A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

• Chronic disease
• Psychological impairment
• Psychoanalysis
• Facial microexpressions
• Memory reconsolidation
• Reflection
• Relationship
• Resilience

• affect regulation
• clinical relevance
• epistemology
• interdisciplinarity
• psychoanalytic research
• therapeutic relationship

The field of the sciences of the mind is evolving fast. With the diversification of knowledge and accumulation of data, often lacking integration and reproducibility, questions arise. The role of critical thinking and research is evident. As the science of the unconscious, psychoanalysis provides a method and theory to understand human minds and mentalities, helping the patient know his mind and transform action into reflection. Mental activities, including social skills, develop in the social context, depending on the social environment’s demands and resources put onto the individual. Encoding emotional signals, markers of meaning for the individual, is ontogenetically necessary and has influences on memory encoding. Beyond theoretical understanding, implicit relational knowledge is actualized in the therapeutic setting. With a strong focus on experiencing emotional reconsolidation of memories, previous relationships’ repercussions are enriched with broadening viewpoints in the analytic environment. The long-term effects of psychotherapeutic treatments have been examined. A sufficient explanation of the specific factors contributing to success or an answer when an impact is lacking is still under investigation. When investigating subliminal and implicit mechanisms leading to memory reconsolidation and the formation of functional object relations and interaction patterns, the focus is set on affective interplay and processing prior/during and after social interactions. The present paper discusses which parameters might contribute to the reshaping of memories and the linkage of memory with the emotional load of experience. Providing insights into such dynamic mental phenomena could enhance process research by investigating moment by moment interactions in psychoanalysis, treatment, and learning processes. Due to the research subject’s complexity, different research methods and integration of associated research fields are required.

• Psychoanalysis
• Hermeneutic circle
• Evidence-based medicine
• Bias
• Affective interplay
• Micro-process

• Epistemology
• attachment
• empirical research
• psychotherapy
• relational psychoanalysis

• affective interplay
• doctor-patient-relationship
• interpretation and confrontation
• micro-expressions
• working alliance

• Adult
• Aged
• Emotions
• Facial Expression
• Female
• Humans
• Male
• Middle Aged
• Professional-Patient Relations
• Psychological Tests
• Psychotherapy/methods
• Social Perception

• mimicry
• movement synchrony
• nonverbal communication
• social anxiety disorder
• therapeutic process

• Adult
• Consciousness
• Female
• Guilt
• Humans
• Internal-External Control
• Interpersonal Relations
• Male
• Quality of Life
• Self Concept
• Shame
• Social Adjustment
• Social Perception
• Surveys and Questionnaires
• Sweden
• Unconscious, Psychology