Abstract

This article demonstrates the digital assessment of two clients over the course of five psychotherapy sessions with very different outcomes. One was very successful and the other minimally successful or possibly a “failure.”  Both clients experienced ART (Accelerated Resolution Therapy) in session four before terminating. They also did the exercises in chapters one, two, three, and four in the book “The Forgiveness Solution”, as well as breathing exercises and the “Psychological Uplifter.” During this period, there were substantial changes on many measures for one client using the “Pragmatic Tracker” and “Blueprint digital assessment platforms”, and less change for the other client.  The changes that took place in these two clients were demonstrated with measures such as depression, anxiety, negative and positive affect, life balance, cognitive fusion, experiential avoidance, valuing, affect balance, self-forgiveness, outcome, well-being, the working alliance, spiritual awakening, and the benefits of therapy. It appears that both clients benefitted from the ART intervention. Three ACT (Acceptance and Commitment Therapy) measures of psychological flexibility (cognitive fusion, experiential avoidance, and valuing) were used. Large differences were seen between the clients in the working alliance and spiritual awakening as well as the overall benefits of psychotherapy.

“I am here only to be truly helpful. I am here to represent Him Who sent me. I do not have to worry about what to say or what do because He Who sent me will direct me. I am content to be wherever He wishes, knowing He goes there with me. I will be healed as I let Him teach me to heal.”  (Schucman, A Course in Miracles, 2021).

INTRODUCTION

In previous issues of the International Journal of Healing and Caring or IJHC (Friedman, 2020, 2021, 2023A 2023B, 2023C in press) and the Journal of the Society for the Advancement of Psychotherapy (Friedman, 2019) new psychological scales were developed and introduced that can be used to assess change during psychotherapy. One of these scales (the Friedman Life Balance Scale) has been recently translated and validated on Chinese nursing students in Nantung, China and was recently published (Zhao, F.F., Friedman, P., et. al., 2023). These scales (Friedman, 2020, 2021) were also used to track changes in two clients in psychotherapy during a severe bout of COVID 19 (Friedman, 2022). The purpose of this paper is to digitally assess change in two clients in brief psychotherapy (five sessions) using the ICBEST (Integrative, Cognitive, Behavioral, Energetic and Spiritual Therapy), ACT (Acceptance and Commitment Therapy) and ART (Accelerated Resolution Therapy) models of intervention. In one case there was substantial and in the other case minimal to no change when the client terminated treatment.  More specifically the purposes of this paper are:

1. To demonstrate how to track change digitally session by session during brief psychotherapy on a variety of measures using a case study methodology
2. To briefly describe the ICBEST model of therapy and assessment scales that are used in this approach
3. To briefly discuss some interventions used in the ICBEST approach
4. To discuss the use of affective balance as a core measure of change during brief psychotherapy
5. To demonstrate the power of self-forgiveness in healing and change during brief psychotherapy
6. To further introduce the concept of psychological flexibility/inflexibility drawn from the ACT approach to therapy
7. To investigate the relationship between affective balance, self-forgiveness, and psychological flexibility
8. To briefly examine the role of the working alliance during psychotherapy and the working alliance’s relationship to therapeutic change during very successful and minimally successful cases of brief psychotherapy.
9. To discuss the differences in spiritual awakening between the two clients in brief psychotherapy.
10. To demonstrate the role of Accelerated Resolution Therapy (ART) in these two brief psychotherapy cases.

Case Study of Two Clients

For confidentiality purposes, names and identifying information have been changed.

“Judy” is a 44-year-old, married architect in her second marriage with two children ages 15 and 13. She recently left a lover in another state to return home with some regrets. She reports having four previous courses of psychotherapy and numerous affairs in the past. She has been very successful in her architectural career and often travels in her job. She stated that extramarital sex brings her highs but also guilt. Her husband is a 46-year-old physical therapist. She is agnostic/atheist. She feels responsibility towards her kids. Her parents are divorced, and her father had been an alcoholic. She reports having had alcohol problems in the past but not presently.  Her general attitude towards life and therapy is cynical, skeptical, and belittling.

