PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES

2020, VOL. 19, NO. 1, 1–11

https://doi.org/10.1080/14779757.2019.1618370

Overcoming shame and aloneness: Emotion-focused group

therapy for self-criticism
Sarah Thompsona and Laura Girz a

a
Centre for Student Development and Counselling, Ryerson University, Toronto, Ontario, Canada

ABSTRACT ARTICLE HISTORY

Emotion-focused group therapy is a relatively new therapy format Received 3 December 2018
that utilizes individual emotion-focused therapy (EFT) work in Accepted 28 February 2019
a group setting to evoke and transform painful emotions, both KEYWORDS
directly and vicariously. Currently, EFT groups are being run at Emotion-focused therapy;
sites in Canada, Australia, Spain, Norway and the United States, group; self-criticism; anxiety;
and interest appears to be growing in offering these groups. depression
Existing literature shows reductions in disordered eating and
depression symptoms among EFT group participants with eating
disorders; however, there is a dearth of data on participants with
mood disorders. Participants in the current study were university
students presenting to counseling with symptoms of depression
or anxiety who identified significant self-critical processes, and
who were referred to a weekly EFT therapy group. Over the course
of group, participants reported statistically and clinically significant
decreases in depression and anxiety symptoms, as well as signifi-
cant improvements in emotion regulation. These results contribute
to the emerging literature on group-based EFT, and implications of
these results on group provision are discussed. Overall, this study
suggests that emotion-focused group therapy is a promising treat-
ment for symptoms of anxiety and depression, and is worthy of
further study. Experiential therapies, which work to transform
painful emotions underlying symptoms, are typically individual
treatments, and group therapy can provide increased access to
this type of care.

Surmonter la honte et la solitude: autocritique et

thérapie de groupe centrée sur l’émotion
Le groupe de thérapie centrée sur l’émotion (TCE) est une forme
de thérapie relativement neuve qui utilise la thérapie individuelle
centrée sur l’émotion dans un cadre de groupe pour évoquer et
transformer les émotions douloureuses, à la fois directement et de
manière vicariante. A l’heure actuelle, des groupes de TCE sont en
place en diverses contrées au Canada, en Australie, en Espagne, en
Norvège et aux Etats Unis et l’intérêt envers ces groupes semble
aller croissant. La littérature disponible montre des réductions des
troubles alimentaires et des symptômes de dépression chez les

CONTACT Laura Girz laura.girz@ryerson.ca Centre for Student Development and Counselling, Ryerson
University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
Supplemental data for this article can be accessed here.
© 2019 World Association for Person-Centered & Experiential Psychotherapy & Counseling
2 S. THOMPSON AND L. GIRZ

participants de groupes de TCE ayant des troubles alimentaires,

bien qu’il y ait un manque de données relatives aux participants
ayant un trouble dépressif. Les participants de l’étude en cours
étaient des étudiants universitaires s’étant présentés en counsel-
ing avec des symptômes de dépression ou d’anxiété qui dénotent
de processus auto-critiques significatifs et qui ont été adressés à
un groupe hebdomadaire de TCE. Dans le cours du groupe, les
participants reportent une baisse statiquement et cliniquement
significative des symptômes de dépression et d’anxiété, ainsi que
des améliorations significatives de la régulation des émotions. Ces
résultats contribuent à la littérature émergente à propos des
groupes de TCE. Les implications de ces résultats sur l’offre de
tels groupes sont discutées.

Scham und Einsamkeit bewältigen:

emotionsfokussierte Gruppentherapie gegen
Selbstkritik
Emotionsfokussierte Gruppentherapie ist ein relativ neues Therapie-
Format, welches emotionsfokussierte Einzeltherapie-Arbeit im
Gruppensetting verwendet, um schmerzhafte Emotionen hervorzuru-
fen und zu transformieren, sowohl direkt als auch stellvertretend.
Aktuell gibt es EFT-Gruppen in Kanada, Australien, Spanien,
Norwegen und in den Vereinigten Staaten. Das Interesse daran scheint
durch das Angebot solcher Gruppen zu wachsen. Es gibt Literatur zum
Thema Essstörungen und EFT-Gruppen, die zeigt, dass Essstörungs-
und Depressionssymptome bei den Teilnehmenden mit Essstörungen
zurückgehen. Es gibt jedoch zu wenig Daten zu Teilnehmenden mit
affektiven Störungen. Die Teilnehmenden dieser Studie waren
Universitätsstudierende, die sich mit Depressionssymptomen oder
Ängsten an die Beratungsstelle wandten und die signifikante selbst-
kritische Prozesse zeigten; sie waren zu einer wöchentlichen EFT-
Therapiegruppe überwiesen worden. Im Lauf der Gruppe berichteten
Teilnehmende sowohl von einer statistisch und klinisch signifikanten
Verringerung ihrer Depressions- und Angstsymptome als auch von
signifikante Verbesserungen in der Emotionsregulation. Diese
Resultate ergänzen die noch junge Literatur zu gruppenbasierter EFT.
Die Implikationen dieser Resultate für das Angebot von Gruppen
werden diskutiert.

