Processing emotions in emotion-focused therapy. Exploring the impact of the two-chair dialogue intervention
Not peer reviewed
MetadataShow full item record
An increasing range of approaches to psychotherapy emphasize the importance of unprocessed emotions in explaining the root of psychological problems. These approaches suggest different interventions intended to enhance emotional processing. 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 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 throughout the treatment. However, this was not significant greater for the phase which included the two-chair dialogue intervention.
In paper 3, the qualitative enquiries indicated three main themes. The first theme, termed as Talking to a chair: An obstacle to overcome, refers to the clients’ experiences with regard to the intervention as awkward and sometimes difficult to engage in. The second theme, Heavy, intense, horrendous, and nice captures the experiences of the intervention as being emotionally intense, physically and mentally draining, painful, but at the same time helpful. The third theme, titled as Realization: What am I doing to myself? captures the clients’ reports pertaining to the attainment of a better understanding of the way in which they treat themselves. Further, it records the way in which the intervention enhanced their sense of agency.
All of the findings combined suggest that the addition of the two-chair dialogue intervention to the basic Rogerian conditions and empathic attunement to affect, contributes to certain aspects of emotional processing (emotional arousal), and supplements the alleviation of symptoms of anxiety and depression. In addition, the results indicate that productive emotional processing is also facilitated by empathically attuning to the clients’ emotional experience, while complying with the basic Rogerian conditions. Results further indicates that the two-chair dialogue intervention was experienced as being intense, helpful, and difficult to engage in.