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Emotional Changes During Therapy: What to Expect

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Lots of people turn to therapy when they’re feeling down. “I am anxious about everything.” “I’m sad all the time.” “I’m constantly angry and bite everyone’s head off.”

Cognitive Behavioral Therapy (CBT)

CBT, short for cognitive behavioral therapy, is a go-to method for help. Aaron Beck came up with it and first told the world about it in 1964 with his book, “Cognitive Therapy: Basics and Beyond.” CBT hones in on the wonky thoughts and mistakes in our thinking that stir up trouble in our lives. 

Beck pointed out that what we believe about ourselves, others, and the world starts shaping up when we’re pretty young. Sometimes these beliefs are off-track and not so helpful. Therapy zeroes in on these current, messed-up beliefs and thoughts that have turned into sticky patterns in our brains. 

Feelings don’t get the spotlight in CBT. They only come up when they’re tied to thoughts and actions that bring up emotions people don’t want. The therapist works with the person to change their actions by looking at their thoughts and beliefs, not digging into why they feel a certain way.

Emotion-Focused Cognitive Behavioral Therapy (ECBT) 

A branch of CBT is emotion-focused CBT, cooked up by Mick Power and shared in his 2010 book “Emotion Focused Cognitive Therapy.” It picked up on what regular CBT missed—the emotional bit. ECBT’s all about getting a handle on feelings to shape up behavior.

In ECBT, emotions get a bit of the stage. They’re spotted and figured out in simple ways. Someone learns to control their feelings to smooth out their actions. Here too, the therapist guides the person to tweak how they deal with emotions.

Beck thought that screwy thoughts sparked off-track emotions and actions. But it’s like asking what came first, the chicken or the egg. Which starts the trouble—wonky thoughts or rough emotions? And what should a therapist help with first—mindset and actions or the emotional stuff?

Interactive Talk Therapy 

Dr. Homer B. Martin and I looked at nearly 4,000 patients of all ages in dynamic talk therapy across eighty years. We found that feelings pop up first in kids, before they even start to figure out what those feelings mean.

This therapy is not like CBT. It digs deep into feelings, believing they’re what kick-start off-kilter thoughts and actions. The aim is to really get into where feelings come from. Then, a person starts to work on their inner world, seeing how emotions get mixed up with wonky thoughts and actions that don’t quite work out. The big win is to understand your feelings deep down, not just to get your head around stuff or pick up new ways to act.

In psychodynamic therapy, feelings are a big deal and they’re treated differently than in CBT or ECBT. Feelings are what this therapy is all about. They’re talked about and poked at from every angle. Therapists get patients to really dig into their emotions, asking about the times they feel nervous, down, mad, low, or even over the moon.

A big chunk of time in this therapy is spent chatting about how you’re feeling right then and there. Plus, you get to understand where all those feelings started, way back when you were just a kid. What used to make you mad or tearful back in the day? How did you let out your emotions when you were little?

The whole point of diving deep into your emotions is to get a clearer picture of who you are. From there, you can figure out if there’s anything about yourself you’d like to change.

CBT vs. Interactive Talk Therapy: Which Lasts Longer? 

Back in 2010, Jonathan Shedler did a study to see which works better: CBT or dynamic talk therapy, like what you find in meta-analyses. Turns out, both are pretty good. But, he noticed that the benefits from dynamic therapy stick around longer after sessions end than with CBT. With talk therapy, people keep getting better even after therapy’s done. It seems understanding your emotional ins and outs really helps you handle future ups and downs. On the other hand, the boost from CBT tends to fade faster.

Now, each therapy handles feelings differently. If you’re looking to just get your actions in line without diving deep into emotions, CBT might be your thing. If you’re into tracking your moods and learning to juggle those emotions with some new actions, ECBT could lend a hand. But if you’re up for a deep dive into your emotions, picking them apart to see how they tick now and how they ticked in your childhood, psychodynamic therapy could be a real eye-opener. 

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