Using alba emoting to work with emotions in psychotherapy
Clinical Psychology and PsychotherapyClin. Psychol. Psychother. (2011)Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/cpp.790
Practitioner ReportUsing Alba Emoting™ to work with emotions inpsychotherapy
Juan Pablo Kalawski*Counseling Center, University of Louisville, Louisville, KY, USA
Alba Emoting™ is a physical method to help recognize, induce, express and regulate the basic emotions. This is achieved through speciﬁc breathing, postural and facial behaviours. Alba Emoting is based on psy-chophysiological research by Susana Bloch and her collaborators, who have applied this method mainly totrain actors. Alba Emoting can be used in psychotherapy to facilitate emotion awareness, regulation andtransformation. It can also help therapists better recognize their own and their clients’ emotions. Theapplication of Alba Emoting in psychotherapy is illustrated with a case example. Copyright 2011 JohnWiley & Sons, Ltd.
Key Practitioner Message:• Alba Emoting is a physical, scientiﬁc method for working with emotions.
• Alba Emoting can help therapists better recognize their own and their clients’ emotions.
• Alba Emoting can help clients achieve better emotional awareness and regulation.
• Alba Emoting can also help clients experience and express emotions they may normally inhibit.
Keywords: Alba Emoting, Emotions, Psychotherapy, Breathing, Basic Emotions, Body
In the minds of laypeople, emotions are central to the work
been in theatre. Even when Alba Emoting is used in a con-
of psychologists. Yet for decades, psychological theories
text other than psychotherapy, it often has therapeutic
viewed emotions as third-class phenomena, after behaviour
effects. The next two sections of this paper summarize
and cognition. In recent years, psychological science has
the Alba Emoting method. The following section will
ﬁnally began to acknowledge that emotions are not just
review the rationale for the application of Alba Emoting
epiphenomena but rather serve important functions in
in psychotherapy. Finally, I will present a case example.
organizing thoughts and behaviour. Understandably, theo-ries of psychotherapy have lagged behind in integratingthe science of emotions into clinical practice. Lacking a the-oretical understanding of emotions and speciﬁc methods to
work with them, therapists fall back on what they know,that is, working with behaviours and thoughts and hoping
In the early 1970s, Susana Bloch and Guy Santibáñez
that emotions follow suit. Slowly, however, theorists like
started a research program to study the physiological
Leslie Greenberg and his colleagues (e.g., Greenberg, 2004;
changes occurring during different emotions (Bloch &
Greenberg & Paivio, 1997; Greenberg, Rice, & Elliott, 1993)
Santibáñez-H, 1973; Santibáñez-H & Bloch, 1986). They
have begun to present coherent approaches to working
asked professional actors to relive different emotions. They
with emotions in psychotherapy. The aim of the present
also hypnotically induced those emotions in participants
report is to present the applications in psychotherapy of a
with anxiety disorders and participants with no psycho-
speciﬁc method for working with emotions. The method is
pathology. In these experiments, Bloch and Santibáñez were
interested in six emotions that they considered basic: joy,
Alba Emoting is not a method of psychotherapy. It is
sadness, fear, anger, eroticism and tenderness. Bloch and
rather a method for working with emotions that can be
Santibáñez (1973; Santibáñez-H & Bloch, 1986) found that
applied to psychotherapy as well as to other ﬁelds. The
several physiological changes accompanied each of these
most developed application of Alba Emoting so far has
emotions. Of those changes, the most distinguishing featureamong the different emotions was a speciﬁc breathingpattern. These studies conducted in Chile are unique in threeways: ﬁrst, Bloch and Santibáñez (1973; Santibáñez-H &
*Correspondence to: Juan Pablo Kalawski, Counseling Center, Uni-versity of Louisville, Louisville, KY, USA.
Bloch, 1986) measured actual breathing behaviour while
participants were experiencing real emotions, as opposed to
Copyright 2011 John Wiley & Sons, Ltd.
