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FOEPT- Focusing-Oriented/Experiential Psychotherapy

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    Focusing-Oriented/Experiential Psychotherapy

    Introduction and Overview:

    C: But why in the hell do I get so scared? I mean, I’m just sick to think I have to meet him. Iget this feeling like some pressure’s gonna come on me. ike...like when I was talking to himon the phone today, he goes, !I’ve really missed you.! "ouldn’t you think that would makeme feel good?

    #: It feels like pressure, you say. Can you sense what is the $uality of that pressure?

    C: I don’t know. I mean...I...I just feel like...like he could make me do something that I didn’twant to. %r something. &ow what could he make me do that I don’t wanta do? I don’t know.

    #: "hy don’t we just slow down and see if you can sense that. It feels like pressure, like youcould do something you don’t wanta do. "hat is your sense of all that?

    C: 'ee, I’m not sure... (deep )reath*........(long pause*.......this is kinda dum)+ you know, I’mthinking that...(tears*...I mean, what if I even liked him more or something? %r something. Idon’t know what it is (tears*.

    #: #hat you might like him more...

    C: hum...

    "hen people do well in psychotherapy, this is how they usually sound, regardless of theorientation of their therapist. #hey pause and grope for words or images. #hey pay attention toan unclear, )ut )odily-sensed aspect of how they are in a situation. #hey don’t just think a)outthe situation and they don’t drown in emotions. #hey attend to what we call a !)odily feltsense of--! a situation or pro)lem. "ords or images arise directly from that sense. "hatcomes is often a surprise. new aspect of e/perience emerges, a small step of change that

    )rings a )ody response, like a slight physical easing of tension, or tears, or a deeper )reath."e call this a !felt shift.! #his kind of process is one !motor of change! in psychotherapy.

    0ocusing-%riented1 2/periential 3sychotherapy is an interaction in which clients can contacttheir direct e/perience in this manner. It grew out of a colla)oration in the 4567s at theniversity of Chicago )etween Carl 8ogers, the founder of Client-Centered 3sychotherapyand philosopher, 2ugene 'endlin. Coming from the philosophical tradition of 9ilthey, 9ewey,erleau-3onty and c;eon, 'endlin developed a 3hilosophy of the !Implicit! and applied itto the work 8ogers was doing.

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    #he hypothesis was that clients who are more successful in therapy will show an increasinga)ility to refer directly to )odily felt e/perience, as illustrated in the e/ample a)ove. #o theirsurprise and dismay, some findings indicated that 2/periencing evel early in therapy

    predicted outcome. Clients who )egan therapy already a)le to speak from their innere/perience did well and those that started una)le to do this didn’t necessarily learn and had a

    poorer outcome. In response to the pro)lem that failure could )e predicted from the outset,specific instructions were developed to teach people how to do this important process, whichwas named, !0ocusing.!

    #he importance of emotion and the relationship with the therapist have )een acknowledged ascentral to psychotherapy, )eginning with 0reud’s initial emphasis on a)reaction andtransference. #hese lines were further developed through the work of 8ank and 8ogers.8ogers saw therapy as involving personality change along !a continuum which reaches fromrigidity and fi/ity of psychological functioning ...to psychological flow and changingness.!'oing even farther in the direction of a process definition of therapy 'endlin says, !#herapydoes not consist mainly of familiar, already defined kinds of e/perience, whether dreams oremotion, actions or images. #herapy is rather a process that centrally involves e/perience

    )efore it )ecomes one of these defined !packages! and again afterward when it dips )ack intothe one at the edge of consciousness.!

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    science has great power in relation to machines, )ut it is inade$uate to understand people. Doucan put your car in a garage, ignore it for a year, and return to find it pretty much as you leftit. living creature dies within a few days, if the interactions which constitute it cannot go on.2/periencing is on-going process. %ne implication is that pathology is )locked process.

    Felt Sense: How T e Body Is !ise"hen we pay attention to our )odily e/periencing, we find that it has in it the comple/ity ofhow we are living with others. t first this is an unclear, whole sense in your )ody thatdoesn’t yet have words or parts, )ut is felt $uite distinctly. @top now for a minute and payattention to your whole sense of a friendship with someone with whom you love to spendtime. It has a distinct feel, )efore you have yet thought any words. &ow sense yourrelationship with someone who is difficult for you. gain, you have a distinct felt sense , )utdifferent from the first one. #his fu y sense is an intricate mesh of past history, currentmeanings, the other person, the physical setting, the relationship and much more. ll this is

    implicitly present. #his )ody-sense is not like a cramped muscle, )ut the )ody as it lives in asituation. #his is called a ! felt sense!. It is neither just thinking, nor is it emotion. It refers tomeanings felt in the )ody.

    "arrying Forward# Implied $ext Steps Of %iving

    iving implies its own ne/t steps in a highly ordered se$uence. In digestion, eating impliessaliva in the mouth, which implies juices in the stomach, which implies a)sorption ofnutrients )y the )lood, which implies elimination of to/ins and wastes. If the events that areimplied do not occur, there is a disruption of this very fine order. #here is trou)le. %ur felte/periencing has this same implying of ne/t steps in our interactions. %ur )odies can alsoimply )rand new action steps. Carl 8ogers o)served that when therapists e/pressed empathy,unconditional regard and congruence some clients seemed to naturally grow into fuller living,without any content directives )y the therapist.

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    in the )ody. #he attention )oth therapist and client pay to the client’s felt sense allows e/actwords, or images or gestures or new action steps to arise from the felt sense to carry the )odyforward into fuller living. #his )rings an easing in the )ody which we call a !felt shift.! "ithmany such small shifts, life changes.

