The Neuropsychology of the Unconscious: Integrating Brain and Mind in Psychotherapy

342 Pages·2015·1.41 MB·English

by  Efrat Ginot

The Neuropsychology
of the Unconscious
Integrating Brain and Mind
in Psychotherapy
Efrat Ginot
FOREWORD BY ALLAN N. SCHORE
W. W. NORTON & COMPANY
New York • London
A NORTON PROFESSIONAL BOOK
The Norton Series on Interpersonal Neurobiology
Louis Cozolino, PhD, Series Editor
Allan N. Schore, PhD, Series Editor, 2007–2014
Daniel J. Siegel, MD, Founding Editor
The field of mental health is in a tremendously exciting period of growth
and conceptual reorganization. Independent findings from a variety of
scientific endeavors are converging in an interdisciplinary view of the mind
and mental wellbeing. An interpersonal neurobiology of human
development enables us to understand that the structure and function of the
mind and brain are shaped by experiences, especially those involving
emotional relationships.
The Norton Series on Interpersonal Neurobiology provides cutting-
edge, multidisciplinary views that further our understanding of the complex
neurobiology of the human mind. By drawing on a wide range of
traditionally independent fields of research—such as neurobiology,
genetics, memory, attachment, complex systems, anthropology, and
evolutionary psychology—these texts offer mental health professionals a
review and synthesis of scientific findings often inaccessible to clinicians.
The books advance our understanding of human experience by finding the
unity of knowledge, or consilience, that emerges with the translation of
findings from numerous domains of study into a common language and
conceptual framework. The series integrates the best of modern science
with the healing art of psychotherapy.
To my beloved family: My husband Prem,
my daughters Ariel and Talya Ramchandani
CONTENTS
Acknowledgments
Foreword by Allan N. Schore
Introduction
Chapter 1“My Unconscious Made Me Do It”: An Excuse or an Accurate State
of Affairs?
Chapter 2The Lasting Power of Anxiety: The Developmental Building Blocks
of Self-Systems
Chapter 3The Unknowable in Action
Chapter 4Therapeutic Enactments: Unconcious Processes and Self-Systems
Revealed
Chapter 5Aspects of Affective Dysregulation: Self-Narratives as Expression of
Unconscious Self-Systems
Chapter 6Repetition and Resistance
Chapter 7Injury, Defense, and Narcissistic Personality Structure
Chapter 8Implicit and Explicit Therapeutic Processes: The Elements of
Enduring and Sustained Change
Chapter 9Intergenerational Enactment of Trauma: The Role of Unconscious
Self-Systems
Chapter 10Intersubjectivity and Unconscious Self-Systems: The Coexistence of
Conflicting Processes
Conclusion
References
FOREWORD
ALLAN N. SCHORE, PHD
The construct of the unconscious, in psychoanalysis, psychology, philosophy,
and even neuroscience, has its origins in the late 19th century. For most of the
ensuing 20th century these models remained unchanged, and somewhat static.
But in the last quarter of that century emerging relational and intersubjective
clinical psychoanalytic models triggered a significant transformation in Freud’s
major contribution to human knowledge: a deeper explication of the human
unconscious in all aspects of human functioning. As a result, psychoanalysis, the
science of unconscious processes, is at this point in the 21st century undergoing a
substantial reformulation. In parallel, scientific studies of essential “implicit”
functions have shifted focus from a “cognitive unconscious” to an “affective
unconscious.” As the reader will soon appreciate, a substantial driver of this
transformation continues to be the integration of neuroscience with
psychoanalysis. In this important volume, Efrat Ginot takes on the challenge of
integrating psychoanalysis and neuroscience in order to continue this deeper
exploration of the human unconscious. I believe she makes a substantial
contribution in that effort.
Freud’s monumental contribution to science was his discovery of the
critical role of the dynamic unconscious in everyday life (1901), and in his
works he created a theoretical perspective that could bring into focus the
unconscious, subjective internal world that is instrumental in guiding the
individual’s moment-to-moment interactions with the external environment.
Drawing upon his early experience as a neurologist, over the course of his
prolific later writings as a psychoanalyst all of his investigations represented
attempts to elucidate the realms of the mind beneath conscious awareness.
Although throughout his career he attempted to reformulate his ideas with the
structural and topographic theories, his classic concept of the dynamic
unconscious remained unchanged—that the self-regulatory functions of the
unconscious system operate via the process of repression in order to bar access
of sexual and aggressive wishes into consciousness. In this manner, consciously
experienced painful negative emotions are repressed and thereby denied entrance
into conscious awareness. Clinical technique is thus aimed at “making the
unconscious conscious.”
