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The Power Of Emotion In Therapy - Page 3

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When Does Emotion Go Wrong?

When we can access, regulate, and integrate our emotions, they provide an essential guide to living. But emotions, like everything, can go wrong. They’re like “best guesses” as to what we should do in a situation, not “surefire winning solutions,” says Stanford psychologist James Gross, who’s done extensive research on emotional regulation. Demystifying the problems that occur with emotion can again increase confidence that emotion shouldn’t be feared by clients or therapists.

For better and for worse, strong emotion tends to restrict our range of attention. A negative emotion, like fear, can elicit irrational beliefs. It can flood us so that we can’t think straight or only think in constricted, black-and-white terms. One metaphor that’s now taking hold among my neuroscience colleagues is that the brain is a ruthless capitalist, which budgets its resources. Being afraid and trying to calm yourself is expensive in terms of resources like blood and glucose; areas specializing in cognitive tasks, like the prefrontal cortex, get starved.

In simple terms, therapists and clients describe problems in terms of too much emotion, too little emotion, or conflicting emotions. Emotions can be overwhelming and create feelings of disorganization or chaos. Some clients can connect with different elements of their emotional experience, but can’t order them into an integrated coherent whole; they use words like fragmented and confused to describe their inner life. Traumatized clients speak of being hijacked by all-encompassing emotional experiences in traumatic flashbacks. Other clients report feeling flat or cut off from any clear sense of their experience; their inability to formulate or name emotions leaves them aimless, without a compass to steer toward what they want or need. Many clients express conflicting emotions. In couples therapy, they speak of longing to be close and fearing to be close. In individual therapy, they may deny the fear laid out in a previous session, shame at vulnerability now blocking the recognition of this emotion. Specific strategies for regulating emotion can be problematic as well, especially if they become habitual and applied across new contexts. Therapists working with trauma survivors need to validate that, at certain times, it’s functional and necessary to compartmentalize or even dismiss emotion. Alan, an Iraq War veteran, tells me, for example, “When you’re landing a helicopter under fire, you just focus on the IAI [Immediate Action Item], coping. Get the chopper down. Never mind your fear. Just step past it and focus on the task.” This saves Alan’s life on deployment. But if suppressing emotion becomes a general strategy, it turns into a trap. Numbing is the most significant predictor of negative outcome in the treatment of PTSD. It also sends Alan’s marriage into a spiral of distress that further isolates and overwhelms him.

A clear model of emotional health helps therapists find their way when these emotional processing problems occur. As a Rogerian and an attachment-oriented therapist, I have five goals for my clients. I want to help them: tune in to their deeper emotions and listen to them; order their emotional experience and make it into a coherent whole; keep their emotional balance so they can trust their experience and follow their inner sense of what they need; send clear, congruent emotional signals to others about these needs; and reciprocally respond to the needs of others. Buddhist teacher Jack Kornfield speaks to these goals in his book The Wise Heart, where he suggests, “We can let ourselves be carried by the river of feeling—because we know how to swim.”

We all encounter negative experiences and emotions; that’s simply how life is. But humans have an invaluable survival adaptation: when we’re emotionally stressed and our prefrontal cortex is “faint” from hunger, we share burdens and turn to others for emotional and cognitive sustenance. When we can learn—often with the help of another who’s a “safe haven” for us and can offer an extra prefrontal cortex—that negative emotions are workable, that we can understand them and find meaningful ways to cope with and embrace them, they lose much of their toxicity. They can become, in fact, a source of aliveness.

Countless studies on infant and adult attachment suggest that our close encounters with loved ones are where most of us attain and learn to hold on to our emotional balance. This echoes ancient Buddhist wisdom encouraging practitioners to meditate on the faces of loved ones or on the experience of being held as a way of finding their balance in an emotional storm. Secure connection with an attachment figure, or a surrogate attachment figure—a therapist, for example—is the natural place to learn to regulate our emotional responses. It’s when we can’t reach for others or access inner models of supportive others in our minds that we resort to more problematic regulation strategies, such as numbing out, blowing up, or rigidly trying to control our inner world and loved ones. The attachment perspective allows a therapist to see past these secondary strategies to discern deeper, more primary emotions—the desperate loneliness and longing for contact behind apparently hostile or dismissing responses, or the sense of rejection and helplessness underlying a withdrawn person’s apparent apathy. The attachment perspective asserts what neuroscientists like James Coan are discovering in their MRIs: regulating emotions with others is a baseline survival strategy for humans. Effective self-regulation, behavioral psychology’s mantra for years, appears to be dependent on and emerge from positive social connection.

Emotion in the Consulting Room

So what are the main messages of this new revolution in emotion for therapists? The first message is that emotion matters. When it’s dismissed or sidelined, we’ll often fail to engage our clients optimally or make the tasks of therapy personally relevant, and thus limit positive outcomes. The second message is that if we know the structure and function of emotion, as well as how it’s shaped in human relationships, we can use its power to create lasting change in a deliberate, effective manner. This is true in individual and couples therapy, and for each, I suggest that the old adage that significant change requires a “corrective emotional experience” applies. But specifically what have experiential therapists learned from the science of emotion about dealing with emotion and creating such corrective experiences?