“Lou” is a 38-year-old recently separated chef who was blindsided when his girlfriend left him suddenly and took her child with her to California where her parents lived. He mourns the loss of her and the child. His 28-year-old ex-girlfriend was just starting an interior decorating business when she left. He is quite religious and has had no previous psychotherapy. He rarely travels. Lou has some health issues. He is temporarily living with his parents but plans to move out soon. He is working on getting a real estate license as a possible second job. He is a kind person and has a good sense of humor. Lou knows someone who was treated by this writer successfully and came in with a positive attitude towards the therapy process.

The ICBEST model was used with both clients. See below.

Stated below are the goals of Lou and Judy created during the second psychotherapy session after they completed a series of psychological assessments which were discussed with them.

Lou’s Goals

• Greatly decrease sadness, fear, shame, grief, hurt and bitterness
• Greatly increase happiness, peace joy and overall well-being
• Greatly reduce self-judgment
• Greatly increase self-forgiveness
• Greatly increase forgiveness of his ex-girlfriend and her family
• Greatly increase gratitude
• Greatly accept the situation with his ex-girlfriend and her family
• Greatly increase living in the present not the past or future
• Greatly decrease cognitive fusion and mental turmoil
• Greatly increase psychological flexibility
• Greatly increase awareness and be more focused
• Greatly increase self-discipline.

Judy’s Goals

• Figure out the roots of my issue so that I can heal it.
• Figure out what’s up with my desires for sex and unfaithfulness
• Greatly increase peace, joy love and happiness
• Greatly increase and enjoy regular things in life and let go of the past
• Greatly decrease my fear or mortality
• Greatly increase self-esteem, self-forgiveness, self-love, self-compassion
• Greatly decrease self- criticism and judgement and self-attack
• Strengthen positive beliefs and decease negative beliefs
• Greatly decrease shame, guilt, anger /irritability, anger to self. dread, sadness, bitterness and spiraling distress
• Increase psychological flexibility
• Strengthen my marital relationship and be faithful
• Be content with and accept the end of the relationship with the other man. 

DIGITAL ASSESSMENTS

Lou and Judy were given online questionnaires before every therapy session that they filled out from links sent by Blueprint and Pragmatic Tracker on their cell phones or computers. Weekly, they filled out the Friedman 5 Factor Personality Scale (Friedman, 2020); the Generalized Anxiety Disorder-6 item (GAD-6; Spitzer et al., 2006)) scale; the Patient Health Questionaire-9 item (PHQ-9; Kroenke et. al., 2001) depression scale; the Friedman Affect and Friedman Belief Scales -short form (Friedman, 2021); the Friedman Life Balance Scale (Friedman, 2020); the Friedman Spiritual Awakening Scale (Friedman, 2020); the Clinical Outcomes in Routine Evaluation10 items (CORE-10; Barkham, et al., 2013) scale; the Working Alliance Scale (WAI; Horvath & Greenburg, 1989); the Outcome Rating Scale or ORS (Duncan, et. al., 2003); the Cognitive Fusion Questionnaire or CFQ (Gilanders et.al., 2014); the Acceptance and Action Questionnaire or AAQ-II (Bond et.al, 2011); the Valuing Questionnaire or VQ (Smout et. al., 2014); and the Benefits of Therapy Scale (Friedman, 2020). The first two sessions consisted of an initial interview, the Psychological Uplifter, with a white light imagery and meditation at the beginning of each therapy session. Then they were asked to read the introduction to my book “The Forgiveness Solution” (Friedman, 2010) at the end of session two.clients were sent a copy of the book, “The Forgiveness Solution,” at the end of session two. They were asked to read and do the exercises in three chapters in the Forgiveness Solution book for the next two weeks.

