Introduction
Every problem operates at two levels; peripheral level - it’s visible outward appearance and root level - its clandestine originating point, which usually is hidden from one’s normal vision. Successful solution lies in attacking the root-cause to shut down the oxygen supply, rather than the periphery, since the latter is often a catastrophic off-shoot of the former, if left unattended. That’s why as children, beyond a point, our parents often stop always surrendering to our demands for expensive toys, as a solution to our post-rejection tantrums that annoy them, and instead personally counsel us to instill reasoning about the prevalent situation, uncover and clarify our level of understanding and misunderstanding of it and help us manage our own expectations. A strategy, that definitely makes us more mature and responsible with passing time.
Similarly, a physician’s anti-dote, based on his diagnosis targets the disease’s origination point, rather than its visible symptoms. However, for curing mental diseases, the psychologist still deploys a strategy governing contemporary psychotherapy that heavily rests on delving deep into the patient’s unconscious mind, as a root-cause of his problems manifested at a conscious level.
This essay tries exploring the realm of the unconscious, as a key element to both the schools of thought, and understanding its role in current psychotherapeutic techniques and implications for future practice.
Discussion
Modern day psychotherapy, defined by Norcross (1990, pp. 218-220 as cited in Tan, 2011, p.1), “as the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behavior, cognitions, emotions, and/or other personal characterisitics in directions that participants deem desirable” largely flows from the concept of unconscious, that attempts to increase their (peoples’) awareness of these hidden behaviors, cognitions, emotions and fears by bringing them to surface of their conscious level and helping them deal with them.
“Conscious” versus “Unconscious”
Both conscious and unconscious were originally devised by Sigmund Freud as part of his psychodynamic perspective (to be discussed later on).
Conscious refers to a “direct and subjective idea or experience capable of being introspected, across a wide spectrum of different psychological states, such as waking alert state, dream state etc. Often synonymous with terms like ‘awareness’, ‘reflective awareness’, phenomenal awareness’ and ‘phenomenal representation”, it implies our immediate cognizance of both recent and latent knowledge. That is why we are conscious in intoxication, psychosis or even about an obsessive occupation or hallucination” (Sousa, 2011). Finally, all conscious thought processes and actions consensually bear the common characteristics of being “intentional, controllable, serial in nature i.e. consuming limited processing resources and also being accessible to awareness i.e. verbally reportable” (Bargh & Morsella, 2008).
On the other hand, unconscious, though originally was used to indicate one’s unintentional actions devoid of the ability to process “subliminal-strength information” (Bargh & Morsella, 2008), as evident from Freud’s initial hypnosis sessions with patients, wherein, the therapy induced them to behave in a manner, the causes of which they were unaware, later on making him extend the usage of the term to include even those actions that took place consciously, without any deliberate or conscious intention, such as slip-of-the-tongue or Freudian slips, thereby, resulting in “labeling of all behaviors or processes characterized by unawareness of the influence or consequences of the stimuli that provoked a particular behavior, rather than the stimuli themselves” (Bargh & Morsella, 2008). But, ultimately, with passing time, his interaction with anxiety-ridden neurotic patients during his psychotherapy sessions made him increase the term’s ambit further to denote a storehouse within the mind “containing repressed past painful experiences replete with trauma and conflicts, with many of them haunted by loss, helplessness, shame and rage, powerful enough to befit the title of a dark repository or trashcan full of split-off, unwanted and unassimilated aspects of childhood” (Cornell & Landaiche III, 2008).
Two Most Influential Approaches to Psychotherapy - An Overview
Psychodynamic approach. This approach, proposed by Sigmund Freud “considers man’s behavior as a by-product of both conscious and unconscious forces like images, thoughts or feelings that govern his daily life and actions” (Wedding & Stubber, 2010, pp. 135). Further, this behavior directly originates from a conflict experienced by the individual due to an ensuing clashing of needs of the three parts that make up his/her entire psyche or personality, namely; id - the deeply entrenched unconscious ‘beast in man’ which is primarily a dark pleasure-seeking and pain-avoiding reservoir of basic biological instincts like hunger, thirst, sleep, & sex etc., all of which demand immediate gratification, come what may; superego - our conscience made up of all ethical and moral building blocks, which refrains us from acting upon the id’s impulses using feelings of anxiety and guilt; and ego - an aware or conscious component dangling between id’s irrational and superego’s ethical demands, that tries to satisfy the devil’s needs in a manner considered acceptable by the moral watchdog. This tussle takes the form of defense mechanisms - an acceptable channel through which the id’s unconscious and illegitimate demands are satisfied. For example, “a person might displace and redirect an otherwise unacceptable impulse away from its original target onto a more acceptable one, such as being angry with his friend, but instead taking it out on a football in the playground by kicking it” (Sammons, 2009). Similarly, “an otherwise neglectful husband might try indulging in undoing acts such as showering his wife with expensive gifts and presents, as an atonement for his past misconduct” (Wedding & Stubber, 2010, pp. 141). Further, the theory also describes exactly how the ego performs this strenuous job of trying to deal with both its masters; a methodology traced to one’s childhood in the form of psychosexual stages of development, namely; oral, anal, phallic, latent & genital stages, each of which play a crucial role in shaping up the child’s adult personality. In each stage, the child’s different body parts and actions provide libido i.e. sexual pleasure and gratification to him and influence his personality development. An important issue here is excessive gratification or deprivation which if faced, can fixate him at that stage, thereby, carrying its left-over traces in his/her adulthood personality. For example, during the oral stage, the mouth and oral activities like sucking and chewing are sources of pleasure; usually manifested in breast-feeding and weaning onto solid food etc. Here, if too little or too much breast-feeding is done or the child is not stopped from putting every new thing into his mouth after a certain age, then he will experience fixation at oral stage, which would show up later in his adulthood as “smoking habit or nail biting, dependency and aggression” (Sammons, 2009).