It is now clear that Freud was correct in positing that the unconscious mind
develops before the conscious, and that the early development of the
unconscious is equivalent to the genesis of a self-regulating system that operates
beneath conscious, verbal levels for the rest of the life span. However, the idea
that the unconscious solely represents material that is repressed and banned from
consciousness has been disproven. Psychoanalytic theoreticians are now
describing “implicit memory and unrepressed unconscious” (Mancia, 2006). It is
now established that implicit memory systems mature before explicit memory
systems, and that the right brain matures in the first two years, before the left
(see Schore, 2012). I have therefore suggested that the later-onset repression
results from the growth of left prefrontal callosal axons over to the right. Levin
(1991) points out that callosal transmission begins at 3 and 1/2 years of age, a
period of intense interest to Freud:
Thus, the beginning of the Oedipal phase, a psychological and
neuroanatomical watershed in development, coincides with the onset
of the ability (or inability) of the hemispheres to integrate their
activities (p. 21)...The development of this defensive function, which
Freud called the repression barrier, is accomplished by the increasing
and reversible dominance of the left over the right hemisphere, which
is known to occur during brain maturation (p. 194).
Basch (1983) also proposes that “in repression it is the path from episodic to
semantic memory, from right to left [brain], that is blocked” (p. 151).
Recent discoveries about implicit functions and the right brain (Hugdahl,
1995) have thus been a major force in upending Freud’s equivalence of
repression with the unconscious (Schore, 2003a). In recent years neuroscience,
especially brain imaging research, is actively exploring the implicit
(unconscious) processing of cognitions, but even more importantly, affect and
affect regulation. Thus the processing of both negative and positive emotions
occurs at unconscious levels, not because they are repressed, but because bodily
based affects are expressed rapidly and spontaneously, so rapidly that they occur
beneath levels of conscious awareness. Moreover, neuroscience has also
confirmed that not only cognitions but also affects can be unconscious, indeed
dissociated, and therefore the unconscious also contains not only repressed but
dissociated affects.
Due to the fact that all of these implicit emotional functions are in turn
expressions of the “emotional” right brain, I have proposed that Freud’s seminal
model of a continuously active unconscious mind describes the adaptive
moment-to-moment operations of a hierarchical, self-organizing regulatory
system that is located in the cortical and subcortical areas of the right brain.
Regarding this transformation in Freud’s unconscious I have suggested, “Instead
of a repository of archaic untamed passions and destructive wishes, it is now
seen as a cohesive, active mental structure that continuously appraises life’s
experiences and responds according to its scheme of interpretation” (2003a, p.
xvi).
Another significant alteration of Freud’s model is expressed in the concept
of a “relational unconscious” whereby one unconscious mind communicates
with and interactively regulates another unconscious mind. Due to the fact that
affects are communicated within relational transactions via right brain-to-right
brain emotional transactions, implicit relational knowledge and internal working
models of relationships operate at unconscious levels. Thus adaptive self-
regulating processes of the brain-mind-body that occur at levels beneath
awareness occur in two modes, (a) autoregulation, via the processes of a “one-
person psychology” of an intrapsychic unconscious, or (b) interactive regulation,
under the operations of a “two-person psychology” and a relational unconscious.
These conceptual alterations have in turn had significant impacts on clinical
practice. Ultimately, the most powerful theoretical and clinical models of both
psychoanalysis and neuroscience must incorporate aspects of both the one-
person psychology of an autoregulating isolated brain and the two-person
psychology of an interactively regulating brain.
Indeed, that integrative goal is a major focus of this groundbreaking book.
In the following pages, Ginot concludes, “the centrality of the dynamic
unconscious—the one created by the rejection of unwanted material—as the
foundation of everyday pathology can no longer be accepted without doubts.”
She observes, “Far from serving a defensive function and being the container for
unwanted experiences, unconscious processes are ever present and widespread
and in essence are the neuropsychological force behind most of our mental and
behavioral operations.” Throughout the book, she blends theory and clinical
practice with the pragmatic dictum, “the more we learn about our unconscious
forces, the better equipped we are to better understand and treat the emotional
and behavioral predicaments we encounter in our patients and in ourselves.”
