Friday, March 1, 2013

Emotion-Focused Therapy Versus Cognitive Behavioral Therapy...What Next?



              Emotions are obviously a key focus when working with clients in a psychotherapeutic alliance no matter which theoretical orientation you might favor.  Emotion-Focused Therapy (EFT) may very well be a useful approach to resolving emotional disturbances, but the readings really did not give me enough information to make an informed decision in that regard.  I will refer to the readings to elaborate on this point, make some general comments regarding “humanistic” psychology, and provide some thoughts on the similarities of different theories as well as the need to develop one overarching meta-theory.


            You will have to excuse me, because I come from a primarily cognitive-behavioral framework and, therefore, have some difficulty grasping some of the “grayness” of humanistic and some of the experiential theories.  Do not get me wrong; even though I am somewhat of a dichotomous thinker, I still believe there are some very valuable concepts to be taken out of the readings and humanistic theories in general.  However, in Elliott, Watson, Goldman, and Greenberg’s text entitled Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change (2004), there is very little mention of therapeutic methods or techniques.  The text explains Process-Experiential Theory in appropriate detail, although I would not necessarily say it was “made simple” as the title of chapter two suggests.  Because I come from a “primarily” cognitive-behavioral perspective, that doesn’t mean that I don’t utilize an eclectic approach and find value in other treatment modalities formulated by such notable and intelligent theorists such as Rogers, Perls, Moreno, or Freud.  On that note, I would have hoped to read more about the contributions of EFT regarding therapeutic techniques, that is all I’m saying.
            In fact, none of the readings, with the exception of Repairing Discordant Student-Teacher Relationships: A Case Study Using Emotion-Focused Therapy (Lander, 2009), focused on therapeutic methods or techniques, which I found quite disappointing.  I hope that these missing components will be elaborated on more in other works.  Lander (2009) did provide an excellent case study that I found quite interesting and possibly useful in working with children.  Since I have very little experience working with small children, the techniques utilized piqued my interest and will inspire me to seek additional information regarding their specific applications. 

            As Wampold (2001) stated so elaborately in his text, I saw the “general effects” in Lander’s (2009) case study as being equally, if not more, responsible for the positive changes (outcome) in the relationship between Guy and Ms. Greenberg.  I believe the individual techniques were an excellent vehicle for building an alliance between teacher and student, and that the collaborative nature of the exercises did more to repair the relationship than any of the exercise’s products.  For the first time, the two individuals were able to see each other as human beings with struggles and emotions not so different from each other.

            Elliott, Watson, Goldman, & Greenberg (2004) mentioned that neo-humanism evolved because the humanistic movement “fell out of favor” (p. 6) in the 1970s and 1980s, but did not elaborate on why that occurred.  I have to assume it is because that is when the behavioral and cognitive revolutions in psychology began to take hold and the humanists really did not fit very well with the medical model.   It would have been nice to hear why the humanists believed this happened, why they felt compelled to create a neo-humanistic model, and what the differences are between the two. 

            I have noticed a lot of discussion of “dialectical” frameworks in the literature over the past several years and it seems to be a concept catching on in many theoretical camps including Linehan’s Dialectical Behavior Therapy (DBT) and EFT.  Is that the big difference between humanistic and neo-humanistic models?  Dialectical constructivism, as described by Elliott, Watson, Goldman, & Greenberg (2004), is not much different from dialectics as described by Linehan (1993).  Both Greenberg and Linehan are talking about the polarity of emotions as well as the dialectical relationship between therapist and client, yet they are coming from humanistic and cognitive-behavioral perspectives respectively.  Is it the dialectical opposition of emotions that separates the humanists of old from the neo-humanists or is there something more radical that I may have missed in the readings?

            I have to say that I take exception to the term “humanistic” psychology in general.  It is not that I do not believe in the principles behind the humanistic perspective, because I see many positive and useful ideas coming out of the writings of “humanists”.  My concern is that if a theory or therapy does not fall within the confines of the humanistic model, does that mean that all other models are inhumane?  What makes the humanistic theories more relevant to humanism than others theories, therefore making it necessary to make this very specific distinction?  Aren’t all theories concerned with helping people solve their problems and lead happier, healthier lives humanistic?  Don’t psychodynamic, behavioral, cognitive, developmental, and humanistic models all treat people with dignity and respect, nurture their clients, and show compassion for fellow human beings?  Of course they do! 

