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The business of psychotherapy is largely about feelings. We tell our patients what most therapists tell patients: you have to express your feelings. Certainly, this is true: in order to be satisfied, happy, and productive in life you need to express your feelings. But the story is much broader than simply expressing your feelings. There are predecessors to the expression of feelings and there are subsequent behaviors to feeling expression.  So we have come to say that people need to: (1) know what they feel, (2) accept what they feel, (3) value what they feel…and then (4) express what they feel…before they learn to (5) correct what they have expressed…and finally (6) govern what they express.

Children do well expressing their feelings, at least until they are taught to do otherwise. Before being shamed for having feelings of sadness and disappointment, children naturally express their feelings of joy at having something and sadness at losing something. Interestingly, we often have to help people re-learn this simple phenomenon of feeling joy at loving and sadness at losing. Already by middle childhood most children seem to learn that there must be something wrong with their feelings, both joy and sadness. As a result, the feelings of joy and sadness that are love based are supplanted with feelings of defense, namely fear and anger. Most of the people that come to our offices have undue fear (usually shown in anxiety) or anger (usually shown in depression) because they have not learned the importance of these two very basic feelings of joy and sorrow.

But the story is much bigger than that, and we think that many well meaning people, as well as many qualified therapists, do not help people by suggesting that they simply need to “get in touch with their feelings and express them.” The business of feelings and expression of feelings is much bigger, much more complicated, and much harder than expressing feelings. The very competent Gestalt therapist, Joseph Zinker, said that in his workshops and therapy, there was a “lot less yelling and screaming” compared to his earlier days of therapy where such expressions were lauded and applauded as evidence of personal growth. Indeed, yelling and screaming could be very valuable as a person learns to have these angry and sad feelings, but that is not the end of the story.

The first three ingredients of “getting in touch with feelings” are knowing, accepting, and valuing all feelings. This is hard work. While Cognitive Behavioral Therapy (CBT) is valuable, we are concerned that people in therapy think before they feel. We think it should be the other way around: feel first, think second. Then we add a third: act or speak third. If CBT is too simply presented or taught, it can have the effect of repressing feelings, which will most certainly spring up at some later time. Our approach is to help people know what feelings are, namely two forces each with two feelings. The forces are love and defense. The force of love that leads to joy when I love something and the feeling of sadness when I lose something. The force of defense leads to fear and anger. All four of these feelings are valuable to know, accept, and value. We frequently say, “There is nothing wrong with your feelings,” and sometimes add, “but there might, however, be something wrong with the way you express them.” So before one expresses feelings, it is important to know what you are feeling. And, of course, the situation is complicated because I can have two, three, or four of these feelings at the same time, or alternate among these feelings. So we begin with a simple naming of feelings: joy, sadness, fear, and anger.

After knowing (and naming) feelings, one needs to accept them and value them. Accepting feelings begins with knowing that there is noting wrong with feelings, and then adds the dimension that there is something very right with feelings. Feelings are very central to what it means to be human. I need to feel fear when, for instance, I step off the curb of the road and hear a truck coming close to the curb, so I can get back on the sidewalk. I need to be angry when I am attacked so I can properly defend myself. Indeed, we spend a good deal of time trying to help people move away from the preponderance of the defensive feelings of fear and anger, but there is nothing wrong with these feelings: they keep us alive. They certainly keep an infant alive when she might, say, be choking, hungry, or simply lonely. Knowing the love-based feelings of joy and sorrow is equally important, and we strive to help people feel more joy and sadness and less fear and anger. The biggest difficulty, however, is to help feel sadness to the same degree and in the same amount of joy that they feel. We tell patients, “Whatever you love, you will ultimately lose” and follow this up with, “so you can become better at loving in the future” and “not try to hang on to things that you have lost.” So accepting and valuing feelings is valuing this whole process, hopefully over time, being more loving and less defense.