A psychodynamic therapist treats his patients using different methods, either independently or in combination, namely; case-study method, wherein the patient is treated as an individual case and an in-depth qualitative information is gathered about his/her life i.e. childhood, home environment, family background, educational background, social relationships, work relationships etc., which is then closely examined and conclusions are drawn from it. Likewise, the therapist might also use dream analysis or free association method, in which he asks the patient to narrate his dreams without interrupting him in between (free association) and tries deducing as much information as possible from those dream descriptions and anything else that the patient mentions repeatedly, in an attempt to “look for any unconscious motives and memories that might convey any hidden symbolic meaning about the problems faced by him/her, unconsciously” (Sammons, 2009).
Family systems approach. This approach, “has its roots in the psychodynamic approach” (Winek, 2010, p. 89), and was propounded by Dr. Murray Bowen who “in 1954, while treating schizophrenic girls in front of their families, observed their speedy recovery in response to including their families in the therapeutic process” (Rockwell, 2010). This made him conclude that “all families worldwide are large emotional units, sharing the following eight interlocking relationship patterns, in varying degrees, rife with complex emotional interactions that impact the emotional development of each individual unit member and also cause him to develop clinical problems, which can be solved by studying them” (Bowen Theory, 2013):
“Triangles - three-person relationship system which is both the foundation stone and stabilizer for any emotional system, since ‘dyad’ or two-person relation is delicate and unable to tolerate the pressures. For example, a childless couple is a ‘dyad’, and becomes a ‘triangle’ after the arrival of the newborn.
Differentiation of self - a person’s own way of thinking, feeling and acting about himself which can be strong or weak, based on his interaction with family and social groups and desire to yield/not yield to the pressures of ‘group think’ and ‘group shift’.
Nuclear family emotional system - four basic types of problematic relationship patterns in the family i.e. marital conflict, dysfunction in one spouse, impairment of one or more children & emotional distance.
Family projection process - three ways in which parents transmit their emotional problems to their child, namely; scanning, where they focus on the child out of fear that something is wrong with him; diagnosing, where they interpret child’s behavior as confirming their fear; and treating, where they treat the child in a way as if something is seriously wrong with him.
Multi-generational transmission process - describes how slight difference in the levels of differentiation between parents and offspring over many generations create large difference in the shaping of an individual’s ‘self’ both through parents’ conscious teaching and unconsciously programmed emotions and behaviors, which in the long run affect the individual’s overall functioning including longevity of life, marital stability, reproduction, health, educational accomplishments and occupational success.
Emotional cutoff - denotes how people manage their unresolved emotional conflicts and issues with parents and/or siblings by severing emotional contact with them like staying away from them for longer periods or not going home.
Sibling position - means that people in the same and different sibling positions exhibit common characteristics that affect their family relations. For example, an older brother of a younger sister finds it easier to adjust with a younger sister of an older brother as his wife since both have past experience of dealing with the opposite sex, than same sex position couples.
Societal emotional process - describes how the emotional system that governs our societal behavior promotes both progressive and regressive periods in the society in response to factors like population explosion, a sense of diminishing frontiers, and depletion of natural resources, wherein, the repercussions of taking the easy way out on tough matters outnumber the agony associated with acting wisely with patience, keeping in mind the ‘big picture’. For example, a regressive society characterized by plummeting operational codes of conduct makes it difficult for parents to raise their children ethically.
Problems occur because “high intense emotional interdependence among the family members for attention, approval and support, and a need to protect each other in times of distress, makes a change in the functioning of one person trigger reciprocal change in others’ functioning” (Bowen Theory, 2013). The testing times of increased tension and anxiety strain this emotional connectedness, causing one or more members to lose control and get either overwhelmed or isolated. To restore the lost balance a family member tries becoming the ‘shock absorber’ by taking on all the brunt. For example, “he/she might take too much responsibility for others’ distress in a relationship, by agreeing to be at fault for their (others’) unrealistic expectations of him/her; consequently, becoming the soft target for all clinical problems like depression, anxiety and alcoholism” (Bowen Theory, 2013).
