Emotion-focused therapy

Emotion-Focused Therapy is an integrative, humanistic, empirically-supported approach; it emerged from the Person-Centered tradition and in particular its experiential branch (i.e., late Rogers and Gendlin). It integrates active process-guiding therapeutic methods from gestalt therapy and focusing within the frame of a person-centred relationship, but gives emotion a central role in therapy as a source of meaning, direction and growth. In this chapter we describe the core assumptions and values of EFT, EFT emotion theory and practice principles, and some of the main kinds of therapeutic work in EFT (“markers and tasks”). We conclude with a summary of EFT emotion change principles and a brief case exampl

Empathy

After defining empathy, discussing its measurement, and offering an example of empathy in practice, we present the results of an updated meta-analysis of the relation between empathy and psychotherapy outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r = .31 ( p < .001; 95% confidence interval: .28 –.34), for 59 independent samples and 3599 clients. Although the empathy-outcome relation held equally for different theoretical orientations, there was considerable nonrandom variability. Client and observer perceptions of therapist empathy predicted outcomes better than therapist perceptions of empathic accuracy measures, and the relation was strongest for less experienced therapists. We conclude with practice recommendations, including endorsing the different forms that empathy may take in therapy

Research on humanistic-experiential psychotherapies

In this chapter we focus on research published since our previous reviews (Greenberg, Elliott & Lietaer, 1994; Elliott, Greenberg & Lietaer, 2004), which covered research published between 1978 and 2001, plus additional earlier research on humanistic-experiential psychotherapy (HEP) outcome that we have been able to track down. A key element of the chapter is a meta-analysis of nearly 200 HEP outcome studies (through 2008) and a survey of the use of the approach with different client groups. In addition, we offer a meta-synthesis of qualitative research on these therapies (cf. Timulak, 2007), and provide a narrative review of recent quantitative research on change processes in HEPs. We conclude by reviewing and integrating the literature reviewed and discuss policy implications

Humanistic-experiential psychotherapy in practice : emotion-focused therapy

In this chapter, we provide an overview of emotion-focused therapy (EFT), a contemporary humanistic psychotherapy that integrates person-centered, gestalt, and existential approaches. After sketching its history and main theoretical concepts, we outline a set of emotion change principles. These guide an emotional deepening process in which therapists help clients move from undifferentiated distress to secondary reactive emotions to primary maladaptive emotions to core pain and thence to primary adaptive emotions and emotional transformation. To do this, the therapist responds to key markers offered by clients, proposing appropriate therapeutic tasks such as unfolding problematic reaction points or two-chair work for internal conflicts. In addition, we briefly summarize the relevant outcome data, review the EFT case formulation process, lay out treatment principles, consider its application to diverse client populations, and provide a brief case example

Narrative change in emotion-focused psychotherapy: a study on the evolution of reflection and protest innovative moments

Innovative moments (IMs) are exceptions to a client’s problematic self-narrative in the therapeutic dialogue. The innovative moments coding system is a tool which tracks five different types of IMs*action, reflection, protest, reconceptualization and performing change. An in-depth qualitative analysis of six therapeutic cases of emotion-focused therapy (EFT) investigated the role of two of the most common IMs*reflection and protest*in both good and poor outcome cases. Through this analysis two subtypes (I and II) of reflection and protest IMs were identified, revealing different evolution patterns. Subtype II of both reflection and protest IMs is significantly higher in the good outcome group, while subtype I of both IMs types does not present statistically significant differences between groups. The evolution from subtype I to subtype II across the therapeutic process seems to reflect a relevant developmental progression in the change process

Impact of prior biologic use on persistence of treatment in patients with psoriatic arthritis enrolled in the US Corrona registry

