What is emotion processing anyway? How to facilitate emotion processing in psychotherapy with Dr. Antonio Pascual-Leone Part 2

Dan is joined by Dr. Antonio Pascual-Leone in this episode focusing on emotion processing in psychotherapy. 
 
In Part 2 of this conversation, Dr. Antonio Pascual-Leone delves into the complexities of emotion processing, exploring the distinctions between adaptive and maladaptive emotions, the sequential model of emotional processing, and the importance of self-compassion in therapeutic settings. They discuss how emotional awareness and expression can lead to healthier emotional states and the challenges faced in emotion processing research. 
 
Dr. Antonio Pascual-Leone is a clinical psychologist and professor at the University of Windsor. He is an expert in emotion-focused therapy (EFT) and known for his research on emotional change, particularly in resolving unresolved emotional pain. His work emphasizes how structured therapeutic processes can help clients move through emotional difficulties and improve mental health. He has authored or co-authored several books including Emotion-Focused Therapy for Complex Trauma and Principles of Emotion Change: What works and when in psychotherapy and everyday. He has won several awards including several awards for his research and for his teaching.

Special Guest: Dr. Antonio Pascual-Leone

📖 Emotion-Focused Therapy for Complex Trauma

📖 Principles of Emotion Change: What works and when in psychotherapy and everyday

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Transcript

Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 20 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way. I would love for listeners to send in questions, either from me on any topic whatsoever, or from one of my past guests.
I can then reach out to those guests and share their answers in future episodes. In the show notes, you'll find various ways to get in touch. You can leave me a voice message, send a text, email, or connect on social media.
Today, I could be more excited to welcome back one of the world's foremost experts on emotion processing. He's a professor of clinical psychology at the University of Windsor, and has authored or co-authored several books, including emotion-focused Therapy for Complex Trauma and Principles of Emotion Change, What Works and When in Psychotherapy and Everyday. You can find links for these resources in the show notes.
The episode starts with my very special guest helping us understand what emotion processing is. So without further ado, it's my pleasure to welcome back Dr. Antonio Pascual-Leone.
You know, emotion processing is essentially going to be different ways of working with a feeling. If you think of emotions and the feelings you have as symptomatic, as a byproduct of other stuff you're trying to get done, and they're obstacles. And people do, some people do, right?
The clients, even some everyday people are, you know, it's like, I wish I could turn it off, right? And of course, there are some people who, for example, can, or not can turn it off, but who don't feel fear, for example, that exists, and those...
So when you're saying turn it off, you mean distress?
Distress or emotion. Like if I wasn't emotional, I'd be more functional. And there's some people with neurological disorders where they actually don't feel much, and they are actually really not very functional.
But generally, you're talking about unpleasant or distressing emotion. And I think probably we can say that unless we note otherwise, we're going to be talking about unpleasant or distressing emotion.
I mean, one of the interesting things is there's a lot more nuance in your emotional world. Okay, let's start there. In your emotional world, you have kind of pleasant feelings and unpleasant feelings.
And if you went to any dictionary of any language in the world, you would see, I mean, I speak three languages, it's true in those languages, but there are studies on this too. And so somebody let me know if you know otherwise. But in every language, there are way more words to describe negative emotional experiences than positive emotional experiences.
Why is that? Well, positive emotional experiences are bet your needs being met in some way, whatever those needs are. And there's a lot less urgency to figure out the nuance on it.
Things are good. Why? What exactly is good about?
Who cares? It's good, right? There's no urgency.
When things are bad, things are bad. In what kind of way? I don't know.
Let's find it out. Like I need to know, am I afraid? Am I angry?
Am I ashamed? Am I like the, what flavor of bad? It's really important.
I need to know right now because there's an unmet need, right? So there's a lot more urgency for negative emotions. So here we are.
Now the question is, we get to emotional processing. How do you change those feelings? So I'm going to make a contrast or differentiate between the feeling and the process that changes the feeling.
If anybody plays chess, you know there are pieces and they look different. Well, think of those as the different emotions. Happy, sad, fear, shame, angry, right?
They look different, they experience differently. Not only do the emotions look different, but you will apply operations to them. We'll call those the processes of change.
You see what I'm saying? It's like, I'm jumping metaphors here. When you go to math, you have the numbers on your calculator, and then you have plus, minus, multiply, right?
Those are the operations that you're applying to these numbers, okay? Well, in chess, you have these different pieces, and they move along different principles. Some of the pieces just move horizontally.
Some of them move only diagonally. Some of them only move one piece, that if you get the horse, it does this little jiggy jog, right? So the operations for manipulating, shaping, changing an emotional experience are actually going to be slightly different.
That there are different operations is what I'm trying to get at, right? There are not only different emotions, there are different operations. Preview to the next level of complexity is that not all operations actually apply to every emotion, just like in chess.
So certain pieces move certain ways, and they are not allowed to move on the other, do you see what I mean? So, I mean, when we get down the road, down the road, that's when one discovers that certain kinds of emotion can't be changed through the same principles as a different kind of emotion, right? So you have this puzzle of describing, what are the different kinds of emotion?
because it's actually not just happy, sad, so on and so forth. It's more like secondary emotion, which is symptomatic distress tends to be vague. I don't know what I'm upset about, but I'm very upset.
Or primary maladaptive emotion, that old haunting. So the first might be feeling vaguely alone or helpless or anxious, right? You get a primary maladaptive emotion, which is going to be that haunting very familiar kind of self-doubt or shame.