Superar la vergüenza y la soledad: terapia grupal

centrada en las emociones para la autocrítica
La terapia grupal centrada en las emociones es un formato de
terapia relativamente nuevo que utiliza la terapia individual cen-
trada en las emociones en un entorno grupal para evocar
y transformar emociones dolorosas, tanto directa como indirecta-
mente. Actualmente, los grupos de EFT se están ejecutando en
sitios en Canadá, Australia, España, Noruega y los Estados Unidos,
y el interés parece estar creciendo en la oferta de estos grupos. La
literatura existente muestra reducciones en los síntomas de
alimentación y depresión desordenados entre los participantes
del grupo EFT con trastornos de la alimentación, sin embargo,
hay una escasez de datos sobre los participantes con trastornos
 PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 3

del estado de ánimo. Los participantes en el presente estudio

fueron estudiantes universitarios que acudieron a consejería con
síntomas de depresión o ansiedad que identificaron procesos
autocríticos significativos y que fueron remitidos a un grupo de
terapia de EFT semanal. En el transcurso del grupo, los participan-
tes informaron disminuciones estadísticamente y clínicamente sig-
nificativas en los síntomas de depresión y ansiedad, así como
mejoras significativas en la regulación de la emoción. Estos resul-
tados contribuyen a la literatura emergente sobre EFT basada en
grupo, y se discuten las implicaciones de estos resultados en la
provisión grupal.

Ultrapassar a Vergonha e a Solidão: Terapia de

Grupo Focada na Emoção para a Auto-Crítica
A terapia de grupo focada na emoção é um formato terapêutico
relativamente novo que usa o trabalho da terapia focada na
emoção individual no contexto de grupo e transforma emoções
dolorosas, de forma direta e indireta. Atualmente, os grupos de
TFE são levados a cabo no Canadá, Austrália, Espanha, Noruega
e Estados Unidos e o interesse neles parece estar a crescer.
A literatura existente mostra uma redução na alimentação desre-
grada e sintomas de depressão nos participantes de grupos de TFE
com perturbações do comportamento alimentar e perturbações
do humor. Os participantes no estudo atual eram estudantes
universitários que se apresentavam em terapia com sintomas de
depressão e ansiedade e que identificavam processos significati-
vos de autocrítica e foram referenciados para uma sessão semanal
de terapia de grupo. No decurso do grupo, os participantes rela-
taram decréscimos significativos – em termos estatísticos
e clínicos – nos níveis de depressão e de ansiedade, assim como
melhorias significativas na regulação das emoções. Estes resulta-
dos contribuem para a literatura emergente para a terapia de
grupo da TFE e discutem-se as implicações destes resultados
para o surgimento de grupos.

Individual emotion-focused therapy (EFT) is considered an evidence-based treatment for

depression and complex trauma (Greenberg, 2005; Paivio & Pascual-Leone, 2010), with an
emerging evidence base for anxiety (Watson & Greenberg, 2017). EFT involves changing
emotion with emotion by accessing and transforming maladaptive emotions schemes
(e.g. shame, fear and lonely abandonment) underlying presenting symptoms. Therapeutic
tasks assist in moving toward painful and avoided emotions that have not been fully
processed, staying with and deepening painful experience, and using marker-driven tasks
to evoke new and more adaptive experiences of self and others (e.g. self-compassion, self-
soothing, assertive anger). By evoking maladaptive and painful emotions and then coac-
tivating adaptive emotion schemes, novel responses to triggers of maladaptive emotion
schemes are created and re-encoded, transforming enduring painful responses to past
emotional injury.
EFT has the potential to be a powerful modality in group settings given the deep
emotion and vulnerability evoked in doing this work, which lends itself to connection
and vicarious healing. Group EFT involves components of individual EFT, namely
4 S. THOMPSON AND L. GIRZ

