Memory and Healing

Neurocognitive and Psychodynamic Perspectives on How Patients and Psychotherapists Remember

Soren R. Ekstrom

• Publisher: Routledge
• Year: 2018
• Topic: Psychology
• eBook ISBN:
  9780429916182
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book addresses the current demand to apply findings in neuroscience to a broad spectrum of psychotherapy practices. It offers clear formulations for what has long been missing in how psychotherapists present their work: research-based descriptions of specific memory functions and attention to the role that synaptic plasticity and neural integration play in making lasting psychological change possible. The book provides a detailed perspective on how patients integrate into their own narratives what transpires in their treatment and how the clinician's memory guides the different phases of the process of healing. Long-neglected in psychotherapeutic formulations, findings about memory-in particular, episodic and autobiographical memory-have a direct bearing on what happens in treatments. Whether the information is about the recent past, such as what happened between sessions, or about traumatic childhood experiences, the patient's disclosures are in the service of a more complete narrative about self. At the same time, the therapist's ways of remembering what occurs in each therapeutic relationship will guide much of the healing process for the patient.

PART I

APPLYING THE FINDINGS IN RESEARCH

One of the most fascinating achievements of the human mind is the ability to mentally travel through time. It is somehow possible for a person to relive experiences by thinking back to previous situations and happenings in the past and to mentally project oneself into the anticipated future through imagination, daydreams, and fantasies. In the everyday world, the most common manifestation of this ability can be referred to as “remembering past happenings.” Everyone knows what this phrase means and what it is like to reflect on personal experiences, past or future, that are not part of the present

—Mark A. Wheeler, Donald T. Stuss, and Endel Tulving (1997, p. 331)*

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* Psychological Bulletin, 121(3). Copyright © 1997 by the American Psychological Association.

CHAPTER ONE

Why memory and psychotherapy

To begin with, I would like to describe briefly what happens to me as a therapist when I am with a patient. In this instance, the patient—I will call him Brian—enters my office for his weekly session. We exchange short greetings and sit down across from each other. He begins telling me how he is feeling, sometimes referencing our last session. Every so often, I nod. Plain red shirt, I notice. Still the same overweight frame as last week. However, Brian’s facial expressions are definitely livelier today, and he appears less troubled.

As I listen to him begin the session, neither his diagnosis nor a specific treatment plan comes to mind. I remember certain details of his history, but only much later in the session and then as scenes or scripted stories. I have not memorised his treatment up to now, nor could I write a detailed history of it. I am simply responding to a relational event that has followed pretty much the same format since we first started meeting in my office. My mind is focused on the here-and-now and on cues that may tell me something about what is going on in Brian’s mind. I have no conscious agenda, but I am in an entirely attentive frame of mind.

As the session progresses, some things I notice make only a fleeting impression, leaving no lasting traces in my memory. Other impressions stay with me for a minute or two. Many of the things he says, or that I say, will have escaped my memory by the time the session is over. Then there are those exchanges, and perceptions of mine that lead to those exchanges, that inform what I later bring to bear on our conversation. When I take short notes for myself after the session, such exchanges are usually what come to mind.

Most emotionally charged communications would belong to this category. So would any fundamental change in the way Brian relates to me. To a large extent, my experience of his session, and my responses, are formed contextually and are based on cues that inform my responses. My understanding of what is transpiring and my possible recollection of Brian’s past history depend on these contextual cues.

Given how little I consciously retain from session to session, how can I, as a clinician, understand the depth of a patient’s personality, history, and current suffering? What are my tools—absent a consistent, reliable memory of the session—that make it possible for Brian and other patients to feel that I understand them and that I am able to help them to heal, to become psychologically healthy? And how, in spite of all its shortcomings, does my memory of what occurred in the session play a role in this process?

The literature on psychotherapy contains few accounts, if any, of how clinicians remember. Descriptions of the internal processes that psychotherapists rely on for their day-to-day functioning are largely missing. Can we assume that there are forms of memory that are particularly relevant to analytic practitioners, perhaps to all psychotherapists? Can we pinpoint the kind of memory functions that are involved, psychodynamically or otherwise?

