Focusing-Oriented Psychotherapy

Hendricks’s review of the research (2002) shows that: (a) higher levels of experiencing in clients correlates with successful outcomes in a variety of therapeutic orientations and client problem types; (b) the ability to focus and increase experiencing level can be taught to clients; and (c) therapists who themselves focus seem to be more effective in enabling their clients to focus.

The client’s personal construction of the meaning of events in therapy shows that experiencing is positively related to outcome in 51% of 39 studies (Orlinsky et al., 1994, as cited in Bergin & Garfield, 1994). Iberg (1996) found that clients reported greater impact in sessions when therapists used focusing-oriented questions. Leijssen (1996) conducted a study to determine whether focusing enhanced client-centered therapy. She found that 75% of positive sessions used focusing steps, while only 33% of negative sessions used focusing. Client focusing, whether a part of focusing-oriented psychotherapy or other person-centered therapies, seems to enhance the quality of individual sessions and good outcome.

Pre-Therapy

There is a modest and accumulating amount of research supporting pretherapy (Dekeyser, Prouty, & Elliott, 2008). Outcome research conducted on a small sample of persons with schizophrenic symptoms or intellectual disability suggests that “average descriptive and controlled effect sizes for these studies are large, even though they lack statistical power” (Dekeyser et al., 2008, p. 51). There was additional evidence from three single case studies that “communicative contact can improve over a period of one to two years” and especially in the last phase of treatment (p. 51). While research is sparse, years of clinical experience suggests that pretherapy is quite effective with seriously impaired persons.

Emotionally Focused Psychotherapy (eft)

Attention to client emotion is characteristic of all person-centered therapies, but it is the primary focus of EFT or process–experiential (PE) therapists. In the last 20 years, EFT has been extensively researched, led by Les Greenberg and Robert Elliott, the founders of this approach.

Research on depth of experiencing in therapy has been shown consistently to relate to good outcome. The literature on client processing of emotion reviewed by Greenberg, Korman, and Pavio (2002) concluded that: (a) processing information in an experiential manner is associated with productive client involvement and predicts successful outcome; (b) therapies focusing on clients’ emotional experience, when successful, are associated with changes in clients’ in-session emotional experiences; (c) emotion is important in reorganizing personal meaning; and (d) research on therapist processing of client emotion indicates that the individual’s ability to accurately differentiate his or her emotional experience is integral to healthy functioning.

In a recent review of PE psychotherapy research, Elliott and Greenberg (2002) report that: (a) 11 studies yielded large pre-to-post therapy effect sizes with a mean effect size of 1.34; (b) two controlled studies showed a large advantage for PE clients versus wait-list control groups; and (c) in five comparative outcome studies, PE therapy was superior to group psychoeducational treatments, cognitive behavioral therapy, a cognitive restructuring treatment, behavioral problem solving, and client-centered therapy, for a variety of problems.

A randomized clinical trial that compared the effectiveness of EFT to client-centered therapy showed that both CCT and PE were effective treatments for alleviating depression although PE was more effective in alleviating interpersonal problems and increasing self-esteem (Greenberg & Watson, 2006). In a replication study, results demonstrated that with a second sample of 38 clients (19 in each group), EFT was more effective in alleviating depressive symptoms and equally as effective in alleviating interpersonal problems and increasing self-esteem. When the two samples were combined, providing sufficient power to find differences, EFT was found to be more effective on all indices of change (Goldman, Greenberg, & Angus, 2006).

Goldman, Greenberg, and Pos (2005) looked at the relationship between theme-related depth of experiencing and outcome in experiential therapy with depressed clients. Analyses revealed that client level of experiencing (EXP) on core themes in the last half of therapy was a significant predictor of reduced symptom distress and increased self-esteem. Studies that examined expressed arousal showed that a combination of visible emotional arousal and experiencing was a better predictor of outcome than either index alone, supporting the hypothesis that it is not only arousal of emotion but also reflection on aroused emotion that produces change (Missirlian, Toukmanian, Warwar, & Greenberg, 2005). A recent study showed that clients with better outcomes expressed significantly more productive highly aroused emotions than clients with poorer outcomes, suggesting that expression of highly aroused emotions is important in facilitating change (Greenberg, Auszra, & Hermann, 2007).

In an extensive review of the literature, Elliott, Greenberg, and Lietaer (2004) concluded that “experiential treatments have been found to be effective with depression, anxiety, and trauma, as well as to have possible physical health benefits and applicability to clients with severe problems, including schizophrenia” (p. 510). Regarding the effectiveness of PE/EFT for depression, Greenberg and Watson (2006) concluded:

Client-centered and process experiential therapy . . . have been shown to be effective in alleviating depressive symptoms, with process experiential therapy showing greater effectiveness overall. Regardless of type of treatment, emotional arousal and depth of experiencing were found to predict outcome. (p. 15)