Measurement of Levels of Emotional Awareness Before, During, and After Psychotherapy

A modern trans-theoretical perspective holds that avoidance of the experience of emotional distress is an important source of symptoms or maladaptation and that overcoming such avoidance permits changes to occur. For psychotherapy research purposes an empirically tractable method is needed for characterizing what overcoming avoidance consists of and quantifying the extent to which a person is aware of their emotional responses. Here a model called "levels of emotional awareness (LEA) " is presented that holds that awareness of one's own emotions progresses on a cognitive-developmental continuum of five levels consisting of awareness of bodily sensations, action tendencies, single emotions, blends of emotion and a combination of blends. This framework can be used to capture individual differences at baseline as well as changes from the baseline state. It can also be used to study within-subject state-related changes which lend themselves to the study of emotion processing changes within a given client and within a given psychotherapy session. In this paper, particular emphasis is placed on the latter. The author reviews the theoretical and empirical foundation of the LEA construct and describes the measurement method and its use in published psychotherapy research and other contexts. The advantages and disadvantages of this approach are then put into context in relation to other related measurement approaches. Particular emphasis is placed on the implications for future research, including an adaptation of the LEA scoring method to psychotherapy transcripts to facilitate examination of the mechanistic linkage of the process to outcome.