Your feelings are the key to positive change

It's possibly one of the more frequent questions you'll be posed in a therapy session. And it's also one of the most important. Because I think that underlying all mental health issues is a difficulty in managing or regulating our emotions - maybe we overcontrol them, or maybe we don't control them enough, in the case of anxiety or anger. But often it's our fear of emotions and what we do to avoid them that causes problems.

Some people use alcohol, drugs or some other addiction to cope with, or avoid, their otherwise overwhelming feelings. Others may swallow their feelings by binge-eating or, alternatively, starve themselves as a way of feeling more in control. You might have developed a protective false self that lacks any emotion, but serves to please and adapt to others in social situations - just like you were forced as a child to try and keep your parents happy and ensure your own survival in a dysfunctional home. Or you might 'cover' the real emotion with a surface one - get angry, when actually you're sad; or conversely, struggle with anxiety and panic, when actually you're really angry over childhood losses. The ways we try to avoid feelings are many. The trouble is, the feelings never really go away; they remain, influencing us outside our awareness.

For example, a client who, as a child, was taken into care from a violent home, learned to cope by numbing himself emotionally. Then, it helped Charlie* (not his real name) to survive, as he got moved around several foster homes, by protecting him from full awareness of the frightening reality and insecurity of his situation. But now, as an adult, his continued avoidance of his feelings of sadness, fear, loss and hurt meant he came across as 'flat', lacking energy in all he did and also struggled with chronic indigestion - a common consequence of holding tension in your stomach. Charlie's colleagues didn't know much about him and he had never had a relationship with a woman, just fleeting sexual encounters that didn't demand anything of him emotionally. He also drank excessively. The one emotion he was very familiar with was anger. He found himself lashing out in incidents of road rage - the release of tension such outbursts gave brought him a temporary relief from the high levels of arousal that go with feelings like sadness and hurt. Charlie didn't understand his behaviour and felt powerless to change it; he just tried not to think about the past.

But how could facing such painful feelings help Charlie? It might seem to make sense to avoid feeling so bad if you possibly can. However, not dealing with the emotions associated with past pain means you lose the opportunity to be transformed and instead remain trapped in the bad feelings. While facing the feelings can be frightening and exhausting, subsequently it makes us feel more real, more whole, more connected. And after years of avoiding feelings and the huge energy that requires, the relief can be great.

Critical to how we deal with emotion, found psychoanalyst John Bowlby, are our early attachment experiences - that is, how we are treated by those who matter most to us as a child; our everyday interactions with them and whether we feel safe and secure or not. Usually, the mother provides a "secure base'' for a child from which to explore the world, offering a "warm, intimate and continuous" relationship. We go on to develop an internalised secure base - essentially, a symbolic image in our minds of our attachment figure - that helps us to regulate or manage our emotions throughout life. As psychologist David J Wallin says, being able to turn to this reassuring internal presence makes us emotionally resilient because it allows us to self-soothe, and this is the key to a healthy, strong self-structure.

However, if our primary caregiver is inconsistent, emotionally unavailable, insensitive or is outright rejecting, then we will develop a representation of them in our mind that reflects this. It's likely to comprise negative emotions and messages like "I'm not good enough" or even "I'm disgusting". There's no internal safe place and so the inevitable ups and downs of life will be distressing and hard to cope with; and defences will develop to avoid painful awareness of needs and feelings. The self that emerges then has varying degrees of damage, and grows up expecting to be treated similarly badly by others.

No parent can, or even should, be perfect - children need experiences of disappointment in order to learn how to deal with it. Parents just have to be 'good enough'. So perhaps we all have some work to do on our emotional skills. Psychologists Mary Main and Wallin and psychoanalyst Peter Fonagy, and others, believe our main task is to strengthen our 'reflective self'. This is where, instead of being caught up in the emotional tide of a moment and simply believing whatever we think or feel, we can consciously reflect on whatever is happening and question it.

Being able to reflect, 'mentalise' or be mindful are 'pathways to psychological liberation', says Wallin in his brilliant book on attachment. It's what we aim to do in therapy - offer a healing relationship that provides experiences of being understood and cared for, and that also cultivates your ability to reflect on what has happened to you in your life. In this way, it offers the chance to create that internal secure base you may be missing. It has been found that being able to talk about your past trauma, no matter how bad, is a significant protective factor for mental wellbeing.

Charlie* didn't reach out to anyone for help because, up to then, his experience had been that others couldn't be trusted and only hurt him. His experience in therapy helped him begin challenging his beliefs. He learned to tell his life story - piecing together a more realistic narrative of his experience, where he stopped blaming himself for his caregivers' failings. Up to then, he'd seen himself as inherently unlovable. With greater acceptance of his feelings and through allowing himself to grieve for the first time over his losses, he no longer had to be continuously on guard for threats that could trigger the emotions he was avoiding, such as situations of potential closeness and intimacy. He began taking responsibility for how he was creating his life in the present, and learned to soothe himself in healthier ways than by drinking.

Importantly, we all need to know how to comfort ourselves - simple things like surrounding yourself with nice smells (incense, candles, hand cream, perfume, etc), tuning into your breathing as often as you can, carrying photos that have a calming effect when you look at them, soothing music or talking comfortingly to yourself. You could also create an internal 'safe place' that you can visit any time you need to: think of a place you love. Next time you're there, really try and notice everything you see, hear, feel and smell and take a mental picture of it. You can then use this image during times of stress - call to mind the full experience of being there, and you will reduce your arousal level.

The good news, the thing to hold on to, is that our emotions aren't permanent, they change over time and ebb and flow like a wave. Trying to avoid or get rid of distress only makes it worse and keeps the feelings going. Whereas accepting them allows them to pass. We may think we don't want to be aware of our current circumstances, but there's a difference between being completely embedded in or overwhelmed by our situation and just allowing it to be, or observing it - for example, by simply labelling what you feel in your body, for example: "Ah. I have that tight feeling in my chest; I'm feeling anxious".

The body is actually key to allowing feelings, and if you've been in psychotherapy, you'll probably have been asked at times to tune into what's happening in your body while you are talking. It's because paying attention to the body results in emotion - and, letting yourself feel is what results in real change. It works like this: the right-hand side of the brain specialises in emotion, and it also has the most links to the body. So, for example, if you constrict part of your body, like your throat or stomach, it means you squash the emotion too. So just noticing and breathing into areas where you are tense can put you in touch with the feeling.

Perhaps, too, we need to accept that not everything in life is going to be easy or enjoyable; and that it's OK to feel bad sometimes. This Christmas, I hope you get to experience lots of positive emotions; but that if you do experience the bad, you'll be gentle with yourself.

* Cited client case is a composite of several clients, with any identifying characteristics disguised to protect confidentiality

Gayle Williamson is an Irish Association of Counselling and Psychotherapy-accredited psychotherapist. See ferneytherapy.ie