III: Working with emotion in psychotherapy: Helping clients learn how to access and use their emotions

The final step is helping clients learn how to use their emotions skillfully and appropriately in their everyday lives.  Emotions are always experienced in a particular context and clients have to learn appropriate ways to deal with them within the contexts in which they arise.

Here are some of the ways I have helped clients begin to experience and then use newly emerging emotions.

Dealing with softer, vulnerable emotions:   First, with respect to “vulnerable,” more tender emotions such as sadness,  grief and even love,  the most important factor in learning to express these emotions is their determining whether the context is safe and whether or not they have the internal support to express them.  In order to convey them to me, they need to see me as a supportive,  empathic presence.  To make it safe for them, I need to explore how they experience me,  their perceptions of me and possible negative transference expectations.    Even though I see myself as being usually a kindly therapist, they may still expect me to be a harsh authority figure who will judge them if they are vulnerable with me.  (I have seen too many therapists, particularly in the distant past, who tried to force their clients to experience and express emotions, which they certainly couldn’t do because they weren’t safe with those therapists.  Such therapists didn’t seem to understand the need for an understanding, sympathetic audience for those clients.  Ironically, they usually had trouble experiencing and expressing their own vulnerable emotions. )

Prohibitions against vulnerability:   Even if the clients do see me as safe, they may have internal prohibitions  against being vulnerable.   One way to determine whether the inhibiting factors are external and/or internal, is to ask them if they are able to express these emotions–e.g., crying when sad–when they are alone.    If so, then the prohibitions are more external, i.e., the expectation that others will see them as weak or foolish if they express vulnerable emotions and take advantage of them.

Experiencing the physical effects of inhibition of emotions:  One tack I often take is to suggest that they just allow themselves to silently experience the emotion physically in their bodies.   I often  notice that they are doing something bodily to stop themselves from surrendering to the emotion,  such as tightening their abdomen, clenching their jaw, squeezing their eyes, inhibiting their breathing.    If it appears that  they are feeling sadness, even needing to cry,  but are stopping themselves from doing so by inhibiting their breathing and tightening  parts of their body,  I will point that out.  I ask them how that feels physically and they then usually become aware that the physical inhibition makes them  feel tense and uncomfortable.  I will then explore with them where and how they learned to inhibit affect in that way.    Note that I never see inhibition as “resistance,” which not only has negative connotations, but also deprives the client of the opportunity to discover what he or she is doing actively, albeit unconsciously, to prevent emotional experiencing and expression.  I also view the inhibitory process as an active, countervailing force which had a positive, survival benefit at some point in their lives.   In fact, I prefer the verb “inhibiting” to the noun “inhibition,” which has a static connotation.

It might be that they are feeling embarrassed showing the emotion and are reluctant to do so in my presence.   This is especially true with respect to crying, particularly with male clients who have been given the message that crying shows weakness.

A frequent fear is the expressed idea:  ‘If I started to cry, I’d never stop.”  They are usually surprised, when they begin to let go and cry fully, that  the crying usually doesn’t last very long and they then experience a sense of calm.

Sometimes it is only necessary for resolution of the affect for clients to express vulnerable emotions such as hurt or sadness to me.   But note that I’m using the term “expressing,” not just stating the emotion.  Clients often will say what they think they should be feeling in a specific situation but are not really allowing themselves to actually feel it or express it.  I make the inference they are stating the emotion without really experiencing it  by noticing their tone of voice and bodily expressions.  It it seems they are just announcing the emotion, I will usually ask if they are really feeling it, perhaps asking them to hear their own voice,   or  if they are saying what they think they should be experiencing.  Some client think I want them to express the emotion and are trying to please me.  If the former is the case, we need to do more work on their prohibitions;  if the latter,  we need to explore why they feel they need to please me.

