Does the two-chair dialogue intervention facilitate processing of emotions more efficiently than basic Rogerian conditions?

Abstract

Scientific environmentThis dissertation is the result of a collaboration between Institutt for Psykologisk rådgivning AS, the Department of Clinical Psychology, University of Bergen, and Arbeids-og velferdsetaten.Institutt for Psykologisk rådgivning and the Research Council of Norway each provided fifty percent of the project's funding. One such intervention, derived from Emotion-focused Therapy (EFT), is referred to as a two-chair dialogue. This intervention aims to enhance the emotional processing of individuals with regard to destructive self-criticism. More specifically, the intervention is expected to effect the arousal of emotions and help clients attend to and appraise their emotional experiences. The purpose of this dissertation is to investigate and explore the impact of the two-chair dialogue intervention.Twenty-four clients presenting with destructive self-criticism were recruited from a Norwegian public mental health program, meant for people who are on sick leave due to depression and anxiety, which is the most common mental health difficulties. In this study a multiple baseline design was used. Each client was assigned to a baseline phase comprising either 5, 7, or 9 sessions. For the baseline phase, the therapists were asked to focus on the relationship aspect of EFT, that is, they were required to empathically attune to the clients' emotional experience, provide validation and reassurance for the clients' emotional experience, while complying with the basic Rogerian conditions of empathy, genuineness, and unconditional positive regard. In the second phase, we added a two-chair dialogue intervention for five consecutive sessions.This dissertation comprises three papers. For paper 1, all clients' sessions were recorded on video and analyzed with the Client Emotional Arousal Scale III and Experiencing Scale. Subsequently, it was investigated whether the phase which included the two-chair dialogue intervention was associated with a higher level of emotional processing in comparison to the baseline phase. Results suggest that the phase containing the two-chair dialogue intervention is associated with significantly more high-arousal episodes than the baseline phase. Experiencing increases 7 throughout the entire treatment, but not significantly more in the phase including the two-chair dialogue, suggesting that both phases are associated with enhanced emotional processing.In paper 2, we investigated whether the phase which included the two-chair dialogue intervention was marked by a significantly greater decrease in symptoms compared to the baseline phase. Here, results suggest that adding the two-chair dialogue intervention is associated with a more substantial decrease in depression-and anxiety-related symptoms, in comparison to the baseline phase. A closer analysis of the symptoms of depression indicates that the majority of reduction effected in depressive symptoms is related to the somatic-affective and not the cognitive components of depression. Destructive self-criticism exhibited reduction thro...

“You Feel They Have a Heart and Are Not Afraid to Show It”: Exploring How Clients Experience the Therapeutic Relationship in Emotion-Focused Therapy

“…The therapist had to withhold the self-critical chair interventions in the first phase of treatment, and then to use these interventions actively in the second phase of treatment. This may have limited the therapists’ flexibility to choose what problem they would respond to (client marker), how they would respond to this problem (task) and when they could use specific interventions to target particular clients problems (phase one or phase two of the multiple baseline design) (Stiegler et al, 2018b). The present study does, however, indicate that alliance ruptures and repair processes may be important to understand how the therapeutic relationship may hinder or promote change in EFT.…”

“…The participants, all native Norwegians, were recruited from a public RTW program designed to treat mental health conditions that resulted in sick leave (Stiegler et al, 2018b). Eligible patients suffered from mild to moderate severity of anxiety and/or depression and had to meet criteria for mental health difficulties as assessed by an intake interview.…”

“…The aim of this study was to explore how clients experience the role of the therapeutic relationship in EFT. The participants in this study were drawn from a larger clinical trial of time-limited EFT as a return to work intervention for individuals struggling with major depression, anxiety, and self-criticism (Stiegler et al, 2018b). We have previously examined how clients experienced the process of undergoing two-chair dialogues to work with their emotions (Stiegler et al, 2018a) and their experience of pre-determined time-limits as context for therapeutic work (Submitted).…”

“Nothing is just smooth or perfect”: What can students learn from intensively reviewing psychotherapy conducted by experienced therapists whilst being focused on emotional processes?

“…The data in this study were collected as part of a larger study, investigating the effect of an emotional evocative intervention in Emotion‐Focused Therapy (EFT; Greenberg, ), offered to clients with depression and severe self‐criticism (Stiegler, Molde, & Schanche, ). The Rogerian conditions of therapist empathy, listening, authenticity and warmth were particularly emphasised throughout all phases of the design.…”

“…The scale ranges from objective and intellectual (1) to being in touch with one's own emotions whilst exploring them (7). Participants are taught to judge whether the client speaks about something abstract or not directly relevant to his or her experience, whether there are references to one's inner world, or whether he or she is in touch with their own emotions whilst talking about their inner experience in a fresh and explorative manner (Stiegler et al., ). According to Pascual‐Leone and Yeryomenko (), the Client Experiencing Scale is the single most widely used measure of good in‐session process.…”