Like many cognitively-orientated therapists who have observed the power of charged emotional work, I've struggled to integrate these approaches in ways that are evidence-based and intellectually rigorous.  As they used to say in the early groups I was involved with in the 1970's - "Lose your head and come to your senses."  I agree but would balance this remark with the delightful "It's important to keep an open mind, but not so open that your brains fall out."  There's so much that I could write about this integrative journey.  Today I want to introduce a model - "The triangle of emotions" - that I find very helpful in orientating much of the work I do in this area.  I was triggered into evolving this approach by a couple of research papers.  One was the 2003 meta-analysis by Leichsenring & Leibing comparing the effectiveness of psychodynamic and cognitive behavioural treatments for personality disorders.  I was startled that psychodynamic approaches seemed somewhat more effective for these problems.  The 2004 paper by Svartberg & colleagues hammered this point home with a similar finding in a head-to-head trial of short-term psychodynamic psychotherapy and cognitive therapy for cluster C personality disorders.  I decided to look at the therapy this latter group had been using in more detail, and this led me to Leigh McCullough's books "Changing character" and "Treating affect phobia".  I've put together four slides that highlight the main points of this "Triangel of emotions" model - they're downloadable from about half way down the list on the "Emotions, feelings & personality" handouts page.

The first slide looks at "Basic needs".  To flourish and grow healthily, human beings (and many other animals) have basic psychological needs that demand to be met.  For example children have needs for security, stability, feeling valued & loved, feeling encouraged & trusted to build independence.  Most of these needs continue into adulthood.  The drive to satisfy them emerges as primary emotions that push us towards psychological health, like hunger or thirst push towards satisfying basic physical needs and physical health.  Just as we may sometimes be hungry or thirsty for food or drink that in fact isn't good for us, so emotions don't always push us in healthy directions.  It's important to be perceptive about when emotions are healthy drives and when they are in danger of pushing us in distorted or unhelpful ways.    

It's good to contact and 'listen to' adaptive primary emotions that push to satisfy basic psychological needs.  Unfortunately for nearly everyone, as we grow up, we don't always experience ideal responses to our needs.  Our parents, brothers & sisters, schooling, and other important early influences may well not be respectful and encouraging of these drives to satisfy our healthy needs.  We pretty inevitably then try to make sense of why our needs aren't being met.  At this stage we're still only children.  We have very limited information about the world, and we expect that adults will know more and better than we do.  If we run into conflict or other dissatisfying interactions with adults (parents, school, and so on), chances are we will assume that we're the ones - not the adults - who are at fault.  It must be because we are unloveable, untrustworthy, not good enough that causes us to be treated in this way.  These toxic feelings and beliefs then typically lead to understandable but often eventually problematic forms of behaviour.  And the toxic feelings and beliefs about ourselves, about others, and about the world are likely to stay with us into adulthood.

Slides 3 & 4 go on to look at how inadequately met Needs and unhelpful Beliefs tend to lead on to Maladaptive Behaviours, and how this triangle of frustrated needs, dysfunctional beliefs, and outdated behaviours probably made sense and may even have served them well, when the pattern developed in childhood/adolescence (e.g. in relation to "past people", slide 4), but that the triangle may well not be serving them well now (in relation to "current people" in their lives, and possibly with "therapist or group" too - providing learning opportunities in-session).  I tend to encourage work at all corners of the triangle - clarifying healthy needs, challenging dysfunctional beliefs, and exploring more functional behaviours.  

This model informed the work I did in the group.  Of course, like pretty much everyone else, I want to be cared about and valued.  I was by my parents, but at boarding school from age 8 I was repeatedly brainwashed into a culture where "winning", "coming top of the class" and "competing" seemed all important for accolades and being valued.  I was good at it.  Heady stuff, doing well at school.  I do think though that it led me to feel that, in order to be accepted, I had to be a success and achieve a great deal.  Of course there's some truth in this, but it can get very out of balance too.  I think this urge to "earn" acceptance and appreciation can be part of the shadow side of being a therapist, helper, expert, and generally "good person" ... that part of me feels that's the key way to get bouquets and appreciation (I also feel another, more central, part of me wants to do the work I do because it feels deeply right and worthwhile).  What I did in the group was get to a place where I asked to be valued and cared for just "as me" without a load of achievement medals.  Simple stuff.  Helpful stuff!

And see too tomorrow's post on "The broadening, evidence-based relevance of emotional processing".