Both clients, Judy and Lou, experienced ART (Accelerated Resolution Therapy) during therapy session four. After that both clients terminated therapy but for very different reasons. Lou felt he had made major gains and reached his goals. Judy decided that she didn’t resonate with the approach and wanted to terminate.

INTERVENTIONS

This psychotherapy approach is called the ICBEST model (Friedman, 2015) which stands for integrative, cognitive, behavioral, energy and spiritual therapy. This approach includes the positive pressure point techniques (Friedman, 2006, Friedman 2010) which is a variation of the emotional freedom techniques or tapping techniques (Freedom, 2013, Church, 2018, Stapleton, 2019, Gallo, 2022); integrative forgiveness therapy (Friedman, 2010; Friedman, 2015); ART or accelerated resolution therapy (Kip et al., 2013, Rozenzweig, 2020), which uses bilateral eye movements; and CBT or cognitive-behavioral therapy (Hollon & Beck, 2013); and practice-based evidence (PBE) feedback. The author’s approach includes practice-based evidence (PBE), weekly digital assessments which provide client feedback and helps to monitor change (Friedman, 2021). The spiritual component focuses on love, compassion, forgiveness, peace, intuition, and healing based on A Course in Miracles, (Schucman, 2021; Friedman, 2010). In the authors’ approach major clinical goals include enhancing the client’s love, compassion, forgiveness, and peace.

Guided Light Imagery and Breathing

Clients were provided the guided mindfulness provided below at the beginning of all psychotherapy sessions.

“Close your eyes and put your awareness on your breath. You’re going to breathe in peace and to breathe out release; breathing in peace on the in breath and release on the outbreath; peace on the in breath, release, relax and let go on the outbreath; breathing in peace breathing out release, relax and let go. Now, the past is over, the past is over so we release the past; we delete the past.  The future is not here yet so we release the future; the future is on its way but not here yet, so we release the future. Now is the only time there is, now is the only time there is and right now we’re going to breathe in peace and breathe out release, relax and let go.  We’re going to breathe in peace and breathe out release, relax and let go. Some people say that it’s best to breathe in to a count of four on the in breath, then hold for a count of two and then release, relax and let go for a count of six; so then we would breathe in peace slowly, hold and breathe out release, relax and let go for a count of four, two and six. Now is the only time there is and now is the most important moment of your life. So we’re going to breathe in peace and breathe out release, relax and let go for the next two minutes silently to yourself.”

This is done at the beginning of every session.

At the beginning of the second session and following the previous paragraph, while their eyes are still closed, clients are instructed in the following phrases:

“Put your hands on your heart.  We’re going to do “love in all directions.” Imagine a radiant, white light coming from above, coming from your soul or spirit or infinite or divine intelligence or even God, coming down through the top of your head into your heart connecting with the light and love in your heart.  The light and love in your heart then goes out almost automatically to the people that you’re closest to, family, friends, colleagues, neighbors and strengthening the love and light in their heart. It then comes back to you, i.e., the light and love, which strengthens the light and love in your heart even more. Then the light and love in your heart goes out to all the people in my practice, known or unknown, visible or invisible and connects with all those people. The light and love in their heart strengthens the light and love in their heart and again comes back to you almost automatically and strengthens the light and love in your heart even more. Now the light and love in your heart goes out to all the people in the world who are upset, distressed, hurting or fearful in any way or ever have been or ever will be or who know anyone in any of those categories.  This should pretty much cover the seven or eight billion people on the planet. 

“So then the light and love in your heart expands even further to the entire animal kingdom; the dogs, the cats, the giraffes, the elephants, the whales and all the fish in the sea; then the eagles, the sparrows, the robins, the owls and all of the birds in the air and even the little worm; love and light goes out to all of those beings without exception; then it expands even further to the solar system, the galaxy, the whole universe. The light finally comes back around and encircles you in a bubble of light, healing light and love and then it enters you through the skin, into every artery, vein, tissue, organ, muscle, and cell in your body, accelerating or activating a healing process in all levels of your being; physical mental, emotional and relational.”

