Experiences of the step-out technique in emotion-focused therapy for clients with autistic process

Figures & data

Table 1. Process-experiential task: marker, intervention, end state.

Task marker	Intervention	End state
Experiencing tasks
Interoception Marker: Interoceptive functioning difficulties (e.g. out of touch with internal bodily sensations and feelings; disembodied with self)	Step-out	Expressions of sensory signals and feelings located in awareness (externalized to internalized sensory shift; bodily awareness; embodied self)

Table 2. Thematic analysis of step-out.

Theme	subtheme	illustration
IN-SENSING ME TO CONNECTING TO YOU
IN-AND-OUT-OF INTEROCPTIVE CONTACT	No felt change Expanding body awareness Emotional overwhelm	‘Feels the same. Feeling neutral’ [gives non-verbal neutral gesture] “feel it in my chest” that “it helps control my heart rate” ‘Oh my god! Not too great! My heart is beating fast, I’m not feeling great because I know my heart is beating fast.
LETTING GO OF TENSION	Pain reliever Regulatory sensibility Harmonious state	‘it feels good as the pain in my back is less’ ‘Feels good. When I exhaled it was like a cooling feeling. Like a fresh sensation’ “it’s a net improvement of more awake and more relaxed
BEYOND SELF- EXPERIENCE		“I know what you mean by neutral. I’m the same as you [points toward the other male group member]. It is a latent feeling most of the time and I don’t feel anything at all, which is good”

Table 3. Client’s trajectory from fear response to relaxation.

Step-out Task	Immediate Response
Session 1	Oh my god! [face flushed] I can’t believe that [holding her eyes and then rubbing her eyes] (T) How are you feeling just now? Not too great! My heart is beating fast, I’m not feeling great because I know my heart is beating fast.
Session 2	Good. When I exhaled it was like a cooling feeling. Like a fresh sensation.
Session 3	I feel the same as I did last week. Cooling and refreshing. Feels about the same. Its good.
Session 4	The same as last week. Good. Feels fresh.
Session 5	Yeah. It feels good. Feels cooling and refreshing.
Session 6	It feels good. Cooler and refreshing.
Session 7	The same as last week. When I exhale it feel a fresh sensation. It feels good.
Session 8	Good. I feel calmer and it cools me down.
Session 9	The same as the last few weeks. Cooler when I exhale and calmer, more relaxed.

Table 4. Client illustration of interoceptive sensibility and interoceptive awareness.

Step-out Task	Immediate Response
Session 1	I’m not as toastie (warm) as I was. Quite good. More realxed.
Session 2	I’m not as warm as I was, I’m not sweating as much, which is always good. Like you said improved respiration.
Session 3	That’s actually helped my back a bit. Stretching usually does. My back hurts less which is good.
Session 4	[stroking bead] Or stroke your beard as it may be. It felt good. I’ve actually been able to synchronise my sweating a little bit. Breathing is really good for that. It’s hard to do if you’re in a rush.
Session 5	[You know I can’t feel my hands through my beard] I feel a bit cooler, which helps. Which I see as a net improvement because it was pretty toasty when I got in. It feels kinda like aerobics, I was thinking that when my hands were going up and down. It seemed to help. You sweat a lot when you’re warm, but if you can regulate your breathing you can control your rate of sweat. It did seem to have a good net effect for that.
Session 6	[twisting neck from side to side] My necks cramped. I’ve been getting that quite a lot. Its always in the same spot. I’ve been thinking about going to casualty to see if they will x-ray it. I feel more relaxed. I think the breathing is really good for that. It controls your sweat and tension.
Session 7	Cathartic, a relief. Both the last session and the S-O and last week. Last week I was just really agitated and the train station barrier wouldn’t lift and this created stress. The S-O helps to feel a bit calmer. Helps you to control your heart rate.
Session 8	Less sweaty
Session 9	Better. I’m breathing better. I think it is really good for that, to control pace. To control the pace of your breathing.

Table

Individual steps of the Step-Out Task	Perceived level of Competency
	Failing	Emerging	Passing
1.Find a space in the room where you can stand alone, with space between you and other group members
2.Stretch out your arms to see if you have enough room to move without touching anyone standing close to you
3.Listen to my instructions and or look at me (the therapist) demonstrating the actions (or both) which ever you find most helpful, now:
4.Stand in an upright position with your feet apart and parallel, aligned with your hip bones.
5.Allow your facial muscles to relax and have your eyes open looking straight ahead, at the level of the horizon.
6.I (the therapist) am going talk you through the following action and when doing this you should try to have your breathing (respiratory rhythm) synchronized (in time) with the movement of your arms:
7.Inhale and extend your arms, and lift them in front of your body with your fingers interlinked loosely, tracing a sort of “generous arc” over your head, bending your elbows as your hands reach behind your neck. [the therapist demonstrates this action while the inhalation is synchronized with the speed of the lifting arms].
8.Pause and hold the pose
9.Release your breath through slightly open lips, and now bend your arms in synchrony with your exhalation until they return to the original position. All the breath should be exhaled.
10.Inhale and extend your arms, and lift them in front of your body with your fingers interlinked loosely, tracing a sort of “generous arc” over your head, bending your elbows as your hands reach behind your neck.
11.Pause and hold the pose
12.Release your breath through slightly open lips, and now bend your arms in synchrony with your exhalation until they return to the original position. All the breath should be exhaled.
13.Inhale and extend your arms, and lift them in front of your body with your fingers interlinked loosely, tracing a sort of “generous arc” over your head, bending your elbows as your hands reach behind your neck.
14.Pause and hold the pose
15.Release your breath through slightly open lips, and now bend your arms in synchrony with your exhalation until they return to the original position. All the breath should be exhaled.
16.Inhale and extend your arms, and lift them in front of your body with your fingers interlinked loosely, tracing a sort of “generous arc” over your head, bending your elbows as your hands reach behind your neck.
17.Pause and hold the pose
18.Release your breath through slightly open lips, and now bend your arms in synchrony with your exhalation until they return to the original position. All the breath should be exhaled.
19.Inhale and extend your arms, and lift them in front of your body with your fingers interlinked loosely, tracing a sort of “generous arc” over your head, bending your elbows as your hands reach behind your neck.
20.Pause and hold the pose
21.Release your breath through slightly open lips, and now bend your arms in synchrony with your exhalation until they return to the original position. All the breath should be exhaled.
22.Touch your face with both hands, apply gentle massage-like movements from the center of your face outwards.
23.Shake the whole of your body