Experiential Therapy

CHAPTER 4


EXPERIENTIAL THERAPY


Alberta E. Pos


Leslie S. Greenberg


Robert Elliott


Two ways of knowing are possible. We can know conceptually (knowledge by description) and we can know by experience (knowledge by acquaintance). The distinction between these two ways of knowing, first made by St. Augustine and later emphasized in the writings of William James and Bertrand Russell, is essential for understanding the fundamental orientation of experiential therapy. Experiential therapies are approaches to therapy that emphasize the importance of promoting and using knowing by experience when facilitating client change.


To experience means “to live through,” to have firsthand knowledge of states, situations, emotions, or sensations. Experience is the domain of a whole and embodied person. In opposition to a Platonic/Descartian view that proposes that ideas can be perfect, objective, and exist independent of the body, experiential approaches to psychotherapy are informed by humanists (e.g., Blake, Rousseau, and Kierkegaard; Howard, 2000) and by European phenomenologists (e.g., Husserl, Heidigger, and Merleau-Ponty; Rennie, 2000). This diverse group of philosophers proposed that experience (including conceptual knowledge) is inextricably based on the embodied process of living (Lakoff & Johnson, 1999). Experiential therapies and existential psychotherapy (see Chapter 8) are grounded in humanistic, phenomenological, and existential principles that emphasize that clients are aware organisms, self-reflective creative agents with subjective phenomenal experiences, beings who are actively and dynamically involved in the construction of their own realities. This dynamically changing, in-the-moment phenomenal experience is viewed as fundamental data, as valid, and as an important source of information about the self and the world in which that self is situated.


From this perspective, the self is most knowable from direct experience, rather than from ideas or beliefs about the self, or self-concept. Several current literatures (infancy, neuroscience, philosophy) are contributing substantial support to the importance of embodied experience to the formation of self (Damasio, 1999; Stern, 2005). Our earliest sense of a coherent self has been shown to require neither conceptual cognitive capacities (Neisser, 1993) nor even memory. Rather, it requires only the here and now of natural innate processes such as movement, perception, and emotional experiences. This is the foundation upon which all other aspects of self—self-knowledge, self-consciousness, and self-experience—are constructed.


Experiential therapies, therefore, are those approaches that, in the context of an acilitative human relationship, emphasize focusing on clients’ experiential process to promote change. This includes helping clients to be better aware of in-the-moment experience (sensations, perceptions, emotions and feelings, and implicit meaning), to find symbols to represent experience in consciousness, to reflect on and make sense of experience, to use newly accessed experience as information to create new meaning, and to live more genuinely, agentically, and adaptively.


Three other concepts are important to a general understanding of an experiential approach to psychotherapy: (1) awareness, (2) process, and (3) dialogue. Awareness is a process by which experience enters consciousness. The idea of process is central to experiential psychotherapy. Experiential psychotherapy is centrally concerned not only with what experience someone is aware of (content), but more important with the process of awareness and experience. How one is aware or not aware, where awareness habitually goes or doesn’t go, how awareness is limited, how experiences are generated, linked, or beget other experiences, how meaning is constructed—are all processes with which the experiential therapist is essentially involved. The therapist helps the client gain awareness of these processes through here-and-now experience to promote change.


From the experiential perspective a particular form of facilitative therapeutic relationship is also fundamental and necessary to promoting clients’ experiential process. The experiential therapist provides a supportive, safe, and respectful relationship. A defining feature of an experiential therapy relationship is that, while first attending to and promoting interpersonal safety, the therapist also offers a relationship that is real. In experiential therapy, client and therapist are in genuine contact and optimally in a collaborative dialogue. In this relationship, the therapist and client can meet each other as two valid people (Buber, 1965, 1970). The therapist does offer certain expertise, but if he or she appears in the relationship as an expert, it is to offer expertise on how to facilitate experiential processes, not as an expert on what the client experiences or needs. Therapists may guide and suggest ways of working with experience and share their personal experiences, including those they have of the client, but they always give primacy to the client’s expertise on his or her own experience. Also, when possible, the therapist will defer to the client’s need to steer the therapeutic process.


HISTORY OF THE EXPERIENTIAL APPROACH AND ITS VARIATIONS


Beginnings of the Approach


The experiential approach to psychotherapy emerged from what was called the “third force” that swept North America in the 1950s and 1960s. Experiential therapies were spawned from the humanistic movement as an alternative to objectivist behaviorism and drive-based Freudianism. They offered a counterpoint to the deterministic views of human nature implicit in the behaviorist and dynamic psychotherapies that saw human nature as determined solely by reinforcement, drives, and past influences. The experiential perspective proposed a more positive orientation toward human nature: that people are determined by more than biologically reinforced contingencies, innate drives or the past; that instead, each person has the potential for creativity and agency and is capable of awareness and choice.


Experiential psychotherapy approaches promised to optimize human creativity and agency and revolutionize human well-being. Some of these therapies and practitioners unfortunately became associated with many of the excesses of the counterculture of the period, including groups in California (Esalen Institute in Big Sur), encounter groups, confrontation sessions, cathartic techniques, anti-intellectualism, and “telling it like it is” (Wheeler, 1991; Yontef, 1998). Although the influence of these approaches waned during the 1970s and 1980s, when cognitive-behavioral therapy (CBT) and dynamic therapy approaches dominated the mainstream practice of psychotherapy, experiential approaches have continued to be practiced. They are presently garnering renewed interest and recent revival.


This recent revival is for good reason. Several current lines of research (particularly related to emotion, cognitive science, and development) suggest the importance of paying renewed attention to the contribution that an experiential perspective to psychotherapy can bring to the practice of psychotherapy and to human change. Despite their relative neglect in North American mainstream psychology, experientially oriented therapies have continued to develop in small pockets of North America and more extensively in Europe. As a result, several current and sophisticated experiential approaches have emerged, and some have been empirically researched and validated (Elliott, Greenberg, & Lietaer, 2004). These new experiential approaches have generated new theoretical perspectives on human functioning and have drawn on advances in emotion and cognitive science. They have developed into more focused, process-oriented treatments, including brief treatment approaches for different client populations. These include emotion-focused/process experiential therapy for depression, emotional trauma, borderline processes, and recently eating disorders (Elliott, Watson, Goldman, & Greenberg, 2004; Greenberg, Rice, & Elliot, 1993; Greenberg & Watson, 2006); emotion-focused couples therapy for marital distress and trauma survivors (Greenberg & Johnson, 1988; Johnson, 2002, 2004); dialogical Gestalt therapy (Yontef, 1998, 2002; Yontef & Reinhard, 2005); experiential therapy for anxiety (Wolfe & Sigl, 1998); Mahrer’s (1996/2004) experiential therapy to promote extra-therapeutic personality change; interpersonal approaches to experiential therapy (van Kessel & Lietaer, 1998); focusing-oriented psychotherapy (Gendlin, 1996; Leijssen, 1998; Weiser Cornell, 1996); and experiential therapies of psychosomatic and personality disorders (Sachse, 1998).


A grounded understanding of experiential therapy begins with an understanding of its roots. We begin with a discussion of the main historical influences that have shaped experiential therapy as it is practiced today. These are the contributions of person-centered, Gestalt, and existential therapies.


Person-Centered/Client-Centered Therapy


Person-centered therapy (originally referred to as client-centered psychotherapy) has fundamentally shaped the current practice of therapy in general and of experiential therapy in particular. Carl Rogers’s (1957, 1959) writings on the essential elements of a therapeutically facilitative relationship, and the power of such a relationship to promote clients’ experiential process and their capacity for growth, form the ground of this therapy approach.


Rogers’s view of the therapeutic relationship evolved over time. In the early phase of his work, he emphasized the importance of therapists being nondirective. Rogers believed that clients’ capacity for agency and growth was undermined by giving advice or making interpretations. He proposed instead to consistently follow the client while accepting and mirroring the clients’ feelings. Rogers described specific techniques (e.g., reflections) that would communicate therapists’ understanding of their clients’ present feelings. After receiving a therapist’s reflection, he encouraged clients to check internally the felt “goodness of fit” of the reflection. This implicitly teaches clients that they are the final arbiters of their own experience, and that they are the only ones who can evaluate the accuracy of the therapist’s attempt to capture and symbolize it with them. Rogers felt this would communicate the therapist’s trust in the clients’ expertise on their own experience and in its validity and value. Clients would then also come to value and trust their experience and to use it to increase self-knowledge, to grow, and to live genuinely.


Rogers later increasingly emphasized dimensions of the therapeutic relationship that he believed were necessary and sufficient conditions for promoting client change (Rogers, 1957). He referred to these relationship conditions as empathy, unconditional positive regard, and congruence. Empathy means communicated understanding of the client’s subjective internal world; unconditional positive regard means holding an attitude of nonjudgmental acceptance of the client; and to be congruent as a therapist means to be genuine in the relationship as a person who does not present a false front and who might even be open or transparent as a person. Rogers emphasized sensitive empathic immersion into the client’s world, prizing of the client, and being in the therapeutic relationship as a genuine person who might reveal their own experience when deemed helpful. He proposed that these conditions together contributed to promoting relationship safety and supporting clients’ experiential process. Although his focus initially was on empathy and prizing the client, in the later stage of his views Rogers described growing recognition of the therapist as a person in the relationship, to be trusted by the client just as the client is trusted. The relationship conditions that Rogers articulated continue to be recognized as fundamental ingredients of most experiential therapy approaches as they are practiced today.


In the 1960s, a more experiential approach that focused on deepening experience (van Kessel & Lietaer, 1998) split off from traditional person-centered therapy. In addition to Rogers’s influence, this experiential stream was strongly influenced by several experiential practitioners and theorists. In particular, Eugene Gendlin further developed the concept of experiencing, and Laura Rice, David Wexler, and Fred Zimring explicated an information-processing and meaning-construction perspective in experiential therapy.


Gendlin’s theory of experiencing (1962) continues to be an important influence in experiential theory and practice. Although working in the person-centered tradition, Gendlin’s interest was in phenomenology and the process of the creation of meaning (Gendlin, 1964). Consistent with Damasio’s (1999) recent proposition that consciousness at its base is the perception of the body as it dynamically changes in response to internal and external events, Gendlin theorized that in any lived event embodied experience is a consistent source of preverbal or tacit knowing (cf. Merleau-Ponty, 1962). He believed that the body provides complex and integrated perceptions of events that are implicitly felt but not explicitly known because they are preverbal experiences. Because our body states reflect several overlapping processes (e.g., physiological, sensory-motor, relational), Gendlin proposed that implicit body-based meaning is full of potential implications and “may have countless organized aspects” (Gendlin, 1964, p. 140). When we become aware of this preconceptual, body-based meaning, it becomes an object of consciousness and is accessible for reflection. Gendlin asserted, however, that to grasp and reflect on the implicit meaning in embodied experience, it must somehow be symbolized in awareness (be given words or images). Symbolizing the felt and implicit meaning completes or carries forward the bodily felt sense into consciousness, making an explicit meaning from what was implicitly felt.


Gendlin proposed that bodily experienced meaning is not “sitting there” as complete meaning just waiting to be labeled with words. Within a bodily felt sense, many potential implications or meanings are possible. Gendlin argued that meaning-making is produced in the interaction of a felt meaning and the symbols that we use to contain it. This was an early explication of what has recently been termed the dialectical constructive perspective on the relationship between experience and conscious meaning (Greenberg et al., 1993). This proposes that the process of meaning-making feeds back into and therefore changes experience, and that meaning-making from experience creates subsequent experiences that in turn seek symbolization in consciousness in a dynamic and iterative process.


