Humanistic Psychotherapies

5
EMOTION IN PSYCHOTHERAPY:
AN EXPERIENTIAL–HUMANISTIC
Copyright American Psychological Association. Not for further distribution.
PERSPECTIVE
ANTONIO PASCUAL-LEONE, SANDRA PAIVIO,
AND SHAWN HARRINGTON
The idea that accessing and exploring painful emotions and bad feelings
in a therapeutic relationship may result in one feeling better in the long
term is now a widely held belief among several schools of psychotherapy,
but it has always been a central position among humanistic and experiential
therapists beginning with Rogers (1951) and Perls (1969). In this chapter,
we review process and outcome research on emotion in psychotherapy, with a
special focus on the theoretical framework and interventions of experiential
treatments.
Humanistic and experiential therapies have led the way in developing
interventions that address emotion directly in a manner that is sensitive to
personal development and idiosyncratic meaning. The recent emergence of
affective neuroscience has further stimulated interest in the role of emotion
in psychotherapy by providing a means to observe and measure affect in vivo.
Early work examining emotional experience included Rogers’s (1951) focus
http://dx.doi.org/10.1037/14775-006
Humanistic Psychotherapies: Handbook of Research and Practice, Second Edition, D. J. Cain, K. Keenan, and
S. Rubin (Editors)
Copyright © 2016 by the American Psychological Association. All rights reserved.
147
on the importance of attending to and prizing a client’s internal frames of
reference, Gendlin’s (1964) articulation of how productive experience unfolds,
and Gendlin’s (1996) emphasis on affective expression, enactments, and evoc-
ative encounters.
Drawing on this foundation, Greenberg and others (Greenberg, 2002;
Greenberg & Pascual-Leone, 2006; Greenberg & Watson, 2005) have identi-
fied five distinct types of emotion processes that are useful in therapy, depend-
ing on a client’s presenting concern. They are (a) emotional awareness and
engagement; (b) arousal and enactment; (c) emotional regulation and self-
soothing; (d) reflection on emotion and meaning-making, which involves

enduring cognitive change; and (e) emotional transformation, or changing
emotion with emotion. Research findings are summarized below and illustrated
with brief examples of client process. We go on to highlight some of the practi-
cal implications of working with emotion from a humanistic and experiential
approach.
SUMMARY OF MAJOR EARLY LITERATURE TO 2000:

EMOTION AND EMOTIONAL PROCESSING
Since their inception, humanistic and experiential understandings of

emotion have assumed that, when emotion is authentically experienced and
expressed in an empathic and facilitative interpersonal context, it can be
adaptive. Although there are exceptions to this, research has supported the
role of emotion in adaptive functioning in at least six distinct ways.
Role of Emotion in Adaptive Functioning
First, the emotion system may serve as an adaptive orienting system.

Discrete, basic emotions are associated with specific motivational information.
For example, fear tells people that they are in danger and in need of protection
or safety. This tacit information entails specific neurological activity, expressive-
motor patterns, and dispositions for orientation to and readiness for action in
specific goal-directed behavior important for survival (Frijda, 1986).
Second, emotions are both motivators and states of readiness for action.
They help people to survive by providing an efficient, automatic way of
responding rapidly to important situations. To that end, affect is processed
faster and requires less mediation (fewer levels of processing) than cognition
(LeDoux, 1996). It has been demonstrated, for example, that emotion can
be activated with subliminal stimuli and inform behavior outside a partici-
pant’s awareness (Whalen et al., 1998). Moreover, emotional processing has
been shown to be essential for exercising good judgment and decision making
148 pascual-leone, paivio, and harrington

(Damasio, 1999). In short, cognitive goals are given impetus by the orienting
and action functions of affect.
Third, the salience of particular emotions provides important information
about one’s priorities. Negative emotional responses, such as anger or sadness,
signal and are related to the experience of specific unmet needs (Frijda, 1986).
The assumption here is that there is a basic need or drive for internal
coherence that compels maladaptive emotional processes to be resolved.
This assumption also underlies constructs such as cognitive dissonance
and narrative coherence. Simply put, individuals have a predisposition
to be internally coherent (J. Pascual-Leone, 1990; Pennebaker, 1997).

Positive, negative, adaptive, and maladaptive emotional experiences all
inform people about the degree of this coherence and the need to resolve
inconsistencies. Emotion is the impetus for the neural integration in the
brain that results in attention to priorities and movement toward coherence
(Schore, 2003).
Fourth, the ability to work with and express emotional experience is an
important part of emotional intelligence and healthy development (Goleman,
1995; Mayer & Salovey, 1997). Work in personality and social research has
highlighted the importance of emotional intelligence. Curiously, in the clini-
cal field, differences in emotional intelligence among clients are more often
described in terms of clinical change in emotional health rather than as a trait
per se. A series of studies have shown the positive effects that writing about
emotion has on autonomic nervous system activity, immune functioning, and
physical and emotional health (Pennebaker, 1997). Conversely, the inhibition
of emotional expression has been linked to poor health and impaired immune
system functioning (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). Finally,
emotions are an interpersonal communication system telling others to draw
closer or back off. Experience and appropriate expression of emotion increase
the likelihood of getting interpersonal needs met.
Emotion as a Densely Packaged Unit of Information
Over the past 60 years, the humanistic emphasis on spontaneous and

emerging experience has described emotion as a chief source of personal infor-
mation. Rogers anticipated this in some of his early writings: “While . . . insight
appears simple enough, it is the fact that it comes to have emotional and opera-
tional meaning [italics added], which gives it its newness and vividness” (Rogers,
1951, p. 119). Gendlin (1964) further stated that it is through contact with,
and exploration of, feelings that new feelings and meanings emerge, resulting
in reduced client distress. This distinction between the felt and the known
(see also Damasio, 1999) is one that has been emphasized by all leading expe-
riential theorists.
emotion in psychotherapy 149

When Greenberg and Paivio (1997) applied the ideas of Frijda (1986) to
clinical work, they illustrated how emotion consists of a multimodal associa-
tive network of information or meaning system (see also Greenberg & Safran,
1987). For example, in session,
77 anger organizes one to fight and defend one’s boundaries;
77 fear organizes one sometimes to freeze and monitor, then run,
flee, and escape;
77 shame organizes one to hide oneself from the scrutiny of others;
77 sadness organizes one to seek comfort but later to withdraw and

conserve resources;
77 disgust organizes one to spit out or reject some noxious experience;
77 guilt organizes one to repair some situation; and
77 love, happiness, curiosity, and other positive emotions organize
one in different ways to reach out, build, share, celebrate, and
explore.
In earlier literature, the term emotion structure is most frequently used to
refer to this system (Foa & Kozak, 1986; Greenberg & Safran, 1987; Rachman,
1980). From this perspective, evocative experiences are encoded in emotion
structures centered on the experience of certain emotions. Current stimuli that
resemble the original emotional context (i.e., a trauma) can activate feelings
of fear and helplessness, associated somatic experiences, the desire to escape
the danger and avoid harm, and beliefs about self and the situations formed at
the time of the trauma. In this case, exposure procedures are intended to acti-
vate this fear structure so that maladaptive components are available for modi-
fication. Whatever the emotion in question, activation takes place through
attention to sensory and somatic aspects of memory.
Thus, to overcome emotion avoidance, clients must first be helped to
approach emotion by attending to their emotional experience. Fritz Perls and
Gestalt therapists were among the first to describe how to contact and acti-
vate emotions, which involved enactment, or expression of feelings toward
an imagined other or some part of the self (Yontef & Simkin, 1989), a pre-
cursor to techniques later used in emotion-focused therapy. For change to
occur, clients must also allow and tolerate being in live contact with aroused
emotions. These two steps are consistent with notions of exposure. Although
experiential and humanistic conceptualizations were arguably more nuanced
(see Greenberg & Paivio, 1997), behavioral therapy offered some of the first
palpable research findings about the importance of activating emotion. There
is a long line of evidence on the effectiveness of exposure to previously avoided
feelings. For example, in a series of studies on behavioral exposure (Foa, Riggs,
Massie, & Yarczower, 1995; Jaycox, Foa, & Morral, 1998) as a treatment for
posttraumatic stress disorder after rape, good outcome was predicted by the

aroused expression of fear while clients retold trauma memories during the first
exposure session and by the attenuation of distress during exposures over the
subsequent course of therapy.
Overwhelmingly, the early literature on humanistic and experiential
therapy underscores the importance of emotion in psychotherapy. In par-
ticular, this body of early research has pointed to emotion as an adaptive
network of meaning, rich with information that allows one to orient oneself
toward and prioritize problems while also motivating one to act to resolve the
problem. In doing so, clients must engage, instead of avoid, emotion and be
willing to accept emotional experience.
CURRENT RESEARCH ON EMOTIONAL PROCESSING:

