Confrontation and Heightening of Emotion

After the development of a healthy therapeutic relationship, as measured by client self-reports and the SRS, confrontation was utilized in session to confront dysfunctional cycles. Confrontation was also utilized to heighten emotion in session, a hallmark of the SEFT approach. Stephan described the cycle of interactions with his ex-wife since the divorce which resulted in significant increases of depressive and anxious symptoms immediately following by asking “What happened to change? I guess old habits die hard.” Rather than continue to enable the cycle, the therapist used confrontation to highlight how Stephan was contributing to his own distress and exacerbation of symptomology. Session 10 occurred after a painful encounter for Stephan in which his ex-wife revealed that she was now dating a woman and wanted to cease all contact with him (notice the extreme difference in ORS scores in Figure 1). While discussing the conversation in session, the therapist utilized questions to access Stephan’s underlying feelings regarding the situation resulting in an observable increase of anxiety symptoms. Stephan’s respiration increased, he began to perspire and exhibited fidgeting behaviors. Stephan reported “I’m sorry. These are all great, thought-provoking questions, but right now I can’t even think straight. How could she do this to me?” After unsuccessful attempts to manage anxiety in session, he opted to terminate the session early—a choice that was brought up at the start of the next session.

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