is a retired Chief Inpatient Mental Health Service of General Hospital of Vila Nova de Gaia, group analyst and training member of the Sociedade Portuguesa de Grupanálise e Psicoterapia Analítica de Grupo. Works in Private Practice. Adress: Praça do Marquês nº 66 – 3º, 4000-390 Porto, Portugal.
Email: [email protected]
is a consultant psychiatrist for Addictive Behaviours at National Alcohol and Drug Treatment Network, group analyst and member of the Sociedade Portuguesa de Grupanálise e Psicoterapia Analítica de Grupo. Works in Private Practice. Adress: Rua Adélia F. S. Carvalho, 126- 3 D 4470-130 Maia, Portugal.
Email: [email protected]
Aucíndio Valente & José Raio
Words, neuroscience, implicit knowledge and therapeutic change in a group analytic
This article seeks, among other aspects, to highlight the importance brought to group analytical theory by some of the new knowledge resulting from the development of neurosciences, particularly those of mirror neurons, and from the conceptualization of embodied mind and implicit knowledge. We argue that this body of new knowledge allows a better understanding of concepts that are so dear to group analytic theory and practice, such as, group pattern, internal relational matrix, and ego training in action, without leaving behind the concepts of unconscious, transference and countertransference that are at the core of any analytical-based psychotherapy in general. We express our opinion that words are crucial in the therapeutic process not only for being symbols and have meanings but because they include and convey intentions, affections, emotions, and actions.
Mirror neurons, embodied mind, implicit knowledge, words, therapeutic change, group analysis
This article seeks, among other aspects, to highlight the importance brought to analytical theory by some of the new knowledge resulting from the development of neurosciences, particularly those of mirror neurons, and from the conceptualization of embodied mind and implicit knowledge brought to the group analytic theory.
It is accepted, (Gabard, 2017; Schore, 2009) that this new knowledge allows a better understanding of the clinical practice of analytical-based psychotherapy in general, and of aspects that are so dear to theory and group analytic technique (Ferreira, 1992 e 2005) in particular. We refer to the concepts of matrix and group pattern (Cortesão,1989), internal relational matrix (Leal, 1994) and ego training in action (Foulkes 1975), without leaving behind the concepts of implicit relation knowing (BCPSG, 2015), unconscious, transference, and countertransference. Lastly, but not least, we refer to relational and interactive therapeutic processes in a subjective perspective that trigger healing. That is, how therapeutic change (BCPSG 2005) occurs and what role words, understood as a gestalt, play in it.
However, we would like to make clear that in no way we seek to be conclusive but only to leave doubts and questions that stimulate our reflection about these topics.
We have relied on one hand, on texts by authors who in recent years have been dedicated to the study and investigation of analytical theories (new contributions to these theories and theories of technique) as well from neurosciences and their mutual influence; on other hand, on the repercussion and evidence they have had in our clinical practice either as psychiatrists, or as a group analyst.
These authors (Beebe, 2002), (Daniel Stern, Louis Sander, Karlen Lyons-Ruth belonging to the Boston Change Process Study Group e Stephen Mitchel) present an integrated theory of development and treatment (that are inherently and simultaneously, similar to the group analytic process developing synchronically in time and space) and take into account the contributions of clinical theories such as the unconscious motivations, the conflicts, the relational interactions, the human development as well as the treatment of adults.
One of the questions raised by some of these authors, and that in our group analytic activity has become pertinent, is to know whether the therapeutic relationship (BCPSG, 2005) is by itself, a required or underlying condition for therapeutic change, even in the absence of interpretations or of any other analytical technique, (synchronism in time and space?).
Regardless of the answer, we think we should look at the therapeutic relational interaction (namely the one existing in the group matrix) in a new perspective from which, eventually, a new concept of group analytic activity may arise, where words have another function beyond the reflexive one triggered through its signs or meanings, but where we must also include intentions, emotions, feelings and affections, desires, and fears whether they are conscious or unconscious during the therapeutic relationship.
For a better understanding of what we try to expose we think it is important to recall some concepts that we all know but in our opinion they are outdated, and sometimes we do not have it present, even though they are underlying and thus can negatively influence our clinical practice. In doing so, it is also our intention to compare them with the new knowledge so that we can ask ourselves about their importance.
Thus, it is generally accepted and/or known that:
1 – Freud as a Cartesian (BSPSG, 2007) separated the physical from the psychic. Body and mind are separate entities, and conceived thought as being a derivative or consequence of an inhibited action. For him, the action was primary and only when inhibited gave rise to the mental phenomenon. Hence the use of the divan technique that in addition to other purposes was used to inhibit actions and more easily have access to the mental phenomenon through the verbalization of the free association of ideas.
2 – Also for Freud the unconscious to be analyzed was fundamentally constituted by aspects that had previously been pre-conscious or conscious and only later repressed, making up the dynamic unconscious.
3 – Also acting and words were two dichotomically alternating forms of expression since he saw action and verbalization as two individualized/singular and separable phenomena. The cure came from the patient verbalizing his feelings, “make the unconscious conscious”, and what he analyzed was the transference.