Other important person-centered theorists contributed information-processing and meaning-construction perspectives (Rice, 1974; Toukmanian, 1990; Wexler, 1974) to experiential therapy. These theorists noted that vast amounts of information are available to an organism from both internal and external sources. The meaning constructed from this information is constrained by both selective attention and schemes that have been organized over time to make sense of the world. They suggest that by necessity we cannot attend to the whole of what is available to our awareness. In our attempts to represent reality, aspects of the stimulus field are always left out, often in ways that maintain the problematic and habitual schemes we use to organize our experience. Current representations of reality, regardless of their incompleteness or inaccuracy, will endure unless new information challenges their incompleteness or inaccuracy. These theorists saw increasing client experiencing as helping the client elaborate and attend to more information in the stimulus field. They began to see the therapist playing an evocative role in helping clients increase their access to experience. Rice in particular explicated how the therapist through evocative reflection can be a surrogate symbolizer of experience who brings clients’ experience forward by symbolizing it in more vivid forms than the client might themselves be capable of (Rice, 1974). This brought a heightened focus on the therapeutic use of language in experiential therapy.


Gestalt Therapy


Gestalt therapy is one of the earliest experiential therapies. Although it has undergone considerable change in the past decades (Resnick, 1995; Wheeler, 1991; Yontef, 1998), its original form made essential contributions to experiential therapy. Its earliest form was described by Fritz Perls and his collaborators, including his wife Laura Perls (who studied with Gestalt psychologists and Martin Buber), Paul Goodman, and Ralph Hefferline (Perls, Hefferline, & Goodman, 1951). Beginning as a revision of psychoanalysis, Gestalt therapy quickly became an independent and theoretically informed alternative to psychoanalysis and behaviorism. As a therapy, it was also informed by the Gestalt psychologists Wertheimer, Kofka, and Kohler, whose work focused on human perception and our tendencies to perceive wholeness, completeness, movement, intention, and so on.


Gestalt theory integrated key ideas from several intellectual influences of the time, including existential and phenomenological philosophy, liberal theology, and modern psychoanalysis. These influences continue to inform Gestalt and other experiential therapies today. These ideas include the concepts of holism, the self-regulating organism, Gestalt principles of perception, field theory, phenomenology, and the nature of dialogue. Gestalt’s early form and public profile was also very much influenced (both positively and problematically) by the person of Perls himself (Yontef, 1998; Wheeler, 1991). His larger-than-life personality became figural and sometimes relegated to the background important and sophisticated theoretical contributions of other Gestalt thinkers such as Lewin (1938) and Goldstein (1939).


Perls, however, did contribute importantly. One of his earliest and most important contributions introduced in his first important publication Ego, Hunger, and Aggression (1947) was to reframe the concept of aggression from a destructive instinct into a life-affirming instinct. Perls related aggression to “biting off, chewing, swallowing, and spitting out”—functions essential to eating. Perls used these functions of eating as a metaphor for the inherent aggression required in healthy contact between an organism and its environment. Aggression was considered to be a natural and essential feature of contacting the environment because a person must meet the environment (and its societal norms) and take from it (bite off) what it needs and finds necessary for its survival. Perls argued that a mature person does not “swallow things whole,” but instead chews on things thoroughly before swallowing, and if necessary spits out or rejects what can not be taken in or assimilated by the individual as it naturally regulates his or her own well-being. He saw development as infected by the “swallowing” of societal norms and parental shoulds. He was later also influenced by Karen Horney’s (1964) view on the negative role of shoulds in the personality. A certain preference for self-reliance and the independent authority of an individual became implicit in this view and was a central feature of Perls’s personal practice of Gestalt (Wheeler, 1991; Yontef, 1998).


Other important concepts such as field theory also informed Gestalt therapy (Perls et al., 1951). Field theory assumes that reality is context dependent and that there is no such thing as an isolated phenomenon that can be understood independent of the elements with which it is mutually relating. All phenomena are contextualized—they exist in a field. In field theory, everything is in relation to a system of continuous and dynamic interrelationships. In any one moment, what appears in the field as an isolated phenomenon is what, by a process of our attention, has become figural—a figure. The figure is opposed to what is not attended to and therefore left in the background—the ground. In the Gestalt view, what is conscious is what we are aware of as figure, and what is unconscious is that which is outside of awareness but that which can become conscious if it is made figural in awareness. Lewin (1938) hypothesized that present needs organize the perception of current figures of attention. This became a central tenet of the Gestalt theory of functioning.


In a field theoretical view, elements in the field are differentiated from each other by boundaries. Gestalt therapy formulated that an organism both connects to, and is differentiated from, its environment at the contact boundary. An important Gestalt idea is that experience is created at this contact boundary and that the quality of experience depends on how that contact is made. A number of possible problematic disturbances at the boundary that interfere with optimum experience and adaptive adjustment were explicated and can be read about in several texts (Perls et al., 1951; Wheeler, 1991).


The following boundary disturbance terms can be and often are used by experiential therapists: Introjection was the term taken from psychoanalysis to describe unexamined acceptance and taking in of ideas, beliefs or identity without awareness. This was thought to result from a weak or inadequate boundary between self and environment, over-identification with the environment, or confluence. It also arises from a lack of deconstructing experience that is required in order that a person can choose what to take in or reject for proper assimilation. Attributing phenomena to another person due to inadequate contact or awareness of yourself, or not being able to own an experience is termed projection. An impulse directed toward the environment that is turned against the self is called retroflection, whereas an impulse or desire for something from the environment that is turned from a two-person event to a one-person event (e.g., stroking yourself when you want another person to do so) is called proflection. Both retroflection and proflection were assumed to result when a person cannot make adequate contact with the environment.


Gestalt theory also introduced the concept of organismic self-regulation; that is, people have needs and desires that are organized hierarchically and that are self-regulated by the organism as it interacts with the environment (Goldstein, 1939). Needs were seen as being met by either contacting or withdrawing from the environment. Organisms were seen as motivated to creatively adjust themselves to the environment or to adjust the environment to them to solve their problems and meet their needs. Creative adjustment became the criterion of health. A healthy organism is aware of shifting needs and allows the most pressing need to become figural in awareness. This figural need (e.g., hunger) organizes perception of the field of attention so that what can satisfy the need becomes figural (e.g., hot dog stand). This process organizes action toward the figure leading to satisfaction of the need (e.g., buying the hot dog), and then to the opportunity for a new need to become figural. Homeostatic balance is maintained as the experience cycle of awareness of emerging needs, action toward figures that are potentially available in the environmental field, and finally need satisfaction and withdrawal repeatedly unfolds.


Gestalt therapy also introduced an increased focus on the body in therapy. Perls studied and was very much influenced by Reich’s (1949) idea that the body’s muscular patterns and habitual ways of moving reflected character and habitual ways of organizing and preventing experience. If attended to, these could become more accessible to awareness and explored. Most experiential therapies use in-the-moment, body-based experiences at times to anchor the client in the present moment of lived experience. Some modern experiential therapies focus very strongly on body-based experiences (Gendlin, 1996; Leijssen, 2006). As well, most current body-oriented therapies are strongly experiential in approach. Bioenergetic psychotherapists (Lowen, 1958) focus on individuals’ muscular patterns and introduce the client to physical expressions or exercises to help him or her experience, explore, and undo muscular blocks for the purpose of increasing the client’s experience of repressed feelings. Dance therapy is also based on some of the same experiential mind-body relationship principles.


Awareness is a central and important idea in Gestalt therapy. A basic tenet of Gestalt therapy is that allying with the part of the person that thinks they should change can make them worse and that people come to therapy already exhausted and discouraged by their efforts to change themselves. Paradoxically, change is seen as being facilitated by helping the person accept their experience rather than trying to change or get rid of it. Awareness in Gestalt therapy draws from Zen mediation and is akin to what many see as mindfulness or paying attention to what is salient in the present moment (Geller, 2003). Awareness was offered as a current Western perspective on an ancient Asian tradition and was the essence of Gestalt therapy.


Finally, an important contribution of Gestalt to experiential therapy is the concept of the therapeutic experiment. Gestalt therapy introduced the idea of using in-session procedures or techniques for both generating and exploring experience in the moment. Many experiments of awareness were introduced (Perls et al., 1951). When using such experiments, therapists direct clients to “try this and see what you experience.” The purpose is to produce, not just talk about, experiences and to process these experiences as they occur in real time. Some Gestalt techniques (e.g., enactments, guided imagery, body awareness, and chair work for clarifying parts of the self or working on unfinished business with others) are still used in present-day Gestalt and other experiential therapies.


Existential Psychotherapy


A third main influence on present experiential therapies comes from existential psychotherapy. Existential psychotherapy is centrally concerned with people’s uniqueness and the meaningful development of individual potential. Existential therapy emphasizes that therapy works best when focusing on the immediate and whole person. Therefore, this approach does not decompose the person into drives, conditioning, or archetypes. A more complete description of existential therapy is given in Chapter 8.


Existential therapy, while focusing on each person as unique, has also contributed a focus on shared human experiences. As human beings, we all suffer from the normal anxiety that comes from having to grapple with universally given existential issues or ultimate concerns (Schneider & May, 1995; Yalom, 1980). Some of the concerns highlighted in this approach are meaninglessness versus finding meaning in life; limits and the inevitability of death; freedom, choice, and responsibility; and the primary isolation of being. Existential therapy sees patients’ suffering as deriving from the whole context of what it means to be human. Existential therapy privileges choice as the major process of change and is an orientation that can be integrated to other approaches to psychotherapy.


The existential view that unique human beings nevertheless share certain processes and experiences is an important one for experiential therapies. Unique and universal experience are not antithetical. When working with anger in psychotherapy, it is important to address the uniqueness of a particular client’s anger in his or her individual situation while also recognizing that anger is a universal species-specific response to a class of human experiences relating to a violation of freedom or person.


The Neohumanistic Revival: New Developments in Experiential Therapy


Several second-generation experiential approaches have emerged over the past 20 years, including emotion-focused therapy (Greenberg et al., 1993), focusing-oriented psychotherapy (Gendlin, 1996; Leijssen, 1998), dialogical Gestalt therapy (Yontef, 1998), and Mahrer’s experiential therapy (1996/2004).


Emotion-Focused Therapy


Emotion-focused therapy also known as process experiential therapy (PE; Elliott, Watson, et al., 2004; Greenberg, 2002; Greenberg & Johnson, 1988; Greenberg et al., 1993; Greenberg & Watson, 2006; Johnson, 2004) has developed as a result of the growing attention being paid to emotion in psychotherapy. The term emotion-focused is increasingly being used as a descriptor of other therapy approaches (i.e., emotion-focused cognitive therapy, emotion-focused dynamic therapy). When we use the term emotion-focused therapy in this chapter, we are referring to emotion-focused process experiential therapy. In the remainder of this chapter for simplicity, we employ the broader term emotion-focused therapy (EFT). Emotion-focused therapy is an integration of person-centered, Gestalt, and experiential therapies in a theoretical frame that also includes contemporary constructivist and dynamic views on human functioning. Emotion-focused therapy for couples in addition includes systemic influences. Added to these influences, is a specific theory of emotional functioning that has been informed by both clinical and neuropsychological research on emotion.


Emotion-focused therapy is an empirically supported humanistic treatment that views emotions as centrally important in the experience of self, in both adaptive and maladaptive functioning, and in therapeutic change. It involves a style that combines both following and guiding the client’s experiential process and emphasizes the importance of both relationship and intervention skills. It takes emotion as the fundamental datum of human experience, while recognizing the importance of meaning-making. Ultimately it views emotion and cognition as inextricably intertwined.


