Imaginal confrontation versus evocative empathy in emotion-focused trauma therapy.

摘要

This study is part of a larger, ongoing study comparing two versions of Emotion Focused Trauma Therapy (EFTT) for adult childhood abuse survivors (Paivio, Jarry, & Holowaty, 2004). Previously, the main vehicle for trauma exploration was the imaginal confrontation (IC) intervention (Paivio & Neiuwenhuis, 2001). However, because some clients found IC difficult to engage in, evocative empathy (EE) was developed as a viable but gentler alternative. The present study explored the similarities and differences between IC and EE by examining key client processes, specifically experiencing, emotional arousal, and therapeutic alliance (N = 30). Associations between processes and client characteristics and process contributions to outcome also were explored. Overall, the two interventions were found to be equally effective in producing positive client change and in promoting key processes. However, IC appeared to be more emotionally evocative both in the early and late stages of therapy. There also was some evidence to support higher levels of experiencing late in therapy in IC. On the other hand, EE promoted steady and higher levels of engagement with trauma material and overall lower levels of arousal. This supports the original intention of developing EE as a gentler and less stressful alternative. However, there were no group differences in terms of client-reported distress. Client depth of experiencing during trauma exploration contributed to client change in both conditions with a broader impact in EE. Alliance quality additionally directly contributed to client change in the EE condition. There were some associations between client characteristics and processes. Specifically, alexithymia appeared to moderately interfere with experiencing in the EE group but not in the IC group. Also, clients who were more severely abused were more likely to report strong therapeutic alliance in both groups. Results replicate and extend previous findings regarding EFTT with IC and identify EE as a viable treatment alternative for this client group. Process differences between the two procedures could indicate different routes to change and could interact with different client characteristics. Future research is recommended to further elucidate process differences.