I teach cognitive psychology to doctoral clinical psychology students. By the time they take my class, in the second semester of their third year, they have already acquired considerable clinical experience and knowledge. They know that patients communicate through such signals as physical appearance and movement, not only through words. They know that when a patient is “stuck,” not moving, this does not necessarily imply “resistance.” They search for ways to work with patients who are not progressing, and they have been trained to use their own subjective experience as a guide for clinical work.
Before taking my class, some of the students speak of their clinical experiences in ways that are troubling to me. They talk about a particular kind of psychic maneuver they believe some patients make, in which a feeling the student-therapist may regard as unusual or peculiar, as an “unacceptable, alien, split-off self element,” a “split-off aspect of the patient,” has been projected or put into the therapist. The student clinicians often go on to talk about how they use this information in subsequent clinical interactions with the patient. When asked to explain these phenomena, they give explanations like these: “I identify and feel as if the patient's projection belongs to me. I become the paralyzed [angry, frightened, etc.] part of the patient. I become a rigid therapist [experience a wish to attack the patient, feel afraid of the patient].”
One of my major interests in working with psychoanalytic clinicians has been to help them find ways of using ideas derived from cognitive psychology in their work with patients. It has been perhaps the most gratifying experience of my teaching career that by the end of the course, many of the students have acquired a new understanding of psychoanalytic clinical concepts like projective identification and of various aspects of the treatment process as well — an understanding rooted in a systematic psychological theory that I have developed during the last two decades of my scientific research on the way in which information is registered and organized in the mind. I have called my work “multiple code theory” and have applied it to free associations, dreams, and many other psychological phenomena.
As I developed my theory of multiple coding, I have drawn upon new discoveries in cognitive psychology and related disciplines to provide a theoretical structure that can both support empirical research and account for the internal experiential processes with which psychoanalysis is concerned.
Several aspects of multiple coding contribute to an understanding of the analyst's use of subjective experience in emotional communication with the patient: subsymbolic processing, an emphasis on dissociation rather than repression, and the repair of dissociation in the referential process.
Humans represent and process information, including emotional information, in three basic modes: the nonverbal subsymbolic, nonverbal symbolic, and verbal symbolic modes. The nonverbal symbolic and verbal symbolic forms are familiar to us as the codes of imagery and language. Subsymbolic processing is systematic processing that occurs in motoric, visceral, sensory form — as sounds, smells, and feelings of many different sorts.
In cognitive science, such processing is characterized as formally analogic — processed as very fine variations on continuous dimensions, in parallel and distributed formats, rather than generated from discrete elements. Such processing is hard to describe technically, but it is familiar to us in our daily lives. We know it as intuition, as “the wisdom of the body” and in other related ways. The patient and analyst communicate profoundly in this mode.
The three systems are connected, partially and to varying degrees, by the referential process. Emotion schemas — the psychic structures with which we are centrally concerned — are made up of components of all three systems, but are dominated by the subsymbolic sensory, somatic, and motoric representations that constitute the schema's affective core. Pathology is defined in terms of dissociation, which may occur at varying levels within the emotion schemas.
The fundamental goal of treatment may be characterized as the integration or reintegration of systems that have been dissociated, rather than making the unconscious conscious, placing id where ego has been, or in any sense transforming more primitive representations to higher or more complex forms. The focus on dissociation rather than repression applies for all forms of neurosis, not only for conditions of trauma and abuse.
Change occurs through the bidirectional effects of the referential process, in the context of the therapeutic relationship. Three major phases of the referential process have been identified:
Arousing an emotion schema, dominated by subsymbolic representation and communicated most directly (often not intentionally) in behavioral and somatic form (e.g., changes in facial expression, particular types of body movement, and vocalizations such as laughing, crying, sighing).
Describing an image or telling a narrative that represents the emotion schema in metaphoric form.
Reflecting on the meaning of the narrative, leading optimally to some repair of dissociation, some widening of the components of the schema that can be claimed and integrated.
Our research is directed toward developing indicators, in language and behavior, of the three phases of the referential process and examining therapeutic work in each phase. Consistent patterns of interaction, factors affecting these interactions, and effects on patient responses have been identified across diverse patient-analyst pairs. These observations also highlight noteworthy events in a session, such
Wilma S. Bucci, Ph.D., is a professor of Psychology at Adelphi University in New York. She is an honorary member of the American Psychoanalytic Association and chair of the Research Associates of APsaA.
as deviations from expected interaction patterns or indicators of impasse. These observations can then be addressed directly with clinicians and can provide a basis for direct collaboration between clinical work and research that benefits both.
From a theoretical perspective, the new theory provides a systematic psychological explanation for the clinician's subjective experience, outside both verbal and symbolic modes. Given such an explanation, the therapist need not resort to notions of magical and mysterious transmission, but can search for the source of her response to the patient in his multi-leveled emotional communication and her own emotion schemas. The therapist can see that it is not the patient's emotional paralysis or rage or terror that she is experiencing; it is her own. It is not occurring “as if” it belongs to the therapist; it is hers. The therapist can then work to understand, in the context of her own emotion schémas, why this patient elicits this response in her.
Psychotherapy research has sometimes been criticized as oversimplifying clinical work, or at best validating what clinicians already know. But my students tell me that their knowledge of psychological processes, based on empirical research, has helped them see more of the complexity of their clinical work. In return, their clinical experiences help to validate the psychological concepts.
Psychoanalysis is at its core a part of psychology. There are multiple interfaces among scientific psychology, psychotherapy research, and clinical psychoanalysis. Discoveries at these interfaces will benefit us all.