Corrective Emotional Experience Is the Key to Therapeutic Effectiveness By Allen Frances, M.D on 3/15/22 - 1:36 PM

During my early training in psychotherapy, I was struggling to understand my role and what to say to patients.

A wise supervisor introduced me to the term “corrective emotional experience” and said that once I fully understood its implications, my job would seem a whole lot simpler and I'd have much less trouble finding useful things to say to patients.

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He taught me that the main and unifying goal of all psychotherapies is to help patients have new and better experiences, both in the sessions and also in the rest of their lives. Such experiences could heal wounds from the past, change perceptions and attitudes in the present, and result in healthier behaviors and virtuous cycles in the future.

Virtuous cycles are positive mirror images of the negative vicious cycles that so often grease a slippery downward slope for people with emotional problems. A virtuous cycle starts with a small corrective emotional experience which triggers a chain of other desirable experiences in a continuous cycle of improvement. An example would be where someone afraid of socializing screws up the courage to take a tennis lesson and gets invited to a party, which results in a new friendship, which makes it easier to approach other people socially in a variety of other social relationships, which improves job performance, which results in a raise, which increases confidence, and so on.

This advice hit home, stuck with me, and has ever since guided all my clinical work and teaching. Corrective emotional experience is, I think, the best way to understand the mechanism of psychotherapy process and change—and also to integrate the bewildering variety of therapy techniques into one unified and harmonious psychotherapy. The process best explains the process of change as it occurs across all forms of psychotherapy.

Sandor Ferenczi introduced this experiential way of viewing psychotherapy change in the 1920s. He was a master clinician who understood and made use of the healing power of the therapeutic relationship. His suggestion, radical at the time, was that emotional experiences in therapy, not intellectual insights, are the real drivers of change. As his student Sandor Rado would put it much later, “Insight alone never cured anything but ignorance.”

It's fair to say that Ferenczi, not Freud, had the most important influence on psychotherapy as it is practiced today. Freud readily admitted that he found clinical work interesting mostly as a research tool, necessary to build and test his theories of mental functioning, but was much less engaged in the human and healing elements of therapy. His patients were often disappointed, describing Freud as talking too much, too abstractly, and too didactically.

In 1946, Franz Alexander (another of Ferenczi's students) named and concisely defined Ferenczi's theory of change: “The patient, in order to be helped, must undergo a corrective emotional experience suitable to repair the traumatic influence of previous experiences. It is of secondary importance whether this corrective experience takes place during treatment in the transference relationship, or parallel with the treatment in the daily life of the patient.”

In answering the crucial therapy question of how best to promote corrective emotional experiences, the first insight I have is that psychotherapy sessions are not all created equal. Change tends to occur in leaps, not in small steady increments. I have treated some patients intensely for years—with absolutely no discernable progress. In contrast, I have seen many patients for only fifteen minutes in the emergency room who years later said something along the lines of “you probably don't remember me, but you said something I've never forgotten that changed my life.”

This makes every patient contact an adventure, potentially ripe with opportunity, never routine. There is always the possibility of a magic moment in therapy—saying something that promotes a corrective emotional experience and sets off a virtuous cycle. We can't expect magic moments to happen often, we can't predict them, we probably won't even know that they have happened—but we can and should always be alert for the potential and try to create favorable conditions through our relationship with the patient.

While the unifying goal of all therapies is, or at least should be, to help patients have corrective emotional experiences, there are many different ways of getting there. Sometimes the corrective emotional experience comes from an insight that clarifies how the past is influencing the present or how unconscious conflicts are causing self-destructive behaviors. Sometimes it comes from changed behavior, such as facing phobic situations instead of avoiding them. Sometimes from testing and correcting cognitive distortions. Sometimes from emotional catharsis. Sometimes from a paradoxical injunction. And sometimes from the simple therapeutic act of validation. These are just to name a few.

Corrective emotional experiences are also, of course, constantly happening as part of everyday life—a new friend or love relationship, adopting a pet, beginning an exercise regimen, getting acquainted with nature, a better job, an act of resilience in the face of stress and disappointment, or just about any other positive new experience. Therapy is just a way to increase the odds of having (or noticing) corrective emotional experiences, speeding things up, and triggering virtuous vs. vicious cycles.

Too often these days, therapists adhere slavishly to one or another therapy school, and schools compete with one rather than join forces. This guild warfare is bad for psychotherapy, bad for therapists, and, most of all, bad for patients. Every therapist should have eclectic training that provides a full tool kit of techniques that promote corrective emotional experiences. No one school has a monopoly on wisdom or therapeutic power.




File under: The Art of Psychotherapy, Musings and Reflections