We can certainly point to variations in this regard. Each practitioner’s personality, experience, and training are reflected in how he or she works. But surely we can also assume common features in how therapists put their memory to use. In this book, I argue that a more informed understanding of this process will illuminate in crucial ways how we retrieve and bring into play the information most essential to the patient’s recovery.

Neuroscientific research on memory

The current models for human memory that have emerged from brain research over the last decades are based on data that were largely unknown when the original psychoanalytic formulations about psychotherapy were made. Our progress in understanding mind and brain is in many ways astonishing. Antonio Damasio of the University of Southern California, a major contributor in neuroscientific research, summarises this development in the following way:

Over a brief period of time, roughly twenty years, there has been an explosive development of new theories regarding the brain and its workings, as well as powerful techniques that allow us to study the brain experimentally—from the level of the individual nerve cells and molecules those cells require in order to operate to the level of the brain’s macrosystems.

(1999, pp. ix–x)

Some of these findings have not only changed how researchers view the mind-body interaction. They have also made tools available for understanding what happens in psychotherapeutic treatments—tools that previously were missing and that now need to be used in relation to a wide range of phenomena encountered in treatments.

The picture of the human brain that emerges from the research is of billions of cells at work, as in a factory in twenty-four-hour–production mode. Whether we are fully awake or deeply asleep, lost in thought or staring at the wall, certain circuitries remain active. Chemicals are in perpetual transmission aided by biologically propagated electrical charges (LeDoux, 2002). The brain is constantly transmitting signals, which are turned into information—most of this going on implicitly, outside the reach of consciousness. Memory, like all other functions of the brain, such as perception and emotion, is not held in local storage, as if recorded by a camera or electronic device, but is the result of specific neurons working or firing together; a process also known as Hebbian plasticity (ibid., p. 79).¹

Model one: the synaptic self

One of the models proposed by neuroscientists reflects this plasticity of the brain. Joseph LeDoux of New York University’s Center for Neural Sciences, revisiting the problem of self and synaptic organisation, writes:

Let’s start with a fact: People don’t come preassembled, but are glued together by life. And each time one of us is constructed, a different result occurs. One reason for this is that we all start out with different genes; another is that we have different experiences. What is interesting about this formulation is not that nature and nurture both contribute to who we are, but that they actually speak the same language. They both ultimately achieve their mental and behavioral effects by shaping the synaptic organization of the brain. The particular patterns of synaptic connections in an individual’s brain, and the information encoded by these connections, are the keys to who that person is.

(2002, p. 3)

What LeDoux refers to as “shaping the synaptic organization of the brain” is a process commonly called synaptic plasticity and is viewed as an “innate capacity for synapses to record and store information” (2002, pp. 9, 307).² Many psychological and behavioural functions central to psychotherapy theory are mediated by cells joined by synapses and working together. The trillions of synapses that allow the brain’s cells and neural networks to communicate are themselves modified by experience, a process that represents learning (LeDoux, 1998, 2002).

When equating memory with learning, nature and nurture for LeDoux are no longer opposing forces. And the simple fact that we have genetic dispositions does not mean that our experiences cannot interact with those dispositions and mould them. They do; and they do so by affecting the entire organisation of the brain. Memory reflects learning acquired by the brain and is the key to the entire organism’s survival. Memory, a function only rarely mentioned in most psychotherapy formulations, becomes one of the most critical functions in our understanding of the human mind (Ekstrom, 2004; Schacter, 1996).

Also, according to this research, memory consists of both conscious and unconscious systems. Some memory may even be labeled nonconscious in that it functions automatically, beyond awareness, as when we apply grammar to our thought processes (LeDoux, 2002). The unconscious systems, often called implicit, are devoid of the subjective internal experience of correctly recalling information, such as our sense of the time or place for when an event occurred.

