10.1. Case Example: George: Re-processing Problem Experiences
George is a 62-year-old retiree who has sought therapy for a severe bridge phobia with accompanying panic symptoms (Partyka et al., 2001) as part of exploratory research to evaluate the possibility of treating specific anxiety problems with PE therapy (building on previous work by Shear, Pilkonis, Cloitre, & Leon, (1994) and Wolfe & Sigl, 1998). In the first few sessions, his therapist provides George with a PE formulation of panic and phobia problems, and the two of them explore George’s problems and life situation. Then, having agreed that the bridge phobia is the key therapeutic issue, the therapist proposes that they use the Systematic Evocative Unfolding task to re-evoke and re-work specific panic episodes. George is highly skeptical that this could be done in the safety of the therapy room, in imagination. However, on the second try, while trying to imagine an attempt to cross a bridge, George is able do so vividly enough to set off a panic episode in the session. Interestingly, George’s nonverbal behavior during the episode appears to be that of a person cringing in the face of being beaten. When the therapist points this out, George admits to a history of severe physical abuse as a child, something that he has never revealed to anyone. Over the next several sessions, he retells many different episodes of being whipped or struck with different objects by his mother and a babysitter ( = Trauma Re-telling). Knowing that Meaning Creation is often an issue in trauma such as childhood abuse, the therapist listens for George to protest the unfairness of his abuse (a marker for Meaning Creation). Although he still experiences considerable emotion pain from the abuse, it appears to violate no cherished beliefs of George’s, but rather confirms his understanding that other people are not to be trusted. Instead, he protests against the unfairness of his having worked all his life in order to retire comfortably, only to find his dream to move to a warmer part of the country stymied by his phobia and his wife’s job. These things challenge his cherished beliefs of self-sufficiency and hard work being rewarded.
Partyka,
R., Elliott, R., Alperin, R., Dobrenski, R., Wagner, J., Castonguay, L.,
Watson, J. & Messer, S. (Nov., 2001).
An
Adjudicated Hermeneutic Single Case Efficacy Study of Brief Experiential
Therapy for Panic Disorder.
Panel submitted for presentation at meeting of North American Chapter of
the Society for Psychotherapy Research, Puerto Vallarto, Mexico.
Shear,
K.M., Pilkonis, P.A., Cloitre, M., & Leon, A.C. (1994). Cognitive behavioral treatment compared
with nonprescriptive treatment of panic disorder. Archives of General Psychiatry, 51,
395-401.
Wolfe,
B. & Sigl, P. (1998).
Experiential psychotherapy of the atee nxiety
disorders. In L.S. Greenberg, J.C.
Watson, & G. Lietaer (eds.), Handbook of experiential psychotherapy (pp.
272-294). New York: Guilford.
Materials designed to
accompany the book Learning Emotion-Focused Therapy: The
Process-Experiential Approach to Change from APA Books.
©2003 Robert Elliott, Jeanne Watson, Rhonda Goldman, and Leslie Greenberg
http://www.process-experiential.org/learning