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.
This article reviews the process and outcome research on emotion in psychotherapy. Four distinct types of emotion processes are identified in the literature as useful in therapy, depending on a client's presenting concerns: emotional awareness and arousal; emotional regulation, active reflection on emotion (meaning making), and emotional transformation. Research findings are summarized to highlight the practical implications of these different emotion processes to psychotherapy. A range of selected treatments from different therapeutic orientations are addressed collectively as different types of emotion-focused, experiential therapies and are compared on the basis of how they work with emotion in session.
This paper reviews a body of research that has examined Pascual-Leone and Greenberg's sequential model of emotional processing or used its accompanying measure (the Classification of Affective Meaning States). Research from 24 studies using a plurality of methods examined process-outcome relationships from micro to macro levels of observation and builds support for emotional transformation as a possible causal mechanism of change in psychotherapy. A pooled sample of 310 clinical and 130 sub-clinical cases have been studied, reflecting the process of 7 different treatment approaches in addressing over 5 different presenting clinical problems (including depression, anxiety, relational trauma, and personality disorders). The initial findings on this model support the hypothesis that emotional transformation occurs in specific canonical sequences and these show large effects in the prediction of positive treatment outcomes. This model is the first in the field of psychotherapy to show how non-linear temporal patterns of moment-by-moment process relate to the unfolding of increasingly larger changes to create good psychotherapy treatment outcomes. Finally, clinical application of the model is also considered as a template for case formulations focused on emotion. Clinical or methodological significance of this article: This review article examines research on a specific model of emotional processing. (i) Experiencing certain key emotions during psychotherapy seems to predict good treatment outcomes, at both the session and treatment levels. (ii) There is also evidence to suggest that these productive emotional experiences unfold in an ordered pattern. Moreover, (iii) support for this way of understanding emotional processing comes from a number of very different treatment approaches and for several kinds of major disorders.
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