Figure 1. Recordings of prototypical breathing patterns for each basic emotion. From ‘Reproducing emotion-speciﬁc effector pat-terns: A bottom-up method for inducing emotions (ALBA EmotingW)’, by S. Bloch, S. Paulet, and M. Lemeignan, 1994, Proceedingsof the 8th Conference of the International Society for Research on Emotions (N. H. Frijda, ed.), pp. 194–199.
asking people to remember how they breathe during emo-
recordings obtained from subjects experiencing the six basic
tional episodes. Second, they studied discrete emotional epi-
emotions (Bloch, Paulet, & Lemeignan, 1994).
sodes as opposed to emotional disorders or emotional traits.
Other changes that were somewhat distinguishing of par-
Third, they reported the form of the breathing cycle—
ticular emotions were facial expressions and body postures
involving parameters such as amplitude, frequency, the
(Bloch & Santibáñez-H, 1973; Bloch et al., 1994; Ekman &
presence or absence of saccades1 and expiratory pause—
Oster, 1979; Hatﬁeld, Cacioppo, & Rapson, 1994; Lemeignan,
and not just isolated variables or breathing output such as
Aguilera-Torres, & Bloch, 1992; Levenson, Ekman, & Friesen,
oxygen consumption.2 A later study with Danish partici-
1990; Santibáñez-H & Bloch, 1986). All these behaviours have
pants (Bloch, Lemeignan, & Aguilera-Torres, 1991) showed
the special feature of being under both voluntary and auto-
that the distinction among breathing patterns for the differ-
matic control (unlike other changes present during different
ent emotions could be shown not only qualitatively but
emotions such as heart rate and blood pressure).
quantitatively as well. Figure 1, taken from a summary
Bloch and Santibáñez (1973; Santibáñez-H & Bloch, 1986)
presented at a conference, shows actual pneumographic
investigated what happened if they asked a person to repro-duce the respiratory-posturo-facial patterns for eachemotion without naming the emotion. They found that this
1‘Saccade’ usually refers to small, rapid, intermittent eye movements.
procedure could activate the rest of the emotional system,
Here, the term refers to small breathing movements superimposed on
namely the subjective experience of the person and auto-
nomic changes such as heart rate. Several studies have
It is unfortunate that no other researchers have studied the relation-
ship between emotions and breathing in this same way, but it is never
reported this phenomenon under different circumstances
too late to conduct similar studies.
(Bloch, Orthous, & Santibáñez, 1987; Bloch et al., 1994; Bloch
Copyright 2011 John Wiley & Sons, Ltd.
& Santibáñez-H, 1973; Ekman, Levenson, & Friesen, 1983;
experience. Most of the time, participants report feeling the
Levenson & Ekman, 2002; Levenson, Ekman, & Friesen,
target emotion. Sometimes, however, participants may
1990; Riskind, 1983; Santibáñez-H & Bloch, 1986). On the
report no emotion, a different emotion or a combination of
basis of these ﬁndings, Bloch et al. (1987) developed a
the target emotion and another emotion. There is a corre-
method for emotional induction based on the reproduction
lation between the correctness of the pattern and the likeli-
of the respiratory-postural-facial emotional patterns. Bloch
hood of feeling the target emotion (Bloch et al., 1994).
(2006) called this method ‘Alba Emoting ™’. The method also
The last day in an introductory workshop is devoted to
includes a ‘step-out’ technique. This technique, also based on
reviewing all the patterns and working on the partici-
speciﬁc breathing, posture and facial actions, is designed to
pants’ ability to modulate their intensity, switch from
stop the emotional activation and bring the person back to
one emotion to another or switch from any pattern to the
an emotionally neutral state. Alba Emoting is thus a physical
neutral state. This is often done in games. For example,
method to help recognize, induce, express and regulate the
participants may be asked to perform the same action
basic emotions. Bloch and her colleagues have used it in
while doing different emotion patterns. One interesting
several countries as a tool for teaching actors how to express
exercise is saying a phrase while in one emotion and then
emotions (Bloch, 1993, 2006; Bloch et al., 1987).
again with a different emotion. Both the performer andthe rest of the participants get to see how the same phrasecan have different meanings under different emotions.
