Using alba emoting to work with emotions in psychotherapy

Clinical Psychology and PsychotherapyClin. Psychol. Psychother. (2011)Published online in Wiley Online Library ( DOI: 10.1002/cpp.790 Practitioner ReportUsing Alba Emoting™ to work with emotions inpsychotherapy Juan Pablo Kalawski*Counseling Center, University of Louisville, Louisville, KY, USA Alba Emoting™ is a physical method to help recognize, induce, express and regulate the basic emotions.
This is achieved through specific breathing, postural and facial behaviours. Alba Emoting is based on psy-chophysiological research by Susana Bloch and her collaborators, who have applied this method mainly totrain actors. Alba Emoting can be used in psychotherapy to facilitate emotion awareness, regulation andtransformation. It can also help therapists better recognize their own and their clients' emotions. Theapplication of Alba Emoting in psychotherapy is illustrated with a case example. Copyright 2011 JohnWiley & Sons, Ltd.
Key Practitioner Message:• Alba Emoting is a physical, scientific method for working with emotions.
• Alba Emoting can help therapists better recognize their own and their clients' emotions.
• Alba Emoting can help clients achieve better emotional awareness and regulation.
• Alba Emoting can also help clients experience and express emotions they may normally inhibit.
Keywords: Alba Emoting, Emotions, Psychotherapy, Breathing, Basic Emotions, Body In the minds of laypeople, emotions are central to the work been in theatre. Even when Alba Emoting is used in a con- of psychologists. Yet for decades, psychological theories text other than psychotherapy, it often has therapeutic viewed emotions as third-class phenomena, after behaviour effects. The next two sections of this paper summarize and cognition. In recent years, psychological science has the Alba Emoting method. The following section will finally began to acknowledge that emotions are not just review the rationale for the application of Alba Emoting epiphenomena but rather serve important functions in in psychotherapy. Finally, I will present a case example.
organizing thoughts and behaviour. Understandably, theo-ries of psychotherapy have lagged behind in integratingthe science of emotions into clinical practice. Lacking a the-oretical understanding of emotions and specific methods to work with them, therapists fall back on what they know,that is, working with behaviours and thoughts and hoping In the early 1970s, Susana Bloch and Guy Santibáñez that emotions follow suit. Slowly, however, theorists like started a research program to study the physiological Leslie Greenberg and his colleagues (e.g., Greenberg, 2004; changes occurring during different emotions (Bloch & Greenberg & Paivio, 1997; Greenberg, Rice, & Elliott, 1993) Santibáñez-H, 1973; Santibáñez-H & Bloch, 1986). They have begun to present coherent approaches to working asked professional actors to relive different emotions. They with emotions in psychotherapy. The aim of the present also hypnotically induced those emotions in participants report is to present the applications in psychotherapy of a with anxiety disorders and participants with no psycho- specific method for working with emotions. The method is pathology. In these experiments, Bloch and Santibáñez were interested in six emotions that they considered basic: joy, Alba Emoting is not a method of psychotherapy. It is sadness, fear, anger, eroticism and tenderness. Bloch and rather a method for working with emotions that can be Santibáñez (1973; Santibáñez-H & Bloch, 1986) found that applied to psychotherapy as well as to other fields. The several physiological changes accompanied each of these most developed application of Alba Emoting so far has emotions. Of those changes, the most distinguishing featureamong the different emotions was a specific breathingpattern. These studies conducted in Chile are unique in threeways: first, Bloch and Santibáñez (1973; Santibáñez-H & *Correspondence to: Juan Pablo Kalawski, Counseling Center, Uni-versity of Louisville, Louisville, KY, USA.
Bloch, 1986) measured actual breathing behaviour while participants were experiencing real emotions, as opposed to Copyright 2011 John Wiley & Sons, Ltd.
Figure 1. Recordings of prototypical breathing patterns for each basic emotion. From 'Reproducing emotion-specific effector pat-terns: A bottom-up method for inducing emotions (ALBA EmotingW)', by S. Bloch, S. Paulet, and M. Lemeignan, 1994, Proceedingsof the 8th Conference of the International Society for Research on Emotions (N. H. Frijda, ed.), pp. 194-199.
asking people to remember how they breathe during emo- recordings obtained from subjects experiencing the six basic tional episodes. Second, they studied discrete emotional epi- emotions (Bloch, Paulet, & Lemeignan, 1994).
sodes as opposed to emotional disorders or emotional traits.
