'Anger can be a very healthy emotion'

In a nutshell, what is Emotion-Focused Therapy?

It's an exploratory process which views the empathic relationship and, more specifically, empathic attunement to affect, as being most important. People experience painful emotions and these are seen as core underlying determinants of the difficulties they bring in to therapy. Within EFT, there are also particular interventions for specific emotional problem states. So it combines relationship, which focuses on 'following' and 'guiding' as a style of therapy, and works on particular kinds of problems like self-criticism, for example.

How is emotion defined within EFT?

Most fundamentally emotion is a survival action tendency. My most fundamental need is my need for survival, so somehow emotion is appraising 'is it safe for me?' Fear organises me to run away, anger organises me to thrust forward. It's also my primary meaning system, my emotional brain reads patterns and gives me a global feeling, not conceptually or in my awareness but through my body. So when I'm lecturing to a group, my emotional brain is reading whether they're responsive or not responsive. I don't think about it, but then I find myself feeling more calm or more tense in my body as a function of my brain reading the environment. So emotion is ultimately a very rapid action, an automatic appraisal of situations in relation to my needs.

Are all emotions equal? 

Among people in general outpatient therapies, we discovered that the three most commonly experienced painful feelings were fear, shame and sadness. Interestingly, anger wasn't in there. Many people would say anger is a core maladaptive emotion, but we often find that anger isn't at the core of people's suffering. The important thing in therapy is how to help change emotion. What is most novel about our approach is that we see that the best way to change emotion is with another emotion. Spinoza was the first person who stated that "the only way to change an emotion is with a stronger and opposing emotion". We find that healthy anger, healthy sadness and compassion, are the three most helpful adaptive emotions that help transform the painful emotions. Anger, for example, changes fear and anxiety. They're opposite kind of states. So when you're angry you're not anxious, but this doesn't mean destructive anger, blaming anger, rejecting anger – it's assertive, empowered anger where you have backbone.Then there's healthy sadness; the sadness of grief is different from the sadness of lonely abandonment. The sadness of lonely abandonment may be the sense that 'I feel all alone'. The sadness of grief is more like 'I'm grieving for what I wished I had but understand that I will not have'. It's about facing the loss. Provided people are non-defensively organised, grief evokes their own compassion toward themselves. Once people allow themselves to see their own sadness, it affects them just as though they're seeing someone else grieving. They feel compassion, caring, tenderness toward themselves.

What role does 'gut feeling' play in EFT?

We have a whole system of classifying emotions within EFT, and the most important are primary emotions. These are the very first feelings people feel in response to a stimulus situation – essentially 'gut feelings'. 'England is going to win!', may be a gut feeling, for example, or the feeling that 'you're rejecting me', or 'you're angry with me'. The thing is 'gut feeling' is a non-specific global term, a global apprehending of what's going on. People respond predominantly with gut feelings to situations – the initial emotional reaction – but they're often not aware of it, but everything builds from there.

Are these gut feelings always to be trusted?

In EFT primary feelings are broken down into adaptive and maladaptive. Primary adaptive feelings are defined as those that happen in the moment, they're new and fresh because they're responses to the situation, and they help you adapt and cope with the situation. Maladaptive feelings are like these 'old' feelings, they come from the past but they are activated in the present. They're like a good old friend whose bad for you. You've known this feeling for a long time in your life and you know that it gets you in trouble, that it's not good for you, and it doesn't help you cope with the present situation. Primary adaptive emotions are to be trusted and primary maladaptive – although they're very real and need to be validated – are not to be trusted as 'good' guides. Primary maladaptive emotions can lead people astray, or are not that helpful. Part of therapy is helping people to discriminate between these feelings.

Can you give an example of how EFT might help people to discriminate between feelings?

People know that their painful feelings are ones they want to move away from or that they're not helping them. They know their fear is dysfunctional especially when they've been traumatised. They know that their shame is not good for them. Because EFT is an exploratory process, as the therapist I'm not the expert, I'm not here saying 'I know what your primary emotion is'. We're exploring together to get to what's most fundamental, so we have to have this good, collaborative working relationship. I might offer some conjectures, but essentially I'm always guiding attention towards deeper feeling. Feelings are dynamic, so if you follow the feeling one leads to another. Often if someone expresses anger, for example, in their non-verbal mannerisms, in their facial expressions, there's also hurt. This is a very common sequence. I might also conjecture, 'I can hear you're really angry and I can imagine that was really hurtful'. So you shift people's attention toward subdominant emotions that are there but are not being explicitly focused on. And slowly it moves more and more toward the primary emotion. 

In today's world, with the prevalence of addiction to stimulants and antidepressants in their various forms, how can we learn to connect more fully with our emotions?

Drugs are obviously not helpful in connecting people with their emotions. When you have addictions, usually they're helping people to mask, or not feel, painful feelings like shame and anger. When you work to overcome the addiction, you have to work with the underlying feelings. Of course, having developed EFT I believe everything should be dealt with by addressing the underlying emotions! It's the avoidance of painful feelings that is problematic, and our culture is designed to help us not feel that pain. There's a whole cultural thing of 'don't cry' and 'don't be sad', which is a major block. So there are opportunities both at a societal and educational level to make emotion more acceptable, but views have to change and people have to first understand emotion. There's definitely a change going on in society (meditation, for example, has become very popular), but the process of cultivating awareness and developing emotion-friendly attitudes takes a sustained effort. We need emotion education in schools and in families. Parents have to be educated in some way to be good emotion coaches to their children, and this means becoming more aware and accepting of their own emotions. 