This section is added beginning with the third and subsequent therapy sessions.

Then the light turns like a laser beam into the following phrases that you can repeat out loud after me:

“May all beings including myself be at peace; may all beings including myself be healthy; may all beings including myself be happy; may all beings including myself be kind, compassionate and blessed; may all beings including myself be forgiving, grateful and loving, may all beings including myself be connected to their deepest inner self and may all beings including myself live a life of ease.”

“So now take a slow deep breath, three slow deep breaths actually, in through your nose and out through your mouth, in through your nose and out through your mouth, in through your nose and out through your mouth. Finally, very, very gradually open your eyes and bring your consciousness back into the room.” 

The Psychological Uplifter

At the end of the initial session clients are taught the “Psychological Uplifter”:

The following phrases are repeated three times while rubbing the neurolymphatic reflex point at the upper left side of the chest:

“Even though I have some of this problem or negative emotion (fill in the emotion/problem e.g. fear, anxiety, hurt, anger, depression, sadness, guilt, shame, low self-esteem, work, marital, relationship and family problems, etc.), I accept myself deeply and profoundly, and I am a good, competent and magnificent person.”

Followed by: “I love myself unconditionally despite my problems and limitations,” three times while rubbing on the sore point.”

Followed by: “I am entitled to miracles,” three times, while rubbing the neuromyopathic reflex point. 

Judy and Lou were encouraged to practice the “Psychological Uplifter” 10-20 times per day, or as often as the person can. This writer demonstrated the activity, while Judy and Lou completed it themselves.

Anything is Possible

At the beginning of the second session Judy and Lou and all clients are taught the “Anything is Possible” exercise:

“While tapping with five fingers of one hand on the fleshy part of the side of the other hand (Acupoint SI-3, often called the “karate chop point”).  They repeated it three times: “Anything is possible; I am entitled to miracles; Miracles are happening”; and “Miracles come from love and forgiveness.”

Clients were asked to practice both the “Psychological Uplifter” and the “Anything is Possible” statements one after the other.

A third exercise was taught as well called Releasing/Choosing.

Releasing/Choosing:

“While tapping with five fingers of one hand on the karate chop point, repeat two times:

“I release the hurt, anger, depression, guilt or any negative emotion and all of the roots and causes (known and unknown) and all of the effects on me and everyone else in my life.” Then repeat two times: “Instead I choose to feel calm, relaxed, peaceful and happy.”

The therapist first demonstrated this exercise and then did it together. Judy and Lou were encouraged to practice the “Releasing/Choosing” exercise after the “Psychological Uplifter” and the “Anything is Possible” exercise five or more times a day.

These three exercises are forms of Energy Psychotherapy (EP) and are similar to the Emotional Freedom Techniques (Freedom, 2013; Church, 2018; Stapleton, 2019, Gallo, 2020).

Integrative Forgiveness Therapy and Accelerated Resolution Therapy

Between sessions two, three and four, Judy and Lou read the introduction and chapters one through four in the book “The Forgiveness Solution” (Friedman, 2010) and did the Integrative Forgiveness Therapy (IFT) exercises. See the Appendix for a description.

In the fourth therapy session Judy and Lou were taught and experienced Accelerated Resolution Therapy (ART). See the Appendix for a description. Below is summary of notes of the session.

“Judy and I discussed some of her responses to the WAI and in particular her belief that we needed to be more specific in applying the forgiveness model. I mentioned to her that she was particularly low on the self-forgiveness/self-love items on one of the scales. She picked an incident with her mother and father when she was about 8, when they told her at the dinner table that they were splitting up and her father was an alcoholic. She felt hurt, angry, bitter, and disappointed. Judy felt like she must have done something terribly wrong and that she was a bad person. We did an extensive stress release exercise called ART with affirmations and her subjective units of distress (SUD) level reduced from nine to zero.”