Like, you know, this is true for clinical and non-clinical populations. When you go crazy, you do it in your own particular signature way, and you're like, here I go again, right? People worry.
I personally, I don't worry too much about competence. It's just not my Achilles heel. For some people, feeling competent is like, you know, which doesn't mean I always do a good job.
Sometimes I do a terrible job. Like I have made huge failures, but I kind of go, well, that's part of the game and keep like, it doesn't ruin me, doesn't keep me up at night. What keeps me up at night is feeling misunderstood, or feeling disconnected, misunderstood.
Like, you know, so that's my particular poison. You see what I'm saying? And it's different for different people.
So this is a maladaptive emotion. That's that familiar haunting. It's different from a vague symptom.
It's much more narrative, autobiographically anchored. You can think of adaptive emotions, right? That where this is a fresh new feeling and organize you in a healthy way.
And finally, you can think of instrumental emotions. Sometimes you do stuff to have an impact socially. That's a real thing too, but that's like a different kind of emotion.
And anger, for example, I'm just going to pick anger, could be instrumental. When I start yelling at you, because you don't give me what I want. And if I yell at you, you might, yeah, you're more likely to give me, you know, or I might be angry because I'm actually defending my rights, or I might be angry in a vague, I don't know what I'm fighting for, but I'm upset kind of reactive way.
So that's a secondary, adaptive and instrumental in that, right? So those now are the different pieces rather than happy, sad, angry, right? These are the different pieces.
So let me just cut you off for a second, because there's a few things you've said that I want to just kind of colloquially have. So folks understand how. So if we just go with very basic, maybe even a way you'd explain it to a client, an adaptive versus a maladaptive emotion.
We just sort of took a look at those two. How do you think? How do you, you know, what makes it adaptive and what makes it maladaptive?
You know, first people have secondary emotions. That's usually the presenting thing, right? And this is it.
So would it make more sense, Antonio, would it make more sense to go with also to compare and contrast primary versus secondary?
And that's an easier place to start, right?
Okay, let's do that.
So you have like, usually people have a feeling about their feeling, right? And you kind of you're managing your feelings, right? And this is the client who says comes into session and says, I need to work on my I need to work on my guilt.
I feel really angry at my dad. And I shouldn't like I just shouldn't feel angry at him because he's done so much for me. But I like it.
It racks me. So I need you to help me with my guilt. Of course, I'm angry.
I feel guilty because I'm angry. The primary experience is actually anger. If you want the most bang for your buck in that therapy session, the therapist should, yes, acknowledge and validate that you feel guilty.
But that's secondary. The deeper issue, which will be more useful for the client, is actually to address the fact that they feel angry at their father. Okay.
So, secondary emotions are reactive. They're often feelings one has, because one's struggling with some deeper process. That deeper process will be the primary emotion.
Okay.
So, would it be generally be reasonable to say a secondary emotion is like an emotion about an emotion?
That's a good way to go.
Something like, you know, examples, just like you said, like, I shouldn't be angry about this, or we can think about, you know, when somebody loses someone, there's a normal grieving process, but they might be saying to themselves, you know, I shouldn't be feeling so sad. I shouldn't be, you know, I should get over it, that sort of stuff.
And if we're putting it in, yes. And if we were put in an emotional context, they wouldn't just be saying, I shouldn't. You know, if I said to that client, and given that you shouldn't, but you do, how do you feel about that?
They might feel, they might say, Oh, I feel hopeless or I feel helpless. That's secondary emotion. So that's state, right?
And we could spend a lot of time exploring your sense of hopelessness and helplessness. And I mean, that's useful as a starting point, as an entry, that's the portal, right? But if you want the most productive experience, you're going to have to get to the deeper feeling, which is going to be the primary feeling, right?
So the secondary emotions in general, is it reasonable to say that those are getting in the way of us? And we'll get into this sort of processing our primary emotions.
Yes, getting in the way, eclipsing, overshadowing, right? Here's an everyday one for people who might be listening. It's like parents in the parking lot and the kid gets out of the car, runs out, and that way, and they yell at the kid, right?
Get back here, right? So clearly angry, but anger is secondary. What's primary?
Fear. They're scared. They're scared of what's going to happen, right?
So I want to highlight the fact that it's primary, I hear air quotes, right? In the sense that it's the deeper kind of driving emotional experience. It's not necessarily the first one to be expressed, right?
So this is the puzzle. The kid's like, she's angry at me.
Right. But it's actually she's scared for you.
Scared for me, right? And she's protective of me. So that doesn't make it any better for that kid, of course.
But we're just highlighting how within that parent at that moment, there's a secondary emotion that's kind of the reaction that's kind of trying to manage the primary experience. Okay.
That's I think that's a fantastic example, and I hadn't really thought about it in that way. I mean, it's unique because, you know, we sort of but it is.
No.
Especially for me. Yeah. Especially as a parent that like you're sort of hitting me right where in my experience, which is that like fear for your kid drives so much, you know, almost always when you're, you know, I mean, I guess there is, you know, the kid spills on the thing and so you maybe just actually are.
So it's messy, right? The chemistry of life is messy because you might have these parallel. Yeah.
But but so much of anger as a parent or whatever is driven by fear because you're like, I want to need to keep my kid safe. And this is my the best way for me to be effective in doing it in this exact moment.
Absolutely.
Yeah.
Yeah.
OK. OK. This is great.
OK.
So now you get to primary motion.
Right. All right.
Here's the problem. Well, let's start with healthy people. I mean, there's research on like emotional awareness and expression in people with health problems and showing that if you can get people to become more aware and express what are they feeling and then express that feeling, that they actually have symptom reduction, sometimes physical symptoms like rheumatoid arthritis, asthma, chronic pain, all sorts of things.