    Focusing and Experiencing: )efining and *easuring A(rocess +aria,le

    8esearch in the Client-Centered12/periential tradition goes )ack forty years. Initially, itconsisted of content analyses. #he shift to process varia)les ('endlin and imring 455 *,a)out how the client related to e/perience, led 8ogers to redefine the self in process terms.Clients who self actuali e in successful therapy should )ecome !a)le to live more fully andacceptantly in the process of e/periencing, and to sym)oli e the meanings which areimplicitly in the immediate moment.! (8ogers, 4565, pg. 47E*. 8elia)ility and validity weredeveloped for the 2/periencing @cale. Fudges are trained separately through standardi edmaterials. #he scale measures a continuum, from e/ternali ed narrative to inwardly ela)oratedfeeling statements, )ut this may not )e a single varia)le measure. iddle stages measure the

    presence of emotions, )ut focusing on a felt sense is distinctly different from emotions. #his )egins at stage four. #he following are e/cerpts from the #raining anual.

    Stage One: #he content is not a)out the speaker. #he speaker tells a story, descri)es other people or events in which he or she is not involved or presents a generali ed or detachedaccount of ideas.

    Stage Two: 2ither the speaker is the central character in the narrative or his or her interest isclear. Commentsand reactions serve to get the story across )ut do not refer to the speaker’sfeelings.

    Stage T ree: #he content is a narrative a)out the speaker in e/ternal or )ehavioral terms withadded comments on feelings or private e/periences #hese remarks are limited to the situationsdescri)ed, giving the narrative a personal touch without descri)ing the speaker moregenerally.

    Stage Four: 0eelings or the e/perience of events, rather than the events themselves, are thesu)ject of the discourse. #he client tries to attend to and hold onto the direct inner reference of e/periencing and make it the )asic datum of communications.

    Stage Five: #he content is a purposeful e/ploration of the speaker’s feelings ande/periencing. #he speaker must pose or define a pro)lem or proposition a)out self e/plicitlyin terms of feelings. nd must e/plore or work with the pro)lem in a personal way. #he clientnow can focus on the vague, implicitly meaningful aspects of e/periencing and struggle toela)orate it.

    Stage Six: #he su)ject matter concerns the speaker’s present, emergent e/perience. sense of active, immediate involvement in an e/perientially anchored issue is conveyed with evidenceof its resolution or acceptance. #he feelings themselves change or shift.

    Stage Seven: 2/periencing at stage seven is e/pansive, unfolding. #he speaker readily uses afresh way of knowing the self to e/pand e/periencing further. #he e/periential perspective is

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    now a trusted and relia)le source of self-awareness and is steadily carried forward andemployed as the primary referent for thought and action. ( ;lein et al 45 7, 3gs. = and 6=-=G*

    @achse and &eumann (45AG*, developed a 0ocusing 8ating @cale ( 08@*, which was validatedindirectly against the 2H3 scale with a correlation of .57 . Clients who are a)le to focus

    immediately in response to standard instructions were also found to )e high on the 2H3 @cale.0ocusing distinguishes

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    @imilarly, ;u)ota K Ikemi (4554* found sessions rated as successful )y clients had higherclient 2H3 levels.

    Focusing and (syc ot erapy Outcome:

    #wenty three studies find that 0ocusing, measured )y instruments other than the 2H3 @cale,correlates with successful outcome. #hey are summari ed in #a)le E .

    In a Belgian study, eijssen (455=* audio taped A47 sessions from E= clients over si/ yearsand conducted a series of analyses. In an initial study she took sessions with e/plicitly

    positive and negative evaluations )y client and1or therapist. #o )e included as positive, theclient had to say something spontaneously a)out the helpfulness of the session, without thetherapist asking. #ranscripts of the complete sessions were read, and focusing was judged

    present when the therapist gave a focusing instruction and the client accepted the invitation, or when the client spontaneously did one of the si/ steps of focusing. @eventy-five percent of

    positive sessions contained focusing, and only GG M of negative sessions contained focusing.

    In a second analysis, all clients who successfully terminated therapy in less than E7 sessionswere studied. !8emarka)le was the prominent use of focusing in all eight cases. lmost everysession ac$uired an intense e/perience-oriented character and the client discovered aspects ofthe pro)lem which had remained hitherto out of reach. ll these clients achieved contact withtheir )odily felt e/perience without )eing flooded )y it. 0our of these clients seemed to find a

    personal form of self-transcendency during focusing.! ( eijssen, in press*

    @achse’s (455E* research over many years has not )een reviewed in depth in the nited@tates.

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    0ocusing-%riented #herapy has )een found to correlate with successful outcome for prisoninmates ("olfus K Bierman 455=+ 'oldman et al 455=**, psychotic patients ('ray, 45 =+

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    scale to analy e triplets. 2lliott et al (45AE+ 45AG* found greater residual gain in 2H3following therapist interventions rated as high in helpful e/periencing, depth and empathy.

    #hree studies (;ris 455E+ Fennen 45 A+ 'i))s 45 A* find that #herapist $ualities of 2mpathy,9epth, and1or

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    • Clients who process in a ow 2/periencing manner can )e taught to focus andincrease in 2/periencing manner, either in therapy or in a separate training.

    • #herapist responses deepen or flatten client 2/periencing. #herapists who focuseffectively help their clients do so.

    • @uccessful training in focusing is )est maintained )y those clients who are the

    strongest focusers during training.