Other changes that were somewhat distinguishing of par- Third, they reported the form of the breathing cycle- ticular emotions were facial expressions and body postures involving parameters such as amplitude, frequency, the (Bloch & Santibáñez-H, 1973; Bloch et al., 1994; Ekman & presence or absence of saccades1 and expiratory pause- Oster, 1979; Hatfield, Cacioppo, & Rapson, 1994; Lemeignan, and not just isolated variables or breathing output such as Aguilera-Torres, & Bloch, 1992; Levenson, Ekman, & Friesen, oxygen consumption.2 A later study with Danish partici- 1990; Santibáñez-H & Bloch, 1986). All these behaviours have pants (Bloch, Lemeignan, & Aguilera-Torres, 1991) showed the special feature of being under both voluntary and auto- that the distinction among breathing patterns for the differ- matic control (unlike other changes present during different ent emotions could be shown not only qualitatively but emotions such as heart rate and blood pressure).
quantitatively as well. Figure 1, taken from a summary Bloch and Santibáñez (1973; Santibáñez-H & Bloch, 1986) presented at a conference, shows actual pneumographic investigated what happened if they asked a person to repro-duce the respiratory-posturo-facial patterns for eachemotion without naming the emotion. They found that this 1'Saccade' usually refers to small, rapid, intermittent eye movements.
procedure could activate the rest of the emotional system, Here, the term refers to small breathing movements superimposed on namely the subjective experience of the person and auto- nomic changes such as heart rate. Several studies have It is unfortunate that no other researchers have studied the relation- ship between emotions and breathing in this same way, but it is never reported this phenomenon under different circumstances too late to conduct similar studies.
(Bloch, Orthous, & Santibáñez, 1987; Bloch et al., 1994; Bloch Copyright 2011 John Wiley & Sons, Ltd.
& Santibáñez-H, 1973; Ekman, Levenson, & Friesen, 1983; experience. Most of the time, participants report feeling the Levenson & Ekman, 2002; Levenson, Ekman, & Friesen, target emotion. Sometimes, however, participants may 1990; Riskind, 1983; Santibáñez-H & Bloch, 1986). On the report no emotion, a different emotion or a combination of basis of these findings, Bloch et al. (1987) developed a the target emotion and another emotion. There is a corre- method for emotional induction based on the reproduction lation between the correctness of the pattern and the likeli- of the respiratory-postural-facial emotional patterns. Bloch hood of feeling the target emotion (Bloch et al., 1994).
(2006) called this method 'Alba Emoting ™'. The method also The last day in an introductory workshop is devoted to includes a 'step-out' technique. This technique, also based on reviewing all the patterns and working on the partici- specific breathing, posture and facial actions, is designed to pants' ability to modulate their intensity, switch from stop the emotional activation and bring the person back to one emotion to another or switch from any pattern to the an emotionally neutral state. Alba Emoting is thus a physical neutral state. This is often done in games. For example, method to help recognize, induce, express and regulate the participants may be asked to perform the same action basic emotions. Bloch and her colleagues have used it in while doing different emotion patterns. One interesting several countries as a tool for teaching actors how to express exercise is saying a phrase while in one emotion and then emotions (Bloch, 1993, 2006; Bloch et al., 1987).
again with a different emotion. Both the performer andthe rest of the participants get to see how the same phrasecan have different meanings under different emotions.
As previously stated, more advanced training in Alba Emoting is usually tailored to the needs of the trainee. In Bloch et al. (1987; Bloch, 2007) have developed a way to the case of actors, the main goal is for them to perform the train people in the Alba Emoting method. Most of those patterns with enough accuracy and speed to convincingly who have participated in this training are actors. Other portray emotions on stage. For other participants, it may performers, like dancers and musicians, have also partici- be more important to be able to identify emotions both in pated in Alba Emoting training, as well as psychologists, themselves and in others. Alba Emoting training in a work- business people and laypeople interested in emotions.
shop format can have therapeutic effects. In addition, Alba The basics of the training are the same for all these groups, Emoting can be incorporated into standard forms of psycho- whereas more advanced training varies according to the therapy. In the next section, I provide a theoretical frame- trainees' needs. The first step in training is an introductory work for the therapeutic usefulness of Alba Emoting.
workshop. Such workshops normally last 5 days, more orless. The goal of these workshops is to introduce partici-pants to the respiratory-posturo-facial patterns of the sixemotions, the neutral pattern and the step-out technique.
