Pain is a part of life, both physical and mental. In fact, they're indistinguishable in an MRI brain scan. Pain is an automatic signal that something may not be good for you, like an injury or an irritant. I say may not because the signal itself is just a message, and the brain must decide how to interpret the message.

Maybe the message is that a threat exists to our well-being. Maybe you burned your hand on a hot stove a long time ago. Now, you may be cautious when you approach it, even if it's not hot. From your memory of pain, you may even be afraid to get close to it. You may even avoid the kitchen altogether. We can understand this as one basis for fear.

Biologically and evolutionarily, we are equipped with four built-in reflexes to react to physical threat. Mediated by the nervous system, these reflexes are:

• Fight - go on the offensive

• Flight -get out of there

• Freeze - like a deer in headlights

• Appease -submit or placate the other

Just like the hot stove example above, emotional pain that we encounter through life can be stored in a type of emotional memory. While these are adaptive for responding to physical threats in the outside world, fight, flight, freeze, and appease often cause problems when we are reacting to emotional fear, which we can call anxiety. Anxiety tells us that some emotional pain has been triggered, and more often than not, our instinct is to move away from the pain using the four reflexes above.

Unfortunately for our mental health, reflexively moving away from emotional pain causes, directly or indirectly, 99% of the symptoms that lead to psychological distress and suffering, and that are described in the DSM. That's right, our very pain reflexes that protect us from physical threats often keep us stuck in anxious, conflictual, or depressive states.

In psychotherapy, we seek help with our symptoms by exploring their mechanisms through talking about them. This can be tricky since emotional memory is understood to be non-verbal, and our reflexes are unconscious. And yet, emotional pain requires a certain type of attention and processing. To do this requires us to override our reflexes to get away from or fight the pain. It requires us to press on the pain points a little in order to assimilate them or heal them.

Over the years, I have found that mental health pain points come from four sources:

• Loss - death of a person, identity, or relationship

• Aloneness - physical and emotional

• Disapproval -  from others, implicit or explicit

• Guilty-Anger - or strong mixed feelings towards others

Everyone, regardless of circumstances, will experience these sources of pain as life unfolds. And they don't always lead to mental health symptoms. However, emotions from these sources don't seem to have an expiration date: the pain, anxiety, and reflexes they generate can exist for decades or even a lifetime if left unattended.

So what to do about this state of affairs? That's the business of effective psychotherapy. Across the different models of experiential counseling and treatments, we find four actions that appear to help us move through our pain points in therapy:

• Feel - the emotions in the body

• Understand - how the emotions make sense

• Verbalize - find the right words to translate the emotions

• Visualize - picture and imagine the emotions 

Notice how the actions above use different senses or parts of the brain: body sensations, cognition, language, and creative/imaginative. That seems to be the secret to more impactful psychotherapy. Experiential models use interventions like role-playing, body-awareness, guided imagery, neuro-linguistic programming, and meta-cognitive awareness to activate the brain more fully.

Having a "good enough" brain experience of the difficult emotional material so that the pain reflexes get integrated and updated. We can also call  this desensitization. We can also call this "healing". Therapists know this as a "corrective emotional experience". Is this difficult to achieve? Absolutely. Is it worth trying? Only you can say.