Emotion-focused therapy proposes that emotions themselves have an innately adaptive potential that, once activated, can help clients change problematic emotional states or unwanted self-experiences. This view of emotion is based on the belief, now gaining ample empirical support (Damasio, 1994), that emotion, at its core, is an innate adaptive system that has evolved to help us survive and thrive. Emotions are connected to our most essential needs. They rapidly alert us to situations important to our well-being. They also prepare and guide us in important situations to take action toward meeting our needs. Clients undergoing EFT are helped to better identify, experience, explore, make sense of, transform, and flexibly manage their emotions. As a result, clients become more skilful in accessing the important information and meanings about themselves and their world that emotions contain, as well as become more skilful in using that information to live vitally and adaptively.


In EFT, emotion schemes are seen as the main source of experience, rapidly and implicitly functioning to automatically produce felt experience. Emotion schemes themselves are not readily available to awareness. However, they can be understood through the experiences they produce. These are available to awareness and can be attended to, explored, and made sense of by a process of reflection. Our higher order sense of our selves in the world emerges from emotion schemes as they are dynamically synthesized in the moment from their automatically integrated components (perception, sensation, memory, implicit meaning, or conceptual thought). Activated emotion schemes produce changing self-organization or self-sense. Experience of this is available to consciousness and is constructed by attending to emotion scheme components in the present moment, by symbolizing this experience in awareness, reflecting on it, and forming narratives that explain it (Greenberg & Watson, 2006).


Emotion-focused therapy employs a differentiated view of emotion and suggests that emotion schemes can be organized into four distinct classes of emotional response (Greenberg & Safran, 1987). Of these four, only one is considered truly adaptive. The other three are considered problematic to adaptive functioning. The first class, primary adaptive emotion responses, is an immediate emotional response to a situation that helps an individual take appropriate action. For example, anger at violation helps a person to assertively set boundaries that may prevent future violation. Primary maladaptive emotion responses, a second class, are also immediate, but involve overlearned responses from previous, often traumatic, experiences. Once useful in coping with a maladaptive situation in the past, they are no longer a source of adaptive coping in the present. Adaptive fear of affection from an abuser in the past may result in problematic fear of affection from a partner in the present. Third, secondary emotional responses are emotional reactions to primary emotional experiences. A man may feel initially afraid in a dangerous situation (primary adaptive) and then feel ashamed for being afraid (secondary) because he believes it is unmanly. Finally, instrumental emotion responses are emotional responses that are used to influence and control others. These may be habitual learned responses and may or may not be deliberate or conscious. Using anger displays to intimidate or sadness displays to elicit help are two common examples. These distinctions in emotional responding are important in EFT because each emotion category is worked with differently in therapy (Greenberg & Paivio, 1997).


From the EFT perspective, change occurs by means of awareness, regulation, reflection, and transformation of emotion taking place in an empathically attuned relationship. A basic working principle of this approach is that people must first arrive at a place before they can leave it. Therefore, in EFT, an important objective is to arrive at the live experience of maladaptive emotion. This is not to access its good information and motivation but to make the maladaptive emotion accessible to transformation. The transformation comes from the client accessing a new primary adaptive emotional state in the session. The therapist facilitates this by attending to subdominant emotions that are currently being expressed on the periphery of a client’s awareness, helping the client attend to and experience the more adaptive primary emotions and needs that provide inner resilience. Once accessed, new emotional resources can undo the automaticity of the maladaptive emotion scheme that determines the person’s mode of processing. This enables the person to challenge the validity of appraisals of self or other connected to the maladaptive emotion, ultimately weakening its hold on them.


Another defining feature of EFT is that intervention is marker-guided. As themes of treatment emerge, therapists are continuously attuned to particular markers of client process that point to the underlying determinants of their difficulties. EFT therapists are trained to identify common markers of problematic emotional-processing problems (e.g., puzzling over a problematic reaction, feeling torn between alternatives, criticizing the self, or having unresolved bad feelings toward a significant other). They utilize markers to identify optimal moments for introducing the specific intervention or task that can best serve the client in resolving that particular emotional processing difficulty.


Emotion-focused therapy employs several task intervention methods to activate, regulate, and work with underlying emotions, as well as to access new emotion. All EFT interventions are used in the context of a highly attuned empathic relationship intended to provide interpersonal safety. Empathic exploration is a fundamental intervention in this approach. By sensitively attending moment-by-moment to what is most poignant in the client’s narrative, a therapist’s empathic exploration can capture the client’s experience more richly than can the client’s own descriptions (Rice, 1974). This helps the client symbolize implicit experience consciously in awareness. When a therapist’s response ends with a leading focus on what seems most implicitly alive in a client’s statement, the client’s attention is encouraged toward focusing on and differentiating the edges of their experience.


Emotion-focused therapy interventions are also guided by phases of treatment that can be broken into three major phases (Greenberg & Watson, 2006): The first is the bonding and awareness phase. The therapist deeply holds a therapeutic attitude of empathy and positive regard and creates a safe environment for the client to turn inwards and explore his or her inner experience; the therapist also provides a rationale for working with emotion and helps the client approach, value, and regulate his or her emotional experience. Therapists and clients collaboratively develop an understanding of the person’s core pain and work toward agreement on the underlying determinants of presenting symptoms.


Second, comes the evocation and exploration phase. Evoked emotion is explored to arrive at successively deeper levels of emotion; for example, moving from secondary anger that quickly may occur after primary feelings of fear to the experience of primary fear itself. Many techniques are used to do this, such as empathic evocation, focusing, and Gestalt chair dialogues. However, before activating emotion, therapists assess the client’s readiness for evoked emotional experiences and ensure that the client has the internal resources to make therapeutic use of them. Once assured of this, EFT therapists help people experience and explore what they feel at their core. Interruption and avoidance of emotional experience is also worked through in this phase. Therapists focus on the interruptive process itself and help clients become aware of and experience the ways they may be stopping and avoiding feelings.


Finally, therapy concludes with a phase of transformation and generation of alternatives. Having arrived at a core emotion, the emphasis shifts to the construction of alternative ways of responding emotionally, cognitively, and behaviorally. By accessing new internal resources in the form of adaptive emotional responses (e.g., primary anger), clients have new transforming emotional experiences from which they start to create new meanings and self-narratives that reflect a more resilient and integrated sense of self (e.g., “I’m not a witch for being angry; I have the right to protect myself from violation I don’t deserve”). The therapist acknowledges, validates, and helps clients use newly found self-validation as a base for action in the world, collaborating on the kinds of actions that could consolidate the change.


During EFT, therapists provide a relationship of safety and guide the process while pursuing in-session tasks. Optimal active collaboration between client and therapist allows each to feel they are working together harmoniously in a combined enterprise. Although disjunctions or disagreement can occur, the relationship always takes precedence over the pursuit of a task and the therapist always defers to the client’s expertise on their own experience. Closely attending to potential disjunctions expressed in clients’ verbal statements and subtle nonverbal behavior, the EFT therapist constantly monitors the state of the therapeutic alliance during therapeutic tasks to balance responsive attunement and active stimulation.


As well as individual EFT, there is also EFT for couples developed by Greenberg and Johnson (1988) and further refined by Susan Johnson for treating couples suffering from trauma (Johnson, 2002). In this empirically validated therapy, couples are coached in understanding the primary pain underlying the secondary critical and attacking emotional behaviors that often underlie dysfunctional patterns of communication within couples. Johnson (2004) has developed an attachment-oriented form of EFT in which the main unexpressed feelings are thought to relate to attachment insecurities and injuries.


Focusing-Oriented Psychotherapy


Focusing (Gendlin, 1964, 1996; Leijssen, 1998; Weiser Cornell, 1996) is a psychotherapy, an intervention, and a client process that was developed by Gendlin (1962).


Two things distinguish focusing from other forms of therapy or intervention. First, focusing-oriented psychotherapy encourages clients to bring a particular object of attention into awareness called a felt sense—the apprehension in attention of an unarticulated bodily based experience. This felt sense is often experienced as a vague and complex set of sensations inside the client’s body that contains an unclear emotional tone or a gut feeling in relation to a present situation. Gendlin writes that every implicit bodily based experience has the possibility to be moved forward; to do this, the patient must find the unclear edge of that experience and focus there (1996). Second, the client is encouraged and supported in taking an interested and welcoming stance toward an unclear edge of experience and in being willing to experience it as it is. This is referred to as taking the focusing attitude.


An assumption in focusing-oriented psychotherapy is that a presently operating felt sense in the client’s body is an ever-present, complex source of information relating to present issues and problems in his or her life. When considering a particular problem or event, the felt sense can be carefully attended to in order to get in touch with this information. To access unarticulated embodied information, requires that the person consciously interact with the felt sense using symbols—usually words, articulated metaphors, or images—in an attempt to get a handle on it or capture its meaning. These symbols are thought sometimes to emerge by themselves. Alternatively, the person tries symbols on. Each time a symbol is found the client checks back in with the bodily felt sense to experience the impact of the symbol that they have chosen to contain the felt sense. When it is adequately symbolized, there is usually a marked shift in the experienced felt sense. The shift has been described as the body resonating with the good fit of the symbol or symbols used, and it may be accompanied by a feeling of relief, a sense of clearly perceiving the problem, or a feeling of increased orientation and strength. Felt shifts that result from adequate symbolization of a felt sense are thought to be evidence of the problem moving forward. New felt senses occur that in turn can be focused on and symbolized. The result may be a series of small continuous shifts or even be a big shift or an “aha” experience.


Focusing-oriented psychotherapy usually follows a particular series of steps that may include (a) clearing a space (preparing to focus by setting aside emotional clutter), (b) finding the felt sense to be worked on, (c) getting a handle on the felt sense (finding adequate symbols for it), (d) experiencing embodied resonance with the symbolic handle, and (e) asking questions that move the felt sense forward toward fuller resolution. Leijssen (1998) has articulated several microprocesses that are useful in each step, and she provides useful clinical examples of them (e.g., the importance of finding an optimal distance from experience to support the focusing process).


Focusing-oriented psychotherapy is a stand-alone psychotherapy, as well as a highly useful intervention that can be assimilated into other therapies. Focusing is an intervention that is within the repertoire of therapists practicing emotion-focused therapy and is applied there when clients communicate that they are unclear about what they are feeling (Elliot, Watson, et al., 2004; Greenberg et al., 1993; Greenberg & Watson, 2006). It has also been used with several populations, ranging from those suffering from trauma to incarcerated domestic violence abusers.


Dialogical Gestalt Therapy


Yontef (1998) makes a distinction between Gestalt practices and attitudes and Gestalt theoretical principles. He believes that at times Gestalt therapists (including Perls) have been guilty of practicing Gestalt therapy in a manner that is inconsistent with its theoretical ground. He points to two main misconceptions that have hindered practice and development of Gestalt therapy. One issue is an unnecessarily rigid application of the here-and-now phenomenological focus that has failed to consider important implications of field theory. Another issue relates to the manner in which confrontation in the therapeutic relationship was used as a method for breaking down defenses against experience that did not adequately consider the important issue of client safety. Both issues have informed Yontef’s recent revision of Gestalt therapy that he calls dialogic Gestalt therapy (Yontef, 1998) and that is guided by the three cornerstones of gestalt theory: (1) field theory, (2) phenomenology, and (3) dialogue.


As a phenomenological approach, dialogic Gestalt therapy focuses on the here and now—that which is immediately experienceable and observable. Gestalt theory and practice techniques traditionally focused on the dynamic experience of what was occurring in the room and in the moment, as opposed to what was static, be it history and/or personality structure. Following from this, the clinician, relating only to what was alive now, was prohibited from considering diagnosis, history, personality, or culture. In-session discussion of the past or planning for the future might also be discouraged. Yontef argues that these practices arise from a shallow understanding of the field theory concept of ground. In field theory, ground is an inclusive, flexible, and clinically rich concept. A client’s past physical abuse is the ground, for example, out of which their present fearful contact with reality and experience emerges. In dialogical Gestalt therapy, therefore, field theory and phenomenology are no longer described in a naive and simplistic fashion. Rather, in-the-moment awareness (e.g., of fear) is presently described as potentially supporting awareness of many aspects of time and space (e.g., past abuse or inability to imagine an extended future). Although awareness is anchored in present phenomenological experience, it can be used to explore what may be here and now in the room (e.g., distrust of the therapist), memories of past experiences, or images of the future. Dialogical Gestalt therapy also addresses the issue of personality by promoting insightful awareness of repetitions and invariants in psychological process (what other approaches would define as character) that contribute to habits in the way awareness functions in the present moment.