focusing, two-chair work for self-critical splits and self-interruptive processes, self-
compassion tasks and unfinished business with attachment figures. With the exception
of the first and last group meetings, one participant each week engages in an individual
EFT session in front of the group, usually with a focus on self-criticism, and other group
members witness this work and share their emotional reactions and experiences. Telling
one’s story, especially when paired with the experience and expression of felt emotion,
in front of a group is a tremendously vulnerable act. Feeling compassion toward one’s
peers, feeling connected to one’s peers, and feeling safe in the presence of others when
vulnerable has tremendous capacity to shift maladaptive emotion schemes. When
maladaptive schemes are repeatedly evoked (directly and vicariously), when fundamen-
tal needs are repeatedly articulated, and when adaptive schemes are repeatedly evoked
toward others and toward one’s self, profound restructuring of emotion schemes occurs.
In a group setting, after feeling profound compassion for others, and after having deeply
identified with the experience of self-criticism described and enacted by others, it
becomes harder and harder for clients to maintain the belief that they are truly different
and undeserving of compassion themselves. In this group then, we see deep changes in
evoked emotion schemes, and in clients’ narratives regarding their own and others’
experiences, pairing affective change with new meaning.
EFT groups are relatively new and little has been published on the effectiveness of
group EFT, although sites in Canada, Australia, Spain, Norway and the United States are
currently running groups based on EFT principles. Preliminary findings have shown
reductions in disordered eating and depression symptoms as well as improvements in
emotion regulation over the course of group EFT for individuals living with eating
disorders (Ivanova, 2013; Tweed, 2013; Wnuk, Greenberg, & Dolhanty, 2015). One pilot
study (six participants) to date has examined group EFT for depression and anxiety, with
significant increases in emotion regulation observed, but no significant change in
anxiety or depression scores, possibly because the number of participants was so low
(Lafrance Robinson, McCague, & Whissel, 2014). Given the evidence base for EFT as an
individual therapy, and the preliminary evidence indicating possible effectiveness of EFT
group for eating disorders, further exploration of EFT group therapy for other presenting
issues, including depression and anxiety is merited. Additional contributions of the
current study include examination of group EFT in a university population and inclusion
of outcomes over two rounds of chair work.

Method
Participants
Participants were undergraduate and graduate students at an urban public university
who were seeking counseling services (mean age = 23.6 (SD = 4.0); 21% male and 79%
female). Participants were referred to group by counseling staff to work on self-critical
processes associated with anxiety or depression symptoms. All participants were asked
to attend an intake appointment with one of the group facilitators to assess suitability
for the group. During the group intake, the purpose and format of the group was
explained, psychoeducation about emotions and EFT was provided, and participants
 PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 5

were asked to engage in a brief (20–30 min) chair work session to assess their ability to
access and regulate emotions, and to give them a sense of the task to be used in group.
Inclusion criteria for the group included self-identification of a harsh inner critic
(contemptuous or anxious), ability to safely regulate emotion and capacity for deep
compassion for others. When recruiting for group, clinicians were asked primarily to
refer clients with ability to express emotion once evoked, but clients who were over-
regulated and had difficulty accessing or expressing emotion were also accepted as
referrals and considered for group. Often two to three participants with difficulties
accessing emotion were invited to group, as vicarious experiencing of others’ emotional
processing appeared to be helpful in helping them deepen their own experiencing and
access to emotion. Including more than this number of overregulated participants
tended to detract from the group process and power of group, possibly due to reduc-
tions in group cohesion related to too much avoidance of emotion in the group process.
Exclusion criteria included individuals engaging in frequent nonsuicidal self-injury, or
those living with persistent patterns of active suicidal ideation, and a suicide attempt
within the past year. Individuals were also excluded if they were struggling with
psychosis or possible prodromal psychotic features, or for other presentations where
explicit attention to ‘aspects’ of self may have been psychologically destabilizing as in
the case of significant dissociative processes.

