Cognitive-affective processing using integrated focusing: pursuing the therapeutic implications of the interacting cognitive subsystems model

The therapeutic implications of Teasdale and Barnard’s (1993) Interacting Cognitive Subsystems model were used to develop an integrative approach to psychotherapy, Integrated Focusing Processing (IFP). In order to achieve integrated cognitiveaffective processing, IFP uses a modified form of Focusing (Gendlin, 1978) incorporated with interventions from different schools of therapy including cognitive behaviour, client-centred, emotion focused, and Gestalt therapies. IFP is also informed by schema focused, Ericksonian, and redecision therapies. IFP attempts change at the Implicational level of meaning, a holistic level of meaning derived from multi-modal schema, responsible for emotion production. Following the ICS model, change at this level has the potential to change not only psychological symptoms but also intellectually-held, maladaptive beliefs as well as emotionally-held, maladaptive beliefs. This thesis presents a series of studies to examine whether IFP could be an effective therapy. Study one is a one-session, exploratory, therapy development study with six private practice patients. All patients rated their onesession gains as significant and made clinically significant gains as judged by their referring therapist. Study two is an exploratory pilot study conducted at a community mental health service for three chronic, complex cases comprising six treatment sessions which integrated Focusing, Gestalt, emotion focused, and cognitive therapy with imagery rescripting. Quantitative and qualitative data were collected. All three cases no longer met DSM-IV criteria and made clinically significant gains on multiple measures which generalised. Treatment gains were maintained at 6- and 20- month follow-up for two cases and partially, but substantially, for one case. One case is described in more detail to serve as an illustration of IFP and highlights working within a dissociative state in imagery rescripting which was immediately followed by clinically significant improvement that generalised and was maintained. Process measures showed changes that suggested treatment gains were likely to be specific to IFP. The studies presented give prima facie evidence that justifies further research into IFP.