What is Person-Centred Experiential Therapy?

Counselling and psychotherapy practitioners understand their work from a variety of perspectives. There are a variety of well-established 'models' or 'approaches' and these generally hold many insights in common, whilst also having their own specific contributions and characteristics (click here for a brief summary of these from BACP). My work is firmly but flexibly rooted in person-centred experiential approaches.

This approach to therapy originated in the work of psychologist, therapist, educator, and researcher, Carl R. Rogers (1902-1987), who was the initiator not only of what he called 'Client Centred Therapy' but also of innovative approaches to education, human relations, and community-building. In the decades since his death, the approach has been developed by practitioners and theorists in many parts of the world, and notably in Scotland. These developments have led to a number of different emphases in working, collectively now described as 'Person-centred and Experiential Psychotherapies' (PCE), which have a long-established,

1. Person-Centred/Experiential
Approaches to Social Anxiety:
Initial outcome results
Robert Elliott & Brian Rodgers
University of Strathclyde

2. Why Study Social Anxiety
(SA)?
Some research on PTSD/trauma and
Generalized Anxiety, but social anxiety
neglected
Common but debilitating problem, affects
social adjustment, work functioning
Relevance to government initiatives targetting
anxiety/depression in chronic unemployment
Risk factor for depression, substance misuse
(self-medication)

3. What is Social Anxiety?
(DSM-IV)
A. Marked and persistent fear
One or more social or performance situations
The individual fears that he or she will act in a
humiliating or embarrassing way
B. Consistency: Exposure to feared social situation
almost invariablyprovokes anxiety
C. Recognition: Person experience fear as excessive
or unreasonable
D. Avoidance,or endurancewith intense
distress
E. Interference: interferes significantly with
functioning or wellbeing

4. Why Person-Centred-Experiential
(PCE) Therapies for Social Anxiety?
This client group has been virtually ignored
by humanistic psychotherapies
PCEs shown to be effective with Major
Depression
SA Commonly accompanied with clinical
depression, substance abuse, employment
problems
Resonance with key theoretical formulations:
Standard Person-Centred Therapy: Conditions of
worth
Emotion-Focused Therapy: Anxiety splits:
externalized inner critic

5. SA: Driven by Powerful
Emotion Processes
Key emotions: primary maladaptive
(overgeneralized) shame and fear
Organized by core emotion schemes:
Self as socially defective
Others as harshly judging/rejecting (=internalized
critic)
SA organized around core emotion scheme
of Self as socially defective
Basis of SA: Fear that this core defective self
will be seen & negatively judged by others

6. Core Defective Self-scheme
Socially Defective Self (Experiencer)
Typically grounded in early
physical/emotional/sexual abuse or
rejection/bullying
Organized around primary maladaptive
shame/fear
Symbolized by one or more key
phrases/images, e.g., “rubbish”, “crazy”,
“stupid”, “ugly”, “a freak”

7. Shaming Internalized Critic
Scheme
Complementary emotion scheme:
Harsh, shaming internal Critic
Introject of early rejection/abuse
Emotion scheme primes monitoring for social
dangers
Attribution to current others
But: also has protective function (prevent social
rejection)
Motivates social withdrawal/avoidance &
emotional avoidance

8. Strathclyde PCE Therapy for
Social Anxiety Project
Therapy development/ Pilot study
Open clinical trial
In progress; n = 19 completers to date
Two arms of study (non-randomized but
unsystematic):
Standard Person-centred (PCT)
Including nondirective & broader relational versions
Emotion-focused therapy (EFT)
PCT + active tasks: Focusing, Unfolding, Chairwork

9. Method: Clients
Community sample
Brief telephone screening
Face-to-face diagnostic assessment (2 X 2 hrs):
SCID-IV
Personality Disorders Questionnaire (PDQ)
Create Personal Questionnaire
Inclusion criteria:
Consider self to have problem with social anxiety
Meet DSM-IV criteria for social anxiety
Willingness to be recorded, fill out forms

10. Method: Clients
Specific SA (one specific situation:
public speaking): 49%
Generalized (multiple situations):
51%
Axis 2: mean 3.3 Axis 2 diagnoses
Avoidant Personality pattern: 92%
Borderline: 35%

11. Mean Problem Duration Ratings of
Personal Questionnaire Items
n 17
Mean 6.24
SD 0.78
•“6.2”: somewhat more than 6 to 10 years
•Client presenting problems = chronic

12. Method: Therapy & Research
Parameters
Up to 20 sessions; less if client feels finished
Assessments/data collection at:
Pre
Mid: After session 8
Post (end of therapy)
6-& 18-mo follow-ups

