“Wilma S. Bucci, Ph.D.

, who works on the border of cognitive science and

psychoanalysis, incisively delineates her most recent systematic theory of
human psychological organization. Rooted in current scientific research in
cognitive science and affective and social neuroscience, Bucci masterfully
applies her understandings of the formation and transformation of
emotional schemas to the change processes that occur in psychoanalysis and
psychotherapy. She treats us to a conceptual revision of such phenomena
as unconscious processes and to verbal and non-​verbal (sensorial) symbolic
processes. I believe this book will become a landmark in contemporary
applications of cognitive science to the theories and practice of psychoanalysis
and psychotherapies. This is a must-​read for all serious students of the
human mind.”
James L. Fosshage Ph.D.,
Clinical Professor, NYU Postdoctoral Program of
Psychotherapy and Psychoanalysis,
co-​founding Board Director and Faculty, National
Institute for the Psychotherapies,
Founding Faculty, Institute for the Psychoanalytic Study of Subjectivity

“This is a really important book. It answers the fundamental question of

both psychoanalytic theory and practice: Where do our worded thoughts
fit with the sprawling scenery of images, feeling, gesture, and emotions that
furnish our living world? To answer, Bucci reminds us that emotion and
cognition are not so distinct after all. Whether orienting us in continuous
dimensions or by neat symbols, they work together to interpret our world,
and Bucci’s mission is to describe the nature of that partnership. It has been
hard to get a scientific focus on non-​symbolic awareness. Bucci’s solution is to
use recent neurophysiological findings to particularize the unworded material
that feeds articulated reflection. That, in turn, suggests a new picture of
psychopathology, and a clearer and extremely plausible theory of therapeutic
action.
Not the least of Bucci’s accomplishments is to offer a more than
usually convincing demonstration that hard science can advance real-​life
psychoanalysis. Bucci’s classification of expression into symbolic (language),
sub-​symbolic and emotion schemas has helped expand our empathic
repertoire. This book will give the practitioner a new respect for the centrality
of nuance, a new tolerance for dimensional thinking, and a bit of a vacation
from categorical prisons.”
Lawrence Friedman, M.D.,
Clinical Professor of Psychiatry, Weill-​Cornell Medical College
Faculty, Psychoanalytic Association of New York
Affiliated with NYU School of Medicine
“Over 20 years ago, Wilma Bucci broke new ground with her ingenious
development of multiple code theory. As a result she had been regarded as
one of the most brilliant and creative minds in the psychoanalytic world.
However, with this extraordinary new book she has truly outdone herself.
Dr. Bucci has redefined the relationship between mind and body, and between
emotion and cognition in a compelling integrative effort that will change
forever the way we think about psychoanalytic and psychotherapeutic work.
I highly recommend this new contribution to our field to all those in the
mental health professions.”
Glen O. Gabbard, M.D.,
Clinical Professor of Psychiatry, Baylor College of Medicine

“A lot has been said and written on how the two contexts of our field—​clinical
and experimental—​can come together, but this book marvelously stands
out among the many attempts at exploring the interface between these two
contexts. Wilma Bucci goes directly into the heart of psychotherapy process,
and she does so in a truly interdisciplinary way: she looks simultaneously
from different perspectives such as psychoanalysis, cognitive psychology
and affective and social neuroscience. This is just what is needed, and the
theoretical parts come alive through many clinical vignettes. We also receive
a clear picture of the new developments of Wilma Bucci’s line of research
following her 1997 book, Psychoanalysis and Cognitive Science: A Multiple
Code Theory. This new book should be read by all those who are really
interested in the revision of psychoanalytic metapsychology and in the
scientific standing of psychoanalysis today.”
Paolo Migone, M.D.
Editor, Psicoterapia e Scienze Umane
(“Psychotherapy and the Human Sciences”)
www.psicoterapiaescienzeumane.it

“I have always had the utmost respect for Wilma Bucci’s thinking. I believe
it is important—​even classic. So, despite the fact that she and I don’t always
agree, I am delighted to see this body of work brought together in a single
source. The field of psychoanalysis and, more broadly, cognitive and affective
neuroscience, need this collection. Here you will find statements of dual/​
multiple code theory, for which Bucci is justly famous, as well as elaborations
and clinical applications of those views, including vivid case material. Bucci’s
highly significant work on dissociation—​classic in its own right—​is here too.
Psychoanalysts and their sympathizers should count their blessings that Bucci
has been there to represent them in the wider world of cognitive psychology
and neuroscience. This is a book with which every student of psychoanalysis
and neuroscience should be familiar.”
Donnel B. Stern, William Alanson White Institute, New York
Emotional Communication
and Therapeutic Change

In this book, Wilma Bucci applies her skills as a cognitive psychologist and
researcher to the fields of psychoanalysis and psychotherapy, opening up new
avenues for understanding the underlying processes that facilitate therapeutic
communication and change. Grounded in research geared to understanding
and demonstrating the clinical process (rather than the “outcome”) of ana-
lytic inquiry and therapeutic dialogue, Bucci’s multiple code theory offers
clinicians, researchers, trainers, and students new perspectives on the essen-
tial, often unlanguaged, foundations of the psychotherapeutic endeavor.

Wilma Bucci is Professor Emerita, Derner Institute of Adelphi University;

Co-​Director of Research at The New York Psychoanalytic Society and
Institute; Honorary Member of the American Psychoanalytic Association,
the New York Psychoanalytic Institute and Society, and the Institute for
Psychoanalytic Training and Research; and Member of Faculty of the
Research Training Programme of the International Psychoanalytical
Association.
Emotional Communication
and Therapeutic Change

Understanding Psychotherapy
through Multiple Code Theory

Wilma Bucci
Edited by William F. Cornell
First published 2021
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
52 Vanderbilt Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 Wilma Bucci
All rights reserved. No part of this book may be reprinted or reproduced or utilised
in any form or by any electronic, mechanical, or other means, now known or
hereafter invented, including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
British Library Cataloguing-​in-​Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-​in-​Publication Data
Names: Bucci, Wilma, author. | Cornell, William F., editor.
Title: Emotional communication and therapeutic change: understanding
psychotherapy through multiple code theory / authored by Wilma Bucci;
edited by William F. Cornell.
Description: Abingdon, Oxon; New York, NY: Routeldge, 2021. |
Series: Relational perspectives |
Includes bibliographical references and index.
Identifiers: LCCN 2020035687 (print) | LCCN 2020035688 (ebook) |
ISBN 9780367645601 (hbk) | ISBN 9780367645618 (pbk) |
ISBN 9781003125143 (ebk)
Subjects: LCSH: Psychotherapy. | Psychoanalysis. |
Psychotherapist and patient.
Classification: LCC RC480.B747 2021 (print) |
LCC RC480 (ebook) | DDC 616.89/14–dc23
LC record available at https://lccn.loc.gov/2020035687
LC ebook record available at https://lccn.loc.gov/2020035688
ISBN: 978-​0-​367-​64560-​1 (hbk)
ISBN: 978-​0-​367-​64561-​8 (pbk)
ISBN: 978-​1-​003-​12514-​3 (ebk)
Typeset in Times New Roman
by Newgen Publishing UK
Contents

List of figures  ix
Editor’s preface: A cognitive scientist meets the couch  xi
Acknowledgments: Building an interactive field  xx
A personal note on theory and practice  xxiv
Prologue: The need for evolution of the psychoanalytic
model  xxvi

PART I
Evolution of the basic theory: Concepts and
contexts of multiple code theory  1
1 Symptoms and symbols: A multiple code theory of
somatization  3
2 The need for a “psychoanalytic psychology” in the
cognitive science field  21
3 The referential process, consciousness, and the sense of self  41
4 Symptoms and symbols revisited: Twenty years later  61
5 The power of language in emotional life  75

PART II
Clinical perspectives on emotional communication  99
6 Converging perspectives on emotional change in the
interpersonal field  101
7 The primary process as a transitional concept: New
perspectives from cognitive psychology and affective
neuroscience  126
8 The interplay of subsymbolic and symbolic processes in
psychoanalytic treatment: It takes two to tango, but who
knows the steps and who is the leader?  144
viii Contents

9 Dissociation from the perspective of multiple code

theory—​Part I: Psychological roots and implications for
psychoanalytic treatment  156
10 Dissociation—​Part II: The spectrum of dissociative
processes in the psychoanalytic relationship  174
11 Embodied communication and therapeutic practice: In
the consulting room with Clara, Antonio, and Ann  193
12 Nobody dances tango alone: The choreography of the
analytic interchange  217

Index  223
Figures

P.1 Grounding of emotion schemas in the interpersonal field of

psychotherapy  xxxviii
3.1 Consciousness, sense of self, and emotions and feelings  44
Editor’s preface
A cognitive scientist meets the couch
William F. Cornell

Normal emotional development depends on the integration of somatic,

sensory, and motoric processes in the emotional schemas; emotional disorders
are caused by failure of this integration … These sensory experiences occur
in consonance with somatic and visceral experience of pleasure and pain, as
well as organized motoric actions involving the mouth, hands, and whole
body—​kicking, crying, sucking, rooting, and shaping one’s body to another’s.
(Bucci, 1997)

This epigraph is taken from the chapter that begins this collection of Wilma
Bucci’s writing, which I read when first published in 1997 in an issue of
Psychoanalytic Inquiry devoted to exploring “Somatization: Bodily Experience
and Mental States”. I found this paper riveting and I noticed in the reference
list that Wilma had a book in press. I bought Psychoanalysis and Cognitive
Science: A Multiple Code Theory as soon as it came out, then contacted
Wilma, beginning what has proven to be a decades-​long collaboration. It has
now been more than two decades since that first book, and we decided the time
was right to assemble a new book that gathered together many of her papers
written since then. The result, Emotional Communication and Therapeutic
Change: New visions of the “Talking Cure” Through the Lens of Multiple Code
Theory, is a collection of papers, revised lectures, and case discussions that
show a relentless, incisive, perpetually questioning mind at work.
Bucci’s multiple code theory has been a very timely arrival as efforts to
comprehend the presence and meanings of bodily experience have been emer-
ging in contemporary philosophy, psychotherapy, and psychoanalysis. Since
Freud, the verbal and symbolic order has been the primary means and vocabu-
lary of psychoanalytic treatment, but the reach and means of analytic inquiry
are now increasingly exploring visual, sensate, motoric, and visceral modes
of experience and expression within the bodies of patient and analyst alike.
Bucci titles her acknowledgments section “Building an Interactive Field,”
and she demonstrates throughout the chapters of this book her capacity to
build, question, and rebuild her models through her ongoing engagements in
a profoundly enriching interactive field of fellow cognitive and neuroscience
xii Editor’s preface

researchers, psychoanalysts, and practicing clinicians from a broad range

of disciplines. This book brings the reader a research-​based model of psy-
choanalytic processes that remains alive in its efforts to grasp and demon-
strate the therapeutic forces in psychoanalytically based treatment models.
In its pages, the cognitive scientist faces the couch and the couch faces cog-
nitive psychology and affective neuroscience research. In her personal notes
at the start of the book, Bucci describes her own experience of a somewhat
successful psychoanalysis but then writes that, “I assumed at the time that the
practitioners of the analytic treatment I was receiving had a clear scientific
understanding of the mechanisms underlying this process.” She explored the
existing literature and Freud’s meta-​psychology but did not find what she was
looking for. So she undertook a research program that has carried on (per-
haps to her surprise) for decades. In a paper not included in this book, Bucci
(2008, p. 53) offers a concise challenge to classical psychoanalytic theory that
motivated and shaped her research:

Whereas Freud’s deep and generative insight concerning the multipli-

city of the human psychical apparatus remains valid, the psychoanalytic
premise of lower or more primitive systems—​unconscious, nonverbal,
irrational—​being replaced by more advanced ones needs to be revised in
the light of current scientific knowledge. We now recognize that diverse
and complex systems exist, function, and develop side by side, within and
outside of awareness, in mature, well-​functioning adults throughout life
… The goal of treatment is better formulated as the integration, or reinte-
gration, of systems where this has been impaired, rather than as replace-
ment of one system by another.

Bucci’s research steps out of the outcome-​focused research models that have
come to pervade and pervert the functions of scientific inquiry into the psy-
chotherapeutic project and produce results that are eagerly promoted by
insurance companies, arguing that, “Comparing the outcomes of competing
theories is not useful if we do not identify the psychological mechanisms that
bring about the observed results” (Bucci 2013, p. 16). Bucci has stepped out
of the silos of preferred theories and efforts to prove that one is superior to
another. She asks a fundamental question: How can we understand and dem-
onstrate the means through which therapeutic change comes to be? Through
the evolution of her multiple code theory and the elucidation of the referential
process, Bucci has devoted herself to the study of therapeutic processes and
the identification of factors in psychodynamic therapies that foster change.
Consistent with a fundamental attitude in psychodynamic approaches to
therapy, the therapeutic work studied by Bucci is not focused primarily on the
alleviation or elimination of symptoms, but rather on grasping their meaning.
As Bucci stresses in her closing comments in Chapter 4:
 Editor’s preface xiii

A major distinction that I hope I have made clear through this chapter
and that I want to emphasize particularly here is that symptoms may
operate as symbols—​have symbolic functions—​in the sense that their
expression may enable entry into a symbolic mode. In therapy, somatic
symptoms may provide a pathway to symbolizing emotional experience
that has been dissociated, particularly where other modes of expression,
such as memories, fantasies, and dreams, may not be accessible.