EXAMINING CLIENT PROCESS
To consider how emotional processing is manifested in general, and in

experiential therapy in particular, one must accept that emotional processing
is not actually a singular phenomenon. In this section, we delineate a number
of different processes subsumed under the label of emotional processing, explor-
ing how they function in relation to one another. Doing so is imperative for
a deeper understanding of both what emotional change is and what expe-
riential therapies do to promote this process (Greenberg & Pascual-Leone,
2006). Greenberg (2002; Greenberg & Pascual-Leone, 2006) proposed the
notion of emotional processing subtypes. In a review of emotion research in
psychotherapy, his line of work identified several major ways to work produc-
tively with emotion.
Emotional Awareness and Engagement:

“Getting in Touch With What’s There”
Insight-oriented therapies are founded on the assumption that increas-

ing client awareness of emotional experience—usually the origins, meaning,
and consequences of maladaptive emotion—is an important change process.
Increasing awareness often requires a certain degree of arousal and immer-
sion into bad feelings and emotional pain while accepting this experience.
Again, this is fundamental to the effectiveness of exposure-based procedures.
This is also the assumption underlying posited change processes of emotional
insight, at the same time as challenging “hot cognitions” (Coombs, Coleman,
& Jones, 2002). Even though the importance of emotional awareness is
acknowledged by varying approaches to psychotherapy, emotions associated
with psychological distress are frequently suppressed or avoided, such that
clients feel flat or numb. In these instances, deliberately increasing arousal

is productive not for cathartic purposes, but rather to activate the emotion
structure and thereby increase awareness of the information associated with
emotional experience. However, the deliberate immersion into feeling bad
is difficult for clients and, when client arousal increases in session, therapists
who are not explicitly trained to engage affective arousal can also become
anxious and abandon the task. This, in turn, can be perceived by clients as
invalidating and can reinforce their avoidance.
Humanistic therapists facilitate client awareness; the more experiential
the therapist, the more he or she will also facilitate arousal, from the very begin-
ning of therapy. However, when clients become emotionally aroused and elab-
orate on their experience, there are various possible facets of that experience
(assertion, hurt, disgust, hopelessness, etc.) on which a therapist might choose
to focus. Moreover, not all facets of that experience have equal potential for
client progress. Thus, clinicians need to be selective about which experience
to emphasize to promote further processing (i.e., empathic selection and reflec-
tion; see Greenberg & Elliott, 1997).
Emotion awareness and engagement are not simply talking about emo-
tion, but also feeling it. This issue of how clients engage in emotion has been a
critical one. A key study on this topic (Paivio, Hall, Holowaty, Jellis, & Tran,
2001) showed that dosage (i.e., quality of process multiplied by frequency of
engagement) has been found to be the most predictive variable in terms of
outcome, rather than either quality or frequency of engagement alone (Paivio
et al., 2001). Thus, clients who are only minimally engaged during such emo-
tionally evocative tasks may need to be encouraged to participate in them
more frequently and fully to receive maximum benefit.
Another issue that presents itself in psychotherapy is that some clients
have marked difficulties in accessing and elaborating their emotional expe-
rience. The current conceptualization of alexithymia, which literally means
“no words for feelings,” is that it describes an individual’s limited capacity
to symbolize and elaborate emotional experience (Taylor & Bagby, 2013).
Despite this being an often-discussed construct in clinical literature, the
treatment research is sparse, although it does seem to suggest (contrary to
some clinical opinion) that a client’s level of alexithymia has little influence
on the treatment he or she may prefer. Nevertheless, it is associated with
poorer treatment outcomes in both psychodynamic and supportive therapies
(Ogrodniczuk, Piper, & Joyce, 2011). Interestingly, one outcome study using
emotion-focused therapy for relational trauma found a 68% decrease from
pre- to posttreatment in the number of participants who met the criteria for
alexithymia (Ralston, 2006, as cited in Paivio & Pascual-Leone, 2010); this
occurred despite the fact that the characteristic emotional shallowness of
alexithymia is commonly considered a personality trait (see Taylor & Bagby,
2013). One interpretation of this unique finding is that, because the aim

of an experiential therapy is to deepen experiencing (i.e., clients’ affective
awareness and symbolization), the observed reductions in alexithymia may
have occurred through improvements in clients’ capacities for experiencing.
Gendlin (1996) originally described the concept of depth of experiencing
as a process dimension reflecting individual differences that were antithetical
to alexithymia but that were also amenable to development through effortful
practice. The 7-point experiencing scale eventually became the gold standard
for measuring good process in experiential as well as in other psychotherapies.
Shallow levels on the scale represent unengaged levels of experiencing. At
deeper levels of experiencing, which are often indicative of good process, clients
begin to puzzle over their emerging experience or use currently accessible feel-
ings to solve problems or create new meanings (Klein, Mathieu-Coughlan,
& Kiesler, 1986). This line of work helped dramatically in elaborating the
humanistic conceptualization of experiential awareness.
Pos, Greenberg, and Warwar (2009) used the experiencing scale to study
only those therapy segments during which the client discussed emotional
content, a procedure that effectively yields a precise measure of emotional
experiencing. They found that a client’s individual capacity for emotional pro-
cessing early in therapy predicted outcome, but also that the increase in degree
of emotional processing from early to mid-, or early to late, phases of treat-
ment was found to be an even better predictor of outcome than early levels of
processing or the early alliance (Pos et al., 2009). In short, a capacity for emo-
tional processing does not guarantee a good therapeutic outcome; however,
entering therapy without this capacity does not guarantee a poor therapeutic
outcome, either. Although it is likely an advantage, early emotional processing
skill appears not to be as critical as the ability to acquire and increase the depth
of emotional processing throughout therapy.
Several other studies have considered the impact of client experienc-
ing in general (and, consequently, both emotional awareness and meaning-
making) on treatment outcomes. A. Pascual-Leone and Yeryomenko (2015)
recently conducted a meta-analysis that quantified the relationship between
client experiencing and treatment outcomes using all available process out-
come studies that met certain criteria: a total of 11 studies and 458 clients.
About half of these studies examined experiential treatments, although a
number of significant data sets were also included from cognitive–behavioral,
psychodynamic, and interpersonal treatments (see Coombs et al., 2002).
Study findings demonstrated that, when peak (i.e., maximum) client experi-
encing was measured during the middle portion of therapy, it predicted symp-
tom improvements in depression, general psychopathology, interpersonal
difficulties, and self-esteem by the end of treatment. Moreover, the evidenced
effect (r = .236) was consistent across experiential–humanistic, cognitive–
behavioral, and psychodynamic–interpersonal treatment approaches. Thus,

although further studies are needed, it seems possible that client experiencing
is actually a common factor, one that is of a similar magnitude and impor-
tance as the therapeutic alliance.
Client experiencing can also be thought of in several different ways within
a causal framework. A path analysis by Pos et al. (2009) has demonstrated that,
during the middle phase of therapy, the relationship between therapeutic alli-
ance and treatment outcome was partially mediated by client experiencing.
Considering the role of another affective process, Watson, McMullen, Prosser,
and Bedard (2011) showed that the degree to which a client was able to regu-
late affect fully mediated the relationship between client experiencing and final
treatment outcomes, thereby highlighting the interrelated complexity of emo-
tional processing subtypes (e.g., experiential awareness vs. regulation).
When clients approach the meaning-laden emotions of assertive anger,
grief, or nonblaming expressions of hurt, these feelings should be deeply explored
and experienced. This process is exemplified by an excerpt from a session with
a client who had become estranged from his family and had most recently had
a falling out with his sister.
Client: Well, I’m really angry. I’m angry enough that I don’t want to
see her. And I would, ah, be very happy not to see her ever
again. [He frowns.]
Therapist: What happens inside you when you say that?
Client: [Sighs] Oh, I don’t know, just a feeling of sadness. [He shakes
his head, sighs deeply.]
Therapist: Sadness.
Client: Yeah, because we have been, since 2006 . . .
Therapist: Speak from there . . . something about the sadness.
Client: Well, it just is, uh. . . . [long pause] It means we won’t ever get
together again, to have a swim, to have a BBQ to . . . talk. . . .
Therapist: So it’s like, “I’m sad about losing her.”
Client: [Tears well up in his eyes.] Yes. I’m very sad about losing her.
[Nodding slowly; he is deeply moved. He closes his eyes.] I,
I, ahh . . . Oh! [He sighs deeply, opens his eyes, looks at the
therapist.] She more than anybody.
A new emotional awareness such as this derives from the exploration of
a single situation rather than across situations and is formulated at a relatively
low level of abstraction. Even so, clients often experience the newness felt
in such an emerging experience as a tangible moment of insight. In another
example, after a client has become aware of some previously unexplored