As previously stated, more advanced training in Alba
Emoting is usually tailored to the needs of the trainee. In
Bloch et al. (1987; Bloch, 2007) have developed a way to
the case of actors, the main goal is for them to perform the
train people in the Alba Emoting method. Most of those
patterns with enough accuracy and speed to convincingly
who have participated in this training are actors. Other
portray emotions on stage. For other participants, it may
performers, like dancers and musicians, have also partici-
be more important to be able to identify emotions both in
pated in Alba Emoting training, as well as psychologists,
themselves and in others. Alba Emoting training in a work-
business people and laypeople interested in emotions.
shop format can have therapeutic effects. In addition, Alba
The basics of the training are the same for all these groups,
Emoting can be incorporated into standard forms of psycho-
whereas more advanced training varies according to the
therapy. In the next section, I provide a theoretical frame-
trainees’ needs. The ﬁrst step in training is an introductory
work for the therapeutic usefulness of Alba Emoting.
workshop. Such workshops normally last 5 days, more orless. The goal of these workshops is to introduce partici-pants to the respiratory-posturo-facial patterns of the sixemotions, the neutral pattern and the step-out technique.
After an introductory workshop, participants are not yet
One of the more recent areas of application of Alba Emot-
qualiﬁed to teach the emotional patterns to others, only
ing is psychotherapy. I pioneered the exploration of this
to use them on themselves. The only technique partici-
application in my unpublished thesis (Kalawski, 1997).
pants can safely teach others is the step-out technique.
In this article, I would like to ﬁrst present a conceptual
The correct reproduction of the respiratory-postural-
framework for the application of Alba Emoting in psycho-
facial patterns can be physically challenging. For this
therapy, and then discuss a clinical case.
reason, most of time in an introductory workshop is
Greenberg (2004) proposed three principles for working
devoted to preparatory physical exercises. Some of these
with emotions in psychotherapy. The principles are (1)
exercises are intended to improve the participants’ ability
increasing awareness of emotion; (2) enhancing emotion
to bring different muscle groups under voluntary control.
regulation; and (3) transforming emotion. Alba Emoting
Although Alba Emoting relies on voluntary muscles,
can serve in the implementation of each of these principles.
many people have difﬁculty isolating speciﬁc musclegroups, or adjusting their muscle tone at will. Anothergoal of the preparatory exercises is to improve voluntary
control of breathing, including breathing rhythm andabdominal versus thoracic breathing. Interspersed among
The importance of emotional awareness for therapeutic
the preparatory exercises there is speciﬁc training on the
change is widely acknowledged. Some clients can easily
respiratory-posturo-facial pattern for each emotion. Each
identify their feelings, whereas others have great difﬁ-
pattern is always taught without ﬁrst naming the emotion
culty. Often, clients may only be able to identify being
it corresponds to. This way, participants are encouraged to
‘upset’ or ‘stressed’ without further elaboration. A ﬁner
report any feelings they may have, and not ‘try’ to feel
distinction among emotions may help clients better
anything in particular. After working on each emotional
identify their associated needs and action tendencies. For
pattern, participants are encouraged to discuss their
example, the impulses associated with anger are not the
Copyright 2011 John Wiley & Sons, Ltd.
same as those associated with fear. Alba Emoting provides
of the step-out technique, by contrast, is to achieve a relaxed
a clear and physical way to distinguish among different
yet alert state. In the step-out technique, the person is stand-
emotions. When a client has experienced the respiratory-
ing up and with his or her eyes open. The goal is to be aware
postural-facial patterns of the basic emotions, he or she
of one’s environment, as opposed to looking inward.
