Recent decades have seen a significant increase in the number of studies exploring client perspectives on, and experiences of, psychotherapy. The present article provides a practice friendly overview of this research, identifying common domains of inquiry, and providing examples of findings relevant to practitioners. Research in this area can be categorized in terms of the client's perspective pertaining to theoretical constructs, studies of client satisfaction, and qualitative studies that are either open-ended or explore specific aspects of client experiences. Examples of this latter category include studies looking at distinct processes (e.g., self-disclosure), particular theoretical constructs (e.g., therapeutic alliance), helpful versus unhelpful aspects of therapy, and significant events. Research suggests that therapist willingness to seek client perspectives, openness to hear what clients have to say, nondefensiveness in the face of negative feedback, and ability to modulate actions accordingly are all likely to contribute to stronger relationships with clients and stronger collaboration, correspondingly contributing to stronger therapeutic outcomes.
Among psychological therapies for generalized anxiety disorder (GAD), cognitive-behavioral therapy has a dominant position as the most studied therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive-behavioral therapy models for GAD should be examined. The present study was an exploratory study, assessing pre-post outcomes and 6-month follow-up of emotion-focused therapy for GAD, supplemented by qualitative posttherapy client accounts of helpful and unhelpful aspects of therapy and changes reported since therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre-post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing emotion-focused therapy as a treatment for GAD in a randomized controlled trial. (PsycINFO Database Record
Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16–20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre–post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD.
Recent years have seen the emergence of transdiagnostic psychotherapeutic treatments, typically targeting depression, anxiety and related disorders. The rationale for developing transdiagnostic protocols is based on a number of factors; shared etiology and maintenance mechanisms, high co-morbidity, hypothesising that discrete disorders may be underpinned by common psychological vulnerabilities, and the burden currently placed on clinicians to master multiple disorder-specific interventions. This paper describes a transdiagnostic model of emotion-focused therapy (EFT-T), which combines modular (targeting specific clusters of symptoms) and shared mechanisms (targeting underlying vulnerability) approaches to the treatment of depression, anxiety and related disorders such as obsessive-compulsive and trauma/stressor related disorders. The model proposes that clients' core vulnerabilities are linked to specific chronic painful feelings, and that these chronic feelings are constellations of sadness/loneliness, shame, and fear-based emotions, idiosyncratically shaped by personal history. The paper describes how EFT-T addresses problematic symptoms but primarily focuses on transforming emotion vulnerability, or Core Pain, by activating adaptive emotional responses, such as compassion and protective anger, to embedded unmet needs. As all hitherto presented transdiagnostic protocols have emanated from within the cognitive behavioural paradigm, the aim of the described model is to increase the choice of evidence-based transdiagnostic interventions available to clinicians and clients.
BackgroundGeneralised anxiety disorder (GAD) is a chronic and debilitating condition characterised by high co-morbidity. Alongside pharmacological treatment, cognitive behavioural therapy (CBT) is an established psychological therapy for GAD. Its effectiveness is limited, however, with only an estimated 50% of clients presenting in the non-clinical range after a course of treatment. Furthermore, not all clients prefer CBT as a psychological therapy. Recently, emotion-focused therapy (EFT) was developed for GAD and was tested in an open trial with promising results.Methods/designThe present research project is a feasibility testing randomised controlled trial (RCT) that compares the efficacy of EFT with an established treatment for GAD, CBT. Sixty clients presenting in a primary care psychology/counselling service will be randomly assigned to one of two conditions: EFT or CBT. Outcomes will be assessed using several measures (Generalised Anxiety Disorder-7, Generalised Anxiety Disorder Severity Scale, Patient Health Questionnaire-9, and Clinical Outcome in Routine Evaluation – Outcome Measure). Clients will be assessed prior to and at the end of therapy, as well as at 6-month follow-up. On the basis of findings from the initial open EFT trial with regard to the optimal length of therapy, it is proposed that therapy last between 16 and 20 sessions.DiscussionThis study aims to test the feasibility of a full comparison RCT. It will test subject recruitment, therapist adherence to manualised treatment, and client retention rates. It will also provide estimates of comparative outcomes that can inform power calculations for a definitive trial.Trial registrationISRCTN Registry, ISRCTN52689081. Registered on 24 October 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2892-0) contains supplementary material, which is available to authorized users.
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