You know, people. So but this is a non-clinical population. See what's happening?
They have suppressed or repressed or somehow not. For any host of reasons, we could get into them, but we don't have to right now. They're not making use of their primary emotional experience and sort of stifled and they have these secondary emotions.
And if we can get them become more aware of and express and be moved by their adaptive, primary adaptive emotions, assertive anger, grief, you know, these sorts of things, then that will be good for them and healthy for them. And it's even like, as I said, it shows up in some of this. The thing is, that is not a psychiatric population.
Okay. And I think when you move to a psychiatric population, a clinical population, awareness and expression are both going to be very important. But then there's something else.
because in a psychiatric population, when somebody is depressed, clinically depressed, anxious, I'm not just saying they're worried, normal with the normal limits or get wound up, they're anxious, they're depressed, they have an eating disorder. Now, we're talking about somebody who, when you get to the primary emotion, that primary emotion isn't necessarily adaptive, right? I should just say adaptive emotions are these things that, you've evolved to have these emotions, right?
I mean, this is like, if you could get rid of your feelings, you will be so functional because they serve a purpose, right? Each emotion organizes you in a different way. And it comes with the hardware, the evolutionary hardware, okay?
It wasn't learned, it comes in the box kind of thing.
So would you say that an adaptive emotion, it, the, I don't know if action potential is the right phrase here, but the sort of behavior, the whatever sort of comes from that, generally, we could sort of view it and say, oh, this was helpful for this person. Like this, this, they're sort of, it sort of facilitated this beneficial thing, this beneficial behavior experience, whatever in that person, that makes it adaptive.
Yes. Yeah. It organizes them in a way to meet the, to meet needs, unmet existential needs.
And by existential, I mean interpersonal or otherwise, right? They're not just interpersonal. The thing is, sometimes, I mean, you learn stuff in life, you learn stuff, and sometimes the stuff you learn isn't so good for you, and you get bent out of shape.
And, you know, for those who are interested in neuroplasticity, I would highlight and say, the stuff you learn changes your brain. It's not, right? When I say you learn, you have maladaptive learning experiences.
Somebody treats you like garbage as you grow up, and then you develop this maladaptive shame. It's not, I mean, shame, there are healthy examples of shame, but the unhealthy examples of shame aren't, what I did is unacceptable or my state is unacceptable, but like I'm embarrassed about myself or some way. That's healthy in certain scenarios, and makes sure I am acceptable to other people.
I mean, you can't survive without your conspecifics, your fellow humans, right? But if I learn that I am fundamentally unlovable or unworthy, if that's what I've learned because that's what I've been told, or treated, or right, that becomes part of who you are as well. This is a primary maladaptive shame.
We can also think of primary maladaptive fear. This is like traumatic fear, or the notion that the deep sense that I am vulnerable and unable to survive on my own, right? It's like the young person who doesn't want to travel, justin Kay, just like, go out there, see the world, you'll be fine.
But like, I feel too fragile, too vulnerable, too thin skinned, I can't handle it, right? This is maladaptive emotion. It's fear, maladaptive fear, right?
So those come from learned experiences, right? As opposed to adaptive emotions, which come from the evolutionary hardware.
You with me?
And there's all sorts of, you know, I'll just throw in. When I say they're learned, sometimes the idea of learning, people go, oh, well, great, you'll just unlearn them. Or you'll just, you know, unfortunately, for better and for worse, your brain is not like that, right?
It's not like a decal that is pasted on, and I can just peel off the maladaptive emotion, because it's not really part of me, right? Peel it back and back to the factory reset, and it doesn't work that way. When you learn things, including emotional things, it changes who you are.
It is the software and the hardware are one. You see what I'm saying? Forgive the computer metaphors, but sometimes they're useful.
So, it's not a superficial. Primary maladaptive motion is not a superficial feeling, right? It's like the Ph.D.
student who feels like they're a fraud and has this imposter syndrome and has a sense that, I know I have a Ph.D., but I always feel like I'm the dumbest person in the room. And I feel like somehow there was a mistake that I ended up with this Ph.D.,
right? There's a sense, a fundamental sense of inadequacy that is, that defies reason. You cannot look at the evidence to correct that thought.
So, now we're getting into one, I just referred to a change process, right? And I had said, certain kinds of emotions can be changed with certain kinds of processes, but not all processes will change all emotions. A cognitive reframe is really useful for managing secondary emotion.
Anxiety, for example. It will not work to help change primary maladaptive emotion. I gave you the example of somebody who clearly, 0.07% of the population in Canada has a Ph.D.
So, clearly, it's not an easy task to fake, right? And yet, this person feels like I'm a fraud, yeah? I mean, you might be a fraud in all sorts of other ways, but in that particular way, right?
It's clearly, it's not about the evidence. I know it's not true, but it feels true, says the client. Uh-huh.
Trying to rationally reframe that, right? I mean, we can just say, oh, come on. You know, and I think there is something about just starting new behaviors, which create new learning experiences.
But now we're talking about a different, a third change process, right? So here we go. Secondary motion, primary motion.
Primary motion can be the adaptive or maladaptive, right? And in a healthy population, there are going to be fewer maladaptive motions. Although I gave an example of myself.
Yeah, I mean, we all have all of it, right? The question is, what's your predominant state? And how quickly do you move out of that?
You with me? I think healthy emotional change is not like, oh, no, I'm on level two and I never have to do level one again. No, it's cumulative.
