Emotion or Interpretation: Which Comes First in Therapy?

Exploring the Fundamental Differences Between Cognitive-Behavioral Therapy and Emotion-Focused Therapy

What came first - the emotion or the interpretation? This question is the therapeutic version of the chicken and the egg. Prominent therapeutic schools such as cognitive-behavioral therapy (CBT) advocate that interpretation creates emotion. In contrast, emotion-centered schools of thought assert that emotional reactions are much faster than interpretation, making emotion the determining factor. The latter are, of course, correct (prepare the torches), but why does it matter?

After all, many patients do not know exactly which approach their therapist is using. CBT or EFT, who cares what three letters are on the framed certificate at the clinic entrance? This not knowing is fine because research consistently shows that the quality of the therapist-patient relationship is the most significant predictor of treatment success.

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Despite this, the differences between emotion-focused approaches and cognitive-behavioral therapy are not just theoretical; they have enormous clinical significance. If you have a leak in your house, the question of whether to seal the roof or open the pipes and seal them again is not trivial. The correct action will determine whether you'll be walking around the house with towels in pots next winter.

Let's take a moment to examine the fundamental differences in worldviews to understand why this is crucial. In the CBT worldview, something often referred to as the "APRAT model" is used. The more I learn about the brain, the more this model concerns me, not just because its name sounds like it opposes abortion. The initials APRAT denote the four components from which our emotional experience is built, supposedly in this order: event, interpretation, emotion, response.

APRAT model: Event ---> Interpretation ---> Emotion ---> Reaction ---> Event

What is an event? An event is a moment when our senses encounter new information. An event in a relationship can be, for example, entering the house and feeling upset when seeing our partner not acknowledging us. The active sense here is sight. Interpretation is the explanation we give to the sensory information. While sensory information comes from the outside and is objective, interpretation is internal and subjective. Our interpretation of seeing a partner engrossed in their phone might be, "My presence doesn't matter to them," or alternatively, "They must be dealing with urgent work."

According to the APRAT model, interpretation is critical because it determines the developing emotion. If I interpret my partner's focus on their phone as indifference, I may feel sadness or anger. But if I interpret it as a sign of work stress, I might feel concern or compassion.

In the final stage of the model, my emotion will determine my response to the event. If I feel anger or sadness, my reaction will differ from one of concern or compassion. My reaction then becomes an event for my partner, potentially creating a cycle of interpretation, emotion, and reaction, where a single misinterpretation can lead to a negative loop.

As a therapist using a model like APRAT, interventions would focus on interpretation. Assuming we cannot control triggers (events), we start influencing the person at the first controllable point: interpretation. One technique for this is the "Socratic technique," which involves asking questions that encourage patients to critically examine their assumptions and beliefs, identifying and challenging thinking distortions to correct their reality checker.

My emotion will determine how I will respond to the focus of the event Photo: marekuliasz/Getty Images/iStockphoto

For example, negative filtering is a common thought distortion, causing us to focus only on negative aspects and ignore positive information. If I come home and see my husband on his phone, I might ignore the smell of cooking, the showered children, and his usual affectionate greeting. Confronting this distortion can change my interpretation, affecting my emotions and reactions.

All of this sounds great, but it's only somewhat true. It's like reducing a fever with paracetamol rather than treating the bacteria causing the fever with antibiotics. This approach suits short-term triggers, like dealing with your mother at a holiday dinner.

According to emotion-focused therapy (EFT), our immediate emotional reactions are the slowest factor in our relationship with the environment. Emotions like anger, sadness, fear, and disgust form the foundation of our interactions, fundamentally affecting our perception, cognition, and behavior.

Emotion-focused therapy: Event ---> Emotions ---> Interpretation ---> Reaction ---> Event

In EFT, intellect serves our emotions, justifying them. Emotion and intellect can be compared to Fidel Castro and Che Guevara, where emotions give rise to thoughts that justify them.

Physical knowledge confirms this model. When hearing a motorcycle screeching, we may initially fear an alarm, which triggers fear and then interpretation. During a war, the alarm leads to fear and the interpretation of missile attacks, prompting us to seek shelter. Between wars, the same sound may lead to fear, followed by the interpretation of a motorcycle passing, prompting us to resume our activities.

Applying this to the example of a wife coming home and feeling upset by her husband's inattention, EFT would assume an old emotional wound is being triggered. The therapist helps the woman identify when she begins to feel pain, develop awareness of it, and connect it to older pains. She might reveal sensitivity to her husband's inattention because her parents were never available when she came home from school, spending afternoons alone with microwave snacks.

The therapeutic work focuses on healing childhood wounds, assuming that as the wound heals, it will hurt less when triggered. The patient can manage the pain differently, offering herself self-compassion and communicating her needs to her husband.

The therapeutic work will focus on healing the childhood wound Photo: Rudzhan Nagiev/Getty Images/iStockphoto

Both models recognize that the brain learns through experiences. Both aim to create new emotional experiences to correct previous learning. If you ask EFT therapists about CBT's success, some will say CBT therapists unknowingly use EFT techniques. Conversely, CBT therapists might claim EFT therapists are like broken clocks, right twice a day.