Collaborative Emotional Processes Supported by Brief Psychoeducation

There is nothing like a safe, empathic, therapeutic relationship to help people learn to become aware of, express and make sense of feelings. This is foreign terrain for lots of us and it makes sense that people need help and support in learning how to do this. A study indicated collaborative emotional processing with a therapist is associated with effective therapy outcomes in both interpersonal therapy (IPT) and cognitive behaviour therapy (CBT), while the other form of therapist engagement, characterized as “educative/directive,” was not (Coombs, Coleman, & Jones, 2002). Collaborative emotional processes were more often present in IPT than CBT.

As an emotion-focused therapy, collaborative emotional processing is the heart of emotion-focused mindfulness therapy, helping people to learn how to access, modulate, and transform emotions. Therapists help clients access emotions by helping them become aware of and express emotions. Modulating emotions involves learning to regulate and reflect on emotions, and can include calming or heightening their intensity in order to better access them. One of the most powerful ways of calming intense emotion is helping people acknowledge, name, express and reflect on their feelings.

Transforming emotions involves helping clients arrive at primary emotions and sort out whether they are adaptive or maladaptive. Adaptive emotions have a lot of implicit information about current situations and reflecting on them helps people realize what matters most to them and motivates them to act. Maladaptive emotions, on the other hand, tend to be too intense, paralyzing, and do not help us navigate our lives. Examples would be feeling like an orphaned child in a big threatening world or feeling ashamed and wanting to melt into the floor.

Maladaptive emotions do not help us orient to current situations, they are loaded with information about the past. We can transform them by finding memories of the toxic situations that shaped these deeply conditioned patterns. Reflecting on these memories and identifying unmet needs, such as needing but not being protected, loved, appreciated, and treated with respect, tends to evoke implicit adaptive emotions, which, when attended to and expressed, can transform the maladaptive emotions. For example adaptive anger can transform fear, while empathy and love can transform shame and sadness. (You can read more about this in my earlier posting “How We Learned to Suppress Feelings.”

The experience of transforming maladaptive emotion and developing a new healing narrative within an empathic, collaborative therapeutic relationship is a powerful new growth experience. Witnessing other group members processing in this way also opens people’s hearts, provides powerful vicarious learning opportunities, and deepens group members’ trust in each other and the group process.

Emotion-focused mindfulness therapy (EFMT) emphasizes experiential and emotional processing, whereas mainstream MBIs do not specify nor encourage this, emphasizing instead decentering from and letting go of difficult thoughts and feelings and returning to present-oriented experience (Gayner, 2019). In integrating MBIs into emotion-focused therapy, I gradually adapted the MBI format to create more time for collaborative emotional processing.

In EFMT, after session one, sessions now involve meditation, journaling the meditation experience, and then each participant taking a turn describing their meditation experience and how they are now, with the therapist responding in an empathic, collaborative way to deepen their emotional experiencing and, as appropriate, help them access, modulate or transform emotions. After a particularly novel or intense process, such as when someone transforms primary maladaptive emotion through inner child work, the therapist debriefs with the client and the group and then provides some brief psychoeducation to help people integrate this new experiential learning into their meditation and lives. Psychoeducation is used strategically and sparingly to help support live experiential learning.

When I was initially exploring how to integrate MBIs into emotion-focused therapy (EFT), I retained the basic MBI format including the formal psychoeducation period at the end of each session. I had not yet realized it was possible to include powerful EFT chair tasks in therapy groups. These are very helpful in transforming maladaptive emotions, but I was concerned they would be too intense and emotionally dysregulating for other group members. My opinion changed after reading the small, emerging EFT group literature (Ivanova, 2013; Lafrance Robinson, 2014; Wnuk, Greenberg, & Dolhanty, 2015) and consulting with Les Greenberg who is the foremost developer of EFT and Sarah Thompson who uses chairwork in her EFT groups for students struggling with harsh self-criticism at Ryerson University here in Toronto. I learned that rather than being too intense for people to witness, people’s hearts soften and open and they find themselves acknowledging and beginning to find their own way through their own material. “Do it,” Les encouraged me.

I knew introducing chairwork would require more time within the session and the formal psychoeducation part of each session would have to go. I was comforted by the knowledge that it is collaborative emotional processing rather than psychoeducation that is associated with effective therapy outcomes.

However, it didn’t make sense to introduce more intense emotional processing until sessions four or five when group coherence and therapeutic alliance has become strong enough to support it. This meant I was still including formal psychoeducation at the end of sessions two to four, which I used to teach participants about experiential and emotional processing. This is the format described in the paper (Gayner, 2019).

This changed when I read Ann Weiser Cornell’s (2013) book, Focusing in Clinical Practice: The Essence of Change. I had been introducing participants to focusing through formal psycho-education, trying to explain to them what focusing is and how to do it, and then they would try it in the group, we would debrief, and I would provide more coaching on it — a relatively traditional way of teaching focusing. Cornell’s book helped me understand how to introduce focusing as a fluid, seamless part of therapeutic processing with someone.

For example, say I am exploring someone’s experience with them and I ask them how they are feeling, and they respond, “There is nothing there. It feels empty.” Following Cornell, I have learned to respond to them by saying, “Something is there that feels like ‘nothing,’ like ’empty.'” This helps them turn their attention inwards and to be with how it actually feels, rather than externalizing this as a problem that can not be addressed. Cornell has all kinds of helpful suggestions like this for how to introduce clients to focusing before they have even heard of the word “focusing” and without creating performance anxiety about it.

Now, formal psychoeducation in EFMT is limited to individual intake sessions and the first group session, introducing people to the intervention, meditation and journalling and how to develop a regular meditation practice between sessions. In the early afternoon of the one-day retreat, there is also a talk on values that sets up an experiential exercise to help people experience and acknowledge what matters most to them and what kind of life they want to show up for. New learning and growth takes place through participants’ own exploration in meditation, journaling and life as well as through collaborative emotional processing with the therapist supported by debriefing and brief psychoeducation afterwards to integrate the new learning into meditation and life.