A Neuropsychological Model of the Unconscious and Therapeutic Change

by Efrat Ginot

The neuropsychological model of the unconscious presented here seeks to tackle recurrent difficulties that often confront both therapists and patients—the perniciousness of repetition and the difficulties involved in achieving sustained therapeutic change. Why are emotional and behavioral difficulties so enduring, stubborn, and repetitive even when we gain insight and think we can exert wilful influence on our feelings and actions? Why do people continue to engage in behaviors and interactions that cause misery to themselves and others?

Efrat Ginot

It is often not easy for patients (as well as therapists) to sustain new patterns of perceiving, feeling and acting. Traditional interpretations would suggest emotional resistance is at play, but does this help us grasp the underlying reasons for such impediments to change? Indeed, as will be further discussed, unconscious patterns are resistant to change, but not because of dynamically-motivated defensive reasons or a dynamically determined connection to old self-object representations; the resistance is built into the machinery of the brain/mind and more specifically, enacted unconscious maps (Damasio, 2010).
In other words, the problems involved in lasting changes to one’s moods, affect regulation capacity, typical ways of perceiving, feeling, and interacting stem from the very nature of unconscious processes. Consequently, an integrated neuropsychological model of the unconscious-conscious continuum will greatly expand our understanding of the all too human difficulties both patients and therapists experience. Indeed, a better knowledge of unconscious processes and their embeddedness within our neurobiology will enable both psychotherapists and patients tackle and ameliorate difficult patterns with more, empathy and effectiveness. More specifically, understanding the power of reflective awareness to slow down harmful automatic processes can offer a path towards sustained change.

Unconscious Maps and Self-Systems
From the very beginning of life on-going learning processes—epigenetically interacting with one’s inborn capacities—underpin the foundation for our unconscious, rendering its functions entirely adaptive or “normative” (Fosshage, 2005, 2011; Stoycheva et al., 2014; Wilson, 2003). At the heart of unconscious processes, and the self-systems they generate, is the brain’s efficiency in acquiring implicit skills and patterns that involve all aspects of our perceptual, visceral, emotional, and cognitive functioning. Throughout evolution such capacities developed as necessary tools that have ensured our success of survival, adaptation, and life management (Damasio, 2010). In this process of implicit learning, memories and experiences are encoded and retained for future adaptation and the maintenance of physical and emotional wellbeing. With an increasing volume of learned associations to the original experiences, a host of network connections create dynamic systems that continue to scan the environment for cues and challenges. Our brains/minds need to understand the environment at all times.
As experiences coalesce into emotional, cognitive, and behavioral procedural networks they do not demand conscious attention when a certain reaction is called for. Throughout development, new experiences are fitted into existing representations and neural maps, further strengthening specific adaptational organizations and complex patterns of response to both conscious and unconscious, external and internal stimuli (Damasio, 2010; Engel, 2010; Hassin, 2007; Koziol and Budding, 2010; LeDoux, 2002; Lewis, 2005; Wegner, 2007). Such complex patterns can pursue goals with apparent motivation and determination, but without conscious will or plan. In effect, conscious awareness is not necessary for the execution of many of our emotional and interpersonal needs (Bargh, 2007, 2014).
What is becoming clear is that despite the more (relatively) recent development of conscious processes, the unconscious ones are still very much in the picture, and furthermore are the center of our functioning. Being ontologically older and much better equipped to quickly respond to familiar situations, the unconscious realm became an essential mode of functioning. In effect, there is ample evidence that unconscious processes monitor and control, the way we pursue goals and desires. They also guide our adaptive and typical approaches to changes in the environment (Bargh, 2007, 2014; Churchland, 2013; Eitam et al., 2008; Glaser and Kihlstrom, 2007; Wilson, 2003).
The unconscious system as a whole, then, is actively engaged with the world outside and inside of us, and although operating out of awareness, it is an active and constant participant in our responses to all stimuli coming from our internal and external environments. Brain, body, and environment are inextricably linked at all times, from the perception, feelings, and interpretation of all stimuli to the unconsciously entrenched responses that automatically follow. The particular ways all these processes are entwine and continually expressed, give unconscious maps or self-systems their unique characteristics; their consciously-manifested self-states are in essence our personality traits. Importantly, unconscious maps and the conscious self-state they give rise to are constantly enacted in every mental and behavioral encounter with the environment and in all relationships, including the therapeutic one (Bromberg, 2006, 2011; Colombetti, 2010; Di Paolo et al., 2010).

