Optimal levels of emotional arousal in experiential therapy of depression.

Objective: To determine the relationship between length of time spent expressing highly aroused emotion and therapeutic outcome. Method: Thirty-eight clients (14 male, 24 female) between the ages of 22 and 60 years (M = 39.5, SD = 9.71), treated for depression with experiential therapy, were rated on working alliance and expressed emotional arousal (with the Client Expressed Emotional Arousal Scale) in their three highest arousal sessions. Among the clients, 34 were of European ethnicity, 2 were of Asian ethnicity, 1 was of Latino ethnicity, and 1 was of Caribbean–Canadian ethnicity. Clients were administered the short form of the Working Alliance Inventory following their 4th therapy session and also completed, pre- and posttherapy, the Beck Depression Inventory (BDI), the Global Severity Index (GSI) of the Symptom Checklist–90–Revised (SCL-90-R), the Inventory of Interpersonal Problems, and the Rosenberg Self-Esteem Scale. Results: Hierarchical regressions showed that a nonlinear pattern of expressed emotional arousal predicted outcome significantly above the alliance. This combination predicted 30% of outcome variance on the BDI and 24% on the GSI (p     

Emotional arousal, client perceptual processing, and the working alliance in experiential psychotherapy for depression.

Early-, middle-, and late-phase client emotional arousal, perceptual processing strategies, and working alliance were examined in relation to treatment outcome on 4 measures in 32 clients who previously underwent experiential therapy for depression. Hierarchical regression analyses relating these variables to outcome indicated that results varied depending on the therapeutic process, phase of treatment, and outcome measure involved in the analyses. Mid-therapy arousal predicted improvements in self-esteem, whereas mid- and late treatment perceptual processing predicted reductions in client interpersonal dysfunction. Emotional arousal in conjunction with perceptual processing during mid-therapy predicted reductions in depressive and psychopathological symptomatology better than either of these variables alone. The implications of these findings for psychotherapy research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of experiential psychotherapy.

Reviews the book, Handbook of experiential psychotherapy by Leslie S. Greenberg, Jeanne C. Watson, and Germain Lietaer (see record 1999-02133-000). The editors of this book note that what they call the experiential therapies (such as client-centered, Gestalt, and existential therapies) have receded into the background since their heyday in the sixties and seventies. Their stated purpose in this useful book is to make professionals aware of how experiential therapies have become more focused, generated a new theoretical perspective on human functioning, and continued research on the process of change. The editors also wish to integrate the experiential therapies to become an alternative to cognitive and dynamic approaches to therapy. Each chapter contains a reference section for those who wish to pursue any of the topics in more depth. The editors might not have succeeded in shaping the experiential therapies as an integrated alternative to the prevailing approaches of our day, but they definitely have provided an exposition of this approach that can inform every clinician's work, no matter what orientation he or she espouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of video-based therapy preparation targeting experiential acceptance or the therapeutic alliance.

Preparation for psychotherapy may enhance the psychotherapeutic process, reduce drop-outs, and improve outcomes, but the effective mechanisms of such preparation are poorly understood. Previous studies have rarely targeted specific processes that are associated with positive therapy outcomes. This randomized experiment compared the effects of preparatory videos that targeted either the Therapeutic Alliance, Experiential Acceptance, or a Control video on early therapeutic process variables in 105 patients seen in individual therapy. Participants watched the videos just before their first therapy session. No significant differences were found between the Alliance and Experiential Acceptance videos on patient recommendations, immediate affective reactions, or working alliance and attrition after the first session. However, the Therapeutic Alliance video produced an immediate increase in negative mood relative to the Control video, whereas the Experiential acceptance video produced a slight increase in positive mood relative to the Alliance video. Surprisingly, patients who viewed the Alliance video were rated significantly lower than the control group on therapist-rated alliance after the first session. These findings suggest there may be specific process effects in the early phase of treatment based on the type of pretraining material used, and also indicate that video-based pretraining efforts could be counterproductive. Furthermore, this research contributes to the literature by providing insights into methodological considerations for future work on the use of technology in psychotherapy and challenges associated with preparing people for successful psychotherapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of experiential psychotherapy.