It's a cumulative test. Life is a cumulative test, right? And change involves developing a wider repertoire, but also becoming more flexible to move between states.
So when I, Antonio, I'll just use myself as an example, feel shame or even maladaptive shame, I don't spend a week there. I might not spend the day there. I might spend five, ten minutes there, or depending on the thing, right?
The envelope is, so I'm more resilient. I can shift. I'm more flexible.
Yeah, I feel I'm pretty embarrassed that it was me and I feel inadequate about that. But there's also, and suddenly now, I feel something else. I think you can think of different emotions as mental sects that come with meanings, action tendencies.
And if you feel something, you're organized a certain way to deal with a problem. And the more feelings you have about a given problem, essentially becomes the more tools you have to consider, contemplate and work through a given problem, right? So, more flexibility, good.
So, I think it would be helpful to walk through sort of the process that you guys have differentiated or you have developed sort of this sequential model of emotional processing. So, and maybe, because, how about if I'll try to sort of like, give you the, we'll start sort of from the least processed, if you will, sort of like the lowest level. And then, you can tell us what that is, and then, maybe, how to get to the next stage, or the next step in the process.
So, you start off by sort of saying the least processed, you talk about this global distress. So, a person having global distress is sort of the least processed. What is global distress?
So, global distress will be this secondary emotion. You know, there are these terms, secondary emotion, primary, primary maladaptant. They're quite abstract, right, as ideas.
So, what I've tried to do, I guess I've done, is try to describe particular emotions with criteria, so we know what it is, like, secondary emotion, which second? Well, global distress, sad, anxious, kind of vague, high arousal, low meaning, that's what it is, okay? So, it is an instantiation of secondary emotion, but that's kind of EFT language.
And I think one thing that has made the model most useful, and we get picked up by very different treatment approaches, including psychodynamic, dialectical behavior therapy, attachment, family therapy, like is that I've kind of couched these examples, these prototypes of adaptive or maladaptive motion, for example, in rather than referring to the abstract categories. But in any case, when we were talking about secondary emotion earlier, global distress is a great example of secondary emotion. It's a reaction to a reaction to a deeper emotion.
It may also be just be a very undifferentiated experience that needs to be further differentiated, right? Which creates a different feeling.
So would it be reasonable? So I think about the metaphor that I always think about with this is that like, I don't even know if I've said this before on this podcast, but I think about like when I was a kid at the beach on a boogie board, and like, you know, sometimes we're on a boogie board on the beach as a little kid, and the waves, like sometimes you get flipped underneath of it, and you get stuck underneath the board. And you have that sense of like, you have that sense, you don't even know how you feel.
You know, you feel bad. You know, you want to get out of that feeling, but you don't know how. You have no idea what direction is down and up or what you're just like, sort of like in the, ah, just freaking out, but with no direction or clarity.
This is not good.
But you're totally, I'm totally unclear what to do, what's happening, how to move my, where my body even is in relation to the board versus the sand underneath of me. Like, I don't have any clarity on anything. I just feel terrible and I want to escape.
Yeah.
That's sort of the metaphor that I use.
You nailed it.
Okay.
That's great. That's great. Yeah.
I mean, and I had a client once who was, he was like, you know, early 20s university student. And he comes in, he at one point in the session, he's like, I get like this feeling, you know what I'm talking about? Like, yeah, like that kind of feeling.
And I was like, it sounds like a bad feeling. Yeah, it's like, like that kind of. So this is high arousal and it's very low meaning in terms of specificity.
Does it signify something? Yes, of course it does. But does he know what he actually needs at that moment?
And the answer is no. He just knows he needs not this, right? So, so, you know, your sample of being stuck under the boogie board.
I mean, it's not just kids, right? People come in like that. And, you know, so, so the, the change process to be applied there, the thing is we're going to move through, we're going to deepen the feelings.
And then when there are conflicts, we're going to work through sequences. And then we're going to sort of, there are antidotes to maladaptive emotion. But there's the thing is there'll be different moves at working in this working through process, right?
If we're put Humpty Dumpty altogether. So, for example, right there, the change process has to be, well, we already kind of have emotional engagement to engage emotion, right? So, therapist focuses on that.
It's like, oh, wow. So, this is important. And the client goes, it is, right?
And they start to pay attention because they probably also come from a personal family and culture where we don't talk about feelings. I'm just making this up. But for example, right?
And so, you bring attention to it. And the project is increase emotional awareness.
Let me just, can I zoom out for a second and just like preempt, put something like if we were editing the document, we go to the top and it's like, hey, emotional processing, I should have started by saying, is often a label. But it's not an explanation of how people change. It's just a label, which is my biggest beef for emotion regulation.
Oh, the emotion regulation. I'm like, you have not explained anything. That is a label for a problem.
It's not an explanation. Right. What is it and how does it happen?
So, you know, and I think there are a lot of problems with referring to emotion regulation as a process. I'll shelf that and you can pick it up later if you want me to explain why. Right.
But most people will be familiar with this idea of emotion regulation. I think it is not a helpful construct and it's a bit misleading. But anyway, the idea of working with emotion, emotional processing, and I'm going to keep this tight.
You can think of five different ways of working with emotion that are categorically different. They feel different when you do them. They have neurologically different substrates that facilitate them.
Always lots of overlap, of course. There is a different basic psychological research on them, and they're measured differently, and they are different predictors of outcome, treatment outcome. All right?
Here is what they are. One, this is basically the summary of my giant book. One, emotional awareness.
This is engaging and becoming more aware of what you feel. All right? Two, well, we can put in down regulation.