After an introductory workshop, participants are not yet One of the more recent areas of application of Alba Emot- qualified to teach the emotional patterns to others, only ing is psychotherapy. I pioneered the exploration of this to use them on themselves. The only technique partici- application in my unpublished thesis (Kalawski, 1997).
pants can safely teach others is the step-out technique.
In this article, I would like to first present a conceptual The correct reproduction of the respiratory-postural- framework for the application of Alba Emoting in psycho- facial patterns can be physically challenging. For this therapy, and then discuss a clinical case.
reason, most of time in an introductory workshop is Greenberg (2004) proposed three principles for working devoted to preparatory physical exercises. Some of these with emotions in psychotherapy. The principles are (1) exercises are intended to improve the participants' ability increasing awareness of emotion; (2) enhancing emotion to bring different muscle groups under voluntary control.
regulation; and (3) transforming emotion. Alba Emoting Although Alba Emoting relies on voluntary muscles, can serve in the implementation of each of these principles.
many people have difficulty isolating specific musclegroups, or adjusting their muscle tone at will. Anothergoal of the preparatory exercises is to improve voluntary control of breathing, including breathing rhythm andabdominal versus thoracic breathing. Interspersed among The importance of emotional awareness for therapeutic the preparatory exercises there is specific training on the change is widely acknowledged. Some clients can easily respiratory-posturo-facial pattern for each emotion. Each identify their feelings, whereas others have great diffi- pattern is always taught without first naming the emotion culty. Often, clients may only be able to identify being it corresponds to. This way, participants are encouraged to 'upset' or 'stressed' without further elaboration. A finer report any feelings they may have, and not 'try' to feel distinction among emotions may help clients better anything in particular. After working on each emotional identify their associated needs and action tendencies. For pattern, participants are encouraged to discuss their example, the impulses associated with anger are not the Copyright 2011 John Wiley & Sons, Ltd.
same as those associated with fear. Alba Emoting provides of the step-out technique, by contrast, is to achieve a relaxed a clear and physical way to distinguish among different yet alert state. In the step-out technique, the person is stand- emotions. When a client has experienced the respiratory- ing up and with his or her eyes open. The goal is to be aware postural-facial patterns of the basic emotions, he or she of one's environment, as opposed to looking inward.
is subsequently better able to recognize when those pat- Many psychotherapists teach their clients different types of relaxation techniques. However, in my experience in An additional advantage of Alba Emoting in promoting several settings in Chile and USA, I have found that the emotional awareness derives from the fact that the vast majority of these therapists have no specific training method provides a way to experience emotions without in these techniques. They usually read a script to the client an external stimulus. Often, people hold beliefs about or, more commonly, give the scripts to clients for them to when it makes sense to experience particular emotions.
practice at home. Clients may still benefit from this type For example, a client may be angry in a situation but have of 'relaxation training'. However, it presents several prob- difficulty recognizing it because anger is not the emotion lems. First, the therapist reading the script may not be she would expect to have in that situation. Alba Emoting relaxed. Second, having practiced a technique personally provides clients the opportunity to experience emotions helps one anticipate possible difficulties a client may have.
as distinct from their purported causes. This helps client Finally, it is harder for a client to trust a therapist who practice the distinction between direct experience and does not practice what he or she teaches. Alba Emoting training is one of several ways for therapists to obtain As Greenberg (2004, p. 8) pointed out, 'emotional aware- hands-on practice in relaxation and emotional regulation.
ness is not thinking about feeling, it involves feeling the In addition to the step-out technique, a typical Alba Emot- feeling in awareness'. Thus, emotional awareness necessi- ing workshop includes standard techniques such as tates actual emotional experience. This process, however, abdominal breathing or progressive muscle relaxation to can be blocked by emotional avoidance. Often, clients avoid help participants improve control of their breathing and experiencing painful feelings due to fears of being over- muscle tone. Such control is necessary to correctly execute whelmed by them, of being out of control or of not being the respiratory-postural-facial patterns.