Reviews the book, Handbook of experiential psychotherapy edited by Leslie S. Greenberg, Jeanne C. Watson, and Germain Lietaer (1998). The editors note in their introductory comment that the "influence of the humanistic approaches to psychotherapy has waned since their prominence in the sixties and seventies" (p. ix). What this book makes eminently clear, however, is that experientially oriented therapies have not disappeared in the shadow of more recent developments in theory and practice. This book is well written, well organized, and rich in content. Furthermore, it fills an important gap in the literature. In a climate dominated by the search for "scientifically validated treatments," for-profit mental service providers, and praxis dominated by issues of efficacy, concern for the fundamental underlying process responsible for positive human change tends to be relegated to the background. This volume not only highlights the contributions experiential/third-force psychotherapy has made and continues to make to our appreciation of these fundamental processes, but also manages to combine and balance interesting theoretical discussion with clinically useful practical material. While this volume is no "cookbook of experiential therapy," the authors respect the practical demands facing practitioners and provide useful examples of applying some of the basic tenets of the "third force" to a range of specific issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Theory, technique, and person: Technical integration in experiential constructivist psychotherapy.

From an experiential constructivist position, the distinction between the therapist as a person, the therapist's theory of psychotherapy, and techniques used within the therapy room is, in some ways, forced and arbitrary. Principles of experiential personal construct psychotherapy are presented along with illustrations of the ways many techniques from many other schools of therapy can be used by the therapist. After exploring some of the implications of this position, I describe four specific, theoretically relevant goals within experiential personal construct psychotherapy (initially connecting with the client, developing a felt understanding of the client's experience, establishing relational intimacy, and fostering creativity). For each of these goals, I illustrate some techniques, originally developed within other theories, which can be usefully integrated into experiential personal constructivist psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional processing in experiential therapy: Why "the only way out is through."

The purpose of this study was to examine observable moment-by-moment steps in emotional processing as they occurred within productive sessions of experiential therapy. Global distress was identified as an unprocessed emotion with high arousal and low meaningfulness. The investigation consisted of 2 studies as part of a task analysis that examined clients processing distress in live video-recorded therapy sessions. Clients in both studies were adults in experiential therapy for depression and ongoing interpersonal problems. Study 1 was the discovery-oriented phase of task analysis, which intensively examined 6 examples of global distress. The qualitative findings produced a model showing: global distress, fear, shame, and aggressive anger as undifferentiated and insufficiently processed emotions; the articulation of needs and negative self-evaluations as a pivotal step in change; and assertive anger, self-soothing, hurt, and grief as states of advanced processing. Study 2 tested the model using a sample of 34 clients in global distress. A multivariate analysis of variance showed that the model of emotional processing predicted positive in-session effects, and bootstrapping analyses were used to demonstrate that distinct emotions emerged moment by moment in predicted sequential patterns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrative dynamic treatment for comorbid depression and borderline conditions.

This article summarizes empirical research and theory on the outpatient treatment of comorbid depressed-borderline patients and presents relevant clinical examples in a format intended to be useful to clinicians. Specific focus is placed on a recent article by M. J. Hilsenroth, J. A. DeFife, M. M. Blake, and T. D. Cromer (2007) reporting therapist interventions found more frequently in the psychotherapy of comorbid depressed and borderline patients who reported both statistical and clinically significant gains over the course of treatment. The specific techniques being recommended include providing structure at the outset of therapy, suggesting specific activities or tasks to be done between sessions, maintaining an active focus on treatment topics, supportive exploration of difficult topics and shifts in mood, and examining cyclical relational patterns. This set of techniques might be considered especially useful in the development of an integrative therapeutic approach for treating comorbid depressed and borderline patients in outpatient clinical practice. The applied implications and limitations of this approach are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of perfectionism, depression, and therapeutic alliance during treatment for depression: Latent difference score analysis.

The authors examined the longitudinal relationship of patient-rated perfectionism, clinician-rated depression, and observer-rated therapeutic alliance using the latent difference score (LDS) analytic framework. Outpatients involved in the Treatment for Depression Collaborative Research Program completed measures of perfectionism and depression at 5 occasions throughout treatment, with therapeutic alliance measured early in therapy. First, LDS analyses of perfectionism and depression established longitudinal change models. Further LDS analyses revealed significant longitudinal interrelationships, in which perfectionism predicted the subsequent rate of depression change, consistent with a personality vulnerability model of depression. In the final LDS model, the strength of the therapeutic alliance significantly predicted longitudinal perfectionism change, and perfectionism significantly predicted the rate of depression change throughout therapy. These results clarify the patterns of growth and change for these indicators throughout depression treatment, demonstrating an alternative method for evaluating longitudinal dynamics in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problem-solving treatment and coping styles in primary care for minor depression.

