Contrasting Two Clients in Emotion-Focused Therapy for Depression 1: The Case of "Tom," "Trapped in the Tunnel"

Abstract

The objective in this paper is to present a case drawn from a series of randomized clinical trials (RCT) comparing brief (16-20 sessions), emotion-focused therapy (EFT) the process experiential approach with client-centered therapy and cognitive-behavioral therapy in the treatment of depression. A case comparison method that triangulates data from clients' histories, in-session process, post-session questionnaires, and post-therapy outcome measures was used to increase understanding of those factors that contribute to successful and unsuccessful outcomes. The case comparison method examines the role of the working alliance, clients' emotional processing, clients' and therapists' interpersonal processes, and clients' cognitive processing, as well as the specific changes that clients report immediately following their sessions that have been found to be related to therapeutic outcomes. The method is illustrated with two examples one a poor outcome case and the other a good outcome case The poor outcome case of "Tom" is presented in this article, and the good outcome case of "Eloise" is presented in the next article by Goldman, Watson, and Greenberg (2011). These two cases extend and build on the cases presented by the authors in their book Case Studies in Emotion-Focused Treatment of Depression: A Comparison of Good and Poor Outcome (Watson, Goldman, & Greenberg, 2007), in which six clients, three good outcome and three poor outcome, were compared and contrasted using the case-comparison method.

Contrasting Two Clients in Emotion-Focused Therapy for Depression 2: The Case of "Eloise," "It's Like Opening the Windows and Letting the Fresh Air Come In"

“…The guiding conception employed with the case of Eloise is the same one employed in the case of Tom by Watson, Goldman, & Greenberg (2011), in this issue of the PCSP journal. Below is a summary of EFT from that article.…”

“…Below is a summary of EFT from that article. More details about the EFT model are provided in the Watson et al (2011) article.…”

“…In line with the EFT model outlined in Watson, Goldman, and Greenberg (2011), case formulation in EFT involves a global assessment of the client's style of emotional processing, identification of the client's characteristic style of treating him-or herself, and potential tasks to resolve interpersonal and intrapersonal issues and to promote more effective affect regulation. Case formulation is not conducted prior to treatment and is a moment by moment process that begins in the first session as clients describe their presenting problems, current context, and life histories.…”

“…The 10 sessions of the therapy mapped meaningfully onto the three phases of EFT that are described in the Guiding Conception section of Watson, Goldman, & Greenberg, 2011, including bonding and awareness, evoking and exploring phase; and transformation. The first three sessions fell directly into the bonding and awareness phase.…”

Extending Systematic Case Study Method: Generating and Testing Hypotheses About Therapeutic Factors Through Comparisons of Successful and Unsuccessful Cases

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ABSTRACTThis commentary focuses on two case comparison studies, one by Burckell and McMain (2011) on Dialectical Behavior Therapy for borderline personality disorder, and one by Watson et al (2011) and Goldman et al (2011) on Emotion-Focused Therapy for depression. The associated case comparison method, which evaluates and contrasts one successful case against one unsuccessful case that are both conducted in similar conditions, provides a unique opportunity for deepening our understanding of therapeutic change.

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