Does an emotion‐focused two‐chair dialogue add to the therapeutic effect of the empathic attunement to affect?

Abstract

An increasing amount of research suggests that it is beneficial to work explicitly with emotions in psychotherapy. Emotion-focused therapy (EFT) utilizes interventions that are thought to enhance the evocativeness of emotional processing and facilitate explorations of new meaning. The purpose of this study was to examine the effect of such an intervention on therapeutic outcome. The intervention, a two-chair dialogue drawn from emotion-focused therapy, was added to the treatment conditions that consisted of empathically following the clients' emotional processes. The treatment comprised 2 phases. Using a multiple baseline design, 21 self-critical clients (15 women and 6 men) with clinically significant symptoms of depression and/or anxiety first received 5, 7, or 9 sessions of a baseline treatment focused on alliance building, empathic attunement to affect, and therapeutic presence and genuineness. A two-chair dialogue intervention was then added for 5 sessions. The symptoms were measured before each session using Beck's Depression Inventory, Beck's Anxiety Index, and Forms of Self-Criticizing/Attacking and Self-Reassuring Scale. An analysis using Hierarchical Linear Modelling revealed that the phase with the two-chair dialogue had a larger impact on symptoms of anxiety and depression when compared to the baseline phase. On BDI-II, there was a greater impact on somatic-affective components than cognitive components. Self-criticism was reduced when we used time as a predictor for both phases but not significantly more after introducing the intervention. The results corroborate that the two-chair dialogue intervention is associated with change beyond what is shown when relationship conditions alone are being provided. Implications and limitations are discussed.

Assessing Intervention Effects in the Presence of Missing Scores

“…We used search engines, including Google Scholar and Web of Science, as well as cross-references to identify missing data methods suitable for SCD studies. The procedure yielded three types of methods for handling missing SCD data: (1) the available data method [33,34], (2) single imputation methods [35], and (3) model-based methods [36,37]. The available data method ignores missing data and assesses an intervention effect solely on the basis of scores actually collected or observed.…”

“…This limitation is demonstrated in Section 5.2 where the MS method is applied to assess the RC intervention in terms of level change. An application of the MS method is shown in Stiegler et al [35]. 1 Imputed scores using MS, MM, or TMM method appear in parentheses as the first, the second in red bold, or the third score.…”

“A definite feel‐it moment”: Embodiment, externalisation and emotion during chair‐work in compassion‐focused therapy

“…Whilst much of the outcome research on chair‐work is preliminary (see Pugh, , for review), technique comparison studies have been notable in demonstrating how chair‐work had a greater impact in reducing mental health problems such as depression, anxiety and self‐criticism when compared to “relationship conditions” alone (Stiegler, Molde, & Schanche, ). Chair‐work has also been shown to outperform written cognitive interventions, in key clinical areas, when addressing the same material (de Oliveira et al, ).…”

Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder

“…They are used on the basis that emerging evidence suggests that they yield a unique contribution to psychotherapeutic change, beyond focusing on relational factors alone. For example, Stiegler et al (2018) reports that adding two-chair work was associated with reductions in depression and anxiety symptoms. In addition, for patients with social anxiety disorders, imagery rescripting was associated with more effective change in autobiographical memory content than simple imaginal exposure (Romano et al, 2020).…”