There is no particular order here, okay? Down regulation, meaning how to calm the heck down. That's a real thing.
Experiential therapists don't focus too much on that until you have a client who is standing on the edge of a building. Then, calming down is a pretty good idea, okay? So, calming down, becoming more aware of what you're feeling, and notice you can calm down without becoming more aware of what you're feeling.
Right?
These are different processes. Three, expression of emotion. That often involves increasing, increasing arousal.
Not a lot of interventions explicitly focus on that, but clearly increasing your emotional arousal on a healthy emotion is helpful. All right? That's a touchy one.
Four, something about sequences. We have already been talking about that. The idea that somehow there might be an emotion that comes afterwards, that if we go there, that will undo this painful sort of thing, right?
We haven't talked a lot about it, but I'm just saying the idea that a positive emotion might be an antidote to a maladaptive emotion. I should say an adaptive emotion might be an antidote to a maladaptive emotion, right? Standing up for yourself could be an antidote to feeling ashamed for yourself.
That's unique, and it's different from downregulating. It's different from becoming more aware. And it's different from expressing, because it actually has to do with the transition between states, right?
That's four. And the fifth one, I'll give you, you know, you can always five, I can make it seven or nine, but I'm going to say five. And the fifth one is a big fat one.
It's going to be reflecting on the context of emotion. So this is reframing. This is working with narrative.
None of those things I just said reframing, working with the context of narratives, right? Are ways of working with emotion where you don't directly work with the feeling as such, but rather the framework of the context of interpretation. You see what I mean?
I'm angry at this person who cut me off. I'm going to use a classic CBT example, right? Cognitive example.
I'm angry at this person who cut me off, and then I think, well, why might they be in such a rush? And then he always goes to, oh, he's having a baby, he's rushing to the hospital. Isn't that nice?
And suddenly, I'm still angry, but I'm less angry, right? And now the situation means something different. I used to be horrified.
I still am. I'm horrified by horror movies. I can't watch them at all.
I went with friends and I like made it through the opening credits of what's it called? Like Dawn of the Living Dead or the zombie movie. And I couldn't watch the opening credits.
I was like, I'm out, I'm out. And my friend who's a script writer, he was like, yeah, but if you think they're using that angle, and there's a boom mic out here, and the blood is actually chocolate sauce. That's what they use.
It looks more like blood than actual blood in the film. Anyway, if you think of all that, it makes it less scary. And I'm like, well, that's not entertaining to me, which is beside the point.
The point is, he's trying to cognitively, he's just reframing it, right? Quite literally, he's talking about thinking about the crew outside the frame of the movies that's so important, right? So it's not the scene that's changing, it's your knowledge of what's around the scene, okay?
You're not working with emotion, you're not working with context around it. Narrative or existential insights have some bearing on that as well, right? So I'm talking about different ways of working with emotion, and I might say, reframing, I mean, there's this local reframing, like right here, and then there's much broader reframing, which is an existential, like, what's my purpose here?
And people put up with all sorts of bullshit. Can I say shit? I just said, I just said shit.
They have all sorts of bullshit in their life that they put up with, because I'm doing it for this higher purpose. It's not kind of like a gigantic cognitive reframing. It's an existential reframe.
But notice it doesn't change how crappy the experience is. It just helps you overlook that experience. So I'm pointing out this is a different way of working with emotion.
So we have five ways of working with emotion. These are the different to tie things together a little bit. These are like, if we have different chest pieces, secondary motion, adaptive motion, maladaptive motion and instrumental emotion, then they move along different lines.
The operations will be awareness, downregulation, expressing and activating the feeling, maybe sequences or maybe some kind of reflection, narrative reflection on the context of that feeling. So those are the operations that we apply to these actual feelings.
So in the context of when you have a client who has global distress, like when you're starting at that level, within sort of this framing of processing emotion, where's the next place that we want to help that person get to?
So this person's in global distress. Thank you. We go back to there, right?
High arousal. I'm so upset. We were at that guy, right?
Or the person's trapped under the boogie board, which is a metaphor here. And they don't know what they're upset about. They just know there's a lot of arousal, and they're not well, and they're upset.
You know, and they might, for lack of solutions, go to other ways of trying to extinguish that bad feeling, which might involve substance abuse, self-harm, or any number of other things, or just suffering, right? So what does that person need at that moment? because I said there are these five operations, but of course, it's very dynamic and it's moving quickly.
Okay? So this is all going to be in time and responsive. At that moment, what this person needs is more specificity.
So increasing emotional awareness. Yes, you feel, uh, but what flavor of, uh, is it more angry or more ashamed or more, right? I might not actually give them the multiple choice like that, although you could, you know, the, the aim here is to go underneath the symptoms, which is the anxiety, the hopelessness, the, uh, and to what's the deeper experience that's haunting you here, right?
And what does it mean? What is it? You know, Jendlin had this turn of phrase like, why does it need to, why does the feeling need to feel like that, right?
This sort of idea of there's a deeper motivation, and that itself will be an emotional difference, but it will be a primary emotional experience.
So there's this trying to move them into more clarity in terms of what more explicitly, what do I feel and why do I feel that way?
And so, concrete operationalizations of that will be a labeling affect, for example, symbolizing the more complex meaning.
So, once a client has or a person has a sense of greater clarity of how they feel and then why they feel that way, where do we go next?
So, here's what's interesting.
Is once you label the emotion and you explore it to its edges, which is to say a feeling is not just labeling it. There's a visceral experience that goes with that. There's an action and tendency.
