How does psychoanalysis cure? Input from the neurosciences
There are numerous general therapeutic factors, common to all schools of psychotherapy, that are well known: the psychotherapist’s empathy, his/her authentic wish to help the patient, the patient feeling that he/she is accepted the way he/she is, to be listened to carefully, the regularity in contact with another person, etc.
There are many other therapeutic factors, specific to psychoanalysis; some have been well known for a long time, other are still insufficiently clear and need to be studied further in order to understand them. Recently we have acquired greater knowledge of one of these therapeutic factors.
Sometimes the input of another discipline, such as the neurosciences, for instance, allows us to find a parallel between brain functioning and a psychoanalytic theory of therapeutic action that had been observed many times, had been abundantly theorized but whose brain mechanisms had remained mysterious. Such is the case of what happens during what neuroscientists call memory reconsolidation, which is particularly relevant for psychoanalysis in the case of traumatic memories. The first intuition of memory reconsolidation was Freud's in 1896 in a letter to Fleiss. Neuroscientific research began in the 1960s and was developped by Nader et al in 2000. Recently, Alberini (2013) has published a book on the subject.
Let us begin, then, with the psychoanalytic thesis on this. We know that we all have the tendency to repeat, in the present, behavioral patterns and experiences that we learned unconsciously within the context of important relationships during childhood and that left traces in our implicit memory. This manifests itself clearly throughout our lives in the way that we establish relationships with others, both positive and negative. Now, there is an essential difference to the way positive and negative unconscious behavioral patterns are repeated.
Positive unconscious behavioral patterns tend, in general, to be reproduced in a flexible way; that is to say, if the person with whom we are relating does not act in a way that corresponds to our unconscious behavioral patterns we will be able to perceive it, adapt to the situation and modify our way of relating to that person accordingly.
The unconscious traces left by negative behavioral patterns during childhood, however, tend to manifest themselves through rigid behavior: the more the trace comes from a traumatic experience, the more rigidly it will express itself and the more difficult it will be for us to perceive the reality of the person in front of us. We will tend to repeat, unwittingly, the bad relational experience or the traumatic situation. Instead of being past, the past will continue to exist in the present, will invade it and will prevent us from having new, potentially good, experiences. This harmful repetition is often the reason for consultation of patients.
During psychoanalysis these unconscious negative behavioral patterns, or traumatic situations, will appear spontaneously in the way that the patient relates to the psychoanalyst. Thanks to the psychoanalytic setting, and to the neutrality of the psychoanalyst, these patterns will be able to be observed in a much more exact way than in any another context and this will allow the patient and the psychoanalyst to discover how something unconscious from the past is repeating itself here and now between them (and in the patient’s daily life) and thus make the unconscious trace conscious in an emotionally significant context. This, of course, does not change the past but it allows us to own unknown aspects of ourselves, to work through the trace by associating it to other experiences that will reduce its damaging power and, above all, it will allow the patient to stop the detrimental repetition. The past will be able to become past and the present will be lived more freely.
What happens, then, at the neurological level? Until recently the dominant paradigm in neurology was that once the brain had developed its structure was unchangeable. However, new research tools, in particular magnetic resonance imaging, have shown that this is not the case, the structure of the brain continues to change throughout life in function of the experiences lived by the individual: neurons grow, make new connections, undo other connections, certain neuron bundles thicken, others diminish. We call this brain plasticity; instead of being a fixed structure, the brain adapts like a muscle. Experiences literally form the brain.
At the level of memory, what has been discovered by neuroscience is that each time that a memory trace is reactivated in an emotionally significant way it becomes fragile and unstable. In other words, it becomes liable to be modified by the experience within which it is being reactivated. This modification will be even more notable if the present experience is not the same as the memory trace because the trace will then be associated to something new. This process happens during memory reconsolidation.
It is thus possible to transform the trace, not by erasing it, but by associating it to other experiences. This discovery allows us to understand that memory is in constant evolution, as are our brains.
Let us make, then, the connection between neurology and psychoanalysis with a concrete clinical example. A person that is afraid of depending on others will, in all likelihood, have unconscious memory traces of bad experiences relating to dependency; at a moment in life where it is necessary to be able to depend intensely and securely on someone else (an experience we all go through in childhood) that person will have felt that she/he could not count on someone to take care of her/him. This will have left an unconscious memory trace that associates dependency to danger and the person will do everything he/she can to avoid dependency at the same time as having a great, unfulfilled, need to depend on someone. This need and this fear will repeat themselves, unbeknownst to the person, in all her/his relationships and also in psychoanalysis if she/he decides to get treatment. The repetition will provide the necessary emotional context for the psychoanalyst to show the patient how something unconscious is manifesting itself here and now and link it to the patient’s past. Fundamentally, however, the repetition this will allow the patient to experience her/his intense need and fear of dependency within a reliable relationship where the feared past will not be repeated. In other words, the traumatic memory trace will be associated to a new, benign, experience that will reduce the damaging force of the original trace and will diminish its tendency to repeat itself. In a word, this allows one to free oneself, little by little, from a traumatic past.