Antonio Pascual-Leone

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.

Developments in task analysis: New methods to study change

Abstract This article provides a conceptual overview of task analysis, which is an inherently multimethod approach. The authors present the method as a step-by-step illustrative template for researchers who seek to develop qualitatively rich models of change and quantitative measures that correspond to these change models. The current article provides an epistemological framework to develop both descriptive and causal models of change. It also offers a comparison with other methods of inquiry that are exclusively qualitative in nature and do not explicitly highlight the use of theory in model development. In addition, the authors describe recent developments in task analysis for dynamic modeling. In tandem with this, they articulate advances in the relationship between task analytic construct development and measurement development.

One Minute of Grief: Emotional Processing in Short-Term Dynamic Psychotherapy for Adjustment Disorder

OBJECTIVE Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional processing in psychodynamic psychotherapy for adjustment disorder and linking these variables with ultimate therapeutic outcome. METHOD In this study, 32 patients underwent short-term dynamic psychotherapy. On the basis of reliable clinical change statistics, a subgroup (n = 16) presented with good outcome and another subgroup (n = 16) had a poor outcome in the end of treatment. The strongest alliance session of each case was rated using the observer-rated system Classification of Affective Meaning States. Reliability coefficients for the measure were excellent (κ = .82). RESULTS Using 1 min as the fine-grained unit of analysis, results showed that the experience of fundamentally adaptive grief was more common in the in-session process of patients with good outcome, compared with those with poor outcomes (χ2 = 6.56, p = .01, d = 1.23). This variable alone predicted 19% of the change in depressive symptoms as measured by the Beck Depression Inventory at the end of treatment. Moreover, sequences of the original model were supported and related to outcome. CONCLUSIONS These results are discussed within the framework of the sequential model of emotional processing and its possible relevance for psychodynamic psychotherapy.

Problem Anger in Psychotherapy: An Emotion-Focused Perspective on Hate, Rage, and Rejecting Anger

This paper explores applies emotion-focused theory, for the first time, to the emotions of hate, rage, and destructive anger. The general case formulation proposed in this paper is that these emotions are always an elaboration of secondary anger. The body of the paper describes three clinical case formulations. First, problem anger is described in terms of an individual’s self-criticism. Second, we present a form of secondary anger, in which hostility and rage are reactive feelings to avoid more vulnerable (primary) experiences. An unfortunate example of this is has been described as a common underlying process in domestic violence. A alternate manifestation of secondary anger results from the deterioration of what may have initially been adaptive anger; thus, excessive arousal and the loss of meaning or focus that one’s anger embodied also leads to rage or destructive anger. Finally, the experience and expression of hate is described as a primary maladaptive and/or instrumental anger. This appears in-session particularly among those with certain personality disorders. The paper highlights implications for research and practice.

Emotion-focused therapy for incarcerated offenders of intimate partner violence: A 3-year outcome using a new whole-sample matching method

Abstract A 3-year follow-up was conducted for Relating Without Violence, an emotion-focused group psychotherapy program for incarcerated men who have a history of intimate partner violence. This is the only known manualized experiential treatment for incarcerated batterers. A sample of 66 men who completed the treatment was compared to 184 men from the same prison. Although the initial research design was quasi-experimental, new procedures were used to match the groups’ averages on all known pre-treatment variables. At 7 and 8 months post-release, the treatment group recidivated by assault and/or sexual assault significantly less than controls. Treatment effects are comparable to those of best practices. The study also demonstrates methodological developments for statistically creating matched groups not previously used in psychotherapy research.

The reported impact of psychotherapy training: Undergraduate disclosures after a course in experiential psychotherapy

The purpose of this study was to explore what students considered to be the personal and professional impact of an experientially based psychotherapy training course on their lives. After completing the introductory course, 24 senior undergraduate psychology students provided personal narratives of their experiences, which were then subjected to a grounded theory analysis. The results produced 28 hierarchically organized individual clusters; revealing that over the semester of training, students perceived multiple changes on both a professional level (i.e., skill acquisition and learning related to the therapeutic process) and a personal level (i.e., self-growth in a more private sphere). Analysis also highlighted key areas of difficulty in skills acquisition. Post hoc analyses further demonstrated gender differences in the reported training experiences.

Emotional Processing, Interaction Process, and Outcome in Clarification-Oriented Psychotherapy for Personality Disorders: A Process-Outcome Analysis

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional processing and by additionally taking into account a therapists appropriate responsiveness to a patients presentation in clarification-oriented psychotherapy (COP), a humanistic-experiential form of therapy. The present study involved 39 patients with a range of PDs undergoing COP. Session 25 was assessed as part of the working phase of each therapy by external raters in terms of emotional processing using the Classification of Affective-Meaning States (CAMS) and in terms of the overall quality of therapist-patient interaction using the Process-Content-Relationship Scale (BIBS). Treatment outcome was assessed pre- and post-therapy using the Global Severity Index (GSI) of the SCL-90-R and the BDI. Results indicate that the good outcome cases showed more self-compassion, more rejecting anger, and a higher quality of therapist-patient interaction compared to poorer outcome cases. For good outcome cases, emotional processing predicted 18% of symptom change at the end of treatment, which was not found for poor outcome cases. These results are discussed within the framework of an integrative understanding of emotional processing as an underlying mechanism of change in COP, and perhaps in other effective therapy approaches for PDs.

Emotion in an alliance rupture and resolution sequence: A theory-building case study

AbstractAims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in alliance rupture and resolution therapy sessions. This is the objective of this theory-building case study. Method: This client underwent a 34-session long, psychodynamic psychotherapy within the context of an open trial. An alliance rupture-resolution sequence of two subsequent sessions, along with a third control session, was selected from this case and these sessions were rated using the Classification of Affective-Meaning States (CAMS), an observer-rated method to classify distinct emotions, according to current emotion-focused models. Results: The results indicate that the rupture session was associated, above all, with core maladaptive fear, evoked in the...

Affective and cognitive correlates of gambling behavior in university students.

The purpose of the following study was to explore certain affective and cognitive components and their relationships to gambling behavior in an undergraduate population. Specifically, the aim was to predict gambling severity using depression scores on the BDI-II, the dependency and self-criticism subscales on the DEQ, emotional awareness scores on the LEAS, cognitive flexibility scores from the STROOP, and a creativity subtests from the TTCT. Participants were 200 undergraduate students and 3.5–7.5% of individuals reported some level of problematic gambling behavior. Multiple regression analysis indicated that self-criticism and creative originality were significant predictors of gambling behavior, explaining 7.6% of the variance. Further analyses reveal a non-linear trend in the creative originality of those who gamble; only the at-risk gamblers were high in creativity whereas abstainers and problematic gamblers display similarly lower levels of creativity. Results are discussed in regards to Blaszczynski and Nower’s Addiction 97:487–499 (2002) subtypes of gambling vulnerability.

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

Abstract Aims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re-purposed to help orient and sensitise trainees to key in-session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential-integrative therapy approach, a 13-week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all ps<.05) in session management, reducing their anx...