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Prof. Stephan Doering, M.D.Department of Psychoanalysis and PsychotherapyMedical University of Vienna, Austria

Focusing the Implicit - Working Mechanisms in Psychotherapy

Implicit Relational Processes

Bruce E. Wampold

The ContextualModel

2015 2015

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5

2002

• Representations in the first year areencoded in a nonverbal, implicitmode of information.

• Nonverbal information is stored in perceptual channels like images, sounds, smells, touch, andtemperature.

• This information may be inaccessibleto attention or language, but maynevertheless continue to operate andaffect how we act and feel.

2012

• Procedural knowledge ofrelationships

• Representednonsymbolically in the form of implicit relational knowing

• Can form a basis for muchof what may later becomesymbolically represented.

More than 65 percent of the informationexchanged during face-to-face interaction isexpressed through non-verbal information in human-human communications (Argyle 1988).

• Gestures and postures• Rhythmic organization

interpersonal gestural rhythms body movement speech production

• Prosody volume of speech sound of speech melody of speech

• Body language facial expression of emotions

• Chemosensory communication

2008

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Mini-Excursus: Olfaction

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right orbitofrontal cortex right fusiform gyrus

hyp

othala

mus

left

fusi

form

gyr

us

The Interplay of FacialExpression of Emotions in Psychotherapy from: Krause (2016)Fig. 1: Reciprocity induced failure

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Unsuccess-ful psycho-therapy

Successfulpsycho-therapy

A Piece of Meta-Theory

Left to right: Daniel Stern, Alexander Morgan, Nadia Bruschweiler-Stern, Louis Sander, Jeremy Nahum, Karlen Lyons-Ruth.

2010

Something more than interpretation is necessary tobring about therapeutic change:

A moment of meeting that rearranges implicitrelational knowing for patient and therapist alike.It produces „implicit relational knowing“ distinctfrom the symbolic domain.

Interpretation and „moments of meeting“ arecomplementary processes and mutative.They use different change mechanisms in different domains of experience.

Wilfred Bion(1897-1979)

1962

Container Model

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Searching the »Missing Link« between Analyst and Analysand, their Bodies, and their SharedMind

Or: How is the Intersubjective Space Constructed and Lined?

Rainer Krause

from: Krause (2016)

Is this mysticism or can it beobserved and studied?

It can be studied, but different research paradigms have to becombined.

Directions of Future Research

• It is not enough to focus on the verbal content ofpsychotherapy.

• Self-reports distort the results towards the consciousaspects of experiences.

• Non-verbal communication and its relation to(1) symptom change and (2) verbal content has to bestudied in more detail by means of: Micro-analyses (e.g., conversation analysis, Facial

Action Coding System), (Neuro-) biological paradigms (e.g., online registration

of physical changes in both, patient and therapist).

• Hypotheses about the unconscious aspects ofinteraction should be generated by using (1) meta-theories and (2) in methologically sound qualitative research paradigms.

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• Based on meta-theories a connection betweenimplicit processes and psychotherapeutic actionand technique has to be established andsubsequently studied.

• The training of psychotherapists should aimmuch more on implicit processes in thetherapeutic relationship.

• Supervision, peer consultation groups fortherapists (“intervision“) should be continuoslyused.

• For the implementation of results of thisresearch into clinical practice, conceptual modelshave to be developed that correspond to theclinical reality of psychotherapists.

Thank you foryour attention!