Literature Review

Literature Review: Emotion-Focused Treatment
Desirée Mertz
Messiah College
Introduction
Trauma can affect many families in many different ways. A child who experiences trauma will carry it to adulthood, which can affect their choices and path through life. The hypothesis is to determine whether emotion-focused therapy is effective in cases of childhood trauma.

Emotion-Focused Therapy and Child Trauma
Emotion-Focused Therapy is beneficial when working with survivors of child trauma. Child abuse survivors are considered to have endured trauma (Paivio and Nieuwenhuis, 2001). A study by Paivio and Nieuwenhuis (2001) was conducted to evaluate the effectiveness of Emotion-Focused Therapy for adult survivors (EFT-AS) and to obtain evidence of change that would permit future examination of the emotional processes related to change. Paivio and Nieuwenhuis (2001) completed this study by doing 20 one-hour weekly sessions of therapy with participants. These sessions had three therapeutic tasks which were to establish a safe and collaborative therapeutic relationship; overcome avoidance or defensive processes; and to resolve issues with past abusive and neglectful others (Paivio and Nieuwenhuis, 2001). Some of the participants were assigned to a wait period that was approximately 20 weeks where the clients were telephoned monthly to inquire about their well-being in a phone conversation that lasted less than 5 minutes (Paivio & Nieuwenhuis, 2001). In this study they found that clients who received EFT-AS had significantly greater improvements in a broad spectrum of disturbances and that the participants maintained treatment success 9 months after the therapy was completed (Paivio & Nieuwenhuis, 2001).
Paivio, Jarry, Chagigiorgis, Hall and Ralston (2010) completed a study using two versions of emotion-focused therapy (EFT) for trauma (EFFT). The first version was imaginal confrontation (IC) which involved using an empty chair and the second version was empathic exploration (EE) which clients interacted exclusively with the therapist to explore issues with the perpetrators (Paivio et al., 2010). Paivio et al. (2010) found that both groups showed a steady rate of improvement. In the IC client a larger proportion was reliably improved and recovered, and smaller proportion deteriorated compared to the EE clients (Paivio et al., 2010). In this article Paivio built on her previous study from 2001 listed above.

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Holowaty and Paivio (2012) researched characteristics of client-identified helpful events in emotion-focused therapy for child abuse trauma. This study looked at helpful events (HE) and control events (CE) (Holowaty and Paivio, 2012). Helpful events were taken from the “Helpful Aspects of Theory Questionnaire (HAT) where clients were asked to respond to four-open ended questions and asked to describe the most important, second most important and third most important events (Holowaty and Paivio, 2012). The events that were descried as most important on the posttreatment HAT were given priority as helpful events (Holowaty and Paivio, 2012). Control evens were researcher-defined (Holowaty and Paivio, 2012). Holowaty and Paivio (2012) found that clients in the HE group achieved the greatest depth of experiencing. This study also found that there were higher levels of emotional arousal in the HE compared to the CE (Holowaty and Paivio, 2012).

Our client suffered from physical and emotional abuse which is classified as trauma. Due to this trauma emotion-focused therapy would be beneficial to her. These studies support the hypothesis that emotion-focused therapy is beneficial for clients who suffer from trauma.
Forgiveness, Anger, and Attachment
In a study by Sandage and Worthington (2010) they looked at forgiveness, empathy, and attachment theory. This study randomly assigned participants to one of three groups which were the Empathy-oriented Forgiveness Seminar, the Self-enhancement Forgiveness Seminar, and the wait-list control group (Sandage and Worthington, 2010). The wait-list control group received no treatment and then in Round one had no interaction with researchers but in Round 2 they were randomly assigned to treatment seminars (Sandage and Worthington, 2010). Sandage and Worthington (2010) found that the empathy-oriented and self-enhancement seminars both promoted forgiveness when they were compared to the waitlist control group. This study found that empathy mediated changes in the levels of forgiveness for the participants’ (Sandage and Worthington, 2010). When looking at shame, guilt, and forgiveness this study found that guilt was positively related to forgiveness scores and shame was negatively related to forgiveness (Sandage and Worthington, 2010).

Steinmann, Gat, Nir-Gottlieb, Shahar, and Diamond (2017) looked at attachment-based family therapy (ABFT) and individual emotional focused therapy (EFT) for unresolved anger with a parent. This unresolved anger can last for a long time and destroy the relationship (Steinmann et al., 2017). In both groups, the clients reported that their relationships with their parents changed for the better and that they viewed their parents differently and with more compassion after the therapy (Steinmann et al., 2017). Steinmann et al., (2017) also found that clients attributed change to productive emotional processing in both groups. In the AFBT group clients noted the importance of their parents participating in treatment and mutual vulnerability (Steinmann et al., 2017). Whereas the EFT clients noted the importance of remembering previously avoided memories and feelings and getting their anger off their chest (Steinmann et al., 2017).

Looking at these studies our client has a lot of anger at her family especially her father and her brothers that is causing her to have problems in her current relationship. Using empathy-oriented seminars may help to lead her to forgiveness. Using ABFT and EFT will help her with her unresolved anger and may lead her to form a secure attachment with her boyfriend. If our client uses AFBT and EFT to practice confrontation and compassion towards her father and brothers it will help bring her closure and a positive outlook as well.

Demographics
The demographics of the participants of these studies were very similar. In all of the studies there were more females than males. Most of the participants in each of these studies was Caucasian/White. The largest group of perpetrators in these studies was family consisting of mothers and fathers. Our client is a Caucasian female who experienced child abuse from her father and her brothers but she also blames her mother for not protecting her and stopping the abuse that she endured. Blaming of the mother is a very common thing to do when in these situations.

Conclusion
After reviewing this literature it supports the hypothesis that emotion-focused therapy is beneficial for child trauma survivors. Due to the trauma that our client endured, it appears that emotion-focused therapy will be beneficial to her. This therapy may help her to be able to form secure attachments and change her maladaptive emotion schemes. In the future she could feel more secure, having had the opportunity to work through her toxic emotions in a safe environment.

References
Holowaty, K. A. ; Paivio, S. C. (2012). Characteristics of client-identified helpful events in
emotion-focused therapy for child abuse trauma. Psychotherapy Research, 22, 56-66. http://dx.doi.org/10.1080/10503307.2011.622727
Paivio, S. C., Jarry, J. L., Chagigiorgis, H., Hall, I., ; Ralston, M. (2010). Efficacy of two
versions of emotion-focused therapy for resolving child abuse trauma. Psychotherapy Research, 20, 353-366. doi: 10.1080/10503300903505274
Paivio, S. C. ; Nieuwenhuis, J. A. (2001). Efficacy of emotion-focused therapy for adult
survivors of child abuse: A preliminary study. Journal of Traumatic Stress, 14, 115-133. http://dx.doi.org.ezproxy.messiah.edu/10.1023/A:1007891716593
Sandage, S. J. ; Worthington, Jr., E. L. (2010). Comparison of two group interventions to
promote forgiveness: Empathy as a mediator of change. Journal of Mental Health Counseling, 32, 35-57. http://dx.doi.org.ezproxy.messiah.edu/10.17744/mehc.32.1.274536n518571683
Steinmann, R., Gat, I., Nir-Gottlieb, O., Shahar, B., ; Diamond, G. M. (2017) Attachment-based
family therapy and individual emotion-focused therapy for unresolved anger: Qualitative
analysis of treatment outcomes and change processes. Psychotherapy, 54, 281-291. http://dx.doi.org/10.137/pst0000116