Measures
Participants filled out measures of anxiety (BAI; Beck Anxiety Inventory; Beck, Epstein,
Brown, & Steer, 1988), depression (BDI; Beck Depression Inventory; Beck, Steer, & Brown,
1996), emotion-regulation (DERS; Difficulties in Emotion Regulation Scale; Gratz &
Roemer, 2004) and well-being (MHC-SF; Mental Health Continuum-Short Form; Keyes,
2009) after the first group session and every fourth group session thereafter, including
the final group session. Participants completed these questionnaires immediately fol-
lowing group, or took these home to fill out within a day if they could not stay after
group. Participants returned the questionnaire packets at the following group session
and measures not completed within the week were not included in the analysis.
Data were collected as part of program evaluation across eight separate groups
between the years 2014 and 2017. Completion of questionnaires was completely volun-
tary and participants were informed that data collected would be deidentified and used
only in aggregate data analyses. Therapy groups involved an initial session, a week for
each participant to engage in chair work and a final session. After this, some groups were
extended so that each participant who elected to continue would have an opportunity for
a second session of chair work in front of the group. Participants were asked to commit to
one round of group, in which each participant would have one opportunity to engage in
a chair work session in front of the group. After this, participants could elect to participate
in a second round of chair work in group, or to discontinue. Three of the eight groups did
not offer a second round due to scheduling constraints on the part of the therapist. As
such, participant numbers are larger for Round 1 of group (N = 58) than for Round 2 of
group (N = 25). Complete data were obtained for 64% of participants in Round 1 (N = 37)
and 88% of participants in Round 2 (N = 22).
6 S. THOMPSON AND L. GIRZ

Group structure
Group size ranged from 6 to 11 participants, with the number of group sessions offered
based on the number of participants plus an opening and closing session. All group
participants were asked to commit to attending regularly for group cohesion, and drop-
outs were rare during the first round (four participants in total). Reasons for leaving
included the following: group was not the right fit, group was too intense, a preference
for mindfulness rather than EFT and a focus on coping through positivity rather than
deepening emotion. Some groups then extended into a second round of chair work for
those interested. Individuals who elected not to attend the second round of chair work
did so because of conflicts in class schedules that could not be altered, or due to
commencement of internship or co-op placements that could not be flexibly scheduled.
The first group session includes structured exercises to scaffold self-disclosure, invita-
tions into vulnerability, and development of group identity and cohesion from day one
forward. A focus in the first group session is on building understanding of the solid
rationale for bringing up painful feelings, and beginning to pair adaptive and maladap-
tive emotion schemes.
Following the first group, with a few exceptions, each group session had a common
format creating for clients (and therapists) a predictable framework to deepen experien-
cing. Each of these groups began with a 15-min check-in, and offered one group
participant an opportunity to come to the ‘front’ of the group to engage in a 45-min
individual session with a therapist. This experience was then debriefed with the group
members for an additional 45 min, followed by a 15-min check-out experience. Although
the individual session typically involved chair work, this was not always the case if
relevant markers were not present.
After all participants had a chance to engage in chair work one time, there was
a session without chair work in which group was either terminated, or during which
goals, progress, and desired next steps were reviewed in anticipation of a second round.
When a group was in agreement to continue, a second round of chair work was offered
for each participant, extending the group to allow for a second chair work session for
each client, followed by a session with a focus on group termination processes. This final
group session focused on articulation and consolidation of gains, and a termination
exercise as participants prepared to close off this intensive experience.
All groups were facilitated by two therapists. Groups were run by a registered
psychologist with training in EFT, and a supervisee training in this modality, or in
some cases by two registered psychologists.
Further description of the method and procedures for running EFT groups can be
found in a manual prepared by the authors in the online Supplementary Material.
(Thompson & Girz, 2018).

Results
Multilevel modeling allows for estimation of two sets of parameters: (1) fixed effects that
describe the average change in outcomes over time, and (2) random effects (variance
components) that allow for estimation of individual variation in this change between
therapy groups and between individuals within each group. Three-level multilevel
 PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 7

modeling with the therapy group at level 3, individual clients at level 2, and time of
measuring outcomes of therapy at level 1 was used to compare means on all measures
between the start of group and the end of Round 1, between the end of Round 1 and
the end of Round 2, and between the start of group and the end of Round 2. Changes
over Round 1 were analyzed separately from changes over Round 2 of group because
only a subset of participants elected to participate in both rounds of group.
The initial model included the random effect of time; however, since this effect was
not significant, it was dropped from further models. No significant variance around the
average effect of time indicates that the average adequately describes changes in
individuals. In addition, no significant variation in group effect was observed, which
indicates on average that the effects observed were similar across groups.
Participants completed questionnaires at the start of Round 1, the end of Round 1,
and the end of Round 2. A subset of participants who completed Round 2 of group did
not complete questionnaires at the end of Round 1 because they missed this group
session or forgot to bring questionnaires back. As such, 22 participants completed
questionnaires at both the start of Round 1 and the end of Round 2 and therefore
have data across both rounds of group, whereas only 16 completed questionnaires at
both the end of Round 1 and the end of Round 2 and have data across Round 2
specifically (Table 1 and Table 2).
Depression (BDI) scores decreased significantly over Round 1 (N = 37, M = 28.1 to M =
22.4) and over Round 2 (N = 16, M = 19.8 to M = 11.1). Overall, depression scores
decreased from the high-moderate to the minimal range between the start of group and
the end of Round 2 (N = 22, M = 26.4 to M = 13.2).
Anxiety (BAI) scores did not decrease significantly over Round 1 (N = 37, M = 25.3
to M = 22.1) but did decrease over Round 2 (N = 15, M = 21.4 to M = 18.1). Overall,
anxiety scores decreased significantly from the high-moderate to the low-moderate
range between the start of group and the end of Round 2 (N = 22, M = 26.2 to M = 17.0).
Difficulties in emotion regulation (DERS) scores decreased significantly over Round 1
(N = 37, M = 118.6 to M = 101.0) and over Round 2 (N = 16, M = 98.3 to M = 83.8), as well
as over the course of both rounds of group (N = 22, M = 114.7 to M = 83.6). Although