is subsequently better able to recognize when those pat-
Many psychotherapists teach their clients different types
of relaxation techniques. However, in my experience in
An additional advantage of Alba Emoting in promoting
several settings in Chile and USA, I have found that the
emotional awareness derives from the fact that the
vast majority of these therapists have no speciﬁc training
method provides a way to experience emotions without
in these techniques. They usually read a script to the client
an external stimulus. Often, people hold beliefs about
or, more commonly, give the scripts to clients for them to
when it makes sense to experience particular emotions.
practice at home. Clients may still beneﬁt from this type
For example, a client may be angry in a situation but have
of ‘relaxation training’. However, it presents several prob-
difﬁculty recognizing it because anger is not the emotion
lems. First, the therapist reading the script may not be
she would expect to have in that situation. Alba Emoting
relaxed. Second, having practiced a technique personally
provides clients the opportunity to experience emotions
helps one anticipate possible difﬁculties a client may have.
as distinct from their purported causes. This helps client
Finally, it is harder for a client to trust a therapist who
practice the distinction between direct experience and
does not practice what he or she teaches. Alba Emoting
training is one of several ways for therapists to obtain
As Greenberg (2004, p. 8) pointed out, ‘emotional aware-
hands-on practice in relaxation and emotional regulation.
ness is not thinking about feeling, it involves feeling the
In addition to the step-out technique, a typical Alba Emot-
feeling in awareness’. Thus, emotional awareness necessi-
ing workshop includes standard techniques such as
tates actual emotional experience. This process, however,
abdominal breathing or progressive muscle relaxation to
can be blocked by emotional avoidance. Often, clients avoid
help participants improve control of their breathing and
experiencing painful feelings due to fears of being over-
muscle tone. Such control is necessary to correctly execute
whelmed by them, of being out of control or of not being
the respiratory-postural-facial patterns.
able to calm down afterwards. Alba Emoting can be a
When discussing emotional regulation, it is important to
valuable resource in helping clients deal with these concerns.
distinguish it from repression or inhibition. Often, clients
Alba Emoting is empowering, as it provides clients with a
may suppress their emotions with body tension. This may
tool to step in and out of an emotion at will. The usefulness
not only lead to health problems; it also interferes with emo-
of the step-out technique as a means for emotional regula-
tional awareness. My training in Alba Emoting has helped
tion will be discussed in the next section. The emotional
me be more aware of when clients are suppressing their feel-
induction (the ‘step in’ part) via the respiratory-postural-
ings. For example, knowing that breathing is an important
facial patterns may help clients experience emotions as more
element in emotion, I have noticed that many clients literally
familiar. Willingly entering into an emotion through breath-
hold their breaths when discussing painful topics. I have
ing can help clients own their emotions and experience them
even seen clients pinch their noses to avoid crying. I have
as something that they do as opposed to something
also noticed that people sometimes unconsciously try to con-
trol their emotions by doing the opposite of the emotion’smovement pattern. For instance, in sadness, the gaze isprototypically down. I have seen people looking up to try
to stop themselves from crying. In contrast to these examplesof emotional suppression, the step-out technique does not
Even though emotional experience is both an adaptive
involve ‘choking’ an emotion. It does actually calm it down.
human response and a necessary element in deep thera-
Often, emotions are responses to events one must deal with.
peutic change, emotions can sometimes be maladaptive. Al-
Obviously, the step-out technique does not solve or eliminate
though it is difﬁcult to work therapeutically with clients who
these events. But often, emotions perpetuate themselves via
are emotionally constricted, it is also difﬁcult to work with a
cognition–emotion loops in a way relatively independent
client while he or she is experiencing intense, overwhelming
from external events (Lewis, 2005; Lewis & Granic, 1999).
