The 5D model of emotional literacy as a transdiagnostic framework in psychotherapy: a systematic mixed-methods case study

Introduction Difficulties in emotional processing and regulation are increasingly recognized as transdiagnostic mechanisms underlying diverse forms of psychological distress. This study explored emotional literacy as a process-oriented transdiagnostic framework for case formulation and psychotherapeutic intervention within the bio-psycho-social-spiritual-ecological (5D) model of human experience and the circular emotional reaction (CER) model. Methods A systematic exploratory mixed-methods single-case study was conducted within an outpatient university psychotherapy clinic. A convergent mixed-methods design integrated four complementary levels of analysis: quantitative psychological distress and functioning as clinical outcomes (CORE-OM); structural patterns of emotional functioning (“what”), assessed quantitatively through an exploratory emotional-awareness measure, discrete emotional experiences, conflict management styles, and value orientation; emotional processes (“how”), examined qualitatively through a CER-based semi-structured interview exploring anger, fear, sadness, and joy; and developmental-relational context (“why”), examined through a life-script and attachment interview. Results Quantitative findings indicated clinically relevant anxiety, depressive, psychosomatic, and interpersonal difficulties, accompanied by relatively advanced empathy and interactivity but incomplete emotional differentiation, predominantly compromising and avoiding conflict styles, and an achievement-oriented value profile. The emotional profile was characterized by difficulties regulating guilt, sadness, anxiety, and shame, alongside relatively low reported anger. Qualitative analyses suggested a pattern of anxious attachment, heightened sensitivity to rejection, dependence on external validation, and inhibition of anger. Within the CER framework, recurring primary disturbances were interpreted at the levels of apperception and valorization. Discussion Within the 5D framework, the integrated findings suggested that the client’s difficulties reflected a developmental organization characteristic of the transition from collective toward individual levels of consciousness, rather than a discrete diagnostic category. Ongoing psychotherapy included work on constructive expression of anger, boundary setting, and reduced accommodation of others’ needs; these therapeutic developments provide contextual clinical information but were not systematically assessed as treatment outcomes. Retrospective client feedback during publication consent supported the personal relevance of the case formulation. The findings illustrate the potential clinical utility of emotional literacy as a process-oriented transdiagnostic construct linking emotional awareness, attachment, values, interpersonal functioning, and psychological distress, although cross-diagnostic applicability remains to be examined. CER-informed emotion analysis may help identify primary disturbances, support individualized case formulation, and inform targeted psychotherapeutic interventions.