    @ome of the studies can )e faulted methodologically )ecause relia)ility is low, sample si esare small and control groups are lacking. %ther studies have a small spread of 2/periencingevel, with few clients reaching the higher ranges. and a)ove areseparately looked at, as in 'oldman’s study (455 *, the correlations with successful outcomeare even stronger.

    #he finding that

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    From &esearc To (ractice

    T e Interaction is First

    #he )asic criteria of 0ocusing %riented 3sychotherapy is whether the client’s e/perience is )eing carried forward in the moment in the particular interaction with the therapist. "e wantto interact with our client in such a way that the client can contact a )odily felt sense of lifesituations. #o do this re$uires that we respond to that which is vague and unclear, at the edgeof the client’s attention. If we pre-define or rely on a techni$ue or model to form ourresponses, we will not )e a)le to hear what is sensed )y the client )ut not yet articulated.any clients have only a fragile connection to their felt sense. If we don’t respond to it, thenthey cannot enter further into it.

    %istening is t e Baseline

    "e listen to the person’s e/perience, rather than to our ideas a)out the person. "e say )ackwhat the client intends to convey. In addition to acknowledging the client’s e/perience, thisallows the client to resonate the words or images against the felt sense and correct them or seewhat emerges ne/t. "e listen to the te/ture and intricacy in e/perience and respond to theunclear edge from which steps of change come. "hat will carry forward the client’se/perience is very e/act. Fust this word, action, image touches or moves something right now,while many others do not. "e try to protect the emergent process, knowing it is more likelythan anything we might come up with to carry e/perience forward. #his is why the therapist

    )aseline )ehavior is an empathic listening attitude. 2mpathy, congruence and positive regardare increased in )oth therapist and client when we let words or e/pressions arise from the feltsense.

    ! en t e "lient and T erapist Bot &espond to t e Felt Sense

    In the session )elow, we see what focusing looks like when it is working. @ometimes we think of 0ocusing in steps. lthough not formally named, the client forms a felt sense2 as's - inner$uestions are directed into the felt sense*, sym,oli4es (lets words1images emerge from it* 2resonates (checks to see if there is a response in the )ody to the words* and receives (makeswelcoming, non-judgemental room inside for what has come*. #here are a series of small felts ifts and )eginning small steps of change. #his client is in her early thirties and has told adream. #he therapist invites the client to get a felt sense of the whole thing.

    #4: Can you sense where in all that you want to pay attention? (0ocusing $uestion*

    C4: (@ilence as she checks inside.* #he only place I can really connect to feeling5wise is if Isay to myself...!may)e my infinite energy doesn’t have to come through )eing se/ual, may)eI can let it...may)e it just wants to come now...!

    (#he client has found the issue that has a )odily felt dimension, rather than just words.*

    #E: I want to say that )ack to you...( @aying )ack welcomes the person, and e/actly whatevercontent came and lets the client resonate the words with her felt sense.* Dou get a real feeling

    response when you say, !may)e now the spiritual can come in its own form, it doesn’t have tocome only through )eing se/ual.!

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    CE: Des. nd that’s very hard for me )ut that feels li'e t e rig t place .

    ("hat she means )y !place! is a felt sense in her )ody. "hat she means )y !right! is a $ualityof resonance. : T ere6s more t ere (felt sense*. ... ! at is t at ?(@he is asking into her felt sense. #his isnot a cognitive or deductive $uestion.* ... w y is t at so scary ? ( gain she is asking right intoher felt sense which then starts to open.* ...It’s also somet ing in it li'e ...(so)s...* ;eepingthe channel only se/ual also narrowed how much energy could come through orsomething...some part of it is really scary.. may,e I could really live in relation to t atenergy all t e time if I didn’t restrict it to that channel (sym)oli ation*. (0elt shift*

    #6: @cary to live in relation to it all the time?

    (#he therapist is confused )y the fact that this content is the opposite of the previousstatements. #here is an e/act e/periential order in this kind of process )ut it is different thanthe order of logic.*

    C6: h hum...I’ve always )een hidden. It’s saying, !don’t do that anymore, . ookO... %et yourenergy ,e visi,le , use it2 live in it2 t at would ,e suc a c ange in w o I am 7..Be in it inthe daylight. (Change @tep. @he is )eing more visi)le right now.*

    #=: hmm......let it manifest, perceive it, see it...("elcoming, reflecting*

    C=: 8ight... ()ig sigh*...(crying*..take it seriously..()ig sigh, )reath, $uieter... laughs*...that oldenergy still wants to pull me down and )ack into that dark hole..)ut, it’s a little more free, it’smoved a little, it’s like, !oh, may)e there is a road.!

    "hen people focus they use language in a new way. &otice the fre$uent use of open pronouns

    like !something,! and !it! and !some!. "ords are )eing used to point towards the felt sense

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    that is not in words, )ut is tangi)ly present. #here is no way to use content words yet, withoutclosing the felt sense.

    ! en t e T erapist Fails to &espond to t e "lient8s Felt Sense

    nfortunately, it can happen that the client is close to focusing and the therapist does notrecogni e the client’s felt sense. Because the therapist is the e/pert, the client may )ecomeconfused, feel inade$uate, defer to the therapist’s authority and disconnect from her directe/perience. "e saw in @achse’s study, that a !flattening! response )y the therapist leads to aflattening of e/periential depth in GM of su)se$uent client responses. #here is an unhappystalemate, which the therapist may interpret as !resistance,! on the client’s part, when it reallyis an undeveloped capacity in the therapist that is the pro)lem.

    C4: nd yet I feel... there’s something underneath it all but I don’t know what ... (felt sense*and if I kind of knew what it was...I might feel differently, I don’t know. But it’s vague rightnow .