Virtually every aspect of the multiple code theory calls the adequacy of
manualized, cognitive-​behavioral treatment into serious question for any
therapeutic goal beyond symptom relief and insurance reimbursement. Bucci
critiques the underlying assumptions of the theories underlying cognitive-​
behavioral models of treatment and issues a challenge to clinicians of both
psychoanalytic and cognitive behavioral models to carry out research to iden-
tify and demonstrate potentially common factors that contribute to the effi-
cacy of varying methodologies:

The field of psychotherapy research has recently focused on outcome

rather than process studies, with outcome mainly evaluated in terms of
symptoms and behaviors. This emphasis has occurred for many reasons,
including professional, ethical (and financial) considerations—​as well as
the fact that process research is difficult, time consuming and expensive.
(Bucchi 2013, p. 22)

Following a graduate education in phenomenology, I trained simultaneously

in psychodynamic psychotherapy (transactional analysis and subsequently
contemporary psychoanalysis) and a neo-​ Reichian approach to body-​
centered psychotherapy. After more than twenty years of practice, I still had
not found a coherent means of integrating these rather incompatible models,
theoretically or clinically, to my satisfaction. Freud privileged mind over
body, and language over action and affect, perspectives that have carried on
for over a century in classical psychoanalysis. Reich sought to reverse the
Freudian order, declaring that mental processes were often woven so deeply
into the warp and woof of characterological and somatic defenses as to need
to be circumvented through his body-​based interventions. It was my Reichian
training that brought the body directly into my therapeutic work. However,
in stark contrast to Freud, Reich and his followers privileged affect and
action over language and thought. Each had value, but the integration of
these models proved elusive. I got my first glimmers of means of integration
through the work of Winnicott and Bollas, but the waters remained murky.
Then along came “Symptoms and Symbols” and Cognitive Science and
Psychoanalysis, which were a revelation to me—​they provided a framework
within which I could see the potential for thinking about and truly integrating
xiv Editor’s preface

the divergent models that had informed (and sometimes frustrated) my work.
Here was the demonstration of bodily experience—​sensate and motoric—​as
a form of psychic organization, as a means of coming to know and be known
by another. The subsymbolic domains are seen through the multiple code
theory as essential forms of psychic organization, as means of knowing and
learning, informing us about ourselves and others, consciously and uncon-
sciously. There is vast potential for understanding and emotional contact
when we open ourselves to how something is said to us, as well as how we
respond in pace, tone, postural shifts, facial expression, and so on. The mul-
tiple code theory provides a structure within which language and cognition,
so valued by Freud, and affect and the body, so valued by Reich, each have a
place, a value, and necessary functions through the interrelationship of three
fundamental forms of psychic organization: verbal symbolic, nonverbal sym-
bolic, and subsymbolic. Bucci began to recognize that the key to therapeutic
change was the gradual evocation of all three modes of experience within the
therapeutic process and their gradual linkage (the referential process) within
a psychodynamic relationship that is sufficiently emotional and personally
engaged.
In his classic book, Character Analysis, Reich insists that “the beginnings of
living functioning lie much deeper than and beyond language. Over and above
this, the living organism has its own modes of expressing movement which simply
cannot be comprehended with words (Reich, 1980, p. 359, italics in original).
Reich, in many ways foreshadowing contemporary neuroscience and parent–​
infant research, grounded his therapeutic approach within the foundations of
the emotional and physical qualities of the mother–​infant relationship and
the autonomic nervous system as they were known at that time.
Winnicott, in his emphasis on the developmental indwelling of the psyche
in the soma through the mother–​infant relationship, also saw somatic experi-
ence as being at the heart of health and vitality:

Here is a body, and the psyche and the soma are not distinguished except
according to the direction from which one is looking. One can look at
the developing body or at the developing psyche. I suppose the word
psyche here means the imaginative elaboration of somatic parts, feelings,
and functions, that is, of physical aliveness … Gradually the psyche and
the soma aspects of the growing person become involved in a process of
mutual interrelation … At a later stage the live body, with its limits, and
with an inside and an outside, is felt by the individual to form the core for
the imaginative self.
(Winnicott, 1958, p. 244, italics in original)

For Winnicott, the infant discovers and elaborates the self through movement
(for which he created the notions of muscle pleasure and motility) through
their immersion in the subsymbolic realm:
 Editor’s preface xv

So in every infant there is this tendency to move and to get some kind of
muscle pleasure in movement, and to gain from the experience of moving
and meeting something …What will quite soon become aggressive
behavior is therefore at the start a simple impulse that leads to a movement
and to the beginnings of exploration.
(Winnicott, 1984, pp. 93–​94)

The summation of motility experiences contributes to the individual’s

ability to start to exist, and out of this primary identification [with the
body] to repudiate the shell and to become the core. The good enough
environment makes this possible.
(Winnicott, 1958, pp. 213–​214)

In more poetic language, Bollas extends Winnicott’s grasp of the subsymbolic:

If the developing child feels increasingly free to release the body to its
being, to embody their subjectivity, they will develop a very peculiar
expression which we know as “sensuality.” This capacity to use the senses
is an acknowledgment of the body’s freedom of movement and the sen-
sual self has matriculated desire into gestural being. But sensuality is not
achieved by the self alone.
(Bollas, 1999, pp. 152–​153)

Sensualisation is a form of embodied perception and reverie-​like phys-

ical expression, the subject moving in the physical world of body-​to-​body
communication.
(Bollas, 1999, p. 155)

Bollas infuses Winnicott’s properly British “good enough” with a vivid sense
of the eroticism and vitality of the forces of our early development.
Winnicott famously framed psychotherapy as a form of “play”:

Psychotherapy takes place in the overlap of two areas of playing, that of the
patient and that of the therapist. Psychotherapy has to do with two people
playing together. The corollary of this is that where playing is not possible
then the work done by the therapist is directed towards bringing the patient
from a state of not being able to play into a state of being able to play.
(Winnicott, 1971, p. 38, italics in original)

The thing about playing is always the precariousness of the interplay of

personal psychic reality and the experience of the control of objects. This
is the precariousness of magic itself, magic that arises in intimacy, in a
relationship that is being found to be reliable.
(Winnicott, 1971, p. 47)
xvi Editor’s preface

Contained within Winnicott’s conceptualization of play is the active (motoric

and verbal) exploration of the self in the world through movement (motility),
imagery, fantasy, and nonverbal as well as verbal exploration and communi-
cation. This conceptualization of play captures what I have come to see as the
heart of the referential process.
These sensory and motoric processes are not limited to infancy or primi-
tive states of being. As Bucci demonstrates, we do not grow out of them as
we mature; these are the vitalizing forces of life. The subsymbolic domain is
the foundation of intimacy, play, eroticism, aggression, sexuality, and nurtur-
ance throughout life. Within the context of a reasonably responsible envir-
onment, this vital domain of experience forms the basis of a resonant and
resilient sense of self. When the interpersonal/​developmental environment is
one of neglect or impingement/​trauma, the capacity to integrate experience is
diminished and the self learns to survive through varying degrees of dissoci-
ation (Chapters 9 and 10). Often split off from the experience of one’s self,
these are the formative forces that can emerge to inform and motivate dynam-
ically informed psychotherapies (Chapter 11). Bucci’s stress on the centrality
of subsymbolic experience and its gradual integration into symbolic modes,
both verbal and nonverbal, challenge many assumptions of both classical
psychoanalytic and cognitive-​behavioral theories that endeavor to explain the
treatment processes and outcomes. In my own book, Somatic Experience in
Psychoanalysis and Psychotherapy (Cornell, 2015, p. 44), I note that:

Shaping one’s body to another’s represents quite a challenge to the classical

analytic process. Somatic processes place unique demands upon psycho-
analytic theory, the psychoanalyst, and the therapeutic relationship. In
these sensori-​motoric realms, the therapeutic process becomes a kind of
psychosomatic partnership that can often be wordless, entering realms of
experience that may not easily come into the comfort and familiarity
of language. We experience the successful or unsuccessful shaping of our
bodies in all of our vital, intimate relationships of any age and develop-
mental stage. There is a fundamental knowing of self and other which
forms first through the experience of one’s body with another’s. In life,
and in psychoanalysis, healthy development involves the integration of
motoric and sensate processes within the context of a primary relation-
ship, establishing subsymbolic, somatic schemas of the self in relation to
one’s own body, to cognitive and symbolic processes, and to the desire for
and experience of the other.

It is, of course, the good enough environment, a vitalizing base (Cornell,

2001, 2015)—​be it parental or psychotherapeutic—​that facilitates the mat-
uration of the developmental/​referential process of developing one’s capacity
to utilize and move among the different modes of experience within one’s
self and in relation to others. When Winnicott speaks of the mother–​infant
 Editor’s preface xvii

dyad, he is also addressing the therapist–​patient dyad. Winnicott’s transform-

ation of the Freudian and Reichian premises is in his recognition of the neces-
sity of an other’s repeated attention to and languaging of somatic experience
that situates the mind in the body, the psyche-​soma as the foundation for a
robust sense of self in the world. Language can be in the service of the body
rather than in place of or in competition with it, facilitating an ease of flowing
self-​contact between the unlanguaged subsymbolic orders with those of the
verbal, symbolic realms that have been so long the primary domain of the
analytic endeavor.
In the formative years of her research, Bucci—​of necessity, I think—​placed
a great deal of emphasis on the distinctions between the verbal symbolic,
nonverbal symbolic, and subsymbolic domains of experience, working per-
sistently to gain recognition of the legitimacy of the subsymbolic as an essen-
tial means of knowing oneself in the world. As Bucci and her colleagues
have developed methods of studying transcripts of actual therapy sessions
(Chapter 5), she has begun to articulate the referential process of the arousal
of emotional schema, the connection to the symbolic mode, and the capacity
for reflecting/​reorganizing (Chapters 8 and 11). Here language comes to the
forefront, not as a form of cognition superior to the nonverbal and sensate/​
motoric but rather as connected to it, expressive of it:

In our characterization of verbal emotional communication, we expand

the ends of this [speech] chain to incorporate the activation of emotional
experience underlying the construction of a linguistic message (spoken or
written) and its connection with subsymbolic experience in a listener or
reader. We are concerned with the inverse process, the power of language
to connect back to imagery and subsymbolic representational modalities
in the speaker (or thinker), and to lead, potentially, to reorganization of
emotional life.

Here the linking and integrative functions of language within the referen-
tial process become crucial. The therapist’s words can become the means
by which the therapist and patient focus and deepen somatic, subsymbolic
experience. Quinidodoz (2003, p. 35), for example, describes her use of “incar-
nate language,” which she defines as a “language that touches as one that does
not confine itself to imparting thoughts verbally, but also conveys feelings
and the sensations that accompany those feelings” (emphasis in original).
Descriptive language on the part of the analyst—​words often informed and
inflected by the therapist’s own somatic experience—​is crucial here; such lan-
guage is experience-​near, conveying a felt sense of one’s interior and somatic
states. Incarnate language is a way to speak to the patient’s body rather than
speaking about it, an avenue for the “sensualisation” of the emergent process.
Contemporary psychoanalysis has come to see and to articulate the cen-
trality of the therapeutic relationship in the vitality and efficacy of the
xviii Editor’s preface

treatment—​this is also the case in transactional analysis, gestalt therapy, and

some approaches to CBT. The richness and realness of the therapeutic rela-
tionship is communicated and experienced through the realms of the non-
verbal symbolic and the subsymbolic. Significant growth and change can
emerge through those domains of learning, with little to no verbal represen-
tation, yet language—​especially incarnated language—​can further deepen
and “cement” the nonverbal aspects of therapeutic process. The referential
process demonstrates that, over time, the access to and integration of all three
modes of experience creates the ground for lasting psychological change.
As we reached the final stages of preparing the manuscript to send to
Routledge, I began to write this preface. It was the time of the Covid-​19
lockdown, and suddenly psychoanalysts and psychotherapists worldwide
were working remotely, via various forms of online platforms. Suddenly the
felt presence of being on the couch or sitting together face-​to-​face in our
consulting rooms, talking and listening, was gone. Now, a voice on the phone
or faces on computer screens were all there was. The list-​serves of every
major psychotherapy association were filled with discussions of the impact
of these changes. Over and over again, psychoanalysts and psychotherapists
wrote of their fatigue at day’s end. My consultation groups, rather than being
the intimate exchanges of colleagues who had worked together for years,
sitting together in close proximity, were also on line—​and everyone reported
their fatigue. Speaking as a somatically oriented psychotherapist, I offered
a posting to the open forum of the International Association for Relational
Psychoanalysis and Psychotherapy. It seems like an appropriate way to bring
my reflections on the multiple code theory and its rich implications to a
conclusion:

