The Role of Enhanced Emotional Awareness in Promoting Change Across Psychotherapy Modalities

Although there is widespread agreement that emotion plays an important role in effecting change in psychotherapy, exactly how it plays a role is uncertain. A way forward is to draw upon the preclinical literature for guidance in bridging basic science with clinical application. Here we focus on the promotion of emotional awareness, the recognition and description of one's own emotional experiences, as foundational to change across a variety of psychotherapy approaches. We begin by focusing on emotion from a preclinical perspective, highlighting how automatic emotional responses provide instantaneous adaptation to changes in interaction with the environment. We distinguish these responses from awareness of them, which makes changing them possible. We then briefly refer to a body of empirical research on levels of emotional awareness that can be used to understand and measure clinically relevant change in emotional awareness. Next, the role of emotional awareness in how change occurs is considered from the perspective of 3 different ways of doing psychotherapy: current cognitive-behavioral approaches, emotion-focused/experiential psychotherapy, and psychodynamic psychotherapy. All 3 modalities consider the developmental process of enhancing emotional awareness to be necessary but not sufficient for change, potentially serving as a common factor comparable in importance to the therapeutic alliance. In consideration of the broader question of how emotion contributes to change, this new perspective highlights the need to further examine the relative importance of emotion expression per se versus the awareness that precedes emotional expression or arises in the symbolization process inherent in verbal expression.