Bowen’s therapy, unlike Freud, mandates the patient’s family involvement in the therapeutic process for studying the pre-existing relationship patterns within it as evident in the “patient’s repetitive recall of his/her prior childhood emotional experiences and reactions, called transference” (Rabstejnek, n.d.), as well as his interaction and communication with his family members, which holds the key to his clinical problems. Though, an important difference is that “the family therapist refrains from any emotional contact with the family and chooses to operate from outside as an observer, supervisor, teacher and coach” (Rabstejnek, n.d), unlike Freud who frequently mentions therapist’s emotional entanglement with the patient, a process he labeled countertransference.
How Does “Unconscious” Fit Into The Picture? - A Critical Evaluation
Personal speaking, despite its sexually pathological nature the best thing about Freud’s gift of the “unconscious” is its ability to truly lend itself to the ‘periphery and root cause analysis’ discussion in the beginning of this essay, which in fact is very realistic, because time and again, we are often preached both personally and professionally, “not to accept anything at its face value, and instead probe deeper by questioning it”; thus, needless to mention, its widespread acceptance in most of the current psychological texts and journals.
However, more interestingly, in the last two decades “the family system therapists - Freud’s biggest critics have been found to increasingly use his psychoanalytic ideas like ‘the unconscious’, ‘transference’, ‘countertransference’, and ‘projective identification’, to seek an understanding about some aspects of the therapeutic relationship experiences of the families involved in the therapeutic process” (Flaskas, 2005, p. 125). As Flaskas (2005, p. 128-129) continues, “the immense capacity of the unconscious mind to hold thoughts and emotions quite distant from conscious awareness, lends distinctness and authenticity to the patient’s entire narration in a free association or dream analysis setting by including an account of his experiences, emotions, struggles and conflicts; something missing in a plain linguistically bound story script”. This assigns a holistic connotation to the actual story told by the patient, which, “though is constructed with the help of the therapist” (McConnell & Pickering, 2005); making it appear more than just reading out text from a story book, thereby, triggering empathy on the therapist’s part, to extract the best possible treatment from him/her.
Ryan, Lynch, Vansteenkiste, & Deci, (2011), consider the patient’s continued motivation to actively participate in the therapeutic process, as a key aspect governing this therapeutic alliance. “This source of motivation, in psychodynamic approaches and its other derivative approaches like ego psychology, self-psychology, and family systems approach etc., is the unconscious” (Ryan, Lynch, Vansteenkiste, & Deci, 2011). As Gabbard (2005 as cited in Ryan, Lynch, Vansteenkiste, & Deci, 2011, p.221) says, “that each of these concepts has relevance in working with client motivation because the patterns of motivation from the past are likely to have continuity with the clients’ attitudes and investment in therapy”.
Finally, on the flip-side, “Eric Berne, challenged ‘unconscious’ as being ineffective in psychotherapy, labelling it more confusing than clarifying on the grounds that it is neither ‘totally unconscious’, nor irrational and pathological, but rather ‘preconscious’ - can be brought back to the patient’s conscious level, through a mental dialogue between his parent, adult & child ego states which are consistent patterns of thinking, feeling and behaving. This happens when the patient’s final display of behavior in the therapeutic environment results from his wishes expressed as visual imagery in the child ego state, that are ultimately acted upon, based on auditory images or voices in his head once said aloud as a result of the above mental dialogue; voices that can be changed by getting another voice of the therapist in his head, thereby, ensuring theraputic compliance on his (patient’s) part” (Cornell W. , 2008, p. 96).
Conclusion
The above discussion highlights the ultimate intended goal of all psychotherapists, whether, Freudian or Bowenian, to enhance the patient’s recovery, by focusing on the therapeutic relationship between them. However, the historically ambivalent relationship, between both the theories, also can’t be ignored and raises questions regarding their “precise” co-existence in the therapeutic process without blurring each other’s foundational demarcations and preventing sacrifice of the “bigger endeavour”. This also implies challenges for future clinical psychotherapeutic practice.
However, a close scrutiny reveals “integrative practice” (Flaskas, 2005), as a possible solution, allowing creative unison of therapeutic ideas, from all corners, only for inspirational purposes, based on one’s actual clinical experience, to dictate the therapeutic process, instead of a deliberate intermingling of theoretical models and frameworks to flout the ground rules; remembering the primary goal of intended patient recovery. Thus, making us conclude that keeping an unrelenting focus on clinical experience of psychotherapeutic practice is the only universally beneficial strategy regardless of the diversity encompassing theoretical models and frameworks, since, they also depend on it for practical application and expression.
References
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