How Therapy Works: working with the unconscious

When particular emotions and needs are not responded to in a supportive enough way (this could happen from lots of reasons; whether that’s: abuse, chronic lack of acknowledgement, chronic criticalness or dismissiveness, strong limits without acknowledgment and validation of a person’s emotions and needs, neglect, etc.) they go underground. Meaning, they become something we try not to feel or show. The current understanding of this is also that whatever developmental level our needs were at when they went underground is the level they stay at while dormant. Meaning, if they get a chance to come out again later in life they are usually messy in the beginning because they are still at the level they were when we were younger, other parts of us matured but not that part because it didn’t get a chance to be inside of relationships out right.

Even though our feelings and needs are underground they are still dynamic. They still get evoked and they still make noise. Only they need to come out in disguise so not to be rejected (by us or by others since usually when we get in touch with what we’re unconsciously feeling it evokes the shame or emotion state we originally felt in reaction to other’s mishandling of our feelings/needs - that’s a disturbing feelings and one that scares us and usually causes us to re-reject that part of ourself). That usually means we behave in ways that unconsciously signal our feelings and needs. These behaviors are what we usually call self protective or defensive behaviors. They are a form of dissociation. Problem is usually those disguised signals are not usually picked up on and responded to so that the feelings can come vulnerably to the surface again and restart their development. In fact often those behaviors evoke other people’s split off emotions and then both people’s defenses play together in ways that re-play the original hurt, sending feelings and needs an even stronger message of “stay away!”. This happens especially with close relationships, like a marriage partner.

We used to think of these behaviors as attempts to not remember, to sabotage remembering and keep us safe from surfacing vulnerable feelings and needs that could be rejected. However, we now think of these as generative attempts to remember, to tell the story of what’s happened and try to have it go differently this time around so we can find healing. Only, without recognizing the things under the surface we usually are just left to moments of hope and then difficult moments of repeated failure. It’s part of why therapy that only focuses on behavior usually isn’t as lasting or deeply changing.

A psychoanalytic therapy focuses on helping people re-integrate parts of themselves they’ve dissociated and unconsciously put away. And it does that inside of a relationship. It’s messy and difficult and it takes quite a bit of time but the research is pretty clear, doing that is what creates more substantial and lasting change. In fact the research shows psychoanalytic therapy continues to promote change after the therapy is over. This is because psychodynamic therapy changes lasting patterns which build on themselves. Here is one of many research articles on the evidence based nature of psychoanalytic therapy: http://internationalpsychoanalysis.net/wp-content/uploads/2009/11/Shedlerarticle.pdf.

In terms of how the unconscious becomes conscious there are competing ideas about that within psychoanalysis. I work primarily from the Self Psychology school within psychoanalysis. Self Psychology’s theory of how the unconscious becomes conscious is that when a person feels deeply connected with and secure with someone they will naturally begin to allow what is unconscious to become conscious. This happens within the context of the therapeutic relationship and the therapist’s interventions of course but chiefly it is a way of saying the therapist does not do a lot of interpreting of the unconscious. Instead they stay closer to what the patient is aware of so that the person can increasingly feel understood. This is what allows for dissociated emotions to be evoked. When that happens the self protective behavior usually occurs. Over time though, as the therapist learns to understand when the self protective behavior is happening and what it means and how they themselves contribute to it, the patient begins to feel enough hope and trust that they could let the unconscious feelings and needs into awareness with this person. In other words, they slowly begin to believe that this time they could have a new experience with their needs and not have to disavow them. This process has to be repeated over and over again and often uses what’s called the “rupture and repair” process. Which is the process of the therapist and patient learning how to best relate to the each other, a process that inevitably has misses in it. In other words, the therapist will fail at reading and responding to the patient well enough at times. It is in the moments of rupture though, when the patient feels once again misunderstood or mistreated as they have in the past, that the biggest opportunity for healing exists. For in those moments or seasons the patient and therapist get the chance to do what didn’t happen in life, namely, to understand what happened, without judgement and with secure attachment. The patient gets the chance to find out they can be understood and welcomed even in conflict, this changes how they relate to themselves and others and what they expect of others. This is the process of healing and changing. For more on the rupture and repair process see the blog post on how therapy works: rupture and repair.