aspect of her experience, she elaborates on what it is like to have a moment
of emotional awareness.
Client: I’m not sure how I get to that sad feeling. [She wipes tears from
her face.]
Therapist: Uh-huh . . . and right now. . . . Where do you feel that in your
body? . . . Can you describe it?
Client: It’s there. But I think that’s the first time I’ve ever felt it.
I mean, I knew it was there. Such a big empty space. . . .
[She points to the center of her chest.] The only way I’ve been
able to explain it to people is as a “lack of direction,” an
emotional void. . . .
Therapist: Longing for something more tangible, more solid. . . .
Client: Yeah, more meaningful.
Arousal, Expressiveness, and Enactment
Although the development of awareness is essential to working with

emotion, these experiences also need to be activated in session to increase
client awareness of the associated information. The observation that emo-
tion can be targeted and evoked through physical movement has been a
long-standing technique of contemporary acting. If a scene requires an
actor to weep, he might initiate this affective process by performing congru-
ent physical actions, such as taking a deep sigh or holding his head in his
hands (Moore, 1984). The essence of this notion of working with emotion
has stood up well to experimental scrutiny. As Berkowitz (2000) reported,
when research participants were encouraged to tightly clench their fist while
recounting an angering event, they reported stronger emotional experiences
of anger. In contrast, when participants used the same fist clenching while
reporting a sad event, they felt less sadness. In short, motor expression can be
used to intensify congruent emotional experiences or to dampen incongruent
emotional experiences. These findings are important for facilitating emotion
in psychotherapy as well as for observing how clients (often outside their
own awareness) may suppress emotional experience (see Greenberg, Rice, &
Elliott, 1993; Perls, 1969).
Arousal plays a critical role in ushering in and vivifying awareness.
Although arousal might be thought of as a simple extension of awareness,
the distinction becomes a critical one when discussing the deliberate arousal
of anger in session. Greenberg and Pascual-Leone (2006) discussed a number
of studies on the treatment of depression and on the recovery of traumatic
abuse survivors in which the arousal and expression of anger were related to

positive therapeutic change such as the development of agency, self-efficacy,
and self-assertion (Beutler et al., 1991; Van Velsor & Cox, 2001). In gen-
eral, however, there are mixed findings and views regarding the relation-
ship of aroused anger (among other feelings) to therapeutic outcome, with
some evidence that venting of anger is not therapeutic (Bushman, 2002) and
becomes unproductive unless related to problem solving (Tavris, 1989) in the
service of well-articulated existential needs (A. Pascual-Leone, Gilles, Singh,
& Andreescu, 2013).
The assertion that the experience of emotional arousal in general is help-
ful is congruent with how clients see their own change process. A recent study
found that, when clients being treated for complex trauma using emotion-
focused therapy were asked what they found most helpful, they reported those
events in which they experienced high emotional arousal while exploring
traumatic events (Holowaty & Paivio, 2012). Furthermore, the blanket
view that aroused emotion was good for treatment was refined by Carryer
and Greenberg (2010), who examined the relationship between the amount
of time clients spent in aroused emotion and the outcome of their treatment.
These researchers found that, when 25% of a session was observed as contain-
ing moderate to highly aroused emotional expression, this provided an opti-
mal prediction of good treatment outcome, one that was over and above the
working alliance. When sessions with high arousal contained either more
or less duration of this arousal, they offered poorer outcome predictions. As
Carryer and Greenberg explained, this shows that a moderate amount of
arousal would seem to be the most therapeutic.
In a study of 32 clients undergoing experiential therapy for depression,
observations of increased arousal in the middle phase of treatment were a posi-
tive predictor of increased self-esteem at final outcome (Missirlian, Toukmanian,
Warwar, & Greenberg, 2005). This particular outcome relationship may speak
to an individual’s expressions of aroused emotion as helping to affirm one’s sense
of self. However, what happens, or what productive clients are doing, during
moments of high arousal remains a key issue. To that end, Missirlian et al. (2005)
also showed that, during the middle phase of therapy, the combination of emo-
tional arousal and meaning-making (perceptual processing) predicted improve-
ments in depression and other symptoms better than either process variable
alone. This finding suggests that how affect is being processed and the meaning
that clients construct from their aroused emotion determine the ultimate expe-
rience and address why aroused emotional experience might be helpful.
In short, what the arousal means or signifies to the client who experi-
ences it is an issue of chief importance that cannot be separated out from the
question of whether arousal is productive. This formulation has been conclu-
sively supported by experimental research conducted by Bushman (2002).
Thus, although arousal of emotion is clearly important, several studies have

shown that purging or venting emotion alone is not a productive process.
Rather, emotional processing is achieved through aroused expressions mainly
in the context of deeply and meaningfully articulating one’s emotional expe-
rience (Greenberg, 2002).
In an example from the treatment of complex trauma (Paivio & Pascual-
Leone, 2010), a client was disclosing for the first time her experience of being
raped by her father when she was a child. These memories had always been
highly distressing, so she would quickly shut them out of her mind, which
truncated her process. So the therapist validated this and asked for more.
Client: When I go back there, all it brings up is this rushing sense of

fear and pain.
Therapist: Yes, it must have been so painful. Can you get past that? Was
there anything else going on in your little mind as a child?
Client: [With a focused voice] I remember him saying, “Daddies do
this to their little girls.”
Therapist: Stay with that. What did you think when he said that?
Client: At the time, I was so confused. I remember thinking I must
have done something wrong, that my mother would be angry
at me. But I couldn’t figure out what I had done.
Therapist: So somehow you were at fault, a bad girl?
Client: Hmm, I never really saw it like that before, but yeah, that’s
exactly how it played out.
Here, by increasing arousal and activating the trauma memories, the client
clearly accesses information that was not previously available—that is, core
maladaptive shame and associated maladaptive beliefs about her self formed
at the time. These became available for exploration and change. How shame
can be transformed is another change process that is discussed below.
Emotional Regulation and Self-Soothing
The previous example of exploring trauma memories illustrates that there

is a delicate balance between facilitating emotional arousal in the service of
awareness and managing those very intense emotions. It is clear that in evok-
ing memories there is a range for optimum arousal; both the therapist and the
client must collaborate to develop a sense of what the most productive level is.
Generally, it is most productive when clients are able to take a reflective stance
regarding their emotions, allowing the feelings to be active yet sufficiently
regulated to be useful in the exploration and creation of new meaning. In
humanistic therapies, Gendlin (1996) was instrumental in articulating that

the level of affective intensity is an important issue to address with clients (i.e.,
when the therapist says, “Put the feeling far enough away so that you can still
tolerate it”).
Emotion regulation and associated self-soothing are essential processes
in all therapies that deal with distressing events such as trauma. In current
cognitive–behavioral approaches to complex trauma (e.g., Chard, 2005;
Cloitre, Koenen, Dohen, & Han, 2002), as well as in eye movement desensiti-
zation and reprocessing (Shapiro & Maxfield, 2002), emotion regulation strat-
egies are taught in the early phase of therapy, before trauma exploration. In
current experiential–dynamic approaches (e.g., Fosha, 2000) and in human-

istic therapies, emotion regulation is part of the overall fabric of therapy and
is accomplished largely through provision of a safe and empathic therapeu-
tic relationship, which provides the foundation for exploring and processing
painful traumatic experiences.
Therapists should be mindful of clients’ capacity for emotion regula-
tion in the early phase of therapy, when painful emotions are explored for the
first time. Later, in the working phase, clients will often need to be coached
through self-soothing and regulation strategies (i.e., breathing, positive self-
talk, making use of physical comforts, and appropriate self-distractions) both
to tolerate and to work through painful emotions. Facilitating regulation is
important when clients are overwhelmed by undifferentiated feelings such
as global distress, secondary emotions such as rage, or primary maladaptive
emotions such shame or fear, as in panic attacks. The short-term goal of emo-
tion regulation is to gain psychological distance from these experiences, to
help clients turn down the intensity. Until this happens, painful emotion not
only remains unarticulated in the moment but also is not experienced in detail
(A. Pascual-Leone, 2005; Stern, 1997) and therefore cannot be a useful source
of information or guide adaptive action.
Therapist interventions in humanistic and experiential therapies that
facilitate emotion regulation vary depending on a client’s level of dysregulation.
In the short term, explicit use of skills training exercises, similar to those
used in cognitive–behavioral therapy in the treatment of fear and avoidance,
are helpful. The long-term goal of facilitating emotion regulation in these
instances is to help the client develop a repertoire of strategies for coping with
intense feelings. Such methods of emotion regulation are illustrative of how
humanistic and emotion-focused approaches may draw on and integrate inter-
ventions from nonhumanistic models. Clients may be experiencing intense
and painful emotion, but it remains bearable, at least for the time being. This
was the case with the client described above, who was remembering the rape
by her father. Distress that is intense yet bearable is a marker for empathic
affirmation of client vulnerability, followed by therapists helping clients to
articulate the meaning of their emotional pain.