Yontef (2002) also describes dialogical Gestalt therapy theory as relational at its core. In particular, classical Gestalt therapy often interpreted the requirement for a genuine contactful relationship as an invitation to engage in interpersonal confrontation. Yontef argues that by employing confrontation many practicing Gestalt therapists inadequately addressed the importance of interpersonal safety in promoting experience. Confrontations resulted that were often counterproductive, triggering shame in both clients and trainee therapists. Experience has naturally led to a refinement of the Gestalt working relationship. It is now accepted that there is a need for a balance between clinical frustration and support, because support is now considered more important that it was once believed to be. This has led therefore to an increased emphasis in Gestalt therapy on the importance of the therapist’s understanding of and respect for what the client experiences and for contact that is more intimate. This is a more accepting relationship stance than the confrontational style that was often espoused in encounter groups in the past.


In Gestalt therapy theory, the therapist does not make change happen, but rather he or she is an agent in creating an environment that maximizes conditions for growth (Yontef & Reinhard, 2005). The therapist also creates conditions that allow attention to focus on what is needed for healing and growth. Rather than trying to change the client, the dialogical Gestalt therapist believes in meeting patients as they are. The object is to use increased awareness of the present, including awareness of figures that start to emerge (e.g., thoughts, feelings, impulses) to organize new behavior such as new awareness of how the client interrupts his or her behavior or exploring new ways to make contact with him- or herself and the environment. To do this, therapists are invited to be creative in experimentation and to use chair work, attention training, and other creative interventions. Gestalt therapy gives both client and therapist permission to be creative (Zinker, 1977).


Mahrer’s Experiential Psychotherapy


Mahrer uses the general term experiential psychotherapy to identify his particular experiential psychotherapeutic approach (Mahrer, 1996/2004). To avoid confusion, we call his approach Mahrer’s experiential psychotherapy. His theory of personality employs classical experiential concepts, such as self-actualization, experiencing, and constructed personal worlds. Mahrer (2005) takes a rare perspective on psychotherapy theory. He openly identifies his theory as one “of usefulness” rather than “of truth” (p. 439), therefore taking the instrumental versus realist approach to scientific theory and research (Furedy, 1991). In so doing, he asserts that his system of personality and psychotherapy is a “convenient fiction” whose usefulness is tested by achieving the desired results of its application. According to Mahrer, the result is successfully arriving at two psychotherapeutic goals: (1) at the end of every session, the client undergoes a radical, wholesale change to become a radically new, transformed person; and (2) the qualitatively new person leaves the session free of the painful feelings that were identified as the problem focus of the session. These ends are to be achieved in each session.


Mahrer’s (1996/2004) theory proposes that personality is comprised of a system of related potentials for experiencing. Some potentials for experiencing are designated operating potentials, whereas others are designated deeper potentials. When relationships between operating potentials and deeper potentials are unfriendly or antagonistic, this results in the experience of painful feelings. If relationships between operating and deeper potential for experiencing can be made more affiliative, the individual has the potential for accessing deeper potentials for experiencing and subsequently achieving profound and fundamental change.


In this approach, each session is viewed as a mini therapy that adheres to a set session structure composed of four stages: First, the client focuses on and reexperiences a strong feeling. At the peak of this reexperiencing, an emergent deeper potential for experience is accessed. Second, the client explores, experiences, and expresses aspects of the new deeper potential, both positive and negative, welcoming it and being it. Third, the client uses imagination to reenter past scenes, to experientially re-live them as if from the perspective of the new experiential potential. The client then also imaginatively projects him- or herself into possible future scenes and experientially test-drives new potential selves, using experiential feedback to select realistic ones, and experientially rehearses them. Finally, clients commit to being a qualitatively new person who creates the new postsession world.


Mahrer (2005) describes two client variables that may limit being able to make productive use of this approach. Clients who seek a therapist on whom they can be safely dependent are not well suited. As well, clients must be willing and have sufficient readiness to explore and playfully enter various states to activate and facilitate new experiential processes. Therapists in the initial stage may encourage clients to yelp, wriggle, or otherwise express themselves in a manner not habitually engaged in. The therapy furthermore appears to put less emphasis on the therapist as providing relationship conditions and more on the therapist as a coach and surrogate-experiencer whose attention is on the client’s experience. In this process, the common face-to-face arrangement between therapist and client in psychotherapy is changed. Client and therapist sit next to one another, elbow to elbow.


What is unique to this approach and potentially useful to other therapies is the creative manner in which presently accessed and newly experienced potentials are used to imaginatively generate further experiences. Clients are coached to playfully and imaginally reenter past scenes in memory as their presently transformed self and to experience these past scenes in a new way. They are also coached to consider and experience future possible scenes in which they can be this newly transformed self. In this way, Mahrer’s interventions offer a potentially powerful technique for solidifying, strengthening, or generalizing in-session change because clients are explicitly coached on how they can exercise being a newly transformed self.


THEORY OF PERSONALITY AND PSYCHOPATHOLOGY


A general theory of human functioning and pathology in the experience-centered therapy field has tended to lag behind its more developed theories of practice. This is currently changing. Advances in emotion theory (Damasio, 1994, 1999; Greenberg & Safran, 1987; Lazarus, 1991; Scherer, 1993); research in human development, particularly of the development of self and human affectivity (Rochat, 2001; Stern, 2005; Trevarthen, 2001); as well as influences from recent developments in the cognitive sciences, particularly dialectical constructivism (Greenberg & Pascual-Leone, 1997; Neimeyer & Mahoney, 1995), have all provided substantial contributions to the development of a more integrative, complete, and current experiential theory.


The following principles are fundamental humanistic principals that inform experiential approaches:



  • Experiencing is the basis of thought, feeling, and action. The gerund, verb-as-noun form, experiencing, is intentionally used here because it best communicates the constant, dynamic, and active integration of perception, memory, emotion, sensation, meaning, behavior, and conceptual thought that constructs our experience of a particular moment and then dynamically changes to create the next moment of experiencing. Experiential therapies view experiencing as the door to an individual’s lived reality and posit that it should be respected and valued as an inherent subjective authority on reality.
  • People have the potential for agency, choice, and self-determination because they are fundamentally free to choose what to do and how to construct their worlds. Although genetics, biology, and environment constrain human freedom, they do not eliminate it (Elliott, Watson, et al., 2004). Clients are treated as active participants in establishing the direction of their change process. Experiential therapists offer expertise in ways that encourage and access experience, but do not view themselves as authorities on the content of the experience that a client is having.
  • People are pluralities that function best as integrated wholes. People are made up of many parts, or self-organizations, each of which may be associated with quite distinctive thoughts, feelings, and self-experiences. Although constituted by many parts, experiential therapies hold that people function best when they have an integrated understanding of and a relationship to all their parts. People are most adaptive when they act as well-integrated and coherent wholes.
  • People function best when within relationships characterized by authenticity and psychological presence with an accepting and noncontrolling other with whom they can have a genuine contactful human relationship. An experiential assumption is that people at all stages of life need such relationships to develop fully.
  • Growth and development are potentially and optimally lifelong processes. When in supportive environments, people spontaneously not only maintain their coherence but also continue to develop more sophisticated and flexible capacity to deal with what faces them as they pursue important life goals.

Key Theoretical Concepts on Human Functioning and Pathology


Actualizing Tendency


Experiential theorists posit a core human tendency toward actualization. Rogers defined this as the “inherent tendency of the organism to develop all its capacities in ways which serve to maintain or enhance the organism” (Rogers, 1959, p. 196). This view asserted that the person was not solely guided by regulating internal deficiencies, but also was a proactive and self-creative being organized to grow.


Neither Rogers nor Perls saw actualization as the unfolding of a genetic blueprint. Rather, they were committed to the concept of an inherent organismic tendency toward increased levels of organization and evolution of ability. In doing so, they drew on Goldstein’s (1939) conceptualization that humans adaptively strive to organize increasing capacities for optimal coping. Maslow refined Goldstein’s ideas (1954) by locating the need for what he called self-actualization in a hierarchy of needs, from the lower biological-survival to the higher “being” needs.


Organismic Valuation


In addition to the actualizing tendency, Rogers explicitly, and Perls implicitly, also proposed an organismic valuing process, believing that experience provided an embodied felt access to this valuing capacity (e.g. when a gut feeling communicates that a job doesn’t suit you without being able to say why). Organismic valuation is thought to measure how present events are consistent with, respect, and serve important organismic needs. This proposed organismic evaluation does not provide a logical valuation of truth or falseness, but rather a global apprehension of the meaning of events in relation to lived well-being.


Experiencing


Rogers (1959) defined experience as all that is “going on” in the organism that at any moment is potentially available to awareness. Awareness of in-the-moment embodied “goings-on” is thought to be essential to being able to access the information implicit in organismic valuation.


Self-Organization


Experiential theorists are self theorists who, while differing in their views of the nature of the self, see the self as central in explaining human functioning. All have adopted the idea of an active integrating self, a guiding or self-organizing agent. Rogers developed the most systematic self-theory and equated the self with the self-concept. He viewed the self as an organized conceptual system consisting of the individual’s perceptions of self and of self in relation to others, as well as the perceived values attached to these perceptions. Needs were seen as important determiners of behavior, but a need was thought to be satisfied only through the selection and use of behavior that was consistent with the self-concept.


A structural theory of self was also offered by Perls et al. (1951) and is instructive for its parallels to Rogers’s self-theory. Three necessary aspects were thought to explain functioning of the totality of self: (1) personality, (2) the id, and (3) the ego. Personality was seen as a habituated self-concept or a social role that was the source of an inauthentic, false self. The id was seen as the spontaneous, organismic, preverbal level of experiencing. Finally, the ego was viewed as an agent that variedly identified with, or alienated itself from, aspects of id functioning.


Implied in both person-centered and Gestalt theory is a tension in an organism between actualization or growth, on the one hand, and the need for positive regard (or what Maslow identified as the need for belonging), on the other hand. Rogers implied that the need for positive regard was a persistent, universally present need in all people. Experiential theory assumes that there is an inherent challenge in self-organization for all individuals. This arises from the difficulty of coherently reconciling the strong need for actualization or growth (autonomy) and the need to maintain positive regard from others (affiliation). An implied assumption in person-centered and Gestalt theory is that normal social development constrains construction of the self-concept to only those self-aspects that procure needed positive regard from others. Moreover, it is assumed that a person will only organize or be aware of self-experience that is consistent with their self-concept. Organismic needs continue to function but can be satisfied only by behavior that is consistent with the self-concept, with positive self-regard, and with positive regard from others. If this is achieved, the internal harmony of the individual both as an organism and as an individual participating in social bonds is maintained. Perls also saw needs as central to human functioning, but he provided a more dynamic and homeostatic model of the self. The organism was seen as self-organizing while contacting the environment to take action to satisfy his or her needs. As opposed to Maslow’s hierarchy of basic needs, Perls held that there were thousands of psychological needs. In the Gestalt field theory of motivation, needs were seen as something that emerged out of an organism-environment interaction. For example, needs for romantic companionship may become figural when alone in a room full of couples, or the need to eat may become figural when in front of a butter tart. This theory allowed for self-organization and motivation to change depending on the interaction between the current state of the individual and the environmental field. Health involves being able to act on the environment as needed to meet an emergent need.


