How and when immersion and distancing are useful in emotion focused therapy for depression

Figures & data

Table I. Evolution of depressive symptoms in the six cases (BDI-II).

Group	Case	Session 1	Session 4	Session 8	Session 12	Session 16
Good-outcome group	Case 1	19	15	18	8	2
	Case 2	15	27	0	0	1
	Case 3	28	19	11	4	1
Poor-outcome group	Case 4	32	26	22	18	29
	Case 5	25	19	18	23	16
	Case 6	22	21	18	23	22

Table II. Brief description of immersion and distancing subcategories.

Type of speech	Subcategories	Contents	Examples
Immersed	What statements	Client describes a specific chain of events	“He yelled at me and treated me badly.” “He told me to back off.”
		Client describes specific and original thoughts or behaviors	“I went to my room and cried for a long time.” “My work is worthless.”
	Attributive statements	Client ascribes characteristics to self or others without explaining or providing reasons to them	“He was mean.” “I was kind of stupid.”
		Client describes feelings or other internal states	“I feel sad.” “I feel happy.” “I have a great pain and a permanent restlessness.”
Distanced	Insight statements	Client describes the causes underlying the event, his or her feelings, behaviors, and cognitions	“He does not respect me because I never established any limits.”
		Client establishes relations between behaviors, feelings, or cognitions	“Maybe I reacted that way because I felt he rejected me.”
		Client expresses new awareness about own behaviors, feelings, or cognitions	“It may have been somehow irrational but now I better understand my motivation then.”
	Closure statements	Client indicates he or she assesses a past experience from a broad perspective, taking into account past and current experiences to make sense of feelings and experiences	“I look back and I see that suffering had to do with how I interpreted criticisms. Now I know that critical remarks can be constructive and it does not mean that others do not like me.”
		Client establishes relations (contrasts or similitudes) between past and present behaviors, feelings or cognitions.	“Today I know that I’m valued by my father.” “Today I barely hugged my father, whereas before we were like brothers.”
		Client express present feelings or thoughts about past experience or situations	“I thought about how glad I am that part of my past is over.” “I see my past as a difficult moment of my life that brought implications in what I am today.”

Figure 1. Evolution of immersed and distanced speech and clinical symptoms in the good-outcome group.

Figure 2. Evolution of immersed and distanced speech and clinical symptoms in the poor-outcome group.

Table III. Evolution of distanced speech in the six cases.

Group	Case	Number of words total per session					Number of word of distanced speech					Relative frequency of distanced speech (%)
		Sessions					Sessions					Sessions
		1	4	8	12	16	1	4	8	12	16	1	4	8	12	16
Good-outcome group	Case 1	4102	3906	6088	4667	6284	456	1009	2039	2204	3866	11.12	25.83	33.49	47.23	61.52
	Case 2	5248	5372	10224	9825	10017	442	357	3864	6043	5094	8.42	6.65	37.79	61.51	50.85
	Case 3	4770	2231	3494	1686	1797	344	411	1014	745	1449	7.21	18.42	29.02	44.19	80.63
Poor-outcome group	Case 4	2523	3161	2463	1477	2410	287	839	660	429	1119	11.38	26.54	26.80	29.05	46.43
	Case 5	5283	6116	4248	2526	3212	1023	887	603	504	1679	19.36	14.50	14.19	19.95	52.27
	Case 6	3995	3911	3109	2102	2638	567	335	827	537	509	14.19	8.57	26.60	25.55	19.29