It’s Not You—It’s Your Unconscious

Why therapy takes so long to work: Part one.

Posted Jun 12, 2019

The Brain Resists Change

Jenny, a young woman in her thirties, has now been in therapy for over two years. She entered treatment looking for help getting through a contentious divorce—but now her divorce is history and she is still struggling. She asks me how long until her depression and anxiety subside. How long, in other words, until therapy works?

This is not an uncommon occurrence, and Jenny isn’t alone in her worry and fear. Is it ever going to get better? How long will it take?

In reality, therapy often takes longer than first-time patients anticipate. Sometimes this is because they enter treatment for a concrete problem, only to discover deeper, more chronic difficulties. (And as we will see, there is a reason why difficulties become chronic.) In Jenny’s case, and in the course of treatment, we also unearthed earlier childhood trauma, which had shaped much of her relationships and ways of interacting with other people and with the world in general. This trauma has left her with core beliefs of worthlessness, feelings of self-blame, and a deeply-rooted sense of incompetence and insecurity.

If you are beginning to wonder why Jenny’s story sounds familiar, it is because "Jenny" is not any single patient—she is a representation of a typical story that unfolds in many therapists’ offices. In each unique case, however, even after the history is gathered and pain is out in the open, clients’ specific goals of healing, reducing depression or anxiety symptoms, or improving relationships may take a long time to achieve. It is as if the mind is vehemently resisting change. Jenny may not be real, but she’s also not alone in her discouragement. With my real patients, I frequently hear the words, “Is my brain broken? Does it hate me?”

Photo by Daniel Hjalmarsson on Unsplash
Source: Photo by Daniel Hjalmarsson on Unsplash

Enter: The Normative Unconscious

Together with one of the leading experts on the unconscious, Dr. Joel Weinberger, in our new book The Unconscious: Theory, Research, and Clinical Implications (soon to be published by The Guilford Press), we explore how our knowledge of the unconscious today has evolved significantly since the days of Freud’s “cauldron of seething excitations,” such as fantasies, defenses, and resistances. In fact, cognitive science, social psychology, and computational neuroscience have all contributed to a monumental shift in our acceptance of and knowledge about unconscious processes.

Today, we can confidently say that most—if not all—of our behaviors, beliefs, and attitudes (as well as the speed of your progress on the therapy couch), are directly determined by a combination of conscious and unconscious processes operating in unison. This is not the Freudian unconscious we are so accustomed to thinking about. It has less to do with repressed wishes and defenses, and much more to do with automatic, implicit, and unmotivated processes in the brain and mind.

We have called these processes normative because they occur in our everyday lives, are present all the time, and are not motivated by internal conflict (like Freud’s unconscious). The normative unconscious is not irrational like myth should have it; rather, it is arational. In other words, it follows its own rules, which have nothing to do with what our conscious brain is telling us is “the right” thing to do. 

Think about how the molecules of one compound interact with the molecules of another, to form bonds and new substances. We do not call the work of those molecules rational or irrational, it just is. And just like the laws of chemistry or physics, we now know that unconscious processes are ubiquitous and central to psychological functioning. They operate in parallel with our conscious thought processes, and on many occasions, our decision-making is impacted by processes within and outside of awareness, at the same time. In fact, it is hardly possible to describe psychological functioning without accounting for the work of the unconscious (Hassin, 2013).

There are several normative unconscious processes that unknowingly impact your work in therapy. In this blog series, I will focus on implicit memory, implicit learning, heuristics, implicit motivation, attribution theory, affective primacy, automaticity, and embodied cognition. I will explore how these processes influence how we process information, make judgments, engage in decision-making or behaviors, and, most of all, affect the therapy process. All of these processes taken together impact our ability to make use of therapy, learn and implement new coping skills and ways of relating to the world and others in it. We start with:  

Implicit Learning and Implicit Memory

Implicit learning and implicit memory are two sides of the same coin. We are constantly acquiring knowledge of the patterns around us. We implicitly learn to connect different experiences without intending to do so, without realizing that we are, and without being able to verbalize what we have learned. We then form implicit memories, of which we are also unaware, but which can sometimes be demonstrated in action.

Evidence of this exists as early as 1911. The Swiss neurologist Édouard Claparède reported a case of a woman with Korsakoff syndrome, who forgot events and people introduced to her just minutes earlier. She did not recognize the nurses and doctors caring for her daily. Claparède put a pin between his fingers, which pricked the patient every time he took her hand. Soon after, despite having no conscious memory of ever being pricked, the patient learned to withdraw her hand when Claparède reached for it. Not only did she have no recollection of being pricked, she also could not provide an explanation as to why she avoided the handshakes.

Implicit learning and the formation of long-term implicit memories are not motivated processes. We do not set an intention to acquire or retain knowledge. They occur automatically and are a product of the everyday interactions between us and our environment. Young children learn and use grammatical structures correctly, for example—long before they explicitly study them in school. Similarly, we learn to associate different characteristics of the environment and of relationships.

Implicit learning and implicit memory provide a credible explanation as to why we sometimes engage in what may be described as unhealthy coping behaviors. Implicit memories from early childhood may exert influence well into adulthood. For instance, patients who grew up with an alcoholic parent, who hid his or her drinking, may in adulthood experience a dreadful sense of mistrust in their partner. They do not know where this disturbing suspicion is coming from, yet feel powerfully affected by it.

Implicit memory and implicit learning are also closely related to heuristics, both in their mechanisms of functioning and in how they impact how long it takes us to improve in therapy. For that, stay tuned for It’s Not You—It’s Your Unconscious: Why therapy takes so long to work, part two.

This post is also published at www.TraumaProfessionals.com

References

Weinberger, J. & Stoycheva, V. (in press). The unconscious: Theory, research, and clinical implications. New York: The Guilford Press.

Hassin, R. R. (2013). Yes it can: On the functional abilities of the human unconscious. Perspectives on Psychological Science, 8, 195–207.