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The Power of Behavior

The Fluidity of Cognition

Explicit and Implicit

Chapter 10: Behavior and Cognition

The Amazing Power of Behavior

(Energy = Behavior Times The Speed of Light Squared) The speed of light squared is a very very big number, so the formula means that even a small change in behavior will have powerful emotional effects. Before the turn of the century (20th), Freud identified "acting out" as a powerful means by which patients avoided remembering and feeling. Behaviorists came to understand that if you change behavior emotions are destabilized and change as a result.

These truths need to be revisited, especially for those with a psychodynamic background. Historically, upper class victorians were inhibited and it did not take more than a light comment from the therapist for them to stop acting out. Today, the motto is "Just do it," and behavior has become the most prevalent way to avoid feeling. A mild suggestion that dysfunctional behavior might represent a resistance to progress is rarely strong enough to bring about change in behavior. In addition, in psychodynamic circles, the tradition of neutrality has had a chilling effect on therapist's willingness to make behavioral recommendations. In the 21st century, it is time to pay attention to behavior.

Therapists will do well to bear in mind that unhealthy behavior binds a great deal of emotional energy. This means that unless we are "pushy" about behavior change, it will most likely stay the same. In addition, it means that when you do begin to suggest behavior change, you will meet surprisingly intense resistance. It also means that when behavior change does take place, you can expect powerful emotional reactions and realignments.

 

Is Behavior Change Structural?

Behavior change is a powerful and often necessary destabilizer of the status quo in therapy. As I have pointed out above, while behavior change is "viscous," it is still fluid. What this means is that behavior patterns, even habitual ones tend to adapt spontaneously to current conditions. A behavior that is no longer held in place by emotions or internalized values and attitudes will change. Several patients, for exampel have reported that their habit of nail biting simply disappeared in the course of therapy. They were unable to say exactly what caused this to happen, but were pleased that it did. Even though it may be recommended, and the patient may make a conscious effort to practice new behaviors, behavior change is not structural in the same way that cathartic healing and internalization are.

The Fluidity of Ideas

Even more than behavior patterns, ideas are fluid. Our understanding and beliefs respond to new data quickly and without resistance, at least in the absence of an underlying emotional investment. For this reason, change in ideas is a tool we use to uncover and destabilize entrenched patterns and to foster the healing processes of catharsis and internalization. In the same way as behavior change, change in ideas is not structural.

A patient who was severely traumatized by her psychotic mother held the belief that she had caused her mother's illness. Many years later she found out that her mother had had a mental hospitalization before she was born. She flew immediately into an uncontrollable rage. The change in ideation was instantaneous and fluid, but led to a radical change in her emotional equilibrium as her inner anger shifted from herself to her abuser. The ideational change was not the end product, but the means for producing an emotional shift. From that time on, depression turned to rage that could be worked with in therapy.

As indicated earlier, I have avoided the term cognition in this discussion because cogntion is broad enough to include internalized values, attitudes, etc., and they are structural in the sense that they do not change spontaneously.

 

Making the Implicit Explicit

Neural science has clarified that there is a marked anatomical and functional difference between background and foreground (or implicit and explicit) information. Memory systems for storing the two kinds of data are different. Explicit information is stored through the hippocampus, whereas storage of implicit information is much more diffuse. Thinking is something we do with explicit information but not background or contextual information. How is this distinction important for psychotherapy? It explains a number of very important phenomena that we encounter every day.

Example: "You are depressed:" This is a typical example of making the implicit explicit. A casual observation by the therapist suddenly turns background unhappiness into a foreground label. The patient feels suddenly validated. "My suffering is real!" What had been a dull ache suddenly becomes acute pain. Furthermore, the label suddenly pulls in a host of associated ideas that were not part of the implicit picture a moment before. In this case, our culture has many ideas associated with "depression." It is not your fault. It is a "thing" that happens out of the blue. It can be treated with medicines.

The consequences may be both positive and negative for the therapy. On the positive side, the patient now feels understood and validated. He or she now feels entitled to help and hopeful that it is available. Guilt is assuaged. On the negative side, in our culture, the new label may promise help without having to delve into the painful affects. The following are some commonly used techniques that involve of the use of explicit meaning for therapeutic ends:

1. Labeling: By giving something about the patient a label, we make it accessible to intellectual discussion. More important, our choice of label pulls in other ideas and connotations that may be helpful (or problematic) for the therapy.

2. Reframing : "Maybe you didn't want to die as much as you wanted someone to rescue you." This is a suggestion to change from one explicit idea to another, which may (depending on many factors) diffuse suicidal intent and focus the patient on needs that he or she was keeping in the background and not addressing.

3. Making real: By naming things like the patient's strengths or the degree of suffering we make these things explicit and give them power. When we recognize a strength, the patient takes greater ownership of that characteristic, and will very likely be able to make more use of it. Recognizing suffering makes it more real. The patient may be horrified to realize what he or she has endured, and proud of his or her ability to cope. The effect is that suddenly things that were in the background, felt but unrecognized, become available for emotional reaction. (Note the word un-re-cognized and think how making the implicit explicit does re-cognize information.)

Explicit Ideas as Defenses

Patients also use explicit ideas to maintain the status quo. "Oh, that's me, when I feel like it, I just do whatever comes to mind without thinking." This statement might be used to fend off an invitation to question an entrenched pattern of dysfunctional behavior or to recognize a developmental deficit in impulse control. By making the status quo into a "principle" the patient easily avoids having to change.

Self concept can thus function as an anchor to block behavior change and the accompanying affects. It is sometimes necessary to educate patients that one is never too old to change and even go through developmental steps that normally belong to a much younger chronological age.

In the example of the patient who believed she had caused her mother's psychosis, an explicit belief had been used to hold back frightening rage. Interestingly, many sessions had focused on her self-abnegation, but that particular belief had not come up. Perhaps she had unconsciously guarded it from the light of day, knowing on some level that it was suspect. In retrospect, the work in therapy to that point had made her ready to cope with the rage that erupted, where before, she was, in all likelihood, not ready.

 

Can Explicit Ideas Become Implicit?

Yes, of course. A cognition that is enormously helpful in therapy may fade into the background. When patients describe their therapy experience, the insights (explicit ideas) cherished by the therapist will often have faded from awareness. "O I don't remember exactly what we talked about, but today I really don't react the same way."