Classical Incongruence Model of Health and Pathology


A central experiential assumption has been that an individual must maintain the experience of consistency among an acceptable self-concept, experience, and behavior. To avoid anxiety an individual also limits awareness of current feelings and needs that may motivate behavior that is inconsistent with his or her sense of self. This defense against experience of feelings and needs is viewed in the long run as (a) leading to maladjustment, (b) thwarting actualization, and (c) restricting life by a limited and “other”-defined self-concept.


In general, therefore, experiential approaches view pathology as resulting from the inability to integrate certain experiences into the person’s existing self-organization. From the experiential perspective, what is unacceptable to the self is dealt with, not by expelling it from consciousness (repression), but by failing to experience it as belonging to yourself. What is disowned is not by definition pathogenic. Therefore, healthy needs may be as equally likely to be disowned as unhealthy impulses or trauma. Experiential theory has therefore tended to focus on the dysfunction that occurs from both the disowning of healthy growth-oriented resources and needs and from the avoidance of painful emotions. The key aim in experiential change process is thus not the making conscious of repressed contents, but the re-owning of authentic, growth-oriented experience and the reprocessing of painful material to assimilate it into existing meaning structures to create increasing self-coherence and harmonious integration of a whole person.


In addition, all experiential theorists view the person as a complex self-organizing system. The greater the awareness of experience of the self and the field or environment in which it is operating, the greater the integration, and more adaptive the engagement with the environment. In this view, it is the integration in awareness of all facets and levels of experience (Greenberg & Safran, 1987; Perls, 1969; Rogers, 1961; Schneider & May, 1995) that has been seen as important in healthy functioning. To describe a fully functioning person of this kind, Rogers formulated an experiencing continuum. A fully functioning person (Rogers, 1961) experiences optimally and can focus on and express freely feelings, attitudes, and meanings relating to his or her behavior and experiences. This person can access well-differentiated aspects of self as an immediate felt referent and use it as an online, in-the-moment source of information to inform present and subsequent behavior. A person with limited experiencing does not attend to ongoing fluid internal events and avoids feelings and conflicts. This person relates to his or her environment by using an idea of self (self-concept) to guide behavior, rather than using the presently unfolding experience of the self in presently occurring processes of perception and feeling. The individual relates to the present as it triggers sets of past expectancies so that the newness, richness, and detail of the present moment are lost. This level of functioning is ruled by the past, imposing the past on the present (Gendlin & Zimring, 1955/1994), thus becoming maladaptive or contributive to pathology (Kiesler, 1973; Klein, Mathieu-Coughlan, & Kiesler, 1986).


In classical Gestalt theory, limits to experience were conceptualized as interruptive processes that were seen as producing poor awareness and disturbances of contact. A core set of interruptive mechanisms were posited that prevented the ego from unwanted identification with emerging id experience as well as prevented contact between emerging id experience and the environment.


Gestalt theory also views the person as being constituted by natural polarities and parts (Yontef & Reinhard, 2005). Interruptions to experience are thought to create disintegration among the parts that rob the organism of vitality. Phenomena such as conflict between polarities, unfinished business, avoidance, and catastrophizing are seen as arising from this internal disintegration or splitting. Rogers also saw that selectively perceived, distorted, or denied self-awareness resulted in self-estrangement so that the person no longer lived as a whole, integrated person. Therefore, experience-based therapies tend to hold implicit modular theories of self and postulate that all aspects of the self need to be integrated or reconciled to promote health.


Limitations of the Incongruence Model


Classic experiential theory essentially suggests that the more the self operates as a rigid self-concept, the more it must deny or disclaim vivid experience, and the more this leads to pathology. This formulation is problematic on several counts. First, it assumes that a self-structure or concept functions independently from experience and acts as a gatekeeper of which aspects of experience and behavior are allowed into awareness. Second, this position also assumes that experience is generated independently from the self-concept, existing fully formed outside awareness. As such, the incongruence model cannot adequately explain the occurrence of spontaneous, automatic experience and behavior.


Third, another problem is the degree to which the self-concept and ultimately pathology are seen as originating predominantly from internalized views of the person adopted from others. This fails to capture the inherent complexities of self-organization. As individuals, we are not merely reflections of our ideal selves formed by introjecting only those self-aspects others find acceptable. Rather, we develop and actually experience ourselves coming into existence in relation with others as we interact with them (Buber, 1965; Trevarthen, 2001). Their affirmation and mirroring helps form who we are. Contact with others may at times constrain self-organization, but it is also essential in the creation and strengthening of the self.


A fourth problem is positing one universal motivation, the actualizing tendency, as the sole mechanism to explain all psychological distress. All dysfunction fell under one common principle. Incongruence between the governing self-concept and organismic experience results in denial—disowning or lack of awareness of experience. Although the incongruence captures one form of dysfunction, many problems stemming from such diverse phenomena as lack of self-esteem, attachment disorders, childhood maltreatment, and disorders as diverse as depression, panic, addiction, and personality disorders cannot all be explained by this one dynamic of dysfunction.


Incongruence theory also fails to address fully the issue of a stable personality. Experiential theory contains an implicit assumption that the self-concept is a consistent structure that when rigid promotes dysfunction, whereas the organismic self is a dynamic experiencer in the constant process of attuning to the present moment and, as such, is fluid and healthy. Health is viewed as fluidity. Yet no one can approach the ideal of the pure spontaneous experiencer unique in each moment of experience. We experience ourselves as having both a structural core and sense of continuity. We feel that we are, in many ways, the same person we always were, and a constancy of the self rings true, phenomenologically. A consistency construct of some sort must explain our sense of healthy continuity (cf. Varela, Thompson, & Rosch, 1991). The self as subjective process (I), as well as self as objective structure (me), and the experience of consistent identity or sameness over time all must figure in an adequate self-theory.


Current Dialectical Constructivist Experiential Theory


Current experiential theory now proposes a more comprehensive dialectical constructivist theory of human functioning (Greenberg & Pascaul-Leone, 1997; Greenberg, & Pedersen, 2001; Greenberg et al., 1993; Greenberg & Watson, 2006; Guidano, 1995; Neimeyer & Mahoney, 1995). In this view, people are seen as biological dynamic systems who are also social beings. We are hardwired with innate affective responses, yet we also build on and develop this innate affective repertoire in cultural contexts and through our lived histories. As a result, we respond emotionally with adaptive innate responses, but also with complex socially constructed emotion that is personally and historically tinged. From the experiential perspective, this complex human emotionality is a fundamental building block of self-organization and self-experience.


We suggest that it is the biologically adaptive emotion system that provides the scientific basis for an organismic valuing process. In current experiential theory, however, emotion is not viewed as an organismic valuation process that can always be counted on to support adaptive behavior. Rather, a more sophisticated, complex, and clinically relevant view of emotion has emerged. Emotion is now viewed as potentially adaptive, but with the potential also to be problematic or maladaptive. Still, emotion is seen as central to providing essential and important information concerning an implicitly operating present internal reality.


Emotion is a complex dialectical process. In any one moment, it reflects the integration of multiple processes at multiple levels of functioning. The initial prereflective reaction entails the perception of a stimulus, with preconscious cognitive and affective processing and the accompanying physiological changes. Over time, this level is influenced by cultural practices (e.g., child-rearing practices or emotion display rules) and by learning and experience, to become organized into schemes based on emotion experienced in situations. These emotion schemes become the primary generators of experience; and tacit organization of these emotion schemes is accompanied by “the feeling of what happens” (Damasio, 1999); that is, a bodily felt sense of who one is at any given moment.


At any one time, a person may be organized by a tacit synthesis of one or more of these emotion schemes. A person might be self-organized simply as vulnerable or mellow or, more complicatedly, as simultaneously being self-organized with more than one voice (e.g., when a child is both afraid of, and disgusted by, a father’s abusive behavior). Emotion schemes may even be evoked in battalions of related schemes (e.g., when experiencing simultaneous hurt, anger, and shame). In this current dialectical constructivist view, the actualizing tendency is seen as the tendency to synthesize dynamically the most coordinated, coherent self-organization possible in the present moment. The term self most realistically refers not to an entity but to this dynamic organization of experience into a coherent whole. Complex internal emotional experience is produced via this dynamic synthesis of self-coherence or self-organization.


Self-Narrative and Identity


Our conscious experience of self-organization results when the implicit embodied feeling of a present self-organization is attended to and symbolized explicitly in awareness. This requires participation of reflective processes. Within each person, there is always a constant dialectic between ongoing implicit internal experiences (sensory, perceptual, neurophysiological, memory, and implicit meaning) and explicit reflective processes that interpret, order, explain, and construct conscious meaning out of elementary experiential processes. This is the functional domain of the self-concept of classic experiential theory. However, in a dialectical constructive view of experiential theory, the notion of a self-concept is replaced by the notion of the narrative construction of an identity—the story we tell to understand and explain our lives and to maintain a sense of coherence. In this ongoing process, people make articulated sense out of experience and coherently explain their actions. This involves a conscious conceptual process of identity formation, influenced by learning, values, and a variety of different cognitive and evaluative processes involved in the creation of meaning. Rather than possessing a thing-like self-concept, people actively evaluate and reflect on their experience and create stories or views of who they and others are, and how and why things happened (Greenberg & Angus, 2004).


Personality


Although self-organization is a constantly changing dynamic process, in each moment there is also stability in who we feel we are. The individual’s sense of this stability comes from two sources: (1) the repetitive structure and function of the building blocks (i.e., our emotion schemes) and (2) the continuous construction of consistent narrative identities. Emotion schemes carry our learned connections between situations, experiences, and responses and account for some of the regularity in behavior. In a dialectical-constructivist process view of functioning, stability is seen as arising from repeated constructions of the same state. People are viewed as stabilizing around characteristic self-organizations that each time are constructed afresh from multiple constituent elements. These characteristic organizations act like attractor states in a dynamic system and impart recognizable and apparently stable character to the person. This tendency to self-organize repeatedly in similar ways is responsible for the more enduring aspects of personality.


Our conscious explanations of experience and events also account for some of the regularity. The recurrence of familiar idiosyncratic emotional experiences in our autobiographies gives us a sense of continuity. We repeatedly construct the same stories, thereby giving us a stable identity.


Experience and Meaning-Making


From the experiential perspective, experience and the meaning-making that emerges from it mutually influence each other in a never-ending circular process. Conscious control can influence experience and the synthesis of meaning, but conscious awareness itself is always being influenced by processes out of awareness. Thus, in the face of public insult, a person can symbolize the event and the bodily experience of an adrenaline rush in different ways: “I’m angry about this” or “This is embarrassing.” Both symbolizations focus experience in particular ways that can change the bodily experience that follows, as well as change subsequent awareness and behavior (expressing outrage versus slumping). Following this, new experience will again be generated that may or may not be symbolized in awareness.


An important point is that symbolization of experience is not a process of representation (Seager, 1999) but rather a process of construction (Maturana & Varela, 1988). Constructions, however, can never be complete because they cannot include all available tacit information. Collections of coactivated emotion schemes function together to produce a complex internal field (Greenberg & Pascual-Leone, 1997), all of which is potentially available for experience. This complex internal field contains much more than any one explicit symbolic rendition could possibly capture. Thus, many authentic meanings may be generated, and an experience thus can mean both “this” and “this” (e.g., both anger and shame). Conscious meaning occurs by the symbolization of whatever aspects of this internal complexity are attended to, selected, and symbolized. Attention is a key means for accessing, broadening, completing, and integrating multiple facets of experience into consciousness to effect meaning construction and new experience. Most important, attention to new aspects of experience allows us to explore for what more there is and to reconfigure and see it in a new way. From the experiential perspective, therefore, there is not a “true self,” but multiple potential “true self experiences” (Fosha, 2004) expressing “multiple potential selves” (Hermans, 2006).