Dealing with anger and other aggressive emotions:   With respect to other emotions, such as anger, the first step is  to help them realize that they are actually experiencing it.  I might notice that they are clenching their fists or sounding or looking angry and simply ask them what they are aware of  feeling.    Clients are often loathe  even to admit they are angry or identify a specific target of their anger.  They may use vague terms such as “Well, I’m just upset.”   I then  explore with them, as with hurt or sadness, where they learned to suppress or deny these feelings.   Clients who are able to admit they are angry often, however,  use the defense termed deflection in Gestalt Therapy.   Deflection involves avoiding clear identification of the source, target, location or intensity of an emotion.     One deflection is substituting a vague comment such as “there’s anger” instead of owning the anger as emanating from inside the self,  i.e., “I am angry.”  A second type of deflection is masking it while only partially expressing it, as in sarcasm or teasing.   A third type of deflection is not identifying  toward whom the anger is directed, e.g., “Well, I’m just angry,  not at any anyone in particular.”  Another very common deflection is judging the other instead of  owning  the anger as originating from within the self, e.g., telling the other that he or she is stupid, bad, selfish.  This  can be especially destructive to the object of the judgment because it usually results in shame if the other believes the judgment, or defensiveness and counterattack if the other doesn’t accept the judgment.  A final common type of deflection is minimizing the emotion by using terms like “little,” as in “Well, I’m a little sad.”   When a client precedes most emotions with “little,” I will suggest they try rephrasing the statement, leaving out the word “little.”  They usually then realize that expressing the emotion in this non-deflectdive way results in them  experiencing it in its fullness rather than in a watered-down fashion.

Anger usually requires some verbal action for a sense of resolution although I find that many clients were never taught to express anger verbally.  This is often the case with clients whose parents either hit them when they were angry or expressed their anger through negative judgments toward their children.  In these cases,  I must explore with them what they learned as children about anger and help them learn ways to express it verbally.   Were they shamed if and when they did?  Were they punished physically when they did?  Were they made to feel guilty?  Did the parent(s) present a picture of weakness so that the client got the impression that, were he or she to show anger, the parent would collapse?  Or they would destroy the family?  These are very often messages clients got as children and can become very subtle,  subconscious blocks against the experiencing and expression of anger.

When the client is ready to express anger and similar emotions, I frequently have them imagine the person they’re angry at in the room  in an empty chair opposite them and suggest they tell that person their feelings.   If they still can’t do it, or if they feel foolish talking to an empty chair,  I often ask  if they can think of  other ways  of expressing it.     They may decide they want to do it in person, which is fine with me.    They might be afraid  that their anger won’t have an impact on the other, that they will feel foolish doing so, that it might give the other the “satisfaction” of knowing they were impacted in that way.   If they decide there is nothing they can do with the anger and refuse to think of a way to deal with it,  I do what I stated earlier:  having them note  the result  for them physically and psychically in containing their anger by having them hone in on their bodily sensations.    There is usually a physical feeling of tension and discomfort and feelings of resentment towards that person, which creates distance between them.   The issue of the unexpressed anger will probably  be revisited in a later session.

It is frequently the case that clients do not have an implicit anger scale.    “Anger” may signify uncontrollable rage to them.  In these cases, I try to suggest a scale I use from mildest anger to most intense:   (1)  irritation, (2)  annoyance,  (3)  anger, (4)   fury, (5)   rage.

Sometimes I have to help a client who tends to withdraw spitefully when hurt or angry to learn to express  it verbally and in a nonjudgmental, non-accusatory way.  This is particularly important when working with couples, who often fall into the common configuration of one person aggressively blaming the other, who then, feeling impotent and frightened, withdraws.

Dealing with so-called taboo emotions:  Clients often feel shame or guilt about experiencing certain emotions such as jealousy, hatred, envy, fear, sadness about oneself.  Men is particular often have difficulty admitting they feel afraid or hurt because they assume this is a sign of weakness.  I have had both men and women refer to sadness about one’s current or past situation as feeling sorry for oneself,  i.e., self-pity.  These are often people who were shamed as children for showing sadness.    I will  attempt to normalize these emotions, pointing out that most people experience them at times.  But I often also have to explore their past experience with parents, siblings and peers when they felt and expressed the emotion in question.

Importance of context with respect to expression of emotions:  Finally, learning the different contexts in which one is experiencing emotion and how to tailor one’s expression to appropriately fit that context  is essential to the work of learning to identify and express emotions appropriately.  Yelling at a boss at work or one’s child would probably not be to the client’s benefit even though it might be momentarily satisfying.   Expressing hurt to an uncaring or sadistic person would also usually not be wise. The empty chair method referred to earlier and discussed more fully in another blog, is often an excellent way to help clients experiment with expressing emotion toward people from whom they previously felt they had to withhold these emotions.