How Do We “Know” What We “Know?” And Change What We “Know?”

Abstract

How the implicit and explicit domains of affective/cognitive processing are similar, are different, and interconnect is pivotal for theories of therapeutic action. The specific focus here is on how these systems encode information for processing and memory and how the encoding formats and learning processes of the implicit system affect its accessibility to higher order reflective consciousness and change processes. In contrast to positing that the implicit processing system exclusively uses a nonsymbolic format of encoding, the evidence strongly indicates that the implicit system primarily uses, as the explicit system, imagistic and verbal symbolic formats for encoding and processing information. The use of the same symbolic formats, it is proposed, facilitates the fluid interplay between these two systems and their access to higher order reflective consciousness. In addition, a variety of factors contribute to the variability of procedural knowledge (as well as explicit attitudes) to reflective conscious access. For example, the formative process of implicit procedural memory that begins with an explicit focus is more available to consciousness than those implicit memories formed totally out of awareness. Other factors include the age of onset when the procedure was being learned, frequency of repetition, intensity of affects, degree of emotional trauma, dissociation, and the current analytic intersubjective context. These considerations play a major role in what this author has proposed as two fundamental, interrelated pathways of therapeutic action involving explicit reflective exploration and implicit learning that occur in the psychoanalytic encounter. Rather than change taking place primarily through reflective exploration, the traditional focus, or primarily through implicit relational learning, a more recent proposal, this author is emphasizing the interplay between the implicit and explicit systems for therapeutic change.

Acknowledgments

Portions of this paper were presented at the conference “The Therapeutic Action of Psychodynamic Psychotherapy: Current Concepts of Cure,” March 28 to 29, 2008, Continuing Education Program, Harvard Medical School and Massachusetts Mental Health Center, Department of Psychiatry, Boston, Massachusetts, and the Panel, “How Do We Come to ‘Know’ and How Do We Change What We ‘Know,’” Spring Meeting of APA's Division 39, April 11, 2008, New York City.

Notes

¹I prefer to describe implicit processing as unconscious rather than nonconscious processing, for unconscious is a better descriptor of the level of awareness. Unconscious processes, thus, include both the implicit realm as well as Freud's dynamic unconscious, the latter involving repressive processes.

²In a well-known study providing empirical support for reflective capacity engendering change, Fonagy and his colleagues (Fonagy, 2001; Fonagy, Steele, Steele, Moran, & Higgitt, 1991), using their Reflective-Functioning Scale, demonstrated how severely deprived mothers with strong reflective functioning were able with greater probability to alter the usual intergenerational transmission of insecurity and, instead, raise securely attached children.

³I use the term relational psychoanalysis (with a lowercase “r”) to refer to all the various relational psychoanalytic approaches and use the uppercase “R” to refer to the American Relational authors (Fosshage, 2003a).

⁴This clinical vignette is based on an extensive clinical case presented in Fosshage (2007b).

⁵In serving these various functions implicit processing during waking parallels the well-researched organizing functions of dream mentation (see Fosshage, 1997, 2007a). Dreaming could be viewed as the continuation of implicit (unconscious) processing while asleep (keeping in mind the differences that sleep makes, for example, the reduction of external input). Both implicit processing and dreaming use imagistic and verbal symbolic encoding and processing, to be discussed.

⁶All relational models conceive of the genesis of psychopathology as an emergent property of relational systems. Relational theorists, however, vary as to placing the emphasis on learning versus the vicissitudes of aggression and defensive operations, what I consider to be remnants of intrapsychic drive and ego psychological models.

⁷The traditional manifest/latent content distinction, an assumption that the manifest content is always the product of defenses and is a compromise formation provides the underpinning for a skeptical attitude toward a patient's articulations.

⁸I prefer the term imagistic, instead of nonverbal, to refer to this format of symbolic processing. “Imagistic” is more descriptive; “nonverbal” only says what it is not. In addition, I wish to avoid confusion with our use of the term “nonverbal” to refer to the whole realm of communication that involves gestures, facial expressions, tonality, and so on.

⁹In keeping with the traditional emphasis on words in psychoanalysis, the emergence of symbolizing capacity often is erroneously paired in our field with the onset of language. Imagistic symbolic capacity, a capacity that is present at birth, is quite frequently overlooked.