Revising the Deep Unconscious System and Strong Adaptive Techniques
by Robert Langs, M.D.
Largely by virtue of working with managed care patients, I have found it necessary to revise my view of the deep unconscious system. In addition, this work has produced an unprecedented clinical frame-related finding and a newly adopted principle of technique. This note describes these three developments.
A Revised deep unconscious system
The clinical data on which my view of the deep unconscious system has been revised have been there all along and I had been dimly aware of them. But the picture remained unformed until recent incidents with managed care patients compelled me to develop the film, so to speak, and precisely identify the features whose outline to me were vague and blurred.
The result is a significantly revised view of the structure and functions of the deep unconscious system. I shall deal first with this fundamental change and close the paper with a description of the single new finding I’ve also come upon in this new setting in which I am now working—managed care psychotherapy.
The Old Model
The emotion-processing mind is comprised of two operating systems: conscious and deep unconscious. Conscious system intake is governed by a regulatory system called the Message Analyzing System (MAC). This system operates unconsciously and screens out those emotionally-charged inputs—information, meaning, and events—that would threaten to destabilize efforts and conscious coping. The result is conscious system denial and obliteration, and a reduction in conscious adaptive intelligence.
The incoming inputs that are blocked from conscious registration are sent to the deep unconscious system for registration and adaptive processing. This minimizes the use of denial by this system—it’s invoked only in response to extremely devastating, death-related inputs. It follows that the deep unconscious is highly sensitive and perceptive, but in addition, its adaptive processing capabilities are extraordinarily wise and effective. In addition, this wisdom system is focused on the state of, and transactions related to, rules, frames, and boundaries, an aspect of human experience with extensive effects. The results of the adaptive operations of this system are encoded in dreams and other narrative forms, which must, then, be decoded in light of their evocative triggers—a process called trigger decoding. Because its wisdom is encoded, short of trigger decoding, its adaptive recommendations do not reach awareness and it has little effect on conscious system knowledge and adaptations.
The second system of the deep unconscious mind is a system of morality and ethics. This system operates on the basis of very high-minded, pristine set of values and judges every act and thought we experience. This system also has access to encoding and to behavior, but it also unconsciously affects conscious system choices and actions. Adherence to its values is unconsciously rewarded with wise conscious decisions and behaviors, while departures from, and failures to meet, these ideals evoke deep unconscious guilt and unconsciously orchestrated self-punitive decisions and behaviors.
The New Model
What then were the clinical observations that this model was unable to take into account? In essence, the answer lies with a variety resistances and self-defeating behaviors of patients that did not appear to be the result of deep unconscious perceptiveness or deep unconscious guilt. This arose in the adaptive context of the security of my office, indications that I would hold to all of the ground rules of the therapy except those that inusrers mandated that I modify (e.g., rules related to who pays the fee and bopth confidentiality and privacy), and indications forom me that we would do therapy on the bvasis of the patient’s dreams and other stories (i.e., that we would be exploring the patient’s death-related traumas and deep unconscious experiences). These adverse reactions took several forms:
1. Patients seen in consultation who encode the value of the secured frame and work with narratives, yet do not accept treatment.
2. Patients who do not encode much in the consultation session, but ask for a frame modification near the end of that hour—e.g., personal questions about the therapist, permission to miss sessions without paying the fee for these hours, . When not granted, these patients inevitably fail to return for a second appointment.
3. Patients who are subjected to a major frame modification such as the therapist seeing a spouse or child of an adult patient, who then fail to decode. Almost always such patients have histories of major death-related traumas and high levels of existential death anxiety.
The old model of the emotion-processing mind has major difficulties
in accounting for these clinical phenomena. They are clearly unconsciously driven. The patients who flee therapy have no conscious idea why they are really leaving treatment; they tend to rationalize that they don’t feel understood by or connected to the therapist. And the patients who fail to encode do so entirely without awareness that they are communicating without much in the way of encoded derivatives and behaving in an idiosyncratic fashion—i.e., that they should be encoded deep unconscious s of the devastating effects of their therapists’ frame violations.
