"Emotional EEEEs" Part 1

The "EEEEs" approach to healing emotional pain

NOTE: If you have arrived here without reading the previous pages extracted from the book "Wanterfall", the four "E"s in "Emotional EEEEs" stand for Encourage, Explore, Express and Evaluate. (These are the Four Essential Steps when dealing with any painful emotions.)

Introduction

Although the four steps referred to above are discussed in some detail in the following pages, appropriate further study and supervised practice is also essential, if you intend to provide grief counselling or any other type of therapy. Communication skills are particularly important when working with people who, because of their emotional distress, are very sensitive to both verbal and non-verbal nuances. Communication skills are not addressed in this book, but they are the subject of my "Notes on Communication".[72]

The origin of emotions, and the characteristics of many of the emotions that we know, have been discussed in earlier articles in this series. Here, I will be concentrating on what we can do about those emotions. That is because dealing with painful emotions – whether new or old, and regardless of where they come from – is the essence of successful grieving. It is also, incidentally, the essence of dealing with any other type of emotional distress.

There are various ways of dealing with painful emotions, but the effective ones have much in common – once they have been stripped of their sometimes confusing nomenclature. The method described here is broadly derived from my training, some decades ago, in the Kübler-Ross "intensive growth" process[73] and the Barham method of psychodrama[74]. It has also been influenced by my long and varied medical career.

As the majority of my clinical work has been with individuals, rather than groups, my comments on the expression of emotions in a group environment owe a very great debt to my earlier experiences as participant, trainee and assistant in the group activities mentioned above.

However, the application of the EEEEs model is not limited to group activities. Intensive growth workshops, psychodrama sessions, or any other specific methods, are entirely optional within this framework. Also, it can be used by itself, or in combination with other forms of therapy; and it can be used with the help of one or more other people – or as self-help.

Before I describe the EEEEs method itself, I would like you to imagine a hypothetical situation. You go out for a walk and come across a large, hideous animal. You might easily run away, to escape from the apparent danger. Perhaps you trip and fall. The animal, following with interest, catches up. Though frightening in appearance, it is actually a harmless animal – but you have been seriously injured in the fall.

Or perhaps you do not fall, but find a cave with a narrow entrance, and take shelter. The animal sniffs at the entrance for a few minutes, and then disappears. Where is it? You don't know, and you don't dare to come out. Even if the cave itself is free of hazards, you may remain unnecessarily imprisoned for some time – perhaps with serious consequences.

All you were trying to do was the best thing you could think of in the circumstances. Others may have known that the animal in question was harmless, but you didn't. So, by doing your best to help yourself, you injured yourself, or imprisoned yourself, or perhaps both. Had you been armed, you might have killed or injured the harmless animal; and possibly also one or more people who happened to get in the way.

In the case of painful emotions, some people know that, while large and hideous, they are not dangerous in themselves. Unfortunately, many other people do not know this. And fleeing in terror from hideous emotions, hiding in fear from frightening emotions, or attacking the presumed cause of painful emotions, often has tragic consequences.

Emotional EEEEs is a simple and practical technique which can help you to stop running, if you are running; or come out of your cave, if you are hiding; or see that violence is not necessary, if you are poised to attack. It will also show you that your emotions can only hurt you with your co-operation.

It may not seem easy to start with, but you only need to take one step at a time – and the steps get easier with practice. I will look at each of the four "E"s in turn (giving much more time to "Express" than the other three, simply because it usually needs the most attention). But regardless of how simple or complex each may be, all four "E"s are important in every case.

When discussing each individual "E" in detail, I will start each time by listing all four Essential "E"s like this:

·       Encourage

·       Explore

·       Express

·       Evaluate

However, the "E"s which are not currently being discussed will appear in a pale grey colour, as you can see under the first of their four individual headings, below:

Encourage

·       Encourage

·       Explore

·       Express

·       Evaluate

You could reasonably say that this is not, in itself, part of the healing process. After all, encouragement just has to do with getting started on exploring. However, so many people simply never begin, unless they receive considerable encouragement, that I prefer to include it as an essential part of the process.