Table 1. Means and standard deviations for depression, anxiety, difficulties with emotion regulation
and well-being scores across group.
Number Mean (pre) SD (pre) Mean (post) SD (post)
Depression (BDI)
Time 1 – Time 2 37 28.1 10.2 22.4 12.1
Time 2 – Time 3 16 19.8 9.6 11.1 7.8
Time 1 – Time 3 22 26.4 8.6 13.2 10.0
Anxiety (BAI)
Time 1 – Time 2 37 25.3 11.0 22.1 11.6
Time 2 – Time 3 15 21.4 11.9 18.1 8.3
Time 1 – Time 3 22 26.2 10.2 17 9.4
Emotion Regulation (DERS)
Time 1 – Time 2 37 118.6 15.5 101 22.2
Time 2 – Time 3 16 98.3 25.0 83.8 20.0
Time 1 – Time 3 22 114.7 18.9 83.6 21.7
Well-being (MHC-SF)
Time 1 – Time 2 20 1.8 0.9 2.3 1.1
8 S. THOMPSON AND L. GIRZ

Table 2. Multilevel model of changes in depression, anxiety, difficulties with emotion regulation and
well-being scores across group.
Depression (BDI) Anxiety (BAI) Emotion regulation (DERS) Well-being (MHC-SF)
B SE B SE B SE B SE
Fixed Effects
T2 to T3 −8.241*** 2.208 −5.024* 2.203 −14.831*** 3.960
T1 to T3 −6.520*** 1.022 −4.072*** 1.019 −15.406*** 1.845
Random effects
Group 12.607 13.222 0.000 0.000 2.436 28.615
Individual 64.313* 20.866 72.443* 24.265 256.011* 75.813
LR test 21.32*** 20.62*** 24.17***
N observations 116 116 116
Fixed Effects
T1 to T2 −4.956** 1.795 −2.941 1.801 −15.918*** 3.140 0.341* 0.172
Random effects
Group 10.170 12.479 0.000 0.000 0.000 0.000 0.000 0.000
Individual 59.090* 22.938 68.050* 23.283 238.738* 80.400 0.577* 0.234
LR test 11.32** 10.02** 9.89** 10.28**
N observations 94 94 94 53
*p < 0.05. **p < 0.01. ***p < 0.001.

there are no clinical ranges for this measure, the literature indicates that nonclinical
samples of university students and community adults average 75–80 (Grats & Tull, 2010).
Well-being (MHC-SF) scores were measured on a scale from 0 (Never) to 5 (Every Day),
with lower scores indicating reduced frequency of experiencing aspects of wellbeing,
including positive affect, social belonging, and life purpose. These data were only
available for a subset of participants because the MHC-SF was not included initially in
the questionnaire packet; as such, sufficient data are only available for Round 1 of group.
Results show increases in well-being over Round 1 (N = 20, M = 1.8 to M = 2.3), with four
participants moving from the ‘languishing’ to the ‘moderate’ category, and three parti-
cipants moving from the ‘moderate’ to the ‘flourishing’ category.