Growth and Development


Growth is inherently dialectically synthesizing new experience with existing structure while maintaining an identity and being continually in the process of living creatively and spontaneously. The person grows toward greater and greater complexity and coherence by constantly assimilating his or her own experience, integrating incongruities and polarities. We reject any notion of a vitalistic tendency in which a genetic blueprint is actualized for the person to become who he or she truly is. Rather, we envisage an interpersonally facilitated growth tendency that is oriented toward increased complexity and coherence and adaptive flexibility.


Self-Development in a Social Context


Recent infant research in the development of the self makes it clear that shortly after birth the embodied infant begins to develop a sense of self and of other in a nonverbal interpersonal context. Interaction with others is fundamental in the development of affect regulation and, following from that, self-organization and experience (Rochat, 2001; Stern, 2005; Trevarthen, 2001). As individuals, we are unable to regulate our affect as infants. Infants therefore rely on close others to be sensitive to their aroused states and to engage and disengage with them in ways that help them regulate arousal in optimal ranges that support their being able to maintain experiential contact with reality. Failures in this process result in painfully over- or underaroused states, over- or underregulation of affect, and difficulties in either accessing or being overwhelmed by experience. Primary maladaptive emotion schemes and secondary emotion schemes are formed by these failures in regulation.


In this view, psychological difficulties are sequelae of these fundamental emotional regulation problems. Again, these do not exist as rigid structures; they are tendencies to repeatedly organize. Thus, the inability to regulate or the tendency to overregulate emotion is a dynamic constructive process in an interpersonal context. However, the current interpersonal relationship has within it the power to provide new experiences. These are new opportunities for affect regulation with a helpful other, new self-experience through mirroring and being in contact with another. This allows the activation of alternate adaptive emotion schemes that can potentiate emergence of new self-organizations. These new self-organizations generate new experiences that can be symbolized to generate new meaning and new self-narrative.


It is for this reason that the relationship is assumed to play a pivotal role in experiential therapies. The assumption is that, as a real other, the therapist is a potential agent in promoting the strengthening and developing of the sense of self and in providing new self-other experiences. The therapist’s empathic presence over time is internalized, strengthening the client’s ability to regulate or tolerate affective experience. By holding an accepting attitude toward the totality of the client’s experience, the therapist confirms the existence of the client, and strengthens the client’s experience of integration and self-coherence. There is an existential certainty that the other can provide, something that cannot be achieved alone (Buber, 1965). By affirming the client’s experience in this way, his or her sense of self is strengthened, made more whole, and supported toward continued growth and development.


Pluralistic View of Dysfunction


In current theory, dysfunction is not viewed as stemming from any one singular mechanism alone, such as incongruence (mismatch between actual and perceived self; Rogers, 1959), interruptions of contact (Perls et al., 1951), or a blocking of the meaning-creation process (Gendlin, 1962). Rather, dysfunction is thought to arise via many possible routes including avoidance of internal states, protection against injury to your self-esteem from others, internal conflict, developmental deficits, traumatic learning, and blocks to development of meaning. A more individualized, phenomenologically based view of dysfunction is proposed here. Rather than assuming certain limited global determined sources of dysfunction, the therapist attempts to determine or work with the specific current determinants and maintainers of each person’s problems. Three general difficulties that contribute to pathology have been noted however. The first is the construction of recurrent self-organizations that continuously operate in a manner that constrains access to an alive awareness of self and that lead to disowning of primary experience. We have identified these as secondary emotional responses that are emotional reactions to primary emotional experiences. A man may feel initially sad when experiencing loss (primary adaptive) and then feel ashamed at himself for being sad (secondary) because he believes it is a sign of weakness. Second, in line with Gendlin, Perls, and Rogers, we also see the inability to symbolize bodily felt experience in awareness as a general source of dysfunction. A person may, for example, not be aware or able to make sense of the increasing tension in his or her body, and therefore be unable to symbolize it as resentment that can support the emergence of assertive self-organization. Third, a major source of dysfunction involves the activation of core, often trauma-based, maladaptive emotion schemes. Primary maladaptive emotion responses are immediate, and over-learned responses that helped an individual cope with a maladaptive, often traumatic situation in the past. However, in the present situation, they result in maladaptive coping. This leads either to painful emotions or maladaptive emotional experience and expression. These three processes are only some of the creative ways people organize in dysfunction.


Processes of dysfunction also manifest in individualized ways in different people. In EFT, we propose the identification of a large variety of specific cognitive/affective processing difficulties that arise in therapy and provide opportunities for therapeutic interventions best suited to these states (Elliott, Watson, et al., 2004; Greenberg et al., 1993). Self-interruption of experience (stopping oneself from having an experience) or conflict splits (experienced conflicts between wishes or impulses to act) are diagnosable in the moment and can be intervened with when they occur. This offers a differential view of dysfunction in which current determinants and maintainers of disorders are identifiable by a form of process diagnosis that should guide intervention.


THEORY OF PSYCHOTHERAPY


Goals of Therapy


Experience-centered therapies contend that optimal functioning requires that the organism orient to and be aware of its implicit functioning. This is because it is a person’s automatic reactions as an organism living in real time that provide information essential to adaptive functioning and well-being. The overarching process goal in experiential therapy, therefore, is to help the client deepen experience and symbolize it accurately in awareness. Experiential self-knowledge is assumed essential to the achievement of personal wholeness, integration, and the adaptive self-coherence that supports choice and continued growth. Experiential therapists help clients approach, tolerate, symbolize, explore, and construct new meaning from experience. Newly found meaning can then inform new self-narrative and future behavior. To achieve this, the therapist first has the goal of establishing and maintaining a specific form of therapeutic relationship that provides the client with the experience of a safe, genuine, and helpful other. In that relationship, the client’s freedom to choose is supported by allowing him or her to direct the focus and direction of therapy.


Following this primary relationship goal, two types of therapy goals can be distinguished in an experiential approach: (1) content goals and (2) process goals. The client chooses content goals, the domain he or she wishes to pursue, whether it is to improve relationships or work on his or her self-esteem. That the client is an active agent in his or her change process is fundamental to experiential therapy and is consistent with a humanistic goal to support a client’s self-determination and mature interdependence. Therapists, however, also offer process goals: deepening the client’s experiencing and guiding the client’s process moment by moment to help him or her achieve this aim. Experiential therapists are knowledgeable in theories of determinants that contribute to clients’ problems. However, treatment focus is not driven by an imposed theory of the causes of, say, depression or anxiety. Rather, a sense of the determinants is built from the ground up by helping the client use his or her experience as a constant touchstone for what is true. Treatments therefore are custom made for each person, and a client is understood in his or her own terms. Still, the therapist plays an essential role by empathically reflecting and exploring how the client views his or her problems. Therefore, optimal thematic foci co-constructively emerge as core issues are collaboratively identified (Bordin, 1979). To support the development of an optimum focus, the experiential therapist is attuned to and reflects what is most poignant and emotionally alive for the client; in particular, the client’s pain, which is seen as a signal that alerts the therapist to poignant and important areas for exploration.


Assessment Procedures


Most experiential practitioners agree with Rogers’s (1957) concern that diagnosis communicates expertness and creates a power imbalance that interferes with the formation of a genuine relationship. Having said this, experiential therapists may use an initial diagnostic interview process to identify clients suitable for treatment. Most often, an empathic interviewing style is used to gather information about relevant life circumstances to assess and understand the client’s current problems, levels of functioning, relationships, and attachment and identity histories. If strong biological factors (i.e., a biochemical disorder) or systemic factors (which deem the person more appropriate for marital or couples therapy) are judged as being primary problem determinants, the client is referred for a more appropriate treatment. In addition, people who have psychotic, schizoid, schizotypal, borderline, or antisocial personality processes are not suitable for short-term experiential treatment. Even long-term experiential treatment is not considered appropriate for antisocial personality disorders.


Once suitability is established, case formulations are not generally made based on early assessment. Rather, a therapeutically productive focus is co-constructed by client and therapist with the assumption that whatever is most problematic, poignant, and meaningful will emerge progressively in the safe context of the therapeutic environment. Therapists do not attempt to establish what is dysfunctional or presume to know what will be most salient or important for the client. As far as specific diagnoses are concerned, knowledge of certain nosological categories or syndromes is useful. However, experiential therapists conceive these as guides to possible experiential processing difficulties rather than as descriptions of types of people.


The defining feature of an experiential approach to case formulation and assessment is that it is process diagnostic rather than person diagnostic (Greenberg et al., 1993). Diagnostic focus is on problematic processes in which clients may currently be engaged. Case formulation is a dynamic process that tracks clients’ process states, such as how they are currently experiencing their problems or how this is impeding or interfering with their own experience. A differential process diagnosis involves the therapist attending to a variety of different in-session markers of in-the-moment processes at different levels of client processing. This is the second characteristic of experiential assessment that it employs process markers. Problematic processes are then addressed by interventions designed to address the specific difficulty. These processes may include markers of clients’ emotional processing style (i.e., being external), markers of characteristic styles of responding (perhaps using impersonal pronouns), and micromarkers of client process (e.g., silence or shallow breathing). The therapist observes whether the client is emotionally overregulated or underregulated by noting the client’s vocal quality and degree of emotional arousal. The therapist notices whether the client has the capacity to articulate, explore, and have interest in their internal experience and whether they can reflect on and make sense of emotion. Therefore, attention is paid to how clients are presenting their experiences in addition to what they are saying. Formulation and intervention therefore connect constantly and intimately, span the entire course of treatment, and occur constantly at many levels (Goldman & Greenberg, 1997).


Process of Psychotherapy


Two inextricably linked therapeutic processes are at the core of experiential therapies: (1) the therapeutic relationship and (2) experiential and emotional processing. There are three essential elements an experiential therapist provides in the experiential therapy relationship: (1) interpersonal safety, (2) genuineness, and (3) expertise in experiential processing. The therapist provides a safe, accepting, and validating relationship, following the client by maintaining and communicating empathically attuned contact to his or her moment-to-moment experience. By communicating and checking their understanding of the client, the therapist both welcomes and encourages the client’s corrections and clarifications. The therapist also is a genuine person or other whose communications are more than mere mirroring reflection. They provide what Buber (1965) described as “not a mere echo but a true rejoinder” (p. 2) and the contact of deep, companionate understanding that increases clients existential certainty in their experience and self.


Following the client’s internal track is one half of a dialectic tension that the experiential therapist maintains. To only follow the client can invalidate the client’s real need for the helpful other and for efficient routes to change, whereas only leading can undermine the client’s agency and the validity of their current experience. Therefore, the experiential therapist also guides by providing expertise in facilitating experience. The therapist coaches the client to acquire increasing levels of emotional processing skill (Greenberg, 2002) by engaging the client in emotional processing tasks that can meet and resolve the client’s current processing difficulties. Experiential therapists go beyond approaching, tolerating, and accepting experience. They also assume that accessing implicit levels of automatic functioning requires that experience be an object of present attention and awareness, and that this requires experience be presently activated. Experience-centered therapists have technical expertise in activating experience and in coaching or training awareness of events as they are occurring in real time. Experiments in directed awareness are seen as helping both to concentrate attention on inchoate experience and to intensify the vividness of experience so that it can more easily be attended to and explored.


The duration of experiential therapies vary. A client may engage in a few short-term (16 to 20 week) sessions or long-term (years) therapy. The duration is flexibly decided between therapist and client, often depending on the goals of therapy. For example, a client suffering from unipolar depression may find they are able to overcome the perfectionistic criticism that has been a determinant of their depression in a short-term protocol (Greenberg & Watson, 2006), whereas another client suffering from borderline processes may require a longer term therapy.


