiveness factor

Empowering Presence, Content Nondirectiveness, Clarity/brevity

4. Student therapists scored lower on all items5. No difference between fully trained PCT and EFT therapists on: PC, Exp, and nondirectiveness subscalesConclusion: Therapist and training effects much more important than PCT vs EFT differences

The PCEPS study – Mean PCEPS ScoresN Seg-ments

Mean score

% “passing” (at least 3.5)

Range

Student therapists

60 3.1* 17% 0 – 33%

PCT therapists

24 4.4 92% 83-100%

EFT therapists

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

The PCEPS study – PCEPS Subscale Results for Social Anxiety Clients

PC Scale: Mean

PC Scale:% pass

Exp Scale:Mean

Exp Scale:% pass

NDir ScaleMean

Ndir Scale % pass

PCT therapists

4.5 92% 4.2 96% 4.6 87%

EFT therapists

4.2 78% 4.2 75% 4.0* 72%

EFT fully trained

4.6 96% 4.7 96% 4.4 83%

*P<.01 vs. PCT therapists; all other effects nonsignificant

The Future

Where does this leave us?Some concluding thoughts about avenues for continuing the dialogue Provides an agenda for the future

1. Beyond ideology, Or: Back to the Process Itself

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 self-report data

Both quantitative questionnaires & qualitative interviews

PCEPS study illustrates value of following the example of early Carl Rogers and colleaguesWe need to return to the study of therapy process

2. A Pluralistic community of practice: Using our different strengths as therapists to complement each other

Most of us are never going to be effective therapists across a range of different therapy approachesBut: We can do a better job of listening to and learning from each other within the PCE tradition:

Classical, nondirective therapistsBroadly relational person-centred therapistsFocusers and EFT therapistsPerson-centred-based pluralistic experimenters in other approachesNear neighbors in 4th generation CBT (eg Schema therapy) and contemporary relational psychodynamic therapy

3. Toward a deeper understanding of nondirectivity via Task Analysis

Here in the Counselling Unit, I have found myself fascinated by rigorous nondirectivity in therapyPersonally, I could never adopt a sustained, rigorously nondirective stanceNevertheless, it is clear to me that there are clients and moments when this is absolutely the best thing to doI 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)

4. Conclusion: Living with the creative tension between nondirectivity and process guiding

It’s so difficult to live in the middle:Between dichotomies/unresolved differences/ ambiguity/ complexityDavid 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

And by the way…

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: robert.elliott@strath.ac.ukBlog: http://pe-eft.blogspot.com