Saturday, June 23, 2012

Emotions in Therapy

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The Power of Emotion in Therapy

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MJ2012-1How to Harness this Great Motivator

By Susan Johnson

Neuroscientists have recently established that emotion is the prime organizing force shaping how we cope with challenges. Now psychotherapists are learning how to work with emotion, rather than trying to control it. 

“God guard me from those thoughts men think in the mind alone. He that sings a lasting song, thinks in a marrow-bone.”—W. B. Yeats.
Mike leans forward, and in a low, intense voice, says, “Look. It wasn’t my idea to see a couples therapist. And I hear that this therapy you do is all about emotions. Well, that about counts me out. First, I don’t have them the way she does.” He points to his wife, Emma, who’s staring angrily at the floor. “Second, I don’t wantto have them or talk about them. I work through problems by just staying cool. I hold on tight and use my little gray cells.” He taps his head and sets his jaw. “Just tell me what’s wrong with us—why she’s so upset all the time—and I’ll fix the problem. Just tell me what to say, and I’ll say it. We were just fine until we started to have kids and she started complaining all the time. All this spewing of ‘feelings’ just makes things worse. It’s stupid.” He turns away from me, and the silence is filled with the sound of his wife’s weeping.
The irony of this type of drama never fails to intrigue me. In one of the most emotional scenarios ever—a couple trying to talk about their distressed relationship—here’s a partner insisting that the solution to distress is to ignore the emotion! Worse still, I’m getting emotional! This client is upsetting me. I breathe in and get my balance. After all, I remind myself, what he’s saying is so normal.
Mental health professionals would agree with him. In fact, I agree with him, to some extent. Venting strong, negative emotion—usually called catharsis—is nearly always a dead end. More than that, most of us are wary of strong emotions. Emotions have traditionally been seen, by philosophers like Ren√© Descartes, for example, as part of our primitive animal nature and, therefore, not to be trusted. Reason, by contrast, has long been thought to reflect our higher spiritual self. In neuroscientific terms, the implication is that we’re at our best when we live out of our prefrontal cortex and leave our limbic brain behind. More specifically, emotion is often associated with disorganization and loss of control. As Latin author Publilius Syrus, known for his maxims, wrote in the first century B.C., “The sage will rule his feelings; the fool will be their slave.”
All this is now changing. We’re in the midst of a revolution, as far as emotion is concerned. Antonio Damasio, one of the great scholars in the emotion field, notes that this revolution began in the 1990s, when the inherent “irrationality” of emotion began to be questioned. We’re now at the point where emotion—the apparently crazy, irresponsible sleazebag of the psyche—has been identified as an inherently organizing force, essential to survival and the foundation of key elements of civilized society, such as moral judgment and empathy. Emotion shapes and organizes our experience and our connection to others. It readies us for specific actions; it’s the great motivator. As the Latin root of emotion, movere(to move) suggests, strong feelings literally move us to approach, to avoid, to act.
Way before this emotion revolution, many therapists accepted that there was more to emotion than simply learning to control it—that directly working with emotion was somehow central to the task of therapy. We recognized that old Publilius was wrong: it’s not always good to control your emotions rigidly, and it’s not always foolish to listen to them! The idea that some kind of “corrective emotional experience” was necessary for any kind of effective psychotherapy was repeated endlessly, at least in the more dynamic psychotherapies. But exactly what the key elements of this experience are and how we get there with our clients remains difficult to define.
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. For many years, this seemed to be particularly true in couples and family therapies. It makes sense, in that emotions are especially intense in difficult interactions with loved ones. Therapists have to deal with powerful attachment dramas, which unleash rivers of emotion in their clients, and their own emotional issues can be triggered as they watch these dramas unfold. Such therapists had better know their rivers, and how to swim! Otherwise, it’s safer to sit on the bank, hold on to the traditional distrust of emotion, and try to create change through purely cognitive or behavioral means. But these interventions may not be sufficient, given that emotion and emotional signals are the central organizing forces in intimate relationships and that changes in emotional responses, such as increased love and tenderness, are hard to generate if we don’t work with emotion directly.
