II: Working with Emotion in Psychotherapy (Continued)

Part II:  Helping clients access and articulate emotions:  In working with people who are blind to some or all emotions, I go through various steps.  But I must state a caveat:  this is not a linear process.  Dealing with emotion takes place all through an intensive psychotherapy and I almost always focus on what the client brings up in each session rather than have some content agenda.  But my underlying emphasis is usually the affect issues accompanying the content of what we are dealing with, no matter whether it’s relationship issues, transference issues, parenting problems,  work-related problems or intra-psychic issues.

First, I help them notice what they are experiencing physically when they relate something that would typically be associated with an emotion, e.g., a man unemotionally telling of being constantly criticized by his father.   I  ask the client if he or she is aware of a feeling connected to the memory.   If the client denies experiencing any emotions, I might ask him or her what sensations he or she  is experiencing in the body, particularly the torso.   Typically, the first answer might be “nothing,” or “I’m fine.”  But I persist, encouraging the client to notice anything that might emerge in awareness the body.  Usually, the emerging experience will be something like tightness in the chest,  the abdomen,  the shoulders or the face.

Second, I have them attend to that part of the body where they experience the sensation, which almost always results in them beginning to experience it  as  an emotion.  For example, the man who was remembering incidents where his father criticized him harshly became aware that the initial tightness morphed into  hurt, shame and fear in response to his father’s harsh treatment of him.   Another client began to realize that the emptiness she felt in her abdomen was an expression of emptiness and loneliness.

Third, clients often have trouble staying with the emerging emotion and, instead,  deflect it in some way, e.g., changing the subject, judging it as being “silly” or  shutting down physically.    Another common deflection is to name the emotion but not owning it as part of the client, e.g., saying “there’s sadness.”    In such cases I ask the client to experiment by changing the sentence to “I’m sad,” and noticing the difference in feeling tone between the two statements.  I also help them begin to understand why and how they had learned that deflection was necessary.   One common reason for deflection with me is that experiencing emotion in my presence  can feel too vulnerable, so I must proceed slowly.  A frequent  fear of the experiencing of a previously taboo affect is shame, a particularly important affect to identify  and deal with.

Fourth, there are often complicating factors in this work.  Some emotions are secondary reactions to other emotions.    A common example is the client beginning to experience anger at mistreatment by someone in his current or past life.  This is an important step for the client who has suppressed anger and it should be allowed to exist as such until the client has begun to integrate anger into his or her life.  In order for the work to be complete, however,  I have to,  at some later point, help them realize that this may be a defense against a more vulnerable affect, e.g., hurt, helplessness, terror,  shame.   For the client to begin to own the primary, more vulnerable feelings, it is necessary that he or she experience me as a trustworthy, empathic, non-threatening person.  I have to be continually aware that, although I see myself as a positive presence,  the client may very well need to see me for a time as a potentially threatening authority figure lest he or she expose himself or herself prematurely.

Another complicating factor is that sometimes there was a lack of emotional expression on the part of one parent, while the other may have been “overly” emotional, i.e., expressed affect in a way that was overwhelming to the child.  Intense emotion of any kind may then have become threatening, leading to self-fragmentation.  Further reinforcement of the avoidance of emotion in self or others in many clients was that the non-emotional parent expressed subtle contempt  for the other parent when he or she was out of control emotionally.    This gives the child two messages:  intense emotion is contemptible and that he or she should expect to be unsupported when experiencing intense emotion later in life.

Usually it is the case that some emotions were acceptable in the family,  others not.  A macho father, for example, may accept and even encourage his son to express anger (although usually not against the father!), but shame or otherwise negatively reinforce vulnerable emotions such as fear or sadness or hurt.   Or a mother, who may not be getting the love, attention and support of her unemotional husband, may enlist  a son or daughter to be a surrogate spouse or parent, thereby suppressing more assertive or aggressive emotions in the child.  These are important issues to explore in the therapy.