The Inevitability of Repetition
Unconscious maps or self-systems repeat themselves when the influence of subcortical regions (e.g. the cerebellum and the basal ganglia) overrides that of higher-level cortical areas. In such a case their neural messages may bias the prefrontal cortex to interpret perceptions in an inflexible way that entirely relies on old maps. Within an interpersonal situation, for example, when an entrenched prediction is biased toward a humiliating outcome, what is released by subcortical networks are old behaviors that successfully relieved shame in the past, regardless of their adaptability to new situations (Koziol, 2014). When predictions regarding perceived emotional or interpersonal threats are based on an internal model alone, they do not take into account aspects of current reality. In this case, the entrenched maps, encoded by the cerebellum, fail to correct the activated defensive responses to adapt them to the current circumstances. These faulty predictive processes may lead to the repetition of behaviors and defenses that no longer work (Pally, 2000, 2007). While unconsciously expecting humiliation, avoidant behaviors will be automatically activated.
The evolutionary expanded pathways between conscious and unconscious functioning extend to the main planning areas of the brain, the PFC and its various executive functions (Donald, 2001). These links explain the control unconscious processes have over higher executive functions; it also leads to the automatic and out-of-awareness implementation of complex course of actions, belief systems, and goal pursuit, sometimes occurring over long periods of time (Bargh, 2007, 2014). What is important to underline is the brain/mind’s propensity to employ existing maps in the constant efforts to make sense of and interpret reality. We can all recognize in ourselves this tendency to see the world according to what we already know, or more accurately, according to the maps stored in subcortical regions (Damasio, 2010; Koziol and Budding, 2010)
This continuous tug explains how unconscious patterns seem to have a life of their own, and often win over conscious intention and deliberate wishes. Unless mindful efforts are exerted, the quick and automatic activation of subcortical networks can override the slower, reflective function characteristic of the PFC (Damasio, 2010; Lane et al., 2014; LeDoux and Doyere, 2011; Ochsner and Gross, 2005).

The Role of Automaticity in Repetition
The unconscious action of the subcortical and other regions indicate that the brain/mind favors automaticity. An automated response is one occurring without conscious participation, biasing the PFC to release old patterns in a rigid and repetitive way. As shown in imaging studies, automatic behaviors demand less effort and show less activation; decrease in activation during learning indicates that representations within the brain have become more efficient as automaticity has taken hold (Damasio, 2010). Being important for performing tasks automatically, the basal ganglia also mediates repetition of emotional, cognitive and behavioral patterns. Together, the interacting and merging cortico-cerebellar and cortico-striatal systems manipulate and guide response patterns that “know” what to do and how to react, repeating past patterns entirely out of awareness (Koziol, 2014; Koziol and Budding, 2010).
Reinforced neural processes coalesce into efficient unconscious maps, or self-systems, in response to adaptational pressures, and as we develop, the encoded systems can react to a wide range of stimuli as if they were the same—as if they all represented the same level of threat or challenge (Phelps, 2009). The overall purpose of these levelling processes is to maximize fast and automatic response patterns—to be efficient. Consequently, novel conditions may be perceived and interpreted within the existing “knowledge” of a core system, subsuming new situations into an existing unconscious system.
This characteristic explains what is often witnessed in people: the tendency to feel, behave, and interpret the world in very familiar and predictable ways, even when circumstances differ and these guiding systems work against us. It explains why insight and momentary determination to act differently are necessary but not sufficient for enduring change. Until change itself becomes more habituated, in the absence of reflective awareness unconscious patterns tend to take over. When this happens, a particular self-state is experienced as the only one possible, while we unconsciously scan the environment for ongoing confirmations and proof that what we feel is indeed utterly justified.