Do you think British culture plays a role in how we connect, or otherwise, with our emotions?

I often get asked the question when I'm running workshops in the UK: "do you think people in Britain are more avoidant?" Stiff upper lip and all of that. The stereotype in Britain is that people are more emotion-containing than in other cultures and more conservative, but of course it's not unique to Britain. I think there are cultural and political factors which also have an influence. Because Britain was bombed [during WWII] people had to survive, and they had to put their feelings aside to do that. But now it's no longer an adaptive way of living, to put things aside and simply have a stiff upper lip. 

What empirical support is there for EFT?

There have been a number of studies which demonstrate the effectiveness of EFT with complex trauma, anxiety, depression and eating disorders. Not anything like the quantity of research on Cognitive Behaviour Therapy (CBT), but it's there. In a comparative trial with CBT, EFT was found to be equally effective in reducing symptoms and more effective in improving interpersonal problems. We've also done a lot of research on the mechanisms of change – the change process. Not just 'is it effective?' but also 'what is effective?' We use a method called 'task analysis' where you take people working on a particular problem and describe intensively what it is they're doing, and you find ways of measuring that. Science is based on observation, measurement, explanation and then prediction. Psychology rushed to prediction before it ever truly did observation, measurement and explanation. But if you don't have reasonable measures and don't really observe your phenomena, we're walking before we can crawl. So we need to go back to the real observation of phenomena. In psychotherapy, that means observing what really happens in therapy and what the actual processes of change are. We need to go much more to fundamentals rather than give a treatment to people and see what the outcome is on some paper and pencil test – which isn't really an adequate measure. 

What first inspired you to develop EFT?

I was initially an engineer, solving maths problems. Because I often solved problems without knowing how I was solving them I came to believe that I had a 'gut feeling', and that fascinated me. I knew more than I could say, I was always interested in Michael Polanyi, who wrote books about personal knowledge, this notion that 'I know more than I can say'. I know how to ride a bicycle and turn a corner, without knowing the formula for the inclination and the speed at which it goes, but I could just do it. I came to understand that my emotions were guiding me much more than rationality. At the same time I was in psychotherapy training, which involved a lot of personal work. I trained as a person-centred therapist, a Gestalt therapist, a systemic therapist, and was picking up all kinds of learning, using it to help people gain more access to their emotions and deal with them in constructive ways. When I entered psychology in 1970, there were very few books on emotion, but as I started to do research I saw that emotion seemed to be central in people who were really changing. It seemed to be essential that people experienced what they were talking about, not just talk about it. For example, empathy which evoked emotion was more effective than empathy that didn't. So, slowly that became an entry point into starting to develop a theoretical statement about emotion.

What is something others may not know about you, that would surprise them if they knew? 

People might be surprised that I was a rugby player. That I have a Masters degree in engineering before I entered psychology, and that I was drafted in the South African army for a year, in the first year that there was a draft.

And an idea you hold to be true that you have that others might find controversial?

The belief that emotion produces cognition, much more than the other way around; that cognition works in the service of affective goals and that really emotion is much more fundamental than cognition in determining how we live our lives. The majority of the world lives by their heads, by their concepts, they believe rationality is central to living. I'm saying I believe that emotion is fundamental – emotion is the master and cognition is the servant.

I think another controversial idea is that anger can be adaptive and healthy. Many people think that anger is always dysfunctional, that it's maladaptive, but – handled well – anger can be a very healthy emotion. People often find that difficult to comprehend.

What guidance would you give to people who struggle to connect with their emotions? 

People all over the world are avoidant of pain, for fear that if they feel it they will not be able to cope. Cultures deal with emotion in different ways. In the West people use rationality to avoid pain. In the East they use meditation to distance from the emotion, to observe it. So everyone is struggling with protecting themselves from painful feelings, but you have to face your pain in order to learn and to revitalise. Emotions come out in relationships. Connecting with emotions is a complex task but I think the work is to first find a safe relationship in which you feel you can talk about your emotions. To find an empathic listener. To begin to deliberately pay attention to that place inside where we feel things, and to ask, 'what am I feeling in my body right now?' It's hard to do it on your own, because as soon as you start to feel something it's easier to go up into the conceptual process of explaining it, figuring out why, or how to handle it, rather than staying attentive and open to the emotions.

We often have to make complex social decisions in our lives. But if we don't pay attention to our emotions and we try to make these decisions without it, we're missing a crucial piece. For example, I can be angry at my wife, husband or partner, but if I don't know that I'm angry and say 'oh everything is fine', we just build bricks in a wall that make us more or more distant. People who deny that feeling and try to block it out become resigned and depressed and helpless and they don't know why. On the other hand, if you pay attention to the feelings and you just say 'damn the rest', you're also going to end up in trouble. I've got to figure out how to deal with what I'm angry or sad or ashamed about. Emotion informs you but you still have to process it further. Emotions are the first step in problem solving… they define what the problem is. 

- Read more of Kal's interviews with key figures in therapy.