emotions. In this respect, the Yerkes-Dodson Law may also
The step-out technique helps break this cycle, allowing one
apply to psychotherapy in that there is an optimal level of
emotional arousal that is most conductive to therapeuticchange. The step-out technique can be an important tool tohelp clients regulate their emotions. It is in a way similar to
deep breathing techniques usually taught to clients. Themain difference is probably that sometimes deep breathing
The cognitive-behavioural therapies have popularized the
is used as a part of a deep relaxation routine. The objective
concept of coping to the extent that many of my clients ask
Copyright 2011 John Wiley & Sons, Ltd.
for help ‘coping’ with depression or anxiety. I often say I
warrant it and even though they may wish they could feel
can help with that and suggest we may also try to help
angry or sad. Some clients have great difﬁculty feeling
the client not be depressed or anxious. The difference be-
sexually aroused. Many of these clients may even have a
tween coping with anxiety and not being anxious is the
good deal of insight into the origin of these blockages
difference between emotion regulation and emotion trans-
but are still unable to overcome them. Traditional tech-
formation. This is how Greenberg (2004) explained the
niques for accessing emotions such as empty chair work
or imagery are often not effective in these cases. AlbaEmoting provides a unique way for clients to access these
Although the more traditional ways of transforming emo-
emotions through the reproduction of their speciﬁc
tion either through their experience, expression and com-
pletion or through reﬂection on them to gain newunderstanding do occur, we have found another processto be more important. This is a process of changing emo-tion with emotion. This novel principle suggests that a
Alba Emoting and the Therapeutic Relationship
maladaptive emotional state can be transformed best byundoing it with another more adaptive emotion. In time
The three principles of emotion awareness, regulation and
the coactivation of the more adaptive emotion along with
transformation are effective to the extent that they occur
or in response to the maladaptive emotion helps transform
within a good therapeutic relationship. Rogers (1957) pro-
posed that in such a relationship, the therapist experiences
Schemes of different emotional states (. . .) are synthe-
and expresses empathy, genuineness and warmth. It
sized to form new integrations. Thus in therapy maladap-
should be clear by now that training in Alba Emoting
tive fear, once aroused, can be transformed into security
can only aid in the development of empathic attunement,
by the more boundary-establishing emotions of adaptive
as it helps the therapist better recognize the non-verbal
anger or disgust, or by evoking the softer feelings of com-
signs of the basic emotions. In addition, the basic emo-
passion or forgiveness. Similarly maladaptive anger can
tions framework (e.g., Bloch, 2006; Izard, 2007; Kalawski,
be undone by adaptive sadness resulting in acceptance.
2010) helps therapists conceptualize the endless variety
Maladaptive shame can be transformed into acceptance
of affective phenomena as arising from a few basic emo-
by accessing both anger at violation, self-comforting com-
tions. Greenberg and Paivio (1997) proposed that it is use-
passion and by accessing pride and self-worth. (. . .)
ful for therapists to distinguish between basic emotions
Withdrawal emotions from one side of the brain are trans-
and the more complex emotion schemes derived from
formed by approach emotions from another part of the
brain or vice versa (Davidson, 2000). (p. 12)
These [basic] emotions are attended to and expressed in
Greenberg (2004) described several ways for therapists
therapy in order to access the adaptive information and
to facilitate this process. One of these is shifting the client’s
action tendency to guide problem solving. They are core
and irreducible responses and therefore are not exploredto unpack their cognitive-affective components. For
Shifting people’s focus of attention to pay attention to a
example, anger at maltreatment is a primary, irreducible,
background or subdominant feeling is a key method of
and core emotional response that needs to be evoked and
helping them change their states. The subdominant emo-
symbolized in therapy in order to access the adaptive
tion is often present in the room non-verbally in tone of
action tendency to push the offender away and establish
voice or manner of expression (p. 12).
