Psychotherapeutic Interventions
Psychological Health
Empathic interventions are actions undertaken to understand clients and to convey this understanding back to them. These are basic interventions that are used every session. Moreover, the information gained from these interventions informs what additional interventions would benefit the clients.
Nonverbal action-dialogue is another important empathic intervention. Based on research on mother-infant face-to-face interactions, these interventions require us to attune to subtle nonverbal cues in our clients. Beatrice Beebe and Frank Lachmann write that just as mothers relate to their infants “through the procedural action-dialogue constructed through gaze, face, voice, orientation, and touch,” we can relate to our patients “through the procedural action-dialogue of facial expression, head orientation shifts, postural tonus, breathing rhythms, self-soothing, [and] shifts in the chair.” They reference studies showing that when we match another person’s behaviors, including their facial expressions, gestures, and posture, this enhances our ability to understand them.
Supportive Interventions
Supportive interventions support the development of ego functions. Sometimes a client’s ego functions can be supported through psychoeducation. For instance, following the lead of Leslie Greenberg, I might describe the function of emotions. Sometimes a client’s ego functions can be supported through skill-building. For instance, I might teach Stephen Hayes’ methods for tolerating distressing emotions (Gordon and Borushok) or Marsha Linehan’s DEAR MAN steps for asserting one’s needs.
Expressive Interventions
Expressive interventions are used to identify unconscious thoughts and feelings. Put differently, exprssive interventions are used to make the unconscious conscious. To identify unconscious material, I listen for many different things, including emotions, defenses, slips of the tongue, behavioral patterns, inner conflict, transference, and countertransference.
More recently, writers from different theoretical orientations have articulated how the principle of memory reconsolidation can be used to create corrective emotional experiences. In order for this to happen, it is necessary for the client to bring to mind a memory that shaped a key schema; the client must fully experiences the emotions that accompany the memory; and once this happens, I must create an opportunity for the client to have a corrective emotional experience (Lane et al.). A number of techniques can be used to foster the corrective experience, including imagery rescripting, imagery dialogues with one’s adversaries, imagery reparenting, and chair dialogues (Elliott et al., Kellogg, van der Wijngaart, and Young.)
I can also encourage clients to engage in behaviors outside of the sessions that create further corrective experiences. Young offers some pointers for such homework assignments: describing the task in concrete and measurable terms, working on one behavior at a time, practicing the healthy behavior by having the client first imagine the situation, and rewarding the new behavior (e.g., buying oneself a small gift or giving oneself permission to engage in a fun activity).
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Beatrice Beebe and Frank Lachmann, The Origins of Attachment, 2014.
Lorrie Brubacher, Stepping into Emotionally Focused Couple Therapy, 2018.
Deborah Cabaniss, Psychodynamic Psychotherapy: A Clinical Manual, 2011.
Robert Elliott, Jeanne Watson, Rhonda Goldman, and Leslie Greenberg, Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change, 2004.
Timothy Gordon and Jessica Borushok, The ACT Approach: A Comprehensive Guide for Acceptance and Commitment Therapy, 2017.
Scott Kellogg, Transformational Chairwork, 2015.
Richard Lane, Lee Ryan, Lynn Nadel, and Leslie Greenberg, Memory Reconsolidation, Emotional Arousal, and the Process of Change in Psychotherapy, Behavioral and Brain Sciences, 2015.
Sue Johnson and T. Leanne Campbell, A Primer for Emotionally Focused Individual Therapy, 2022.
Remco van der Wijngaart, Imagery Rescripting: Theory and Practice, 2021.
Jeffrey Young, Schema Therapy: A Practitioner's Guide, 2003.
Not only do we have physical needs, but we also have psychological needs, chief among them being relatedness and authenticity. Relatedness refers to our need for meaningful and supportive relationships. Authenticity refers to our need to discover and express our core self, to develop our personality and potential.
When our psychological needs are met, we’re likely to feel good and experience emotional health. When they’re not met, we’re at risk of developing emotional problems.
Psychological Problems
Different adversities can prevent our needs from being met, causing emotional pain. If these adversities persist, we might try to mitigate our pain by pushing certain thoughts and feelings from conscious awareness. We generally have only a dim understanding that we’re doing this.
