Psychotherapy

Review of "Expressing Emotion"

By Eileen Kennedy-Moore and Jeanne C. Watson
Guilford Press, 1999
Review by Brent Dean Robbins on Apr 18th 2002
Expressing Emotion

Kennedy-Moore and Watson have teamed together to develop a text that is a supreme achievement in the psychological literature on emotion. The text, moreover, is an achievement on a number of different levels. First of all, the authors manage to meaningfully integrate theoretical insights and empirical studies from a wide variety of orientations. Secondly, the text also synthesizes findings from both ‘pure’ research in emotion and clinical research (either directly or indirectly related to emotional expression). Third, despite their massive undertaking, Kennedy-Moore and Watson are then able to develop these findings into a coherent, powerful model of emotional expression. Their model of emotional expression appears also to successfully resolve problematic anomalies apparent in the various orientations and studies explored throughout the text. Finally, as if the above were not enough, the authors still manage to articulate how their model of emotional expression has clinical implications.

Specifically, they provide practical guidelines for working generally with emotion in psychotherapy, therapeutic guidelines for treating emotional constriction in depression, advice for helping clients who are flooding or blunting as a result of bereavement and/or trauma, insight into the dynamics of emotional expression in marital therapy, and expression-related interventions in health psychology. All of the above is accomplished within 400 pages and with clear, concise and rigorous language. I am completely in awe of this book.

Kennedy-Moore and Watson rhetorically develop a thread that runs throughout the book, which is guided by a single, simple question: What is more important for well-being, expression or non-expression of emotion? Their answer, as one may expect, is not a simple one. The problem with prior models of emotion, as the authors point out, is that they tend to provide a single, one-shot solution to this inherently complex, non-linear problem of expression and non-expression. The imposition of a simple solution to a complex problem leads of course to a bad solution. This is something the authors understand well and thus a problem that they consequently avoid. Yet they are not dissuaded from developing an elegantly parsimonious model to help us grasp more simply what is inherently complex. Thanks to the grace of these researchers, they are able to do so without apparent violence to the phenomenon.

The nonexpression of emotion can be healthy or unhealthy, depending on the circumstances. In the case of a trauma survivor, for example, the expression of emotion can work toward helping him or her to cognitively process the experience. This can lead to integrating the traumatic experience into his or her worldview. On the other hand, a person who values stoicism and restraint from emotional expression may not fair well with the encouragement to express emotion. It will compromise what for him or her is an adaptive way to cope with difficult feelings. Another person may highly value the expression of emotions, but under circumstances of stress may find he or she is unable to safely express emotions without negative consequences. The inhibition of emotional expression, in this case, could lead to serious consequences for the person’s mental and physical health.

The expression of emotion is, likewise, a complicated affair. For example, the expression of emotion may lead to negative consequences if the recipient of the emotion is uncomfortable with the emotion. In the case of anger, it can lead to the resolution of a conflict or it can substantially increase the anger of both parties. Again, there does not appear to be a simple rule of thumb.

Based on their model of emotion, Kennedy-Moore and Watson develop general guidelines for working with emotion in psychotherapy. The aim is to help the client to develop an adaptive balance between expression and non-expression, based on the context of the person’s life as a whole. The person should come to understand rather than be overwhelmed by his or her feelings. They should use their emotions to help them cope with situations, rather than be impulsively controlled by them or paralyzed by them. Finally, emotions should be used in the service of improving adaptive, interpersonal communication rather than damaging relationships.

The normal process of emotional expression follows five cognitive-evaluative steps:

1) prereflective reaction, 2) conscious perception of the response, 3) labeling and interpretation of the response, 4) evaluation of the response as acceptable, and 5) the perceived social context for expression. These steps do not progress in a linear way. Rather the progression through the stages of expression are more like a spiral, wherein later stages are fed back through older stages and vice versa. Also, particularly in cases of strong emotion, emotion is often expressed prior to later stages, before it can be processed at a higher level. The authors refer to this phenomenon as emotional “leakage.”

Problems arise when emotional expression is disrupted along one of the above stages of expression. At step one, minimal prereflective reaction to a stimulus results in nonexpression. In this case, the “catharsis” of emotion in psychotherapy would be pointless, since the stimulus is not at issue for the client. Disruption at step 2, on the other hand, involves a motivated lack of awareness leading to nonexpression. Here, the person reactions emotionally, but denies the conscious awareness of the feeling, perhaps due to a repressive coping style. In the event of such repression, the client may very well benefit from encouragement to express the emotion in a safe place.

Nonexpression in step 3 is due to skill deficits in emotional processing. For example, people with alexithymia have difficulty developing a verbal understanding of their emotional experience. Consequently, the person may indeed experience emotion, but will have an exceptionally difficult time expressing the emotion in words. In the case of persons with poor vocabulary for emotion, perhaps due to learning deficits, psychoeducation may be the best approach.

A disruption of emotional expression at step 4 is the consequence of a person’s negative attitude toward emotion. In this case, perhaps due to cultural or personal values, the nonexpression of emotion in general or in regard to specific emotions is central to the person’s identity. In some cases, a psychotherapist would avoid using cathartic methods with a person with a negative attitude toward emotion, since this would risk damaging the therapeutic alliance. In other cases, the client’s negative attitude toward emotional experience may only be one side of ambivalent, contradictory feelings, and resolution of the conflict may ultimately require the expression of emotions relating to both sides of the conflicting goals and/or beliefs.

Finally, nonexpression may also be a disruption of step 5, resulting in a perceived lack of opportunity to express. In cases where nonexpression is contextually appropriate given the person’s situation, this type of nonexpression is healthy and adaptive. However, in the case of a person who lacks a social support network of trusted persons who can safely assist him or her to express and articulate emotional experience, nonexpression can be unhealthy and lead to significant distress for the person.

This cognitive-evaluative model of emotional expression has incredible practical value for clinicians working with a wide variety of clients. Based upon this schema, it is possible for clinicians to properly assess the best approaches to working with emotions in psychotherapy. The clinician must first assess the stage at which emotional expression has been disrupted, and whether or not that disruption is adaptive, before deciding on appropriate interventions. Along these lines, the work of Kennedy-Moore and Watson can go a long way toward the development of powerful and very useful clinical assessment tools to determine the nature of problems with emotional expression or nonexpression.

Finally, I can personally say that Expressing Emotion has incredible pragmatic value as a clinical resource. Since I began reviewing this book, I have used it on several occasions to assess disruption of emotional expression in clients who I see in psychotherapy. In each case, I found the information to be invaluable for clarifying the best approach to treatment. Not only that, but I have also used the text for supervision. In my supervision of a social work student, my supervisee found the book helpful for guidance in the treatment of a client with delusional disorder. The client had particular difficulty with maladaptive expression of anger, and the book was very useful in clarifying for my supervisee how, in this case, a cathartic approach to therapy would have done more damage than good.

I cannot recommend this text highly enough. I can honestly say that, in the literature on working with emotion in psychotherapy, Expressing Emotion is the very best around.

 

© 2002 Brent Dean Robbins

 

 

Brent Dean Robbins is a Doctoral Candidate in Clinical Psychology at Duquesne University. He is current completing his pre-doctoral internship at University of Pittsburgh Counseling Center, and in August, he will begin work as Visiting Assistant Professor of Psychology at Allegheny College. His dissertation, currently in progress, examines the phenomenology of joy from the perspective of the metaphysics of feeling. Mr. Robbins also serves as a co-editor of the interdisciplinary journal, Janus Head, and is a partner of Trivium Publications. His home page can be found at Mythos & Logos.

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