As I read the posts on this forum, talk and write with colleagues
around the world, work with my consultation groups, and meet with my
clients—​all now through virtual means—​the questions and realities of
embodiment do indeed come to the forefront. I think the term “working
remotely” is far more accurate in capturing experiential reality than
“working virtually”.
We are, in fact, working remotely. We are not in the same room; we
are not in one another’s physical presence; and we are deprived of the
wealth of sensate, emotional, and nonverbal communications that
silently inform, enrich, and enliven our sessions (with a huge nod to
Wilma Bucci’s accounting of the place of subsymbolic experience in
the psychotherapeutic process). I hear (and myself experience) over and
over again the fatigue, exhaustion people experience working the “vir-
tual” realms all day long. It has given me new insights into the anxie-
ties and disconnections my younger clients experience when they spend
so much time with the misnamed “social” media. The screens create an
illusion of contact. The screens dominate our immediate experience with
 Editor’s preface xix

two-​dimensional, visual and vocal data. Our receptive tools and capaci-
ties are seriously diminished, and I think we are constantly consciously,
and unconsciously, trying to fill in the experiential gaps in our contact.
I often hear weary versions of, “It’s better than nothing.” But from
a somatic perspective, it is the areas of “nothing” that need to be
acknowledged. I have found it essential as these days of remote sessions
go on and on to not pretend that this is good enough, better than nothing.
I am finding it essential to acknowledge and inquire about the experiences
of absence, what is missing. This is an acknowledgement of elements of
our lived realities as we cannot be in close or physical contact with those
with whom we are working, with those we love who are now held at a dis-
tance. The experience of loss, anxiety, and grief in our sessions is a core
aspect of working somatically.
(April 8, 2020)

References
Bollas, C. (1999). The mystery of things. London: Routledge.
Bucci, W. (1997). Symptoms and symbols: A multiple code theory of somatization.
Psychoanalytic Inquiry, 17, 2, 126–150.
Bucci, W. (2008). The role of bodily experience in emotional organization: New
perspectives on the multiple code theory. In F. S. Anderson (Ed.), Bodies in
Treatment: The unspoken dimension (pp. 51–​76). New York: The Analytic Press.
Bucci, W. (2013) The referential process as a common factor across treatment modal-
ities. Research in Psychotherapy: Psychopathology, Process and Outcome, 16, 16–​23.
Cornell, W. F. (2001). There ain’t no cure without sex: The provision of a vital base.
Transactional Analysis Journal, 31, 233–​239.
Cornell, W. F. (2015). Somatic experience in psychoanalysis and psychotherapy: In the
expressive language of the living. London: Routledge.
Quinidodoz, D. (2003). Words that touch: A psychoanalyst learns to speak.
London: Karnac.
Reich, W. (1980). Character analysis, 3rd edn. V. R. Carfagno (Trans.) M. Higgins and
C. M. Raphael (Eds.). New York: Farrar, Straus and Giroux.
Winnicott, D. W. (1958). Through paediatrics to psychoanalysis: Collected papers.
London: Karnac.
Winnicott, D. W. (1971). Playing & reality: London: Tavistock.
Winnicott, D. W. (1984). Deprivation and delinquency. London: Tavistock/​Routledge.
Acknowledgments
Building an interactive field

I have been doing this work for a long time and have had the great good
fortune of building close relationships with many people—​clinicians and
researchers—​whose collaboration and inspiration have been indispensable in
this work. This volume happened because my friend and colleague William
Cornell suggested that it was time for me to do a book that brought together
several papers, and because he offered to be the editor. I am extremely grateful
that he was willing to do this, not only because it is important to me to have
produced this book, but also because he is such an original thinker and elo-
quent writer that it seemed above and beyond expectations for him to be
willing to take on the role of editor of this volume. Bill’s work intersects
closely with mine in recognizing that subsymbolic bodily and sensory experi-
ence needs to be alive and present in the session and in the therapeutic rela-
tionship in order to bring about change; he is a master at knowing how to
bring about such activation in the consulting room. His characterization of
the therapeutic process from the perspective of somatic psychotherapy, and
his vivid clinical descriptions have provided validation for the ideas of mul-
tiple code theory and also opened new questions and ideas.
The evolution of multiple code theory has been interactive with the devel-
opment of methods of measurement from its beginning, but the project of
measurement took a giant leap when Bernard Maskit entered this work about
fifteen years ago. Bernie is a research mathematician who by now probably
knows more about psychoanalysis and psychotherapy than any mathemat-
ician ever has. Using some mathematical ideas, and also acquiring an enor-
mous amount of mysterious computer skills, he has developed the innovative
program that is the basis for our explorations into the psychotherapy process.
Bernie is the partner of my life as well as my work; following the theme of this
volume, his contributions transcend boundaries. He has brought his awesome
ability to think outside the box to our conversations about work and every-
thing else for the past 40 years and more.
There are many colleagues with whom I have collaborated and discussed
ideas over the years. Here I will just mention three people who were instru-
mental in developing the theory and research approach. Norbert Freedman
 Acknowledgments xxi

was a mentor who became a colleague; his work in developing the interface of
theory and research in the clinical context was highly innovative and continues
to be influential. Erhard Mergenthaler introduced innovations in the com-
puter assessment of language style that are central to our research. Richard
C. Friedman’s broad and courageous vision of psychoanalysis as a living
theory that requires reexamination and revision provided inspiration, and his
personal encouragement provided support. I have also had the privilege of
supervising the research of many students who did their dissertations with
me at the Derner Institute of Adelphi University and elsewhere; I remember
each of them as a special collaborative relationship. Some of their work is
represented in this book; some is represented in other publications that are
referred to here and elsewhere. I wish I could thank each of my colleagues and
students, past and present, individually here.
I also want to mention several people with whom I actively collaborate
today. We work closely with Leon Hoffman, of the New York Psychoanalytic
Society and Institute (NYPSI), whose insights and creative energy are indis-
pensable to our thinking, our projects and our program of research, on many
levels. Also, through Leon’s efforts, NYPSI provides us with a base for our
work. With the resources of the Pacella Research Center, we have been able
to support several graduate students and postdoctoral fellows to participate
in the projects and we are beginning to establish a research presence in the
education of candidates. Here we are realizing at least a start at repairing the
split between the institutes and the universities that has hampered the devel-
opment of the psychoanalytic field from its early days.
Sean Murphy has been a central, indispensable member of our group; he did
his dissertation with me at Adelphi, graduating in 2012, and has been involved
in our research program ever since, continuously generating new ideas at the
interface of theory and practice, developing new projects, and spreading the
word. His grasp of technology is awesome and constantly expanding; he and
Bernie bring their different and complementary talents and skills to our col-
laborative research. Sean is also strongly, viscerally aware of the need for revi-
sion of theory and practice to meet current critical mental health needs. In
addition to working directly with us at NYPSI, and teaching research design
at the university level, he now has the position of data scientist at a nonprofit
service and advocacy organization. In this role, he is exploring the application
of features of the referential process to develop a protocol for responding
to calls on suicide hotlines. Sean’s work gives me the opportunity to add a
note of looking forward to the future of our theory and measures, opening a
broader direction of their application to urgent mental health needs.
The Clinician-​ Researcher seminar that we have established at NYPSI
has provided a new approach to repairing the split in the field. I thank Drs.
Wendy Olesker, Charles Jaffe and Christopher Christian for their invaluable
contributions in sharing their own treatments and their own perspectives.
Our Italian colleagues are adding a cross-​cultural perspective and their own
xxii Acknowledgments

imaginative and creative ideas to this work; here I’ll mention particularly
Rachele Mariani, Attá Negri, Luigi Solano, and Marina Amore.
We are fortunate to include graduate and post-​doctoral students as members
of our current research group at the NYPSI, including Karen Tocatly, who
has been central in our current project of developing a measure of the arousal
function of the referential process, and You Zhou and Xinyao Zhang, who
have worked closely with us on several theoretical and technical projects.
Mentioning You and Xin allows me to close these acknowledgments with
what feels like a necessary reference to the existential crisis in the world, the
widening plague that provides the context in which we now live, love, and
work. A colleague on a listserv noted that there was one word in Chinese for
both crisis and opportunity; I asked You and Xin whether they could fill in
the current usage of this word. Xin says: “the word that pops up in my mind is
”危机” (wei ji, pronounced “wei gee”), which usually means crisis in everyday
usage. But … if you split the word apart, 危 means danger/​crisis and 机 means
opportunity … In this sense, perhaps a better matched English word is “crit-
ical time,” which equally implies urgency (i.e. a tiny difference might end up
with a big butterfly effect that is qualitatively different) with a more neutral
connotation. A similar word is “Kairos moment,” with a connotation of
criticality but more positive.” You Zhou says that the most frequently used
meaning of this word in China is

a moment that has danger and opportunity; it is a moment to test

decision-​making and problem-​solving abilities. It is a turning point in life,
group, and social development. Life and death are at stake, and benefits
are transferred, it’s like a fork in the road. So yes, I think this is a good
word to hold to help getting through this period of turbulence … I think
there remains latent opportunities in this situation, depending on how we
view, approach, and deal with it.

For me, this concept of wei ji provides a way to end these acknowledgments
with love and gratitude for my family, friends, colleagues and students, who
continue in these critical times to provide new turning points, new opportun-
ities, new tests, and new meanings to expand our explorations.
Earlier versions of the following chapters appeared elsewhere and are
adapted here by permission:

Chapter 1: Symptoms and symbols: A multiple code theory of somatization

(1997) Psychoanalytic Inquiry, 17, 151–​172.

Chapter 2: The need for a “psychoanalytic psychology” in the cognitive

science field (2000) Psychoanalytic Psychology, 17, 203–​224.

Chapter 3: The referential process, consciousness, and the sense of self (2002)
Psychoanalytic Inquiry, 22, 766–​793.
 Acknowledgments xxiii

Chapter 6: earlier version titled The role of subjectivity and intersubject-

ivity in the reconstruction of dissociated schemas: Converging perspectives
from psychoanalysis, cognitive science and affective neuroscience (2011)
Psychoanalytic Psychology, 28, 247–​266.

Chapter 7: The primary process as a transitional concept: New perspectives

from cognitive psychology and affective neuroscience (2018) Psychoanalytic
Inquiry, 38, 198–​209.

Chapter 8: The interplay of subsymbolic and symbolic processes in psycho-

analytic treatment: It takes two to tango, but who knows the steps, who’s
the leader? The Choreography of the Psychoanalytic Interchange (2011)
Psychoanalytic Dialogues, 21, 45–​54.

Chapter 9: Dissociation from the perspective of multiple code theory—​

Part I: Psychological roots and implications for psychoanalytic treatment
(2007) Contemporary Psychoanalysis, 43, 165–​184.

Chapter 10: Dissociation from the perspective of multiple code theory—​Part

II: The spectrum of dissociative processes in the psychoanalytic relationship
(2007) Contemporary Psychoanalysis, 43, 305–​326.
A personal note on theory
and practice

I started thinking intensively about the need for a scientific study of psycho-
analytic ideas at a time when I had recently finished my graduate work in cogni-
tive psychology and psycholinguistics and had my first position at the Clinical
Behavior Research Unit at Downstate Medical Center. I was considering a
mixed career of clinical work, including psychoanalytic training, along with
research; I had been in the clinical program at the University of Michigan
a few years earlier. At Downstate, I had a few therapy patients, supervised
in a thoughtful and supportive way by the psychoanalytically oriented fac-
ulty there. They were the kind of very complicated, very difficult patients—​
presumably not seen as suitable for analytic treatment—​who were assigned to
inexperienced therapists in those years.
At the same time, I was a patient in psychoanalysis—​lying on the couch,
in a fairly classical analysis, trying to following the basic rule: to say what-
ever comes to mind no matter how trivial or irrelevant it seemed, violating
normal conversational constraints, possibly insulting the person I was talking
to, causing pain and even shame for myself. I was asking myself how this pro-
cess was going to help me resolve the emotional and somatic difficulties that
had brought me to treatment. I assumed at the time that the practitioners of
the analytic treatment I was receiving had a clear scientific understanding of
the mechanisms underlying this process. But when I looked into the psycho-
analytic theory, there was nothing that answered my questions in the terms
I was looking for. The concepts were grounded in a theory of a century or so
earlier, the psychoanalytic metapsychology, sometimes as psychological and
sometimes as neurological concepts; and the process was far from being well
defined or amenable to systematic research.
Yet the process worked for me. I could actually feel the moments in the
treatment when something was changing; I gradually felt different within
myself, others saw me as different, I acted differently to some extent, people
responded differently to me. The modes of experiencing, thinking and relating
that opened up for me in psychoanalytic treatment have continued throughout
my life since then, as both life-​saving on the one hand and endlessly fascin-
ating on the other. As a researcher, I saw the development and continuing
 A personal note on theory and practice xxv

examination of a coherent theory with well-​defined concepts linked to observ-

able events as a central responsibility of the field. I became fully involved in
teaching and research, and did not continue the clinical work—​perhaps in
another life. I was fortunate to be entering this field of research at the time
of the “cognitive revolution” and the emergence of a new approach to the
study of language initiated by Chomsky’s work. There were many ideas emer-
ging from these new approaches that were applicable to the psychoanalytic
process—​and, conversely, that might also benefit from the discoveries and
insights of psychoanalytic theory and practice. It is the essence of these ideas
that they are continuously changing, and that is what I have tried to represent
in this volume. It is also the essence of these ideas that they evoke passionate
disagreement, and I hope that will be reflected in this volume as well.
Prologue
The need for evolution of the
psychoanalytic model