The old model saw the deep unconscious system as perceptive and wise, but these responses are insensitive and unwise. With patients who flee therapy, the therapist has not behaved in a severely traumatic fashion, so deep unconscious denial is ruled out. Much the same applies to patients who fail to encode after a third-party frame violation. While this is a damaging frame-related intervention, it too is usually not severe enough to evoke deep unconscious denial—such responses are seen with more blatant deviations, such as a therapist’s visiting a patient at home or in a hospital or becoming physically involved with a patient.
There is then no sign of the activation and encoding of deep unconscious adaptive wisdom, not of deep unconscious guilt. Nevertheless, the behavioral resistance (leaving treatment) and the communicative resistance (failures to encode as expected) are unconsciously motivated and driven. What unconscious system is involved in these responses?
In the old model, I postulated a superficial unconscious system, but it was used solely to account for thinly disguised encoded images, as seen when a teacher is used to disguise a therapist and the trigger is self-evident—i.e., there’s little indication of heavily disguised deep unconscious perceptions and processing activities. This system could not, then, account for these observations. The only recourse was to postulate a second deep unconscious system that lacked wisdom and operated to block retrievable deep unconscious registration of traumatic triggers and their meanings, and that also interfered with the encoding of deep unconscious perceptions of therapists’ similarly traumatic triggering interventions. Unconscious wisdom was clearly blocked, and initial evidence indicated that deep unconscious guilt was not the primary motive for the activities of this other deep unconscious system. Instead, it appeared that a history of significant death-related traumas, severe degrees of death anxiety, and the dread of expressing deep unconscious meanings that patients thought would risk the descent into madness were the main deep unconscious motives for these phenomena.
I have decided to call the system that is open to unconscious inputs which it processes and readily encodes the deep unconscious perceptive system and the system that blocks such perceptions and their encoding the deep unconscious defensive system.
Among the implications of this division is the thesis that there are two splits in the emotion-processing mind: The first is between the conscious and deep unconscious systems, whose independent reactions to a given triggering event often are in opposition, while the second is between the deep unconscious perceptive and defensive systems which are on opposite ends of the pole when it comes to deep unconsciously registering, processing, and encoding emotionally-charged inputs.
Another notable implication is that the perceptive system tends to use encoded narratives as its primary outlet and influences conscious adaptations mainly when moral issues are involved in one’s own behaviors. On the other hand, the defensive system only rarely uses encoded narratives as an outlet—and when it does, it interferes with patients’ conscious acceptance and use of their trigger decoded interpretation. In the main, the system uses actions and somatizations as their mode of expression—an indication of the extent to which they are the unconscious basis for maladaptations and emotion-related symptoms and seriously need to be understood deeply so we can develop techniques to modify the system’s activities.
A final note on the development of these ideas. I first formulated the presence of deep unconscious defensiveness in observing patients gross behavioral resistances, such as early flights from treatment. Later on ,when I observed failures to encode in response to blatant frame violations, the formulation of a deep unconscious defensive system helped me to understand the basis for this unconsciously driven reaction. Thus, a thesis developed on the basis of one set of unexplained observations proves useful in explaining a very different unexplained set as well.
These tentative formulations are now open to further validation—or its lack—and further expansion if future studies prove to be supportive.
Two Additional Changes
Two additional changes, one in observation and the other pertaining to technique, are of note. First, I have with managed care patients on three isolated occasions in a single year observed patients who unconsciously supported a frame modification. Heretofore, in the private psychotherapies I conducted and in my supervisory work, I had not, on any occasion with patients here or abroad, detected encoded images that spoke for a deviant frame condition—the deep unconscious system, without exception, supported the ideal or archetypal frame. The first two instances are complicated, while the third seemed much clearer.