able to calm down afterwards. Alba Emoting can be a When discussing emotional regulation, it is important to valuable resource in helping clients deal with these concerns.
distinguish it from repression or inhibition. Often, clients Alba Emoting is empowering, as it provides clients with a may suppress their emotions with body tension. This may tool to step in and out of an emotion at will. The usefulness not only lead to health problems; it also interferes with emo- of the step-out technique as a means for emotional regula- tional awareness. My training in Alba Emoting has helped tion will be discussed in the next section. The emotional me be more aware of when clients are suppressing their feel- induction (the 'step in' part) via the respiratory-postural- ings. For example, knowing that breathing is an important facial patterns may help clients experience emotions as more element in emotion, I have noticed that many clients literally familiar. Willingly entering into an emotion through breath- hold their breaths when discussing painful topics. I have ing can help clients own their emotions and experience them even seen clients pinch their noses to avoid crying. I have as something that they do as opposed to something also noticed that people sometimes unconsciously try to con- trol their emotions by doing the opposite of the emotion'smovement pattern. For instance, in sadness, the gaze isprototypically down. I have seen people looking up to try to stop themselves from crying. In contrast to these examplesof emotional suppression, the step-out technique does not Even though emotional experience is both an adaptive involve 'choking' an emotion. It does actually calm it down.
human response and a necessary element in deep thera- Often, emotions are responses to events one must deal with.
peutic change, emotions can sometimes be maladaptive. Al- Obviously, the step-out technique does not solve or eliminate though it is difficult to work therapeutically with clients who these events. But often, emotions perpetuate themselves via are emotionally constricted, it is also difficult to work with a cognition-emotion loops in a way relatively independent client while he or she is experiencing intense, overwhelming from external events (Lewis, 2005; Lewis & Granic, 1999).
emotions. In this respect, the Yerkes-Dodson Law may also The step-out technique helps break this cycle, allowing one apply to psychotherapy in that there is an optimal level of emotional arousal that is most conductive to therapeuticchange. The step-out technique can be an important tool tohelp clients regulate their emotions. It is in a way similar to deep breathing techniques usually taught to clients. Themain difference is probably that sometimes deep breathing The cognitive-behavioural therapies have popularized the is used as a part of a deep relaxation routine. The objective concept of coping to the extent that many of my clients ask Copyright 2011 John Wiley & Sons, Ltd.
for help 'coping' with depression or anxiety. I often say I warrant it and even though they may wish they could feel can help with that and suggest we may also try to help angry or sad. Some clients have great difficulty feeling the client not be depressed or anxious. The difference be- sexually aroused. Many of these clients may even have a tween coping with anxiety and not being anxious is the good deal of insight into the origin of these blockages difference between emotion regulation and emotion trans- but are still unable to overcome them. Traditional tech- formation. This is how Greenberg (2004) explained the niques for accessing emotions such as empty chair work or imagery are often not effective in these cases. AlbaEmoting provides a unique way for clients to access these Although the more traditional ways of transforming emo- emotions through the reproduction of their specific tion either through their experience, expression and com- respiratory-postural-facial patterns.
pletion or through reflection on them to gain newunderstanding do occur, we have found another processto be more important. This is a process of changing emo-tion with emotion. This novel principle suggests that a Alba Emoting and the Therapeutic Relationship maladaptive emotional state can be transformed best byundoing it with another more adaptive emotion. In time The three principles of emotion awareness, regulation and the coactivation of the more adaptive emotion along with transformation are effective to the extent that they occur or in response to the maladaptive emotion helps transform within a good therapeutic relationship. Rogers (1957) pro- posed that in such a relationship, the therapist experiences Schemes of different emotional states (.) are synthe- and expresses empathy, genuineness and warmth. It sized to form new integrations. Thus in therapy maladap- should be clear by now that training in Alba Emoting tive fear, once aroused, can be transformed into security can only aid in the development of empathic attunement, by the more boundary-establishing emotions of adaptive as it helps the therapist better recognize the non-verbal anger or disgust, or by evoking the softer feelings of com- signs of the basic emotions. In addition, the basic emo- passion or forgiveness. Similarly maladaptive anger can tions framework (e.g., Bloch, 2006; Izard, 2007; Kalawski, be undone by adaptive sadness resulting in acceptance.
