Clinical Applications of an Interpersonal View of the Emotions

A PATIENT, A 42-YEAR-OLD PROFESSIONAL woman, moves rapidly onto the couch for her session. With an agitated tone and at a rapid pace, she describes being "upset" after the last session. She felt the analyst was being too rational, implying that she ought to accept her mother's recent death, and her analyst's impending vacation. She felt that by discussing her intensely emotional responses to these occurrences as difficulties with separation, the analyst implied that she should develop equanimity toward these life events. Since what she felt was anything but equanimity, she wondered whether she could ever improve in treatment. Perhaps she is too sick to be helped.

The analyst's theory about the role of emotions in health, in pathology, and in the treatment process is, I believe, a crucial determinant in how this clinical moment is experienced and responded to. What, for example, makes an emotional response "healthy"? Is it that the emotion expressed seems appropriate to the occasion, or that its intensity feels "right, " or that the affect facially expressed matches the affect implied by the words? However formulated or unformulated they may be, the analyst's beliefs about healthy and appropriate emotionality will influence which aspects of the patient's communication become the analytic focus of attention.

Beliefs about what constitutes "healthy" emotional responses directly shape the analyst's definition of therapeutic goals. Many analysts responding to this vignette would view as part of the therapeutic task the clarification of the patient's description of being "upset." Does she really mean she is angry with the analyst? Or is she more disappointed than angry? Is she depressed at not feeling understood or accepted? Is anger at what she felt was the analyst's unempathic stance being turned inward, into a depressed sense of