    #4: %kay. If things could )e a little more definite. If you were really a)le to identify thecause ..you really think that you’d )e a)le to cope with it then. But right now you can’t seemto put your finger on what the real problem is.

    CE: Duh..and...that..like when you say that...that makes me mad )ecause I feel...you know likeI’m..intelligent. I can figure things out. nd yet...right now I don’t know what the hell’s goingon with me.

    #he therapist is una)le to respond to the client’s felt sense, which is the rich intricate, not yet

    known place from which movement would come. #he client has given a clear prescription ofwhat needs to happen ne/t. @he literally tells the therapist that if she could just sense moreinto this unclear place underneath it all, she has a sense that something would move fromthere. Because the therapist does not know a)out this level of process, he uses his words in acognitive, closed, defined way that cannot point to or invite what is not known to open. #heclient is left self critical and, pro)a)ly, rightfully, angry at the therapist. #his kind ofinteraction underscores the need for therapists to develop this sensitivity as part of theirtraining.

    ! en "lients )o $ot Focus

    #here has )een a great ela)oration over years of how to help clients learn 0ocusing when it isnot spontaneously present. ("eiser Cornell 455=+

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    client is una)le to do so and continues to get involved in ideas a)out it. #he therapist againinvites him to form a felt sense. : Can you just check that image of you groping and can’t gra) anything in your )ody. 9oesthat feel right?

    C6: Lery much. (8esonating* ... nd now that I have it I remem)er having similar kinds ofimages in different sessions in different ways.

    client like this will often say things like, !"ell, I pro)a)ly feel this way )ecause of the waymy parents treated me when I was little.! %r, ! y therapist says I must have )een very angryas a child to have withdrawn so much.! @uch clients do not have their own direct sense.Connections do not emerge from their own process, )ut are imposed down on their e/perienceeither )y themselves or the therapist. #his kind of client is also likely to narrate many reportsof events during the week with no reference to personal felt meaning of the events.

    "learing A Space or 9etting )istance Instead of )rowning In Emotions

    #he other dead end in therapy comes when clients drown in emotions. #hey just re-e/periecne painful events or feelings. 0ocusing distinguishes )etween emotions and a felt sense. nemotion is narrower and tends to )e the !universal! response to given situations e.g. ifsomeone dies, one is sad. #o get a felt sense, one must step )ack and form one’s owncomple/, unclear sense of some !whole thing.! #his will )e particular to the individual. #heelderly client )elow has suffered from a very severe depression all of his life and has )eencompletely identified with intensely painful emotions. .

    C4: I feel very upset. I cannot take action. I didn’t call him and follow through. I never followthrough. I’ve )een this way my whole life. I think this is related to my mother always sayingto me, !9an, remem)er, you are very sick.! I feel terri)le. &ow I will )e depressed all week. Idon’t want to leave feeling like thisO (#he client is angry, agitated and depressed*.

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    #his is familiar. ny approach to his relationship with his mother sends him down a chute ofe/treme )ad feeling.

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    CE: (@he is $uiet, getting a felt sense, and then )egins to cry.* O 7 I 'now w at it is0 I was soe!cited" (@ym)oli ation from 0elt @ense*. y daughter wants to )a)ysit so much and Ithought it was going to happen. nd I feel like I spoiled it...I felt so e/cited I think I didn’t

    pay attention to what was coming )ack to me from her. I just kept talking )ecause I was soe/cited and I wanted it to happen.. 0actually now t at I t in' of it2 I did feel sort of li'e I

    didn6t really agree wit some of t e way s e was t in'ing a)out child care. I remem)erfeeling like s e seemed sort of overly protective or rigid in er approac 0

    #E: @o, in your e/citement you really didn’t pay attention to some of your own signals. Douactually didn’t like what she was saying, )ut you didn’t stop and pay attention to your ownfeeling.

    CG: Deah...that’s right...I feel )etter now that I have a sense of what happened for me.

    #he emergence of the words, !%hO I know what it is. I was so e/citedO! is a small felt shift.#he words are new and surprising to the client. #he content !e/citement! is $uite differentfrom !I am a monster.! nd the movement of the felt sense into words that carry her forwardin her )ody is felt as relief and tears, a whole )ody response. Change is directly felt in the

    )ody in this kind of therapy. #he client does not need to speculate a)out whether she ischanging. It is an immediate e/perience. #his is also an e/ample of the e/periential version of a psychodynamic point. #he concept that depression is anger turned inward fits this material.But, the emergence of her dislike from her own sense is more powerful than if the therapisthad offered the interpretation that she was angry at the friend. "e can see here a small step ofchange and ego development in her a)ility to form her own perspective.

    Implied Forward )irection and Emergence of Steps

    In the section on )asic concepts, we spoke of living organisms implying their ne/t step ofliving in a finely ordered, e/periential way. #he )ody !knows! what needs to happen ne/t.@ometimes the felt sense does not respond to waiting and sensing into it with the $uestion,!"hat is in this whole sense?! #hen we can ask a different kind of $uestion. "e ask, !"hat isneeded here?! or, !"hat would )e right to happen ne/t?! #hese are not a)stract, intellectual$uestions, )ut rather focusing $uestions that ask directly into the felt sense of what wouldcarry life forward now in this situation. #hen we wait and see if something forms. #hee/ample )elow marks a turning point in therapy for a client with a severe post traumatic stressdisorder , when her )ody responds to the $uestion, !"hat does it need now?! @he has )eenuna)le to find a proper distance from her a)use e/perience and so cannot focus on it. @he has

    flash)acks, partially dissociated states, is chronically hyper vigilant and feels terror most ofthe time. @he feels deep grief that , even though she functions at a high level jo), normal life is passing her )y and she will never )e a)le to have children )ecause she cannot tolerate se/ualcontact with her hus)and. "hen she focuses, what always comes is her longing to have achild. @he is GA years old.