Research was undertaken to compare problem-solving treatment for primary care (PST-PC) with usual care for minor depression and to examine whether treatment effectiveness was moderated by coping style. PST-PC is a 6-session, manual-based, psychosocial skills intervention. A randomized controlled trial was conducted in 2 academic, primary care clinics. Those subjects who were eligible were randomized (N = 151), and 107 subjects completed treatment (57 PST-PC, 50 usual care) and a 35-week follow-up. Analysis with linear mixed modeling revealed significant effects of treatment and coping, such that those in PST-PC improved at a faster rate and those initially high in avoidant coping were significantly more likely to have sustained benefit from PST-PC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reduced specificity of autobiographical memory in Cluster C personality disorders and the role of depression, worry, and experiential avoidance.

The study objective was to investigate whether, compared with nonclinical controls, participants with an avoidant, dependent, or obsessive–compulsive Cluster C personality disorder (PD) manifested reduced levels of memory specificity and whether the association of Cluster C PDs with memory specificity is mediated by repetitive negative thoughts and experiential avoidance. The Autobiographical Memory Test (R. J. McNally, N. B. Lasko, M. L. Macklin, & R. K. Pitman, 1995) was administered along with self-report measures (translated into Dutch) for repetitive, uncontrollable, and negative thinking in the form of worry (Penn State Worry Questionnaire; T. J. Meyer, M. L. Miller, R. L. Metzger, & T. D. Borkovec, 1990) and experiential avoidance (Acceptance and Action Questionnaire; S. C. Hayes et al., 2004) to 294 clinical participants diagnosed with Axis I disorders (assessed with the Structured Clinical Interview for DSM–IV Axis I Disorders [SCID-I]; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1994) and Axis II disorders (assessed with the SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, & J. B. W. Williams, 1997)—202 with avoidant, 49 with dependent, and 120 with obsessive–compulsive PD—and to 108 matched nonclinical controls. Participants with a Cluster C PD showed lower levels of memory specificity than did nonclinical controls. Depression and worry mediated the effect of Cluster C PDs on memory specificity. Besides depression severity, repetitive, uncontrollable, and negative thinking may constitute a general mechanism mediating the association of various Axis I and II disorders with memory specificity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient interpersonal impacts and the early therapeutic alliance in interpersonal therapy for depression.

The therapeutic alliance consistently predicts positive psychotherapy outcomes. Thus, it is important to uncover factors that relate to alliance development. The goal of this study was to examine the association between patient interpersonal characteristics and alliance quality in interpersonal therapy for depression. Data derive from a subsample (n = 74) of a larger naturalistic database of outpatients treated at a mood disorders clinic of a university-affiliated psychiatric hospital. Following Session 3 of treatment, therapists completed the Impact Message Inventory (Kiesler & Schmidt, 1993) to assess patients' interpersonal impacts on them. Also following Session 3, patients completed the Working Alliance Inventory (Horvath & Greenberg, 1989) to assess alliance quality. As predicted, patients' affiliative interpersonal impacts, as perceived by their therapists, were positively associated with alliance quality, controlling for baseline depression severity. Although unrelated to the initial hypotheses, patients concurrently taking psychotropic medications reported better alliances than patients receiving psychotherapy only. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biased processing of emotional information in girls at risk for depression.

Researchers have documented that children of depressed mothers are at elevated risk for developing a depressive disorder themselves. There is currently little understanding, however, of what factors place these children at elevated risk. In the present study, the authors investigated whether never-disordered daughters whose mothers have experienced recurrent episodes of depression during their daughters' lifetime are characterized by biased processing of emotional information. Following a negative mood induction, participants completed an emotional-faces dot-probe task. Daughters at elevated risk for depression, but not control daughters of never-disordered mothers, selectively attended to negative facial expressions. In contrast, only control daughters selectively attended to positive facial expressions. These results provide support for cognitive vulnerability models of depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working alliance as a mediator of client attachment dimensions and psychotherapy outcome.

Studies that employ multidimensional attachment measures to explore the impact of attachment style on psychotherapy process and outcome are virtually absent in the literature. Further, the role of the working (therapeutic) alliance as a mediator of the influence of attachment on treatment outcome has not been formally investigated. In order to address these gaps in the research, archival data from 66 psychotherapy clients treated at a university graduate program training clinic were used to examine the influence of three adult attachment dimensions (Comfort with Closeness, Comfort Depending on Others, and Rejection Anxiety) on the therapeutic alliance and outcome, as well as to assess whether the alliance mediates the relationship between attachment and therapy outcome. Both Comfort with Closeness and Comfort Depending on Others were significantly related to alliance and outcome, whereas Rejection Anxiety was not significantly related to either variable. Alliance was a significant partial mediator of the effect of Comfort with Closeness on outcome. The results suggest that multidimensional measures of attachment capture important influences on alliance and psychotherapy and that Comfort with Closeness promotes successful outcome by virtue of its influence on alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)