There is an unmet need. And now you start to elaborate. Well, what do you need when you feel like that?
And we start to get in it now. And you say, where do we go next? And I'm going to say, but now the client feels something different.
Elaborating meaning changes a feeling. The emotional awareness is a change process. It's not just clarifying the feeling.
It's like, well, now that I feel I'm scared. That's what's going on for me. And if we go to your boogie board example, you're actually scared for your life in that moment.
It's like, what do I do? But on the deepest level, that's actually what's happening in that instance. There's lots of things, and you're going to pick one, in terms of, it's almost like the global distress.
When you have a very vague emotional experience, it's like a block of marble, and you carve away the mess, and there's a feeling in there that's much more specific. This is the old Leonardo, Michelangelo kind of question of is the sculpture inside the marble, or did I make the, was it already in there before I started? And of course, we could take the metaphor a bit too literally, but you're making use of what's there, and you're trying to interpret it, and you could label it several ways, but not any way, not anything.
It's like when you look at clouds, and you say, it looks like a turtle, and I go, yeah. You say, it looks like a horse now. I go, yeah.
You say, it looks like a snake, and I'm like, what?
Right.
I was like, I don't see that. Show that to me. I mean, so before you label an emotional experience, it could swing several ways, but not an infinite.
There is an actual referent there, right? It's not totally socially constructed. So there's me being like a hard no to the radical social constructivist perspectives.
So the idea is once I understand what it is, understand the why I'm able to make meaning of it, and then it turns into a adaptive, an adaptive primary emotion.
A new feeling? So that's the question. Maybe underneath that secondary emotion is a primary adaptive emotion, hopefully.
Or maybe it's a maladaptive emotion. Maybe it's the feeling, isn't that primary adaptive? Let's go to maladaptive because this was a client, right?
And I'm not referring to that client because I don't quite remember the details of that case a long time ago. just took it, really stood out to me, the slightly Alexa Phymic kind of moment there. Well, not slightly, very.
You know, and as they explore what it means and the deeper significance of that feeling, it starts to feel more like a sense of inadequacy. And it's like, I'm just not, I feel like I'll never be good and there's nothing I can do. And I'm unworthy, I'm going to load it.
The person says, I'm just like, I'm unworthy as a member of the human race. Okay, that's primary maladaptive, right? So now we have a different state.
Which state? Primary maladaptive emotion. There was going to be some sort of primary emotion.
It might have been adaptive, but you know, it turns out to be maladaptive. And now you need a different change process. The change process for primary maladaptive emotions are to create sequences.
So an adaptive emotion will be the antidote to this maladaptive emotion.
All right.
Which is to say, you don't just replace it with another feeling, but rather you can undo it. The sequence is what changes the person. And so we've done all sorts of research, and there's also experimental research, and there's showing that when there's a good process outcome, and even we've gone to predict treatment and symptom outcomes in different disorders and different treatments.
So this is something, this is something, let me show you. Look, jumping way back to one of your first questions, because it occurred to me, but I didn't remember to say it. When you're like, was there a time when you're like, oh yeah, this makes a difference.
I did a dissertation, came up with a model, and I was like, I think it's like this. And it was like several studies later by other people, where they found the same thing and they weren't just predicting good outcomes in the session, which is what makes for a good session. They were using the same patterns in emotion sequences to predict treatment outcome months later, like if this emotion comes after this emotion, you get a reduction in depression at the end of treatment.
Findings like that, where I was like, oh shit, it's not just made up. Some of the research seems made up. And I was like, maybe I was just made this up.
I mean, it's true, but maybe it's just true in my study. And there was a moment where I was like, oh wow, I can't believe it. Somebody actually found this is true.
Right.
So that was a real eye opener moment, a very encouraging and made me feel like they found it too, they found it too.
So, let's start with the first one, which is exploring maladaptive emotion. So, maladaptive emotion, you could do lots of things after that, but if after a maladaptive emotion, the person explores what do you most deeply need, what's the unmet need, okay? Another sequence, exploring a need, and that leading to a primary adaptive emotion.
That was a different sequence that's predictive of outcome. If you link them together, you realize you end up with a chain.
So say that again, say that again. I got lost on differentiating those two things you said.
Now, adaptive emotion. So one thing is one could say certain emotions predict outcome. And that's interesting already.
But then you can actually study certain sequences.
Right, I got that. So then the one example you gave, you said...
Now adaptive emotion followed by a need is a sequence that predicts symptom change.
Right. So if I say, so if I'm the client and I say...
I feel unworthy.
I'm unworthy. And then you say, as a therapist, you would say, what would you say?
I might push for that. I might focus on... That is a marker to focus on unmet needs.
Particularly if there's a spike in arousal. So let's imagine, because we had another study that spikes in arousal, increase the likelihood that clients can respond to your prompt for an unmet need. You know, if you walk in and say, what do you need?
You're like, I don't know. But when you say, I feel inadequate as a person, and you tear up, that's the window. And now is the best time, optimal time for the therapist to say, to validate that, that that's a real feeling.
It's like, so there's a sense of inadequacy. And I guess what you most need. So what is, you know, I might not know, what do you need when you feel like that?
I mean, it's, and the client says, it's, you know, they have increased arousal. That makes it ripe. They're more likely to be able to answer this very difficult question.
And they say, it's not to feel successful or what. It's just like to have somebody who's like, I get you. You make sense to me.
So the sense of feeling recognized or validated as your position is legitimate. That's the unmet need, right? There's some sense to have that experience.
