“Why does my brain hate me?”
Resistance as relearning
Derrick L. Hassert
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Periodically, clients have confronted me with a question that is both challenging and thought-provoking: “Why does my brain hate me?” Sometimes this sentiment takes on other forms: “Why is my brain trying to sabotage me?” or “Why doesn’t my brain want me to get better?” Often the assertion is much blunter and more pessimistic: “My brain just doesn’t want me to be happy.” These comments and the experiences behind them highlight that the psychotherapeutic journey can be a tumultuous one: therapy is seldom a wholly linear and unidirectional process. Desirable change in psychotherapy is quite often distressingly punctuated by periods when the old ways of functioning burst back onto the scene as though they had never left the stage, leaving the client feeling as though they have fallen off the wagon, undoing any progress made up to that point, and perhaps revealing an unspoken assumption that change or therapeutic progress must be without error for it to be real or meaningful. The question and the challenge for both client and therapist is rooted in Why? Why do such things occur, especially when there is an explicitly stated desire to charter a new emotional, behavioral, or cognitive course?
The Ubiquitous Phenomenon of Resistance
Therapists have long recognized that there are times when clients can appear to be one of the most significant impediments to their own adaptive change. In the classic psychoanalytic framework such instances of self-defeating behavior are often characterized as resistance. Schlesinger (2003) comments that “what therapists commonly call resistance is behavior that manifestly opposes what the patient believes the therapist wants to do or wants to happen” (p. 81). While in the psychodynamic tradition this resistance is often verbal in form, it can be expressed nonverbally and emotionally as well (Schlesinger, 1982) and is considered “a ubiquitous phenomenon in all psychological treatments” (Samberg & Marcus, 2005, p. 233). The longing for therapeutic change is not just that of the therapist, it is also the want of the client, in that they are the one seeking assistance, and yet their behavior is strikingly at odds with this expressed intention. It could be added that quite often the client will declare that they are relatively unware as to why they are feeling or behaving in opposition to the therapist’s wishes, most notably because they themselves have explicitly espoused these same sentiments for change (Samberg & Marcus, 2005). For this reason, the emergence of resistance and the why of its occurrence are often said to be beyond the awareness of the client, beyond consciousness.
Insight Often Isn’t Enough
Once clients have observed themselves engaging in specific behaviors they are then usually able to describe and verbalize this behavior, both to themselves and to their therapists. Taking note of one’s behavior, verbalizing it, and perhaps even noticing patterns in the behavior (or accepting the reality of patterns pointed out by others) is sometimes enough to produce a notable behavioral change—something a psychodynamic therapist could liken to the concept of insight (Messer & McWilliams, 2007) and a behavioral therapist might consider an instance of reactivity (Kazdin, 1974). For example, a client may take note that they tend to eat mindlessly and perhaps excessively during the day when bored or stressed, only coming to this realization by carefully monitoring and reflecting upon their own behavior over an extended period or by being open to the observations of others observing those patterns. Bringing the behavior into the spotlight of conscious awareness may be enough to curtail it substantially. Nevertheless, insight (or conscious recognition) regarding behavioral patterns and/or behavioral reactivity to self-monitoring doesn’t always produce lasting cognitive, behavioral, or emotional alterations. In the example just mentioned—that of mindless eating—the client may fall back into not paying attention to their eating behavior, leading to a relapse of sorts into the old and undesirable ways when fatigued, hurried, bored, or otherwise stressed. The client may fault themselves for “knowing better” and yet not “behaving better” when they realize the problematic behavior has reinstated itself.