Experiential therapists have long argued that symbolizing bodily felt emo-
tional experience can decrease emotional arousal (Paivio & Laurent, 2001).
For example, a study that encouraged girls to use emotion diaries found that
the simple practice of disclosing and tracking emotion reduced anxiety symp-
toms, particularly for girls who had difficulty coping with emotion (Thomassin,
Morelen, & Suveg, 2012). Recent research from affective neuroscience has
corroborated these clinical and experimental observations. Findings from a
study using functional MRI demonstrated that, when healthy participants
were presented with distressing images and then given the opportunity to label
their feelings with words, it reduced the activity in their amygdala (Lieberman
et al., 2007).
Furthermore, this process of using symbolization as soothing operates
individually as well as interpersonally. The process of soothing through mean-
ing happens interpersonally when a therapist who is empathically attuned
tentatively captures a client’s affect in just the right words, expressing it in a
way that also conveys acceptance and validation. Internal security develops by
feeling that one exists in the mind and heart of the other; thus, the security of
being able to soothe the self develops by internalizing the soothing functions
of a protective other—perhaps the therapist (Fosha, 2009; Schore, 2003). The
long-term goal of such empathic and dyadic regulations of affect is to help
clients develop their capacity to calm and comfort themselves by internal-
izing the soothing responses of the therapist, as well as by constructing mean-
ing that makes distressing experiences more comprehensible and manageable
(Greenberg & Pascual-Leone, 2006; Paivio & Laurent, 2001).
As an example, a client who suffers from social anxiety and depression
and is in the middle phase of treatment describes his feelings of shame in
social settings. Although the client becomes highly distressed, his therapist
joins him in empathically exploring the meaning entailed in this very painful
emotion.
Client: Umm. Everything I say is just a bit off, you know . . . off
of how other people see or . . . talk about things. [His voice
cracks, and he breaks down, sobbing heavily.]
Therapist: It’s just really. . . . It hurts to say that. . . . Can you say what
hurts so much?
Client: [He sniffles. There is a long pause; he seems lost for a moment in
his pain.]
Therapist: It’s just a feeling of inadequacy that gets pulled . . . or . . .?
Client: Well, yeah, I have to monitor everything I say, even while
I’m saying it, because I’m . . . I know, or feel, that everything
I say is just a little bit off, just doesn’t. . . . You know, people
will just do a double take or disregard me as a nutcase.

In this example, instead of deflecting his emotion or breaking down
into despair, the client begins to follow the therapist’s attentive and empathic
initiative and starts to articulate the meaning of his feelings. In so doing, the
dyadic process serves to regulate his arousal from sobbing back into a manage-
able range in which meanings can be explored.
Reflection on Emotion and Active Meaning-Making
The process of reflecting on emotion results in increased self-awareness;

however, clients also use narratives to explain their experiences and to under-
stand why emotion is aroused (and comes into awareness). Research has shown
across a number of contexts that being able to contextualize and explain
painful emotional memories promotes their assimilation into a coherent per-
sonal narrative, which in turn promotes healing (Angus & McLeod, 2004;
Pennebaker & Seagal, 1999). Thus, narrative accounts, or the stories one tells
about emotion experiences, play several roles in contextualizing, integrating,
and assimilating these experiences. Reflection on emotional experiences then
provides an evolving interpretive verbal and cultural framework, which entails
self-narratives and personalized themes that begin to interact with, and color,
the nature of emerging experience (Angus & Greenberg, 2011).
Furthermore, creating narratives about oneself also requires internal coher-
ence (J. Pascual-Leone, 1990; Pennebaker, 1997). In the context of traumatic or
depressogenic events, individuals sometimes make appraisals about themselves,
others, or the nature of events that are later shown to be untenable. Paivio
and Pascual-Leone (2010) gave the example of a woman who recalled how her
parents “helped” her with homework during grade school. She described her
emotionally volatile mother leaning over, screaming at her as she struggled with
homework late at night. She also recalled periodic beatings by her father that
followed any wrong answer during these late homework sessions. As an adult in
treatment, she remembered weeping as a child, feeling exhausted, and thinking
how she was obviously unintelligent and inadequate. However, after reflecting
on the terror she felt, she eventually concluded that any child, or even any adult,
would have had difficulty performing under those conditions and that perhaps
she was not given a fair chance. From a cognitive perspective, reflecting on emo-
tion can be understood as a way of changing a client’s assumptive framework
(i.e., schema; see Beck, Freeman, & Davis, 2004).
From an existential point of view, reflecting on emotion can result in the
insight that one is not only the reader but also the author of one’s life story.
The prototypical existential insights described by Yalom (1981) are essential
reflections that recontextualize distressing emotion, offering a new interpretive
framework, as in (a) “Only I can change the world I have created,” (b) “There is
no danger in change,” (c) “To get what I want I must change,” and (d) “I have

the power to change” (pp. 340–432). Reflexive states such as these are simple,
yet profound. Although they can always be entertained from an experience-
distant position as theoretical possibilities, their full and real impact is only
appreciated when they are lived moments of awareness rather than items of
conceptual or behavioral learning. To that end, Gestalt therapy has highlighted
intentionality rather than insight per se (Perls, 1969). Thus, the experiential
emphasis is on experience and process (what the client feels and how it is expe-
rienced or done) over content and cause (what is being talked about and why
the client experiences or does things).
Given the fundamental humanistic position that the client is the agent
in the development of his or her new insight, one common intervention for
facilitating reflection on emotion is to explore collaboratively any troubling
reactions clients may have to situations they have encountered. When clients
express confusion or describe having felt puzzled by their own emotional reac-
tions in a given situation, it is a marker to facilitate reflection on that experi-
ence (Angus & Greenberg, 2011; Rice & Saperia, 1984). Overall, reflection
on emotion and its circumstances can help clients with “re-storying” the pain-
ful experiences they have lived.
In psychotherapy, insight often involves reflection on emotion. A tra-
ditional psychodynamic interpretation, for example, is usually based on the
therapist’s appraisal of core themes relevant to the client (e.g., “This seems a lot
like the kind of powerlessness and depression you used to experience with your
father. Rather than experiencing your rage, you collapse”). Some experiential
therapists may choose to guide the client process, but they do not presume to be
experts on the client’s experience or dynamics. Following this position, thera-
pists encourage their clients to articulate insights about emotional experience
as those insights emerge from the client’s perspective. Finally, reflection on
emotion is also facilitated by modeling a discovery-oriented approach in which
therapist and client alike are trying to understand the client’s story of emotion
(Therapist: “Somehow you collapse into feeling like that powerless little boy.
How does that happen? What goes on for you on the inside?”).
The following excerpt is from a session with a client suffering from
depression. She has begun by discussing her marital difficulties, which leads
to her speaking about her relationship with her children. She notes a theme
and goes on to elaborate reflection on her emotional style:
Therapist: Oh, so you can’t accept love just for being who you are?
Client: [Talking rapidly] No. I owe them. Somebody . . . I owe my
children when they do something nice for me. I owe them so
big I could never buy them enough gifts. I am so touched that
somebody bothers to love me. It’s so big for me. I think . . . I’m
starting to formulate something here in my mind. [Her speech
slows and becomes focused.] Give me a second. . . . I think I

turn people off, so I don’t have to owe. I’m just realizing that
at this moment in time . . . because I turn a lot of people off.
And it seems to me—Why would I do that? I mean, that’s
like shooting yourself in the foot. . . . But I think I do that
simply for the purpose of not having to owe them. I just
discovered that.
Notice that this example of an in vivo reflection on emotion involves a
more top-down process, in which the client makes connections and identifies
a pattern that applies across situations. Taking a bird’s eye view has powerful
advantages at certain moments; clients may develop a more contextualized self-

