A Cognitive-Developmental Model of Emotional Awareness and Its Application to the Practice of Psychotherapy

The ability to be aware of one's own emotional states has been a time-honored ingredient of successful psychodynamic psychotherapy. With the rise of cognitive-behavioral therapy (CBT), however, the utility of experiencing and reflecting upon emotional experience has become less certain, and a quantifiable measure of emotional awareness for clinicians has not been previously available. Several recent advances cast the role of emotional awareness in psychotherapy in a different light: (1) a new theory of change in psychotherapy has been formulated that highlights emotional experience as an important ingredient of change in a variety of modalities; (2) new evidence shows that individual differences in the capacity for emotional awareness predict successful psychotherapeutic outcome in the treatment of panic disorder both by manualized psychodynamic psychotherapy and CBT; and (3) a new online version of the electronic Levels of Emotional Awareness Scale (eLEAS) has been created that can be used with individual patients as a guide to psychotherapy treatment. Here we review evidence of a reliable and valid measure of emotional awareness that has been used in both normative and clinical contexts. The psychotherapeutic treatment of three patients is described to illustrate the clinical manifestations of the different levels of emotional awareness and the ways the eLEAS can be useful in the clinical context, including (1) assessment of the patient's current level of emotional functioning and his or her potential for higher levels of functioning, (2) the targeting of interventions to facilitate functioning at the next level, and (3) a possible marker of treatment progress. These observations suggest that the eLEAS has the potential to be a clinically useful tool that may assist clinicians in guiding psychotherapy treatment.