Why Processes Matter In Clinical Science

I was about three years into grad school in clinical psychology before I felt I understood emotions. I think there are some wise people who do get emotions without specialized training – but that was not me.

I was listening to my friend Mary go on about ‘processing’ emotions and thinking to myself, with some shame and frustration, what the heck is she talking about? I was trying to put the elements together:

- Emotions communicate information
- Emotions motivate action, hopefully adaptive action
- Somehow, sometimes, crying helps me feel amazing…

And then it clicked for me: process is about being in motion. Absorbing the signal that emotion presents; feeling it; and as a result changing – yielding to the stimulus of the emotion and in doing changing the emotion itself. Instead of freezing in avoidance, unfeeling stillness – like keeping really still to avoid feeling the pain of a torn muscle – processing is about the truth that emotion can teach us how to move on – even if we need some external stimulation help to get started in the right direction (or in my case, several years of graduate training…).

Later on, I came to understand how this insight of mine about process speaks more broadly to the value of understanding psychological processes in our work as clinicians.

It’s like this:

On the one hand, we have diagnoses that put people into categories. You are depressed. You are depressed and have generalized anxiety. You have OCD. You are a borderline. And so on.  But all of this categorization is like saying, with respect to the weather, ‘it’s raining’ or ‘it’s 67 degrees.’ It’s a static picture. It leaves context out.

And then insidiously it tends to make us focus on what the label says rather than what’s left out. We end up responding to the label more than to the person. We make the person less than whole.

It would be like – referring back to my post last year about cooking – someone critiquing my steak by saying ‘This steak is 110 degrees.’ The only reason that static description is valuable to me is because I know how to change it. Knowing the label without knowing how to change it is at best a non-event, at worst depressing. It’s like when a doctor diagnoses your very painful affliction with a label starting with ‘idiopathic, treatment resistant…’ Thanks for giving me a very fancy label for the fact that we don’t know what the heck is going on.

But what is happening – what happened before, what will happen next? What can I do about it?

Working with process is about working with wholeness in motion. Wholeness in the sense that we are all susceptible to these processes – we share a common humanity. Wholeness in the sense that there are many parts of us, capacities in motion. Here are some examples of transdiagnostic approaches to psychopathology by Harvey et al. (2004) and Frank and Davidson (2014). There is also a growing body of research showing that certain processes are active across different types of psychotherapy; here is an example by Arch et al.(2012).

So at PracticeGround and in our home organizations like ABCT or ACBS: instead of treating depression, we work on activation and avoidance and mindfulness.

Instead of targeting anxiety, we work on approach and flexibility and values.

Instead of borderline personality disorder, we work on emotion regulation, self awareness, and building a life worth living.

We work on these processes – not just with our clients but with ourselves, because we are whole too.

This month, we are launching a new on-demand course on the process of building and connecting to values. The skills you’ll learn in this course are relevant to a variety of psychological issues and can be applied within different clinical traditions. You’ll learn principles and techniques step-by-step through engaging didactics, exercises for yourself and for your clients, and many video-demonstrations of therapy interactions.