“Lou went back to an earlier time in his life when he was troubled in his relationship with his father. He felt his father was unavailable to him, ignored him, uncommunicative and didn’t love him. This was triggered by some leftover feelings of hurt, anger, disappointment and betrayal he had in his relationship with his ex-girlfriend. We did the director scene from ART where he had an opportunity to recreate in imagery what happened in a more positive and constructive way and this seemed to be very beneficial and helpful to him. His SUD level came down from eight to zero”

Both Judy and Lou terminated after the fifth session but for different reasons. Lou terminated saying that he was feeling much better and had reached his goals. Judy terminated saying that she didn’t resonate with the approach. Although her termination surprised this writer, (Friedman) it was realized that Judy’s skepticism, cynicism and belittling approach to life and therapy contributed substantially to her termination. Despite attempts to turn this around with positive reframes, affirmations and techniques, there was always an underlying tension from her attitude and demeanor. She obviously wanted to change at some level, or she wouldn’t have been in therapy, but part of her had serious doubts about the possibility that therapy could help her. Her sudden termination with minimum results  is atypical by the fifth session of this treatment (Friedman, 2018).  Judy’s average WAI, for example, was 43 out of 60. The average WAI score for this treatment is 59.3 out of 60.

Here are Judy’s and Lou’s scores on the psychological assessment questionnaires over the course of this brief five session therapy.  Average scores for each assessment are included for comparison.

Table 1: Changes in the PHQ-9 Depression Scale

The PHQ-9 (Patient Health Questionnaire-9) is a multipurpose assessment for screening, diagnosing, monitoring and measuring the severity of depression. PHQ-9 scores of 5, 10, 15 and 20 represent mild, moderate, moderately severe, and severe depression. Table 1 shows that Lou’s scores on the PHQ-9 Depression scale dropped dramatically, whereas Judy’s scores dropped only slightly over the period of five weeks.

Table 2: Changes in the GAD-7 Anxiety Scale

The GAD-7 is a seven-question screening tool that is often used to measure anxiety and track change in psychotherapy. Scores of 0 – 4 indicate minimal anxiety; 5 – 9 indicate mild anxiety; 10 – 14 indicate moderate anxiety; and 15 – 21 indicate severe anxiety. Judy’s scores show a mild reduction in anxiety; whereas Lou’s scores show a large reduction in anxiety over the course of five weeks.

 Table 3: Changes in the Friedman Negative Affect Scale

The Friedman Negative Affect scale measures five kinds of negative affect (hostility, guilt, sadness, fear, and fatigue). This table shows that both Judy’s and Lou’s levels of negative affect dropped substantially over the five-week period, with Lou showing a significantly larger drop than Judy.

Table 4: Changes in the Friedman Positive Affect Scale

The Friedman Positive Affect scale measures five kinds of positive affect (Jovial, Self-Assurance, Attention, Peace, and Love). This Table shows that Judy’s levels of positive affect didn’t change, while Lou’s positive affect increased substantially over the five-week period.

Table 5: Changes in the Self-Forgiveness, Self-Compassion and Self-Love Subscales

The Friedman Life Balance Scale measures three subscales related to life balance (reflect, clarify, sort; understand self and others and self-forgive, compassion, love). This table focuses on the Self-Forgiveness, Self-Compassion and Self-Love subscale. It shows Judy’s scores increasing from 10 to 16 over the five-week period; while Lou’s scores, after dropping somewhat over weeks 1 to 3, were virtually unchanged after five weeks. Judy’s score started quite low while Lou’s initial score was higher than average.

Table 6: Changes in the Friedman Affect Balance Scale: Positive Minus Negative Affect

The Friedman Affect Balance Scale measures the balance of affect (emotionality), “positive” minus “negative.”  This table shows that Judy’s Affect Balance dropped over the five-week period (while remaining in the “negative” side of the Balance); whereas Lou’s Affect Balance increased significantly from being very “negative” to shifting to a measurement of 39 in the very “positive” side at the end. Affect Balance is a key measure of change.

