‘Nothing that feels bad is ever the last step:’ the role of positive emotions in experiential work with difficult emotional experiences

Abstract

The goal of this paper is to show (i) how the moment-to-moment tracking and processing of emotion to completion-in an emotionally engaged patient-therapist dyad where the individual feels safe and known-constitutes a powerful mechanism of therapeutic transformation, and (ii) how positive emotions are sensitive affective markers of that transformational process. Evidence from transformational studies is used to elaborate the vital role of positive emotions in the process of change in general, and, more specifically, in the course of therapeutic work with painful and overwhelming emotional experience. It is proposed that these emergent positive emotions are affective markers which signal the operation of healing transformational processes in psychotherapy. Several types of positive emotion that arise spontaneously during moment-to-moment experiential therapeutic work will be described and their role as markers of different transformational processes will be elucidated. The paper begins with examples of clinical work with emotion in AEDP (Accelerated Experiential-Dynamic Psychotherapy), an emotion-focused and attachment-based model of therapy that places the dyadic regulation of affect at the centre of both theory and practice. Copyright © 2004 John Wiley & Sons, Ltd. * Correspondence to: Dr Diana Fosha, 80 University Place, 5th floor, New York, NY 10003, USA. Tel. 212 645-8465. E-mail: dfosha@aol.com 1 The title of this paper comes from Eugene Gendlin's book Focusing (1981). Here is a larger excerpt of the text from which the title sentence comes: 'You feel better because your body feels better, more free, released. The whole body is alive in a less constricted way. . . . No matter how frightening or intractable a problem looks when it first comes to light, . . . at the very next shift it may be quite different. Nothing that feels bad is ever the last step ' (pp. 25-26). Sam, a man with a history of early abuse, rejection and betrayal sought treatment for the severe depression that followed the break-up of a relationship. Intensive psychotherapeutic work cleared his depression and led to a long period of being symptom-free and feeling well. However, Sam arrives for the session described below having felt worse in the days preceding it than he had in a long time. Positive EmotionsIn the session, Sam reports that, for days, he has been in the grips of an emotional pain that he has experienced in his body, with no thoughts about the reasons for it. I focus on Sam's somatic pain, e.g. exploring where and how he feels it, and encourage him to stay with his experience of it. Tracking his experience moment-to-moment, some possible links emerge between his somatic state and some recent events. By staying connected with and pursuing the painful reactions, the message is that in the therapeutic relationship, deep feelingshis and mine-can be tolerated without the disconnection and humiliation with which his early attachment figures had met his emotions. As his affect deepens, Sam starts to thaw. Thoughts begin to flow. Gradu...

Emotion, True Self, True Other, Core State: Toward a Clinical Theory of Affective Change Process

“…AEDP (Accelerated Experiential Dynamic Psychotherapy) --a model that integrates experiential and relational elements within an affect-centered psychodynamic framework, and places the somatic experience of affect in relationship and its dyadic regulation at the center of how it clinically aims to bring about change (Fosha, 2000)--roots its understanding of how therapy works firmly in transformational studies (Fosha, 2004; Fosha & Yeung, in press), fields of endeavor devoted to investigating naturallyoccurring progressive transformational processes that operate powerfully, often rapidly and dramatically, yielding substantive changes that are often lasting. The evidence from transformational studies (see below) points to affective processes experienced within the context of an affirming relationship as being central in such quantum transformations.…”

“…When people have this even once, they no longer helplessly wonder for years whether they are changing or not. Now they can be their own judges of that" (Gendlin, 1981, p. 7) AEDP seeks to harness the power of these natural affective change processes to effect therapeutic results (Fosha, 2002(Fosha, , 2004Fosha & Yeung, in press) through its stance, the experiential method, and its healing centered orientation.…”

“…consequence of the conceptual focus on change and the study of change processes, and of the experiential technical focus on the experience of change, is the appreciation of the crucial role of positive affects in the therapeutic process (Fosha, 2004), an area of experience often neglected or only minimally discussed. Since much of what has to be renegotiated in the course of treatment are difficult, painful experiences, at times of unbearable proportions, treatment is commonly assumed to, of necessity, focus on the bad stuff; positive affective experiences are seen as the outcome of therapy, but not inherent in and integral to the moment-to-moment processes of therapy.…”

“…Technically, this involves bypassing defenses, and counteracting the inhibiting impact of functionally pathogenic affects, such as fear and shame. With defensiveness, fear, and shame no longer prominent clinically, phenomena characteristic of the affective change processes can come to the experiential fore (Fosha, 2000;Fosha & Slowiaczek, 1997) where they can be tracked moment-to-moment and worked through to completion (Fosha, 2002(Fosha, , 2003(Fosha, , 2004.…”

“…As a model of change rooted in pathology it focuses more sharply on how and why people don't change (or get worse), than on how and why people get better.Fosha Emotion, True Self, True Other, Core State 5 A model of therapy needs at its essence to be a model of change (Fosha, 2000(Fosha, , 2002.This metapsychology of the therapeutic process should not be derivative --a poor cousin-of the theory of psychopathology, but function as a strong explanatory framework in its own right. My goal here is to begin to articulate a transformation-based, healing-oriented metapsychology of therapeutics.AEDP (Accelerated Experiential Dynamic Psychotherapy) --a model that integrates experiential and relational elements within an affect-centered psychodynamic framework, and places the somatic experience of affect in relationship and its dyadic regulation at the center of how it clinically aims to bring about change (Fosha, 2000)--roots its understanding of how therapy works firmly in transformational studies (Fosha, 2004; Fosha & Yeung, in press), fields of endeavor devoted to investigating naturallyoccurring progressive transformational processes that operate powerfully, often rapidly and dramatically, yielding substantive changes that are often lasting. The evidence from transformational studies (see below) points to affective processes experienced within the context of an affirming relationship as being central in such quantum transformations.…”