The Reciprocal Relationship Between Conscious and Unconscious Processes
Although it is impossible for us to have introspective access to the causal connections between neural activity and its behavioral outcomes, we still grasp for a clearer picture of these unconscious processes. More specifically, in spite of the structural dissociation between conscious intention and the behavioral (motor) systems in the brain—rendering most of the processes that guide action opaque to conscious access (Bargh, 2007; Prinz, 2003)—we still need to better understand how unconscious influences manifest themselves. For therapists who repeatedly witness the dual facets of the therapeutic process—its struggles and its victories—such a quest is particularly important. Although we cannot directly access those guiding neural processes, nor would we want to, we need to better understand their telltale signs in our patients and ourselves.
In fact, the inaccessible workings of the brain/mind notwithstanding, we still recognize unconscious patterns and motivation, actions carried out of awareness, at times at great cost to one’s wellbeing. How do we reconcile this contradiction, and proceed to conclude that we “know” one’s unconscious? The answer is provided by the dynamic relationship and resulting continuum between hidden neural processes and their enacted expressions in bodily sensations, feelings, thoughts, and behaviors—often inextricably entwined. This active and ongoing interchange between the unconscious and the conscious realms enables us to identify the unique self-systems that make up neural patterns. Paradoxically, this reciprocal relationship between the conscious and the unconscious makes our understanding of unconscious processes and repetitions at once more complex and more accurate and could lead us toward better psychological treatment.
Some of the more traditional conceptualizations of the unconscious have viewed it as a separate entity containing well-delineated memories or traumatic experiences that were made unconscious because they could not be tolerated by the conscious sense of self. Consequently, such approaches assumed that uncovering repressed—or in the more contemporary parlance, dissociated—memories would make the unconscious conscious and thus enable psychic integration. As we have learned, however, the immense unconscious system does not confirm to this view; the widespread networks that always hum in the background and give rise to our conscious states cannot be reduced to specific events, memories, and content. This unconscious background is composed of many fused perceptions, memories, and emotions, many of them created before conscious memory is viable, others the result of unconscious associative learning processes.
Understandably, the importance of recognizing the unconscious has always been an inseparable aspect of dynamically oriented psychotherapy, and recently the ability of mindful awareness is considered a necessary precursor to affect regulation and integration (Cozolino, 2002; Siegel, 2007; Wallin, 2007). But views as to how we recognize the unconscious, its effects, and its manifestations are rapidly changing. Slips of the tongue and free associations, for example, have long been thought to get to what is hidden and give us clues about out of awareness wishes, conflicts, or motivation. But because physioaffective, cognitive, and behavioral processes are all enmeshed within brain/mind processes and structures, the words uttered as slips of the tongue or free associations, uncensored as they might be, are too limited to get to the heart of the unconscious. Words cannot actually convey the complexity of the intertwined neural/mental procedures embodying an unconscious self-system with widespread characteristics (Churchland, 2013). Although words alone may indeed fall short at revealing our unconscious properties, what is becoming exceedingly clear is that enacted affects, thoughts, and behaviors can.

The Enacted Unconscious
As neuropsychological data indicate, unconscious processes can only be inferred and glimpsed mostly through the endless ways we actively experience and negotiate our internal and external environment. Although our mental patterns reflect a very narrow slice of the engine underneath, the brain’s tendency to enact unconscious systems automatically and without deliberation underlies our ability to recognize and identify some of the unconscious influences at play. This is what the brain does well: automatically, and out of awareness, implementing past experiential lessons so that we do not have to relearn things each time anew. The repeated enaction (a very useful term coined by Varela et al., 1991) of neural/self-systems gives expression to learned perceptual biases, emotional patterns, automatic cognitive interpretations, successful actions, and defenses. These authors, like many others after them, actually stress the embodied properties of the mind, aspects we often experience in the therapeutic process.
Interestingly, evidence that action tendencies motivate most mental processes—conscious and unconscious alike—is offered by the two poles of neuropsychological research. While cognitive neuroscience underscores enacted cognition (Colombetti, 2010; Engel, 2010; Koziol, and Budding, 2010; Sheets-Johnstone, 2010), Panksepp, a leading voice in affective neuroscience, also emphasizes the motor or action tendencies underpinning consciousness. In his words: “There is considerable evidence that our actions continually guide and focus our attentional and perceptual resources, for one end—the generation of effective behavior to help us survive” (Panksepp, 2003, p. 204). In other words, any understanding of how unconscious maps influence perception and behavior has to take into account the active motor connection to facets of functioning. Both the cognitive and the affective fields of study agree that unconscious self-systems “know” what to do and how to react, and thus create a pattern that repeats itself entirely out of awareness (see also Fosshage, 2005, 2011). Moreover, novel conditions are perceived and interpreted within the existing “knowledge” of the core system, ensuring a familiar reaction (Koziol, 2014).
On the other hand, higher-order control provides autonomy from automatic reactions, but the more deliberate system also functions slowly, having to reassess the nature of an appropriate response anew each time. Because such a process is a drawback to quick adaptation based on past learning, repeated and automatic self-systems have remained a major part of adaptational demands (Damasio, 2010; Koziol, 2014; Lewis and Todd, 2007). In the case of unintended slips of the tongue and free associations, it is possible that they may indeed reflect a lack of guardedness, spontaneous utterances that essentially give voice to what is already “half there,” a self-state that is not fully recognized yet, but can still be identified through enacted behaviors. Bollas’s (1987) “unthought known” comes to mind. When discussing the unconscious, then, it seems much more accurate to speak of unconscious processes rather than well-delineated memories (Churchland, 2013; Damasio, 2010).