Working with emotions in ISTDP

What do we mean by "getting in touch with your feelings?" Davanloo gave us an operational definition that allows us to be certain about the answer to this question, as well as providing us with techniques to distinguish between feelings, the events that trigger feelings, anxiety and defense.

[@Bo-ce3dx]

Dr. Coughlin/Patricia. Just watched the video. Excellent! Thank you for doing these and for putting the concepts into concrete terms. Helps to integrate quicker into practice and help mobilize the patient. Looking forward to watching the others to follow.

[@gronkel4158]

Thank you Dr. Coughlin for sharing all your knowledge. For newly hatched clinical psychologists like myself these videos are very, very helpful. I watch one video a week and try to incorporate the theories and concepts into what is happening in the sessions throughout that week. You're an indispensable resource when trying to transfer the theories into practice! Thanks again!

[@patriciacoughlinphd1852]

So glad to know it's helpful 1

[@rokorok40]

thank you Dr. Patricia

[@danielleonstern2303]

Wonderful channel

[@user-nn3cz5tx1f]

This was so helpful. Thank you!

[@patriciacoughlinphd1852]

My pleasure.

[@rikkehvelplund1920]

👏👏thank u😊

[@annasokolova6923]

Thank you for this video. I have a common problem with my patients while I am trying to work with their emotions. They are describing some recent or not emotional episode, and I am asking for feelings and at some point they can say, I was angry (for example). But they don't look angry at here and now. I am asking them about that, they can say "I was angry then, but I don't feel that now". I am trying to help them to understand their block of affect through some defences (for example, maybe they don't feel safety with me to experience their feelings, and often I don't see some signs of anxiety here only if I am starting to press on them). Sometimes I am focusing them on that situation to remember all details to help them to get in touch with their feelings. But still it is hard sometimes to deal with this situation "I don't feel it now". So I would be very grateful if you could touch this question at some point. And anyway I am grateful for your channel :)

[@lildavey09]

Anna, my first thought is that there are Defenses preventing them from re-experiencing their emotions in the moment, with the therapist. Often in ISTDP this is referred to as a, “resistance against emotional closeness” (RAEC). They felt angry then but what did they do with their anger then? Depress it, walk away from it, discharge it by cussing, turn it against themself? Typically when we recall an affect-laden memory, the affect will also return, so if they “feel nothing now,” I suspect there are unconscious defenses inhibiting them from experiencing their emotions in the therapy, with the therapist...

[@patriciacoughlinphd1852]

Where did the feelings go? If the patient experienced and expressed the feelings in a healthy manner, they would not longer be present and no longer causing anxiety. Remember, we are only going to explore feelings that are anxiety laden. Remember to ask, "How do you feel toward him NOW, as you tell me about this incident." If you are asking how they felt in the past, they won't be feeling it now. Does that make sense?

[@annasokolova6923]

@@lildavey09 Thank you for your reply and suggestion. Probably yes, it could be RAEC, just sometimes I don't see signs of that kind of resistance (like avoiding my eyes and so on). But maybe I should look for more hidden signs :)

[@annasokolova6923]

@@patriciacoughlinphd1852 Thank you Patricia. It makes sense. And yes I am usually trying to ask about present feelings. But maybe sometimes I really am starting to explore feelings before I see some signs of anxiety. It is an important moment, thanks for reminder. I have a question in this regard. If a person experienced the feelings in the past but expressed them but in unhealthy manner (through yelling for example), will these feelings still be present when he is remembering that episode?

[@patriciacoughlinphd1852]

@@annasokolova6923 Don't worry about the past - it is gone. You are trying to help patients experience their feelings NOW. Again, only feelings that are anxiety laden and get triggered in symptom generating situations get our therapeutic attention. Since the patient DID NOT experience their feeling at the time, but went to anxiety or a defense like discharge and acting out, they can't retrieve it. You want to facilitate a new and corrective experience right now.

[@leoy8820]

Thank you Dr. Coughlin, "Wait for the emotion", that's an interesting idea, I never waited more than a few seconds, thought patients were drifting away, if I waited more than that. How long should we wait in general?

[@patriciacoughlinphd1852]

Not sure what you are referring to here. We wait for the impulse - until you see a sign in the body that impulse is mobilized- before proceeding to a portrait and breakthrough.

[@patriciacoughlinphd1852]

Press for feeling in the body until you see impulse mobilized, then of for "portrait".

[@patriciacoughlinphd1852]

If feelings are being avoided, then you need to do defense work to clear the path.

[@leoy8820]

@@patriciacoughlinphd1852 Thank you Dr. Coughlin. Yes, first we press for feelings, then patients goes back inside to feel the feelings. Sometimes they can report a feeling after a short while, sometimes, they lost in defense (thinking, dizziness, prejection). So how long should we wait to make the call? if she is feeling the feelings, or using the defense?

[@patriciacoughlinphd1852]

This is where your engagement and attunement come into play. There is no formula. In some instances, you'll see the patient drift and intervene immediately, but at other times you can see the wheels turning and know they are focusing internally. In that case, I don't want to interfere and pull them into an external focus. Hope that helps.

[@gmork9279]

Sounds a little like CBT basic's :)

[@patriciacoughlinphd1852]

While it may sound that way, in reality, it is quite different. In CBT patients are encouraged to talk about conscious emotions. In ISTDP we focus on the visceral experience of emotions, as well as the impulses they evoke, in order to get a breakthrough into the unconscious.