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Working with Emotions in Psychotherapy
This blog completes my effort to show that my book, Cognitive Neuroscience and Psychotherapy: Network Principles for a Unified Theory, is not as radical as some readers may think by reporting that my call for working with emotions is not that unique or unusual. Here I briefly review four books that aim to help clinicians work with emotions in psychotherapy. While many clinicians already practice in an eclectic way, they have lacked theoretical support for doing so until now. This lack of theoretical support is the reason why eclectic practice is criticized for the following reasons.
A major problem with eclectic practice is that the various treatment techniques are derived from, are based on, different, and often contradictory, theoretical perspectives. Which theoretical perspective should you begin a particular case with? Which theoretical perspective should you switch to if treatment does not go as planned? There is no good way to justify these decisions. Appeals to clinical experience reveal a trial and error approach which is always unnerving. The absence of theoretical support to guide eclectic practice suggests that the clinician does not understand what they are doing. In a real sense this is true because theory is how science understands and the absence of theory to guide treatment selection constitutes a lack of understanding.
Few clinicians are completely constrained by their theoretical orientation. Hence, nearly all clinicians engage in some form of eclectic practice and need a theoretical rational to guide them. My book provides the required theoretical support via core and corollary principles.
Greenberg and Paivio
Greenberg and Paivio (1997), in their book entitled Working with Emotions in Psychotherapy, state: “Although a lot has been written about cognition and reason in psychotherapy, not that much has been said about emotion. This book begins to restore the balance” (p. vii). The theoretical basis of cognitive-behavioral therapies is extremely limited and informal. The view of emotion by this popular clinical orientation is that emotions result from cognitions. This is a very narrow perspective. It is also contradicted by consistent convincing neuroscience evidence that I provide in Chapter 5 of my book. Emotions arise/originate unconsciously from subcortical neural networks. We are the editors of our emotions; not their authors. We can modify the expression of our emotions but that is about it. This broader view is fully consistent with the psychodynamic clinical orientation.
Greenberg and Paivio (1997) discuss “The centrality of emotion in psychotherapy”. In Chapter 1, they stated that “The essence of our approach to treatment involves the establishment of an emotionally focused empathetic dialogue between two people in which the therapist is attuned to, stimulates, and focuses on the clients’ emotional concerns” (p. 2).
These authors coined the term “emotion schemes” to refer to emotional memories, both hopeful and fearful, plus expectations, both positive and negative, that effect how we think, feel, and behave. They distinguish emotion schemes from schemas on the basis that the emotion schemes are action oriented whereas schemas are more cognitive. My discussion of prototype formation in Chapters 4 and 11 of my book provides missing mechanism information for how these structures form and operate.
Part One of their book is entitled “Theoretical Framework”. It is devoid of neuroscience information including cognitive neuroscience information which means that their theoretical framework is not constrained by neuroscience facts. It is notable that Greenberg and Paivio (1997) do not provide any mechanism information for how emotional schemes work. Working with mechanisms that you don’t understand is generally not a wise practice.
I comment on the Emotion Focused Therapy (EFT) developed by Greenberg and Paivio in several places in my book. On page 218 I provide mechanism information for their transformation principle. On page 463 I comment on how EFT modifies the client’s personal narrative. On page 506 I consider the clinical benefits of reactivating emotional memories.
Plutchik (2000) recognizes the relevance of emotions to every school and psychotherapeutic approach. His focus is on the role of emotions in mental health and illness rather than on the promotion of a new school of psychotherapy. His training in what was then called physiological psychology means that his views on emotions have been informed by neuroscience. Plutchik identified a crucial link between emotions and psychiatric diagnoses as follows:
I believe that most psychiatric symptoms are actually disorders of emotion. A detailed examination of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) reveals that most symptoms that define the various diagnostic categories are, in fact, descriptions of excessive emotions (e.g., panic) or decreased emotions (e.g., flat affect). Within each diagnosis, at least one or more symptoms refer explicitly to emotional states (p. 4).
Thoma and McKay
Thoma and McKay (2014) substantially expand the clinical practice of cognitive behavioral therapy (CBT) with their edited volume that provides expert advice on how to work with emotions within a CBT orientation. The contributors to this book emphasize empirically supported experiential techniques but do not provide a comprehensive theoretical foundation for this expanded clinical practice. My book provides the required theoretical foundation for the clinical practices that Thoma and McKay recommend.
Barlow et al.
Barlow et al. (2011) proposed a unified protocol for the transdiagnostic treatment of emotional disorders. They distilled the essential therapeutic components of effective treatments based on more than 25 years of clinical research. I was unaware of their book when I wrote my book but was delighted to see that their independent empirical clinical research and scholarship fully supported my Principle 8 regarding the need to induce dissonance and control its reduction towards consonance. Hence, no new clinical evidence is required to support the Applied Psychological Science model that I proposed.
This ends my multiple blog series aimed at showing that my book is not as radical as some readers might think. This series started with three blogs that provided supportive cognitive neuroscience evidence from Pennington (2014). The next two blogs demonstrated that my book is consistent with the latest neuroscience understanding of consciousness. The previous blog justified the neural network approach that my book takes on the basis that the brain is a network of neural networks. This blog provides evidence from four books that supports my call for a more comprehensive approach to psychotherapy. While many clinicians already practice in an eclectic way, they have lacked theoretical support for doing so until now. My book provides the required theoretical support via core and corollary principles.
Warren’s book, Cognitive Neuroscience and Psychotherapy: Network Principles for a Unified Theory is available for purchase on the Elsevier Store.
Use discount code “STC215” at checkout and save up to 30% on your very own copy.
About the Author
Warren W. Tryon received his undergraduate degree from Ohio Northern University in 1966. He was enrolled in the APA approved Doctoral Program in Clinical Psychology at Kent State University from 1966 – 1970. Upon graduation from Kent State, Dr. Tryon joined the Psychology Department faculty at Fordham University in 1970 as an Assistant Professor. He was promoted to Associate Professor in 1977 and to Full Professor in 1983. Licensed as a psychologist in New York State in 1973, he joined the National Register of Health Service Providers in Psychology in 1976, became a Diplomate in Clinical Psychology from the American Board of Professional Psychology (ABPP) in 1984, was promoted to Fellow of Division 12 (Clinical) of the American Psychological Association in 1994 and a fellow of the American Association of Applied and Preventive Psychology in 1996. Also in 1996 he became a Founder of the Assembly of Behavior Analysis and Therapy.
In 2003 he joined The Academy of Clinical Psychology. He was Director of Clinical Psychology Training from 1997 to 2003, and presently is in the third and final year of phased retirement. He will become Emeritus Professor of Psychology in May 2015 after 45 years of service to Fordham University. Dr. Tryon has published 179 titles, including 3 books, 22 chapters, and 140 articles in peer reviewed journals covering statistics, neuropsychology, and clinical psychology. He has reviewed manuscripts for 45 journals and book publishers and has authored 145 papers/posters that were presented at major scientific meetings. Dr. Tryon has mentored 87 doctoral dissertations to completion. This is a record number of completed dissertations at the Fordham University Graduate School of Arts and Sciences and likely elsewhere.
His academic lineage is as follows. His mentor was V. Edwin Bixenstein who studied with O. Hobart Mowrer at the University of Illinois who studied with Knight Dunlap at Johns Hopkins University who studied with Hugo Munsterberg at Harvard University who studied with Wilhelm Wundt at the University of Leipzig.
Cognitive Neuroscience and Psychotherapy: Network Principles for a Unified Theory is Dr. Tryon’s capstone publication. It is the product of more than a quarter of a century of scholarship. Additional material added after this book was printed is available at www.fordham.edu/psychology/tryon. This includes chapter supplements, a color version of Figure 5.6, and a thirteenth “Final Evaluation” chapter. He is on LinkedIn and Facebook. His email address is email@example.com.
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