I began writing the introduction to this book in the summer of 2019, in the
context of almost three years of assaults on decency and humanity and on
our system of government, distinct from anything I had known before. Like
many others, I woke up each morning wondering what new horror would be
unveiled today. There were so many unthinkable events and they happened
so fast that whatever I read about one day was likely to be outdone by the
next day’s reports. And then came the late winter and spring of 2020, with its
plagues, floods, fires, protests, and continually deepening fears for our way of
life. This book is about a theory of emotional organization that addresses the
questions of how interacting and talking with another person can help to heal
the wide variety of emotional disorders that emerge in contexts such as these,
as in the other challenges of life, and what kind of interacting works best for
whom, when, and how. Related and new questions concerning the processes
of psychotherapy also need to be addressed when the threats to humanity
come ex machina, as has happened in the pandemic of the late winter and
spring of 2020.
In August, 2019, I read how the Trump administration was moving to block
immigrants who may need government aid:

U.S. President Donald Trump’s administration unveiled a sweeping rule

on Monday that some experts say could cut legal immigration in half
by denying visas and permanent residency to hundreds of thousands of
people for being too poor. The long-​anticipated rule, pushed by Trump’s
leading aide on immigration Stephen Miller, takes effect Oct. 15 and
would reject applicants for temporary or permanent visas for failing to
meet income standards or for receiving public assistance such as welfare,
food stamps, public housing or Medicaid.
(Trotter & Rosenberg, 2012)

According to the current acting director of U.S. Citizenship and Immigration

Services (USCIS), Ken Cuccinelli, in a Fox News interview, the principle
driving this new rule “is an old American value and that’s self-​sufficiency.”
 Prologue xxvii

Cuccinelli actually said, when asked about the poem by Emma Lazarus
inscribed on the Statue of Liberty, that a version of the poem can still
apply: ‘give me your tired, your poor—​who can stand on their own two feet
and who will not become a public charge.’
Also in August 2019, a few days after two horrendous massacres in El
Paso and Dayton, the FBI along with local police departments arrested three
young men in their early twenties for allegedly making mass shooting threats.
Referring to one of these men, the Florida sheriff who made the arrest said,
“When you look at this kid’s background, he is the profile of a shooter. He lost
his job, he lost his girlfriend, he’s depressed, he’s got the ammunition and he
wants to become known for being the most prolific killer in American history.”
This was also the summer in which Jeffrey Epstein, the multi-​millionaire
who was charged with operating a sex trafficking ring with teenagers, who had
socialized with Donald Trump, Bill Clinton, and Prince Andrew, and who
owned mansions and islands around the world, hung himself in a vermin-​
infested cell in a Manhattan prison.
During this same summer, a new and brilliantly designed city playground
opened on our block. The area is designed with flexible equipment and zones
that allow people to create their own games. The playground teems with chil-
dren with their assorted caretakers—​nannies, mommies, daddies and others.
We pass there on most days; in the several minutes we stand there, we observe
uncountable dramas that refute Tolstoy’s assertion that all happy families are
alike—​or Aristotle’s earlier version that men are good in one way but bad in
many. One day, a little child—​barely walking—​noticed a still smaller barefooted
baby in a stroller, became fascinated with the baby’s feet and began to play
with them. The baby was at first a bit taken aback, then began to participate
actively in the play with these interesting objects. The caretakers exchanged
smiles, one checking that this was alright with the other responsible for the
little toes. Around the same time, another child started crying and three speed
racers of about two to three years old on little vehicles and wearing helmets
stopped briefly to look on with expressions of concern. These and many other
different dramas occur so constantly that it is difficult to stop watching. The
playground closed for several months in the spring of 2020 as the city worked
to contain the virus, but it is open again now, with the masks and hand sani-
tizer that characterizes New York City’s social experience today.
It seems to me that the various fields of psychology and psychotherapy
have important roles to play in addressing the patterns of shame and grandi-
osity and hatred and fear of the other that underly the horrors we are seeing
and experiencing, while also recognizing the varied possibilities of human
behavior. How could a little child who was delighted with a baby’s toes or
a two-​year-​old who was concerned about another child’s crying become
someone who needs to rape and kill?
In The Fire Next Time, James Baldwin (1962, pp. 81–​82) refers to the role
of psychic change in the context of social conditions in this country:
xxviii Prologue

But in order to change a situation one has first to see it for what it is … To
accept one’s past—​one’s history—​is not the same thing as drowning in it;
it is learning how to use it. An invented past can never be used; it cracks
and crumbles under the pressures of life like clay in a season of drought.
How can the American Negro’s past be used? The unprecedented price
demanded—​and at this embattled hour of the world’s history—​is the
transcendence of the realities of color, of nations, and of altars.

Clearly it is not only the American Negro (using Baldwin’s term) for whom
such change is needed, but also the many people in the towns and countrysides
of America who are controlled by their fears of strange people from other
lands, or the young men who are driven to kill by their lack of power and
hope and love, and the many others—​perpetrators and victims—​about whom
we see and hear and read every day. Baldwin focuses on the need to transcend
the accepted categories of color, nations, and altars. He would probably have
referred as well to changes in the categories of gender and sexuality, but that
broadened perspective was not yet sufficiently accessible in 1962.
We can see a related process of transcending accepted categories in scien-
tific thought about the physical world. In Einstein’s general theory of rela-
tivity, the categories of space and time were redefined in terms of one another
as part of a single continuum, known as space-​time. Einstein’s discoveries
concerning the interdependence of these dimensions opened a revolution in
the characterization of the physical world that continues today.
The chapters of this book focus on the need to revise or transcend accepted
concepts and categories in the fields of psychoanalysis and psychotherapy,
and on the need for a systematic theory of psychic organization and thera-
peutic change, rooted in current scientific work and able to be examined in
a research context. In the years since the publication of my 1997 book, the
development of multiple code theory has been informed by new directions of
investigation and exponentially growing advances in knowledge concerning
emotion, cognition and somatic functions, as well as by new recognition
of the inherent interconnections of these functions—​within oneself and
with others. These advances have come from research in fields of cognitive
psychology and affective and social neuroscience. Advances in theory have
also come from the writings of clinicians based on their observations in the
therapy context.

The relativity of emotion, cognition and bodily

experience
There is increasing recognition in the field of affective neuroscience that the
functions that have been categorized as emotion and cognition are not dis-
tinct, but instead need to be redefined in terms of one another. The insep-
arability of emotion and cognition, to the point where it is misleading to
 Prologue xxix

have distinct terms to define these processes, is argued by researchers such as

Pessoa (2008) and Phelps (2006), and discussed in this volume.
The interaction of emotional and mental functions with bodily and sen-
sory functions is also inherent in this network. The relation of mind and body
has been a major concern of psychoanalytic theory (as well as a puzzle and a
trap for philosophers) from its earliest days. The psychoanalyst Ernest Jones
(1946, p. 59) addressed this topic in terms that are closely related to the per-
spective I’m offering here:

The Germans have a beautifully non-​ committal word Trieb, which

Americans have translated by the useful term “drive.” It applies to any
driving force whether innate or acquired … To ascertain what exactly
comprise the irreducible mental elements, particularly those of a dynamic
nature, constitutes in my opinion one of our most fascinating final aims.
These elements would necessarily have a somatic and probably a neuro-
logical equivalent, and in that way we should by scientific method have
closely narrowed the age-​old gap between mind and body. I venture to
predict that then the antithesis which has baffled all the philosophers will
be found to be based on an illusion. In other words, I do not think that
the mind really exists as an entity—​possibly a startling thing for a psych-
ologist to say. When we talk of the mind influencing the body or the body
influencing the mind we are merely using a convenient shorthand for a
more cumbrous phrase such as “phenomena which in the present state of
our knowledge we can describe only in terms that are customarily called
‘mental’ (emotions, phantasies, etc.), appear to stand in a chronological
causative sequence to others which at present we can refer to only in som-
atic phraseology.” It is purely a matter of convenience and accessibility
of approach whether we use one language or the other for our empirical
purposes, and it would not be at all surprising that when a common for-
mula is discovered for both it will be expressed only in mathematical ter-
minology, as appears already to have happened in the physicists’ attempt
to define matter.

Winnicott (1954) also emphasized the inherent interaction of functions that

have been termed “mental” and “physical.” He characterized mental activity
as a special case of the functioning of what he termed the psyche-​soma. On
a theoretical level, like Jones, he pointed to the distinction between the defin-
ition of these concepts and the subjective experience of them:

We are quite used to seeing the two words mental and physical opposed
and would not quarrel with their being opposed in daily conversation. It
is quite another matter, however, if the concepts are opposed in scientific
discussion.
(Winnicott, 1954, p. 201)
xxx Prologue

Based on a large body of experimental research in the area of emotion and

thought, Lisa Barrett recently expressed a perspective strikingly similar to the
psychoanalytic one:

Your body is part of your mind, not in some gauzy mystical way, but in a
very real biological way. This means there is a piece of your body in every
concept that you make, even in states that we think of as cold cognition.
(cited in Armstrong, 2019)

As Barrett (cited in Armstrong, 2019) also says, the brain must continu-
ally construct concepts that guide the body by integrating scraps of sensory
input with memories of similar experiences from the past; this can be seen
as a version of the multiple code concept of emotion schemas in the cogni-
tive science field. According to Barrett, creating this internal model of your
body in the world provides a basis for inferring the causes of the sensory
data that comes in through the sense organs, guides actions, and constructs
experiences.
Here it appears that current research, along with clinical observation, is
leading us to question accepted boundaries, not only between emotional and
mental functions, but also in relation to somatic ones. Based on this work, it
feels misleading to use the terms “emotion,” “mind,” and “body” separately.
The conceptual boundaries, like those of color, nation, and altar to which
Baldwin referred, need to be transcended and changed. Einstein referred to
a concept of space-​time; Winnicott’s term “psyche-​soma” comes close to
this—​interpreting “psych” as incorporating what have been termed emotion
and mind.1 The multiple code concept of emotion schemas, Damasio’s (1994)
concept of dispositional representations, and the psychoanalytic concept of
drive all build on this network of functions.

Transcending concepts of self and other

The new perspective on psychological organization also includes a new view
of the boundaries between the concepts of self and other. We can see an early
version of this formulation in Winnicott’s famous footnote to his paper, “The
Theory of the Parent–​Infant Relationship” (1960, p. 187):

There is no such thing as an infant, meaning, of course, that whenever

one finds an infant one finds maternal care, and without maternal care
there would be no infant.
(Discussion at a Scientific Meeting of the British
Psycho-​Analytical Society, circa 1940)

In his terms, the infant–​mother unit includes the “psyche-​soma” of both. The
insights of Winnicott and many other clinicians have now been supported
 Prologue xxxi

and extended by several decades of work on the mirror neuron system and
related processes.
The discovery of mirror neurons was important in providing a physical,
neurological basis for direct access to the experience of another person.
The discoveries began with the finding in 1992 that specific types of visuo-
motor neurons discharge both when a monkey executes a motor act and
when it observes a similar motor act performed by another individual, the
experimenter (Di Pellegrino et al., (1992). Since that time, there have been
many studies providing evidence—​not surprisingly—​for the operation of
mirror neurons in humans as in other primates, and many studies examining
their anatomy and their impact on social interaction. Research in the area
of social neuroscience with human subjects has provided evidence for the
role of the mirror mechanism in the integration and control of emotion at
all levels of experience and thought. As the neuroscientist Keysers (2011,
p. 104) writes:

without the physical feeling of thrill we sense when our thinking leads to
success, I doubt we would care to think at all. Our mind is grounded in
our bodies. Through the discovery of shared circuits, the body becomes
central not only to our own emotional lives but also to the exchanges
between our minds. To understand the actions of other individuals, we
need to map them onto our own body’s motor programs. To understand
their emotions, we need to map them onto our own visceral feelings.

The new findings on the integration of emotion and cognition, and on the
development of the “psyche-​soma” can be applied as well to the processes of
communication between self and other. The implications are potentially great
for understanding how humans function in an interpersonal world, and the
struggles they confront, and for an understanding of how psychotherapy can
intervene to bring about change.

