Understanding Psychodynamic Psychotherapy Through the Fascinating Lens of Language Acquisition
The process of language acquisition, embedded in our formative years, provides a unique lens through which to examine the unconscious mechanisms at play in psychodynamic psychotherapy.
This article aims to unravel the complexities of psychodynamic psychotherapy by drawing parallels with the way we learn and absorb language.
It explores unconscious processes during a time when the brain’s architecture, particularly the prefrontal cortex, is still in its formative stages.
As we examine the implicit memory within the motor striatum and its role in language development, we aim to illuminate the nuanced relationship between language, behaviour, and the unconscious patterns psychodynamic psychotherapy endeavours to understand and modify.
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PART 1 - WHY LANGUAGE?
The inquiry into the origins of language use leads us down a path to understanding the unconscious.
The acquisition of language occurs synchronously with the laying down of the unconscious, which is critical to the framework of psychodynamic psychotherapy.
The term ‘unconscious’ is integral to this therapeutic approach, yet its explanation often poses a challenge, even for seasoned therapists, making the core concepts of psychodynamic work somewhat elusive.
How does one absorb their native tongue?
You know the words but think about the journey of making those words your own – the meanings they hold, the nuances in how they’re used, the emotions they stir, and the actions they initiate.
Consider how often our communication extends beyond words to include gestures and expressions. These elements come together to form a complex puzzle.
This mastery of language seems to happen without conscious effort, an ability we cannot fully recount, mainly because it’s embedded in implicit memory within the motor striatum.
This occurs during a developmental stage when the prefrontal cortex (PFC) is not yet fully mature.
Implicit or procedural memory operates beneath our conscious awareness, guiding the actions we perform without active thought, such as cycling or swimming.
In this way, our fluency in our native tongue is essentially unconscious.
Regardless of whether the explanation is psychological or biological, language learning happens “automatically.”
In biological terms, this is articulated as the minimisation of reward prediction errors (RPEs), a concept central to the mechanism of reward learning.
What exactly are RPEs, and what role do they play?
An RPE is essentially a surprise signal that alerts us when outcomes don’t align with our predictions. It is a prediction-outcome mismatch. [Schultz, 2016]
It represents the cornerstone of reward learning, initiating with an unexpected emotion or feeling, a sort of ‘surprise’ that arises from a disparity between what we predict and what actually occurs.
This propels our brain into action, prompting behaviours that work to minimise future surprises, which is the process of minimising RPEs.
We thereby fine-tune our predictions to better match possible outcomes, guiding us as we navigate through the uncertainties of life.
Yuval Noah Harari encapsulates the essence of this concept:
We do not become satisfied by leading a peaceful and prosperous existence. Rather, we become satisfied when reality matches our expectations. [Harari, 2016]
When an RPE is resolved, it’s integrated into the habitual circuits of our brain, and we proceed to form new goals, new predictions, and new learning processes.
Take, for instance, a child experiencing the sweetness of a lollipop for the first time—they are likely to associate a lollipop with a sweet sensation, a quintessential example of positive RPE minimisation.
Conversely, a child who encounters fear in the dark is creating unconscious memories charged with behavioural responses.
These formative experiences, whether delightful or distressing, shape our earliest understanding of the world and continue influencing us throughout our lives.
PART 2 - CONNECTING RPEs TO LANGUAGE
Now, let’s consider how RPEs relate to language acquisition.
The minimisation of RPEs in learning the language, words and their meanings is a dynamic process filled with trials, errors, and constant adjustments that eventually become habitual, nestled within the dorsal striatum, part of our implicit or procedural memory.
Take a child who utters “DADA cuddle,” anticipating the embrace of a caregiver.
This expectation, when met with a warm response, fosters affectionate emotions and behaviours that solidify with each occurrence.
The child unconsciously comes to understand the predictability associated with the word “cuddle.”
This word becomes an automatised prediction that bypasses the need for conscious thought.