Discussion
Participants reported statistically and clinically significant decreases in depression and
anxiety scores, and significant increases in emotion regulation over the course of group.
Well-being scores also changed significantly over the group; however, the absolute
magnitude of change was not large. We wonder whether longer-term follow up
would show more marked increases in well-being as symptom reduction persists. It is
notable that a second round of chair work produced additional change in symptoms for
depression and emotion-regulation, and that it took two rounds for significant change
to occur with respect to anxiety. These results have prompted us to routinely offer
a second round of group.
Overall, it appears that emotion regulation improves first and then more marked
changes in depression and anxiety symptoms occur, although this was not tested
directly. We speculate that these results are in line with EFT case conceptualization
frameworks (Goldman & Greenberg, 2014), which posit emotion awareness and regula-
tion as initial steps that occur before transformation of core maladaptive emotion
schemes which underlie symptoms, followed by meaning making and consolidation.
For many clients entering group, the first round allowed vicarious experiencing of deep
 PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 9

emotion processing and for greater access to, and regulation of their own emotions,
many of which may have been avoided prior to group. In these groups, it was not
unusual for clients to feel worse before they felt better. Anecdotally, this was related to
first becoming aware of and approaching long-avoided and painful emotions, learning
first to approach, tolerate, and fully differentiate these emotions, typically in the first
round of group. The second round of group then allowed space to begin transforming
painful emotions, often through work with self-critical aspects of self. Of course, some
clients came to group with a well-developed capacity for awareness and regulation, and
jumped directly into evocative chair work, which deepened experiencing and awareness
for other participants who were more avoidant of their feelings. Although this was not
studied directly, we speculate that clients who had the ability to access painful emotions
prior to beginning group were able to begin working directly on transforming these
emotions and showed changes in depression and anxiety symptoms across the first
round of group. In contrast, participants who came to group with difficulties accessing
and tolerating painful emotions may have seen shifts in being able to approach and stay
with painful feelings during the first round of group, and shifts in depression and anxiety
symptoms during the second round of group as they were able to begin working to
actively transform these emotions.

Limitations
Limitations of the present study include the lack of a control group, which leaves open
the possibility that improvements are not a result of the EFT group intervention. It is also
possible that improvements may be correlated with academic cycles and stress related
to academics, however group start and ends times have been distributed across the year
suggesting that this is not the case. Additionally, it is unclear whether additional benefits
of the second round of chair work represent a treatment length effect (e.g. two times
through the chairs) or whether people who respond better to this treatment were more
likely to remain in the group for the second round.
Additionally, complete data were not gathered for each group, as some participants
missed group sessions at the end of rounds one or two when the questionnaires were
handed out, and occasionally other participants who did attend group forgot to return
questionnaires the following week. We have no evidence that missing data were
distributed nonrandomly. These data were collected initially as part of program evalua-
tion and clinical care was prioritized over data collection.

Future directions
Given the magnitude of change both clinically and statistically, the results suggest
that emotion-focused group therapy may be an effective intervention in the reduc-
tion of self-criticism underlying anxiety and depression and that this modality is
worthy of further study. Future directions may include replication of these results,
ideally within a controlled trial, as well as examination of the effects of chair work
itself versus group process on shifts over the course of group. For example, timing of
chair work, degree of resolution achieved in the chair session, and depth of proces-
sing in each group session could be analyzed with regard to impact upon shifts in
10 S. THOMPSON AND L. GIRZ

symptoms over the course of group. Furthermore, it would be useful to examine

whether initial ability to access and express emotion is predictive of retention in
group or of trajectories of change across the course of group treatment.
It may also be fruitful to examine the differential effects of group versus individual
EFT for the core emotion schemes of shame, fear, and sadness/aloneness. We speculate
that group may offer a unique benefit for participants experiencing core shame and core
sadness/aloneness. Experiencing and tolerating previously avoided shame (a social
emotion) in the presence of peers who can validate, provide compassion and be
vulnerable in return is often transformative. In addition, exposure to empathic connec-
tion through vulnerability for clients with core sadness/loneliness may allow for a new
depth of connection and emotional experiencing facilitating a greater awareness of
what is missing and what is needed.

Disclosure statement
No potential conflict of interest was reported by the authors.

Notes on contributors
Sarah Thompson, Ph.D, C. Psych is a faculty member and registered psychologist in practice at the
Centre for Student Development and Counselling at Ryerson University and in private practice at
Transforming Emotions where she divides her time between clinical supervision, and the provision
of individual and group psychotherapy. She lives and works in Toronto, Ontario, Canada.
Laura Girz, Ph.D., C. Psych is a faculty member and registered psychologist in practice at the
Centre for Student Development and Counselling at Ryerson University. In addition to providing
group and individual counselling, she holds key responsibilities for system and program planning,
as well as evaluation at the Ryerson counselling centre.

ORCID
Laura Girz http://orcid.org/0000-0002-5385-8006

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