For example, some clients may have experienced debili-
Alba Emoting can also help develop therapists’ genuine-
tating or paralyzing fear in a traumatic situation. When
ness as it helps them become better aware of their own emo-
the client recalls this situation in the session, the empathic
tions. Finally, I see Rogers’ condition of warmth as closely
therapist may notice that, in addition to fear, the client
related, if not identical to, tenderness. Alba Emoting should
experienced other emotions too. Helping the client pay
not (and probably cannot) be used to artiﬁcially manufacture
attention to the subdominant feeling helps transform the
tenderness. Rather, knowing the respiratory-postural-facial
dominant emotion. A therapist with training in Alba
pattern of tenderness may help therapists notice when they
Emoting may be better able to recognize non-verbal signs
are not experiencing or expressing that emotion. The tender-
ness pattern may then help therapists access tenderness in
Some clients have great difﬁculty experiencing particular
themselves. However, I believe that this should only be done
emotions in almost any context. For example, some clients
when the therapist already believes that the client deserves to
never get angry or sad, even when the situation may
be regarded with tenderness. If this belief is not present, it is
Copyright 2011 John Wiley & Sons, Ltd.
probably better to begin by exploring the thoughts and feel-
would ask him about what he felt ‘right now’, he would
ings the therapist does have about the client.
say he felt ﬁne, in spite of his clear display of anxiety. Robert
Finally, I want to make clear that training in Alba Emot-
understood that he had difﬁculty being in touch with his feel-
ing is not sufﬁcient to develop a positive therapeutic rela-
ings, so we agreed to work on helping him increase emo-
tionship. This is an art that requires guidance, discipline
tional awareness using embodiment exercises. We started
and experience. However, an embodied understanding
with a centering exercise. I asked the client to sit on the desk
of human emotions can only help in this regard.
chair and adjust its height. Then I coached him through anabdominal breathing exercise. At the end of the exercise,Robert reported feeling ‘focused’. He added that the exercise
helped him realize that he had been constricting his breath. He also became aware that earlier in the session he was ‘more
Robert was 36 years old when I ﬁrst met him. He was
anxious than [he] realized’. Robert requested to do this kind
referred to me by a therapist colleague who led a process
of exercise in future sessions and I agreed.
group in which Robert participated. My colleague said
On session 3, Robert reported that he was still sleepy
that Robert had attended this group for several years,
being just after 8 AM. I began teaching him the step-out
but he had much difﬁculty exploring and expressing his
technique. Robert had difﬁculty but reported being more
emotions. Thus, my colleague thought I might be able to
awake. Then we began discussing the client’s desire to
help Robert with this. Robert readily accepted the referral.
‘connect’ with people. Robert’s discourse quickly became
When Robert was 5 years of age his father suffered a
intellectual and detached despite my asking questions
brain injury. The father thereafter would behave erratically
about his feelings. I pointed out this observation and
and had difﬁculty relating to people. His intellectual ca-
asked the client if, instead, he would like to try a body
pacity was clearly diminished. Robert’s mother apparently
exercise that may have to do with connection. Robert
could not deal with this situation emotionally and pretty
agreed enthusiastically. I coached him through the respira-
much withdrew. The client was told, for instance, not to
tory-postural-facial pattern of tenderness. He did OK but
let anyone know about his father’s condition because his
had much difﬁculty smiling. I wondered if Robert’s facial
mother was embarrassed by it. Robert’s memory was that
muscles were under-exercised. His breathing also appeared
his mother could not deal with his emotional needs be-
slightly forced. We ended with the step-out procedure.
cause of the stress of his father’s illness, so he learned to
Robert reported a feeling of ‘calm’ and ‘almost like happi-
stiﬂe his emotions. The client felt he never had any emo-
ness’ during the tenderness pattern. He did not report
tional support or any emotional outlet at home. He did
tenderness or any memories. He also reported having fewer
well in school, which he experienced as a relief from the
thoughts than usual, which he considered positive. Robert
pressures of being at home and helping to care for his
expressed that he was not sure where the body exercises
father. He went on to college and graduated at age 24. By
would lead but trusted my intention to help him.
