Neuroscience and Psychoanalysis, Gabbard and Westen

Introduction

Drew Westen (1999) writes that recent cognitive science has provided evidence for the the following psychoanalytic propositions:

(1) that enduring aspects of personality begin to coalesce in childhood, and that child- hood experiences play an important role in personality development, shaping in particular the ways people form later social relationships; (2) that mental representations of self, others, and relationships guide peo- ple’s interactions with others and play a substantial part in many forms of psychopathology; (3) that mental processes, including affective and motivational processes, operate simultaneously and in parallel, so that individuals can have conflicting feelings toward the same person or situation and can craft compromises outside of awareness; (4) that personality development involves not only learning to regulate sexual and aggressive feelings and wishes, but also moving from an immature dependent state to a mature interdependent one; and (5) that much of mental life is unconscious.

He focuses his attention on evidence for the fifth proposition.

Unconscious Cognitive Processes

Cognitive scientists today recognize that thought and memory have two main components, explicit (conscious) components and implicit (unconscious) components. Explicit memory involves the “conscious retrieval of information such as childhood memories or the name of a friend,” while implicit memory involves “memory that is observable in behavior but is not consciously brought to mind.” One type of implicit memory is procedural memory, which is the ability to complete a task even though one cannot consciously state how one would go about doing so; examples include “the motor memory involved in throwing a ball or playing on the piano a complex piece that once required considerable conscious attention.” Another type of implicit memory is associative memory, which is “the formation of associations that guide mental processes and behavior outside of consciousness.” Evidence for associative memory can be found in the many experiments done on priming.

From VeryWellMind: “An example of priming is when a person is shown a picture of a car, and then asked to identify a second picture that is related in some way (e.g., another car). If they are able to identify the correct match faster than if they had never seen the first picture, then it is considered evidence that the first picture primed the person to recognize the second.”

Westen provides an example of unconscious networks of association. “Consider a patient who reports a difficult relationship with his father, describes a series of authority conflicts at work, and begins to display subtle signs of disrespect toward the analyst. One can presume that networks of association related to authority figures (or perhaps male authority figures, depending on his particular dynamics) have been activated and, by spreading activation to particular neural networks, are increasing the likelihood of certain ways of interpreting and reacting both to bosses and to features of the analytic situation.”

Unconscious Affective Processes

Cognitive science has also shown that “affective processes can be unconscious and that people can protect themselves against unpleasant feelings with unconscious defenses.” This has been evidenced by “investigations of patients with brain damage, conditioning experiments using humans and other animals, and a variety of other scientifically rigorous studies.” There are several clinical implications of this truth:

First, free association. Because we’re not aware of some of our emotional reactions to people and other stimuli, it follows that free association is useful. Free association “bypasses defensive processes that inhibit conscious attention to certain thoughts, feelings, or motives.” Additionally, free association “is useful in mapping out the unconscious networks of association and the affects encoded along them that may underlie many forms of psychopathology.”

Second, traumatic memories. A traumatic event can become part of our explicit memory or implicit memory or both. If implicit memory, it might be “encoded as procedural memory (a tendency to behave in a particular way under certain circumstances) or as a tendency to experience certain feelings, which may in turn evoke a set of affect-regulatory tendencies (such as defensive processes or impulsive actions).” Consequently, the therapist must generally work to help the patient retrieve “conscious representations of the event (what cognitive scientists call episodic memory, or memory specific episodes) but also altering the automatically elicited feelings, and the ways of regulating those feelings, that are part of the implicit memory system.”

Third, exposure. Helping a patient to understand how a fear became associated with a particular stimulus does not necessarily weaken the implicit neural connections between them. Consequently, we need to follow Freud’s lead and realize that “insight alone will not eliminate a phobia if the person does not use this insight to force himself to confront it. His own view suggests the potential importance of adjunctive or integrative use of cognitive-behavioral techniques that emphasize exposure to the feared stimulus in the treatment of anxiety. For unconscious affective associations to change, a person must come, through experience, to associate a representation with a different affective state.”

References

Gabbard, G. O., & Westen, D. (2003). Rethinking therapeutic action. The International Journal of Psychoanalysis, 84(4), 823-841.

Westen, D. (1999). The scientific status of unconscious processes: Is Freud really dead? Journal of the American Psychoanalytic Association, 47(4), 1061-1106.

Westen, D. (2006). Implications of research in cognitive neuroscience for psychodynamic psychotherapy. Focus, 4(2), 215-222.