    ...#he tension level has )een even more than usual and it’s un)eara)le even the way it usuallyis. #here’s a racing in my chest. &othing we are doing is touching this. &othing touches it.I’m taking something like twenty pills a day right now and nothing is any different than it’sever )een. I don’t know what to do.

    #herapist and client spend a)out >7 minutes trying to find some way to work with thistension, to no avail. @he is una)le to get a felt sense of it and nothing else helps either. @he

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    remains locked in this awful tension state that has no psychological content. #he therapistthen asks her this other kind of focusing $uestion, trying to engage her )ody’s own knowledgeor implying of what is needed now.

    #4: @o, why don’t you gently )ring your attention in the front part of your )ody. ;eeping your

    attention there, let’s see if we can get a sense# maybe an image of what would help. et’s ask inside# $What does it need now for all this whole thing to gently ease# so you can feel %& in

    your body?$

    C4: ( ong silence* I get two things (words emerging from the felt sense*....%ne is if I didn’thave to leave until I wasn’t worried anymore a)out leaving. If I didn’t have to )e aware of theclock ticking... nd I got another thing. dog--a Collie. (@he )egins to cry. 0elt shift with

    )ody response.*. I don’t know if I’ve told you )ut when I was a kid and so scared all the time,so terrified, I used to ask my parents for a dog, a Collie, like assie. assie sat on #immie’s

    )ed and would have protected him from anyone coming in the window, so no one could hurthim. nd assie was his friend and kept him company too. I used to feel a Collie could makeme less scared and )e my friend. 2very single Christmas, every Birthday, anytime I wouldever get anything, I would ask them for just that one thing, a dog. #hey always said if I didsomething a certain way or for long enough or whatever, they would give me one. But theynever did. #hey always said I didn’t do whatever it was good enough or some other e/cuse.(@he is still crying.*

    #E: @o you knew even then, as that little person, something that would help, )ut they wouldn’tdo it.

    CE: 9an (her hus)and* says they were really mean not to give it to me.

    #G: Deah, I was just feeling the same thing. I feel mad at them. But, that whole thing is whatcomes now. ' feeling that if you had your own assie that would help# would let the tensionease inside. (#herapist is returning to the felt sense. By saying it )ack the client can reconnectto it.*

    CG: I asked 9an could we get a Collie. : But, may)e it would )e right, now. (ou have a feeling sense that getting a dog wouldmake you feel more safe in the inside place and like there was company. ( gain the

    therapist is returning to the point where there was an opening, a felt sense of what wouldhelp.*

    C>: Deah. ast week 9an and I were in the )ookstore.

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    now...Dou could get a dog for yourself now. (#herapist is still trying to protect and make roomfor the step that came, so it isn’t overwhelmed )y all these o)jections*

    C=: ay)e I could get that small kind of Collie that only grows to two feet.

    # : "ell, how a)out not compromising, )ut really doing what that place needs?

    C : (@he is $uiet for awhile. laugh wells up in her )ody.*

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    difficulty or pu le, without yet having words or sym)ols. t such an unclear edge, new andcreative steps of living emerge. #his could )e a dancer waiting for ne/t steps in herchoreography, or a poet sensing for the right word, or a physicist pursuing an implicit sense of the answer to a pu le. s therapists we can point to this felt sense level )y asking the clientthe simple $uestion, !

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    2mpathy. Dissertation Abstracts International, DAI A #$%&', GA>. ( niversity icrofilms &o.C A44E E6*

    Clark, 9. (45A7*. 2ffects of 2/periential 0ocusing with 3sychotherapy 3atients. Dissertation Abstracts International, . ( niversity icrofilms &o. A74 =AA*

    Custers, . (45 G*. 9e manier van ervaren in het therapeutisch proces.. Psychologica elgica,'3, 4E6P4GA. Cited in ;lein et al (45=5* )he E periencing Scale

    9avis, ., K , ay*. &onver)al aspects of therapist attunement. *o+rnal oflinical Psychology, -& (G*, G5GP>76.

    9avis, ., K , ay*. &onver)al aspects of therapist attunement. *o+rnal oflinical Psychology, -& (G*, G5GP>76.

    9avis, ., K 7PG64.

    9on, &. @. (45 *. #he transformation of conscious e/perience and its 22' correlates.. *o+rnal of Altered States of onscio+sness, 3, .

    9osamantes- lperson, 2. (45A7, @pring*. 'rowth effects of e/periential movement psychotherapy. Psychotherapy/ )heory, 0esearch and Practice, '1, =GP=A.

    9urak, '., Bernstein, 8., K 'endlin, 2. #. (455=, 0all1"inter*. 2ffects of focusing training ontherapy process and outcome. )he 2olio/ A *o+rnal for 2oc+sing and E periential )herapy,'-, P4>.

    2gendorf, . K Faco)son, . (45AE* #eaching the very confused how to make sense: ane/periential approach to modular training with psychotics. Psychiatry, >6+>, pp. GG=-G67

    2lliott, 8. Cline, F. K @hulman, 8. (45AE* 2ffective processes in psychotherapy: single casestudy using four evaluative paradigms. npu)lished manuscript, . of #oledo.

    2lliott, 8., ;lein, .

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    'endlin, 2. #. (45=>*. 3ersonality Change. In 3. "orchel K 9. Byrne (2ds.*, A )heory of Personality hange (pp. 47EP4>A*. &ew Dork, &D: Fohn "iley K @on.

    'endlin, 2. #. (455=*. 2oc+sing riented Psychotherapy. &ew Dork: 'uilford 3ress.

    'endlin, 2.#. (455 * A Process 4odel &ew Dork, #he 0ocusing Institute: www.focusing.org

    'endlin, 2. #. (45A4*. 2oc+sing. &ew Dork: Bantam .

    'endlin, 2. #. (45==, Fanuary*. 8esearch in 3sychotherapy with @chi ophrenic 3atients andthe &ature of that !Illness!. A5erican *o+rnal of Psychotherapy, 66, 7o., ', >P4=.

    'endlin, 2. #., K Berlin, F. I. (45=4*. 'alvanic skin response correlates of different modes ofe/periencing. *o+rnal of linical Psychology, '1 (4*, GP .

    'endlin, 2. #., K imring, 0. (455>*. #he $ualities or dimensions of e/periencing and theirchange. )he Person entered *o+rnal, ' (E*, 66P= .

    'endlin, 2. #., Bee)e, III, F., Cassens, F., ;lein, ., K %)erlander, . (45=A*. 0ocusing)ility in 3sychotherapy, 3ersonality, and Creativity. In . . @hlien (2d.*, 0esearch in

    Psychotherapy/ 8ol. III. . "ashington, 9.C.: merican 3sychological ssociation.

    'endlin, 2. #., Fenney, 8., K @hlein, F. . (45=7*. Counselor ratings of process and outcomein client-centered therapy.. *o+rnal of linical Psychology, '1, GP .

    'i))s, B. (45 A*. 2ffects of #herapist and @u)ject 2/periencing evels on the #herapeutic3rocess (9octoral dissertation, California @chool of 3rofessional 3sychology*. Dissertation

    Abstracts International. .

    'oldman, 8honda. (455 * Change in thematic depth of e/periencing and outcome ine/periential psychotherapy (9octoral dissertation, Dork niversity*. Dissertations Abstracts

    International.

    'ray, F. 3. (45 =*. )he infl+ence of e periential foc+sing on state an iety and proble5 sol9ing ability. npu)lished doctoral dissertation, California @chool of 3rofessional 3sychology, osngeles.

    'reen)erg, . @. (45A7*. n intensive analysis of recurring events from the practice of 'estalttherapy. Psychotherapy/ )heory, 0esearch and Practice, '1, 4>GP46E.

    'reen)erg, (45AG* #oward a task analysis of conflict resolution in 'estalt intervention. Psychotherapy/ )heory, 0esearch and Practice , 45AG, E7, 457-E74

    'reen)erg, K 8ice, .(45A4* #he specific effects of a 'estalt intervention. Psychotherapy/)heory, 0esearch and Practice , 45A4, 4A G4-G

    'reen)erg, . @., K

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    'reen)erg, ., K "atson, F. C. (455A*. 2/periential therapy of depression: 9ifferential effectsof client-centered relationship conditions and process e/periential interventions..

    Psychotherapy 0esearch, : (E*, E47PEE>.

    'rindler ;atonah, 9., K 0la/man, F. (4555*. 2oc+sing/An Ad;+nct )reat5ent for Adapti9e

    0eco9ery 2ro5 ancer. npu)lished manuscript, #he Illinois @chool of 3rofessional3sychology.

    *. euven: euven niversity 3ress.

    Ikemi, ., ;ira, D., urayama, @., #amura, 8., K Du)a, &. (45A=*. 8ating the process ofe/periencing: #he development of a Fapanese version of the 2/periencing @cale. )he

    *apanese *o+rnal of =+5anistic Psychology, #, 67P=>.

    Fennen, . '. (45 A*. 0elationship and interaction between therapist conditions, client depthof e periencing d+ring therapy and constr+cti9e personality change in indi9id+al

    psycholtherapy. npu)lished manuscript.

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    Fohnson, . 2., K 'reen)erg, . @. (45AA*. 8elating process to outcome in marital therapy. *o+rnal of 4arital and 2a5ily )herapy, '#, 4 6P4AG.

    ;iesler, 9. F. (45 4*. 3atient e/periencing level and successful outcome in individual psychotherapy of schi ophrenics and psychoneurotics.. *o+rnal of ons+lting and linical

    Psychology, 31, G 7PGA6.

    ;ing, F. ". (45 5*. 4editation and the enhance5ent of foc+sing ability. npu)lished doctoraldissertation, &orthwestern niversity, 2vanston, Illinois.

    ;irtner, ". ., K Cartwright, 9. @. (456A*. @uccess and failure in client-centered therapy as afunction of initial in-therapy )ehavior. *o+rnal of ons+lting Psychology , $$, GE5PGGG.

    ;lein, . of Psychotherapy and eha9ior hange (p. 5>*.

    &ew Dork: Fohn "iley K @ons, Inc..

    eijssen , . (4557*. %n focusing and the necessary conditions of therapeutic personalitychange. In '. ietaer, F. 8om)auts, K 8. Lan Balen (2ds.*, lient entered and E periential

    Psychotherapy in the 7ineties (p. *. euven: euven niversity 3ress.

    eijssen, . (455=*. 2oc+singprocessen in clientgericht e perientiele psychotherapie. npu)lished doctoral dissertation, ;atholieke niversiteit euven, euven.

    eijssen, . (in press* 9ie @taerken und 'ren en von 0ocusing: einige 0orschungserge)nissein: *,>G=P>66.

    u)orsky, . (45AE* Cited in ;lein et al 45A= #he 2/periencing @cales.