However, if the word “cuddle” consistently leads to unpredictable or negative responses, the child faces ongoing surprise signals, a discord that hinders straightforward RPE minimisation.
The term “cuddle” may thus fail to maintain a dependable prediction-outcome connection for this child.
In response, a range of behaviours and words may evolve as the child strives to ‘resolve’ this conflict, whether through adaptive or maladaptive means.
Pause and consider: While these behaviours and words might resolve the issue for the child internally, how do they translate into the broader external world?
Imagine a scenario where the word “cuddle” becomes associated with fear due to an unpleasant past experience.
What happens when this word is heard again?
Does the child run to a perceived safe space in response to this fear?
And crucially, how does this reaction pattern influence their future interactions with the concept of cuddling?
The ‘solutions’ to these challenges often emerge as automatic behaviours, emotions, and words, which can be either adaptive or maladaptive.
Reflect upon the myriad RPEs you’ve processed and minimised.
These are now elements of your unconscious, functioning automatically.
We each have a ‘default mode,’ crafted by these past encounters, which steers our reactions to forthcoming scenarios.
Our instinctive reactions in moments of stress or threat echo our implicit memories.
Much like our linguistic capabilities, our psychological makeup is an amalgamation of learned and internalised components- a bundle of predictions, emotions, and behaviours.
These bundles shape our internal world, with each term (and its connected emotion and behaviour) bearing the imprint of innumerable minimised RPEs foundational to our unconscious.
PART 3 - LEARNING A NEW LANGUAGE AS AN ADULT
The exceptional ability of children to learn a language quickly and integrate new words seamlessly, along with an array of behaviours and emotions, is a testament to the capacity of implicit memory, which is primarily facilitated by the striatum and largely inaccessible to conscious reflection (considering the PFC’s developmental stage).
Implicit or Procedural memories are “hard to learn and hard to forget.” [Solms, 2018]
Why is learning a NEW language so challenging for adults?
The challenge arises because adults must override their brain’s established automatic processes, which have been ingrained over years of language use and cultural immersion.
The prefrontal cortex is now developed.
A mature prefrontal cortex competes with implicit learning of word-forms. Motor learning studies have shown that enhancing cognitive effort during learning results in impaired procedural learning with greater activity in the prefrontal cortex. [Smalle, et al, 2017]
In adult learning, explicit or declarative memory takes precedence, which, unfortunately, is less efficient than the implicit memory systems heavily relied upon in childhood.
This aspect of learning is especially pertinent to psychotherapy, where the objective is to foster change.
Yet, this change encounters resistance from the prefrontal cortex, which prefers maintaining established patterns, having resolved past conflicts and minimised surprise signals.
The ego prefers problems to remain in the solved condition rather than the unsolved one. [Solms, 2018]
Thus, psychotherapy will entail creating expectancy violations, which are new surprise signals challenging the old (incorrectly) minimised surprise signals to bring about new learning and behavioural change.
Learn more about RPEs in the article on Neuropsychoanalysis.
PART 4 - ESSENCE OF PSYCHOTHERAPY
So, how does one successfully navigate learning a new language (or effect change in psychotherapy)?
It involves actively engaging with the language in real-world settings, speaking it, embracing mistakes, and encountering new scenarios. This practical immersion facilitates the shift from explicit to implicit memory, enabling new strategies for minimising reward prediction errors.
The suppressed reliance on the prefrontal lobe, improves implicit procedural learning of a novel skill. [Smalle, et al, 2017]
This shift away from PFC dependency is crucial. It parallels the psychotherapeutic process of ‘shaking up’ the automated, unconscious patterns and bringing them into conscious awareness.
The pathogenic predictions cannot be remembered directly for the very reason that they are automatized (i.e., non-declarative). Therefore, the analyst identifies them indirectly, by bringing to awareness the repetitive patterns of behavior derived from them. [Solms, 2018]
In the therapeutic setting, practitioners work to uncover and reshape these entrenched scripts, akin to how a language teacher might guide a student through new linguistic terrain.