Maladaptive motion, unmet need, that sequence that we just described up there, predicts reduced depression several months later by the end of treatment. Usually, we're trying to look at these sequences in the middle of treatment and see where they're at.
So then you gave another example of a separate sequence. So do that.
The separate sequence, and I'm making the very close overlapping on purpose. The second sequence is something like, a person is exploring what they need, and they shift into either grief or assertive anger. So for example, and so they might not be so emotional at that moment, but they're exploring what they know.
I mean, I guess, oh, here's a good one. This is a client said to me, I mean, I use it in a chapter as an example, because so vivid. He says, I don't know.
It's like I never had. I never felt loved as a kid. And the therapist says, really?
So there's nobody, there's nobody in your life. And he says, well, I mean, not really. I mean, I had aunts and uncles.
And he's just talking. He says, I had aunts and uncles who liked me, but I never. And he sighs and he says, I never had the love that only a parent could give.
And then he bursts into tears, okay? And now he moves into sadness, grieving what I missed out, feeling like I was special. I didn't have that.
That's a sense of loss. This is very painful, but this is grief. It's a real loss and he knows what he's grieving.
So identifying a need followed by grief. Sometimes identifying a need followed by assertion, right? You know, different example.
Client says, you know, father was abusive and it's like, I didn't really, I didn't deserve that. Like I deserved to be treated with more respect. You know, like, damn it.
He had no right, says the client. They raised their voice. Now we're into assertive anger.
And you know, what's the difference between healthy and unhealthy anger? Is you know what you're fighting for. You know what you're fighting for.
So adaptive emotion, you know, if it's adaptive anger, you know what you're fighting for. What about grief? How do you know?
because it's easy to feel sad, and you go to funeral, and people are wailing. I mean, at some funerals, right? Is that adaptive?
And my answer would be, it depends if that person who's wailing knows what they're actually, what they've lost. Meaning, in this specific moment, they bear in mind what they have lost. So, you know, if you don't know what you've lost, you just feel sad, it's not going to be productive.
It's not productive grief. It's not adaptive grief.
It seems like for these processes to be therapeutic, for them to be beneficial, there has to be some sort of self-compassion. I'm using that term sort of not as a proper noun, but just a general sense of like, right, like that I have to have, I have to be able to identify that need that I didn't have and then also say to myself, that sucks, like that wasn't fair, or I should have had that. Where if I say I'm bad for not having that, or you blame yourself, then that's not going to be helpful.
But when you just want to destroy the other person, you're fighting for not this. But that's not an approach what you're actually fighting for.
I think in listening to you sort of articulate this is one of the questions, one of the places I was going to go is I know that you and some colleagues have done some work looking at emotional processing in folks with personality disorders and demonstrating how therapeutically beneficial it is. And what I was going to ask about is sort of like, well, how does that work? You know, I mean, it kind of makes sense to me that if I have a mood disorder, that it's going to be helpful because it's going to allow me to process some of the stuff that's underlying the mood disorder or that I'm not able to.
But how does it work with personality disorders where it might not be, you know, but the more that you're talking, the more I'm thinking about, you know, and let's get sort of used different types of language that like you're attending to schemas, you're attending to, what was I going to say, attachment, you know, or maladaptive attachments, you're attending to, like it's that, or core beliefs, right, to use a very CBT language, like, that this is getting at, you know, this isn't just about changing your emotion in the here and now. That's certainly part of it, but it's about understanding these maladaptive, underlying, you know, processes that are going to be impacting me in, you know, every day.
Yes. So, you know, and the eight, so the idea here isn't to think of emotion as a consequence to something. It's not a byproduct.
It's not just a feeling. Emotion is a self-organization. And it has, yeah, it contains maybe a, well, some sort of belief could be dysfunctional or not, but it also contains an unmet need.
Those are not the same. It contains an action tendency. It has a visceral experience.
There's a context that's related. That's the triggering cue. So when I say emotion, I'm saying emotion scheme, right?
A scheme, you know, emotion isn't just representational. It's not, oh, and so you have this. It's procedural.
It's more procedural than anything, right? You do a feeling. We're human beings, but we're also human doings, right?
Emotion organizes you for action in the broadest sense. It's not just organizing you to fight when you're angry and run away when you're afraid. It literally organizes the network of cognitive associations you have.
So even research on like information retrieval about autobiographical, you know, your emotion state shapes what information you can make use of, right? Emotion is kind of the meta framework for sorting information. It's older than the big old frontal lobe, right?
And so, yeah, we're talking about emotion not just as a feeling, but as a densely packaged unit of information. The information is about whether this is good for me or not. That's what it's a vitality issue, right?
And a lot of, I mean, you are organized by it so quickly that you don't necessarily know what it means. And a lot of unpacking emotion is about trying to articulate, in what way am I organized right now? And when you get there, it's like, oh, that's this feeling.
Of course, once you know the feeling, that changes the feeling itself. When we end up in this domino effect of a sequence of feelings when it's healthy. Right?
There are lots of collapses. There are lots of regressions where you have a... And if we're studying it minute by minute, which is how we study it, where the person has a need, they go to a sort of anger and they say, I didn't deserve that.
pause, pause. They look up the ceiling, the therapist waits too long. And the client says, I don't know.
I mean, maybe I did. Maybe it was me. And it's like a regression.
It's like a collapse. If you think of this as an increased specificity toward emotional change, there's actually a regression to a maladaptive state or any bigger regression would be to back up to global stress. I don't know.
Maybe it's just me. I'm feeling helpless. And so we're back to secondary emotion.
What happened here? So I think that moment by moment, other thing that's useful, I think for therapists to realize is your clients don't get better like this. They have this, right?