For many of us, formal training doesn’t help much here. How many professional training programs—even now, when we know so much more about the significance of emotion—systematically teach how to understand emotion or to engage and use it to create transformation in clients? In clinical psychology programs, young therapists mostly seem to learn how to teach clients techniques for moderating out-of-control emotions. Even if we look at a master therapist who explicitly values emotion, such as the great Carl Rogers, we see less direct focus on emotion than we might expect. So it makes sense that many of us remain a little intimidated or off-balance in the face of the compelling experience of emotion. It’s difficult for us to embrace it as a positive force and use it as a powerful tool for shaping growth in our clients.
“Research tells us that when therapists help clients deepen emotion, clients attain better outcomes in therapy. If we can become comfortable with the power of emotion, it becomes the therapist’s greatest ally, rather than a disruptive force to be contained.”
It’s self-evident that emotion is captivating. If we can tune in to and address clients’ deeper emotions, the therapy process is at once tangibly relevant, and they engage. Research tells us that when therapists help clients deepen emotion, clients attain better outcomes in therapy. When we shape powerful emotional interactions in Emotionally Focused Therapy (EFT), we see seismic shifts in the core interactions that define lifetime relationships. Emotion takes us to the heart of the matter. New emotional mosaics create new perceptions and meanings. Even more important, they move us—psychologically and physiologically—into new response modes. If we can become comfortable with the power of emotion, it becomes the therapist’s greatest ally, rather than a disruptive force to be contained.
Even if we view emotions as essentially problematic, damping them down or circumventing them is no small task. Therapists often try to defuse negative emotion with such techniques as structured skill-building exercises, but the emotion usually seeps through and takes over anyway. We’ve all seen empathy or positive communication exercises miss the mark when they’re done with flat facial expressions or hostile tones. Physiologically, the attempt to suppress emotion is hard work, often resulting in increasing arousal. James Gross, a key researcher in affect regulation, finds that interactional partners pick up on this increased arousal and become more agitated themselves. We can all relate to the argument that goes: “You’re mad,” “No, I’m not” (said with clenched teeth), “Yes, you are; I don’t even want to talk to you.” But perhaps even more important than the effort required to regulate emotion is the fact that new, positive ideas and actions that emerge in session remain peripheral, unless we feel their force and connect with them on an emotional level.
What do therapists need to know to harness the power of emotion in therapy sessions? I remember when I was an idealistic young therapist starting to work with couples and suddenly coming face-to-face with such tsunami-like emotion that, to be able to stay with and focus on the wave, I needed to see the order, the patterned structure of this experience. As I came to understand emotion better, I gained understanding about the way in which key emotions were constructed and processed. I became less intimidated and learned to embrace and ride the wave, using its force to create change. By learning about emotion, I was able to help clients order these experiences and use them positively in their lives.
I could do all of this because I’d been given a great map: I had Attachment Theory—a systematic framework for personality and relationship development—as a guide. This theory of self in relation to others places emotion and its regulation front and center. John Bowlby, its father, saw emotion as the great communicator. It gives us a “felt sense” of our own physiology—our “gut wisdom.” It connects us with our preferences and longings. It links us to others with lightning speed. For Bowlby, the dance of connection and disconnection with loved ones plays a pivotal role in defining who we are; emotion is the music that organizes this dance and gives it rhythm and shape.
In the case of Mike and Emma, I feel more grounded and calm when I can track exactly how Mike regulates his emotions: he dismisses and denies them. This affects how he frames his signals to his partner—a process that elicits particular negative emotional responses from her. These responses then confirm his need to “hold on tight” and deny his emotions. Emotions aren’t just inner sensations and impulses; they’re social scripts. Self and system are molded in an ongoing feedback loop, which neither Mike nor his partner are aware of. The attachment framework sets out the deep logic of seemingly unpredictable emotions and tells me how and why Mike and Emma deal with them the way they do. There are only so many ways to deal with emotional starvation and the universal experiences of rejection and abandonment. When I know the territory, I feel confident enough to explore the terrain.