I will introduce the general principles of encouragement here. However, much of the detail will be covered later, under Safe Expression of Emotions; and still later, under various subheadings of Facilitated Intense Catharsis. The reason is that continuing encouragement is an integral part of assisting with expression, whether the latter is mild, moderate or intense.

In practice, the hardest part of encouragement is often undoing the discouragement of emotional expression, which is so deeply embedded in most societies. This has usually been learned from infancy, or soon after. However, it doesn't stop there. It is reinforced, in one way or another, especially but not exclusively non-verbally, in social situations – on a daily basis.

Two common examples of this societal discouragement are the ideas that men must not cry and women must not admit to aggressive feelings. This is all part of our conditioning, as discussed under The Ramifications of Emotions – and our conditioning can sabotage any or all of the four Es, thus preventing emotional healing altogether.

So, whether you are grieving or helping another to grieve, do not be surprised if you encounter discouragement instead of encouragement – either as a result of preconceptions within your own mind, or in the minds of those around you. Cast off as many of these preconceptions as you can. Those that remain will slow you down, as though you were wading through treacle. But that's OK. Slow progress is much better than none.

Whether you are encouraging yourself or someone else, or are being encouraged, there are three general aspects of encouragement. The first is reassurance, the simple reassurance that it is normal to have strong feelings after a loss – or indeed, in the presence of any emotional distress at all.

The second is permission.[75] And if you are helping someone, it is three kinds of permission. Permission to pay attention to feelings. Permission to share feelings. And the reminder to the person you are helping, repeated as frequently as necessary, to "give yourself permission". If you are working alone, the last of the three is all that is needed. And it is needed absolutely – because without it, you will not even get started.

The third is validation of any feelings that are expressed. I am using validation here in the sense of confirmation that a given instance of expression is perfectly acceptable – and so is the person expressing it. It does not imply that anything has been proved to be correct – that is another meaning of validation.

Feelings, of course, are neither correct nor incorrect – they are just what they are. But confirmation that a particular expression of feelings is appropriate, is often helpful. It is, effectively, a second dose of reassurance – a post-expression reinforcement of the original reassurance that strong feelings are OK.

When given by another person, this reassurance, permission and validation always needs to be given non-verbally. Often, it also needs to be stated verbally, but that is usually of secondary importance.[76] Very simple non-verbal messages are often the most powerful. Handing the person a few tissues, or pushing a box of tissues towards them, is often enough to satisfy any or all of these aspects of encouragement. Indeed, as long as all other aspects of communication are congruent with this gesture, it is sometimes the only specific action required to facilitate a very effective episode of expression of emotions.

Sometimes, more specific encouragement is also necessary, such as a simple explanation of some of the concepts discussed in this section. This should be combined with frequent repetition of the reassurance, permission and validation mentioned above. During expression of feelings, as discussed below, encouragement may still need to be continued. At that time, it should be almost entirely non-verbal. Occasional brief comments, made during pauses in the process, are OK – but a long or complicated sentence usually puts the feelings right back in the box from which they were so recently coaxed.

Encouragement may be the simplest step in concept – but it is often the most difficult in practice. References to encouragement, and sometimes specific examples of it, will also be found under Explore and Express, because it is a continuing requirement during the first three EEEEs.

Wherever it is found, the essence of encouragement is the idea that it's OK to have feelings – that there's no need to hide or deny them due to fear, shame, guilt or simply misguided politeness. Even if this involves standing a lifetime's collection of conditioned beliefs on their reluctant heads, it is essential – because otherwise, the next step may never be reached.

Explore

·       Encourage

·       Explore

·       Express

·       Evaluate

Although encouragement is often necessary to reach this step, there is no need to wait for it. The sooner you start, the better. From early childhood onwards, exploring emotions is highly recommended. But how is it possible to explore something which is invisible, and also inaccessible to the other senses?

It is "the mind's eye" that observes, rather than the physical senses. And it is feelings that are explored, rather than a physical landscape. But apart from that, it is no different from exploring a town or a forest. The method used is different, but the principle is exactly the same.

