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Relevance of emotional processing to psychological therapy
Reprint of article ‘Emotional processing model for counselling and
psychotherapy: a way forward’ from Counselling in Primary Care
Is it possible to bottle up emotions?
Is behaviour therapy really emotion therapy in disguise?
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In a sense all psychological therapies involve some emotional element in as much as they are often focussed on relieving distressing emotions or involve the patient talking about painful emotional experiences. However, for most psychological therapies emotions are a by-product and not the central focus of the procedure. For instance, in Freudian analysis, highly emotionally charged material from childhood may be discussed but it is the interpretation and the therapeutic relationship that is the central point rather than the emotional response itself. Likewise, cognitive therapy centres around emotional topics such as the patient’s distressing obsessional ruminations but the rationale and remedy involves changing cognitive strategies, not emotional strategies.
However, a number of psychological therapies have been developed in which emotion is the central focus. Some of these therapies use procedures to help patients become more aware of their emotions or feelings. Gestalt therapy (Perls, Hefferline & Goodman 1951) uses a variety of different techniques to encourage greater awareness of bodily sensations and emotions in an attempt to give the patient new insights into their behaviour. Eugene Gendlin’s emotional focusing (Gendlin 1978, 1996) concentrates specifically on emotional feelings and sensations to understand the meanings inherent in them. Greenberg and colleagues (Greenberg, Rice & Elliott 1993, Greenberg & Safran 1987) have developed a Process Experiential Therapy sharing many elements with Gestalt and Emotional Focusing, which has been referred to as a ‘moment-by-moment’ process. A ‘genuinely prizing, empathetic’ relationship is used to help the patient explore, understand and restructure emotions.
Carl Rogers’ non-directive psychotherapy or person-centred therapy/client centred therapy is the central plank of counselling throughout the world and is used by organisations such as the Samaritans. In person centred therapy, the person explores their experiences and feelings in an effort to understand themselves better. Rogers (1942, 1951) regards the actualising drive in individuals – the movement towards growth and realisation of full potential – as a self propelling force in therapy. In the context of the right empathic therapeutic relationship, patients move towards greater self understanding and a freer emotional life. Rogers talks of ‘becoming the person one truly is’ (1961).
Some emotion-based therapies emphasise acceptance of one’s emotional life rather than finding meaning in emotions. Steven Hayes’ Acceptance and Commitment Therapy (Hayes 1999) uses metaphor, paradox and experiential exercises to help individuals make contact with thoughts, feelings and memories that have been avoided, learn to recontextualise and accept these private events and commit to needed behaviour change.
In Marsha Linehan’s Dialectical Behaviour Therapy for borderline personality disorder, practical exercises have been developed to encourage patients to tolerate feelings of distress as well as label emotions more effectively.
William Stiles’ Assimilation Model (Stiles, Honos-Webb & Surko 1998) is not a psychological therapy itself but a model which can inform the course of therapy. Various stages of therapy are delineated, indicating the degree to which patients have assimilated problematic experiences. At the lowest level (‘warded off’) the patient is unaware of the problem. During successful therapy the patient moves to ‘unwanted thoughts abut the problem (level 1) and ‘vague awareness (level 2), to problem statement and insight (levels 3 and 4). ‘Working through’, ‘problem solution’ and ‘integration’ are the final three stages. This is reminiscent of Lane’s levels of emotional awareness (Lane 1990) except it is more closely related to the process of psychological therapy than Lane’ model.
Edna Foa’s Prolonged Exposure Therapy (See Psychiatric Times) (Foa & rthbaum 1997), building on the general behavioural exposure literature (Marks 1987), has been used successfully in the treatment of patients with post traumatic stress disorder, obsessive-compulsive disorder and sexual abuse experiences. Unlike Gestalt Therapy, Focusing, Process Experiential Therapy or Person Centred Therapy, it does not seek for meaning in emotional experiences. Also, unlike Acceptance and Commitment Therapy and Dialectical Behaviour Therapy, it does not advocate acceptance of feelings. It aims to remove the distressing feelings. This involves prolonged exposure to the events that trigger distress (situations, memories).
Pennebaker’s Narrative Therapy (1997) encourages patients/individuals to write abut ‘the worst event that has ever happened to them’ over four writing sessions. This frequently unearths emotionally distressing material. Although individuals may initially report greater discomfort, positive health benefits accrue (ie reduced visits to a physician, improved immunological function).
Gidron & Duncan (2002) have developed a structured version of narrative therapy (Guided Written Disclosure) encouraging identification, expression and working through of emotional issues. They hypothesise that the act of verbalising emotional issues is central to effective emotional processing.
Therapy aimed at enhancing emotional processing
Most of the emotion therapies described above are not conceptualised in terms of emotional processing but other emotional dimensions. Perhaps the closest relatives to emotional processing would be Stiles’ Assimilation Model, Foa’s Prolonged Exposure Therapy and Gidron & Duncan’s Guided Written Disclosure. Despite this, one would expect all of the emotion based therapies to assist individuals in processing difficult emotional material.
Is a therapy based on emotional processing possible or desirable? Would it constitute a therapy in its own right or simply an adjunct to a broader based therapy?
It would be possible to use the emotional processing model in varying ways to conduct therapy. At its very simplest, an emotional processing therapy would involve the following basic elements:
▪ retrieving emotionally charged unprocessed memories of negative events
▪ expressing emotions related to this
▪ dealing with issues surrounding the memory
▪ identifying any faulty mechanisms in emotional processing both
– in the way the material was originally dealt with and
– how the patient deals with the emotions in therapy (eg relating the memory whilst staying distant to the emotional feeling)
▪ encouraging healthier processing in the future
The active development of new attitudes and approaches to emotional problems in the future is an important step in ‘innoculating’ patients against future distress and might help to foster long term prevention (Weekes 1989). This may be why person centred counselling (Baker, Baker, Allen, Thomas, Newth, Hollinbery, Gibson & Golden 2002) shows beneficial long term affects.
‘Why waste money on psychotherapy when you can
listen to the B Minor Mass?’
Michael Torke, The Observer