Imagine a child with an emotionally unavailable caregiver. To evade potentially unbearable pain, the child might disavow especially hurtful memories or find ways to become numb to certain feelings. These defensive actions will primarily occur outside the child’s conscious knowledge.
Banishing such thoughts and feelings from awareness can provide short-term relief, but over time it causes us to become alienated from ourselves and ensnared in maladaptive behavioral patterns.
Psychotherapy
Gaining awareness of our thoughts and feelings is essential for overcoming our most intractable problems and getting our basic needs met. My primary goal as a therapist, therefore, is to understand my clients and to help them more fully understand themselves.
To this end, it is the responsibility of my clients to speak as truthfully and freely as possible. It is important that they choose what we talk about each session. A good rule of thumb is to discuss whatever feels most alive at that moment. This might be an event that happened that week, a dream you had, or an emotionally intense memory that came to mind.
When our psychological needs are met, we’re likely to feel good and experience emotional health. When they’re not met, we’re at risk of developing emotional problems.
Psychological Problems
Different adversities can prevent our needs from being met, causing emotional pain. If these adversities persist, we might try to mitigate our pain by pushing certain thoughts and feelings from conscious awareness. We generally have only a dim understanding that we’re doing this.
Imagine a child with an emotionally unavailable caregiver. To evade potentially unbearable pain, the child might disavow especially hurtful memories or find ways to become numb to certain feelings. These defensive actions will primarily occur outside the child’s conscious knowledge.
Banishing such thoughts and feelings from awareness can provide short-term relief, but over time it causes us to become alienated from ourselves and ensnared in maladaptive behavioral patterns.
Psychotherapy
Gaining awareness of our thoughts and feelings is essential for overcoming our most intractable problems and getting our basic needs met. My primary goal as a therapist, therefore, is to understand my clients and to help them more fully understand themselves.
To this end, it is the responsibility of my clients to speak as truthfully and freely as possible. It is important that they choose what we talk about each session. A good rule of thumb is to discuss whatever feels most alive at that moment. This might be an event that happened that week, a dream you had, or an emotionally intense memory that came to mind.
It is my responsibility to decided which interventions will be most beneficial. There are four main psychotherapeutic interventions: empathic interventions, supportive interventions, expressive interventions, and transformative interventions.
Empathic Interventions
Empathic interventions are actions undertaken to understand clients and to convey this understanding back to them. These are basic interventions that are used every session. Moreover, the information gained from these interventions informs what additional interventions would benefit the clients.
Sue Johnson and Lorrie Brubacher outline five techniques that help us empathize with a client’s emotional experience as well as deepen that emotional experience. Emotional reflection conveys an understanding of the client’s emotional experience. Validation affirms the client’s experience as legitimate and understandable given their experience. Evocative questions ask about the different elements of the client’s emotion and evoke more emotion and exploration. The elements of an emotion are the trigger, bodily response, thoughts, and action tendency. Heightening intensifies the emotion; it involves RISSSC — repeating key words for emphasis, using images to evoke emotion, using simple language, slowing our speech, softening our voice, and using the client’s words. Conjectures are tentatively offered reflections which go slightly beyond the leading edge of what a client expressed.
Nonverbal action-dialogue is another important empathic intervention. Based on research on mother-infant face-to-face interactions, these interventions require us to attune to subtle nonverbal cues in our clients. Beatrice Beebe and Frank Lachmann write that just as mothers relate to their infants “through the procedural action-dialogue constructed through gaze, face, voice, orientation, and touch,” we can relate to our patients “through the procedural action-dialogue of facial expression, head orientation shifts, postural tonus, breathing rhythms, self-soothing, [and] shifts in the chair.” They reference studies showing that when we match another person’s behaviors, including their facial expressions, gestures, and posture, this enhances our ability to understand them.
Supportive interventions support the development of ego functions. Sometimes a client’s ego functions can be supported through psychoeducation. For instance, following the lead of Leslie Greenberg, I might describe the function of emotions. Sometimes a client’s ego functions can be supported through skill-building. For instance, I might teach Stephen Hayes’ methods for tolerating distressing emotions (Gordon and Borushok) or Marsha Linehan’s DEAR MAN steps for asserting one’s needs.