understanding and self-interpretative framework. A link that is self-discovered,
as above, or, better yet, “self-created,” will always fit one’s own experience best.
Moreover, emotional knowledge that is attained through one’s own efforts is
more likely to be retained than if it has simply been conveyed (A. Pascual-
Leone & Greenberg, 2006).
Emotional Transformation or Changing Emotion With Emotion
After relationship conditions have been established, and after the initial
contact in emotional awareness, deepening of experience, and clear expression,
experiential therapies move toward transforming emotion. Such approaches
use a process-guiding style to create change by evoking affect to promote emo-
tional processing and access to additional material (Greenberg, 2002). Rice
(1974), a pivotal influence on Greenberg and the development of emotion-
focused therapy, was one of the first to underscore the evocative function of
a client-centered therapist. Thus, after previously unacknowledged experi-
ence has been accessed, the focus shifts to transforming certain emotional
experiences by using emergent and alternative emotions to expand a person’s
repertoire.
The term emotion scheme is often used to capture the dynamic nature
of emotion as a multimodal network of feelings and meanings (i.e., a self-
organization) that could exist in one’s repertoire at various levels of activa-
tion (Greenberg et al., 1993). Attending to a current (maladaptive) emotion
scheme that is in need of transformation, such as feeling worthless, makes it
accessible to new inputs that might change it. Identification of and attention
to unfulfilled needs embedded in a maladaptive state stimulate alternative
self-organizations, which are tacit, emotionally based schemes; they begin to
organize the individual toward meeting an identified need. It is the synthesis of
this new possibility with the old ones that leads to lasting change (Greenberg,
2002; Greenberg & Watson, 2005; A. Pascual-Leone & Greenberg, 2007).
Thus, experiential approaches of this kind make use of the power of affect to
catalyze change, producing a restructuring of core emotion-based schemes.

This access to alternative responses, along with the synthesis of old with new
schemes, is viewed as central to therapeutic change. On a neuronal level,
withdrawal emotions from the right hemisphere of the brain can be trans-
formed by the activation of approach emotions from the left prefrontal cortex
or vice versa (Davidson, 2000). Changing one emotion by way of another
occurs as a client gains new meaning from a freshly emerging emotion, result-
ing in newly formed neural connections and increased efficiency of neural
information transfer (Davidson & Begley, 2012).
Emotional transformation is not simply the process of generating new
experiences in therapy, because it does this by using facets of another, already

present maladaptive emotion. This is possible because there can be coactiva-
tion of adaptive emotion along with, and in response to, maladaptive emotion
(Greenberg, 2002). Although it is implicit in most humanistic therapies, one of
the explicit principles in emotion-focused therapy is to respond empathically to
distressing, even maladaptive, emotion while continually supporting the tenta-
tive emergence of adaptive emotional responses. In this way, bad feeling is not
purged or vented as such, nor does it attenuate; rather, another feeling is evoked
in parallel and in contrast to the maladaptive feeling (Fosha, 2009; Greenberg,
2002; A. Pascual-Leone & Greenberg, 2007).
As Fredrickson (2001) has observed, key components of positive emo-
tions are simply incompatible with negative emotions. Although adaptive
emotions (e.g., grief, assertion) are not necessarily positive (i.e., enjoyable),
the transformation of emotion as described above hinges on a similar prin-
ciple: Activating a new emotion actually changes the preceding emotion. In
a series of laboratory experiments demonstrating this, Fredrickson, Mancuso,
Branigan, and Tugade (2000) showed that cardiovascular effects of a nega-
tive emotion (i.e., anxiety) were not simply replaced but rather undone by
positive emotions (i.e., contentment and amusement). In short, compared with
neutral control procedures, positive emotions accelerated cardiovascular recov-
ery. Similarly, in a psychotherapy analogue study of self-criticism (Whelton
& Greenberg, 2005), people who were more vulnerable to depression showed
more self-contempt but were also less resilient in response to their own self-
criticism than people who were less vulnerable to depression. Meanwhile,
less vulnerable individuals were able to recruit assertive emotional resources
such as pride and anger to combat (transform) depressogenic self-contempt
and negative cognitions. Together, these studies indicated that emotion can
be used as a means to change emotion.
However, this dualistic conceptualization (positive–negative, approach–
withdrawal) of sequential patterns of change has been further developed by
an empirically derived model proposed by A. Pascual-Leone and Greenberg
(2007; A. Pascual-Leone, 2009). By coding emotion states from the videos of
34 sessions of experiential therapy for depression and interpersonal injuries,

these researchers identified a multistep sequential pattern of emotional
change that predicted outcomes. Using moment-by-moment analyses, they
showed that distressed clients first worked through emotions that are global,
undifferentiated, and insufficiently processed. Fear, shame, or rage then rep-
resented a second step, characterized by a deep, enduring, yet familiar painful
state, which was highly idiosyncratic and often anchored in generic autobio-
graphical narratives. Further on, at the third step of processing, articulation of
a core negative self-evaluation was contrasted with an existential need, serv-
ing as a pivotal step in change and occasionally producing a sense of relief.
A fourth step described a set of adaptive emotions. On one hand, clients

entered a state of grief, in which they acknowledged personal losses without
complaint or self-pity. On the other hand, clients mobilized through asser-
tive anger or self-compassion, in which they proactively affirmed a healthy
entitlement to experiences of personal competence, worth, and connection
with others. Eventually, a synthesis of these adaptive emotions (i.e., assertive
anger, grief, self-compassion) led to the resolution of distress and facilitated
resolution of personal difficulties.
The most common targets of emotional transformation and interven-
tion are primary maladaptive fear, shame, or loneliness, which are complex
and dysfunctional affective meaning states that tacitly embody a sense of
being incompetent or bad and unlovable. They are embodied preverbal expe-
riences (schemes) that are not easily amenable to logical or rational change.
In the example of the client described above who had been raped, she stated,
“I know that he was the adult and I was just a child, but I still feel like I was
responsible.” Another client said, “I know in my mind that I’m successful—
I have a PhD, for God’s sake! But I still always have this sense that there’s
been some misunderstanding or clerical error.” The fact that these feelings
defy rational thinking makes it difficult to change maladaptive emotion
through reason and seems to highlight the need for experiential over cogni-
tive approaches to emotional change.
In sum, primary maladaptive emotion is transformed by accessing and
evoking primary adaptive emotion. This process often occurs later in the work-
ing phase of treatment. Although the transformation process cannot be
applied formulaically because it is contingent on each individual’s personal
experience and idiosyncratic meaning, A. Pascual-Leone and Greenberg’s
(2007) process research has supported the idea that a series of prototypic
pathways exists. Maladaptive fear, for example, about being preyed on by
potentially abusive others, can be transformed by supporting the simulta-
neous emergence of assertive anger, in which clients actively defend their
boundaries and dignity (Paivio & Pascual-Leone, 2010). Similarly, shame
and maladaptive self-blame can be transformed by accessing feelings of anger
about injustice (Whelton & Greenberg, 2005). Working through anger,

moreover, can be facilitated by subsequently moving to deeper experiences
of sadness (Rochman & Diamond, 2008).
Some therapist interventions that facilitate emotional transformations
in experiential therapies have been studied in detail. First, Gendlin’s (1996)
focusing exercise often results not only in awareness of a particular emotion,
but also in emotional transformation. Second, enactment tasks and imagi-
nary dialogues are effective ways of activating contrasting emotions while, at
the same time, keeping emotions symbolically and experientially delineated.
Thus, in the context of unresolved feelings toward others, imaginal confronta-
tion (as used in emotion-focused and Gestalt as well as some other therapies)
is a principal way of facilitating emotional transformations (Greenberg &
Malcolm, 2002; Paivio et al., 2001). In the context of self-related difficulties,
two-chair enactments between different and incompatible parts of the self are
useful (Greenberg et al., 1993; Whelton & Greenberg, 2005).
Of course, these enactments are ultimately built on the experiential
bedrock of evocative elaboration (Rice, 1974). To move through an emotion,
clients are encouraged to “stay with the feeling.” Therapists who are empathi-
cally attuned gently guide the clients’ attention to facets of their experience
that may only be in the periphery of awareness (Gendlin, 1996). This role of
the therapist’s empathic attunement is highlighted in both humanistic and
experiential–dynamic perspectives, in that a key target of emotional trans-
formation is a client’s feelings of aloneness in dealing with overwhelming
emotions (Fosha, 2009).
In the following excerpt from therapy, a woman diagnosed with dysthy-
mia and a major depressive episode describes her relationship with her father,
who became emotionally withdrawn after her mother died. The client begins
in a state of maladaptive shame, feeling as though there were something about
her that deserved to be rejected. As she explores this feeling, there is a sense
of anger; the therapist then guides the client’s attention toward those aspects
of the unfolding experience, thereby transforming her sense of worthlessness
into self-assertion.
Client: He was never there for me. All the suffering I put myself
through—I guess I have only myself to blame.
Therapist: So, there’s this sense of somehow not deserving love. . . .
Client: [Tears fill her eyes.] I feel I’ve had too many losses in my life.
It seems so unfair. I had to deal with so much on my own. I
hate him for what he did.
Therapist: Tell him what he did. [Points to empty chair.]
Client: I don’t think you realize . . . all my relationships, everything,
has been so much harder . . . because of the way you treated
me. Every single day I’ve had to fight through that. . . .

