Sometimes a cigar, is just a cigar. Attributed to Sigmund Freud

Psychotherapy is a conversation. Albeit a highly specialised one that does not solely rely on words for meaning to be understood. The idea behind this exchange is to help the client, or patient, achieve a greater awareness of their inner life, and the impact that this has on their interaction with the world. When we understand the connections between our thoughts, emotions, and behaviour, we are in a better position to be able to change. Once we start to develop this kind of awareness, we can alter the way we live, and change our perceptions about our place in the world. In his early attempts to cure hysteria, Sigmund Freud, the founder of psychoanalysis, tried using hypnosis as a way to help people understand these links. However, it turned out that he was not a very good hypnotist, so instead, he developed a technique that he called Free Association. Free Association involves the patient or client, saying whatever comes to mind, no matter how silly, or embarrassing, or weird. Freud hoped, through using this technique, to gain a greater understanding of his patients’ inner lives.

It was the things that they did not say, or where they paused, or made slips of the tongue, that he believed revealed the most about the workings of their unconscious mind.

Freud lived at a time when fluid mechanics was a developing science, and in line with this field of study he postulated the flow of unconscious energies that helped to drive our mental lives.

Although this may not be reflected in our current understanding of psychological processes, his technique allows us to get below the constant chatter of our minds, and access many of the thoughts and beliefs, that do not usually reach full consciousness. In much the same way that we find ourselves ruminating on the day’s events, once have gone to bed, and our mind becomes quieter, the process of Free Association allows these deeper thoughts and emotions to reach consciousness more easily, and not be drowned out by the general chatter of our daily life, or by our internal censor.

Access many of the thoughts and beliefs, that do not usually reach full consciousness.

Cognitive-based therapies achieve the same psychological results by using a different technique. Here, the approach is more direct. The client is asked to consciously process their thoughts, first by recording events, and then through a direct analysis of their responses and beliefs about them. Once the underlying thoughts that are triggering the response have been discovered, they can then be challenged directly, using logic.

Mindfulness meditation is a process of stilling the mind. When we sit and practice, we do our best to avoid getting hooked up in the constant thoughts and conversations that go on in our mind.  Instead, we try to notice our thoughts and feelings as they arise, and observe them passing away to be replaced by other thoughts and emotions. We come to recognise that thoughts are just thoughts, and emotions are just emotions.

When we bring our awareness to the transitory nature of these experiences, we can see how they arise from constantly changing conditions, it then becomes possible to let them enter and leave our minds without our making automatic responses to their content.  This allows us to develop greater choice in how we respond.

Thoughts, and emotions are just emotions.

The human mind can consciously process about 150 kB of information every second. In the same period the brain receives several hundred Etto Bytes of information from our external and internal worlds. Because of this, most of the incoming stimuli are dealt with without reaching conscious awareness. This has evolutionary advantages. Staying alive requires that we make a prompt response to potential danger. If we were to leisurely analyse all the incoming information that the brain receives, we would be paralysed into inaction, making us easy prey for any passing carnivore.

For this reason, during the process of human evolution, many subconscious routines have developed that enable our brain to process this mass of incoming sensory stimulation. These subroutines also include many of the things that we learn, and internalise, as we grow up in our family, our town, and our country. These are the things that make up our view of the world and our culture.   Many of our beliefs and skills, such as religious affiliation, the language we speak, playing the piano, and even the food we regard as edible, are stored in these mental subroutines, and are called into action when required.

One of the strongest parts of this unconscious processing system controls our “fight or flight” responses. These can be triggered by events in the external world and by our own thoughts and beliefs. When our mind is calm and settled, many of these thoughts, ideas, and beliefs about our world become more accessible to the conscious mind. This means that human beings are able to think about their own thinking. This process of thinking about thinking, is known as metacognition.

Psychotherapy achieves many of its benefits by encouraging this process of thinking about thinking to occur more consciously, and in a deliberate way.

The idea behind Free Association is to get people to talk without censoring what arises, and in this way to get them to get access to the workings of this unconscious part of the mind, more clearly. The therapeutic frame, the setting for this conversation, is set up to offer minimal feedback to the client. In the absence of this feedback their mind has to fill in the gaps. It is in filling in these gaps, that our mental subroutines, biases, and prejudices about ourselves and the world become more apparent.

This process of thinking about thinking, is known as metacognition.

Psychoanalysis uses unconscious responses that the patient makes towards the analyst, known as the transference, to help gain a greater understanding of the patient’s past relationships, and how these influence their current behaviours.   These relationship patterns are laid down during the first couple of years of life, when we develop attachment relationships with our care givers. These early relationships form a blueprint that provides us with ideas and beliefs about how relationships work that will influence us throughout our lives.

The similar sorts of response that the therapist has towards their patient, known as the counter transference, can be highly informative as well. It is because of these responses, and the necessity for understanding their true nature, that it is customary for many schools of psychotherapy to require that people in training should have experience of receiving psychotherapy themselves. In this way the therapist can become aware of their own unconscious biases and avoid misunderstanding what is happening in the therapeutic relationship.

Freud also used dream interpretation, which he called “the royal road to the unconscious”, to access these unfiltered thoughts and beliefs. He would listen as people outlined their dreams, and then interpret them back to his clients. Often using symbolic meanings that he attached to the content of the dreams; meanings that fitted with his theories about the causes of psychological problems. His interpretations were influenced by the things that he had learnt about his clients during the progress of their analysis, the transference, and the theories that he developed about human motivation which informed the process of analysis.

Over the last 30 to 40 years, mindfulness has become increasingly popular, not only as a meditation practice, but also as an additional therapeutic tool.   Mindfulness is a process, one in which we gradually learn to pay closer attention to the present moment.  It is non-judgemental, and requires a deliberate choice to attend to what is happening around us, and within us. Typically, the practice involves focusing, as much as is possible, on a single stimulus. The commonest object for meditation is the breath, and the process of breathing. This has the advantage of being something that all human beings do.

As we develop mindfulness we become more aware, both of our internal world of thoughts and emotions, and also of the things that are happening in the world around us.

Mindfulness results in a state of focussed attention, in which we become highly concentrated, and aware of our experience as it unfolds. This state of relaxed attention has much in common with flow and reverie. These highly focused states can also lead to greater understanding of our internal world, and greater awareness of the emotional interplay between ourselves and others, and how this affects our thoughts, behaviours, and emotions. This can give client and therapist greater understanding of their inner worlds. permitting more effective therapy.

In his book, “On Learning from the Patient”, Patrick Casement, a British psychoanalyst, outlines a process of creating an internal supervisor, a part of the mind that pays attention to the process of therapy, and to the emotional content of the therapeutic interaction, in real-time.   This requires a highly attentive state of mind. One that uses the human ability to think reflectively, not only about our own thoughts and thinking processes, but also about those of our client, and the ways in which they interact.

It is through the creative use of free-floating attention that we are able to play with complex psychological interrelationships, and observe the ways in which conscious and unconscious processes influence each other. When we can hold in mind the overt and covert meanings that are being communicated, we can try out several different understandings of the meaning that is being communicated within the therapeutic space, and reach a more effective synthesis of the information before us.

Conscious and unconscious processes influence each other.

Developing a regular mindfulness practice not only has direct benefits for our mental health, but can also lead to sharper focus and more accurate interventions in our work with clients.

Whether this is through carefully developing our own internal supervisor, or because of a greater ability to sustain our attention on the work, it seems that even a little mindfulness can go a long way.

This should result in better outcomes for our patients, and a reduction in stress for ourselves.