Strategies and Interventions


In experiential therapy, deepening experiential processing and subsequent meaning-making is accomplished in a number of ways by using interventions that directly relate to emotional processes, including:



  • Using relationship conditions to create an environment conducive to experiential processing and providing emotion coaching that models approach, valuing, and acceptance of emotion
  • Using particular language modes to recreate emotional stimuli in awareness, as well as to help clients symbolize, regulate, and express experience
  • Directing clients’ attentional resources to the edges of awareness
  • Using evocative empathy to activate an alive experience of tacit meanings on the periphery of awareness
  • Using technical interventions, such as two-chair work, to activate emotional experience to help clients access and express alternative adaptive emotional resources

The Relationship: Providing Safety and Modeling


We have already described how the relationship conditions of empathy, unconditional positive regard, and genuineness or presence provide an optimal environment for the client to attend inwards and explore their experience. However, the therapist, as a person, also leads by example. By attending to, reflecting, valuing, and exploring the client’s emotions, the therapist also acts as a model who approaches, accepts, and values emotional information. The therapist may employ clinically sensitive but genuine self-disclosures of his or her own emotional experiences to normalize emotional reactions and to communicate comfort with experience and expression of emotion. As a result, emotion becomes less frightening as a phenomenon. Therapists therefore demonstrate and guide emotional processing skill and act as emotion coaches (Greenberg, 2002).


Language as a Tool


An important assumption underlies experiential approaches. How an individual talks about his or her feelings and experience is a valid index of the quality of his or her experiencing (Kiesler, 1973). This assumption is rooted in the constructivist view of human functioning (Maturana & Varela, 1988; Neimeyer & Mahoney, 1995) that suggests that the way in which individuals symbolize their experience in language affects the emotional experiences they have. A constant constructivist dialectic occurs in individuals between ongoing experience and the meaning given to that experience by reflecting on it using language and thought. Clients’ experiences are constrained in two ways: (1) by the aspects of experience that get into the field of attention—these have the potential to be symbolized in language or image, and (2) by the aspects of experience that are available to conscious experience—those that are symbolized in language or image. Linguistic thought takes part of our implicit experience, and then orders, explains, interprets, and makes them explicit. Therefore, although emotional experience is rooted in biologically adaptive, hardwired programs, the final subjective experience of emotion is constructed and constrained by the language processes used to symbolize that experience.


For this reason, language plays a very specific and important role in experiential therapies. Different language modes are intentionally used to increase the likelihood that clients access and focus attention more completely on their emotional experience. To do this, the therapist’s reflections focus on the language of the client’s internal reactions, using statements that describe particular not general experiences, and using sensory connotative language as opposed to denotative language (“So it’s like ‘none of my dreams will ever come true’” versus “So you’re afraid that you won’t reach your goals”; Rice, 1974). These specific uses of language are intended to evoke the vividness of the client’s experience, increasing the probability that tacit emotionally laden meanings will become more accessible to the client’s awareness. Adams and Greenberg (1999), for example, showed that clients were eight times more likely to focus internally if the therapist’s previous reflection had an internal focus.


Language is also modeled by the therapist as having the power both to contain experience and to bring it into awareness for reflection and exploration. As such, the therapist is a surrogate symbolizer or coach. When clients are overwhelmed by emotion, being helped to encode emotional experiences in words can modulate their emotional arousal. Alternatively, if the client is too distant from their emotions, poignant evocative and accurate symbolization of a client’s experience can arouse emotional experience and thereby bring it into awareness. Therefore, articulating experience well in words can have both arousing and regulating potential.


Directing Attention


The role of the therapist in broadening attention is also essential. Helping clients focus their attention on previously unattended to aspects of past experiences makes them accessible in consciousness for further processing. The experiential therapist focuses the client’s attention on different levels of processing, including images, emotions, bodily sensations, global linguistic statements, and perceptions generated from recollections. This includes attending in the moment to emotion in its global complexity, including all its relevant components (e.g., the situation, appraisals, bodily felt experiences, desired actions, relevant needs or concerns). Therapists’ attention is also important in this process. Experiential therapists attend to tacit experiences of the client communicated by the client’s nonverbal behavior. Because emotions are connected to related action tendencies, nonverbal behavior, including voice tone, posture, and facial expression, is an important source of tacit meaning and an observable explicit marker of a subjective emotional state.


Empathy: Exploration and Evocation


By sensitively listening to and observing the client for emotional markers, therapists often access aspects of the client’s experience that clients themselves are not attending to. If attuned enough, a therapist can reflect a synthesis of the client’s experience that more closely approximates the original experience than the client’s own constructions of it (Rice, 1974). This is evocative empathy, another method to help clients activate and attend to emotional experience. Evocative reflections may capture clients’ experience in such a way that it becomes more vivid. At the same time, it provides the client with a potential symbolization in language of his or her own felt tacit meaning and gives the client a possible “handle” (Gendlin, 1996) on emotional experience. This may make it easier for the client to attend to the experience in consciousness and bring further reflective or emotional processes to it. In this process, the client is encouraged to check internally the felt “goodness of fit” sensation of such reflections and to evaluate the usefulness of them. This teaches the client that he or she is the final arbiters of the experience and that he or she is the only one who can evaluate the accuracy of the therapist’s attempt to capture and symbolize it.


Accessing Internal Resources and New Self-Experiences


Finally, the purpose of deepening emotional processing in experiential therapy is to activate internal emotional resources in the client; that is, the client’s adaptive tendencies and resources toward adaptive growth (Gendlin, 1962; Rogers, 1957). As clients access an experience of their feelings, they also experience related needs and action tendencies that may actualize the meeting of these needs in the world.


Although accessing internal emotional resources is thought to occur naturally in person-centered therapy, experiential psychotherapy works toward accessing alternate emotional resources of the client in more focused ways by the use of specific techniques, including experiments in attention, focusing, working directly with embodied expression, and using empty-chair and two-chair dialogue (Gestalt-derived techniques in which a client enacts conversations with a significant other or between two parts of the self (Elliott, Watson, et al., 2004; Greenberg et al., 1993; Greenberg & Watson, 2006).


Sequence of Intervention


Sequences of specific interventions differ across different experiential therapies. Mahrer (2005) describes in-session stages (each with their own interventions) that are repeated faithfully in each therapy session. Gendlin (1996) and Leijssen (1998) also describe unfolding stages of focusing and particular interventions used in each. In EFT, the first three sessions are explicitly used to build contact and relationship with empathic attunement being the primary intervention. Thereafter, a variety of intervention sequences is possible depending on the emotional processing difficulties that a client expresses.


Nevertheless, there is a central tenet in all experiential therapies, best articulated by Gendlin and Beebe (1968) who wrote, “contact before contract.” Before any explicit goals for treatment are established or any interventions are engaged in, the therapist first makes contact with the client as a person and works toward giving the client an experience of this contact, with a caring, attentive, helpful other. (The exception to this appears to be Mahrer’s [1996/2004] experiential therapy in which the ability to provide and engage in such a relationship is presumed.) The interventions first used to establish the relationship are empathic attunement and reflection, combined with unconditional positive regard and genuineness. Following the client is another intervention strategy initiated early in the therapy to encourage the client’s sense of efficacy, choice, and control.


At early stages, the therapist also communicates the general goals of the therapy, facilitating the client toward deeper contact with his or her current felt experience. How and when a therapist intervenes to promote this depends on the therapeutic approach as well as what level of experiential contact the client presently is capable of. Access to experience and the alive use of such experience in problem solving is thought to occur in stages. Clients first start to become aware of experience by approaching it with their attention and tolerating whatever experience enters awareness. They then begin the process of symbolizing this experience in awareness in verbal or other symbolic form. Following this, experience is further explored and made sense of, and new experiences are generated. Finally, meaning-making occurs as experience is integrated into preexisting narrative and knowledge.


Markers, both verbal and nonverbal, of the stages or levels of experiential process that a client is currently engaged in have been explicated by Klein and colleagues in the Experiencing Scale (Klein et al., 1986). These distinctions are useful because the experiential therapist at any stage of therapy is attempting to help his or her client move progressively through these stages. The therapist must be attuned to the levels of experiential access that the client currently has and intervene appropriately for that stage. If clients’ narratives have no feeling vocabulary, the therapist helps them symbolize experiences in words. If clients report having no feeling experience, attention to the body with focusing may be called for. Once clients are in full contact with experience, they are encouraged to be mindful of its nuances, to explore its edges, and to make sense of it. In EFT, there are sequences of suggested interventions that respond to what is occurring presently in the therapy. A client who wishes to work on their self-criticism and perfectionism may be offered a two-chair intervention to explore this. However, when a client comments, “I sound just like my father,” the intervention may be switched to an empty-chair task in which unfinished business, perhaps unresolved anger with the father, is explored.


Experiential therapists believe that the need for human compassion trumps the usefulness of psychological technique. Therefore, the relationship always takes precedence over the pursuit of a task, and the therapist always defers to clients’ expertise on their own experience. The therapist closely attends to potential disjunctions expressed in the client’s verbal statements and subtle nonverbal behavior, constantly monitoring the state of the therapeutic alliance during therapeutic tasks to balance responsive attunement and active stimulation.


Finally, one decision that may affect experiential work is that clients may wish to engage in therapy while also seeking pharmacological intervention. Experiential therapists understand that medication is sometimes necessary and is the client’s choice; however, an experiential therapist would prefer medication that does not completely block the client’s emotional access.


Curative Factors


The relationship, awareness, deepening of experience, and creation of new meaning are seen as the core curative factors. Unblocking a restricted or stuck experiencing process allows a person to attend to previously unaccessed aspects of experience and to symbolize this experience in awareness. New meaning is created by this process that activates adaptive emotional resources in the client or changes his or her beliefs relating to maladaptive emotional responses.


By providing empathic emotional attunement, the therapist provides interpersonal safety and contact that reduces the sense of personal isolation. Genuine contact with another who affirms and values the client’s emerging experience strengthens the sense of self. As a coach in activating, accessing, and processing experience, the therapist helps the client gain emotional regulation skill or reduce overregulation of emotion, supporting the client in his or her emotional development. All of these elements of the therapeutic relationship may result in a corrective interpersonal emotional experience that generates new experiences or impacts experiences that habitually occur.


Special Issues


To be able to make use of an experiential psychotherapy in which emotional experience is activated and explored, clients must be able to regulate their emotions or create a working distance from emotion. If necessary, experiential therapists may teach clients ways of doing this. Grounding, self-soothing, breathing, and safe-place exercises can be practiced during a series of graded exposures to emotional arousal. Therapists may even teach a client how to move away from emotion by engaging in conceptual processing or focusing externally. This increases the client’s confidence in having some control over the intensity of the experience he or she will have.


Experiential psychotherapists also work with the assumption that the therapeutic relationship provides an interpersonal safety that precludes the client’s interpersonal issues arising in the therapy relationship. This is an ideal that is not always realized, and it is not always possible to make every client feel interpersonally safe enough to trust in and allow process guiding from the therapist. In such cases, two common strategies are employed: First, the therapist may fall back into a primarily empathic relationship with the client until such time that they can tolerate more active intervention from the therapist. Second, the relationship can become the focus of explicit interactional work. Interactional patterns are not intentionally evoked in an experiential therapy, and if evoked it is assumed most will melt away in time as trust builds. However, if this does not occur, work is done on the interactional issues that keep appearing as process blocks while therapy is underway (van Kessel & Lietaer, 1998).


Culture and Gender


An experiential approach to therapy holds the dialectical tension between the individual and the universal. Although each person has unique experiences and personal meaning, the therapist’s ability to be empathic and understand adaptive emotionality is informed by knowledge of certain biological and universal truths that constitute what it means to be human. Culture, the middle ground between the individual life and human universality, also organizes our experience.


