by Joye C. Anestis, M.S.
For several years now, I have been teaching an undergraduate Clinical & Counseling Psychology course. I focus most of the class on different forms of therapies, with an emphasis on evaluating the empirical support for each therapy for different mental disorders. Students are always amused by the "dodo bird hypothesis", the now-defunct maxim that all therapies are equally effective, but they are even more amazed at the limited impact the dodo bird has on the field of clinical psychology. Despite the multitude of findings that some therapies work better than others for specific disorders, at least two trains of thought persist: 1) clinical psychologists are still by and large trained in one theoretical model of psychotherapy (e.g., psychodynamic, behavioral) & so believe that one approach should work for all mental disorders and 2) clinical psychologists believe the dodo bird hypothesis remains true and so argue that any form of psychotherapy is effective for any disorder and that common factors of therapy offer the true curative piece of psychotherapy. In this series of articles, I will focus on the research examining the curative nature of common factors, factors that cut across models of therapy.
Catharsis, the release of emotion, is often mentioned as a key facet of many types of psychotherapy. It is argued that, no matter what type of therapy is being provided, clients use therapy as a safe place to "let out" bothersome emotions, and this release leads to healing. The cultural maxim that keeping emotions "bottled up" is harmful comes into play here. The empirical literature, however, is skeptical in regard to the helpfulness of catharsis alone in therapy. For example, a myriad of literature has repeatedly shown that catharsis of angry emotions has the opposite effect - it leads to an increase in anger and aggression (e.g., Bushman, 2002; Lewis & Bucher, 1992). Catharsis-focused therapies for anger often require clients to scream, to hit pillows or punching bags, and engage in other types of emotional release. While this release of anger might feel better in the short-term, it leads to increased hostility in the long-term. Other emotions have received less research attention, but still researchers generally find an increase in negative emotion following catharsis (Littrell, 1998). For example, laboratory studies of crying show that crying leads to increased distress and arousal (e.g., Gross et al., 1994; Labott & Martin, 1987; Martin & Labott, 1991).
It is important to note that the literature discussed above refers to the use of catharsis alone and to the hypothesis that emotional release in and of itself is beneficial. Studies which allow the release of emotion in an unstructured manner do not support this hypothesis, and instead find that unstructured release leads to deterioration. However, empirical studies have shown that catharsis, when coupled by an active treatment component, is beneficial (Littrell, 1998) - namely, therapies that teach clients to find a new way to regard the emotion-eliciting stimuli (i.e., restructuring). These therapies, such as behavioral exposure therapies, require clients to face emotion-inducing stimuli (in essence, causing catharsis of the emotion) and teach clients ways to cope with and regulate those emotions. The outcome of these therapies is a decrease in the overall emotion (e.g., Choy et al., 2007; Foa et al., 2005; Monson et al., 2006). These therapies are empirically supported for a variety of mental disorders, including PTSD, OCD, specific phobias, and social anxiety disorder (Chambless & Ollendick, 2001).
So, the conclusion about catharsis as a common factor is this: not all cathartic experiences are created equal. Without an active, problem-solving component of treatment (e.g., cognitive restructuring), emotional release is related to deterioration. Catharsis may be a common factor among therapies, but it is not used in the same manner across therapies. Therapies which rely solely on catharsis are harmful, whereas using catharsis to learn new ways to think and cope results in symptom amelioration.
Joye Anestis is a doctoral candidate at Florida State University.