Perhaps, using the mind's eye, you look around to see what you can see – or perhaps your attention is arrested spontaneously by something very obvious. Noticing something is always the first step – until you notice it, you cannot focus your attention on it. But when you have noticed something, you can, metaphorically speaking, go closer to it and inspect it in more detail.

As with a physical exploration, it is useful to record what you find. You can then compare it with other things you have explored, and see how they fit together – or don't fit together. You can ponder its significance. Slowly but surely, you can build a sort of map in this way – in this case, it is a map of your own feelings. If those feelings are painful, the resulting map of your own sorrow will be your most valuable map; for a map of where you are is always useful – whether you are staying there, or looking for the way out.

Apart from the constant business of noticing feelings throughout the day, other exploratory activities might include keeping a diary to write about feelings; discussing feelings with friends; and using some simple form of non-directed expression of feelings. True, that is the next E – but it also helps you to explore further, so it belongs here as well. Exploration and expression are complementary, and sometimes impossible to separate. This will result in a little repetition.

Examples of non-directed expression which can assist exploration include writing whatever comes to mind, doodling on paper, drawing simple pictures with coloured crayons, and "playing" in a sandbox. When the loss involved is the death of a loved one, viewing the body is another very important way of getting in touch with feelings. The reality of death seems more intense when all the senses are flooded with the evidence.

Planning and participating in the funeral can also be very helpful. However, the degree of participation of a bereaved person is a choice that should be made by that person. I have come across cases in which members of the clergy, or the family, have strong ideas about a fashionable degree of participation, which is not appropriate to the needs of the bereaved person. Even the perfect spanner can harm the works.

The anniversary of a bereavement is another opportunity for emotional exploration. Even when it seems that you could not possibly discover any more feelings, an anniversary may surprise you. It may be an unpleasant surprise, but it is still part of the overall healing process. The same often applies to other anniversaries, such as birthdays, the day you met, and so on.

What about deeply-buried emotions – how on earth can you explore such hidden horrors? Fortunately, there is no need to attempt this. When the next step, expression, is applied to the emotions that are near the surface, and as those emotions move out into the open, the deeper ones metaphorically float up to occupy the newly-vacated space. Sometimes, they are actually connected – in which case they are extracted more directly.

In the former case, it is a bit like a concentration of floating objects which, between them, are holding down more objects underneath. As the surface objects are removed, the deeper ones can rise. In the latter case, it is a bit like drawing a string of pearls slowly out of a purse. Pulling out the first pearl brings up the next one, and so on. In both cases, it is also a bit like peeling an onion, in that the surface must be removed before the deeper layers can be accessed.

Whatever the analogy, working with one emotion frequently reveals another – often, more than one. They may not seem like pearls – at least, not to start with. But however we think of them, we can only work with feelings in the order in which they appear. And, of course, until we at least notice a feeling, we cannot even get started on its expression and evaluation.

But is exploration reliable? How do you know you will not simply manufacture imaginary emotions, while pondering over some distressing event? This is a plausible idea in theory, but I have never seen anything to suggest it in a practical context.

Real emotions have power, which becomes more evident as they come more fully into consciousness, and wanes rapidly after they have been expressed. Imaginary emotions, on the other hand, have no power at all – of their own. If you concoct an emotion and find that it moves you, you can be sure that there is something like it, somewhere in your pool of pain.

In fact, "trying out" possible emotions is one way of exploring. If you try out an emotion which you are not carrying, you will only experience boredom. Of course, this might also occur if your version is too well buried to resonate with the imagined version. In that case, it will have to wait for another day.

Express

·       Encourage

·       Explore

·       Express

·       Evaluate

The text under this heading – especially under the subheading Facilitated Intense Catharsis – is a great deal longer than that which appears under the other three "E"s. That is partly a reflection of the importance of expression in the healing process – which is immense. However, it is also because practical procedures take far more time to describe, than they take to do.

For example, it only takes a moment to put a nut on a bolt, but a full description of the principles and practice of helical thread fixation would run to many pages. Similarly, expression of feelings need not take long, but the following description of its principles and practice occupies about a quarter of this book. As it is one of the most important concepts in the book, if not the most important, I do not begrudge it the space.

