What the word “cognition” has come to mean

The link between emotion and the person of the therapist is not a theme a cognitive therapist has traditionally been concerned with. Could you explain to us your current work on the person of the therapist and on emotional content in therapy?

It may be a question of labels and identities. Many people see me as a cognitivist, and perhaps I am, but the meaning of the word cognition has changed a great deal for me. As my understanding of the brain sciences developed (neurology, body-brain integration, and so on), and with the contribution of the constructivist perspective, a broader concept emerged of what cognition, emotion and behaviour mean. That is why my interest in the emotions of therapists in general, and not only of cognitivists, comes perhaps in part from something I recognised personally: my therapy was different when my approach consisted solely in working on the relation between the client’s behaviour and thoughts. There were many experiences with clients where their message was clear: what they wanted me to listen to and understand were their emotions. And so, in entering their world, the emotional life of clients, I was at the same time entering my own personal life.

What changed in your therapy when you moved from the “cognition and behaviour” module to the integration of emotions?

That is interesting, because at first I thought your question was about what had happened in my personal life. The two change processes are linked, since I personally went through a series of revolutions of my self, of my life and of my work, something resembling what are called oscillations, that is, expansions and contractions, very much like my clients who described something analogous in their own lives. The changes consisted, for example, in an increase in my capacity to attend both to my own experience and to the client’s, perhaps not at the very same moment, but in a more fluid, faster dance, with the possibility of feeling more than one rhythm and with greater respect for moments of silence, without needing to say something profound or directive, or indeed to say anything at all. And also a growth in my respect for the tacit dimension. That is a concept of Michael Polanyi’s, about which he said: “We know more than we can tell.” In my experience, it is a respect for the processes that stand at the edges of my awareness, perhaps what is called intuition — no word seems quite right to me — but it is a respect for processes that are wiser, perhaps, than my intellect.

Emotion as a technical tool

In clinical work, on the technical level precisely, has the way you do therapy changed? How do you use emotions as a technical tool?

It must first be said that at the beginning of my training I believed that all my clients needed to be “more moved”, because that was my “discovery”. Little by little I developed a respect for stages and for different levels. One client, for example, needs a great deal of self-control without having to express it emotionally, and others need to express their emotions. An example that seems clear to me is those clients in whom it is obvious that emotions play an important part — depressions, anxiety disorders — where the energy of the emotion is present without the expression; with these clients, what I do is to express myself little by little in this way: “Right now I do not know how you are feeling, but I myself feel a great ambiguity, a confusion that I can feel here, a little in my arms; perhaps you can help me understand what I am feeling.” In this way, through that invitation, I bring into the therapy the opening of my own feelings.

Was there something in particular that you felt, at a given moment, that allowed you to connect with emotions?

A therapist from California, who was not my personal therapist, a humanist and existentialist, whose name is James Bugental; he is one of the pioneers of the humanistic movement, along with Maslow, Rogers and May, and he is now eighty years old; I went to a workshop he was running, and his presence as a person, his authenticity and his ease with his emotions were very powerful: it was a liberating experience for me. Later, with more experience, I attended (at first with great scepticism) workshops in body therapy. There are various explanations; I am currently working on a book called “the body in psychotherapy”. But my experiences have been powerful. I believe that in the coming century there will be an integration of the psychotherapies of insight (that is, verbal ones) and the body psychotherapies.

It is important for me to share with you that the experience of working with my emotions and from them has been difficult; there have been many challenging moments, because my family is Catholic and of Irish descent, and there it was not possible to express anything at all. That is why it is an adventure that, for me, is still going on.

Writing, listening, learning

In your book Human Change Processes, one is struck by the depth of the theoretical abstraction concerning emotions.

That is interesting, because it took me ten years to write that book. The last chapters, which deal with the therapeutic experience of clients, that of the therapist, and the processes of change, were written in less than eighteen months; I worked on them a great many hours a day, and always standing, never sitting, because the energy was such that I had to move. By contrast, it took me eight and a half years to write the more theoretical part and to gather, read and integrate the literature written on the subject.

Has a patient ever made a personal remark to you that was of great use to you in that same process?

Yes. For instance, while shaking my hand: “Doctor, you are a likeable man”, or, in tears, comments about me as a person that were very moving. I found them hard to hear, because it had been difficult for me to say certain things to those same patients, and I did not think I appeared to them as someone good or likeable.

My life is a mystery, because I have found myself in places and among people, with a great many opportunities: with Bandura, for example, at the beginning of the cognitive revolution, with Beck and Ellis, with Guidano; I knew Skinner, Milton Erickson, I know Viktor Frankl; very powerful people in the world of psychotherapy, and opportunities I do not know why I was given, windows through which to grow. And despite having known them all as teachers, friends and colleagues, I feel that the most important lessons of my life have been moments spent with patients, in silence, when the two of us were alone in a building, on a night of crisis, sharing the difficulty, the complexity and the sometimes painful adventure of life. Those are the strongest lessons in my memory.