Making Psychotherapy More Effective with Unconscious Process Work

Dan N Short

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000412963
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Making Psychotherapy More Effective with Unconscious Process Work is an essential text that seeks to educate readers on the astounding capabilities of unconscious intelligence to both gather information and engage in rapid cognition. By providing a comprehensive and easily understood overview of the recent research on unconscious processes, as well as clinical case material, this book provides readers with skills that will enable them to strategically engagethese resources.

The firstpart of the book discusses the research-based principles that frame this growth-oriented approach towards psychotherapy. New discoveries about the surprising limitations of conscious self-governance force readers to reconsider the overall aim of psychotherapy. The secondpart explores several transtheoretical techniques, focusing on prediction, reimagining, mental contrasting, and incubated cognition. Case examples and key point summaries are used throughout, with the last chapter featuring reflective exercises. This book is essential reading for practicing psychotherapists, Ericksonian therapists, graduate students, and professors of psychotherapy.

1 What is Unconscious Process Work?

DOI: 10.4324/9781003127208-1

If the question for psychotherapy is how to best make use of a person’s mental faculties, then the answer must include some activation of tacit knowledge, or what I call unconscious process work. Unconscious process work can seem mystical and improbable. Metaphorically, it is like lying down under the night sky and watching stationary stars pass by. You realize that during your moment of stillness the earth has moved you. In the following pages, we will see that conscious intention is a lesser thing that rides on much larger bodies of influence.

The best way I know to introduce an idea is to define it and then describe it in action. Within neuroscience, a distinction is often made between content versus process. Content relates to the storage of information, and process is the movement and transformation of information as it passes from one brain structure to another. Similarly, unconscious process work is the transformation of implicit content (e.g., memories, percepts, attitudes, emotions, expectations) in a way that affects the person’s ongoing phenomenological experiences, thoughts, and actions.

To demonstrate, we begin with a case example from my clinical experience. It offers a minimalistic view of unconscious process work that does not involve complex techniques. By definition, techniques are the byproducts of principles. For depth of understanding, as you read the case example, search for underlying principles and ignore the technique. Because it was so individualized, I have rarely used this technique, but the same principles will be echoed on every page of this book (e.g., unconscious problem-solving and self-organizing change).

One of my first post-doctorate clients was a young woman who had read about Milton Erickson (1901–1980) and decided to seek out an Ericksonian therapist. Before ending her initial phone call, she asked, “Is it alright if I fax you a list of my concerns?”

The first thought that came to my mind was Erickson’s admonishment to accept everything the client has to offer and then find some way to utilize it, which I did.

When her fax arrived, I was surprised to see that it was a full two pages filled with bullet-pointed items of intense concern. These included having a pattern of dating abusive men, feeling intensely inferior to others around her, and being unable to recall much of her childhood.

When she came in for the first time, I greeted my client with her list in hand. It seemed the best way to utilize her list was to read it with her. After she sat and gave her consent, I conducted a slow, meticulous, word-for-word reading of her statements aloud. My recitation was so slow that it took half the session. During this time she did not speak, did not blink, and hardly seemed aware of anything else.

Shortly after I read the final item, she began to search for words to express her experience. Her hesitant response was, “It all seems so different when I listen to you read it. Hearing your voice describe my problems makes them seem different.”

I asked her what she wanted to do with the rest of our time together. She said that she wanted to talk a little more about her boyfriend—how she met him and how he had treated her. This part of the session was more traditional, with her talking and me actively listening. Before she left, I asked her to say when she felt it would be the right time to return—the first thing to pop into her mind. She said that for some reason four weeks seemed right.

Four weeks later, she returned and was eager to tell me about her progress. She explained that in the past she had clung to abusive boyfriends until they eventually dumped her. She was always at the losing end. Now, for the first time, she had decided to end the relationship. She explained that after her therapy, she developed the strong feeling that he was not right for her. So, she moved out of his place and rented her own apartment.

This was a big move for her because she had never lived on her own—she had never experienced the feeling of being in charge of the space around her. As she explained, “I cannot say what made me decide to do this, but I realized that I need to discover who I am and that I cannot do that while I am with this guy.”

She was absolutely thrilled with her new discoveries. As she said,

I went to Target and bought red drapes! No one I know would approve of me hanging red drapes. But I like them! I think that red is my favorite color … It was such a wonderful sense of freedom. I bought a CD with Native American flute music. I was so happy sitting in my new apartment listening to my music with a candle burning. It is as if I am just now discovering what things I like.

In this case, most of the process work occurred outside of the client-therapist dialogue and beyond the margin of conscious review or understanding. To understand how this rapid change occurred for the client, we start with the classical definition of process work and then progress to a more modern, scientifically informed understanding of unconscious dynamics.

1.1 Traditional Process Work is Built on Freudian Principles

Hearing the words process work leads most to think of Sigmund Freud (1856–1939) and a therapeutic method that seeks to increase conscious awareness of unconscious processes (uncovering work). Indeed, the term first appeared in the 1970s when Jungian psychologist Arnold Mindell used it to describe his approach to increasing awareness of unconscious emotions and cognition. Mindell’s transpersonal psychology sought to help people develop personal awareness and identify with repressed thoughts, emotions, and experiences that may negatively affect their everyday life.

In the context above, to “process an issue” means helping people integrate the psychological aftermath of a traumatic event within an autobiographical narrative. Most importantly, this narrative is coherent and can be expressed in words. As you read more about the evolution of this concept, keep in mind that we will soon turn in the opposite direction.