Transcending concepts of unconscious processing:

An alternate perspective
Most “psyche-​soma” processing occurs outside of awareness in humans as
in all species, as far as we know. From the perspective of current work in
cognitive science and neuroscience, there is no entity—​no place—​that can
be identified as “the unconscious,” dynamic or otherwise, just as there is no
place—​like a big box—​where memories are stored. Instead, psychic functions
are understood as based on a complex network of processes that are more or
less connected, and more or less accessible to awareness, at different times and
in different ways. At any given time a very small proportion of this network of
processes are brought into what cognitive psychologists have termed working
memory (Baddeley, 1994).2 These constitute the contents that are attended to
xxxii Prologue

at any given moment, that can be worked on directly and intentionally, and
that we call “conscious.” The nature of the factors that determine the entry of
particular information into working memory at any given time has been, and
continues to be, studied intensively by cognitive psychologists.
It is very interesting and somewhat remarkable that Freud (1915, p. 167)
made an essentially similar point:

at any given moment consciousness includes only a small content, so that

the greater part of what we call conscious knowledge must in any case be
for very considerable periods of time in a state of latency, that is to say,
of being psychically unconscious.

The “small content” to which Freud refers can be seen as conceptually equiva-
lent to the current concept of working memory or attention.
Freud then went on to struggle with the distinction between being con-
scious and unconscious in a number of—​manifestly contradictory—​ways. On
the one hand he says (1915, p. 177):

It is surely of the essence of an emotion that we should be aware of it, i.e.

that it should become known to consciousness. Thus the possibility of
the attribute of unconsciousness would be completely excluded as far as
emotions, feelings and affects are concerned.

From a different perspective, throughout his writings Freud refers to affect or

emotion as associated with the id, with primordial forces, unbound energy,
the primary process, the pleasure principle—​all associated with the uncon-
scious mode. These and other apparent contradictions have presented a
challenge to the theoretical framework of psychoanalysis, as I have discussed.
The reconciliation of the manifestly contradictory ideas requires a more gen-
eral attempt to restructure the theory, as attempted by Mark Solms (2013).
For example, in his review of Freud’s metapsychology as presented in “The
Unconscious”, Solms (2013, p. 102) writes:

The core processes of the system Ucs. (the processes that Freud later
called ‘id’) are not unconscious. The id is the fount of consciousness, and
consciousness is primarily affective.

As I point out throughout this volume, we can account for the psycho-
therapy process more directly by focusing on the forms of experience,
including subsymbolic bodily and sensory forms, rather than on level of con-
sciousness. This approach then helps to address the question of when and
how different aspects of experience come into and out of focus in the thera-
peutic interaction for both participants and the implications of these shifts in
focus for therapeutic change.
 Prologue xxxiii

Origins and basic concepts of multiple code theory

It was one of the great discoveries of Breuer, Freud and their patients that
helped to spawn the whole field of psychotherapy that verbal communica-
tion itself—​without medication or physical therapy—​has bodily effects. But
they did not understand in Freud’s time—​and we still understand little now—​
how language connects to emotion and bodily systems, or what kind of lan-
guage works best, when and how, or even whether it is the words or other
components of the therapeutic interaction that are causing the change.
In his several revisions of his theory Freud attempted to account for these
processes on the basis of different theoretical models, moving from the topo-
graphic to the structural models and also attempting to reconcile them.
In the “Outline,” (Freud, 1938, p. 164), his final summary formulation, he
acknowledged the problems and inconsistencies remaining in his theory;
nevertheless, he claimed, one piece of solid ground remains:

Behind all these uncertainties, however, there lies one new fact, whose dis-
covery we owe to psychoanalytic research. We have found that processes
in the unconscious or in the id obey different laws from those in the pre-
conscious ego … In the end, therefore, the study of psychical qualities has
after all proved not unfruitful.

He carried forward this emphasis on the different laws of thought in his

systematic formulation of the dream work; as I have said in many writings,
including several chapters in this book, the recognition of distinct modes
of mental processing and the introduction of the rules of the dreamwork
are areas in which Freud’s theory was most prescient. The theory ran into
trouble, as Freud himself recognized, in his attempt to link differences in
processes of thought with levels of consciousness as well as with concepts
of id and ego.
In 1985, I introduced a dual code theory that attempted to address aspects
of this conceptual difficulty. The theory, based on advances in cognitive
psychology by Paivio (1971, 1978), Bower (1970) and others, focused on
imagery and language as modes of thought operating within and outside of
awareness and in the networks of memory. The different modes of thought
are connected partially and to varying degrees. Whereas the original dual
coding theory proposed by Paivio postulated direct connection of verbal and
nonverbal representations, the dual code theory as I modified it emphasized
the limitations on the connections of the two modes and the difficulties that
people experience in expressing feelings in words.
My 1985 paper began with the somewhat evocative but inadequate claim
that “Only the sounds of speech pass back and forth between analyst and
patient.” Of course, we know now that much more than speech passes back
and forth between the two participants in the analytic relationship; the
xxxiv Prologue

chapters in both sections of this volume address the nature of the therapeutic
communication from different perspectives.

Beyond dual coding: Major concepts of multiple

code theory
Based on further advances in neuroscience, cognitive psychology, and related
fields, including the areas of parallel distributed processing and dynamical
systems, I introduced the multiple code theory, including subsymbolic as
well as symbolic forms of thought, and the associated concepts of emotion
schemas and the referential process (Bucci, 1997). The multiple code theory
went beyond dual coding to identify forms of representation and communi-
cation characterized as subsymbolic, a continuous flow of experience in sen-
sory and bodily form, contrasting with symbolic processing based on discrete
images and words.

The functions of subsymbolic thought

Subsymbolic experience is largely nonverbal, but is related to language
through paralinguistic qualities such as speech rhythms and intonation
patterns, as well as the mysterious features of onomatopoeia. All modes of
thought, subsymbolic as well as symbolic, may occur in conscious forms
as well as in the networks of processing outside of awareness. The major
idea here is that subsymbolic thought is fully as systematic and complex
as symbolic forms, but less well recognized as thought when it occurs,
and less well understood theoretically, as I discuss in this volume. The
subsymbolic mode is necessarily operative in therapy—​as in any human
interaction.
Bollas (1995) refers to the concept of “sensibilitas,” which he characterizes
as referring to an individual’s “receptiveness to impression,” stressing “deli-
cate sensitive awareness or responsiveness.” As he says (1995, pp. 14–​15):

From a psychoanalytic perspective, sensibility refers to an individual’s

unconscious capacity to receive the object world, which results in more
sensitive contact with the other and a greater reliance on feelings than on
cognition. I … suggest here that sensibility is akin to what I have called a
separate sense, that sense deriving from an unconsciousness increasingly
devoted to communication.

All these functions of feeling, delicate sensitive awareness, receptiveness to

impression, and the capacity to attend to these feelings, as they occur in
both participants and in their interaction, are aspects of what I have termed
subsymbolic functions. In contrast to Bollas’s characterization, however, all
these forms of thought may occur within as well as outside of awareness.
 Prologue xxxv

Donnel Stern’s (2013) concept of “unformulated experience” focuses on the

character of such representation as distinguished from the organized sym-
bolic forms that figure in concepts of the dynamic unconscious:

In neither IRP [Interpersonal and Relational Psychoanalysis] nor BFT

[Bionian Field Theory] is dynamically unconscious mentation under-
stood to be hidden away or distorted, as in traditional psychoanalytic
models. IRP and BFT have in common that they are based neither in
repression nor in an understanding of unconscious contents as formed
and ready to be revealed when defensive operations cease. Rather, in both
IRP dissociation theory and in the BFT theory … symbolic experience
has yet to be constructed. In unformulated experience (Stern, 1983, 1997,
2010) … symbolic experience is not yet shaped, or formed; it exists … as
potential that has not yet been actualized in symbolic form.
(2013, p. 632)

The multiple code theory adds to this formulation the perspective on the
systematic nature and organization of experience that “has not yet been
actualized in symbolic form,” existing alongside of symbolic nonverbal and
verbal forms, in consciousness as well as out of awareness.

Emotion schemas
All our knowledge of ourselves and our worlds is based on the formation
of memory schemas; organized representations of knowledge of all types
that are activated and altered by new experience, and that determine how
new experience is perceived. The concept of memory schemas, introduced by
Bartlett (1932), has been a central concept in memory research since that time.
Emotion schemas, as defined in multiple code theory, are types of memory
schemas formed through the repeated occurrence of a set of subsymbolic
sensory, somatic, and motoric processes in relation to certain events of life.
I have termed these clusters of subsymbolic experiences the “affective core”
of the schema. Emotion schemas differ from other memory schemas in two
respects: the dominance of the subsymbolic processes of the affective core;
and the central role of interpersonal interactions in the formation of the
schemas.
The child feels a conglomerate of bodily experiences when her mother
abuses her verbally or physically; she probably does not call her feelings shame
or anger or terror, but she registers the painful experiences in relation to her
mother in her memory schemas. In her mind, and in her memory, she may then
also turn away from the image of her mother as the source of the painful acti-
vation, to avoid acknowledgment that her caretaker upon whom she depends
for life is also the source of danger to her life. She may also seek another
source, in other people or in herself, to account for the painful feelings. The
xxxvi Prologue

organization of her emotion schemas, including the disconnections as well as

connections, are based on repeated experiences of the pattern; she comes to
see the world of other people in a particular way, to expect such interactions,
perhaps to see them when they do not occur; perhaps to act in a way as to
bring them about, or in such a way as to avoid them.
Ogden (1999, p. 987) describes a series of his experiences related to the
dream his patient Ms. S was describing to him. These included anxious
and other mixed feelings about meeting his son at the airport; Ogden “also
experienced fleetingly (more in the form of a subliminal image than a narrative
as he describes it) a combination of fear, sadness, loneliness and emptiness”
as he remembered waiting for a plane to visit his father who was very ill. The
series of events Ogden remembers in relation to his son and his father, which
relate as well to his experiences in the session with Ms. S, are part of a cluster
of experiences within an emotion schema, sharing components of the same
affective core. The same set of sensory and bodily experiences and responses
that were activated in the events with his father and son are being activated in
the session with Ms. S. Other experiences in Ogden’s life, including previous
interactions with this patient, may also be evoked. Ogden sees Ms. S through
the lens of this emotion schema; his interactions with her also add to the net-
work of experiences that comprise his schema.

The referential process

In communicating emotional experience in a therapy session, in literature and
in other contexts, there is a complex route to be traveled from activation of
subsymbolic components of the affective core to its formulation in linguistic
(or paralinguistic) form that can be shared. This process may occur in various
ways in both patient and therapist (or in a writer, or in any conversation), but
in the most general terms the process has three major components: arousal, in
which an experience that is largely in subsymbolic form begins to take shape
as an image or narrative that can be verbalized; symbolizing, in which the
image or story is brought to verbal form and communicated; and reflecting/​
reorganizing, in which the speaker or writer takes a step back to look at the
significance of the experience that has been expressed.
In describing the therapeutic process as he experienced it, Ogden (1999,
p. 987) says:

I will use the term “reverie” … to refer to the analyst’s (or the analysand’s)
day-​dreams, fantasies, ruminations, bodily sensations and so on, which
I view as representing derivatives of unconscious, intersubjective
constructions that are jointly, but asymmetrically, generated by the ana-
lytic pair. These intersubjective constructions, which I have termed “the
analytic third” … are a principal medium through which the unconscious
of the analysand is brought to life in the analytic relationship.
 Prologue xxxvii

This is a version of the activation process, leading to symbolizing—​recall of

memories associated with these feelings. Later, Ogden (1999, p. 988) writes:

As my focused attention returned to Ms. S., the combined effect of the

reverie experiences that I have described led to an increasing awareness
of the anger, sourness and disgruntlement that I had unconsciously been
feeling towards Ms. S throughout the session. I also became aware that
the anger served to protect me against feelings of fearfulness and sadness.

Here he reaches the function of reflecting/​ reorganizing; he reflects and

provides new meaning for the feelings and memories that have been aroused
in him. The sequence of events that Ogden describes provides an example of
the referential process, operating here in the therapist’s experience. The oper-
ation of the process, as it goes on in both participants in the treatment situ-
ation, and also between them, is discussed in detail in this volume.

