How therapists operationalise the experiential components of person‐centred experiential therapy in the treatment of depression: generating psychotherapeutic exemplars for training practitioners

Background Person-centred experiential therapy (PCET) is an evidence-based psychological therapy for the treatment of depression delivered within the English NHS Talking Therapies for Anxiety and Depression programme. Process research is needed to understand how therapists operationalise the experiential components which, according to emotion theory, constitute mechanisms of change.

Method Digital session recordings for 15 PCE therapists in the PRaCTICED trial that received the highest mean score for experiential specificity, emotion regulation sensitivity and emotion focus were selected and transcribed. NVivo was employed to conduct a qualitative analysis of the transcripts using framework analysis. These three experiential items constituted a priori themes, with the most specific subthemes identified as therapist interventions. Representative exemplars were synthesised from verbatim therapist and client exchanges to illustrate each intervention.

Results Four themes were identified: reflecting, intensifying feelings, understanding, and active guiding, with 12 subthemes, and 26 types of therapist intervention. The sequence of four themes suggests a range of interventions which reflect increasing activeness of therapist contributions in the session. The procedure adopted demonstrates that it is possible to generate exemplars for psychotherapeutic interventions based on anonymised but real practice which have potential utility for training, supervision and deliberate practice.

Conclusions Therapists' interventions conform to emotion theory, offering active interventions woven into a nondirective person-centred relationship. The four themes suggested a loose sequence of experiential interventions, beginning with the therapist helping to orient the client towards their emotions, through identifying, articulating and exploring emotions, to working with emotional processes to resolve distress.