The goal is to facilitate learning that becomes intuitive rather than deliberate, fostering skills accessible without conscious frontal lobe engagement, thus enhancing the procedural learning of novel behaviours. [Smalle et al., 2017]
In the quest for unconscious competence, the process of psychotherapy involves a critical step: Elevating the unconscious to the conscious realm, reconfiguring it, and then embedding it back into the unconscious as new, internalised understanding.
It’s about converting the unknown into the known, the unspoken into the spoken, the hidden into something clear and accessible.
The journey of bringing insights from the unconscious to the conscious and then reintegrating them into the unconscious as new learning underscores the essence of psychotherapy.
Reconsolidation is thus achieved through activation of non-declarative traces via their derivatives in the present (this is called “transference” interpretation). As stated above, non-declarative predictions cannot be retrieved into working memory; but patients can be made aware of the here-and-now enactments of those predictions. This is the essence of psychoanalytical cure. [Solms, 2018]
Much like language instructors, therapists don’t just interpret these ingrained scripts; they help re-script them.
Psychotherapy, therefore, is not merely an exercise in awareness but an active reconfiguration of the self.
To effect true change, it’s insufficient to merely elevate the unconscious into the conscious mind.
Such reconsolidation is nevertheless difficult to achieve, mainly due to the ways in which non-declarative memory systems work (they are “hard to learn, hard to forget” and in some respects “indelible”) but also because repression entails intense resistance to the reactivation of insoluble problems. [Solms, 2018]
However, change also requires an understanding that many implicit memories may not be amenable to the conscious mind.
Do you honestly remember all the procedural skills you learnt as a child?
So, if they aren’t accessible to the conscious mind, how do we change them?
Through action.
What it means is that they are not subject to reconsolidation via thinking (via conscious cognition, via working memory); they are only subject to reconsolidation through action. Non-declarative memories can only be activated (and thereby consolidated/reconsolidated) through embodied enactment. [Solms, 2018]
Once these elusive elements are in the domain of conscious awareness, they must be methodically reconsolidated into the striatum as a new automatised prediction, a process necessitating deliberate action.
Living the principles of psychotherapy, much like living in a new country to learn its language, involves immersing oneself in practising new behaviours until they become second nature.
Psychotherapy transcends the confines of theory and extends into habitual practice.
What is the ideal duration for psychotherapy? How long before new behaviours and thoughts become second nature, influencing our dreams? When do we start feeling at ease with these changes?
The answer varies, as varied as the individuals engaged in the process.
For all these reasons, psychoanalytic treatment takes time—i.e., numerous and frequent sessions—to facilitate “working through.” Working through entails numerous repetitions of transference interpretations in relation to ongoing derivates of repressed predictions, while new (and crucially, better) predictions are slowly consolidated. [Solms, 2018]
Psychodynamic psychotherapy is akin to learning a new language of the self.
Each person’s path is distinct, influenced by their objectives and the new terrains they choose to traverse.
Mastery is not a one-way street; it’s a personalised expedition marked by one’s intentions and willingness to delve into the depths of their unconscious.
So the next time you think of psychodynamic psychotherapy, go back in time and think of your journey of learning your first language.
Learn More:
- Unlocking the Neurobiology of Freud’s Psychoanalytic Theories – Neuropsychoanalysis | Part 1 of 4
- Navigating the Spectrum of Narcissism and Narcissistic Personality Disorder in Psychiatric Practice with Dr Ruth Ann Harpur
- Unlocking the Power of Psychodynamic Psychotherapy – Insights and Principles in Clinical Practice – A/Prof Neil Jeyasingam
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References
Dopamine reward prediction error coding.
Homo Deus
Harari, Y. N. (2016). Homo Deus. Harvill Secker.