Emotion and Culture in Psychotherapy

In Emotion and Culture in Psychotherapy, Shigeru Iwakabe, PhD, discusses the topic of emotion and how cultural context dictates the expression and experience of emotion. Culture influences every person’s understanding of reality, and emotional reality is no exception. An emotion that is acceptable to share or recognize in one culture may be problematic in another. Similarly, the way an emotion is experienced may differ from culture to culture. In the therapy demonstration in this video, Dr. Iwakabe works with a client who feels a complicated mix of emotions surrounding aging and living up to the image he has of a beloved and now-deceased parent. Using an affect-focused integrative approach that blends elements of emotion-focused therapy and accelerated experiential dynamic psychotherapy, Dr. Iwakabe allows space for the client to feel the emotions that arise in the session. The dynamic in the room is one of respect for the client’s culture, situation, and—ultimately—the client as an individual. This powerful therapy demonstration is framed by an interview and a discussion of the therapy, hosted by Cheri L. Marmarosh, PhD.

The model demonstrated in this video is an affect-focused integrative approach based on two empirically supported emotion-focused models of psychotherapy, emotion-focused therapy (EFT: Greenberg, 2015) and accelerated experiential dynamic psychotherapy (AEDP: Fosha, 2000, 2021). EFT is a dialectic constructivist-humanistic approach that focuses on facilitating client effective emotional processing within an empathic and collaborative relationship using emotion-activating interventions. Its outcome is supported by a number of rigorous studies for psychological disorders such as depression, complex PTSD, and generalized anxiety disorder (Timulak et al., 2021). On the other hand, AEDP derives its foundation from dynamic and experiential therapies, attachment theory and research, affective neuroscience, and psychology of emotion. AEDP also aims at client emotional transformation within an empathic and affirming therapeutic relationship. Moreover, AEDP has a greater focus on the role of positive emotions in promoting psychological change and flourishing and on relational interventions to provide corrective emotional experiences. The outcome research indicated that AEDP is effective in alleviating depression, a variety of psychological symptoms, interpersonal problems, emotion dysregulation, and in enhancing positive psychological functioning such as self-compassion and flourishing (Iwakabe et al., 2020; 2022).

An affect-focused approach that is demonstrated in this video integrates these two approaches to effectively facilitate client emotional processing in a safe and caring relationship with a goal of clients learning to live in harmony with their emotions. Instead of controlling or avoiding emotions, clients learn to experience them, to be informed by them, and not overwhelmed by their intensity, but to allow themselves to be energized by them. This can be described as developing competent emotion regulation capacity. However, this does not mean that such emotion regulation capacity makes the person completely self-regulating and independent. Adaptive and well-functioning emotion regulation capacity involves allowing oneself to seek help and care from others, and be nurtured by others, in other words, developing coregulatory capacity for giving, receiving, and sharing emotions. In sessions, therapists help their clients to allow painful yet adaptive emotions that have been blocked because of the fear that these emotions are too overwhelming, disruptive, and painful. It is important to help clients identify core beliefs that were associated with these feared-to-be-felt emotions. When such emotions are processed, then the therapeutic focus shifts to processing the experience of change that the client just had: savoring and reflecting on the positive emotions that arise from facing and working through difficult emotions in order to enhance psychological flourishing.

Emotional expression and experience are always influenced by culture that shapes our reality, and provide goals, norms and values that guide socially appropriate behavior. Display rules define what emotions can be expressed to what extent to whom in a particular situation. In many East Asian cultural contexts, interdependence, interpersonal harmony, and respect for one’s seniors are privileged over independence, assertiveness, and autonomy, although this is gradually changing. Emotional expression, particularly of negative emotions, is inhibited in social contexts. The therapist, therefore, needs to help their clients understand that therapeutic situations are special situations where they can express their emotions freely and their beliefs and values about what is appropriate and what is not appropriate to feel according to their values, while being respectful of client’s meta-emotions. Furthermore, therapists need to pay attention to potential ruptures that may occur because of cultural differences between the client and the therapist. Both AEDP and EFT privilege and value the client’s subjective experience and attune themselves to the client’s moment-to-moment emotional state.

Shigeru Iwakabe, PhD, a professor in the Department of Comprehensive Psychology at Ritsumeikan University, Japan. He is the director of Institute of Emotion-Focused Therapy in Japan where he teaches, supervises, and practices both individual and couples therapy. He conducts psychotherapy research on client emotional change processes, therapeutic failures and impasses, and therapist empathy. He is also interested in cultural issues associated with practice of psychotherapy. He authored major textbooks on psychotherapy integration, psychotherapy research, emotion-focused therapy and qualitative research in Japanese. He is a past president of the Society for Exploration of Psychotherapy Integration (SEPI), a current president of the Society for Psychotherapy Research (SPR), and a cochair for AEDP Research Committee. He is a coeditor of Counseling Psychology Quarterly and on an editorial board of a number of journals including Psychotherapy, and Psychotherapy Research.

APA Videos

Accelerated Experiential Dynamic Psychotherapy (AEDP) With a Male Client
Diana Fosha

Emotionally Focused Therapy With Couples
With Leslie S. Greenberg, PhD

Emotion-Focused Therapy Supervision
Leslie S. Greenberg, PhD, hosted by Hanna Levenson, PhD

The First Session in Accelerated Experiential Dynamic Psychotherapy
Karen Kranz, PhD, RPsych

Providing Emotion-Focused Therapy Online
Rhonda N. Goldman

Working With Emotion in Emotion-Focused Therapy
Leslie S. Greenberg, PhD, accompanied by Michael A. Tompkins, PhD, and Norka T. Malberg, PsyD

APA Books

Clinical Handbook of Emotion-Focused Therapy
Edited by Leslie S. Greenberg

Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings, Second Edition
Leslie S. Greenberg
 
Grief Isn’t Something to Get Over
Mary C. Lamia
 
Multicultural Therapy
Melba T. Vasquez and Josephine D. Johnson
 
Undoing Aloneness and the Transformation of Suffering Into Flourishing: AEDP 2.0
Edited by Diana Fosha
 
Working With Emotion in Psychodynamic, Cognitive Behavior, and Emotion-Focused Psychotherapy
Leslie S. Greenberg, Norka T. Malberg, and Michael A. Tompkins

Other Suggested Resources

Fosha, D. (Ed.). (2021). Undoing aloneness & the transformation of suffering into flourishing: AEDP 2.0. American Psychological Association. https://doi.org/10.1037/0000232-000opens in new window

Iwakabe S. (2021). Working with social withdrawal, or hikikomori, in Japan: From shame to pride. Journal of clinical psychology, 77(5), 1205–1218. https://doi.org/10.1002/jclp.23151

Iwakabe S. (2019). Working through shame with an intercultural couple in Japan: Transforming negative emotional interactions and expanding positive emotional resources. Journal of clinical psychology, 75(11), 2060–2071. https://doi.org/10.1002/jclp.22864

Nakamura, K., Iwakabe, S., & Heim, N. (2022). Connecting in-session corrective emotional experiences with postsession therapeutic changes: A systematic case study. Psychotherapy, 59(1), 63–73. https://doi.org/10.1037/pst0000369

Fosha, D. (2000). The transforming power of affect: A model for accelerated change. Basic Books.