Nearly all therapy models now agree on the necessity of creating safety in session, if for no other reason than to facilitate our clients’ open exploration of their problems. This safety is particularly essential if a client is to engage with and explore difficult emotions. For an attachment-oriented therapist, it has a specific meaning: in the session, therapists have to be not just kind or empathic, but truly emotionally present and responsive. This creates a holding environment, where clients can risk engaging in what Fritz Perls, the founder of Gestalt Therapy, called the “safe adventure” of therapy. Part of a therapeutic presence relates to transparency, the therapist’s willingness to be seen as a person who can be unsure or confused at times, rather than an all-knowing expert. If I’m emotionally engaged, my mirror neurons will help me check into my own feelings to understand those of a client.

In the treatment of problems such as depression, across different models, “collaborative,” emotionally oriented interventions have been found to predict positive outcome better than more expert-oriented, “coaching” interventions. Collaborative means that therapists join clients wherever they are—in their reactive rage or numb indifference—and find a way to validate these responses before exploring any unopened doors or alternative angles. Rogers told us long ago that the more we accept ourselves and feel accepted, the more we’re open to change. Often, this means that therapists need to resist the pressure to fix problems instantly, and find the inherent logic in how their client is feeling and acting in the moment.

Attachment and neuroscience emphasize the impact of gesture, gaze, facial expression, and tone of voice on the emotional reality of someone who’s anxious and in pain, and who’s sought the counsel of someone presumably “wiser.” The use of a soft, soothing voice on the part of the therapist makes sense here. Emotion is fast, so it makes sense to slow down if we want to help clients process emotion in new ways. Repeating simple, emotional terms that clients have found for themselves seems to foster the exploration of “hot” experiences. This can be summarized, for those who like acronyms, as using the 3 S’s—slow, soft, simple—to create a fourth S—emotional safety. If a client is overwhelmed, for example, in a traumatic flashback, this kind of presence and empathic reflection grounds him and helps him keep a “working distance” from his emotion. Focused empathic reflection soothes clients; they feel seen and heard. In EFT couples research, the initial level of a couples’ distress doesn’t significantly predict outcome, but the level of engagement in the treatment process does. The kind of alliance described above fosters this engagement with the therapist and the tasks he or she presents.

In the case of Mike and Emma, I might say to Mike softly and slowly, “I hear how much you want to fix this problem, Mike. It must be so hard to be turning on those gray cells and not to be able to fix this. It’s hard to keep your balance. So you just try to hold on really tight when Emma gets upset with you, to keep some control here, yes?” After a while, I begin to ask questions about just exactly how he “holds on tight” and what this feels like. This image offers me an emotional handle, a way into Mike’s experience of himself and his relationship.

An Emotional Focus

Experiential therapists learn to use emotion as a touchstone—to stay with, focus on, and return to emotional experience, constantly tracking emotional responses and developing them further. Creating a corrective emotional experience begins with this process. To stay here, rather than to move on to focus on modifying behaviors, creating insight, or offering advice requires a willingness to be relentless in guiding clients past tangential issues. This is infinitely easier if you have a basic knowledge of the science discussed above and a systematic way of working that’s been empirically validated with different kinds of clients. All this offers a secure base for intervention, but it still isn’t easy to keep reflecting and repeating the themes that show up in each client’s emotional responses until the ordered patterns in experiencing and interacting emerge and their consequences become clear. Empathic reflection is the primary tool here, though its versatility is often missed. In one stroke, a tuned-in reflection can calm clients and build safety, focus the therapy process, and slow down the flow of experience and interaction so that grasping key elements is possible. It helps order and distill emotion into something explicit and workable. As this process is repeated and tentative fresh meanings emerge, often in the form of evocative images, a new, coherent picture of inner and interpersonal realities is formed. Fragmented and unformulated elements are integrated into a new whole, which opens up new possibilities for action.

So with Mike and Emma, the therapist might say, “Can you help me, Mike? You’re saying that you want some magic words that would stop Emma from being upset? And you’re worried that if we talk about emotions, it’ll be just like the arguments you have at home?” Mike nods emphatically. “You’re going to hear Emma complaining about you, saying she’s disappointed with the relationship, while you don’t even understand what’s really wrong here? Talking about this is almost like a danger zone you don’t know the way out of. So you get frustrated and just want all this fixed. And when you can’t fix it . . . ?”

“I leave,” Mike says. “I go for a walk. What’s the point of standing there arguing? I just shut the door on her and go for a walk. There’s nothing else to do.” Understanding emotions in the context of attachment, it’s easy to anticipate that Emma experiences Mike’s withdrawal as a sign of abandonment and then protests his distance by further complaining and criticizing. Indeed, she now adds, “Right, and I’m all alone in the house upset. You just walk away like I don’t matter. I hate feeling so hurt all the time. I spew. I can’t let you just walk away.”

The therapist might reflect the whole emotional drama by saying, “And the more you turn away, Mike, to try to stop the upset, the more you feel alone, Emma? You end up spewing words to get him to turn around and not leave you? This loop has kind of taken over. It’s painful for both of you.”