Table 7: Changes in Cognitive Fusion (CFQ)

Cognitive fusion is the tendency to believe that one’s thoughts and reality are one and the same. Cognitive fusion (CF) occurs when people are entangled in their private experiences. Rigid patterns of CF are a risk factor for various forms of psychopathology.  Acceptance and Commitment Therapy (ACT) emphasizes the relationship a person has with their thoughts and beliefs as potentially more relevant than belief content in predicting the emotional and behavioral consequences of cognition. The Cognitive Fusion Questionnaire (CFQ; Gillanders et al., 2014) is a seven item, self-report, Likert-scaled measure of the tendency for behavior to be overly regulated and influenced by cognition. Judy’s scores changed very little over the five-week period; while Lou’s scored dropped over this period, indicating a significant reduction in cognitive fusion over the course of therapy.

Table 8: Changes in AAQ-II (Experiential Avoidance or Psychological Inflexibility)

The Acceptance and Action Questionnaire (AAQ-II), is one of the three measures of psychological flexibility used in this study along with Cognitive Fusion and Valuing. It can be used weekly to track how flexible individuals are in their emotional lives and is one of the measures of progress in Acceptance and Commitment Therapy (ACT).  Judy’s scores show very little change in psychological flexibility over the five-week period; while Lou’s scores dropped markedly, showing that he was psychologically more flexible at the end of treatment.

Table 9 Changes in VQ (Valuing Questionnaire: A Measure of Psychological Flexibility)

The Valuing Questionnaire (Smout et al. 2014) is a 10-item self-report scale designed to measure how consistently an individual has been living with their self-determined values and is often used during ACT. Values are personal principles someone has chosen to guide their behavior. This table shows that Judy’s scores on the VQ increased slightly over the five-week period; while Lou’s scores increased dramatically over the same period, indicating an increase in his ability to live in accordance with his values.

Table 10: Changes in the Working Alliance Inventory (WAI)

The Working Alliance Inventory-Short Revised (WAI-SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond.  This Table shows that Judy’s working alliance score was very low at intake and continued to be low throughout the course of therapy. Lou’s working alliance score started fairly high and gradually increased to the maximum working alliance score of 60.

 Table 11: Changes in the Friedman Spiritual Awakening Scale

The Friedman Spiritual Awakening Scale monitors and measures the experience of six aspects of Spiritual Awakening (True Nature, Spirituality, Higher Power / Inspired Action, Awareness/Inclusion, Perfection/Inner Unfolding and Compassion, Empathy, Love) Judy’s scores actually dropped on this scale over the five-week period, while Lou’s scores increased consistently over the five-week course of therapy to a high score.

Table 12: Changes in the Friedman Well-Being Scale

The Friedman Well-Being Scale (Short Form) measures four dimensions of well-being: emotional stability; self-confidence; joyfulness and happiness. It has 10 items. Since it consists of adjectives that are bi-polar opposites the scale measures both directions, i.e., emotional stability-instability and happiness-unhappiness. Judy’s scores did not change over the course of therapy while Lou’s well-being scores improved markedly over the five sessions of therapy to a very high score.

Table 13: Changes in Outcome Rating Scale (ORS)

The Outcome Rating Scale (ORS) (Duncan, et. al. 2003) is a four-item scale that assesses a client’s perceptions of the therapeutic approach on a 0 to 10 scale; “zero” is the lowest possible score, and “40” is the highest possible score. Judy’s scores on the ORS did not change over four weeks, while Lou’s scores improved dramatically over the course of therapy.

Table 14: Changes in CORE-10 Outcome

The CORE-10 (Clinical Outcomes in Routine Evaluation) is a short easy-to-use 10-item assessment measure for common presentations of psychological distress, designed to be used for screening as well as over the course of treatment to track progress. The measure asks respondents to self-report symptoms over the past week.  The CORE-10 outcome measure is a session-by-session monitoring tool with items covering anxiety, depression, trauma, physical problems, functioning and risk to self.  On this scale Judy’s scores decreased slightly, while Lou’s scores decreased markedly. Lower scores indicate lower levels of psychological distress.

