Counselling in Primary Care Article




Professor Roger Baker, Consultant Clinical Psychologist, Dorset Healthcare NHS Trust and
Co-ordinator of Dorset Research & Development Support Unit, Poole Hospital NHS Trust

I don’t feel I am an emotional person and when you first said about emotional experience, I thought ‘I don’t have any’. I don’t focus on emotion a lot …. I think there is something about emotions that I probably don’t feel too comfortable with, so that when these feelings come I want to channel it into something else, something more practical. I think sometimes it is a deliberate ploy on my part not to deal with emotional things.” (Sandy T; participant in a research interview study on the topic of emotion)

Most of us are familiar with ways we tend to suppress, deny, avoid, switch off, bottle up, control or smother emotions. The belief in the superiority of rational thought and mistrust of emotions is summarised in our supposed national characteristic – the British ‘stiff upper lip’. Even researchers seem to have regarded emotions as a rather unacceptable subject for study and Scheff in 1984 went so far as to suggest there was a ‘taboo’ on research into emotions. The historical emphasis in clinical psychology too has been behaviour therapy (1965-1985) and cognitive therapy (1985- 2001), and in psychiatry, key negative human emotions such as anxiety and sadness are usually defined as symptoms of illnesses. However, in the last decade, there has been a growth in research on emotions as well as new developments in psychological therapy such as Gendlin’s ‘focussing oriented psychotherapy’ (1996) and Greenberg, Rice and Elliot’s experiential approach (1993).

Emotional Control and Panic Attacks

In the late eighties, when we were developing a cognitive invalidation approach for panic attack sufferers with Malcolm McFadyen (Baker 1989, 95) we also noticed that the patients seemed to go to great lengths to control their emotions and wondered if this might relate to why panic attacks develop in certain individuals. We looked to see if this was so. Researchers at the Courtauld Institute (Watson & Greer 1983, Pettingale, Watson & Greer 1984) had already developed an emotional control assessment scale and had suggested that excessive control of emotions might contribute to the development of cancer. We used their emotional control scale with other tests to measure other emotional dimensions such as frequency and severity of emotions and beliefs about emotional expression. We compared fifty patients with panic attacks with normal individuals from Aberdeen and London and the breast cancer patients that Watson and Greer had studied.

What did we find?

We found that panic attack sufferers tried to control all types of emotional experience measured (anger, sadness, worry) more than normal individuals or the cancer group. They were hyper-aware of the bodily sensations accompanying emotions and were not as good at identifying what emotions they were feeling (Baker 2000). In both research and therapy we found that patients with a range of other psychological conditions such as obsessive compulsive disorder and post traumatic disorder showed similar emotional control difficulties which suggested that this might be a factor underlying quite diverse psychological disorders. We wanted to understand the relationship between emotions, psychological disorder and psychotherapy and to see if a new way of understanding emotion was possible which might have practical applications to counselling and psychological therapy.

Emotional Processing

In 1980 Rachman developed a concept with potential application to many types of psychological therapy, called emotional processing. He believed that “most people successfully process the overwhelming majority of the disturbing events that occur in their life”. If people were unable to remove or “process” strong emotions they would stay at a constantly high level of arousal with so much intrusion from their feelings that it was difficult to concentrate on the daily tasks of living.

Much counselling involves working with events in the client’s life that they have failed to process emotionally. They may have tried to ignore events such as bereavement and suppressed their emotional reaction or had not worked out the links between the events and the way they were feeling. We thought that counselling could help clients to recognise the significance of such an event, make connections with their feelings and work through the experience to a point of resolution by adequately processing these emotional events. This could apply not only to current life events but also to events experienced in childhood, such as sexual or physical abuse.

Emotional processing was further developed by Foa & colleagues (1986) in the context of post traumatic stress disorder, rape and obsessive compulsive disorder. However researchers had so far failed to unpick the different mechanisms involved in emotional processing or reached a stage where it had practical application to counselling.

The Emotional Processing Research Programme – A way forward?

To address this failure we began a research programme in 1988. Its aims were to:

1. Develop a model of emotional processing to explain the psychological mechanisms involved in processing negative life events.

2. Devise a way to assess emotional processing deficits which could assist psychological therapists of all kinds to help clients and patients.

3. Develop new ways of integrating the model of emotional processing into person centred counselling and cognitive therapy.

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