Experiential therapists would be careful to validate and normalize Emma’s hurt so that she’ll continue to explore and own it. Hurt feelings have been identified as a combination of reactive anger, sadness over loss, and fear of abandonment and rejection. Attachment theory predicts that Emma’s critical pursuit is fueled by anxiety and a sense of lost connection with her partner. This knowledge guides the therapist as he or she reads Emma’s emotional cues. As Emma opens up to her emotions, she moves past her rigid, angry stance into deeper emotions of sadness and bewilderment, and begins to tell Mike about her loneliness. The expression of new emotions then evokes new responses. Mike sees her sadness and feels relief and compassion—as it’s happening, in the present

Therapies that privilege emotion, such as EFT and Accelerated Experiential-Dynamic Psychotherapy, state that the most powerful way to work with emotion is in the present moment, as it’s happening and being encoded in the neurons and synapses. Working with emotion from the bottom up, as it’s being shaped, makes for a vivid encounter with key emotional responses. Clients usually start a session by giving a cognitive account of their feelings or going over past emotional stories. But to access the true power of working with emotion, the therapist must bring pivotal emotional moments and responses into the session. This creates an intense spotlight on process, the specific way emotion is created, shaped, and regulated.

Mostly, we act as if emotions simply happen to us; we don’t see how we shape our own experience and induce negative responses from others. Viewing experience as an active construction is empowering. Clients are then able to face the ironic fact that their habitual ways of dealing with difficult emotion—ways that may have gotten them through many dark nights of the soul—now trap them and create their ongoing pain.

So I ask Mike questions that help him tune in to his own emotional processing. “Mike, right here, right now, Emma is telling you that she’s angry and that the moment that really triggers her is when you turn and walk away. What’s happening for you as you hear this?”

“That’s just what she did yesterday,” he replies, and offers a theory that all women get angry for very little reason.

I try again: “Right now, how do you feel when she says, ‘You just walk away,’ in an angry voice?” Mike just shakes his head. He begins, “I don’t know—don’t know which way is up here—lost my balance.”

I lean in and ask, “Can you feel that sense of being off-balance right now?” He nods again. “What does it feel like?”

He slumps back in his chair and says, “Like I’m lost in space. My world is falling apart and I don’t know what to do.” He gives a long sigh.

Many therapists who are comfortable going to the leading edge of a client’s emotions will go one small step further and make small additions or interpretations, such as, “Falling, losing direction, no balance—that sounds very hard, scary even.” If Mike accepts the inference and allows himself to touch his fear, he might reply, “Yes. I’m scared. We’re falling apart. So I run away. What else is there to do?”

By staying focused on Mike’s experience and continually piecing it together in vivid and specific language, the therapist helps him create a felt sense of his experience and expand it. Continual validation of his experience and reflective summaries allow him to stay engaged with, but not be overwhelmed by, his emotions. He can begin to pay attention to Emma’s messages about how his distancing affects her, and both partners can see how they generate the demand–withdraw dance, which triggers their distress. Once difficult emotions become clear and workable, clients can better hear and empathize with the other partner. They begin to own their problematic emotions, move past surface responses into deeper concerns, and take a metaperspective on inner processing and interpersonal responses. But this is only the first stage in personal and relationship change.

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8 comments

  • Comment Link Friday, 29 June 2012 15:22 posted by jan

    Good article. I know that catharsis can be extremely healing if done carefully. I also know that it the therapist is not paying attention it can re-traumatize people. As a meditator I was taught to allow my emotions to have their way with me and simply allow them to pass. This too is useful at times. How could anything in nature that is natural to a body be wrong?

  • Comment Link Friday, 29 June 2012 14:03 posted by cecilia berberich

    Excellent article using the Attachment theory to a sense of emotional awareness, connection and security ; "...slow, soft, simple..." equals emotional "safety"....

  • Comment Link Friday, 15 June 2012 19:25 posted by Tim

    Excellent article that will inspire further reading.

  • Comment Link Friday, 08 June 2012 13:51 posted by Dash4you

    Excellent material that helps me reflect on recent therapy where we entered to work on our relationship. My partner would not let go of her anger at me for taking care of my exhusband during a life threatening cardiac crisis. Long story, yet I choose to be there for our only child a successful adult daughter with two little girls who relied on her dad in many ways. I was able to be there for all of them for two months. Yet my partner saw this as an abandonment. I could never help her see my truth and the relationship ended. I continued to work in therapy
    finding my own dependent attachment. Releasing myself has brought an opportunity to have a healthier relationship in my future. Accepting the end of my relationship has been painfully freeing.

  • Comment Link Monday, 28 May 2012 22:10 posted by Kimi

    "Even with this more emotion-friendly attitude, it seems to me that, as a field, we still tend to err on the side of bypassing or containing emotion, rather than actively using it for change."

    Arts therapists, particularly music therapists, have been doing a great job with this for decades. Unfortunately, turf issues have kept effective arts therapy treatments from rising to the prominence their effectiveness warrants.

  • Comment Link Tuesday, 15 May 2012 10:55 posted by Noreen

    Excellent article!