But the story doesn’t end with knowing, accepting, and valuing. There is a very important need to express feelings. But following expression of feelings, there are equally important elements of correcting these expressions of feelings, and then the most important aspect of governing expression of feelings. Since I work most with men, I continually find that men are not very fluent with expression of feelings, and usually particularly inadequate in expressing feelings of love. Sadly, many men fall into the trap of being good at joy and anger, but terrible at fear and sadness. This limitation in many men is the probable cause for the significant amount of anger and indulgence (unrestrained joy) that men express in early life followed by an equal amount of anxiety (fear) and depression (sadness) men experience in later life. It often takes me months to help men know what they feel before they can express their feelings. Most men simply have never had anyone tell them that it is good to feel sad…because it is evidence of love, and it is good to feel fear…because it is the first line of defense. So expression of feelings is good, but generally early expressions of feelings are quite inadequate. They need to be corrected.

I frequently tell my (male) patients to learn the expression, “Excuse me, I am not communicating very well yet. Please give me a moment to get my thoughts and feelings in order so that I can do better at communicating.” Instead of this self-expression most men (and women) end up saying something like, “You’re not listening. That is not what I said. You are just being defensive. You have it all wrong.” Instead of these defensive (as well as offensive) expressions, it is valuable to say some form of the popular (sport) court expression, “My bad.” It is so easy for men on the basketball court to say, “My bad” but so hard for them to say it when they are trying to communicate with women. That matter, however, is beyond the current discussion. So “correcting” an expression does not mean that I am wrong in my feelings, but rather that I have not adequately expressed them. I often tell men to begin with a precursor statement like, “I want to talk about my feelings, but this is new for me, and I don’t think I will be perfect. So I would like to ask a bit of liberty until I can express my feelings.” To my knowledge no woman in all history has heard such a statement.

Finally, after expressing and correcting the expression of feelings (not correcting the feelings, mind you), there comes the truly mature element of governing the expression of feelings. Few people ever arrive at this state in maturity. They repress their feelings and end up with colitis, ulcers, heart disease, and cancer (yes, cancer and heart disease). And equally importantly, they fail to communicate their feelings. Psychiatrist Gabor Mate’ has spoken well with this phenomenon in When the Body Says No. So if governing the expression of feelings is not repression, what is it? Governing feelings is containment of feelings. This means that the person knows, accepts, values, expresses, and corrects the expression of feelings, and then arrives at a new place in life: it is not always valuable to express feelings. But this is true maturity, and not a place where many people reside. Rather, they repress or they express, but they do not govern and contain. When I contain my feelings, I feel love: love of myself, love of the other person, and love of real and meaningful communication. But I need about 20 hours of therapy to help my readers understand governance of feelings. Or maybe you just need to wait until Deb and I publish Good Grief in which we discuss sadness, expression, and governance.

The most important word learned by most people when they are toddlers is “no.” The word no is more important than Daddy or Mommy. It is more important than love, joy, sadness, excitement, or disappointment. The word no is perhaps the first definitive statement of “self.” No defines me, or rather defines what is not me. When I say no, I am saying that I exist, that I exist separate from something or someone around me. When a toddler says no, s/he is saying I exist, I have wants, and I have rights. We shouldn’t take “no” away from our young children, or from any children for that matter. Children need to say no. Unfortunately, most children hear too many no’s, not enough no’s, or no’s that don’t remain no’s.

Saying No to children

The matter of saying no to children is fraught with difficulties. For one thing, parents use the word no way too often, which is part of the reason that no is the first primary word toddlers learn. They have heard it too much. It is much easier for parents of toddlers to yell at them and say no when their children are crawling up on the table. Parents have to get out of their chairs and then go over to their children and restrain them rather than yelling at them or saying no. Physical restraint is so much more effective, and it is something that I teach parents when they are trying to train and raise young children. For one thing, a child who feels a parent’s hands around him/her will also feel safe and feel love rather than yelling and screaming. But this is not easy to do because it means that the parent has to truly engage the child rather than just yelling at him/her.