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    utgendorf, @. ;., ntoni, . *. Changes incognitive coping strategies predict 2BL-anti)ody titre change following a stressor disclosureinduction. *o+rnal of Psychoso5atic 0esearch, 3:, =GP A.

    athieu-Coughlan, 3., K ;lein, . *. 2/periential 3sychotherapy: ;ey 2vents in

    Client-#herapist Interaction. In . &. 8ice K . @. 'reen)erg (2ds.*, Patterns of hange/ Intensi9e Analysis of Psychotherapy Process (pp. E4GPE>A*. &ew Dork, &D: #he 'uilford3ress.

    c ullin, 8. 2. (45 E*. 2ffects of counselor focusing on client self-e/periencing under lowattitudinal conditions.. *o+rnal of o+nseling Psychology, ' , EAEPEA6.

    orikawa, D. (455 *. aking practical the focusing manner of e/periencing in everyday life: consideration of factor analysis. )he *o+rnal of *apanese linical Psychology, '- (4*, 6AP =6.

    &i/on, 9. (45AE*. )he relationships of pri5al therapy o+tco5e with e periencing, 9oice@+ality and transference. npu)lished doctoral dissertation, Dork niversity, #oronto,%ntario.

    %)erhoff, 8. (4557*. #he 8ole of ttention in 2/periential 0ocusing. Dissertation Abstracts International, . ( niversity icrofilms &o. 5476=E5*

    %lsen, . 2. (45 6*. )he therape+tic +se of 9is+al i5agery and e periential foc+sing in psychotherapy. npu)lished doctoral dissertation, niversity of Chicago, Chicago.

    8ennie, 9. ., Brewster, . F., K #oukmanian, @. '. (45A6, Fanuary*. #he Counsellor #raineeas Client: Client process as a predictor of counselling skill ac$uisition.. anadian *o+rnal of

    eha9io+ral Science, '1, 4=PEA.

    8ichert, . (45 =, pril*. 2/pectations, e/periencing and change in psychotherapy. *o+rnal of linical Psychology, 3$, >GA.

    8iemer, 8. (45 6*. Effects of brief ree9al+ation co+nseling on e periential foc+sing.. npu)lished doctoral dissertation, California @chool of 3rofessional 3sychology.

    8ogers, C. (4565*. tentative scale for the measurement of process in psychotherapy. In 2. .

    8u)instein K . B. 3arloff (2ds.*, 0esearch in Psychotherapy (pp. 5=P47 *. "ashington,9.C.: merican 3sychological ssociation.

    8ogers, C. 8., 'endlin, 2. #., ;iesler, 9., K #rua/, C. B. (45= *. )he therape+tic relationshipand its i5pact/ A st+dy of psychotherapy with schi ophrenics. adison, "isconsin:niversity of "isconsin 3ress.

    8yan, 8. (45==*. )he role of the e periencing 9ariable in the psychotherape+tic process. npu)lished doctoral dissertation, niversity of Illinois, .

    @achse, 8. (4554, ay*. (9ifficulties of psychosomatic clients in assessing personal emotions

    and motives: possi)le conse$uences for therapeutic treatment:. Psychotherapy, Psychoso5atic 4edicine, Psychology, #', 4A P456.

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    @achse, 8. (4557*. #he Influence of #herapist 3rocessing 3roposals on the 2/plication3rocess of the Client. Person entered 0e9iew, -, 7+5ber 3, GE4PG> .

    @achse, 8., K &eumann, ". (45AG, 9ecem)er*. 3ro eBmodell um focusing unter )erucksichtigung spe ifischer pro)leme. BwB info/ Infor5ationsblatter der Besselschaft f+r

    wissenschaftliche Besprachspsychotherapie, -3, 64P G.

    @achse, 8., trops, ., "ilke, 0., K aus, C.. (455E*. 2oc+sing/ Ein e5otions entriertes Psychotherapie 8erfahren RS. Bern, 'oettingen, #oronto, @eattle: Lerlag

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    #omlinson, #. . K @toler, &. #he relationship )etween affective evaluation and ratings ofoutcome and therapy process with schi ophrenics. Psychotherapy >+ 4>-4A

    #rua/, C. B., K Carkhuff, 8. 8. (45=6*. Client and therapist transparency in the psychotherapeutic encounter. *o+rnal of on+seling Psychology, '$ (4*, GP5.

    van der Leen, 0. (45= *. Basic elements in the process of psychotherapy: a research study. *o+rnal of ons+lting and linical Psychology, 3', G56P>7G.

    LandenBos, '. 8. (45 E*. Se9eral analyses regarding Post 2oc+sing hec>list scores. npu)lished manuscript.

    LandenBos, '. 8. (45 G*. An in9ertigation of se9eral 5ethods of teaching "e periential foc+sing." . npu)lished doctoral dissertation, niversity of 9etroit, 9etroit.

    "alker, ., 8a)len, 8. K 8ogers, C (45=7* 9evelopment of a scale to measure process changein psychotherapy. *o+rnal of linical Psychology , 4=: 5-A6

    "arwar, &. (455=*. #he relationship )etween level of e/periencing and session outcome inclient-centered and process-e/periential therapies (9epression*. Dissertation Abstracts

    International, . ( niversity icrofilms &o. I Lol G>-7=*

    "eiser Cornell, . (455=*. )he Power of 2oc+sing. %akland, California: &ew

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    StudyExperiencing

    &atingsOrientation(opulation

    Outcome *easures and Findings

    ;irtner KCartwright

    456A

    anner of3rocess rated

    for firsttherapy hour.

    >E niversitycounseling

    center clients.

