Rationale and focus
Surveying is a powerful technique to illustrate that there is a discrepancy between the client's perception of negative emotions and those of the majority of society. All humans experience negative emotions which are often regarded as a normal and essential part of a reaction (e.g. language) to different situations or circumstances. Knowing about such a discrepancy helps the client realise that having negative feelings is not the problem. The problem is due to his or her belief about negative emotions being abnormal. In using this technique, the focus in the therapeutic process is to use the survey's information to highlight the existence of such a discrepancy, to question the bene®ts of avoiding having these negative feelings and to ®nd ways of handling these feelings.
Together, we came up with a list of speci®c questions to be used in the survey. Note that negative emotions in this survey referred to feeling low, down and sad, as these feelings were particularly troublesome to Adam. The questions are as follows:
1 Do you know just one person who never experiences any negative emotions (e.g. low, down and sadness)?
2 Did you experience negative emotions before?
3 Will you ever experience any negative emotions in future? 4 Is it normal or abnormal to have these emotions?
5 Did you suffer from depression because of these negative emotions? 6 If the answer to Question 3 is `yes', why?
7 If the answer to Question 3 is `no', why?
8 Is it normal and appropriate to feel sad when you lose a loved one? 9 Is it normal and appropriate to feel low and down after a funeral? 10 What will be a helpful way to deal with negative emotions?
Note that responses of either `yes' or `no' to the quantitative questions (1, 2, 3, 4, 5, 8 and 9) would show the extent of the discrepancy between Adam's view about negative emotions and the views of the ®ve people he was going to do the survey with. Their replies to the qualitative questions (6, 7 and 10) not only would help to generate a more realistic view about negative emotions, but would also provide some useful ideas on how to deal with these emotions.
Process: before the survey
Therapist: You believe that there must be something wrong with feeling low, down and sad.
Adam: Yes.
Therapist: Because of?
Adam: I just want to be happy. I don't want to have all these negative feelings.
Therapist: It is nice to feel happy. Why do you think that there is something wrong with having these feelings?
Adam: It is not normal. I should be happy, not feeling low, down and sad. Therapist: Oh. Is it possible to be happy, if you fail to get a promotion?
Adam: No.
Therapist: What should the feeling be? Adam: Disappointment, I suppose.
Therapist: Is it possible to be happy, if the company you work for is planning to make some people redundant?
Adam: Ah. No.
Therapist: What should the feeling be? Adam: Worry and anxiety, I suppose.
Therapist: It is natural to feel disappointed, worried and anxious under these circumstances. Why is it not normal to feel low, down and sad? Adam: Oh. I don't know. After my father's funeral, I was feeling low,
down and sad, and then I was depressed. I have a fear that it may happen again after my neighbour's funeral, because I know that I will feel low, down and sad.
Therapist: Is it possible to be happy after the funeral? Adam: I suppose not.
Therapist: What should the feeling be?
Adam: Oh, yeah. Low, down and sad, I suppose.
Therapist: It is natural to feel low, down and sad over the loss of a loved one. We all feel the same. These feelings are healthy and have nothing to do with depression. Otherwise, we will all end up with depression. Adam: Well, it makes sense. I was already feeling stressed before he died. His death made it a lot worse for me. I didn't sleep well, was tired physically and emotionally, and found it dif®cult to get on with my work.
Therapist: Would you say that these feelings have something to do with your last depression?
Adam: No.
Therapist: Let's do a survey and ask ®ve people their views about negative feelings.
Process: after the survey Therapist: Who did you talk to?
Adam: I talked to ®ve people: a neighbour, two friends, a colleague and my wife.
Therapist: Good. Did any one of the ®ve people know just one person who had never experienced any of these negative emotions? [Question 1 in the survey]
Adam: No.
Therapist: Had they experienced any of these negative emotions before? [Question 2]
Adam: They all said yes.
Therapist: Will they all experience these emotions in future? [Question 3] Adam: One said that she didn't know and the rest said yes.
Therapist: Do they see having these emotions as normal or abnormal? [Question 4]
Adam: Normal.
Therapist: Oh. It seems that their views about negative emotions are different from yours.
Adam: Yes.
Therapist: They had all experienced these emotions before. Did they all end up with depression? [Question 5]
Adam: No.
Therapist: What conclusion can we draw?
Adam: These feelings are normal and have nothing to do with depression, I guess.
Therapist: Absolutely. You view them as abnormal probably because you linked your previous depression to these feelings. It is not sur- prising that you are anxious about having these feelings again after your neighbour's funeral. You simply do not want to be depressed again.
Adam: You're right.
Therapist: What did the other four people say, when they said `yes' to Question 3? [Question 6]
Adam: Because it is inevitable. One person said that you will get upset if you fail an examination or have an argument with somebody. Another said you will feel angry if you're unfairly criticised. They all said that you couldn't control external forces like people or events.
Therapist: Did they say that it is normal and appropriate to feel sad over the loss of a loved one? [Question 8]
Adam: Yes.
Therapist: How about Question 9?
Adam: Again yes. They all said that it is normal and appropriate to feel low and down after a funeral.
Therapist: What conclusion can we draw? Adam: It is okay to feel low, down and sad.
Therapist: When we believe that these feelings are abnormal, it may have the unwanted effect of causing us to feel anxious or even fearful about having these feelings. The thought of `there must be something wrong' will keep coming into our minds which, in turn, can cause more of these feelings, thus creating a vicious circle.
Adam: I can relate to that.
Therapist: How did they deal with these negative emotions? [Question 10] Healthy and unhealthy negative emotions 125
Adam: Two people said that they would just put up with it and it would diminish after a while. One person said that she would accept these feelings as normal and not dwell on them. The other two said that if you keep going on normally, these feelings would not be as bad. Knowing that there was nothing wrong with having these feelings brought a sense of relief to Adam. These feelings were indeed natural under the circumstances. He therefore accepted rather than reacted to these feelings and two days after the funeral he started to feel better. `I did feel low, down and sad after the funeral,' said Adam. `But knowing that it is okay to have these feelings enabled me to tolerate them and carry on life as usual. It has helped.'
Homework
Adam was asked to: