Leslie S. Greenberg

Change Process Research.

Research on change processes is needed to help explain how psychotherapy produces change. To explain processes of change it will be important to measure three types of outcomes—immediate, intermediate, and final—and three levels of process—speech act, episode, and relationship. Emphasis will need to be placed on specifying different types of in-session change episodes and the intermediate outcomes they produce. The assumption that all processes have the same meaning (regardless of context) needs to be dropped, and a context-sensitive process research needs to be developed. Speech acts need to be viewed in the context of the types of episodes in which they occur, and episodes need to be viewed in the context of the type of relationship in which they occur. This approach would result in the use of a battery of process instruments to measure process patterns in context and to relate these to outcome.

Experiential Therapy of Depression: Differential Effects of Client-Centered Relationship Conditions and Process Experiential Interventions

This study compared the effectiveness of process-experiential psychotherapy with one of its components, client-centered psychotherapy, in the treatment of (34) adults suffering from major depression. The client-centered treatment emphasized the establishment and maintenance of the Rogerian relationship conditions and empathic responding. The experiential treatment consisted of the client-centered conditions, plus the use of specific process-directive gestalt and experiential interventions at client markers indicating particular cognitive-affective problems. Treatments showed no difference in reducing depressive symptomatology at termination and six month follow-up. The experiential treatment, however, had superior effects at mid-treatment on depression and at termination on the total level of symptoms, self-esteem, and reduction of interpersonal problems. The addition, to the relational conditions, of specific active interventions at appropriate points in the treatment of depression appeared to hasten and...

Differential Effects of Experiential and Problem-Solving Interventions in Resolving Marital Conflict.

The present study compared the relative effectiveness of two interventions in the treatment of marital discord: a cognitive-behavioral intervention, teaching problemsolving skills, and an experiential intervention, focusing on emotional experiences underlying interaction patterns. Forty-five couples seeking therapy were randomly assigned to one of these treatments or to a wait-list control group. Each treatment was administered in eight sessions by six experienced therapists whose interventions were monitored and rated to ensure treatment fidelity. Results indicated that the perceived strength of the working alliance between couples and therapists and general therapist effectiveness were equivalent across treatment groups and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. Furthermore, the effects of the emotionally focused treatment were superior to those of the problem-solving treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the emotionally focused group were still significantly higher than those in the problem-solving group.

Emotion-focused therapy for depression

ABSTRACT A review of emotion-focused therapy (EFT) of depression including a discussion of its evidence base is provided. EFT aims within an affectively attuned empathic relationship to access and transform habitual maladaptive emotional schematic memories that are seen as the source of the depression. These memories often involve feelings of the shame of worthlessness, anxious insecurity and the sadness of abandonment. Through the therapeutic process, adaptive emotions are accessed to transform maladaptive emotions and to organize the person for adaptive responses. This process of changing emotion with emotion is aided by the use of specific therapeutic techniques that help stimulate arousal of emotion and its processing.

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.

Integrating affect and cognition: A perspective on the process of therapeutic change

There is a growing recognition among clinicians of the need for a comprehensive model of emotion, which illuminates the role of affective processes in psychotherapy. In the present article, we employ a constructive model in which emotion is viewed as resulting from a synthesis of components. This emotional synthesis model is used to explore some of the ways in which “feeling” and “thinking” interact, both in clinical problems and in therapeutic change. It is suggested that many clinical problems involve a breakdown in the emotional synthesis process and that an important focus of therapy should be the integration of the different levels of processing involved in the construction of emotional experience. It is also argued that affect does not play a simple, uniform role in therapeutic change but instead should be viewed as operating in different ways in different change events. For this reason, it is important to begin delineating different mechanisms through which changes in emotional processing can bring about therapeutic change. To this end, three such mechanisms are proposed: the synthesis of adaptive emotional experience, de-automating dysfunctional emotional habits, and modifying state-dependent learning.

Research on the process of change

This paper explores some of the principles involved in the shift toward the study of change events in psychotherapy. A process-analytic approach to the study of change is suggested aimed at the development of micro-theory to explain the change processes that occur in specific in therapy contexts. It is suggested that designs which relate these complex change process to outcome will help determine which factors within a treatment model explain the obtained outcomes.

Task Analysis Exemplified: The Process of Resolving Unfinished Business.

The steps of a task-analytic research program designed to identify the in-session performances involved in resolving lingering bad feelings toward a significant other are described. A rational-empirical methodology of repeatedly cycling between rational conjecture and empirical observations is demonstrated as a method of developing an intervention manual and the components of client processes of resolution. A refined model of the change process developed by these procedures is validated by comparing 11 successful and 11 unsuccessful performances. Four performance components-intense expression of feeling, expression of need, shift in representation of other, and self-validation or understanding of the other-were found to discriminate between resolution and nonresolution performances. These components were measured on 4 process measures: the Structural Analysis of Social Behavior, the Experiencing Scale, the Clients Emotional Arousal Scale, and a need scale.

A guide to conducting a task analysis of psychotherapeutic change

Abstract The epistemological and methodological underpinnings of task analysis are discussed and the steps and concrete procedures for its implementation are described and exemplified in a task analysis of the resolution of unfinished business. Task analysis, a method for studying the process of change, consists of two main phases: a discovery-oriented phase based on rational–empirical model building and a validation phase based on hypothesis testing. The goals of the approach are to (a) build an observationally based model of how therapeutic change occurs for a particular type of affective–cognitive problem, (b) validate the model of change, and (c) relate the process of change to outcome. Benefits and strengths of the approach are presented and factors that have impeded the use of this approach in the study of change processes are discussed.

Emotion-Focused Couples Therapy and the Facilitation of Forgiveness.

The goal of this study was to evaluate the effectiveness of an emotion-focused couple therapy intervention for resolving emotional injuries. Twenty couples acting as their own waitlist controls were offered a 10-12-session treatment to help resolve unresolved anger and hurt from a betrayal, an abandonment, or an identity insult that they had been unable to resolve for at least 2 years. Treated couples fared significantly better on all outcome measures over the treatment period compared to the waitlist period. They showed a significant improvement in dyadic satisfaction, trust, and forgiveness as well as improvement on symptom and target complaint measures. Changes were maintained on all of the measures at 3-month follow-up except trust, on which the injured partners deteriorated. At the end of treatment, 11 couples were identified as having completely forgiven their partners and six had made progress toward forgiveness compared with only three having made progress toward forgiveness over the waitlist period. The results suggest that EFT is effective in alleviating marital distress and promoting forgiveness in a brief period of time but that additional sessions may be needed to enhance enduring change.