In an experiential approach, the individual is given authority over his or her own meaning construction. No generic or unitary view of “normal” human functioning and dysfunction is espoused. This approach, therefore, is seen as appropriate for clients from ethnically and culturally diverse backgrounds. As emphasized, this therapy adopts an empathic and egalitarian relationship and is sensitive to inherent power imbalances that may exist between therapists of the majority culture and their culturally different clients.


Still, as well as individual empathy, cultural empathy is needed. This may include awareness of emotional display rules and norms for emotional experience and understanding how emotion functions in other cultures. Many Asians are less likely to show emotions readily, and the therapist must be sensitive to this by openly discussing a rationale for emotional expression with clients, providing high degrees of safety, allowing for a slower pace, and understanding cultural assumptions related to emotion. In bodily expressive cultures such as some Latin and African cultures, internal bodily based focusing and symbolizing may be needed to bring attention to these habitual modes of emotional expression.


To be truly empathic and helpful in meaning construction, therapists are advised to educate themselves about the client’s cultural background if it is unfamiliar to them, but also to remain a genuine other who is honest and aware of his or her own cultural ground. Potential issues are directly addressed through the therapeutic relationship early in the therapy.


Adaptations to Specific Problems


Experiential therapy has been adapted to work with several different populations and client problems. The best-researched application of experiential therapy to date is EFT for the short-term treatment of depression (see Greenberg & Watson, 2006, for a review). Emotion-focused therapy has also been adapted as a treatment of psychological trauma (Elliott, Watson, et al., 2004; Paivio & Nieuwenhuis, 2001). Emotion-focused therapy for couples has also been developed to deal with relationship distress and for couples in which one partner has been traumatized (Johnson, 2004). Experiential therapies continue to be used and developed with other client issues such as anxiety (Wolfe & Sigl, 1998), borderline personality processes (Eckert & Biermann-Ratjen, 1998), and psychosomatic disorders (Sachse, 1998). Emotion-focused therapy is also presently being investigated as a treatment for eating disorders and social anxiety.


EMPIRICAL SUPPORT


Outcome Research


Elliott, Greenberg, et al., (2004) presented a meta-analysis of 64 studies of modern process-guiding experiential therapies. Eighteen examined emotion-focused individual therapy; 10 evaluated EFT for couples; 10 studied Gestalt therapy; and 15 looked at the outcome of various other experiential/humanistic therapies (e.g., Focusing-oriented, psychodrama, or integrative). The average prepost effect was 1.17, a large effect size (calculated by finding the difference between pre- and posttest mean scores and dividing by the combined standard deviation). Clients maintained or perhaps even increased their posttreatment gains over the posttherapy period, with the largest effects obtained at early follow-up. Clients seen in experiential therapies were also compared to untreated control groups in 16 studies, with very similar results and a large effect size of 1.18 (calculated by finding the difference in prepost effect size for untreated and treated clients).


In addition, there were 34 comparisons between experiential and nonexperiential therapies that showed a slight but not clinically significantly greater benefit for clients who received experiential therapies (an effect size of +.27). In 49% of the comparisons, no significant differences were found. In 38% of comparisons, experientially treated clients did at least .4 better, whereas in 13% of comparisons clients in experiential treatments did at least .4 worse. Overall, these results indicate the modern experiential therapies that we have been describing hold their own against nonexperiential therapies and could be interpreted as showing a slight superiority.


A subsample of 14 studies compared effects between experiential and CBT, again showing approximately comparable effectiveness (effect size +.2 in favor of the experiential therapies). In recent years, CBT has been presumed superior to experiential approaches. However, contrary to this impression, experiential therapies and CBT appeared to be equally effective. If anything, the trend is in favor of the experiential therapies.


The most rigorous outcome research to date has been done on EFT for depression. Emotion-focused therapy has been found to be highly effective in treating depression in three separate randomized clinical trials. In two studies, EFT was compared to a purely relational empathic treatment, whereas the third study compared EFT to CBT. All three treatments were found to be highly effective in reducing depression. Emotion-focused therapy was found to be more effective than a pure relational empathic treatment in reducing interpersonal problems, in symptom reduction, and in preventing relapse (Goldman, Greenberg, & Angus, 2006; Greenberg & Watson, 1998). Watson, Gordon, Stermac, Kalogerakos, and Steckley (2003) found no significant differences in symptom improvement between EFT and CBT for the treatment of major depression. However, clients undergoing EFT reported being significantly more self-assertive and less overly accommodating at the end of treatment than clients in the CBT.


Process Research


The majority of research on experiential psychotherapy has focused on whether depth of experiencing relates to outcome. Hendricks (2002) has reviewed 91 of these studies undertaken between 1958 and 1999. Experiential processing was explored in various treatments (not solely experiential) for varied diagnostic categories, from schizophrenia to marital discord to depression. Twenty-seven studies used the Experiencing Scale (Klein et al., 1986) to measure deepening of experience. The vast majority found that higher experiencing levels predicted better psychotherapy outcomes measured by a variety of outcome measures. Experiencing as a process has also been shown to relate to positive outcomes in CBT and psychodynamic therapy (Castonguay, Goldfried, Wiser, Raue, & Hayes, 1996; Silberschatz, Fretter, & Curtis, 1986) suggesting evidence that this may be an important therapy process, regardless of the therapy orientation. More investigations have been undertaken since this literature review, in particular continued research on EFT.


Three studies have shown that experiencing is a skill that is improved and deepened during experiential treatment, and that clients need not enter therapy “experientially minded” to do well in experiential therapy (Goldman, Greenberg, & Pos, 2005; Pos, Greenberg, Goldman, & Korman, 2003; Warwar, 2003). Pos (2006) also showed that increased depth of experiencing during emotion episodes from the beginning to the working phase of therapy directly predicted end-of-therapy reports of reduced depressive and general psychiatric symptoms and that the alliance contributed to outcome indirectly by supporting the experiencing process.


In addition to the previous studies, Greenberg and Pedersen (2001) studied in-session resolution of two key EFT therapy tasks—splits and unfinished business. Both tasks restructured clients’ core emotion schematic memories and responses. They found that the degree of resolution of these tasks predicted outcome at termination and 18-month follow-up. More important, it predicted nonrelapse over the follow-up period. This supports the hypothesis that deeper emotional processing and emotion schematic restructuring during therapy leads to more enduring change.


Finally, a considerable amount of qualitative research has been done on experiential therapy. Most notably, Stiles and his colleagues have done several cases studies of EFT clients that have yielded rich in-depth qualitative analyses of change in these therapy dyads (Honos-Webb, Surko, Stiles, & Greenberg, 1999).


Emotion-Focused Therapy for Depression


Much of what we have discussed in previous sections applies generally to contemporary experiential therapies. However, to illustrate one current approach in greater detail we now discuss the EFT approach for the treatment of depression. EFT has evolved, through a continuous process of empirical inquiry and clinical trials, to become a fully integrative experiential treatment that coherently organizes essential elements (focusing, empathic exploration, experiential use of imagination, evocative Gestalt chair work) of other experiential approaches. Arriving at this integration by developing a marker-driven and task-focused approach to psychotherapy, EFT holds that there are classes of recognizable problematic emotional processing difficulties and that markers of these difficulties are evident in client narrative and can be identified. Specific experiential tasks best suited to the resolution of these difficulties have been identified and developed (Elliott, Watson, et al., 2004; Greenberg et al., 1993; Greenberg & Watson, 2006). Emotion-focused therapy has also identified common emotional schematic difficulties relating to certain client problems, as well as articulated the paths of resolution that clients often take to resolve these problems. As such, interventions continue to be developed and refined as EFT is used as a treatment for different populations.


Emotion-focused therapy also explicitly employs a taxonomy of emotional processes to identify which emotional responses clients are actively engaged in (primary adaptive, primary maladaptive, secondary, or instrumental emotional responses) and how to respond differentially to each; for example, adaptive emotion is explored for its adaptive information and needs that can motivate action. Maladaptive primary emotion is first explored for the original context in which that response was adaptive in the past and then for the various present consequences the maladaptive emotion has in the present. The therapist then helps the client access alternate more adaptive emotions.


Emotion-focused therapy proposes that the essential curative process in therapy is change in automatically functioning emotion schemes—emotion schematic change. The core maladaptive scheme is accessed and then transformed through encountering newly accessed adaptive emotions. Thus, the core fears of abandonment or shame of worthlessness are transformed by accessing adaptive sadness at loss or assertive anger at violation. When these adaptive responses are coactivated, a new response may synthesize, such as calmness or confidence. In an old familiar context, new or altered emotion schemes may now automatically be activated, along with new embodied experience, sense of self, and behavior.


In emotion-focused therapy, the self seen as a dynamic organizing process forming continually in response to changing situations is based on the activation of emotion schemes. Emotion-focused therapy proposes that at the heart of depression is the evocation of two main types of emotion schemes that generate a core sense of the self as either “weak” or “bad” (Greenberg, Elliott, & Foerster, 1990; Greenberg & Watson, 2006). According to this theory, when a person suffers an interpersonal- or achievement-type loss, depression is not caused by a negative view of self or an underlying personality structure; instead, the person’s emotionally based, powerless, and hopeless sense of weak or bad self is triggered. The experience of being a weak self is the activation of emotion schemes that generate the sense of self as deeply and fundamentally insecure, encoded from experiences of being weak, unprotected, and unable to cope with life alone. Alternatively, what may be synthesized is a sense of self as fundamentally bad, as worthless, incompetent, and inadequate, encoded from experiences of invalidation and criticism. These organizations produce implicit experienced self-meanings rather than explicit self-knowledge.


Based on clinical experience, EFT theory predicts that the weak self-organization usually co-occurs with complaint and resentment in the context of depressive themes of interpersonal loss and disappointment, whereas the bad self-organization co-occurs with forms of shame and self-criticalness, often triggered by the context of failures or threats to self-competence. Both the weak and bad self-organizations that generate depression may be highly intertwined in an individual. A depressed client may have a self-contempt reaction in the face of an experience of the weak self. They may be disgusted and self-critical for being so weak. This self-contempt reaction may then activate the bad self-organization (Greenberg & Watson, 1998), and the client may then feel like a failure for being so weak. Therefore, these two self-organizations are not thought of as descriptions of two types of depressions per se, but rather as two depressogenic self-organizations that may frequently interact during depressive episodes (Greenberg & Watson, 2006; Watson, Goldman, & Greenberg, in press).


Specific Strategies


Empathic exploration is the fundamental intervention of EFT. Sensitively attending to the client’s spoken and nonspoken (nonverbal) narrative, the therapist uses verbal empathic exploration to help symbolize and capture what is at the edge of the client’s awareness. The therapist broadens and moves the client’s attention, helping them bring more experience into consciousness so it can be put into words and reflected on.


In addition EFT therapists also employ particular emotional processing tasks (Elliott, Watson, et al., 2004; Greenberg & Watson, 2006). Once a collaborative focus on the sources of the client’s depression is established, usually in the first 3 to 5 sessions, the therapist uses markers of specific problematic experiential states and matches them with interventions that have been specifically developed to resolve these states. Each of these tasks has the explicit purpose of activating emotional experience in the therapy hour to increase the likelihood that clients will gain access to and process emotional information. Five problematic states found in depression have been identified:



1. Problematic reactions are expressed puzzlement concerning emotional or behavioral reactions to a particular situation. Clients are often puzzled by the intensity of the emotional reactions they have in response to situations. This calls for systematic evocative unfolding. Clients are guided through a vivid reconstruction of the experience to establish the connections between the situation, thoughts, emotional reactions, and related memories, finally arriving at the implicit meaning of the situation that makes sense of the reaction.
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Jul 12, 2016 | Posted by in PSYCHOLOGY | Comments Off on Experiential Therapy

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