2010) helps therapists conceptualize the endless variety Maladaptive shame can be transformed into acceptance of affective phenomena as arising from a few basic emo- by accessing both anger at violation, self-comforting com- tions. Greenberg and Paivio (1997) proposed that it is use- passion and by accessing pride and self-worth. (.) ful for therapists to distinguish between basic emotions Withdrawal emotions from one side of the brain are trans- and the more complex emotion schemes derived from formed by approach emotions from another part of the brain or vice versa (Davidson, 2000). (p. 12) These [basic] emotions are attended to and expressed in Greenberg (2004) described several ways for therapists therapy in order to access the adaptive information and to facilitate this process. One of these is shifting the client's action tendency to guide problem solving. They are core and irreducible responses and therefore are not exploredto unpack their cognitive-affective components. For Shifting people's focus of attention to pay attention to a example, anger at maltreatment is a primary, irreducible, background or subdominant feeling is a key method of and core emotional response that needs to be evoked and helping them change their states. The subdominant emo- symbolized in therapy in order to access the adaptive tion is often present in the room non-verbally in tone of action tendency to push the offender away and establish voice or manner of expression (p. 12).
For example, some clients may have experienced debili- Alba Emoting can also help develop therapists' genuine- tating or paralyzing fear in a traumatic situation. When ness as it helps them become better aware of their own emo- the client recalls this situation in the session, the empathic tions. Finally, I see Rogers' condition of warmth as closely therapist may notice that, in addition to fear, the client related, if not identical to, tenderness. Alba Emoting should experienced other emotions too. Helping the client pay not (and probably cannot) be used to artificially manufacture attention to the subdominant feeling helps transform the tenderness. Rather, knowing the respiratory-postural-facial dominant emotion. A therapist with training in Alba pattern of tenderness may help therapists notice when they Emoting may be better able to recognize non-verbal signs are not experiencing or expressing that emotion. The tender- ness pattern may then help therapists access tenderness in Some clients have great difficulty experiencing particular themselves. However, I believe that this should only be done emotions in almost any context. For example, some clients when the therapist already believes that the client deserves to never get angry or sad, even when the situation may be regarded with tenderness. If this belief is not present, it is Copyright 2011 John Wiley & Sons, Ltd.
probably better to begin by exploring the thoughts and feel- would ask him about what he felt 'right now', he would ings the therapist does have about the client.
say he felt fine, in spite of his clear display of anxiety. Robert Finally, I want to make clear that training in Alba Emot- understood that he had difficulty being in touch with his feel- ing is not sufficient to develop a positive therapeutic rela- ings, so we agreed to work on helping him increase emo- tionship. This is an art that requires guidance, discipline tional awareness using embodiment exercises. We started and experience. However, an embodied understanding with a centering exercise. I asked the client to sit on the desk of human emotions can only help in this regard.
chair and adjust its height. Then I coached him through anabdominal breathing exercise. At the end of the exercise,Robert reported feeling 'focused'. He added that the exercise helped him realize that he had been constricting his breath.
He also became aware that earlier in the session he was 'more Robert was 36 years old when I first met him. He was anxious than [he] realized'. Robert requested to do this kind referred to me by a therapist colleague who led a process of exercise in future sessions and I agreed.
group in which Robert participated. My colleague said On session 3, Robert reported that he was still sleepy that Robert had attended this group for several years, being just after 8 AM. I began teaching him the step-out but he had much difficulty exploring and expressing his technique. Robert had difficulty but reported being more emotions. Thus, my colleague thought I might be able to awake. Then we began discussing the client's desire to help Robert with this. Robert readily accepted the referral.