You may wonder why the topic headings under Express have a musical theme. A few musical metaphors even turn up in the text. I like musical metaphors for emotional expression, because it usually involves sound and the end result is beautiful. Perhaps that is why I often heard Kübler-Ross say, "the screams and curses are like Mozart to me". However, the musical terms are not an essential part of the process, so they can safely be ignored by any readers who find them irritating.

Making Music

I will say a little about the theoretical aspects of the process by which a feeling within the mind of one person can be made accessible to the mind of another person. However, it is important to remember that expressing feelings is not a theoretical process. It is just something you do – like walking or talking. I will include another reminder about this important point when I finish with the rather abstract theoretical ideas.

The most literal meaning of the verb express is to press something out, as in expressing the oil which is already in existence, though not in evidence, within seeds, nuts or olives. This provides a preliminary clue to the process we are about to consider. However, in our present context, the meaning is extended to include interpreting, representing and conveying feelings which are already in existence within the mind.

The first two of these three stages of expression, interpreting and representing, are sometimes performed almost simultaneously. That is analogous to a language interpreter listening to one language and speaking the content in another. However, in the case of feelings, a different representation of the same interpretation – for example, a verbal representation rather than a visual one – might be made later.

Just as a musician has to interpret the musical notation before representing it as sounds, which are then conveyed through the air to be received via the ears of the audience, we face the task of interpreting, representing and conveying feelings. Feelings have their own unique "notation" within the mind. When that has been interpreted, a variety of methods of representation is possible – mainly verbal, visual, sonic, tactile, kinetic and all possible combinations of those.

Notice that neither music nor emotions can be conveyed, until they have first been interpreted (translated) into a form which can be represented in a medium (such as sound or words) which can then be transmitted to, and received and understood by, others. This change of form is not a gratuitous complexity. It is necessary because the original is not directly transferable.

The original form of an emotion exists only as a virtual entity within the mind of its owner. No one, not even its owner, can see, hear, touch, taste or smell it. We cannot even think about it in its original form – in that form, it can only be experienced. And the experience is restricted to the owner of the feeling.

That means that untranslated emotions are inaccessible to conscious processing, and therefore cannot be shared with others – or even evaluated intellectually by their owners. They require some interpreting first. And if they are also to be conveyed to other people, they require a representation which is transmissible in a form that can be received by others.

In practice, however, thinking about the process described above is quite unnecessary – indeed, the intellectual processing involved would interfere with the actual expression of feelings. In practice, it is just a matter of feel – express. This is closer to the language interpreting mentioned above – but even more immediate, as accuracy is less important here than spontaneity.

In other words, a potentially understandable analogue of the feeling is quickly made available to others, if present, without conscious processing. Alternatively, the representation can simply be conveyed to the space outside the owner. An audience is usually helpful, but it is by no means essential.

Very often, the representation is at least partly verbal. The sounds made if the words are vocalised, and any other sounds which are made, can also represent feelings. Because emotional feelings are quite closely linked with physical feelings, various physical actions are also very valuable forms of representation. And as so much of our experience and communication is visual, visual expression is inevitably very important as well.

But regardless of the type of representation used when conveying the feelings, there is always a sense of something which has been hidden or latent – emotional pain – now coming out. First, it is changed into an accessible form, allowing it to move from the pool of pain to the conscious mind. From there, it can be transferred out into a wider context.

This can have a number of helpful effects. The feeling becomes more conscious – and conscious in a more enduring way – than it was before. It is felt more acutely, which may be unpleasant, but it is also seen more clearly. Above all, it has been symbolically pushed out – in a sense, rejected. And symbolism has a strong influence on the mind. It is much easier to let go of a feeling, once it has been symbolically rejected in this way.

If the feeling was associated with a secret, which has been shared with one or more people at the time of expression, that secret is not a secret any more. Can this possibly be a benefit? At first, the sharing of a secret often makes you feel worse. Any associated shame or guilt is greatly intensified. But that is an opportunity to understand and express the shame and guilt, too. And there are few feelings more important to be rid of, than shame and guilt. So even the intensification of shame and guilt can be beneficial – though it does not seem so at first.