Table 15: Changes in the Benefits of Therapy

The Benefits of Therapy assessment measures clients’ subjective perceptions of how much they are benefiting from the therapy process on a 10-point scale. Both Judy and Lou showed increases on the Benefits of Therapy scale, with Lou showing much greater benefits than Judy.

CHANGES IN LOU’S GOALS AT TERMINATION

The Goal Attainment Scale (Kiresuk & Sherman, 1968) is an individualized outcome measure involving goal selection and goal scaling that is standardized to calculate the extent to which a patient’s goals are met.  On the Goal Attainment Scale 10 is the highest possible score and zero is the lowest possible score.

• Greatly decrease sadness, fear, shame, grief, hurt and bitterness etc  0 to 7
• Greatly increase happiness, peace joy and overall well-being 2 to 8
• Greatly reduce self-judgment 3 to 7
• Greatly increase self-forgiveness 2 to 8
• Greatly increase forgiveness of his ex-wife and her family 4 to 9
• Greatly increase gratitude 5 to 9
• Greatly accept the situation with his ex-wife and her family 0 to 8
• Greatly increase living in the present not the past or future 0 to 8
• Greatly decrease cognitive fusion and mental turmoil 1 to 8
• Greatly increase psychological flexibility 3 to 8.

Lou’s Termination Essay

“What brought me into therapy was the abrupt and unexpected end to the relationship with my girlfriend, Jane. The breakup came out of nowhere and it was extremely confusing and hurtful for me. She also had a 2-year-old daughter, “April”, from a prior relationship whom I loved as my own and apparently would not be able to see anymore. A combination of extreme sadness and confusion accompanied with a desire to better change myself is what brought me to seek out therapy. I was having a hard time with anxiety and living in the past. I also was struggling with feeling guilty about the breakup.  I also had a decent amount of frustration and disappointment in both myself and Jane, about how things had went. She expressed a lot of complaints about my personality during the break-up and I wanted to seek out therapy to help myself be a better person in some of the areas that she complained about.  

One of the biggest things that I have learned from therapy that greatly helped me is the concept and perspective of not living in the past and choosing to live in the present. This concept alone has decreased my anxiety and guilt dramatically because I no longer spend time dwelling over things of the past. Living in the present is also very helpful with productivity and appreciation for the things and people that surround me in the present moment.

Within this has also been the very important understanding of the power of forgiveness which I have learned from reading Dr. Friedman’s book, “The Forgiveness Solution.” A big part of letting go of the past is forgiving people in it that may have hurt you  and in my case though I didn’t hold an extreme amount of resentment I did benefit from forgiving Jane and her family. It is hard to describe the feeling of liberation when you choose to forgive and Love people.

I also found the use of positive affirmations very helpful, and I try and use them on a daily basis. That along with the breathing techniques help me control any sort of flareups in anxiety or emotion. I have felt a tremendous amount of positive change in my life since beginning therapy. I used to wake up every morning with anxiety but now I wake up feeling calm and confident in life and myself. I am present to more awareness of my surroundings and myself. This has led me to be more conscious of the things that I am saying and thinking especially when I interact with others. From this consciousness I have also felt a drastic increase in self-control. I do not struggle with sadness anymore because I have accepted that the past is over and that the present is all that I have.

I also have been able to let go of the feeling of guilt that I was having. Though I am not currently in communication or in a relationship with Jane, I feel a lot more confident in who I am as a person and would feel a lot better and comfortable about communicating with her if we were to ever do so. The advances that I have made in my own self-improvement are what give me the confidence in any sort of relationship in my life. The simplicity of living in the present has brought me tremendous peace and improved my daily life. Instead of constantly focusing on things that happened in the past I am able to set small goals and work towards them on a daily basis with confidence and peace. I am grateful for what I have learned in therapy and will carry these techniques and understandings with me for the rest of my life.” 

Judy’s Termination Essay

Judy did not write a termination essay.