As Daniel Siegel (2003), of the UCLA School of Medicine, describes it, implicit memory manifests both behaviourally and emotionally. As procedural memory, it consists of skills like riding a bike that, once learned, do not require intentional retrieval (Schacter, Wagner, & Buckner, 2000). As emotional memory, it often retains painful experiences and makes us avoid situations that may have involved the cause of such pain, without our understanding why (Siegel, 2003). A third kind, particular to early developmental phases in children, is perceptual and event based and retains a sense of familiarity about perceptions and bodily experiences, but without the sense of remembering (Nelson, 1993).

Model two: engrams and mapping

Another model that has emerged from neurocognitive research is that of the engram. Using a term invented by Karl Lashley in the 1950s, Daniel Schacter, one of the leading neuroscientists focusing on memory, defines engrams as “the transient or enduring changes in our brains that result from encoding an experience“ (1996, p. 58). When encoded in long-term memory, engrams are the brain’s records of an event. This record consists of numerous sights, sounds, actions, and words, all being analysed in different sites of the brain, by different groups of neurons.

In the process, these neurons remain connected to one another. They form neural maps that link one part of the brain to another part of the brain. This process, also called mapping, does not produce a finished product. New patterns are constantly being formed, and most of this activity happens outside our awareness. However, when some of these patterns become conscious, they may be experienced as images (discussed in Chapters Five and Six, concerning dreams), or they will be encoded as memories (Damasio, 2010).

Most of the enduring engrams are conscious or explicit memories. However, findings in neuroscience do not support the long prevailing notion of a unitary conscious mind. As examined in detail in the next chapter, the knowledge that we rely on for our everyday lives is not simply of the factual and objective kind. We also have the capacity to remember uniquely subjective experiences and reflect on their meaning (Tulving, 2002).

Depth psychology and neuroscience

Psychodynamic formulations can be traced to an older explanatory model, depth psychology. According to this model, the mind or psyche consists, on the one hand, of the immediate self or the ego as the centre of consciousness; and, on the other hand, of unconscious complexes that may have a determining influence on the conscious mind but function outside it (Roazen, 1975).³ As an abstraction, psyche is not specifically tied to memory; its functioning cannot be traced to neural networks or brain sites. Rather, the notion of psyche is rooted in a long Western philosophical tradition in which soul and matter are two separate qualities (Pinker, 2002). Unless seriously interfered with, consciousness, accordingly, is a distinct and unitary function.

As purely philosophical ideas, there were no direct ways to test the implications of depth psychological concepts in controlled studies. At the time the particular psychoanalytic versions were formulated, neuroscience did not exist and the little psychological research that was done was still the domain of psychiatry, also a fairly new discipline. The first to put depth psychological ideas into use were physicians concerned with a kind of suffering that seemed to have no obvious and discernable physical origin: patients, primarily women, were languishing in sanatoria, unable to live a meaningful life and tortured by the most horrendous memories (Ekstrom, 2004; Shorter, 1997).

Contemporary neuroscience approaches memory from different perspectives and has opened for review many established concepts about the workings of the mind. In some instances, these approaches add several new dimensions to the notions central to psychodynamic thinking. In others, they contradict them. From a neurocognitive perspective, the production of synaptic connections is part of the process of encoding information into a wide range of memory systems. As we have seen, these systems are understood—in much agreement with psychodynamic thinking—to be both a conscious and an unconscious kind. From a neurocognitive perspective, however, what we learn from experience, even when maintained in one of the unconscious or implicit memory systems, is stored for future reference. Thus, memory as a whole is future oriented. Even the one particular system that relates to past experiences has this orientation toward what will be of use in future situations (Tulving, 2000).

This neuroscientific perspective certainly adds a dimension to the depth psychological understanding in which memory is mainly a record of the past (Schafer, 1983).⁴ In psychodynamic thinking, there is no real emphasis on learning. Experiences f...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Acknowledgements
• About the Author
• Preface
• Part I: Applying The Findings In Research
• Part II: Remembering, Reporting, And Teaching
• Notes
• References
• Index