            In reality, the different theories or models of psychopathology and treatment are starting to look more and more similar as time goes on.  I can see many similarities between EFT and CBT for example.  EFT refers to the concept of the “scheme” while CBT uses the term “schema” to capture pretty much the same concept (I believe “schema” came first by the way).  Elliott, Watson, Goldman, and Greenberg (2004, p. 7-8) say they “use the word ‘scheme’ instead of ‘schema’ because ‘schema’ implies a static, linguistically based mental representation, whereas ‘scheme’ refers to a plan of action”.  They go on to say that a scheme is a process, not a thing, including linguistic components but consisting mostly of preverbal elements such as bodily sensations (physiological), images (also cognitions), and smells that are “not directly available to awareness”.  In Beck’s latest book (Beck and Clark, 2010, pp. 44-46), his concept of schemas is not much different from that of Greenberg et al.  Beck describes not only a cognitive-conceptual schema, but behavioral, physiological, motivational, and affective (emotional) schemas as being integral in primary threat mode activation, all of which are “automatic” processes (not directly available to awareness).  Humanists apparently use the “empty chair” technique (referred to, but not elaborated on, on p. 32 of the Greenberg reading), a technique developed by Fritz Perls, but also utilized in cognitive-behavioral therapy as a technique in role playing or behavioral rehearsal.  The readings state that the focus in EFT is on emotions rather than cognitions, but when describing emotions, the authors, Elliott, Watson, Goldman, & Greenberg (2004) and Pascual-Leone & Greenberg (2007), all describe them in terms of thoughts, statements, and cognitions and it is those statements that Pascual-Leone & Greenberg (2007) used to measure “emotion” in the research they describe.  So are emotions and cognitions that different or are they integrated in such a way that they become almost indistinguishable?

            In conclusion, with few exceptions, most science is based on theories that are more or less accepted as facts.  The theory of relativity, for example, doesn’t have four other competing theories explaining how celestial bodies relate to each other in the universe and there aren’t six different theories of evolution (although creationists have an alternative theory of their own), so why does psychology have so many theories of the mind, personality, behavior, emotion, and the treatment of psychopathology?  If we want to be taken seriously as scientists and validate our research on human psychology with credibility, we will eventually need one overarching meta-theory of psychology.  As I stated above, many of the remaining theoretical camps are all starting to sound more and more alike, only using different jargon and semantics to make their approaches sound novel and intelligent.  Rather than fighting each other over who is right, why don’t they all put their heads together and come up with one overarching theory of psychology that we can all accept?  Could that theory change over time?  Possibly.  Nevertheless, who has to say that the theories of relativity and evolution might not change with some unforeseen dramatic discovery in the future?  At least we could be taken seriously as a science and focus our funding and efforts in one direction rather than eight or ten.  If the general effects of therapy are as critical as Wampold (2001) suggested, what would the credibility of one psychological theory add to client expectation, the therapeutic alliance, and positive outcome?  One thing is for sure, allegiance factors, which according to Wampold (2001, p. 206), account for up to ten percent of the variability of outcomes, would be a thing of the past.

References
Beck, A.T and Clark, D.A. (2010). Cognitive Therapy of Anxiety Disorders – Science and Practice.  New York, NY: The Guilford Press.

Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change. Washington, DC: American Psychological Association.

Lander, I. (2009). Repairing Discordant Student-Teacher Relationships: A Case Study Using
Emotion-Focused Therapy. Children & Schools, 31, 229-238.

Linehan, M.M., (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder New York, N.Y: Guilford Press.

Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional Processing in Experiential Therapy: Why “The Only Way Out Is Through”. Journal of Consulting and Clinical Psychology, 75, 875-887.

Wampold, B. (2001). The Great Psychotherapy Debate. Mahwah, NJ: Lawrence Erbaum Associates.

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