Process Experiential Psychotherapy: An Emotion-Focused Approach
For individuals in the U.S. & U.S. territories
In Process Experiential Psychotherapy: An Emotion-Focused Approach, Dr. Leslie S. Greenberg demonstrates this deeply empathic, emotion-focused approach to treatment. In process experiential psychotherapy, the therapist works to guide the client's affective and cognitive processing of experience through the use of appropriate active interventions that facilitate the resolution of painful emotions.
In this session, Dr. Greenberg works with a 34-year-old man who is depressed. Using empathy and in-session activities, they explore the sources of the client's current affective state.
This video features a client portrayed by an actor on the basis of actual case material.
The client, Todd, made an appointment to see Dr. Greenberg on the basis of a referral from his self-initiated contact with the Employee Assistance Program (EAP) at the company where he works.
Over the past 2 months, Todd has taken 15 days of "sick leave" from his job, usually because of exhaustion, an inability to concentrate, and a sense that he "just could not face it." During that time, he felt that he couldn't "face things at work, or anyplace for that matter." Afraid that his job might be jeopardized by all his absences, Todd talked to his supervisor about his problems. She recommended that he contact the EAP.
Todd has tried to force himself to get up and go to work in spite of his increasing desire to "hide." He knows he should "just do it" as his wife, Mary, "tells him to." But, his usual sense of duty and responsibility seems to have dissipated. He has begun to dread each new day because it only brings him a new sense of "inadequacy and a fear that he will never pull out of this."
Todd has been struggling with this for at least 6 months, although the last 2 months have been the worst. About 8 weeks ago, Mary called Todd's father because she thought that even when she couldn't help Todd, his father always seemed to be able to "force him out of these moods." His father called one day when Todd was home from work and started in his usual "shoot-from-the hip, matter of fact way," by telling Todd that he should "snap out of it, and be a man; don't indulge your feelings; you have kids of your own now; do you think you are still a child who can just sit home and cry?" After the call from his father, Todd "just wanted to die." He felt like he was a total "wash out" in both his wife's and his father's eyes.
These feelings were not new, neither the feelings of inadequacy nor the feeling of being "depressed."
He recalled another time when his father had mocked him and made him feel like a "loser." When Todd was about 13 or 14, he went on a ski trip with his father and his brother. Todd didn't want to go. Todd knew that he was "awkward and clumsy," but he tried anyway. He would fall down and get up over and over. His father kept pushing him to try bigger and bigger slopes. Finally, after one really painful fall, Todd just broke down and cried. "I can't do it, Dad. I am just no good at this." Todd's father shouted at him to "Buck up; don't be a quitter. Take your spills like a man for a change." Lots of people were around when his father yelled at him. He felt humiliated and diminished. The ski trip finally did come to an abrupt end when Todd broke his arm trying to break a fall.
About a year ago, Todd was up for a good promotion. Although he was clearly qualified for the job, and it was the obvious "next step up" from his position, the department chief decided to go "outside" of the firm to hire. Todd wondered if he had been unfairly passed over or if this was another case of him being "unable to cut the mustard." "Nothing turns out how I hope," Todd thought. "Always a loser. Always second best and in second place."
Session 1: Todd related "his story" emphasizing the events of the last 2 months: his lack of energy, lack of concentration, sense of despair and growing pessimism. He talked a little about his childhood, specifically the death of his mother and the long-standing criticalness of his father. Dr. Greenberg's primary interventions were geared to establishing an empathetic connection with Todd by emphasizing how awful his life feels for him right now.
Session 2: Dr. Greenberg opened by restating some of the affective domains and psychological issues from Session 1, letting Todd go where his feelings and present mood took him. Todd elaborated on his sense of a deteriorating condition over the past 6 months, the failure of his previous way of coping, the disappointment at work about 1 year ago, and Mary's attempt to elicit his father's help 8 weeks earlier.
Dr. Greenberg continued to emphasize the affective elements of what Todd discussed, working to further strengthen the empathetic connection and to build an alliance between the patient and the therapist. The session ended with mutual agreement that they would have two broad goals: to explore Todd's feeling of inadequacy and his distress about his childhood (particularly his unsatisfying relationship with his father).