the time I started working with Robert, he had achieved
During the fourth session, Robert appeared to be more
a considerable degree of professional success.
aware of his feelings. He talked about his distrust at work,
In addition to his participation in group therapy, Robert
which he related to a fear of people ﬁnding out that he is a
had previously had individual therapy for anxiety and
fraud. We agreed to use a two-chair dialogue (Greenberg,
depression. One of his biggest concerns was that he chroni-
Rice, & Elliott, 1993) to explore his self-criticism of being a
cally cheated on his girlfriends or had several girlfriends
fraud. Robert expressed that the exercise helped clarify the
going at once, unbeknownst to each other. Robert expressed
conﬂict he felt between a critical side, which was much fo-
that he had little feelings either for these women or about
cused on money and prestige, and an experiencing side
his behaviour. However, he understood that his behaviour
that did not care about these things.
was not right. When I started working with this client, he
On the next session, Robert discussed his fear of ‘screw-
had been in a committed relationship for a few years with-
ing up’ his relationship as he had done with past relation-
out cheating. However, the client continued to experience
ships. I asked him to express his doubts about himself to
depression and anxiety. Robert expressed being clueless
himself in an empty chair. He told the other part of him
about the sources of his depression. He seemed to have
that he is getting into a big commitment by getting mar-
previously attributed it to external stressors, but when we
ried. The other side dismissed the signiﬁcance of the com-
began treatment, he reported that his life was good, so he
mitment, saying that he was ready to leave if there are
did not know why he felt depressed. Robert was also taking
difﬁculties. The original side was shocked at this response
Lexapro and Trazodone prescribed by a psychiatrist.
and wondered how genuine the other side’s dismissal
To me, the most remarkable thing about Robert’s presenta-
was. That side, in turn, expressed fear that if he allows
tion was that he chronically displayed the respiratory-
himself to care, he will be hurt. I attempted to explore this
postural-facial pattern of fear. His breathing was sometimes
fear, but Robert switched to a conceptual mode of proces-
audible. Robert complained of depression; however, when I
sing discussing his past patterns in relationships.
Copyright 2011 John Wiley & Sons, Ltd.
On session 6, Robert reported that he had been more anx-
He said that it was good to cry because it showed to him
ious than usual. I asked him to describe the physical sensa-
that he cared. Up to that point, Robert had expressed
tions associated with his anxiety. He described energy in his
doubt over whether he cared about others at all. We ended
arms and hands and showed this by clenching his ﬁsts and
briskly waving his arms. Even though these sensations are
During the next session, Robert expressed that he had a
consistent with anger, Robert considered them anxiety. He
hard time ﬁnding what to talk about due to his stressful
could not understand where this ‘anxiety’ was coming
week. We agreed to try a ‘clearing a space’ exercise
from, so we agreed to explore it through breathing exer-
(Greenberg et al., 1993), which Robert completed success-
cises. We did some work with the step-out technique, and
fully. He chose to focus on his reaction to several difﬁcul-
Robert reported that it helped him reduce his anxiety. Then
ties people at work had recently shared with him. As we
I introduced part of the anger pattern, speciﬁcally the exha-
explored this reaction, Robert discovered that dealing
lation, followed by a return to neutral. Robert expressed
with people both brought him happiness and over-
that he felt an impulse to ‘push away’. We agreed to con-
whelmed him sometimes. He also noticed that he tended
tinue exploring emotions through breathing.
to distrust his feeling of being overwhelmed and instead
During the next session, Robert reported that he had been
tried to conform to injunctions about how social to be.
trying the exhalation breathing that I taught him the previ-
This dialogue gave me the impression that Robert was be-
ous week to reduce his anxiety. I said that it would make
coming more aware of his feelings and needs.