There are various other benefits which can follow the sharing of feelings with a number of people. Witnessing the expression of feelings similar to your own, by others who are present, demonstrates that those feelings are not unique. And if others have feelings similar to your own, then perhaps they are not as terrible as you thought them to be. Also, the acceptance of the person expressing feelings, by others who are present, helps dispel the notion that those feelings are unacceptable to others.

Many other effects which are not consciously noticed will probably also occur. Quite a lot of our emotional life is less than fully conscious. In my experience, the overall effect of a significant episode of sharing of feelings is usually an initial increase in distress, followed by a marked reduction in distress, and later by considerable re-evaluation of the issues involved.

Thus far, the ideas about the expression of emotions which we have looked at have been fairly general in nature. The other subheadings under Express will address the more specific, practical aspects. Because, important as it is to understand emotional expression, the chief value lies in actually doing it.

Incidentally, I will use two other words which describe aspects of expression from time to time. The first is externalisation. I will use the words expression and externalisation interchangeably. Another word, catharsis, is usually reserved for fairly considerable or significant externalisation.[77] That word will come in very handy later, when discussing the more intense forms of expression.

Explicit Lyrics

The emotions which need our attention are, of course, the unpleasant ones. We do not flee from, hide from, or attack the presumed causes of pleasant emotions – nor do we mind, unless we are philosophers[78], if they remain with us forever. It is emotions like sadness, guilt, shame, fear, disgust, and rage – those which in some way upset or distress us – which need to be dealt with by the EEEEs method or its like.

Unfortunately, most people have a strong objection to the practice of expressing unpleasant emotions. That is mainly because they don't sound very polite. But, although it may not be very nice to hear impolite words and ugly sounds, it is very much worse to observe or experience assault, murder, torture, suicide, rape or war. And those are some of the effects of not dealing with unpleasant emotions – which is probably why, as I mentioned a little earlier, I so often heard Kübler-Ross say, "The screams and curses are like Mozart to me".

I will use a fictitious example to comment on some aspects of externalisation. Let's say that a man is talking to a friend about a woman who has been rude to him. If he feels angry, but is not comfortable discussing painful feelings, he might say (with very little non-verbal accompaniment) something like this. "By any standard, the lady was most impolite. Indeed, I think her behaviour could easily be construed as frankly offensive. I am most disappointed in her."

The use of formal language, abstract concepts and non-verbal minimalism is quite an effective way of insulating both speaker and audience from any feelings which may exist. It keeps things on a mainly intellectual footing. Useless? Not necessarily. Like the first steps of a baby, it has the capacity to develop into much faster and more effective progress.

Hearing himself make the above statements, the man might easily feel at least the tip of the iceberg of emotions which he is keeping so well submerged. And if he had made the statement to a perceptive person, they might respond by asking "How did you feel?" He might then reply something like this. "I felt she was rude. Well, I mean, I felt bad. I don't like her, anyway."

Simple language, mainly descriptive and not necessarily logical or grammatical, is a much more effective vehicle for expressing feelings, than formal and abstract language. In this case, the simpler statement was the result of prompting. Prompting need not be verbal, of course – a raised eyebrow might have had the same effect. Nor is prompting always necessary – especially as we get to know our own evasions better. Nevertheless, it is often a great help.

Now, depending on the situation, the man might conceivably feel that more spontaneous verbal expression would be acceptable. If he knows that his friend is not afraid of strong feelings, and if the thought police are taking a break, he might feel less inhibited. If not, perhaps his friend would say "Just spit it out". Or perhaps "Don't be so polite".

Or (as Kübler-Ross invariably said) "Use the words". Anyway, if he is somehow made to feel safe from the risk of disapproval, he will probably rephrase his statement in much more colourful language, and with considerable non-verbal accompaniment. His friend might even learn some new words – unless he is used to encouraging the expression of feelings, in which case he will have heard them all before.