13. Method: Outcome measures
1. Personal Questionnaire(PQ):
Individualized/weekly problem distress; used for
progress monitoring
2. CORE-Outcome Measure (CORE): General
problem distress
3. Social Phobia Inventory (SPIN): Problem specific
4. Inventory of Interpersonal Problems (IIP):
Interpersonal problem distress
5. Strathclyde Inventory (Strath): Person-centred
outcome measure
6. Self-relationship Scale (SR): EFT Outcome
measure (Self-attack, Self-affiliation, Self-neglect)
Qualitative: Change Interview (used in case studies)

14. Results: Post-therapy Outcome for
Combined Sample
Mea-
sure
Cut-off
value
Pre-Therapy Post Therapy Effect
Size
(sd)
N
Clients
Reliable
change
n m sd n m sd
PQ >3.5 185.55.8118 3.341.172.20**14 (18)
CORE >1.25171.58.6715 .95 .72.91* 8 (11); 1
SPIN >1.12172.48.6614 1.50.661.54**9 (16)
IIP >1.5 171.89.6614 1.26.54.96* 7 (13); 1
Strath<1.95171.94.5015 2.66.561.33**10 (8)
mean Pre-Post ES: 1.39
*p < .05; **p < .01 (using both independent & paired samples t-tests)
n of clients showing reliable improvement (p < .05)
(n of client in clinical range pre-therapy)
n of clients showing reliable deterioration (p < .05)

15. Clients Showing Reliable
Change X Measures
(Positive Change unless otherwise noted) N
Global Change: At least two measures 10
Some change: At least one measure 16
Limited Change: One measure but not others 3
Negative/mixed change (evidence of
deterioration) 2
No reliable change on any measure 2

16. Results: SPIN Outcome Benchmarking
Measure: Pre Post Pre-
post
Effect
Size
N M SD M SD (sd)
PCE 14 2.48.66 1.40 .67 1.54
Connor et al 2000:
Medication
28 2.53.62 2.16 .81 1.28
Placebo25 2.4.81 2.16 .75 .31
Antony et al 2006:
Group CBT74 2.64.85 1.81 .92 .94

17. Results: SPIN Subscale Analyses (w
Benchmarking)
Sub-
scale:
Pre-therapyPost-therapyPCE
Effect
Size
(ES)
Antony
2005 ES
M SD M SD (sd) (sd)
Fear 2.80 .761.55 .821.64** .93
Avoid-
ance
2.69 .591.63 .74
1.64** .81
Physio-
logical
1.61 1.00.79 .63
1.03** .69
N = 16 (pre), 14 (post)
Significance tests are pre-post for PCE therapy: *p< .05; **p< .001

18. PCT vs. EFT Pre-post Effect
Sizes
Measure PCT EFT
PQ
2.11 2.23
CORE
0.68 1.09
SPIN
1.61 1.68
IIP
0.75 1.21
Strath
0.96 1.76
Mean Pre-post ES:
1.22 1.60
EFT vs. PCT Difference in
ES: +.37

19. Worse than expected
Better than expected

20. Results: Analysis of Drop-out Patterns
PCTEFT
Completers 9 9
Early drop-outs (1 -2
sessions) 4 2
Late drop-outs (3 -5) 4 0
Changed to other therapy 3 1
Total (re)starts 20 12
% Completers 45%75%

21. Late Drop-outs
Quit before indicating they were done
with therapy or finishing 16-20 sessions
Session 3 -5
Pre-therapy mean PQ = 6.24 (vs. 5.59
for completers)
Last session mean PQ = 5.55
Included 3 of the 4 most initially
distressed clients

22. Clients who changed
therapies
Early drop-outs included 4 clients who
switched between arms of the study
1 client changed from EFT PCT
Scheduling issue
3 clients changed PCT EFT
Negative reaction to lack of structure in
session 1

23. Discussion –General
Conclusion
EFT (also PCT) for Social Anxiety
Promising new approach
Substantial change over therapy
On long-standing problems
Comparable to benchmark treatments
(medication, CBT)

24. Discussion –EFT vs PCT?
Slight advantages to EFT over PCT?
On CORE, IIP, Strath, but not on SPIN, PQ
+.37: Same order as York I study
(Greenberg & Watson, 1998), but smaller
than York II (Goldman et al., 2006)
Some clients react negatively to PCT in
early sessions; fewer drop-outs in EFT
Appears related to greater structure in EFT

25. Discussion -Cautions
But:
Not statistically significant (low power), but
current best guess
Nonrandomized design
Possibility of treatment diffusion
(Chairwork in PCT condition?)
Some clients refuse EFT Chair work
Need to collect more data: target n = 30

26. Next Steps
RCT: Primary Care client population
PCE therapy (PCT & EFT) vs. NHS
Primary Care Mental Health Team
Treatment as Usual (group & individual
CBT)
Continue developing EFT therapy for
SA
Piloting PCT & EFT Adherence
Measures

27. E-mail: [email protected]
Blog: pe-eft.blogspot.com