Outcome and Prognosis
John’s case was amongst the best outcomes in an original treatment study for resolving emotional injuries (Greenberg et al., 2008) according to an evaluation at 2 weeks post-treatment which was maintained at 3 months and 18 months. Measures used included the SCL-90R, the Beck Depression Inventory, as well as measures of forgiveness and measures of letting go of emotional injuries. John made significant improvements on all these outcome measures and what was particularly noteworthy was a significant reduction in symptoms of depression as well as interpersonal problems.
In the early phase of therapy, John was easily distressed and overwhelmed by his feelings, and he repeatedly interrupted his internal process. As the therapist provided a lot of relational support and engaged John in both deliberate regulation as well as automatic regulation interventions, with each session John became more emotionally regulated when talking about feelings of shame and worthlessness as well as his childhood. In addition, as the protective self-interruptions were worked on directly in therapy, it became it easier for John to speak about his feelings and his childhood experiences without becoming overwhelmed and distressed. Over the middle and late phases of therapy, John progressively demonstrated less global distress in-session and engaged in more productive emotional processing demonstrated by his ability to accept, tolerate, symbolize, regulate, make meaning of, utilize, and transform his unhealthy emotions.
In the later sessions of therapy, John expressed meaningful changes related to a decrease in interpersonal problems with family and friends as he reported specific examples in which he was having healthier conversations because he was not feeling triggered and getting angry. In addition, his feelings of shame had notably decreased, and he expressed that even if he felt wounded in a conversation, he was able to calm himself and self-soothe rather than lash out in anger. In the final sessions, he let go of the unresolved feelings of anger and hurt towards his father, grieved his unmet childhood needs, and finally forgave his father. He also developed love and compassion for himself in the present, as well as for the wounded boy in his childhood and described feeling an emotional resilience and strength that he had not experienced prior to this course of therapy.