Therapist: What do you resent? Tell him.
Client: I resent that you didn’t love me. I hate you for being so self-
ish, inconsiderate, and dismissive of me and [pause] . . . for
just never putting me first. [shrugs] Not that I needed that
always. . . .
Therapist: What just happened there. . . . Something changed?
Client: I’m feeling sorry for myself.
Therapist: OK. Try not to go there, stay with your resentment for
now. . . . I know it’s difficult, but tell him more about your
resentment.
Client: [She turns back to squarely face the chair.] It’s hard for me to
confront you, but this I must say: You were not a decent
father to me. You abandoned and neglected me . . . for most
of my childhood . . . and I’m angry at you for that.
In this example, maladaptive shame undergoes a microtransformation as sub-
dominant feelings of anger and healthy entitlement are brought to the fore-
ground. Through this process, the client eventually expresses adaptive assertive
anger, which is supported by the therapist over the course of therapy until it
becomes a new, healthy, and more stable part of the client’s repertoire.
FROM RESEARCH TO PRACTICE: THERAPEUTIC

APPLICATIONS OF HUMANISTIC–EXPERIENTIAL
PRINCIPLES FOR WORKING WITH EMOTION
The emphasis on moment-by-moment client process is a fundamental

tenet of all humanistic and experiential therapies. This unique attentiveness
to emerging experience is a special advantage of this therapeutic approach
when working with emotion. As a result, the tradition has developed a num-
ber of implicit and explicit principles of intervention. In this section, we
discuss emotion in practice and how therapists work with emotion.
The Relationship as the Crucible of Emotion Change
Although today most approaches to therapy acknowledge the importance

of working with emotion, the fact remains that some qualities of the therapeu-
tic environment are more conducive than others to the exploration of affective
experience and meaning. Cultivating these qualities can be particularly impor-
tant when working with clients who have learned to minimize or fear their
feelings. In this section, we offer guidelines for cultivating an environment

that facilitates deeper emotional experiencing, a process that begins in the first
session of therapy and continues thereafter.
Maintain a Consistent Focus on Feelings

Promoting experiencing is an essential part of emotion coaching that
begins in the first session of therapy and (implicitly or explicitly) will be an
important task that contributes to alliance development. As such, therapist
responses that frame problems in feeling terms and communicate that valu-
ing of emotional experience and expression are the foundation for deepening
client experiencing (e.g., “This must be so painful—it’s like you are your own
worst enemy” or “So lonely to keep that secret all these years”). Responses that
focus on affective experience implicitly and sometimes explicitly give the client
permission to experience and express what are often confusing, frightening,
and intensely negative or painful feelings. Therapy, like any social engagement,
is filled with subtle cues that indicate to clients what type of behavior and what
tone is acceptable, desirable, or appropriate. Valuing and validating emerging
feelings communicates to clients that the usual restrictive social norms con-
cerning intense emotion do not apply in this context (e.g., Therapist: “I under-
stand part of you must really hate him for what he did”; Client: “I do. I hate him.
I used to wish he was dead, and then I’d feel guilty”) and that emotions are not
inherently dangerous. This is especially important with clients who fear others
will minimize, misunderstand, or judge their feelings.
This focus on feelings is not only central to exploring affective mean-
ing but is considered essential to the task of processing painful memories in
general. Research from a variety of theoretical perspectives has indicated
that a cognitive emphasis is counterproductive to the emotional processing
of trauma memories. A recent meta-analytic review (Foa, Rothbaum, & Furr,
2003), for example, concluded that, when exposure therapy is augmented
with other cognitive interventions, the combination can actually decrease
the effectiveness of treatment with respect to emotional processing. This
finding suggests that a cognitive emphasis can impede working through dif-
ficult emotions, perhaps because it serves as a distraction from affect.
Another line of research has argued that the rumination characteristic
of worry is distinct from and antithetical to the working through that is nec-
essary for emotional processing (Borkovec, Alcaine, & Behar, 2004). Worry
is understood by these researchers as a cognitive response that allows one to
avoid deeper pain and more primary emotional experience. The cognitive,
verbal–linguistic behavior of worry suppresses potentially evocative imag-
ery, underlying meanings, and even somatic activity. In this way, rumination
can block the natural course of experiential processing. Thus, effective inter-
ventions direct clients’ attention to exploring core emotions that underlie
chronic worry (e.g., a core sense of self as inadequate, fragile, or flawed).

Ensure Optimal Arousal
Very high levels of arousal interfere with the capacity to explore meaning.
Clients who are processing a profound loss, for example, may need to have a
good cry, but arousal must diminish before they can really explore the meaning
of the loss in their lives. Even so, arousal must be sufficiently high to activate
relevant emotional meanings. Thus, to promote experiencing, interventions
need to help clients modulate levels of arousal.
Cultivate a Client’s Attitude of Curiosity and Exploration

Interventions that encourage clients to pay careful attention to their
feelings, needs, concerns, and perspectives promote an attitude of interest in,
respect for, and valuing of their emotional life. This can be made explicit as
part of collaborating on the task of exploring affective meaning (e.g., “I hear
how much this distresses you, and I guess it seems important to get a sense of
how this unfolds for you, how you always end up feeling like the bad guy” or
“So, somehow it’s hard to believe you deserve better?”). In addition, clients
need to be aware that experiencing may result in both discovering and creat-
ing meaning and that answers to their problems do not exist a priori. This
helps to promote tolerance for ambiguity as well as client agency in solving
emotional problems.
Create an Environment Conducive to an Internal Focus

Initially, many clients are often focused on describing external situations
and the behavior of negative or abusive others, or they may talk continuously,
making it difficult for the therapist to intervene at all. Interventions in these
instances need to help the client relax and slow down the process (e.g., “Wait,
wait, so all this was going on and I’m wondering—what’s it like for you to tell
this story? This is worth slowing down for. Take a minute. . . . What’s going on
inside as you tell me this?”). The aim is to help clients become introspective
and self-reflective and learn to be comfortable with a pensive silence so they
can “hear” their internal processes. This applies to recognizing and attending
to positive as well as negative experiences. As Fosha (2000) and others have
argued, successful therapy also includes recognizing, attending to, and explor-
ing clients’ positive emotions.
Maintain Interpersonal Contact

Experiential processing takes time, and clients vary in the amount of time
they need to symbolize and fully process a given experience. Productive silence
can occur naturally when the client is searching internal experience (Levitt,
2001). Therapists would do best to attend patiently to these moments and resist

filling in the spaces. However, silence should not go on for too long, because
clients can easily lose focus or direction. The principle here is to respect the
client’s need for silence and at the same time maintain contact. Therapists
periodically need to invite clients to share what they are experiencing (e.g.,
“Can you tell me what you are thinking or feeling right now?”). Constructing
meaning is a collaborative rather than a solitary process, and it cannot be
prescribed. When processing is productive, clients will typically share their
experience (e.g., “I was just thinking how strange it is that I have let this go
on for all these years; sad, really”). Therapists will then respond with empathic
reflections that work roughly within the client’s horizon of experience (e.g.,
“Hmm, so there is this sense of feeling both grief and feeling puzzled, as we
begin to unpack this together”).
Intervention Principles for Promoting Emotional Experience
A client’s level of engagement often involves reexperiencing the narrated

past (e.g., “I remember sitting alone, thinking there must be something wrong
with me”). At the same time, the client must remain engaged with the pres-
ent moment, which sometimes contrasts and at other times complements or
informs the past narrative (e.g., “Now that I tell the story, I feel angry about the
betrayal I suffered”). Productive experiencing is characterized by an internally
focused vocal quality that indicates a reflection that is unrehearsed and search-
ing (Rice & Kerr, 1986). Often there are pauses as the client concentrates and
gropes toward new meaning. These pauses are indicative of good process and
should be encouraged and supported by the therapist (e.g., “Stay with that,
take your time” or “Keep your attention on that gut feeling, it’s important”). Of
course, externally oriented clients eventually return to their default of describ-
ing situational events and related cognitions, but these repeated forays into
idiosyncratic meanings and feelings facilitate experiencing (Angus & McLeod,
2004; Paivio et al., 2001).
Differentiate Hurt, Upset, and Global Distress