A classical psychoanalytic position may have interpreted such problematic behavior as an unconscious desire to remain the same—to stay in the old way of doing things due to an allusive and long-standing intrapsychic conflict. Where the older position is correct is that it is true that parts of the brain (and therefore parts of the psychological functioning of the individual) are indeed in very real conflict: one functional system of the brain is at odds with another and wants to stay the same while another system of the brain wants the behavior to change. It could be said that there are indeed long-standing and largely nonconscious reasons why undesirable behaviors persist, and these reasons are rooted in the way the brain functions as a multilayered information-processing and response system. Many modern psychodynamic theorists recognize that because so many emotional responses and social behaviors are learned prior to the full developmental and functional emergence of the explicit memory systems of the frontal lobes and the hippocampus, for the most part they function independently of the explicit memory systems:
The declarative system (which is usually assumed to contain ideas and experiences that have been repressed) constitutes a relatively small proportion of the unconscious mind. More extensive by far is the procedural unconscious, which consists of nonverbal aspects of experience that were never repressed, because they were shaped outside of awareness from the beginning, and are inaccessible to introspection and thus to interpretation. (Greenberg, 2005, p. 223)
Indeed, these emotional, procedural, preverbal, and pre-explicit systems form the backdrop for the later verbal cognitive functions and behaviors because those systems emerge prior to explicit awareness. Given the current state of knowledge in psychology and neuroscience this is no longer very surprising as it is now widely acknowledged that much of human mental processing and behavior is acquired and operates in a largely nonconscious manner (Solms & Turnbull, 2004).
These patterns of behavior emerged and persisted because they were beneficial for the individual, at least in some contexts. In the example above we were addressing one behavior (eating) that is based upon multiple behavioral choices, reinforced daily and going back decades, which early in that person’s development made them very happy or very sad, thus providing a strong emotional connection to the behavior. The learning of the behavioral repertoires that comprise these habits and the emotional connections to the behaviors are formed before the development of language and hippocampal-dependent explicit memory, making a behavior such as eating more dependent upon context and consequence than upon verbal rules and logic. Like other behavioral, cognitive, and emotional responses that emerged adaptively prior to the development of expressive language and the more fully developed capacity for explicit memory, the eating behaviors were prompted and reinforced subtly yet substantially in a manner that didn’t require later conscious recollection. Even after the emergence of language and explicit memory, the shaping and perpetuation of such behaviors can continue in the same fairly mindless way, open to the influence of contextual cues we are not fully aware of and yet firmly rooted in the structure of operant conditioning. (For a review of mindless eating and the importance of learning and context, see Wansink, 2006).
Social Behavior and Operant Conditioning
Most of us are quite familiar with the distinction between classical (or Pavlovian) conditioning and operant (or Skinnerian) conditioning. A rather simplistic way of distinguishing between the two has been to state that classical conditioning is involuntary and operant conditioning is voluntary. To some degree this is true when considering neurologically intact individuals. Complex behaviors such as riding a bike, driving a car, or playing a musical instrument generally involve a great deal of mental effort, attention, and intention when we set about learning them: the focusing of this attention and effort is arguably the purview of the prefrontal cortex (Rossi, Pessoa, Desimone, & Ungerleider, 2009). And yet, once they are learned, these behaviors can be executed automatically in an appropriately and adaptive fashion. Research into the neuropsychology of operant conditioning when contrasted with classical conditioning has revealed that both forms of learning can be acquired without conscious memory of the conditioning being necessary for the behavior to be subsequently repeated. Famously, patient HM, after bilateral ablation of the temporal lobes, was able to acquire and improve learned motor behavior over repeated trials, all without explicit memory of the previous exposures to the learning context (Corkin, 1968). Neuropsychological patients with temporal lobe damage, like HM, have been able to learn operant conditioning tasks without conscious recollection of the acquisition. While temporal lobe damage does not impair learning of this sort, damage to the basal ganglia notably does.
To more fully appreciate the extent to which socially significant behaviors are created and maintained by elements of operant conditioning, we could look to instances where adaptive nonverbal social behavior notably and consistently fails, specifically in the behavior of those meeting the diagnostic criteria for autistic spectrum disorders. The behavioral omissions that parents often notice first are the failure of the child to make eye contact or to produce and/or respond to facial emotional displays (Falck-Ytter, Bölte, & Gredebäc, 2013). Such methods of communication are employed before verbal communication has developed, and, for most children, are inherently reinforcing or punishing. When these behaviors fail to progress adaptively, one of the ways that has been shown to therapeutically address these deficits (though not in a universally effective manner) is the utilization of operant conditioning techniques through applied behavior analysis—essentially taking the social behaviors that we often take for granted and breaking them down into discrete units and unambiguously reinforcing these units (Keenan, Henderson, Kerr, & Dillenburger, 2006).[Content protected for subscribers only]