The referential process in the interpersonal

context: Application to psychotherapy
There is a long route of communication—​from activation of the subsymbolic
experience of one individual’s affective core through symbolizing in imagery
and then to the kind of words that have the power to activate imagery and
subsymbolic experience in the other. In addition to that long route, there
is also a direct and powerful route, operating all the time, between the
affective cores of the two participants. The process is shown schematically
in Figure P.1.3
The diagram provides a general framework for understanding how the ref-
erential process plays out within each participant and between them. I suggest
that some version of the process represented here needs to occur to bring
about therapeutic change; the process may be more central in psychodynamic
treatment, but it will be present in other treatment forms as well.
The process depends on activation of components of an emotion schema
in the context of the treatment relationship. The activation occurs in the
subsymbolic, bodily experience of both participants; they will be communi-
cating with one another constantly and actively through their movements and
expressions, and through the paralinguistic features of their communication,
such as speech rhythms and vocal tone (see large arrows in Figure P.1).
For each participant, subsymbolic information may also be connecting to
images and memories and expressed in words. These connections may occur
in both directions within and between the participants in the interchange.
Images may connect to words; words may activate new experience in symbolic
and subsymbolic forms. Some connections within each participant are likely
to be warded off; the disconnections within the patient are central to the focus
of treatment.
xxxviii Prologue

Grounding of Emotion Schemas

in the Interpersonal Field of Psychotherapy

Patient Therapist

Words of Language Words of Language

Verbal Symbolic Verbal Symbolic

Memories, Images Memories, Images

Nonverbal Symbolic Nonverbal Symbolic

Sensory, Motoric, Sensory, Motoric,

Visceral etc. Visceral etc.
Subsymbolic Subsymbolic

Figure P.1 Grounding of emotion schemas in the interpersonal field of psychotherapy

Different forms of treatment are characterized by when, how, and whether

various connections within each participant and between them may or may
not occur. Aspects of this process are examined in this volume, from both the-
oretical and clinical perspectives.
If the treatment is proceeding well, if the relationship has been developed,
painful aspects of the schema may be activated in trace form that is
endurable—​sufficient to activate some connections to experience but not
yet sufficiently intense to precipitate avoidance. This may lead the patient to
connect to an image or memory or fantasy that they tell in detail—​in the form
of dreams, memories, waking fantasies, or events that come to mind, and
also in the experiences of the therapeutic relationship. Specific experiences,
with their emotional meanings, are transmitted from speaker to listener
through describing these images and telling these stories. The connection to
an image and its sharing in verbal form constitutes the symbolizing function
of the referential process, through which elements of schemas that have been
dissociated can come to awareness and can be communicated. The power of
language in sharing experience can be seen in this phase. Ferro (in Ferro &
Nicoli, 2017, pp. 60–​61) outlines a version of this symbolizing process, based
on his Bionian perspective:

But the shocking concept that Bion reveals to us, as I have said time and
again, is that there is a process that continuously transforms the data that
we receive from reality, so that reality is continuously being transformed
 Prologue xxxix

into a movie sequence within our mind. This process comes to life in a
still largely unknown way … we continuously transform the sensory flow,
the flow of stimuli into a sequence of pictograms, into a dream sequence
unknown to us.

Rather than transforming the flow of stimuli to a sequence of images, I talk

about connecting the subsymbolic flow to discrete images that may be described
in words; the activation of the sensory flow must remain to give life to the
images. This step of connection to imagery provides the basis for the expres-
sion of experience in language that is capable of activating corresponding
experience in another person. The emergence of the story or image can have
multiple effects on each participant, and these can be traced following the
various pathways of the diagram.
A particular complexity is that the images and narratives themselves, the
meanings of which are at first not fully understood, may involve experience
that has been dissociated. Bringing these to mind has the potential of bringing
back the old threats. The patient may experience in the moment an activa-
tion of the subsymbolic bodily feelings that they experienced in response to
a caretaker’s attacks as a child, and that they are likely to have experienced—​
perhaps in some respects evoked—​in their encounters with others since then.
The experience may also be accompanied by some glimmer of recognition of
their source or meaning that is fraught with danger for the patient. The mem-
ories are painful in themselves; the recognition of their source or meaning
may carry a greater and more dangerous threat. This activation constitutes a
danger point for the treatment, that may be valuable—​perhaps crucial—​for
change, but that needs to be recognized. The therapist experiences related
feelings—​ needs to experience them—​ but in a different context, enabling
different levels, forms, and meanings in order for the treatment to proceed.
Optimally, the process can lead to finding connections within the emotion
schemas and building new connections. The patient4 says, “I realize now that
there was a moment when I wanted to kill her—​it flashed into my mind—​I was
shocked to think that. I still feel stunned about how she treated me, although
I cannot remember what she said. But I think now I was more frightened
about what I thought than about what she said.” This constitutes part of
what is characterized in the referential process as the reflecting/​reorganizing
function, carrying forward the change in the painful emotion schema that is
the goal of treatment. Activation continues in relation to the new realization,
but the organizing schema is reconstructed to some degree.
Bollas (1995) characterizes the dream process as beginning with a sequence
of psychically intense experiences. In the context of a session, this can be seen
in terms of activation of the affective core of an emotion schema. The process
then “continues with the ‘dream event’ ”; from the perspective of the referen-
tial process, this is essentially the connection of the affective core to a specific
event within the emotion schema that has been activated.
xl Prologue

In Bollas’s terms, the process then continues through “cracking up the

dream contents through free association.” In this “cracking up” function, I see
the process as entering the complex mode of circling around and through the
elements of experience that have been aroused—​through subsymbolic activa-
tion to descriptions of events that may arouse additional affective experiences
or that may be sufficiently painful as to cut off the connection to memory
that has been activated. The interactions will involve the various pathways
within and between the participants to provide a context in which meanings
can change and new experience can be registered.
The therapeutic process, as I have outlined it here in terms of the refer-
ential process, is not based on the functions that have been termed insight
and interpretation, as in the classical psychoanalytic approach, although
it may include aspects of those functions; nor does it depend on functions
of exposure or conditioning, as in behavioral treatments, although it may
include such experiences as well. Aspects of the referential process, including
the relational functions, are involved in mentalization-​ based treatment
(MBT) (Bateman and Fonagy (2004), although MBT focuses less on bidir-
ectional communication of subsymbolic arousal and more on its recognition
and formulation.
From a broader perspective, the central function of the referential pro-
cess is not only a function of accepting one’s past, in James Baldwin’s (1962)
terms, but also involves a set of interactions in which present pain is shared
and new meanings of the present as well as the past may be developed. I hope
that the nature of these functions can be seen to some extent in the several
clinical stories that are told in this volume.

A note on theory development and research

As I discuss in this book and elsewhere, the concepts of multiple code theory,
like those of any theory, need to be continuously re-​examined and revised.
In this volume, I have presented the theory as it has evolved over the course
of the two decades covered here. I have also provided support for the concepts
of the theory based on recent and current research in a range of scientific
fields, particularly cognitive psychology and affective and social neuroscience.
So much that is exciting and important and relevant is constantly emerging
in these areas—​so much that could be used to evaluate the propositions of
the theory, and so much that it would be useful for therapists to know, and
of course much more than someone outside these fields can understand fully
or evaluate from a technical perspective.
Just as clinicians can learn from research in such scientific areas, I also see
the clinical situation as a major opportunity for systematic observation of
the processes that are outlined in the theory. There is no other situation that
is so well suited—​essentially, perfectly designed—​for activation of ‘psyche-​
soma’ functions in an interpersonal field. Neuroscientists are seeking such
 Prologue xli

a collaborative situation; in a recent paper, neuroscientists Schilbach and

colleagues (2013, p. 393) state:

In spite of the remarkable progress made in the burgeoning field of social

neuroscience, the neural mechanisms that underlie social encounters
are only beginning to be studied and could—​paradoxically—​be seen
as representing the “dark matter” of social neuroscience. Recent con-
ceptual and empirical developments consistently indicate the need for
investigations that allow the study of real-​time social encounters in a
truly interactive manner. This suggestion is based on the premise that
social cognition is fundamentally different when we are in interaction
with others rather than merely observing them.

For many reasons, we are not yet in a place where the two contexts—​clinical
and experimental—​can come together readily, but we can work toward such
connections.

The need for theory and research in the mental

health field
In order to situate multiple code theory in a broader scientific context, and
to enable application of the theory in the mental health field, a major part of
our project has been the development of systematic measures of the functions
of the referential process as they play out in psychotherapy. The field of psy-
choanalytic and psychodynamic and related treatments needs to produce evi-
dence for how therapy works and its effectiveness in order to achieve broader
recognition that can affect mental health policy more generally. Here I will
refer to a statement in the announcement of the December 2019 meeting of
the Psychotherapy Action Network. The title of the meeting is “Advancing
Psychotherapy for the Next Generation: Rehumanizing Mental Health Policy
and Practice.” The announcement states:

Psychotherapy is alive and well, bringing growth, understanding, trans-

formation, compassion and cure to millions of people across the globe.
Psychotherapy is also under attack. Insurance companies are reluctant to
cover treatments of any depth; psychology training programs are more
and more constrained to teach only behavioral techniques rather than
dynamically-​informed, relationship-​based treatments; and much public
policy is strongly biased towards short-​term, structured interventions
and medications for people in distress.
(Conference of the Psychotherapy Action Network,
San Francisco, CA, December 2019)

These conditions and views are well documented, and impose a responsibility
and a challenge for research. With a systematic theory, and the measures
xlii Prologue

developed in this context, we have the potential to evaluate various forms

of treatment and to show their effects, using both recorded therapy sessions
and treatment notes. This work is now actively in progress in our Referential
Process Research Group. The measures and their applications are discussed
briefly in Chapter 5 of this volume. A more complete presentation of empirical
work on the referential process, including experimental and clinical designs,
is forthcoming in a special issue of the Journal of Psycholinguistic Research.
Hopefully this work will prove useful in contributing to development of the
therapeutic techniques that are needed today, evaluating their usefulness in
the mental health field, and making such treatment forms and related services
available to the people who need them.

Outline of the book

The chapters in this book continue the project of developing the multiple
code theory, with new ideas and new findings from neighboring scientific
fields, including affective and social neuroscience and cognitive psychology;
and new clinical perspectives, particularly a broader vision of the role of the
relationship and its multiple levels and forms. All the chapters, in different
ways, emphasize what each field can bring to the others.
The chapters are divided into two sections, both including the development
of basic concepts of the multiple code theory in the twenty or so years since
it was introduced, and their relevance to the processes of communication and
change in therapy. The chapters in the first section focus on psychological
organization and emotional communication in a broader sense; those in the
second section focus more directly on clinical applications. Both sections
include new chapters as well as those based on previously published articles
that have been edited for this volume.

Notes
1 The term “psychic” that Freud used throughout his writings—​as in “psychic
apparatus,” “psychic determinism”—​which might be interpreted as referring to
this general structure—​has changed its meaning since his time, now referring to
supernatural functions or powers, which is the opposite of what I mean.
2 Here I note that both “attention” and “working memory” are psychological
constructs, whose definitions, like those of most psychological constructs, are in a
state of development and flux.
3 Earlier versions of the diagram were presented in the paper “Pathways of Emotional
Communication,” based on the work of Ogden, Bollas, Arlow and others, and with
somewhat different features in Bucci (2009); neither of these papers is included
in this volume. The diagram has subsequently been revised through presentations
and discussions with colleagues; the version presented here has not previously been
published.
4 This utterance is paraphrased from a treatment contained in the referential process
data base.
 Prologue xliii

References
Armstrong, K. (2019). Interoception: How we understand our body’s inner sensations.
APS Observer, 32(8). Retrieved from www.psychologicalscience.org/​observer/​
interoception-​how-​we-​understand-​our-​bodys-​inner-​sensations
Baddeley, A. D. (1994). Working memory: The interface between memory and cogni-
tion. In D. Schacter & E. Tulving (Eds.), Memory systems (pp. 351–​367). Cambridge,
MA: MIT Press.
Baldwin, J. (1962). The fire next time. New York: Vintage Books.
Bartlett, F. C. (1932). Remembering: A study in social psychology. Cambridge: Cambridge
University Press.
Bateman, A. & Fonagy, P. (2004) Mentalization-​based treatment for borderline person-
ality disorder. Oxford: Oxford University Press.
Bollas, C. (1995). Cracking up: The work of unconscious experience. London: Routledge.
Bower, G. H. (1970). Analysis of a mnemonic device. American Scientist, 58, 496–​510.
Bucci, W. (1985). Dual coding: A cognitive model for psychoanalytic research. Journal
of the American Psychoanalytic Association, 33(3), 571–​607.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (2009). The sleeping analyst, the waking dreams: Commentary on papers by
Richard Chefetz and David Mark. Psychoanalytic Dialogues, 19, 415–​425.
Damasio, D. C. (1994). Descartes’ error: Emotion, reason, and the human brain.
New York: Avon Books.
Di Pellegrino, G., Fadiga L., Fogassi L., Gallese V., & Rizzolatti G. (1992).
Understanding motor events: A neurophysiological study. Experimental Brain
Research, 91, 176–​180.
Ferro, A., & Nicoli, L. (2017). The new analyst’s guide to the galaxy: Questions about
contemporary psychoanalysis. A. Bompani (Trans.). London: Karnac.
Freud, S. (1915). The unconscious. SE, 14, 166–​204.
Freud, S. (1938). An outline of psycho-​analysis. SE, 23, 139–​208.
Jones, E. (1946). A valedictory address. International Journal of Psychoanalysis,
27, 7–​12.
Keysers, C. (2011). The empathic brain. Cambridge, MA: Social Brain Press.
Ogden, T. H. (1999). The music of what happens in poetry and psychoanalysis.
International Journal of Psychoanalysis, 80, 979–​994.
Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rinehart and
Winston.
Paivio, A. (1978). A dual coding approach to perception and cognition. In H. L. Pick
& E. Saltzman (Eds.), Modes of perceiving and processing information (pp. 39–​52).
Hillsdale, NJ: Lawrence Erlbaum.
Pessoa, L. (2008). On the relationship between emotion and cognition. Nature Reviews
Neuroscience, 9, 148–​158.
Phelps, E. A. (2006). Emotion and cognition: Insights from studies of the human
amygdala. Annual Review of Psychology, 57, 27–​53.
Schilbach, L., Timmermans, B., Reddy, V., Costall, A., Bente, E., Schlicht, T., &
Vogeley, K. (2013). Toward a second-​person neuroscience. Behavioral and Brain
Sciences, 36, 393–​462
Solms, M. (2013). The conscious id. Neuropsychoanalysis, 15(1), 5–​19.
newgenprepdf