The other difficulty of dealing with children is saying no but not abiding by the no. children learn pretty quickly that they can challenge the no, ask “Why?” and otherwise get around a parental no. I continue to be amazed, and a bit appalled, at parents who argue with their four-year old children rather than simply saying no and leaving it at that. When a child asks, “Why?” or “Why not?” the child is asking a rhetorical question, which really means, “I want my way; I want to engage my parent in some kind of rear guard action; and I have had experience in getting my way if I ask a question rather than simply saying that I want my way.” OK, children don’t actually have this exact thinking, but this is really what they are doing with these rhetorical questions. Rather than answering these questions with some kind of adult reasoning, it is better for a parent to say nothing. Saying nothing is difficult for any parent when asked “Why?” , and dare I say, it is more difficult for women who are more inclined to discussion than with men. Unfortunately, women tend to argue with their children and men tend to yell at them or hit them.

Saying no to children is, to say the least, very difficult to do, but it is essential in helping a child develop character. True character, which means among other things, that I have a genuine concern for other people, begins to develop at about eight, a bit sooner for some children and a bit older for others. But character is not truly developed until about age 12, and often much later…if at all. Sadly, many people get through childhood without developing a genuine concern for other people, or worse yet, a shame-based and fear-based artificial concern for others, which is tantamount to being afraid of disapproval or abandonment rather than a genuine concern for others.

So go ahead, and put me out of the business of seeing children, which is about a third of my practice. Say no and stick to it

Saying no to adults

If I can’t say no, my yes’s are not true yes’s. I read an interesting lead article in the most recent Psychology Today magazine (not my favorite journal, however) on the value of no. There were some interesting tips about the value of saying no. I would encourage readers to scout it out. My thoughts about saying no to people is quite simple: be honest. I often tell people, “Give all you have; give your left arm if necessary; give your life in necessary; sacrifice anything and everything if necessary. But don’t give in. Giving in is not the same as giving. Children certainly know that. An adult patient of mine said recently that his father would always say no to Jim when he asked to go out on an evening, but then would almost always give in with some kind of shame-inducing glance together with a $20 bill. Of course, Jim took the $20 and went out, but it was always with a lingering, “I’m not worth this” together with some kind of, “I’m going to have to pay this back somehow.” Jesus said, “Let your yes’s be yes’s and your no’s be no’s.” I couldn’t say anything to add to this simple profound statement. But if you say no to people, be prepared for your own feelings of shame coming up more than the disappointment you might hear from your friends. When I say no to someone, I should feel sad, not ashamed, not afraid of rejection, and not afraid of disapproval. Sadness is born of love. Shame is born of fear. I go for love. But it is not easy.

The practical part of this saying no to adults leads to all kinds of challenges and potential difficulties. For one thing, when I say no, I will probably disappoint my friend (or relative), and no one really likes to disappoint people. Secondly, it probably took some courage for my friend to ask me for something, and s/he will feel some kind of hurt. S/He might even be angry or punitive. S/He might ask a childlike rhetorical question like, “Why can’t you loan me that $5000. You make $100,000 more than I do.” More importantly, however saying no to my friend will cause a distance and a separation between and my friend. Separation/distance is difficult; it is sad. Recall, however, sadness is born of love. If I love someone and want to say yes, but I can’t truly and honestly say yes, I still love that someone. And perhaps my saying no is actually good for the other person in some way that I can’t fathom.

Saying no to yourself

I am a bit of a candy-holic. Not awfully addicted, but I “can’t eat just one” when the M&M’s are on the table, or the cookies, or the donuts. I can stay away from ice cream and cake a bit easier, but not much. So from time to time, like today, I am again swearing off all sweets until I can again get a hold of my addiction to sugar. All the dietary knowledge in the world won’t really get me to stop eating sweets. I have to discipline myself against them. I don’t like it. I want to gorge on donuts. I need to say no to this tendency to gorge.

Saying no to me is also related to saying no to someone else, especially people whom I truly love. When I say no to a loved friend, I probably really want to give him/her whatever that person wants, but for some reason, I shouldn’t give…because giving to that person would be giving in, not giving. So saying no to me is also love-based. I love myself, and as a result, I want to take care of my body. So my saying no to sugar is loving me…even though I don’t like it.

Many more no’s. A few genuine yes’s. And very few maybe’s.