'connect' with people. Robert's discourse quickly became When Robert was 5 years of age his father suffered a intellectual and detached despite my asking questions brain injury. The father thereafter would behave erratically about his feelings. I pointed out this observation and and had difficulty relating to people. His intellectual ca- asked the client if, instead, he would like to try a body pacity was clearly diminished. Robert's mother apparently exercise that may have to do with connection. Robert could not deal with this situation emotionally and pretty agreed enthusiastically. I coached him through the respira- much withdrew. The client was told, for instance, not to tory-postural-facial pattern of tenderness. He did OK but let anyone know about his father's condition because his had much difficulty smiling. I wondered if Robert's facial mother was embarrassed by it. Robert's memory was that muscles were under-exercised. His breathing also appeared his mother could not deal with his emotional needs be- slightly forced. We ended with the step-out procedure.
cause of the stress of his father's illness, so he learned to Robert reported a feeling of 'calm' and 'almost like happi- stifle his emotions. The client felt he never had any emo- ness' during the tenderness pattern. He did not report tional support or any emotional outlet at home. He did tenderness or any memories. He also reported having fewer well in school, which he experienced as a relief from the thoughts than usual, which he considered positive. Robert pressures of being at home and helping to care for his expressed that he was not sure where the body exercises father. He went on to college and graduated at age 24. By would lead but trusted my intention to help him.
the time I started working with Robert, he had achieved During the fourth session, Robert appeared to be more a considerable degree of professional success.
aware of his feelings. He talked about his distrust at work, In addition to his participation in group therapy, Robert which he related to a fear of people finding out that he is a had previously had individual therapy for anxiety and fraud. We agreed to use a two-chair dialogue (Greenberg, depression. One of his biggest concerns was that he chroni- Rice, & Elliott, 1993) to explore his self-criticism of being a cally cheated on his girlfriends or had several girlfriends fraud. Robert expressed that the exercise helped clarify the going at once, unbeknownst to each other. Robert expressed conflict he felt between a critical side, which was much fo- that he had little feelings either for these women or about cused on money and prestige, and an experiencing side his behaviour. However, he understood that his behaviour that did not care about these things.
was not right. When I started working with this client, he On the next session, Robert discussed his fear of 'screw- had been in a committed relationship for a few years with- ing up' his relationship as he had done with past relation- out cheating. However, the client continued to experience ships. I asked him to express his doubts about himself to depression and anxiety. Robert expressed being clueless himself in an empty chair. He told the other part of him about the sources of his depression. He seemed to have that he is getting into a big commitment by getting mar- previously attributed it to external stressors, but when we ried. The other side dismissed the significance of the com- began treatment, he reported that his life was good, so he mitment, saying that he was ready to leave if there are did not know why he felt depressed. Robert was also taking difficulties. The original side was shocked at this response Lexapro and Trazodone prescribed by a psychiatrist.
and wondered how genuine the other side's dismissal To me, the most remarkable thing about Robert's presenta- was. That side, in turn, expressed fear that if he allows tion was that he chronically displayed the respiratory- himself to care, he will be hurt. I attempted to explore this postural-facial pattern of fear. His breathing was sometimes fear, but Robert switched to a conceptual mode of proces- audible. Robert complained of depression; however, when I sing discussing his past patterns in relationships.
Copyright 2011 John Wiley & Sons, Ltd.
On session 6, Robert reported that he had been more anx- He said that it was good to cry because it showed to him ious than usual. I asked him to describe the physical sensa- that he cared. Up to that point, Robert had expressed tions associated with his anxiety. He described energy in his doubt over whether he cared about others at all. We ended arms and hands and showed this by clenching his fists and briskly waving his arms. Even though these sensations are During the next session, Robert expressed that he had a consistent with anger, Robert considered them anxiety. He hard time finding what to talk about due to his stressful could not understand where this 'anxiety' was coming week. We agreed to try a 'clearing a space' exercise from, so we agreed to explore it through breathing exer- (Greenberg et al., 1993), which Robert completed success- cises. We did some work with the step-out technique, and fully. He chose to focus on his reaction to several difficul- Robert reported that it helped him reduce his anxiety. Then ties people at work had recently shared with him. As we I introduced part of the anger pattern, specifically the exha- explored this reaction, Robert discovered that dealing lation, followed by a return to neutral. Robert expressed with people both brought him happiness and over- that he felt an impulse to 'push away'. We agreed to con- whelmed him sometimes. He also noticed that he tended tinue exploring emotions through breathing.
to distrust his feeling of being overwhelmed and instead During the next session, Robert reported that he had been tried to conform to injunctions about how social to be.
trying the exhalation breathing that I taught him the previ- This dialogue gave me the impression that Robert was be- ous week to reduce his anxiety. I said that it would make coming more aware of his feelings and needs.