The first two instances arose with managed care patients who entered therapy with vacation plans some time hence. I had invoked the rule of responsibility for all missed sessions, even though I believed that the managed care contract had a clause that excused patients’ responsibility for sessions when 24- or 48-hour notice was given. A week or two before the vacations were to occur, both patients encoded their entitlement to not have to pay for their pending missed sessions. I interpreted this as such and then, with further unconscious directives from these patients, decided to not charge them for the hours they were to miss. This decision obtained some degree of encoded validation. I must, however, say that one of these patients did not return to therapy after the missed sessions and the other terminated when the frame was secured in others ways.
The managed care frame is highly disturbing for both patient and therapist, and it will take extended study from the strong adaptive vantage-point to sort out the main currents that whirl about in such treatments. In these two cases the managed care contract called for a departure from the ideal frame in that it mandated that these patients not be charged for their missed sessions. When I invoked the ideal frame ,they supported it deep unconsciously, only to turn against it as their vacations were upon us. But let’s be clear: Their encoded directives indicated that I should adhere to the managed care contract—that is, to the frame that I had agreed or should have agreed to use at the onset of our work together. They were indicating that for them this frame should take precedence, even though it was deviant. Interestingly, this choice very much served their conscious self-interests as well.
The third case involved a patient who could not afford therapy without the insurer paying most of the fee. This need was supported by the patient’s deep unconscious imagery in one particular session—as indicated, this was a most unusual occurrence and it did follow the attempt to use a make-up session which created a near-disaster for the treatment. In all of the other sessions, the patient favored the ideal frame—this was the only exception to that trend.
This is merely the beginning of close study of the frame conditions of managed care psychotherapy—a most important pursuit given the prevalence of such therapies at the moment. All we can be certain of at the moment is that the mandated frame deviations of this treatment form are far more disturbing than healing and that the challenge to work as best as possible with patients seen under these conditions ask that at the very least, we secure the ground rules that can be secured in order to offer these patients the best set of conditions for their therapeutic experiences. In addition, I can report that narrative forms of psychotherapy in which patients are advised to begin each session with a dream or made-up story is quite feasible with such patients.
The change in technique that I shall describe proved necessary with managed care patients doing narrative therapy for several reasons:
1. The 45-minute session is too short to allow for a full unfolding of patients’ material to the point of facilitating trigger decoding interpretations or frame rectifications—for that, a 90-minute session is required.
2. Given the basic deviant aspects of the managed care frame, patients are resistant to generating encoded narratives, do so in a limited fashion (death-related themes emerge very slowly and in restricted ways), are fearful of deep unconscious meaning and secured frames. They only rarely embrace work with therapy- and frame-related triggers—that is, the deviant managed care frame supports communicative resistances.
3. The deviant frame supports the need of many of these patients for a modified frame because they suffer from severe secured-frame existential death anxieties.
In sum, managed care patients show inherent resistances to strong
adaptive therapeutic work. They produce sparse derivatives and seldom bring up active frame-related triggers—of which there are many. Nevertheless, their deep unconscious minds are focused on the rules, frames, and boundaries of the therapy, which are seriously affecting their attitudes towards treatment and their outside emotional lives. Effective, insight-oriented, frame securing (where feasible) psychotherapy depends on being able to have from the patient both a strong narrative complex and a currently active trigger. Most of these patients do provide the necessary encoded imagery, however limited, but these patients almost never bring up an active trigger. The therapist’s choice therefore is either to forego offering the interpretation or frame-securing intervention that that the patient needs in the session or introducing the trigger him or herself.
I have found it necessary and quite viable to first ask the patient for an unmentioned trigger, and to then provide it if the patient fails to do so. This then is a major change in technique and it probably is needed in all forms of strong adaptive 45-minute psychotherapy situations, that is, with or without insurance coverage.
Patients accept this intervention rather easily and they tend to unconsciously validate interpretations subsequently made by using the trigger to decode the patient’s narrative imagery. On rare occasion, one hears the old outcry: ‘Must everything be about you and the therapy?’ But these reactions are rare and most patients accept and work through the strong adaptive interventions made on this basis.
I am posting these new ideas to help strong adaptive therapists deal with the inevitable problems posed by managed care psychotherapies. I welcome comments and responses, and hope that clinicians will build their own understanding on the foundation I have tried to offer here.
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