If you're used to working and interested in working experientially, sometimes with a client, it happens to me and I'm like, yeah, yes, yes, yes, yes, yes, yes, no, no, where are you going with that? And the client kind of unravels, right? That's not you.
You didn't do anything wrong. That's the client has ventured. It's like the tide moving in and moving out, and then moving two steps forward, one step back.
We have an article called that. Two steps forward, one step back, and it is showing this kind of building of resilience, and there are these many collapses, and then you reclaim that territory again and keep advancing, right?
And I think that's probably just an important point just to emphasize for the practitioner or person trained to be a practitioner that, and you've done work on this, empirical work, that this is not overtly linear, that it's not just stage one, you know, global distress, to shame and fear, to need, to assertive anger. It doesn't just move, boom, boom, boom, boom, that there is, you know, I think you could generally say there's kind of is a linear-ish pattern, and there's this unfolding process, but it is not a straight line.
because people are also becoming more flexible.
So let me, right, right. So let me, as we're nearing the end here, just a couple of quick things. So one is, what pushback have you gotten for your work?
Yeah. pushback? Yeah, for sure.
You know, I'm sure I've had pushback, but it's hard to... I think it's complicated, you know? So that's been a puzzle.
It's like, how do you explain this in a way that's not so abstract? And is not so oversimplified, you know what I mean?
Has there been pushback in like people saying you can't do this? That like, this is too unique to each person, that our technology, we can't do this?
Absolutely, you know, absolutely. So that's where the rastrophysics, you know, we opened with this a little bit, where it's like, I'm saying this is how people work through, recover from a bad relationship. And people are like, yeah, no, that's not true for me.
Maybe it's not true for you. I mean, we are talking about averages here, right? So there are always anomalies.
And maybe actually you thought this explanation slash video was for you, but you're watching the wrong video because you don't have any maladaptive emotion, right? Or maybe, which isn't to say, like there are different hiccups people encounter. So the part of the complexity for therapists is to clarify that, yeah, you have to be able to identify certain kinds of emotion before this starts to really make sense.
Otherwise, you'll end up with this broad, unified sort of thing, right? You know, emotion regulation is a kind of pushback, where it's like, although that came first, right? This idea of emotion regulation, and everybody's jumped on the bandwagon.
It's very appealing because it's very simple. Very simple. I mean, yes, sure, it's really complicated.
But actually, the fact that everything and anything can be emotion regulation, the problem is, if everything is that, then it's nothing is that. So it doesn't mean anything anymore, right? And I think there's some, weirdly, you can call it emotion regulation in the paper and publish it, and people don't say, what exactly do you mean by emotion regulation?
That James Gross or there was an APA task force to study the possibility of looking at mechanism of change related to motion regulation. Gross and that task were both in their things. because they basically say, emotion regulation could be this, this, this, this, this, this, this, this, this, this.
And so many things that it's really hard to say what it isn't. That's almost like a quote. So I find that emotion regulation is a much simpler explanation, but it doesn't hold any water, is the problem.
The thing that I find tricky is emotion regulation, in theory, could be up regulation or down regulation or changing any kind of way. I listed five different ways. Emotion regulation doesn't go to list those.
They're just different strategies for regulating motion. And as if they were all interchangeable operations, which they're not, or use different parts of the brain, similar parts of the brain, which they don't. And in theory, it could be up or down, but in practice, emotion regulation is always about down regulation.
Yeah, that's my experience of it as well.
Yeah, it's kind of a hidden, a cloaked argument in some ways. Oh, it could be anything, but all the examples they give are about trying to get the person to feel less. And so, the idea that getting people to feel less might be a better way of understanding how to work with emotion creates a big kind of mora, a swamp, right?
And I think it conflates the ends and the means. Yeah, people feel less at the end of treatment. Yes, they're less emotional at the end of treatment than at the beginning, but that doesn't mean all the mechanisms that led to that symptom improvement are actually because of efforts to reduce and downregulate emotion, right?
So, one of the things I like to do at the end of these conversations is sort of give an opportunity for listeners who want to learn more. Are there particular resources that you think are super helpful? So, let me give two first.
So, one, I don't know if you can see it over my left shoulder, but I have the book that you co-wrote with on emotion-focus Therapy for Complex Trauma, which is a really great book, very clinically useful, very like I can see it, which is great. And then another one that I'll link is you and Uli Kramer wrote a chapter in the clinical handbook of emotion-focus Therapy. And I would certainly say that chapter, and in a lot of ways, I think that book as well, could be applied across a number of approaches, orientations, like a lot of the learnings in there.
And is there anything else that you think are like, other than your big ass book, which it sounds like isn't published yet. So I probably can't link to that.
No, it's APA has its thing saying it's coming out in April.
Is there, maybe I can link to it.
You can link that. Sure, sure, you can. You can link to that.
It's coming out in April. It's 800 manuscript pages. So that'll probably print out at about 500.
I didn't want it to be so long, but it ended up being a lot harder to write than I thought. It took me 10 years. And so here it is sort of thing.
But I'm really happy with it. And so, yeah, so there's minor revisions, but in 800 pages of minor revisions ends up taking a lot of time when you have little kids at home too. So that's the deal there.
I think...
I'll link to the TED Talk. That's an easy one to do.
Those are good resources, I think.
Well, Dr. Antonio Pascual-Leone, thank you. That's a wrap on part two of My Conversation with Dr. Antonio Pascual-Leone. And please reach out via email, voice message, text or social media using the links in the show notes.
Until next time.