However, in our view, with the development of neurosciences and the application of the new knowledge to analytical theories, new perspectives emerged on the concepts mentioned above that have somehow allowed us to change them and have a better understanding of those theories, especially group analysis.
From those concepts we are going to refer to three, namely:
1 – The concept of embodied mind (non-Cartesian) (Varela, 1993) What thinks is not the brain, but the person, the brain is an organ belonging to an organism where thought is formed, but it is not its source. The source is the human being who thinks. (Damasio 1999, 2020) (Fuchs, Thomas 2018).
2 – The concepts of unconscious and of implicit relational knowledge (an unconscious knowledge) (Lyons-Ruth, 1998).
3 – The concept of mirror neurons and its importance to understand the previous two above (Rizzolatti, 2001).
Here we want to mention Mark Solms that from a neurobiological perspective, (Solms, 2013) tell us that “the psychology of words has evolved into a psychology of language”, and “words have thus gained the ability to represent the relationship between things”.
Those three concepts have brought into light a new understanding of the previous ones (Freudian) and nowadays we are tempted to see the analysis based in action as well as in the implicit relational knowledge. As referred, we believe, from a group analytic perspective, that they also allow a better understanding of matrix and group pattern concepts (Filipe, 2000), according to Maria Rita Leal (Leal, 1994), and of the Foulkesian concept of Ego training in action (Foulkes, 1975). They represent a contribution to therapeutic change, namely, at the level of the implicit relational knowledge and to the perception of words from a gestalt perspective.
Therefore, the concept of Embodied Mind (Varela, 1993) opposite to the Cartesian one of separated mind and body, that Freud adopted, has been taking shape over these last thirty years. This concept implies that action and verbalization (although different forms of expression) are closely integrated during the development of the person, which in practical terms entails that one cannot feel, think, imagine, or have sensations without a direct participation of the body and that inversely moving or acting is inherent to the expression of a mental intention.
It is thus accepted that the mind is not a reality apart from the body (Fuchs, 2018), but is always integrated into an organic support and that words do not restrict or replace the action; on the contrary, they also integrate the action, this means that what we say and how we say it, everything we verbalize is, thus, an extremely important part of our repertoire of action that we communicate without being aware of it, when we speak.
Moreover, the concept of Unconscious was extended, the implicit relational knowledge (Lyons-Ruth, 1998) become a part of it. It is an unconsciously acquired knowledge, remaining largely this way. It is acquired since birth through relational interaction, with whom surrounds him/her in the various groups that he/she is part of, throughout his entire existence. This knowledge (which we could call a “socially acquired mind”) also includes conflicts which are therefore unconscious without being repressed and which during the analytical process will be the subject of Transference and Countertransference and consequent analysis.
This way, and according to Morris Eagle, (Eagle, 2011) the unconscious is, beyond a Freudian perspective, an unconscious of representations, interrelational schemes, expectations, beliefs and working models that are unconscious, not due to a defense mechanism, but because they were acquired nonverbally in the early stages of life in the pre-verbal stages. Rules, implicit procedures that determine our interaction with other people, as well as self and other representations are also included here.
Lastly, the concept of Mirror Neurons, (Rizzolatti, 2001) which are neurons that are going to be stimulated when a person, without doing anything observes another one performing an action. These neurons correspond to the ones that would be active if the person would be performing the same action. This phenomenon allows us to participate directly and virtually in the actions we observe in others, without having to imitate them. We can experience others as if we would be performing the same action or feeling the same emotion.
Besides its importance the concept of Mirror Neurons, as we can easily realize from its definition, in the acquirement of the implicit relational knowledge and also, in our view, in the acquirement of internal relation matrix and of group pattern, proposes a new conception of words, in which these are more than a sign or a meaning, are also seen as a gestalt, including simultaneously, actions, feelings, motivations, and interests, since what happens at the level of mirror neurons and movements, also happens with words and their verbalization.
In this regard, Gallese (Gallese,2005) suggests that mirror neurons connect words to movement and so, when words are being said they can stimulate mirror neurons appropriate to the actions and movements described (example: the word “walk” would stimulate the neurons adequate to this motor function). We still ignore whether this happens directly or indirectly, however, words can stimulate visual and motor areas in those who listen to them. The author suggestion is that mirror neurons can provide a different neuronal pathway (an internal relational matrix?) to relate words and motor experience (a new perspective of the therapeutic action of words?) with different psychological consequences.
Therefore, words are not only intangible symbols, but also paths to embodied experiences that operate implicitly (unconsciously) and vice-versa (therapeutic action). This perspective helps to explain the evocative power of words and narratives and that we can live them virtually. This is, in our opinion, what also happens in interactive communication among the various elements of group analytic matrix.
Finally, we would like to stress that we tried in a succinct way to emphasize two aspects that seem increasingly important in group analytic practice: the first one is to consider relational interaction in the group analytic matrix supported by the concept of implicit relational knowledge as an important aspect for therapeutic change and in the understanding of the working through concept; the second one is that words can be understood and valued not only by their sign or meaning but also for a communicative gestalt where intentions, affections, emotions and actions, are include and conveyed through the mirror neurons phenomenon.
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