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Summary of Paper Presented at meetings of Society for Psychotherapy Research, Weimar, Germany, June, 2003; and World Association for Person-Centered and Experiential Psychotherapy, Egmond aan Zee, Netherlands, July, 2003.

1. Present the Therapist Experiential Session Form (TESF; Elliott, 1994)

• TESF-1994 is a postsession self-report measure for assessing therapists’ views of their use of the Process-Experiential (PE) therapy approach (Greenberg, Rice & Elliott, 1993).

2. Describe the application of this measure for developing a taxonomy of general types of Process-Experiential Therapy session.

• Completed immediately following session
• Covers the major elements in PE therapy
• Use as form of self-supervision re: use of PE therapy model
• 7 sections:
• 3 open-ended questions
• 68 quantitative items
• First page: (open-ended)

Process notes

Unusual events in session

Ideas for next session

(1) Overall Session Helpfulness: Elliott, 1985; 9-point scale

(2) Client Initial Experiences: measures Stiles’ concept of client resources (focus, motivation, attitude toward therapy; 8 items; 5-point intensity scales)

(3) Treatment Principles: 6 items, rated for presence (5-point); and quality (7-point)

(4) Therapeutic Tasks: 9 PE tasks, rated for presence (5-point), quality (7-point) and task resolution (6-point behaviorally anchored)

(5) Therapist experiential response modes (14 items, 5-point frequency)

(6) Nonexperiential Intervention (6 items, 5-point presence)

• Naturalistic sample of 67 clients seen for at least one session at the Center for the Study Experiential Psychotherapy
• Variety of diagnoses, most common: depression, anxiety, but also substance abuse, personality disorders
• Graduate student therapists, one clinical psychologist (n=25)
• n = 966 PE therapy sessions
• 689 sessions had complete therapist ratings

• Numerical Taxonomy
• Developed by biologists
• Uses statistical analysis to construct classification systems
• Basic method:

• Assess a collection of things on a set of descriptors
• Use descriptors to estimate similarity of things in an abstract n-dimensional space
• Use similarity-distance metric to form increasingly large groups of things until all are included

• Factor analyzed TESF data to create nonredundant, internally reliable indices within each section of the measure
• Result: 16 indicators

Method:

• Distance metric: Squared Euclidian distances
• Clustering method: Between-groups average linkage
• 5-cluster solution (plus residual "other" category) selected as representing a reasonable compromise of differentiation, category size, and inclusiveness.
• Residual category retained because interpretable
• Categories described via indicators

Note: Categories ranked by session outcome

Note: +, - indicate direction of significant correlation

Discussion

Uses of Therapist Experiential Session Form

• Research:

• Reliable indices; predictive validity
• Use to identify sessions for later study (e.g., with meaning creation tasks)
• Use qualitative data as summary of session & to identify relevant life events

• Supervision:

• Self-supervision
• Aid to formal supervision
• Bring to session
• Supervisor can use also

Taxonomy of PE Sessions

• PE Session clusters identify problematic and productive types

More Productive Session Types:

• Exploratory work sessions rated positively by both client & therapist, in context of less client distress.
• Client ahead of therapist sessions favored by clients but not therapists (context: less distress)
• Mixed exploration sessions favored by clients but disfavored by therapists (who see clients as ambivalent)

Less Productive Session Types:

• High PE sessions favored by therapists but disfavored by clients, who are experiencing more distress
• Residual sessions involve a therapist working hard to connect with an unengaged and distressed client, and are disfavored by clients.
• Low PE sessions are disfavored by both clients and therapists
• Bears some resemblance to Orlinsky & Howard (1977) session classification based on sailing metaphor (also: Stiles, 1980, Smoothness X Depth):

• "Smooth Sailing": Exploratory Work, Client Ahead
• "Heavy Going": High PE
• "Coasting": Low PE, Mixed Exploration
• "Foundering": Residual

Some Clinical Implications:

• Importance of Basic exploratory work in PE therapy
• Need to help therapists get up to speed with their clients
• Both high and low extremes of use of PE tasks may be counter-productive