By Tori Rodriguez
It’s usually easy to see when clients are tuned out or turned off, simply not absorbing what you’re trying to get across. What’s puzzling is when things seem to be really clicking in session—when you’re sure clients will return to report their success at having applied the new awareness and skills they’ve just acquired to their lives—and then you find that they haven’t followed through.
A study by David Atkins and colleagues, published in the June 2012 issue of Behaviour Research & Therapy, found that clients in couples therapy are less likely to recall communication skills learned during high levels of emotional arousal. As the authors report, “Greater emotional arousal predicts remembering fewer skills,” and “sustained emotional arousal may impact memory through encoding, retrieval, or both.” Other studies have also established how strongly stress hormones can affect learning and memory. However, in the June 2013 issue of Couple and Family Psychology: Research and Practice, couples therapist Brent Atkinson offers some practical suggestions for addressing this obstacle to therapeutic change. He proposes that combining our emerging understanding of brain science with the power of deliberate practice gives us effective tools for mitigating the power of emotionally charged situations. Keeping emotions in check would then prevent clients from losing access to the insights and skills they’ve presumably acquired in the consulting room.
“Many clients don’t have a basic level of mental fitness required to make changes,” says Atkinson. For these clients, despite their best intentions, being in conflicts with their partner or in other triggering circumstances results in flooding, or becoming overwhelmed by negative emotions. This often triggers diffuse physiological arousal (DPA)—activation of the autonomic nervous system’s alarm response, which initiates changes like increased heart rate, blood pressure, and levels of stress hormones like cortisol, all of which help prepare the body to deal with threats. In spite of the new insights and skills explored in therapy, the chance of new responses being tried out when a client’s nervous system has been hijacked by DPA are radically diminished. So before clients can make changes in their relationship with a partner, before therapy can really begin to have any real impact, the first order of business is to change clients’ relationship with their nervous system.
In Atkinson’s treatment model, the therapist first works with clients to get them motivated to tune up their nervous system, helping them understand why it’s important and introducing them to the concept of mindfulness. The couples then participate in an eight-week mindfulness course, and during concurrent couples therapy sessions, they practice extending the skills they’re learning to their relationships. If clients need help mindfully responding during stressful partner interactions, they listen to their partner’s criticisms via prerecorded voice messages, during which they practice using mindfulness skills to turn down their physiological and emotional arousal. As clients become more skilled at self-soothing, the therapist helps them to identify their typical sequence of conflict and to mentally rehearse how to respond more effectively when conflict arises—much like how athletes or musicians might engage in mental practice to enhance their skills.
Treatment models like Atkinson’s move the field of therapy away from a faith in the magical power of insight, or even the generalized benefits of the therapeutic alliance, toward a closer look at how to concretely make the process of emotional learning more efficient and sustainable. Since therapy outcome studies consistently show a discouraging overall finding—the average results of psychotherapy haven’t improved over the last 50 years—this new research certainly seems to be a step in the right direction.