Emotional experience needs to be sufficiently specific before the under-
lying facets of experience can be put into words. As discussed earlier in this
chapter, when a client’s experience is undifferentiated, hurt, upset, or dis-
tressed, then the client cannot hope to articulate any specific meaning, which
emerges only from an increasingly specific emotional experience. Thus, dif-
ferentiating global upset or distress into discrete emotions is a necessary step in
promoting exploration of meaning and thereby moving the emotional process
forward (A. Pascual-Leone & Greenberg, 2007). Again, this is because discrete
emotions are associated with specific information used in the construction of

new meaning. Promoting experiencing thus requires exploring and integrat-
ing the context-relevant meaning associated with specific discrete emotions.
Explore All Facets of an Emotional Episode

Any important affective event is encoded as a multimodal network of
information (i.e., an emotion scheme or structure), and experiencing entails
activating the structure to explore its components deliberately. When a
client definitively states that he or she feels a certain way (e.g., “Well, it’s just
embarrassing, nothing else”), many therapists who are learning to work with
emotion have difficulty knowing how to explore the issue further; if this hap-
pens, the therapy process can become stuck or redundant. However, labeling
an emotion is only one part of the process; because most of the elements in an
emotional experience are tacit, unpacking or elaborating that information, or
meaning, facilitates client experiencing.
In an effort to describe the components of an emotional experience
in response to a given situation, researchers (Greenberg & Korman, 1993;
Pos, Greenberg, Goldman, & Korman, 2003) have focused on segments in
therapy in which clients disclosed past or present emotional experiences.
Although this was initially intended as a research strategy, being familiar with
the essential components of these kinds of moments can provide direction
for therapists intending to explore a client’s feelings beyond simply labeling
them. Accordingly, when a client refers to a particular feeling (e.g., sad, happy,
afraid, embarrassed), the given emotion usually entails the five following ele-
ments, or facets, of experience, each of which might be a point for exploration.
1. Situation or interpersonal context. This is typically the stimulus or
circumstances of the emotion (e.g., “I have failed in my marriage”
or “My mother left me alone”).
2. Action tendency. Because one of the purposes of emotion, evolu-
tionarily speaking, is to organize a person to express some response
or behavior, emotional experiences are almost always accompa-
nied by some kind of action, or an impetus toward action. In
fact, sometimes clients first present an action tendency (e.g.,
“I wanted to crawl into bed and pull the covers over my head”).
3. Somatic component. Emotions are embodied (Damasio, 1999).
Working with the somatic component of emotion is particularly
elaborated in focusing, Gestalt, and experiential body-based
therapies. Unlike action tendencies, these somatic elements
are not usually indicative of particular goal-oriented behavior;
rather, as described by Gendlin (1996), they represent a pre-
verbal aspect of meaning that can be captured in metaphors or
images (e.g., “I have butterflies in my stomach” or “I feel warm

inside, imagining her beside me”). Focusing (Gendlin, 1996) is
a technique that can be especially useful for elaborating affec-
tive meanings via the somatic component of an experience.
4. Unmet existential or interpersonal need. When emotions are dif-
ferentiated enough, they organize people for action toward some
implicit goal. Thus, therapists need to be attuned to core exis-
tential and often interpersonal needs that drive affective and
cognitive goal-oriented behavior. The verbal symbolization of
existential or interpersonal needs is pivotal in the full elabora-
tion of the meaning of these experiences (e.g., “I needed love,

affection, even just some acknowledgment that I was there!” or
“What he did was just wrong—we deserve justice!”).
5. Concern regarding the self or self-in-relation-to-other. The articulation
of self-related difficulties (e.g., feelings of insecurity, worthlessness,
or harsh self-criticism) usually emerges as the client explores the
effects that difficult experiences have had on personal identity,
hopefulness, and relatedness to others (e.g., “Maybe I’m just an
angry person; I wish I weren’t like that”). Concerns about the
self are usually relatively easy to access in clients who are already
emotionally aroused; sometimes it is sufficient to guide a client
from the situation and circumstances to focusing more on the
personal ramifications it may have (e.g., Client: “She just stood
there and watched him beat the crap out of me!” Therapist: “So,
somehow that says something about both of you—the fact that
she didn’t intervene?”).
Awareness of these five aspects of an emotion episode can be a useful strat-
egy for deciding where and how to explore further when therapists feel stuck
and clients present their feelings as deceptively straightforward. Moreover,
because these elements of an emotion structure are linked together in a net-
work, elaborating one such facet of experience can lead to all the others.
Addressing each of these facets is a potential avenue for further exploration.
Move From Concrete to More Abstract Aspects of Emotional Experience

The principle of exploring all facets of an emotion scheme assumes that
experience needs to be activated. To make an emotion vivid in a client’s
immediate experience, one could begin activating the network with any of
the components described above. However, when clients are not aware of spe-
cific emotions, exploration moves best from concrete sensations (i.e., bodily
felt sense, action tendencies, concrete images) to more complex and abstract
aspects of experience (i.e., thoughts, feelings, desires, and needs), not vice
versa (Paivio & Pascual-Leone, 2010).

In treatments such as emotion-focused therapy, focusing-oriented therapy,
eye movement desensitization, reprocessing therapy, or even anger manage-
ment therapies, for example, clients are explicitly taught to use bodily expe-
rience as a source of information about emotion or arousal states. However,
the higher aim of this experiencing is to symbolize the meaning of affec-
tive experience, not just to be attuned with one’s bodily experience. For
example, “I’m flushed and angry” is useful, embodied, and concrete infor-
mation, but the more abstract meaning of “I’m fighting for my dignity” will
capture what is most important. Although both are needed, the latter is
a higher level process or skill than just creating an awareness of affective

experience.
In contrast, if clients can already identify their feelings (e.g., anger),
directing attention to their associated bodily experience will not typically move
the meaning-making process forward. Similarly, if clients already know what
they want or long for (e.g., abstract experience—the need to be treated with
respect) and that need is vividly experienced in the moment, then directing
a client’s attention toward bodily sensations (e.g., concrete experience—
feeling hot and the impulse to lash out) will not usually move the process
forward (e.g., see A. Pascual-Leone et al., 2013). In these situations, when
clients are already aroused and in touch with the more complex and abstract
aspects of their experience, it is more useful to move directly to helping them
articulate the meanings associated with those feelings in the context of self,
others, and interpersonal relatedness (e.g., “I guess, this is you fighting for . . .
respect? For what’s decent?”).
Listen for the Implied Message

Most training manuals on basic psychotherapy and counseling skills dis-
tinguish between the explicit and implicit aspects of a client’s communica-
tion, emphasizing the importance of responding to the implicit message. In
experiential therapies, this has been called responding to the leading edge
of experience (Gendlin, 1996) because responses that highlight this aspect
of experience move the process beyond what is merely being stated. Thus,
empathic reflections, directives, questions, or interpretations that focus on the
implied message promote deeper experiencing (e.g., Client: “She’s the adult,
she should be looking after that, not me!” Therapist: I hear how much you
resent being saddled with that burden, almost being her mother rather than
the other way around. I imagine you would love some mothering of your own
at times”). The caveat is that the therapist is responding to a client’s intended
message, which is on the periphery of awareness, not to material that the
client wants to keep hidden or private. Responding to the intended message
stands in stark contrast to making deep and often dynamic interpretations that

are not in the periphery of awareness, or confronting a client’s defenses, which
can evoke feelings of shame and defensiveness.
Therapists can respond to a client’s implied message by making small
inferences or attending to overt nonverbal cues. As clients explore, the focus
of their attention shifts from what was an implicit meaning in one moment
to an explicit expression of that meaning, dynamically moving the dialogue
forward. Even so, some affective meaning is beyond the reach of the client’s
verbal symbolization. The client experiences this implicit meaning as a pre-
verbal intuition—a felt sense, to use the words of Gendlin (1996). Therapist
responses that capture this aspect of experience might glean meaning from,
say, the client’s tone of voice, an unanticipated pause or pattern of speech, or
incongruence between the implicit and explicit message. When a therapist
is able tentatively to put words to this felt sense, clients often immediately
recognize it as their own intended meaning. This process of tentatively offer-
ing the client meaning that may be barely be out of reach provides a scaf-
folding that expands the client’s horizon of awareness, thereby facilitating
experiencing.
Attend to Less Dominant Affective Meanings