sense that it would reduce it. However, I discouraged the
At the beginning of the next and last session, Robert
client from using that breathing on his own. I gave him
appeared mildly anxious. We started out with the step-
some theoretical background on Alba Emoting. I explained
out exercise, as usual, but the mild anxiety lingered for a
that the breathing we practiced the previous week was part
while after that. He reported feeling stressed about several
of the pattern of a speciﬁc emotion and that we could
issues, most importantly the preparations for his upcom-
explore that emotion in therapy. I told Robert that the
ing wedding. I coached Robert though the ‘clearing a
step-out technique was the only breathing pattern I recom-
space’ exercise, which allowed him to feel his desire to
mended he use outside of our sessions. He agreed. I
rest. He went on to explore his feelings about the commit-
provided additional coaching on the step-out technique
ment involved in marriage. The client noticed that he did
and then I taught Robert the fear pattern, as always, with-
not have the urge to cheat on his ﬁancée and added that this
out naming the emotion. The client performed it fairly well.
was a discovery for him. Robert talked fondly about his
After the step-out, Robert reported having felt ‘panic’. He
ﬁancée. He reported feeling good about the relationship
had a memory of having had the same feeling as a child,
but also wondering why she loved him. I encouraged him
although he could not recall in what circumstances. He also
to ‘make space’ for feeling good. He expressed that it was
realized that, in situations when he felt ‘paralyzed’, he had a
a surprise to learn that he can make space for positive feel-
similar feeling. Robert expressed that it was useful to under-
ings. On this session, Robert and I agreed to begin spacing
stand his reaction as fear. I encouraged him to pay
out our meetings, with an eye towards ending therapy.
attention to the bodily signs of fear in his life.
Eventually, however, he had to cancel his follow-up
On the eighth session, I asked him if he had identiﬁed
appointments, but he indicated that he was doing very well
more situations in which he felt fear. He said that he felt
fear when thinking about the possible consequences ofhis actions: the thought of being responsible overwhelmedhim. Robert showed a deeper level of experiencing (Klein,
Mathieu-Coughlan, & Kiesler, 1985) than I had observedbefore. Exploring the client’s fear of responsibility, he said
In this section, I would like to discuss how Alba Emoting
that a former employee of his had killed herself some time
helped with Robert’s emotional awareness. Clearly, his
ago. Robert expressed guilt for not having done more for
emotional awareness was deﬁcient. This led him to act on
her. I framed this as unﬁnished business and suggested
impulses that he did not understand when he cheated on
empty chair work (Greenberg et al., 1993), to which
previous girlfriends. Even when he stopped engaging in
Robert agreed. Robert expressed that he missed the
this behaviour, he was unable to trust that this change
employee and that her suicide was unexpected. In the role
would continue. In addition, even though Robert often
of the employee in the other chair, he expressed that sui-
appeared anxious, he was not aware of this feeling. I think
cide had been her way to end her pain and that it was
that the respiratory-postural-facial pattern of fear helped
not Robert’s fault. The client responded expressing his
him become aware of his anxiety by (a) bringing attention
pain about the employee’s death. Robert cried for the ﬁrst
to his body and (b) intensifying the emotion. Following this
time since we began therapy. He then said goodbye to the
experience, Robert was able to recognize this pattern in
imagined employee in the empty chair. After the exercise,
daily life and eventually connect these physical sensations
Robert expressed that he felt he had ﬁnished the dialogue.
to thoughts of having to be responsible. This realization in
Copyright 2011 John Wiley & Sons, Ltd.
turn led to an awareness of the meaning for him of his
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Efectos Adversos de la Terapia Antirretroviral Dr. Raúl Gutiérrez Rodríguez, Dr. Leslie Soto Arquiñigo Médicos del Instituto de Medicina Tropical Alexander von Humboldt de la Universidad Peruana Cayetano Heredia Glóbulos rojos en condiciones de anemia Los efectos adversos han sido reportados con el uso de casi todos los antirretrovirales y son una de las condiciones
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