Psoriatic arthritis (PsA) is a chronic condition characterized by a diverse set of symptoms, from swollen joints to nail disease to skin disease. A variety of treatment options are available, including tumor necrosis factor inhibitors (TNFis). Little is known about treatment persistence in patients with PsA who initiate TNFi therapy, with and without prior biologic use. This study assessed persistence in these subgroups of patients with PsA and identified factors associated with persistence. This retrospective study utilized data from the Corrona registry of patients with PsA-with or without prior biologic experience-who initiated TNFi therapy between October 1, 2002, and March 21, 2013. Kaplan-Meier curves estimated median time to nonpersistence (discontinuation or switch to another biologic). Cox proportional hazards models identified factors associated with TNFi nonpersistence. A total of 1241 TNFi initiations were identified: 549 by biologic-naive and 692 by biologic-experienced patients. Through 4 years of follow-up, more biologic-naive than biologic-experienced patients remained persistent. Biologic-naive patients had a greater mean time to nonpersistence compared with biologic-experienced patients: 32 vs 23 months (p = 0.0002). Moderate and high disease activities based on clinical disease activity index and disease duration were associated with persistence in both biologic-naive and biologic-experienced patients. Additionally, in the biologic-experienced patients, the number of prior medications and skin disease were associated with persistence. The majority of patients with PsA in this study were persistent with their TNFi therapy; biologic-naive patients had greater persistence compared with biologic-experienced patients. Predictors of persistence differed slightly between biologic-naive and biologic-experienced patients

Long-term, Real-world Safety of Adalimumab in Rheumatoid Arthritis: Analysis of a Prospective US-Based Registry

OBJECTIVE: To assess long-term safety in a US cohort of rheumatoid arthritis (RA) patients treated with adalimumab in real-world clinical care settings. METHODS: This observational study analyzed the long-term incidence of safety outcomes among RA patients initiating adalimumab using data from the Corrona RA registry. Patients were adults ( \u3e /=18 years) who initiated adalimumab treatment between January 2008 and June 2017, and who had at least 1 follow-up visit. RESULTS: In total, 2798 adalimumab initiators were available for analysis, with a mean age of 54.5 years, 77% female, and mean duration of disease of 8.3 years. Nearly half (48%) were biologic naive, and 9% were using prednisone \u3e /=10 mg at adalimumab initiation. The incidence rates per 100 person-years for serious infections, congestive heart failure requiring hospitalization, malignancy (excluding nonmelanoma skin cancer), and all-cause mortality were 1.86, 0.15, 0.64, and 0.33, respectively. The incidence of serious infections was higher in the first year of therapy (3.44 [95% confidence interval: 2.45-4.84]) than subsequent years, while other measured AEs did not vary substantially by duration of exposure. The median time to adalimumab discontinuation was 11 months, while the median time to first serious infection among those experiencing a serious infection event was 12 months. CONCLUSION: Analysis of long-term data from this prospective real-world registry demonstrated a safety profile consistent with previous studies in patients with RA. This analysis did not identify any new safety signals associated with adalimumab treatment and provides valuable guidance for physicians prescribing adalimumab for extended periods of time

Self-narrative reconstruction in emotion-focused therapy: A preliminary task analysis

Objective: This research explored the consolidation phase of emotion-focused therapy (EFT) for depression and studies—through a task-analysis method—how client–therapist dyads evolved from the exploration of the problem to self-narrative reconstruction. Method: Innovative moments (IMs) were used to situate the process of self-narrative reconstruction within sessions, particularly through reconceptualization and performing change IMs. We contrasted the observation of these occurrences with a rational model of self-narrative reconstruction, previously built. Results: This study presents the rational model and the revised rational-empirical model of the self-narrative reconstruction task in three EFT dyads, suggesting nine steps necessary for task resolution: (1) Explicit recognition of differences in the present and steps in the path of change; (2) Development of a meta-perspective contrast between present self and past self; (3) Amplification of contrast in the self; (4) A positive appreciation of changes is conveyed; (5) Occurrence of feelings of empowerment, competence, and mastery; (6) Reference to difficulties still present; (7) Emphasis on the loss of centrality of the problem; (8) Perception of change as a gradual, developing process; and (9) Reference to projects, experiences of change, or elaboration of new plans. Conclusions: Central aspects of therapist activity in facilitating the client's progression along these nine steps are also elaboratedtuguese Foun- dation for Science and Technology [grant PTDC/PSI-PCL/121525/2010] (Ambivalence and unsuccessful psychotherapy, 2007–2010) and by the Ph.D. grant [SFRH/BD/30880/2006