xliv Prologue

Stern, D. B. (2013). Field theory in psychoanalysis, Part 2: Bionian field theory and
contemporary interpersonal/​relational psychoanalysis. Psychoanalytic Dialogues,
23, 630–​645.
Winnicott, D. W. (1954). Mind and its relation to the psyche-​soma. British Journal of
Medical Psychology, 27(4), 201–​209.
Winnicott, D. W. (1960). The theory of the parent–​infant relationship. International
Journal of Psychoanalysis, 41, 585–​595.
Trotta, D., & Rosenberg, M. (2019). New Trump rule targets poor and could cut legal
immigration in half, advocates say. Reuters. Retrieved from www.reuters.com/​art-
icle/​us-​usa-​immigration-​benefits/​new-​trump-​rule-​targets-​poor-​and-​could-​cut-​legal-​
immigration-​in-​half-​advocates-​say-​idUSKCN1V219N?il=0
Part I

Evolution of the basic theory

Concepts and contexts of multiple
code theory
Chapter 1

Symptoms and symbols

A multiple code theory of somatization

The interaction of psychic and somatic processes has been a central concern
of psychoanalysis from its initial formulations (Freud, 1895, 1900) to the pre-
sent day. In contrast to Freud’s time, the interaction of emotion and somatic
illness is now also recognized in the medical field. It is not only the special
disorders identified as hysterias, nor even the medical entities traditionally
classified as psychosomatic, that are affected by such interaction; the field of
psychoneuroimmunology supports the view that

All disease is multifactoral and biopsychosocial in onset and course—​

the result of interrelationships among specific etiologic (e.g., bacteria,
viruses, carcinogens), genetic, endocrine, nervous, immune, emotional,
and behavioral factors.
(Solomon, 1987, P-​l)

The potential scope of psychoanalytic treatment is enormously expanded

by these developments, and the need for a coherent psychoanalytic theory is
intensified as well, to bring psychological understanding of the interactions
among cognition, emotion, and somatic functions in line with advances in the
medical field.
Freud’s metapsychology has failed as a basis for a modern scientific theory.
The postulates of the energy theory have been tested only minimally; where
they have been tested, they have generally been disconfirmed (Eagle, 1984).
The metapsychology has been renounced by the scholars who devoted much
of their professional lives to its reconstruction and has also been rejected by
many clinicians (Holt, 1985). Nevertheless, in the absence of an alternate
model, energic metaphors remain in use, with the power to distort theory
and practice in pervasive, often unrecognized ways (Bucci, 1993; Thomae &
Kaechele, 1987).
Psychoanalysis is in need of a new explanatory theory that will account
for the major concepts with which clinicians are concerned, including the
interface of emotion and somatic functions, and that will provide a coherent
4 Evolution of the basic theory

framework for empirical research. This must be a psychological, not a neuro-

logical, model. Psychological theories constitute a distinct level of explan-
ation that cannot be dispensed with, no matter how much we learn about the
neurological level. The psychological and neurological levels have different
constructs, different concepts, different mathematical functions, and different
practical applications, and they need to be studied separately in their own
terms. We need a psychological theory to define concepts such as depression,
anxiety, feelings of abandonment and loss, and the interaction of action,
somatization, and verbalization on the behavioral and representational level;
we need a neurological or physiological model to define the corresponding
concepts in the biological domain.
While psychological constructs cannot be reduced to neurophysiological
ones, the two levels are nevertheless, ultimately, necessarily translatable to
one another. This is obvious but may need to be stated. If our mental and
neurophysiological models were sufficiently complete and accurate, and if we
had enough observable indicators for each theoretical proposition, and if the
mathematical correspondence rules within each system were all in place, the
psychological and neurophysiological theories would be expected to corres-
pond. In this and other senses, observations on the neurological or biological
level exert a potential constraint on theory building in the psychological
domain.
The psychological model that I will outline in this chapter is based on
concepts that are derived from current work in cognitive science and that
meet the constraints imposed by current knowledge in the neurosciences.
The development of a systematic psychological model for psychoanalytic
concepts was not possible in the scientific context of Freud’s time, nor in
the context of the behaviorist position that dominated American psych-
ology during much of the twentieth century, but is potentially within the
purview of the cognitive psychology of today (Bucci, 1985, 1989, 1993).
The new multiple code theory is derived from current cognitive models, but
also expands them in emphasizing the role of emotion in human cogni-
tion and the complex issues involved in translating emotional experience to
verbal form.

Freud’s “dual code” theory

Throughout his writings, Freud recognized unresolved questions and
problems in his theoretical model of the psychical apparatus, as put forth
in the first topography (1895, 1900) and later revised in the structural theory
(1923), as well as in his attempts to reconcile the two models (1940). He also
recognized the lack of supporting data for his fundamental energy theory,
although he did not repudiate or question this in any basic sense. Through
all this, as he sums up his life’s work, one piece of solid ground, one enduring
“fact,” remains clear:
 Symptoms and symbols 5

But behind all of these uncertainties there lies one new fact, the dis-
covery of which we owe to psychoanalytic research. We have learned that
processes in the unconscious or in the id obey different laws from those
in the preconscious ego. We name these laws in their totality the primary
process, in contrast to the secondary process which regulates events in
the preconscious or ego. Thus the study of mental qualities has after all
proved not unfruitful in the end.
(Freud, 1940, pp. 44–​45)

The discovery that he saw as his first and major finding remains the fact
that he holds to most firmly at the end: the discovery of a mode of thought,
characterizing the unconscious or the id, which differs from the processes of
normal, rational, waking life.
The “dual/​ multiple code” theory of emotional information processing
builds on this fundamental psychoanalytic solid ground. What we need to
understand—​and what is really not so difficult to recognize —​is that Freud’s
fundamental observations of two distinct modes of thought, their dynamic
interaction, and their interaction with somatic events do not entail the
assumptions of the energy model or the special assumptions of either the
first or second topographies and can be disembedded from these. The model
and the evidence supporting it have been discussed in detail elsewhere (Bucci,
1985, 1989, 1993, 1997) and will be outlined briefly here, focusing on issues
that are relevant to a new theory of somatization.

The multiple code theory and the referential process

According to the multiple code theory, as in the previous dual code formu-
lation, information is represented in the mind both in verbal form and in the
multiple channels of the nonverbal system. In addition to the basic verbal/​
nonverbal distinction, the multiple code theory also postulates an additional
distinction between symbolic and subsymbolic processing forms. The notion
of the symbol and the process of symbolizing are defined here in their general
information processing sense (Fodor & Pylyshyn, 1988). Thus, symbols are
defined as discrete entities that refer to or represent other entities and may be
combined following systematic processing rules. Symbols in the psychoana-
lytic sense constitute a subset of these.

The verbal system

Language is primarily a symbolic format. From a limited set of phonemes
in each language, a virtually unlimited array of words can be generated and
meanings expressed. Language is the code of communication and reflection,
in which private, subjective experience, including emotional experience, may
be shared and through which the knowledge of the culture and the constraints
6 Evolution of the basic theory

of logic may be brought to bear on the contents of individual thought. It is

also the code that we call upon to direct and regulate ourselves, to activate
imagery and emotion, to stimulate action, and to control it. The verbal code
is primarily a single-​channel, sequential processor; we generate or understand
only one verbal message at a time. Language is dominant primarily, although
not uniquely, in the conscious state.

The nonverbal system

The multiple channels of the nonverbal system incorporate representations
and processes in all sensory modalities as well as motoric and somatic forms.
Nonverbal processing is modality-​specific; representations and processes in
each modality occupy the same processing channels as perceptual experience
itself. This activation is primarily in trace form.
The nonverbal system includes both symbolic and subsymbolic forms.
Models of information processing based on symbolic formats, applied to
imagery as well as to language, have been dominant in cognitive science for
the last several decades (Fodor & Pylyshyn, 1988; Simon & Kaplan, 1989).
What is new in the cognitive science field, and of great importance for a model
of the psychoanalytic process, is the increasing recognition of subsymbolic
forms of information processing and the development of systematic models
to account for these (Rumelhart, McClelland, & PDP Research Group, 1986).
In such subsymbolic processing, we perform rapid and complex
computations on implicit continuous metrics without formation of discrete
categories, following computational principles that may never have been
explicitly identified or formulated and cannot be intentionally invoked or
applied, but that are systematic nonetheless. This type of continuous, intuitive,
modality-​specific and content-​sensitive processing is the focus of the Parallel
Distributed Processing (PDP) models, also referred to as “connectionist” or
subsymbolic models (Smolensky, 1988). Subsymbolic “computations” of this
nature underlie the capacity to anticipate the trajectory of a moving object,
navigate a ship through a narrow channel, ski a slalom course, hit a tennis ball
effectively, or distinguish the taste and aroma of burgundies from different
hillsides or different years. Such computations also serve to distinguish
subtle shifts in facial expression, to identify changes in body movement or
vocal qualities, and to recognize changes in one’s own visceral state. The cat
uses implicit computation of this nature to select a landing-​place on a table
crowded with objects, the football player to direct a ball to the position where
they expect someone will be, or to be in the right place to receive the ball that
is about to be thrown, and the analyst to recognize their patient’s subjective
state and to decide when and how to intervene.
Obviously, I will not attempt to introduce the technical structures of either
the symbolic or subsymbolic connectionist models here. The major pur-
pose of introducing these two basic cognitive science approaches is to point
 Symptoms and symbols 7

out, in a general and conceptual way, that two distinct formats of informa-
tion processing—​both within the nonverbal system—​are now being identi-
fied by cognitive scientists at a far more sophisticated model-​building level
than ever before, and that in the subsymbolic formats, complex constructs
are being developed—​ really for the first time—​ which account systemat-
ically for the types of intuitive and implicit processing, involving visceral,
somatic, and motoric, as well as sensory, modalities, which are central to a
psychoanalytic model.
These subsymbolic processes also have their limitations. While such pro-
cessing is systematic, it is also highly specialized for specific functions. The
PDP models do not account for integration of subsystems in relation to
the overall goals or values of the organism in which they are implemented.
The symbolic processes of the nonverbal system fill this integrative and organ-
izing function (Norman, 1986).
The new multiple code theory thus expands Freud’s fundamental solid
ground to incorporate three—​at least—​rather than two basic systems of
thought: verbal versus nonverbal, and within nonverbal, symbolic versus
subsymbolic. By implication, the new model also emphasizes the crucial role
of connections among all these disparate systems and the corresponding
implications of failure of such connections.

Emotion schemas in the multiple code theory

Within the multiple code theory, emotions are characterized as image-​
action schemata, operating within or outside of consciousness, which
differ from other, more “cognitive,” schemas in their relative domination by
motoric and visceral processing systems, rather than by symbolic imagery
and words. In the most general terms, the emotion schemas constitute the
desires, expectations, and beliefs one has about other people, which develop
through interactions with others from the beginning of life. These schemas
include representations of objects, parts of objects, and relations between
them in all sensory modalities, as well as patterns of activation associated
with motoric actions, and visceral and somatic states. They thus include
images of the object of the emotion, the person we desire or hate or fear;
central nervous system representations of specific actions associated with
emotional arousal—​for example, approach, attack, or flight; and patterns
of visceral or somatic experience associated with such arousal—​what we
feel, or expect to feel, viscerally when we are angry or afraid or in love. The
emotion schemas begin to be formed within the nonverbal system prior to
the acquisition of language; eventually, their contents may be connected to
language as well.
This model of the emotions is based on minimal limiting assumptions, and
is generally compatible with areas of consensus among emotion theorists
today (Scherer, 1984), as well as with current views of the neurophysiological
8 Evolution of the basic theory

basis of emotion (LeDoux, 1989). The multiple code formulation is also com-
patible, in part, with the definition of affects by Kernberg (1990) as incorpor-
ating symbolic representational, motoric, and visceral components; however,
it diverges from Kernberg’s inclusion of discharge phenomena within the
definition of affects and his corollary conception of affects as the “building
blocks” of drives (1990, p. 117). According to the multiple code theory, motiv-
ation is conceptualized in terms of the representational and directive proper-
ties of the emotion structures, independent of the particular source—​internal
or external—​of this activation and independent of energic notions based on
physiological need states.
Emotion structures may be activated by memory images or evoked by
language. Such activation—​states of terror, loss or helplessness, pleasure
or desire—​may then have physiological effects similar to the experiences
themselves. Any component of an emotion schema may be activated by any
other; images of persons, places, or objects may evoke somatic, as well as
behavioral, components of the schema or, conversely, be evoked by them.
In some cases, external stimulation may occur without consequent activation
of emotion schemas; in some cases, the emotion schema may occur in the
absence of apparent external cause or internal need. Any component of an
emotion schema, like any mental representation or process, may occur within
or outside of the focus of awareness. The dynamic unconscious, incorpor-
ating representations that are “warded off,” involves additional explanatory
factors, as will be discussed below.

