Working With Emotion in Psychotherapy

Part I:  Introduction and role of emotion in human functioning:     Many therapy clients of mine through the years have come with very little awareness of the emotions they were experiencing.  This includes many who achieved much cognitive insight in prior treatment with previous therapists  but little awareness of the impact of unacknowledged and unexperienced emotion that were at the root of their problems.    In this first section I shall discuss why emotion is so important in human functioning and why many people lack awareness of what they are feeling.

The numerous emotions humans experience make up what some theorists  consider our major motivational system, having the survival purpose of moving us into action.  Past research showed that trained observers can reliably code infants’ facial expressions into eight different categories that are precursors to felt emotions later in life.  In fact, the word emotion stems from the Latin emouverto move out.   For example,  love motivates the person feeling it to move toward the beloved either psychologically or physically;  anger triggers actions to overcome some frustration or obstacle; sadness leads to actions such as crying and/or seeking solace from a sympathetic figure; fear motivates the individual to avoid and, in extreme circumstance, flee from a feared object.

Therefore,  many who are unaware of what they are feeling emotionally are deprived of the most important factors that  would, if experienced, move them to make effective decisions or act appropriately.   They often are described by others as cold and their interpersonal relationships are usually unsatisfying.   They make decisions based mostly on vague or very little emotional information and often attempt to use mainly logic or judgment to guide them.  In my experience, people  like this often voice justifications for their actions that may have very little to do with  the underlying causes of their motivations.

Another class of persons who are  unaware of what they are feeling are those who react impulsively, sometimes explosively, in a way that appears emotional to others.  However,  they lack the cognitive component necessary  for effective emotional expression.  For example, I have had clients in the past who had tears rolling down their cheeks but denied they were feeling sad.  Similarly, I once had a gang member in treatment who got into a great deal of legal trouble because he would, when feeling insulted, strike out violently.  Yet he denied feeling angry at the people he attacked.

Why clients lack emotional awareness:  The lack of emotional awareness practically always shows itself in a deficit of bodily awareness.  For example a client may sense anxiety or vague feelings of depression and use global referents such as “bad” or “good” to articulate their emotions, but are unable to unpack these sensations into specific emotions such as sadness, hurt or anger.   One of my chief jobs then is to help them to begin to become aware of and label their emotions; and, later, how to use them in creating a richer, more vibrant life.

My most frequent question to clients is:  “What are you feeling?” when they tell me something in a affectless way that would usually be accompanied by an emotion    The typical answer from someone like this is to say something like “I feel that. . . .”  or “I feel like.” When a person begins a sentence with these phrases,  they hardly ever  follow them with emotion words.  This is often a clue that I need to help them become aware of their emotional life.

There are numerous reasons why people are unaware of some or even all of their emotions.  First, they may simply may not have been helped by parents to name their emotions as children.   If the parent is, himself or herself, emotionally aware and empathically attuned to the child, the parent can tell from his or hr actions, facial expressions and verbal utterances, what the child is feeling and suggest that he or she may be experiencing a specific emotion.  For example, if the child throws a toy, the parent might say, “You’re really feeling angry, aren’t you?”  Or if the child has his or her face screwed up in a look that suggests he or she is about to cry, the aware parent might say, “You look like you are feeling very sad and want to cry.  Is that it?”  Of course in the former case the parent’s job is to help the angry child express the emotion in an appropriate way, e.g., verbally; and in the latter situation provide comfort for the sad child when he or she concurs with the parent about the suggested emotion.  These parental reactions not only let the child know that the emotions are valid, but also that he or she can probably expect to be supported in experiencing and expressing them in the future.

Secondly, some emotions may have been taboo in the family.  For example, the parents may have reacted with shaming or hostility when the client expressed anger as a child.    The result is often a suppression of anger and eventually, even a lack of bodily awareness of experiencing sensations of anger.    Or sadness or grief may have been taboo in the family.  The negative reinforcement can be explicit–“don’t feel that way,” or “don’t be a crybaby,” or “you’re just feeling sorry for yourself.”  Or it can be more subtle,  the parent turning away when the child displayed emotion  changing the subject, or just looking uncomfortable.

Here is an example of a client whose family negatively reinforced feelings of grief in him.  He had made great progress in the years we had met on a weekly basis and was functioning very well in his life.  He one day said he felt ready to terminate and expected that this would be his last session.  When I asked him why he wanted to do it so quickly, it emerged that he didn’t want to experience the grief of saying goodbye to me.  I suggested that termination is an important part of the therapy process and we agreed to meet until he had worked through his feelings about saying goodbye to me.  As we explored  the genesis of his need to avoid grief, we discovered that his parents had never been able to help him realize he was feeling this emotion and support him through the grieving process.   One dramatic example was not allowing him to go to the funerals of grandparents he had been close to.  The parents also did not  show their own grief or sadness to him in these or other situations.  So the emotion of grief became a dangerous emotion to him, one that he felt subconsciously he could not tolerate.  Thus the wish to avoid the process of termination, which involved sadness about saying goodbye to someone who had been very helpful to him.

Thirdly, and connected to the above, the emotion may make the person feel too exposed and vulnerable, particularly with the therapist who is, after all, a person often seen in a position of power, control, potential judgment and invulnerability.  A man who may have been shamed by a parent, an older sibling and peers when displaying hurt or sadness will be very resistant to showing such emotions to a therapist, particularly in the early stages of the treatment.