DISCUSSION

This article demonstrates the digital assessment of two clients over the course of five psychotherapy sessions with very different outcomes. One was very successful and the other minimally successful or possibly a failure imagery and breathing exercises, and the Psychological Uplifter and “Anything Is Possible” exercises. Both clients experienced ART (Accelerated Resolution Therapy) in session four. Before terminating both clients reported substantial changes during the ART session. During this period there were very substantial changes on many measures for one client (Lou) using the Pragmatic Tracker and Blueprint digital assessment platforms, and much less so or not at all for the other client (Judy).

Therapeutic progress in these two clients was demonstrated using assessments of depression, anxiety, negative and positive affect, life balance, cognitive fusion, experiential avoidance, valuing, affect balance, self-forgiveness, outcome, well-being, the working alliance, spiritual awakening, and the benefits of therapy. Three ACT (Acceptance and Commitment Therapy) measures of psychological flexibility (cognitive fusion, experiential avoidance, and valuing) were used.  An ICBEST (integrative, cognitive, behavioral, energy, and spiritual therapy) modelas the major approach utilized. There were major differences in the two clients during psychotherapy particularly on the psychological flexibility measures, the working alliance, and spiritual awakening as well as the overall outcome of and benefits of psychotherapy. This was documented in 15 tables and graphs.

CONCLUSION

This case study demonstrates the differences between two clients’ progress in brief psychotherapy (five sessions). One was very successful and the other was not.  An ICBEST (integrative, cognitive, behavioral, energy and spiritual therapy) model was the approach used. The study illustrates the use of digital assessments, viz. Blueprint and Pragmatic Tracker, to track therapeutic progress session by session. It also provides evidence for the utility of assessing multiple measures including depression, anxiety, negative and positive affect, cognitive fusion, experiential avoidance, valuing, affect balance, self-forgiveness, well-being, the working alliance, spiritual awakening and the outcome and benefits of therapy. Therapist-researchers are encouraged to utilize the laboratories of their offices to explore the use of assessments and digital platforms in their own practices.

Addendum

Description of the 3 major interventions used in the two cases.

Accelerated Resolution Therapy (ART) is a newer form of psychotherapy developed by Laney Rosenzweig. It consists of the following components: bilateral eye movement stimulation, core beliefs, sensations and feelings, voluntary image replacement, the director scene, rescripting, scene matching, gestalt techniques, metaphors, shifting perspectives, positive imagery, healing trauma and sometimes spirituality.

Integrative Forgiveness Therapy (IFT) consists of eight principles of forgiveness based heavily on A Course in Miracles, forgiveness affirmations, forgiveness guided imagery, forgiveness-based letter writing and forgiveness-based gestalt-type empty chair exercises. They are collectively integrated into a powerful forgiveness healing process.

The Psychological Uplifter is part of the Positive Pressure Point Techniques (PPPT), which is an offshoot of the Emotional Freedom Techniques (EFT). Both the Positive Pressure Point Techniques and the Emotional Freedom Techniques are Tapping Techniques. The client taps on a series of acupressure points after briefly holding in mind an emotionally charged image or feeling. Sometimes the Positive Pressure Point Techniques utilize affirmations and sometimes not.

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Philip H. Friedman, Ph.D.

Dr. Philip Friedman is a licensed psychologist and Director of the Foundation for Well-Being in Pa. He is the author of “The Forgiveness Solution” and “Creating Well Being” in addition to the Friedman Assessment Scales on Well-Being, Beliefs, Quality of Life, Affect, Life Balance, Spiritual Awakening and the Mini-5 Factor Personality Scale. He is also the developer of the ICBEST model of psychotherapy. Dr. Friedman is an adjunct professor on the faculty of Sophia Univ. (formerly the Institute of Transpersonal Psychology) He is the founder of Integrative Forgiveness Psychotherapy (IFP), the Positive Pressure Point Techniques (PPPT) and the Practice Based Evidence Approach (PBEA) to assessment and change