Personalized treatment - which interaction ingredients should be focused to capture the unconscious

Abstract

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.

Keywords: Chronic disease; Psychological impairment; Psychoanalysis; Facial microexpressions; Memory reconsolidation; Reflection; Relationship; Resilience

Core Tip: Interdisciplinary integration of mental health issues requires communication between different disciplines. Treatment adherence depends on relational problems and thus is not limited to problems within a person influencing the mental health continuum. However, the diagnostic statistical manual lacks representation of relational problems. In contrast, psychoanalysis has focused on relationship problems and abilities emerging from relations with promising outcomes. Targeting unconscious processing is a promising intervention strategy for improving adherence to transformation processes. Unconscious conflicts and resistances might lead to self-sabotage of relationships. Furthermore, such unconscious processes might prevent accessibility of an individual’s abilities and might obscure true motivations.