The paradigm underlying classical process work traces back to Sigmund Freud (1915), who divided all mental activity into two complementary forms of experience—primary processes and secondary processes. Simply put, primary process describes the discharge of biologically based instincts, such as the primitive urges for sex (eros) or aggression (thanatos). But biological drives alone are not enough to govern the actions of a complex organism. As Freud (1900) puts it,

It will be rightly objected that an organization which was a slave to the pleasure principle and neglected the reality of the external world could not maintain itself alive for the shortest time, so that it could not have come into existence at all.

(603)

Thus, Freud concluded there must be a secondary process, one that is capable of binding or regulating the flow of psychic energy as the organism seeks to reconcile itself with the consequences of engaging an external world.

Freud (1924, 306) used the terms conscious and unconscious nominally and spatially, with the unconscious being a mental location that acts as a repository, a “cauldron” of primitive wishes and impulses kept at bay and mediated within a medial level of awareness. This is the preconscious, the place where thought is initially formed as ideas pass from knowledge of thing-representations to word-representations (what non-Freudian theorists, such as Prince, referred to as the subconscious). Next, at the level of conscious awareness, word-based thought is used to allow for the displacement of small quantities of energy. In sum, psychological difficulties were viewed as pent-up energy that can be safely discharged during therapeutic dialogue.

These ideas formed the basis of the talking cure. Many decades since Freud, this same basic approach has been enshrined in the popular maxim “You have to name it to tame it.” In other words, the effects of raw emotional energy become less intense when we can discuss our feelings with someone capable of empathetic understanding. Importantly, this view of process work places great emphasis on verbal expression (the client’s words mediate change). Freud designed analytic therapy to be the antithesis of classical hypnotherapy (the hypnotist’s words mediate change).

In contrast to classical process work, my client was never asked to describe her feelings, nor was her childhood mentioned. In contrast to traditional hypnotherapy, I did not offer any discernable suggestions for any specific change to occur. To recognize the principles at work, a paradigm shift is required.

1.2 Conscious Process Work Can Be Harmful

Freud is not the only one to argue for the importance of discussing our thoughts and feelings. From an academic perspective, cognitive scientists have found that conscious processing helps solidify new attitudes. Similarly, psychotherapy researcher Leslie Greenberg (2012) argues that a spoken (dialectical) synthesis of emotion and reason produces meaning. From this Jamesian perspective, emotion makes action possible while conscious organization adds coherence. Greenberg claims that without conscious articulation, the depth, range, and complexity of emotion cannot develop beyond its instinctual origins. For scholars such as Greenberg, emotional process work is always done at the conscious level of experience, symbolizing it with words and reflecting on it in order to create new narrative meaning. However, as with any set solution, its strength is its weakness.

Folk wisdom has long held that sometimes it is best not to “over think” certain experiences. The more complex and emotionally provocative the object of observation is, the more this seems to be true. Consequently, experiments in a wide variety of contexts have shown that attempts to put complex sensory experience into words impairs judgment and memory. Thus, there are times when words are not enough to capture the complexity of a phenomenological reality. The term used to describe this is verbal overshadowing.

This effect was first reported by Schooler and Englster-Schooler (1990). In this classic study, participants were asked to watch a video of a robbery and then either verbally describe the robber or engage in a distracting task. The result was that those who described the robber were less likely to correctly identify the individual in a lineup. In other words, putting an experience into words can result in failures of memory about that experience, whether it be the memory of a person’s face, voice, or the color of an object. The effect occurs with a seemingly endless number of nonverbal perceptual stimuli. When conducting therapy, it is important to recognize that the client’s own words can distort truth, even to the point of creating false memories.

An even more insidious problem is the distortion of spontaneity by conscious intention. This phenomenon has been named the paradox of introspection. While studying happiness, psychologists Schooler, Ariely, and Loewenstein (2003) found that the direct pursuit of positive internal states can produce a negative effect. What they found was that both the active monitoring of pleasure and the deliberate intention to enjoy an activity lead to decreased enjoyment. In other words, therapy clients who are encouraged to engage in effortful introspection with deliberate attempts to attain a greater sense of well-being may experience the paradoxical effect of becoming more and more discontent with their emotional disposition!

For both verbal overshadowing and effortful introspection, the negative effects disappear once a person reaches a certain level of expertise and proficiency. Thus, the reason therapists love to attend workshops that offer exciting new vocabulary and introspective exercises might be because most are highly proficient in these skills. Clients, on the other hand, may not be prepared to reap the same rewards.

A third problem is emotional flooding—harm caused by excess emotion. This unpleasant experience can produce lasting negative effects. I witnessed this early in my career at a training event. A colleague came out of a psychodynamic therapy group disoriented and in a state of intense emotional distress. She could barely speak and did not know where to go. While the psychodynamic technique certainly achieves its goal of intensifying the patient’s emotional arousal and uncovering old wounds, it can also lead to horrible feelings of shame and failure. This happens when all responsibility for maintaining a productive exchange is thrust upon a struggling client.

As for my friend, I walked her back to her room and suggested she could find privacy and safety there, especially in the bathtub with warm water all the way up to her neck and all the lights off. I called it a “return to the womb experience” (her mother had committed suicide when she was 14 years of age). The next day she smiled and told me she had an amazing return to the womb experience.

Clients become emotionally flooded when pushed too far too fast. As I learned while working in the field of domestic violence, the consequences of emotional flooding can be significant. Those who become ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Foreword
• 1. What is Unconscious Process Work?
• 2. Perception and Memory
• 3. Choice and Deliberation
• 4. Motivation and Goal Setting
• 5. Nonlinear Multidimensional Language
• 6. Prediction
• 7. Reimagining
• 8. Mental Contrasting
• 9. Incubated Cognition
• 10. Unconscious Process Work: A Growth Mindset
• Index