Emotional experiencing is a highly dynamic process. Whether an exist-
ing affective state is an ephemeral one or a stable feature of the client’s per-
sonality, the most salient experience is always in dynamic competition with
other lesser activated states, as with emotions that are just outside the client’s
focus (A. Pascual-Leone, 2009). These potential states can be thought of as
subdominant experiences that exist in the background, yet bleed through
and color the dominant affective meaning state, sometimes in subtle ways
(Greenberg & Pascual-Leone, 1995). This is comparable to Gestalt (Perls,
Hefferline, & Goodman, 1951) ideas of conflict between the dominant top-
dog side of personality and the weaker experiencing self, or underdog, and to
current constructivist views of multiple selves or voices working in harmony
or disharmony (Hermans, 1996; Stiles, 2006). Subdominant experiences
often characterize those more fragile parts of the self that embody authentic
feelings and needs, along with adaptive resources that have been squashed
or damaged by trauma or other painful experiences. Therapists looking to
facilitate an emotional transformation in their clients by way of experiential
exploration need to be attuned and responsive to these less activated and
more subtle emotional organizations.
Consider a client whose core sense of self is that she is worthless, or bad.
This maladaptive state or emotion scheme is a network of feelings and mean-
ings that gets activated across situations. Perhaps the sense of being bad is
elicited in therapy by imagining a critical ex-spouse. The client describes the

most salient facet of her experience as fear of being berated by the spouse. As
she describes this experience, she sometimes lowers her eyes in what might be
embarrassment or shame and sometimes grits her teeth in what seems like a
flicker of anger. She describes wanting to freeze or hide, and, as she says this,
she firmly grasps the armrest of her chair. Unmet needs for security, safety,
and protection are at the center of the maladaptive experience of fear. As
these thoughts and feelings are activated in therapy, they leave her drained of
energy and with a sinking feeling in her stomach. Part of the implicit mean-
ing entailed in this state is captured by her thoughts of “I’m bad” (shame),
“There’s nothing I can do about it” (powerlessness), or even “I’m going to get
it!” (fear), but she also says, “I hate him” when referring to her ex-husband.
Therapists attuned to the nuances of experiential process implicitly
notice signs of shifting affect and meaning in the form of nonverbal cues, frag-
ments of meaning, or emerging incongruous emotion. In the above example,
fear is the dominant aspect of experience, and shame and anger are subdom-
inant. Therapist interventions could focus on either of these subdominant
aspects, depending on the intentions of intervention. In the earlier part of
therapy, the therapist might want to focus on exploring the underlying shame
that prevents the client from holding the spouse accountable for harm. As ther-
apy progresses, however, the therapist may want to increase the client’s aware-
ness of her adaptive anger at maltreatment and possibly help her express this
to the imagined husband, which may or may not be practice for a real-life
confrontation. In such a case, the therapist would be attuned to ephemeral
moments when the client grits her teeth, clenches her fists, deepens her voice,
and expresses anger toward her abuser. By drawing attention to these traces
of anger, interventions orient the client’s attention to a different set of affects
and meanings besides fear, such that they gradually move to the foreground.
Any verbal or nonverbal sign of the subdominant emotion scheme could be
used as a point of elaboration. For example,
Client: [Under her breath, clenching her teeth] I hate him.
Therapist: Yeah, hate him, like he’s a big bully, picking on you and
scaring you. I’m sure you’d like to make him go away, leave
you alone!
or
Therapist: I notice your clenched fists, like you just want to fight
back. . . . Does that fit?
Finally, facets of experiences that are attended to always become
increasingly salient; as the newly emerging process is symbolized in words,
the once subdominant experiences of assertion and anger shift to the fore-
ground and become dominant, and the experience of maladaptive fear

becomes background, at least for the time being. When anger is attended to
and accessed, the client feels she wants to stand up and shout, “Stop it!” She
feels mobilized to assert herself and has a sense of “I don’t deserve this,” “This
is wrong,” and “I’m OK the way I am.” This particular manner of facilitating
deeper experiencing is a central part of interventions used in emotion-focused
therapy (Greenberg & Watson, 2005; Paivio & Pascual-Leone, 2010).
SUMMARY AND CONCLUSION
Working with emotion has been recognized as an integral component

of successful psychotherapy across therapeutic orientations. The underlying
emotional processes that contribute to successful therapy are also not likely to
differ greatly across treatment approaches. However, since the beginning of
humanistic and experiential therapy, the role of emotion has been explicitly
stated and shown to be central to client change. Given this focus, it follows
that practitioners and clinician-researchers from these approaches have pio-
neered many of today’s interventions for working with emotion.
Other approaches to therapy have generally focused on single emotional
processes, such as the cognitive–behavioral emphasis on emotion regulation
or the traditional psychodynamic focus of reflecting on emotion, which have
indeed led to the development of adept interventions for engaging clients in
those specific processes. However, when it comes to working with emotion
in vivo, some of the affective shifts in those treatments were predicated on a
client’s spontaneous experience of hot process or cathartic activation. Thus,
outside the humanistic and experiential tradition, relatively little “technol-
ogy” had been developed to help clinicians increase emotional engagement,
heighten arousal, or purposefully facilitate the transformation of a maladaptive
emotion into another, more adaptive, emotion.
Although specific interventions of this kind are detailed in other chapters
of this volume, a few key research-based strategies include the following: the
importance of deepening client experiencing to facilitate emotional awareness
and engagement (A. Pascual-Leone & Yeryomenko, 2015; Pos et al., 2009);
the pivotal role of promoting emotional arousal in client change, especially in
combination with meaning-making (Missirlian et al., 2005); and promoting
sequences of emotions to bring about emotional transformation (Greenberg,
2002; A. Pascual-Leone & Greenberg, 2007). As one might hope, powerful
strategies such as these for working with emotion have now found their way
back into modern psychodynamic schools and third-generation cognitive
approaches, such that humanistic–experiential interventions have informed
the practice of contemporary treatments at large.

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5

soothing; (d) reflection on emotion and meaning-making, which involves

SUMMARY OF MAJOR EARLY LITERATURE TO 2000:

Since their inception, humanistic and experiential understandings of

Role of Emotion in Adaptive Functioning

First, the emotion system may serve as an adaptive orienting system.

148 pascual-leone, paivio, and harrington

to be internally coherent (J. Pascual-Leone, 1990; Pennebaker, 1997).

Emotion as a Densely Packaged Unit of Information

Over the past 60 years, the humanistic emphasis on spontaneous and

emotion in psychotherapy 149

77 sadness organizes one to seek comfort but later to withdraw and

150 pascual-leone, paivio, and harrington

willing to accept emotional experience.

CURRENT RESEARCH ON EMOTIONAL PROCESSING:

To consider how emotional processing is manifested in general, and in

Emotional Awareness and Engagement:

Insight-oriented therapies are founded on the assumption that increas-

emotion in psychotherapy 151

152 pascual-leone, paivio, and harrington

emotion in psychotherapy 153

154 pascual-leone, paivio, and harrington

Arousal, Expressiveness, and Enactment

Although the development of awareness is essential to working with

emotion in psychotherapy 155

156 pascual-leone, paivio, and harrington

Client: When I go back there, all it brings up is this rushing sense of

Emotional Regulation and Self-Soothing

The previous example of exploring trauma memories illustrates that there

emotion in psychotherapy 157

current experiential–dynamic approaches (e.g., Fosha, 2000) and in human-

158 pascual-leone, paivio, and harrington

emotion in psychotherapy 159

Reflection on Emotion and Active Meaning-Making

The process of reflecting on emotion results in increased self-awareness;

160 pascual-leone, paivio, and harrington

emotion in psychotherapy 161

advantages at certain moments; clients may develop a more contextualized self-

Emotional Transformation or Changing Emotion With Emotion

162 pascual-leone, paivio, and harrington

experiences in therapy, because it does this by using facets of another, already

emotion in psychotherapy 163

A fourth step described a set of adaptive emotions. On one hand, clients

164 pascual-leone, paivio, and harrington

emotion in psychotherapy 165

FROM RESEARCH TO PRACTICE: THERAPEUTIC

The emphasis on moment-by-moment client process is a fundamental

The Relationship as the Crucible of Emotion Change

Although today most approaches to therapy acknowledge the importance

166 pascual-leone, paivio, and harrington

Maintain a Consistent Focus on Feelings

emotion in psychotherapy 167

Cultivate a Client’s Attitude of Curiosity and Exploration

Create an Environment Conducive to an Internal Focus

Maintain Interpersonal Contact

168 pascual-leone, paivio, and harrington

Intervention Principles for Promoting Emotional Experience

A client’s level of engagement often involves reexperiencing the narrated

Differentiate Hurt, Upset, and Global Distress

emotion in psychotherapy 169

Explore All Facets of an Emotional Episode

170 pascual-leone, paivio, and harrington

tion of the meaning of these experiences (e.g., “I needed love,

Move From Concrete to More Abstract Aspects of Emotional Experience