When there are no inhibiting factors, the verbal expression of strong feelings usually involves a mixture of simple language, slang and swearing. The non-verbal expression of strong feelings is more difficult to describe, but it is also very useful. As discussed later under Facilitated Intense Catharsis, the only important thing about non-verbal externalisation is to ensure that it is safe for all concerned. Its effectiveness is not in doubt.

Anyway, externalisation is not always polite. But we live in such a polite society! What can we do? This may seem like an impasse, but in fact it is nothing of the sort. Rather, it constitutes an important challenge. It is imperative that every society finds a satisfactory way to deal with something which cannot safely be ignored – the existence of painful emotions.

When a painful emotion exists, you only have two choices. You can give some attention to it, or you can ignore it – while it festers. There is no third choice. And I have already discussed what can happen if it festers. So, if you are very angry, it is a thousand times better to attend to your feelings, than to leave them to fester. We will look at some ways of attending to painful emotions quite soon.

Playing Safely

This gets a bit musical again – never mind, it's not for long. Assuming that we are now seriously committed to developing a worthwhile performance, there are some practical matters to sort out in advance. Discord may be dramatic, but we will only achieve our aims by working harmoniously in concert – which requires a framework of agreed behaviour. When the lights go down, there will not be time to do much planning. True, most of the expression will be extemporaneous – but there are some important things which must never be left to chance.

Although it has not always been given optimal attention by the medical profession, dealing with painful emotions is a vitally important aspect of human wellbeing. So I think the first and most important principle of medical intervention automatically attaches to it. I was taught this principle in Latin – primum non nocere[79] – but that was admittedly a long time ago.

Anyway, avoiding significant adverse effects is an essential aspect of Emotional EEEEs, just as it is for any other therapeutic intervention. EEEEs work must therefore be done

in a safe way, in a safe place, at an agreed time and with the permission and co-operation of everyone who is directly or indirectly affected.

Those are always the prerequisites for externalisation of emotional pain, regardless of the intensity of the process. Of course, the complexity of meeting the prerequisites depends greatly on the intensity of expression. But the importance of meeting the prerequisites does not vary. Meeting the prerequisites is always essential – regardless of anything at all.

A bit later, I will discuss the process of meeting the prerequisites, at some considerable length. I will do that under Facilitated Intense Catharsis, because the requirements are most complex at that level of intensity. Nevertheless, the principles are the same at any level. With common sense and a little experience, you can apply the information provided there in ways that are suitable to any situation at all.

Program Notes

There are three rather different pieces on my externalisation program, and each will leave a lot to the reader's imagination. The imagination will be needed most of all to fill in the infinite variations possible between mild and extreme externalisation, and the important continuum between encouraging and discouraging catharsis.

The first piece, Gentle Expression, will be my next heading. As the name suggests, I am going to describe some relatively gentle ways of expressing feelings, for which the prerequisites with respect to safety can usually be met very easily. The audience will probably expect something more vigorous to follow this piece – but they will have to wait a little while.

They will have to wait right through the second piece, which is called Calming Catharsis (found on the same page as Gentle Expression in this html version) and has been placed between Gentle Expression and Facilitated Intense Catharsis because it relates to reducing intensity from the extreme back towards the gentle – something which may be necessary for a variety of reasons.

Whenever externalisation is more intense than seems safe and appropriate in the circumstances, the options are to suffer the risk, to change the circumstances – or to reduce the intensity of externalisation for the time being. In practice, the last option, though rarely ideal, is often the best available.

The third piece, Facilitated Intense Catharsis, is perhaps not my most musical title. Be that as it may, it describes a much more intense form of externalisation, with correspondingly stringent prerequisites. As mentioned above, I will address the prerequisites for all forms of externalisation under this heading, but they can easily be modified to suit less intense processes.

Naturally, every gradation between gentle and intense may be encountered. The degree of intensity which can be managed in a given situation depends on many variables. An experienced therapist might facilitate quite intense catharsis in an office situation, working with carefully selected clients. When there is any doubt, though, it is better to err on the side of safety.

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