The Assumption of Avoidance

When clients struggle to access emotions, our default explanation is often avoidance.

Certainly, avoidance exists. At times, people actively push feelings away because they are overwhelming, painful, or frightening.

However, I have increasingly wondered whether “avoidance” has become an umbrella explanation for many different clinical phenomena.

A recent paper by Andy Fung and colleagues particularly caught my attention. Rather than conceptualising experiential avoidance purely as avoidance behaviours, they distinguish between behavioural avoidance and a more fundamental Preference to Avoid Self-Experiences (PASE)—defined as “a preference to avoid engaging with one’s own internal experiences.” This shifts our attention from what clients do to how they have learned to relate to their own inner world.

I find this distinction clinically valuable.

Some clients genuinely want to engage in therapy. They attend sessions consistently, complete homework, and express a sincere desire to understand themselves. Yet approaching certain emotions, memories, or self-states still feels profoundly difficult—not necessarily because they are resisting therapy, but because engaging with these internal experiences has long been experienced as unsafe, overwhelming, or psychologically costly.

This distinction enriches our understanding of emotional accessibility.

Yet I also wonder whether it is still only part of the picture.

Even when clients demonstrate little evidence of a preference to avoid their inner experiences, emotional access may remain surprisingly elusive.

The problem is not always willingness. It is not always experiential avoidance.

Sometimes, the conditions necessary for emotional experience have simply not yet emerged.

Recent developments in affective neuroscience suggest that emotions are not simply hidden entities waiting to be discovered.

Instead, emotional experiences are actively constructed through ongoing interactions between the brain, the body, prior experiences, language, and social context.

This means that emotions do not arise solely from what is happening inside us.

They are also shaped by how we have learned to interpret, organise, and make meaning of our experiences.

Consequently, emotional accessibility depends on more than willingness alone. It also depends on whether emotions feel psychologically safe to approach, whether they have become conceptually meaningful, and whether the relational context permits those emotions to emerge.

For example, imagine a child who grows up in an environment where emotional restraint is valued, conflict is discouraged, and maintaining harmony is considered important.

That child may become highly skilled at monitoring relationships, anticipating others’ reactions, and regulating emotional expression.

As an adult, emotional awareness may not be absent.

Rather, emotional access may occur through pathways that differ from what therapists—or even the client themselves—have come to expect.

Perhaps the most helpful shift is moving away from asking:

“Why can’t my client access their emotions?”

or immediately concluding,

“They are emotionally avoidant.”

Instead, we might ask a series of different questions.

• Has this person learned that certain emotions are unsafe to experience?

• Have they developed a preference to avoid particular internal experiences because these have historically been associated with pain, shame, or psychological threat?

• Do they yet have the language and conceptual framework to make sense of what they are feeling?

• Does the current therapeutic relationship provide sufficient safety for these emotions to emerge?

These questions invite curiosity rather than premature formulation.

Rather than treating emotional inaccessibility as a unitary phenomenon, they encourage us to consider multiple pathways through which emotions may become inaccessible.

For me, this is precisely where the CPR framework becomes clinically useful.

Rather than assuming that emotional inaccessibility necessarily reflects avoidance, CPR invites therapists to ask a different question:

Where is emotional accessibility currently constrained?

Is it primarily a matter of :

Content—the client’s meaning-making and conceptual understanding?

Process—the dynamic relationship between the client and their own internal experiences, including experiential avoidance, emotional tolerance, and the capacity to remain present with emerging emotions?

Relationship—whether the interpersonal context is sufficiently safe for emotions to emerge?

The answer may differ from one client to another, even when their outward behaviour appears remarkably similar.

References for Clinicians:

Barrett, L. F. (2017). The theory of constructed emotion: an active inference account of interoception and categorization. Social cognitive and affective neuroscience, 12(1), 1-23.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., ... & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical psychology: Science and practice, 11(3), 230.

Fung, H. W., Wong, M. Y. C., Chau, A. K. C., Lay, C. M., Huang, S. Y., & Wong, J. Y. H. (2026). The preference to avoid self-experiences scale: Validation and association with complex PTSD and dissociation. Research on Social Work Practice, 36(3), 313-321.

Ng-Kessler, B. (2026). Culture as predictive infrastructure: A constructionist account of emotional access in schema therapy. Journal of Contemporary Psychotherapy, 1-7.

Ng-Kessler, B. (2026). The content–process–relationship framework: A culturally responsive process model for working with emotional inhibition in collectivistic contexts. Practice Innovations.

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: empirical evidence. Journal of consulting and clinical psychology, 70(2), 275.