sense that it would reduce it. However, I discouraged the At the beginning of the next and last session, Robert client from using that breathing on his own. I gave him appeared mildly anxious. We started out with the step- some theoretical background on Alba Emoting. I explained out exercise, as usual, but the mild anxiety lingered for a that the breathing we practiced the previous week was part while after that. He reported feeling stressed about several of the pattern of a specific emotion and that we could issues, most importantly the preparations for his upcom- explore that emotion in therapy. I told Robert that the ing wedding. I coached Robert though the 'clearing a step-out technique was the only breathing pattern I recom- space' exercise, which allowed him to feel his desire to mended he use outside of our sessions. He agreed. I rest. He went on to explore his feelings about the commit- provided additional coaching on the step-out technique ment involved in marriage. The client noticed that he did and then I taught Robert the fear pattern, as always, with- not have the urge to cheat on his fiancée and added that this out naming the emotion. The client performed it fairly well.
was a discovery for him. Robert talked fondly about his After the step-out, Robert reported having felt 'panic'. He fiancée. He reported feeling good about the relationship had a memory of having had the same feeling as a child, but also wondering why she loved him. I encouraged him although he could not recall in what circumstances. He also to 'make space' for feeling good. He expressed that it was realized that, in situations when he felt 'paralyzed', he had a a surprise to learn that he can make space for positive feel- similar feeling. Robert expressed that it was useful to under- ings. On this session, Robert and I agreed to begin spacing stand his reaction as fear. I encouraged him to pay out our meetings, with an eye towards ending therapy.
attention to the bodily signs of fear in his life.
Eventually, however, he had to cancel his follow-up On the eighth session, I asked him if he had identified appointments, but he indicated that he was doing very well more situations in which he felt fear. He said that he felt fear when thinking about the possible consequences ofhis actions: the thought of being responsible overwhelmedhim. Robert showed a deeper level of experiencing (Klein, Mathieu-Coughlan, & Kiesler, 1985) than I had observedbefore. Exploring the client's fear of responsibility, he said In this section, I would like to discuss how Alba Emoting that a former employee of his had killed herself some time helped with Robert's emotional awareness. Clearly, his ago. Robert expressed guilt for not having done more for emotional awareness was deficient. This led him to act on her. I framed this as unfinished business and suggested impulses that he did not understand when he cheated on empty chair work (Greenberg et al., 1993), to which previous girlfriends. Even when he stopped engaging in Robert agreed. Robert expressed that he missed the this behaviour, he was unable to trust that this change employee and that her suicide was unexpected. In the role would continue. In addition, even though Robert often of the employee in the other chair, he expressed that sui- appeared anxious, he was not aware of this feeling. I think cide had been her way to end her pain and that it was that the respiratory-postural-facial pattern of fear helped not Robert's fault. The client responded expressing his him become aware of his anxiety by (a) bringing attention pain about the employee's death. Robert cried for the first to his body and (b) intensifying the emotion. Following this time since we began therapy. He then said goodbye to the experience, Robert was able to recognize this pattern in imagined employee in the empty chair. After the exercise, daily life and eventually connect these physical sensations Robert expressed that he felt he had finished the dialogue.
to thoughts of having to be responsible. This realization in Copyright 2011 John Wiley & Sons, Ltd.
turn led to an awareness of the meaning for him of his Greenberg, L. S. (2004). Emotion-focused therapy. Clinical Psy- employee's suicide. In this particular case, teaching the chology and Psychotherapy, 11, 3-16.
client concrete, specific physical actions facilitated a com- Greenberg, L. S. & Paivio, S. C. (1997). Working with emotions in plex chain of discoveries about himself. This example high- Greenberg, L. S., Rice, L. N. & Elliott, R. (1993). Facilitating emo- lights that emotional awareness is more than just naming an tional change: The moment-by-moment process. New York: emotion. Rather, the embodied awareness of an emotion acts as a guide to what is important to a client.
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medicalisation of modern living Joanna Moncrieff argues Chat psychiatry is a disguised form of social control which, despite a history of resistance, is currently increasing its The institution of psychiatry grew up in the nineteenth century during the emergence and consolidation of industrial capitalism. Its function was to deal with abnormal and bizarre behaviour which, without

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