5.1.1.
Case Example: The Use of PE
Therapist Experiential Response Modes: Rebecca
Rebecca is a 19-year-old woman with severe, crime-related PTSD. She sought therapy for chronic, debilitating fear of re-victimization. Session 12 in a successful 19-session PE treatment begins in this way:
T1: Ok, so where are you today?
C1: Um [laughs] Nothing's really happened this week. [Long pause] Um. But, like on my way in here, you know, I thought that nothing had happened this week and that made me think realize that nothing big ever happens, any week. You know, that that's not my problem. I don't get hysterical once a week, you know.
T2: So that's not what it's about, right.
C2: Right, my problem is that, it's always there. It's mild, but it's always there, you know. I mean it's not drastic, you know.
T3: Right, it's not some raw trauma or something.
C3: Right, it's just a constant.
T4: And that's the fear you’re talking about. [Long pause] So that's what we talked about working on today, (C: uh-huh) for the next three sessions. [Long pause] So where would you like to start with that?
C4: Um [laughs] [pause] I don't know, I kept thinking, like on the way in here today that [pause] nothing is going to change, you know.
T5: You had a sense, “Well, what's the point in this?” Right? “What am I doing?” And that's painful, I can see that's painful for you. Yeah, yeah. [Pause] The sense of being stuck with things how they are. Can you talk from the sadness, from the hurt about that?
C5: [Long pause] I just, think of my life and I just, [pause] I don't want to spend it living in fear.
T6: Uh-huh, you don't want it to be like it is now, do you? And when you think about that, you feel, what?, a great sense of loss, a real hurt about that? [Pause] Yeah. Can you stay with that hurt and sadness for a minute, and just feel what that's about and what that's like?
C7: [Pause] I mean, the simplest way to put it is, I'm afraid of living, I mean of everything. (T: Uh-huh) I mean to the point where I get terrified by the thought of dying, you know...
This excerpt poignantly illustrates the process-directive influence of
the therapist in facilitating client entry into painful, trauma-related
experiencing. The therapist’s
responses were enhanced by (a) the openness of the client, (b) his empathic
attunement and acceptance of the client’s painful experience, (c) the
therapist’s reference to central client experiences (trauma-related fear,
emotional pain), and (d) his use of explicit process directives (“Can you stay
with that hurt, and feel what that’s about?”).
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