As Marv Goldfried has written for decades, there are a number of principles of change that appear to be consensually agreed upon by therapists of divergent orientations. Among them are the importance of the therapeutic alliance; fostering patients’ motivation and expectation that therapy will help them; increasing patients’ awareness of factors impacting their struggles; engaging in reality testing; and promoting patients’ corrective experiences. In this post, I will focus on the last of these: corrective experiences.
One important type of corrective experience involves helping patients bypass their defenses so that they can experience and express what Leslie Greenberg terms primary adaptive emotions or what Diana Fosha terms “core affect.” Not only are such emotions (in contrast to secondary emotions, which are defenses against other emotions or intolerable thoughts) essential to the construction of a vital self-system and our sense of reality, emotional processing is central to decision-making and meaning-making processes, as well as integral to optimal functioning and adaptation to changing contexts.
When patients are able to experience such emotions in the presence of a safety-inducing, empathically attuned therapist, they usually realize that the emotions themselves are not “the problem.” Rather, their estranged relationship to those emotions is more fundamentally problematic. And for many, if not most, patients, their relationship to their emotions is one of avoidance. When they learned this emotional avoidance as children, it was adaptive; however, in their current adult lives, such emotional avoidance almost always maintains their maladaptive patterns. Although it is important to point out that it is not just “corrective emotional experiences,” (CEE) but also corrective cognitive and behavioral experiences that are therapeutic (Goldfried, 2018), this post will focus on the former.
As the triangle of conflict (a key construct in all experiential psychodynamic therapies) illustrates, threatening emotions (patients learned they were threatening when they were punished as children for expressing them or when the children realized that their caregivers could not tolerate their emotions) trigger unconscious anxiety, which then triggers defenses to ward off the emotion(s) and anxiety. This defensive avoidance is powerfully negatively reinforcing. Thus, the defenses that were adaptive in childhood (because they preserved the needed bond with their early attachment figure(s)) become entrenched because they are so effective at reducing or eliminating the aversive experience of intolerable emotions and anxiety. Thus, facilitating patients’ bypassing their defenses to get to their core affect is a powerful corrective emotional experience, one which has garnered considerable consensus among most psychotherapeutic paradigms. As psychiatrist and cognitive/affective neuroscientists Nadel and Lane wrote:
The essential ingredients of enduring change…consist of (a) activating the old problematic memories and their associated emotions; (b) having corrective emotional experiences that allow the old memories to be altered through reconsolidation; and (c) converting these updated episodic experiences into enduring semantic structures by practicing new ways of behaving and experiencing oneself and others in interaction with the world. (2020, p. 5)
As the quote states, corrective emotional, behavioral, and cognitive (new ways of experiencing oneself) experiences are required for the process of memory reconsolidation to occur. “The CEE is a key process in psychotherapy in which the patient’s expectations (i.e., of the therapist’s response) are contradicted by what actually happens. This is precisely the ‘prediction error’ that triggers the mechanism of memory reconsolidation, providing a likely explanation for how the CEE actually works.” (Richard Lane, personal communication, April 19, 2020)
What are your thoughts on the centrality of corrective emotional experiences in psychotherapy?
—Andre Marquis, Ph.D.
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Goldfried, M. (2018). Obtaining consensus in psychotherapy: What holds us back? American Psychologist, 74(4), 484-496.
Nadel, L. & Lane, R. D. (2020). Neuroscience of enduring change and psychotherapy: An introduction. In R. D. Lane & L. Nadel (Eds.) Neuroscience of enduring change: Implications for psychotherapy. Oxford University Press.