    CC

    - .=G

    E7 cases

    CC

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    8ogers et al45=

    2H3 veragefor #reatmentCourse

    rN . =+ . 5

    4>@chi ophrenics

    Control 'roup

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    Fennen 45 A ate rN.A7

    Change

    4G patients .4A.

    ess @uccessful G.64 for mid therapysessions. 2arly session n.s.

    'reen)ergK8ice 45A4

    2H3 9uring#wo Chairwork

    'estalt In @plit 8esolution )oth chairs startout at ow 2H3 and reach

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    #heme-related 2H3ratings forsecond half of therapy rN. A

    4 CC

    4A 3rocess-2/periential

    @econd half of therapy theme related2H3 at @tage > and even more at @tage= correlates with success on resideualgain scores on B9I, @C -578 and, at@tage = with 8osen)erg @elf-2steem.

    r N interjudge relia)ility o)tained on 2H3 ratings.ll studies are significant at p N .76 or )etter unless noted.n.s.N not significantCC N Client-centered therapy

    Ta,le < Focusing and Outcome

    Study Treatment (opulation Outcome*easure

    Findings

    eijssen 455= 2/periential

    3sychotherapy

    niversityCounselingCenter

    47E sessions

    3ositive or &egative C or #rated sessions

    6M positiveGGM of negativehad focusing

    eijssen 455= 2/periential3sychotherapy

    niversitycounselingCenter

    A clients

    @uccessfultermination in E7or fewer sessions

    2very sessioncontainedfocusing

    @achse 455E CC plus0ocusing vs CC

    0ocusingsessions rated on08@

    67 &euroticclients

    6 therapists

    #herapist@uccess 8ating+Client Change inBehavior and2/perienceJuestionnaire+Client rating

    CC plus 0ocusinggroup did )etter.

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    cited in @achse4557, ugust

    mid therapysession

    08@ @cale

    3rocessing @cale

    #herapist3rocessing @cale

    #’s make moredeepening

    proposals

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    @uggestions

    E* 0ocusing

    G*

    3I9epression @cale

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    radiologist + Ggroups,nN=1group

    Juestionnaire

    3re and 3ost

    9epression,0atigue andConfusion.Increased onLigor

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    Study Intervention (opulation*easures

    Findings

    eijssen 455= 0ocusing 3rocess9irectives and

    %pen Juestions

    > failure clients

    E> transcripts

    2H3 @cale

    ll Increased 2H3 duringtraining+ E maintained

    9urak et al 455 0ocusing#raining

    E7 therapy clients

    2H3 @cale

    3re to post therapy sessionsincreased in 2H3. Increasecorrelated with successfuloutcome

    LandenBos 45 G 4* 0ocusing

    E*9esensiti ation

    plus 0ocusing

    G* ffectivessociation0ocusing

    >* Controls

    A non-focusersidentified )y 30C

    E trainingsessions in eachcondition

    0ocusing increased for alltreatment conditions comparedto controls. &o difference

    )etween types of 0ocusingtraining.

    %lsen 45 6 Image 0ocusingInstructions with8ela/ation

    E= private practiceindividualtherapy clients

    2H3+ 30C, I0

    2H3 ( 8elia)ility . = - .A7*increased from pretrainingtherapy sessions during training..ost reached stage >. T&otmaintained in post trainingtherapy sessions = M of non-focuseres in first training sessionwere a)leto 0ocusing duringtraining.

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    >*0 in hypnosis

    Clark 45A7 0ocusing#raining0ocusinginstruction

    after )aseline period

    #herapy patients

    2H3 @cale

    Increase 2H3 when 2 gavefocusing instructions versus

    )aseline periods during therapyanalogue interviews.

    @choeninger45=6

    @elf-2/periencing#raining (4session*

    GEndergraduates

    2H3 @cale

    Increase 2H3 in first part ofanalogue therapy interview(. 6- . *

    E psychoticinpatients

    Control group

    Increased in #alker and

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    2H3+ 0ocusingtraining orcontrols

    A 3sychoanalyticcases

    immediate e/perience producedhigher C 2H3. nd 0ocusingtraining )efore sessions, alsoincreased C. 2H3.

    ;ria et al 455E #herapist8eferent 2H3evel higher thanClient 2H3

    8ogers therapysession with'loria

    Client 2H3 increased

    @achse #herapist3rocessing3roposals.#herapist intendsto deepenClient’s2/periencingevel.

    46E clients at midtherapy+ 64 #

    Client 3rocessing@cale (2H3depth*

    #herapist3rocessing @cale

    # deepening response leads to Cdeepening e/periencing 7M ofthe time

    # flattening response leads to Cflattening response GM of time

    @achse 4557 #herapist3rocessing3roposals

    >A Clients midtherapy+ >A CCtherapists

    @ame measuresas a)ove plus te/t

    analysis

    # has strongest effect whenresponds to core of C statement.

    "hen # misunderstood C,resulted in flattening responseAEM of the time

    @achse 0ocusing training program fortherapists.

    >7 therapiststrained for si/months

    #herapists did learn to focus andthose most a)le were )etter a)leto help their clients focus duringtherapy sessions.

    @achse students4555

    CC12 therapy #herapist 0itCapacity

    0ocusing 8ating

    @cale

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    2lliot et al 45AE+45AG

    #herapist

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    #etran 45A4 2ncounter 'rouptraining

    su)jects Increased 2H3

    8iemer, 45=6 4* 8eevaluationCo counselingclass plus weekly

    pairs

    E* Individualcounseling plusclass to discussfeelings a)outsessions.

    >A collegestudents

    Both groups increased 0ocusinga)ility on 30J and 30C. &odifference )etween groups.


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