| The main objective of this comparative study was to examine the processes underlying client change and their relationship to treatment outcome in two empirically supported psychotherapies for depression: Emotion Focused (EFT) and Cognitive-Behavioural (CBT) therapies. Transcripts from two early and two working phase therapy sessions of each of a total of 57 clients, diagnosed with major depression, were first rated on the Working Alliance Inventory (WAI-O: Horvath, 1982). Self-relevant topic segments from each of these four sessions were then extracted using the Narrative Processes Coding System (NPCS: Angus, Hardtke, & Levitt, 1996) and rated on the Levels of Client Perceptual Processing Scale (LCPP-R: Toukmanian, 2004) and the Experiencing Scale (Klein, Mathieu, Gendlin, & Kiesler, 1970). These ratings were used in the analyses to determine whether or not clients' depth of experiencing and manner of processing (1) improved over time, (2) differed across the two therapies, and (3) predicted, both separately and together within the context of a positive working alliance, reductions in depression on the Beck Depression Inventory (BDI) and in general symptom distress on the Symptom Checklist-90 (SCL-90).;Results revealed commonalities as well as differences in clients' processing across the two therapies. It was found that, in both the EFT and CBT treatments, clients' depth of experiencing and ability to process self- relevant experiences in a more reflective manner increased significantly over the course of therapy. However, EFT clients engaged in complex processing strategies and deeper levels of experiencing more than those in the CBT group in both the early as well as working phases of therapy. In relation to process and outcome, EFT clients' attained (working phase) levels of perceptual processing and experiencing predicted decreases in depression and general symptomatology, whereas for CBT clients, the early phase of working alliance was the only predictor of outcome. Including both process measures in the regression analyses increased the amount of variance accounted for in outcome on both the BDI and SCL-90, but only for the EFT group. In terms of specific modes of perceptual processing and outcome, EFT clients were found to engage in more analytical and internally-focused differentiation in the working phase of treatment than did CBT clients, but this was not related to outcome. Surprisingly and contrary to expectation, working phase engagement in internally-focused differentiation was found to be predictive of higher levels of depression in CBT clients. The implications of these findings for psychotherapy training and practice as well as for future directions of research are discussed. |