Expressive Interventions
Expressive interventions are used to identify unconscious thoughts and feelings. Put differently, exprssive interventions are used to make the unconscious conscious. To identify unconscious material, I listen for many different things, including emotions, defenses, slips of the tongue, behavioral patterns, inner conflict, transference, and countertransference.
Interpretations are conjectures I share with clients in an effort to confirm whether I have identified unconscious material. Interpretations can also foster more exploration. Cabaniss breaks interpretation down into three steps. Confrontation involves pointing out a phenomenon. Clarification involves bringing the unconscious into focus by linking similar phenomena. Interpretation explains a conscious feeling or behavior as being caused by something unconscious. She provides the following example. “I noticed that you just stopped talking” (confrontation). “It seems like it is always hardest for you to talk on Monday mornings” (clarification). “Maybe you have difficulty talking on Mondays BECAUSE you want to avoid the pain of opening up again after the weekend” (interpretation). Genetic interpretation explains the unconscious material and also links it to the client’s past. For example: “I think that you have difficulty talking on Mondays BECAUSE you are protecting yourself from painful feelings JUST LIKE when you were young you had difficulty warming up when you got to one of your parent’s houses from the other’s.”
Transformative Interventions
Sometimes identifying a client’s unconscious thoughts and feelings is enough to free the client from psychological problems. If this is not the case, I might need to create opportunities for the client to have a corrective emotional experience. Corrective experiences can occur within sessions. Object relations theorists have long articulated ways in which the therapist-client relationship can itself be curative, providing patients with important relational experiences that they were denied in childhood.
Sometimes identifying a client’s unconscious thoughts and feelings is enough to free the client from psychological problems. If this is not the case, I might need to create opportunities for the client to have a corrective emotional experience. Corrective experiences can occur within sessions. Object relations theorists have long articulated ways in which the therapist-client relationship can itself be curative, providing patients with important relational experiences that they were denied in childhood.
More recently, writers from different theoretical orientations have articulated how the principle of memory reconsolidation can be used to create corrective emotional experiences. In order for this to happen, it is necessary for the client to bring to mind a memory that shaped a key schema; the client must fully experiences the emotions that accompany the memory; and once this happens, I must create an opportunity for the client to have a corrective emotional experience (Lane et al.). A number of techniques can be used to foster the corrective experience, including imagery rescripting, imagery dialogues with one’s adversaries, imagery reparenting, and chair dialogues (Elliott et al., Kellogg, van der Wijngaart, and Young.)
I can also encourage clients to engage in behaviors outside of the sessions that create further corrective experiences. Young offers some pointers for such homework assignments: describing the task in concrete and measurable terms, working on one behavior at a time, practicing the healthy behavior by having the client first imagine the situation, and rewarding the new behavior (e.g., buying oneself a small gift or giving oneself permission to engage in a fun activity).
* * * * *
Beatrice Beebe and Frank Lachmann, The Origins of Attachment, 2014.
Lorrie Brubacher, Stepping into Emotionally Focused Couple Therapy, 2018.
Deborah Cabaniss, Psychodynamic Psychotherapy: A Clinical Manual, 2011.
Robert Elliott, Jeanne Watson, Rhonda Goldman, and Leslie Greenberg, Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change, 2004.
Timothy Gordon and Jessica Borushok, The ACT Approach: A Comprehensive Guide for Acceptance and Commitment Therapy, 2017.
Scott Kellogg, Transformational Chairwork, 2015.
Richard Lane, Lee Ryan, Lynn Nadel, and Leslie Greenberg, Memory Reconsolidation, Emotional Arousal, and the Process of Change in Psychotherapy, Behavioral and Brain Sciences, 2015.
Sue Johnson and T. Leanne Campbell, A Primer for Emotionally Focused Individual Therapy, 2022.
Remco van der Wijngaart, Imagery Rescripting: Theory and Practice, 2021.
Jeffrey Young, Schema Therapy: A Practitioner's Guide, 2003.
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