Session 3: Began by working on the agreed goals. Midway through the session the "two chair technique" was introduced, with Todd beginning the process of dialoging with his "internalized critic" around messages that "you're inadequate; you're no good." In this session, material about the ski trip when Todd was 13 years old emerged.
Session 4: to be viewed.
The process experiential approach relies on the provision of a genuine, prizing, empathic relationship and on the therapist being highly attuned and responsive to the client's moment by moment feelings and experience. Within the context of an empathic relationship the therapist guides the client's cognitive and affective processing in certain directions.
A central issue for this treatment is achieving a balance between relational responsiveness and process directiveness, between leading and following. The aim is for the therapist and client to work collaboratively to explore the client's experience and to construct new meaning.
Within the safe working environment created by the relationship conditions, the approach uses active interventions in a process diagnostic and process directive fashion. The approach is process diagnostic in that the therapist listens for the emergence of markers of particular types of affective problems with which the client is currently struggling, such as splits between two parts of the self. It is process directive in that when a marker emerges, the therapist suggests a specific in-session task to facilitate task resolution.
Five major sets of markers and tasks have been delineated:
- two-chair dialogues for the resolution of splits
- empty chair dialogues for unfinished business
- systematic evocative unfolding for resolving problematic reactions
- focusing on markers of an unclear felt sense
- empathic affirmation of markers of vulnerability
In this approach, the therapist is viewed as an expert in how and when to facilitate particular kinds of exploration of experience but not as an expert on the content of the client's experience. Rather, clients are viewed as experts on their own experience, and therapy is a discovery-oriented process. The therapist, therefore, works to guide the client's experiential processing in different ways at different times to promote the type of cognitive and emotional processing that is likely to be most productive at that point and likely to lead to the resolution of relevant tasks.
Emotion plays a central role in this approach. Emotions are seen as organizing processes that enhance adaptation and problem solving. Accessing emotion in therapy and the promotion of further emotional processing is seen as leading to enduring change. Emotions are therefore evoked in therapy to help people make sense of what they feel and to promote emotional reorganization through the synthesis of previously unavailable internal resources.
Leslie S. Greenberg, PhD, is professor of psychology at York University in Toronto, Ontario, Canada. He is the director of the York University Psychotherapy Research Clinic.
He has coauthored major texts on emotion-focused approaches to treatment of individuals and couples. His most recent books are Emotion-Focused Therapy for Depression (with Jeanne C. Watson; American Psychological Association, 2005) and Emotion-Focused Therapy (2001). He recently co-edited Empathy Reconsidered (1997) and the Handbook of Experiential Psychotherapy (1998).
Dr. Greenberg is a founding member of the Society of the Exploration of Psychotherapy Integration and a past president of the Society for Psychotherapy Research.
He is on the editorial board of a number of psychotherapy journals, including the Journal of Psychotherapy Integration and the Journal of Marital and Family Therapy.
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- Brief Dynamic Therapy
Stanley B. Messer
- Cognitive–Affective Behavior Therapy
Marvin R. Goldfried
Michael D. Yapko
- Emotion-Focused Therapy for Depression
Leslie S. Greenberg
- Emotion-Focused Therapy in Practice: Working With Grief and Abandonment
Jeanne C. Watson
- Emotionally Focused Couple Therapy for Clients Dealing With Infidelity
- Experiential Psychotherapy
Alvin R. Mahrer
- Short-Term Dynamic Therapy
Donald K. Freedheim
- Chronic Depression: Interpersonal Sources, Therapeutic Solutions
Jeremy W. Pettit and Thomas E. Joiner
- Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings
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- Emotion-Focused Therapy for Depression
Leslie S. Greenberg and Jeanne C. Watson
- Emotions and Life: Perspectives From Psychology, Biology, and Evolution
- Emotions in the Practice of Psychotherapy: Clinical Implications of Affect Theories
- Experiences of Depression: Theoretical, Clinical, and Research Perspectives
Sidney J. Blatt
- Interpretive and Supportive Psychotherapies: Matching Therapy and Patient Personality
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- Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change
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- The Therapeutic Alliance in Brief Psychotherapy
Edited by Jeremy D. Safran and J. Christopher Muran