How Psychotherapy Really works - When and If It Does
(Part 2) by Robert Langs, M.D.
Some Communicative Observations
Communicative studies point to some rather different ideas about cure and its limitations.
First, every patient (and therapist) has a basic way of expressing and defending against encoded expressions of deep unconscious experience. Given a strong, evocative triggering event, some patients will express many encoded images, while others will express few, if any. In general, patients with histories of severe death-related traumas will express the fewest encoded narratives and be most resistant to their interpretation in light of an activating trigger.
On the deepest level, the key issue is the patient’s need to defend against active existential and predatory death anxieties. Such defenses are universal, but they tend to become intense and rigid after death-related traumas, especially of the predator type (where the patient has harmed others; see essay on death anxiety). These modes of expression and defense are not amenable to therapeutic change through any presently known means. It is possible, however, to provide even the most obliterating and resistant patient with moments of underlying insight that can and usually does lessen the extent of their emotional maladaptations.
Second, the curative role played by the therapist’s management of the ground rules, framework and boundaries of psychotherapy emerges as a vital means of healing on the deep unconscious level (and often, consciously as well). There are patients who are so fearful of their inner mental experiences, especially those on the deep unconscious level, that they seldom encode at all. For these patients, holding the framework of therapy secured is the sole means of cure-often to a striking extent (see essay on ground rules). But in addition, for all patients, holding to the deep unconsciously sought, ideal ground rules of therapy has profound symptom-alleviating effects, while departures from these essential rules causes harm and suffering, and interferes with cure.
How then can a patient obtain any measure of relief in a modified framework therapy? This brings me to an attribute of the human mind that therapists have taken unfortunately, however unwitting, advantage of-its ability to respond to trauma and harm by mobilizing its resources and functioning better. These paradoxical cures-and they tend to be short-lived and accompanied by regression in other spheres of functioning-are a frequent basis on which patients in all forms of therapy find a measure of relief from their emotional disturbances.
Communicative studies show that true insight (as compared to pseudo- or false insight in which a denial defense is established in a therapy) arises only after trigger decoded interventions-managing the frame towards its securement and interpreting encoded themes in light of their evocative (usually frame-related within therapy) triggers (see essay on trigger decoding). This maxim is supported by the consistent finding that, without exception, encoded validation follows after trigger decoded interventions and that non-validating imagery and other responses follow after all other types of therapeutic efforts-ranging from cognitive training to confrontations and interpretations of patients’ supposed inner fantasies and memories (efforts that detach the patient’s mind from adapting to immediate realities and see it as an isolated entity).
Human beings, early in life, develop a set of mental/adaptive defenses that arise in the context of, and are greatly affected by, life events. Inner tendencies always are under environmental influence. These defenses constitute a basic mode of coping with life’s exigencies and especially, the inevitability of death. They are necessary for survival in that they protect us from mental disorganization and disintegration. But their use, so strongly embedded in denial and obliteration, with repression as an added support (the obliteration of memories and past events), tends to reduce our knowledge of environmental events and inherently create maladaptations-we pay dearly for our necessary denial-based defenses.
In the course of a sound psychotherapy experience, these defenses-the basic function of the emotion-processing mind-can be softened from time to time so that true insight through trigger decoded interpretations can be achieved. This kind of insight combines with secure frame management to offer the best healing experience available to patients today. Deep structures do not appear to be modifiable through any form of therapy in use today. But nevertheless, symptom relief and healing can take place under the proper treatment conditions and with the proper trigger decoded interpretations.
Concluding Comments
It is self-evident that myths of cure cannot advance our understanding of the human mind and of the process of psychotherapy-they can only impede such pursuits. With a more realistic foundation of understanding, based largely on the trigger decoding of patients’ narratives and deep unconscious wisdom, we can seek out improved methods of cure and advance the field in much needed directions-whatever they may be. The very defenses by which we survive are the very same mental mechanisms that are our undoing and are one of the main causes of emotional suffering. They also are the source of poor forms of psychotherapy and the many myths by which therapists survive and patients suffer. The hope is that with deep unconscious insight into these processes, therapists, who suffer greatly from deep unconscious guilt for the harm they unwittingly cause their patients, will be motivated to take a fresh and deeper lo0ok in the ways therapy works, heals, and harms-and at long last do something constructive about it.
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