And so she sets to the task of utilizing an interdisciplinary perspective in
order to offer a neurobiologically informed model not only of unconscious
processes, but also of the relationship between unconscious and conscious
systems, as well as the unique roles of the right and left hemispheres in what she
calls “the conscious-unconscious continuum.” Over the following chapters the
reader is presented with very recent neurobiological research, which Ginot in
turn integrates into more complex models of essential functions of the human
mind, both implicit and explicit. These data are extracted from a number of
different sources—the laterality literature, including right and left cortical and
subcortical regions, the involvement of the amygdala in unconscious fear
detection, the role of corticostriatal basal ganglia and corticocerebellar systems
in procedural learning, the default system and self-referential functions, and the
mirror neuron system and self-narratives and language development. Much of
this material may be new to the reader.
In addition to a masterful overview of the rapidly expanding body of studies
on the neuropsychology of the unconscious, the author also presents a creative
integration of clinical and neurobiological data to formulate a clinically relevant
model, illustrated by numerous case vignettes. Indeed, along the way she uses an
interpersonal neurobiological model of the unconscious to explicate the
underlying mechanisms of a wide variety of clinical phenomena, including affect
regulation, intersubjectivity, early attachment and emotional development,
trauma, defense patterns of unconscious repetitions and resistance, narcissistic
dynamics, transference-countertransference interactions, unconscious and
conscious therapeutic change mechanisms, and especially the expression of
unconscious aspects of the patient and therapist in clinical enactments, a
significant contribution of her earlier works. Her explorations on the
neurobiological underpinnings of narratives and reflective awareness are original
and provocative.
With respect to the current surge in studies of brain lateralization,
throughout this book Ginot discusses the relevance of my work on the right brain
(as well as the work of others on the right hemispheric portion of the mirror
neuron system, e.g., Cattaneo & Rizzolatti, 2009; Uddin et al., 2007) as a
scientific foundation for more complex neuropsychological models of the
unconscious. My ongoing studies in developmental neuropsychoanalysis models
the early development of the unconscious (vs. the later-forming conscious) mind
and the implicit subjective self. Throughout the life span, implicit emotional
communication and psychobiological regulation, operating at nonconscious
levels, supports the survival functions of the right brain, what I have termed as
the biological substrate of the human unconscious (Schore, 1994, 2003a, 2012).
Consonant with this proposal, Tucker and Moller (2007) assert, “The right
hemisphere’s specialization for emotional communication through nonverbal
channels seems to suggest a domain of the mind that is close to the
motivationally charged psychoanalytic unconscious” (p. 91).
Indeed, a growing body of studies document that unconscious processing of
emotional information is mainly subsumed by a right hemisphere subcortical
route (Gainotti, 2012), that unconscious emotional memories are stored in the
right hemisphere (Gainotti 2006), and that this hemisphere is centrally involved
in unconscious functions (Joseph, 1992) associated with maintaining a coherent,
continuous, and unified sense of self (Devinsky, 2000; McGilchrist, 2008). From
infancy through all later stages of development, right-lateralized, rapidly acting
emotional processes are dominant for enabling the organism to cope with
stresses and challenges, and thus for emotional resilience and wellbeing. These
right brain-to-right brain communications, operating at levels beneath conscious
awareness, allow for the ongoing maturation and development of the human
unconscious mind across the lifespan. The relational nature of the
psychotherapeutic context is thus a seminal matrix for the evolution of more
complex unconscious structure and function.
In light of the fact that in the upcoming chapters the author repeatedly
refers to and elaborates upon my studies, in the next part of this foreword I will
briefly offer the reader some very recent neuroscience data on the unique roles of
the right brain, as well as updates of my ongoing studies on the application of
this research to clinical phenomena. I will specifically address three matters: the
central role of the right brain in attachment communications within the
therapeutic alliance, in transference-countertransference communications within
mutual enactments, and in relational mechanisms of therapeutic change. And
then I shall invite the reader forward into the creative mind of Efrat Ginot.
RIGHT BRAIN ATTACHMENT COMMUNICATIONS WITHIN THE
THERAPEUTIC ALLIANCE
In my writings in modern attachment theory I have attempted to describe the
interpersonal neurobiological origins of the life-sustaining emotional bond
between the infant and the mother. Grounded in both developmental
psychoanalysis and developmental neuroscience, my overarching regulatory
theory posits the long-held principle that the first relational contact is between
the unconscious of the mother and the unconscious of the infant (J.R. Schore,
2012). During attachment episodes of right-lateralized visual-facial, auditory-
prosodic, and tactile-gestural nonverbal communications the primary caregiver
regulates the infant’s burgeoning positive and negative bodily based affective
states. At the most fundamental level, the right brain attachment mechanism is
expressed as interactive regulation of affective-autonomic arousal, and thereby