The referential process: Linking emotional experience

and words
The verbal and nonverbal systems, with different contents and different
organizing principles, are connected by the referential links. The referential
process connects the massively parallel, analogic contents of the nonverbal
system to the single channel, symbolic format of the verbal code. This is a
complex process that can be accomplished only partially, even where factors
of resistance and defense do not interfere.
The referential connections are most active and direct for concrete and spe-
cific entities and words referring to them—​“the brown chair,” “John,” “the
Mona Lisa”—​and less direct for entities where direct labeling terms are not
available—​for example, in describing a subtle or complex color, John’s facial
expression, or the smile of the Mona Lisa. The referential connections are
most distant and least direct for subsymbolic representations and processes,
including the holistic sensory experiences of taste and smell, and the patterns
of visceral and autonomic arousal that figure in the emotion schemas. These
derive their capacity to connect to language by being connected first to spe-
cific images within the nonverbal domain; the power of poetic metaphor to
evoke emotion arises from such connections.
 Symptoms and symbols 9

In contrast, the referential connections for abstract and general terms such
as “truth,” “beauty,” “justice,” “postmodernism,” “epistemology,” derive
their meaning largely from connections to other words within the logical hier-
archies of language, and may be connected to nonverbal representations only
indirectly—​if at all—​through connections within the verbal hierarchies to
concrete and specific words. That is why it is useful to give examples when
presenting abstract material; it is also why intellectualization by patients—​or
analysts—​leaves the nonverbal, emotional representations untouched.
Cognitive models have generally failed to consider the complexity and dif-
ficulty of the referential process. Standard views of cognitive development
(Piaget, 1950; Bruner, 1966) have also failed to recognize the continuing
role of nonverbal processing, including emotional information processing,
throughout life. In both of these developmental theories, it is assumed that
earlier stages of concrete sensory and motoric processing drop out when
levels of formal, logical processing are attained. These standard approaches
to cognition must fail as the basis for a psychoanalytic theory, as Noy (1979,
p. 170) points out:

Almost all of the contemporary theories of cognitive development

approach cognition as a one-​track system, and its development as a
linear process proceeding along a single developmental line. The fact
is that although psychoanalysis has repeatedly attempted to assimilate
part of several of these theories … it has never been able to adopt any
of them in toto. The dual concept of primary and secondary processes
is so deeply rooted in psychoanalytic conceptualization, that any devel-
opmental theory which does not view cognition as being composed of
two systems, forms, modes, levels—​or at least, as a continuum stretched
between two organizational centers—​can never be integrated in psycho-
analytic metapsychology.

Evidence for dual or multiple coding and the referential process has been
developed in experimental cognitive psychology, in neuropsychology, and in
our own experimental, clinical, and psychotherapy research, as summarized
elsewhere (Bucci, 1984, 1985, 1988, 1989, 1993; Bucci & Miller 1993; Paivio,
1986). Recent research on cerebral lateralization and modularity of function
by Gazzaniga (1985), Kosslyn (1987), and Farah (1984) supports the new
multicomponent formulation; the new work takes us well beyond a simple
bicameral left brain/​right brain dichotomy. Thus the underlying neuro-
physiological substrate for emotional information processing and the ref-
erential process would include activation of analogic and global nonverbal
representations, which are dominant in the right hemisphere; connections
across the corpus collosum to the more discrete, “nameable” images that we
now find to be associated with the left hemisphere, the primary site of sym-
bolic processing; mediating processes carried out by the image generating
10 Evolution of the basic theory

component within the left hemisphere; and connections within the left hemi-
sphere between discrete images and words.

Multiple coding in the psychoanalytic process

According to the multiple code theory formulation, the development of emo-
tional meaning in free association occurs in a three-​stage process that previ-
ously was termed the “referential cycle” (Bucci, 1993, 1997), and is referred
to in this volume and elsewhere as the referential process. The same functions
may be traced in dreams. The process has its roots in emotional development;
in somatization, we see the impairment of this process and its attempted
repair. In the first stage of the process, the patient may experience diverse non-
verbal components of the emotion schemas, including specific subsymbolic
elements—​feelings, smells, bodily experience, action patterns—​which they
have difficulty expressing directly in words. In the second phase, the patient
may retrieve a specific memory or fantasy derived from past experience,
events of the day, or events in the treatment relationship; here the connection
of the subsymbolic contents to images and then to words is made. Optimally,
in the third phase, the patient reflects upon the images and stories that have
been told, and further connections within the verbal system and in the shared
discourse may be made. Ultimately, the process of verbalizing the contents
of the emotion schemas lays the foundation for labeling the emotion itself: “I
feel rage”; “I am afraid.” The new connections within the verbal and non-
verbal system then may feed back to open the emotion schemas further, thus
continuing the process on a deeper level. The various forms that the process
may take are discussed in other chapters in this volume, particularly in the
clinical section.
A progression of this nature may also be traced in the construction and
interpretation of dreams. The latent contents, primarily in subsymbolic
format, are connected to the discrete specific images of the manifest contents,
which are then verbalized in the dream narrative (Bucci, 1993; Bucci, Severino,
& Creelman, 1991). In the interpretation of the dream, the latent contents,
including wishes and other emotion structures that have been warded off, may
eventually be acknowledged and verbalized.
The development of emotional meaning in free association and dreams
has its roots in the basic processes of emotional development itself. Normal
emotional development depends on the integration of somatic, sensory,
and motoric processes in the emotion schemas; emotional disorders are
caused by failure of this integration. The origins of the emotion schemas are
found in earliest infancy. The infant “knows” the mother through all sen-
sory modalities—​taste, touch, sound, and smell, as well as sight. All these
separate perceptual functions—​subsymbolic and symbolic—​converge in the
infant’s developing image of the caretaker—​ears, mouth, eyes, and nose—​in
 Symptoms and symbols 11

a consistent spatial relation to one another, whether one looks at or touches

them; breasts where one expects them to be, whether one looks for them with
the eyes or reaches out with hand or mouth; a particular scent; a particular
sound of voice; and a particular soft and warm place to be. These sensory
experiences occur in consonance with somatic and visceral experience of
pleasure and pain, as well as organized motor actions involving the mouth,
hands, and whole body—​kicking, crying, sucking, rooting, and shaping one’s
body to another’s. Enduring prototypic images are built as these images and
episodes repeat. The infant can form a wish for mother or an expectation of
how mother will appear or act in terms of such schemas; these direct and inte-
grate emotional life before language is acquired.
From the earliest stages of their formation, the emotion schemas vary,
reflecting the specific nature of the interactions in each individual’s life. One
schema of need or desire might include the visceral experience of discomfort—​
the feel of crying, kicking, becoming tense—​ followed by the sound of
mother’s voice with a particular soft quality; the sight of mother’s face and
body; the sight, smell, and taste of the breast or bottle; feelings of warmth
and softness; the actions of cuddling, caressing, and sucking; and the som-
atic experience of satisfaction and relaxation. Another schema begins with
the same need but then incorporates mother’s voice with a different, sharper
quality—​the continuing image only of sheets and the bars of a crib, or a
feeling of being handled roughly. Discomfort and stress, crying and kicking
increase. Finally, milk is available to be taken from a bottle, propped up on the
side of the crib. In both of these situations, a specific need state is activated
and satisfied. It is the interpersonal context in which the somatic activation
occurs that determines its emotional meaning, not the physical arousal or
need satisfaction alone.
This account of the formation of emotion schemas corresponds with Beebe
and Lachmann’s (1988) view of the organization of the infant’s “representa-
tional world” as beginning in the first months of life, before the development
of symbolic capacity, leading then to development of generalized protypic
imagery, which becomes the basis for later symbolic forms of self and object
representations. Bowlby’s (1969) notion of the infant’s internal working
models and Stern’s (1985) concept of representations of interactions that
have been generalized (RIGs) reflect similar developmental models. What
the multiple code theory adds to these views is the new formulation of the
emotion schemas and the role of the caretaker within a consistent informa-
tion processing framework. From this perspective, the emerging image of the
caretaker is the crucial, enduring prototypic symbol about which the emotion
schemata are organized from the beginning of life.
The capacity of an individual to tolerate intense affect depends on the
organization of the emotion schemas. If the caretaker is able to recognize the
child’s rage or frustration, and to acknowledge and soothe their distress, this
12 Evolution of the basic theory

facilitates the caretaker’s functioning as a symbol about which the separate

and specialized perceptual, somatic, and motoric functions may converge.
The notion of a benign foreground figure as providing the organizing symbol
for development of the emotional schemas is related to Krystal’s (1988) char-
acterization of love as the central or model affect, about which the affective
system is organized; the capacity to view one’s self as a distinct entity, and to
care for oneself, builds on this.
On the other hand, if the caretaker fails to soothe the child or is
overwhelmed by the child’s distress—​or, in the worst scenario, stimulates
the child’s anguish—​integrated schemata are less likely to be formed, or
schemas that have been formed may be split. The most unbearable state is
flooding of high general arousal and distress activated by the caretaker, so
that the “foreground figure” itself has negative valence, motivating avoidance.
A wish to attack and a fear of being attacked by the caretaker constitute a
catastrophic and intolerable state (McDougall, 1989). Krystal (1988, p. 145)
refers to the child’s “timeless horror” in such states. In terms of the multiple
code theory, the threat may be seen as most dire; the caretaker against whom
the developing infant rages, or whom they fear, is not only the person on
whom they are dependent for their physical needs, but also the person whose
presence organizes their emerging symbolic life.
Repression and the defenses may now be understood as forms of disconnec-
tion and dissociation, both between the nonverbal and verbal systems and, more
crucially, among the multiple channels of the nonverbal modalities. The con-
struct of repression takes on an extended range of meaning within this formula-
tion. Repression may involve breaking or blocking of referential links between
the contents of the emotion schemas and words or, in a deeper sense, may involve
destruction of connections within the emotion schemas, between subsymbolic
somatic or motoric patterns of activation and the prototypic images that are
necessary to organize these schemas. The deepest level of the dissociation would
involve initial failure of these connections to have been formed. Conflicts may
lead to blocking of connections within the nonverbal schemata or between non-
verbal representations and words. In these terms, a componential model of the
defenses may be developed, reflecting different levels of dissociation of systems
and different processes of attempted compensation and repair.

Levels of symbolization in somatic disorders

In the terms of this model, all forms of somatization involve dissociations of
varying degrees of severity among somatic and motoric patterns of activation
and symbolic representations of objects within the emotion schemas. A grad-
ation of somatization disorders can potentially be identified, based on the
degree of dissociation of visceral symptoms from symbolic representation.
At this point, we can only speculate as to the interaction of factors of psy-
chosocial development and physiological vulnerability in the etiology of these
 Symptoms and symbols 13

disorders. Changing visions of these classifications are likely to emerge as the

implications of the model and knowledge of the interacting determinants are
elaborated more fully.

Hypochondriasis and hysterical conversion:

A symbolic focus
Syndromes that traditionally have been classified as hypochondriasis and
hysterical conversion involve focus on particular body organs as damaged
or causing pain. Here, we may say that the particular bodily part or pro-
cess functions as a symbol that organizes the emotion schema when the pri-
mary object of the schema has been dissociated in the service of defense.
The individual may experience intense bodily feelings associated with rage or
terror, or some trace of the motoric image of the consummatory act, while
the image of the object of the emotion is dissociated or warded off. The body
or parts of the body, rather than the interpersonal object, become the focus
of the symbolic consummatory act, the object that is being attacked or from
which attack is feared. The focus on specific bodily symptoms preserves some
organization of the emotion system, while defending against the emergence
of dreaded expectations or desires directed toward an object.
These two types of symptomatic states are similar in that in both a potential
link to symbol systems is available—​that is, the choice of organ that is affected
may have meaning in symbolic terms. They differ in that hypochondriasis involves
fantasy images or, in some instances, delusions concerning the somatic entity
and thus is closer to the symbolic domain. In contrast, hysterical symptoms such
as paralysis or blindness may involve more extensive subsymbolic activation of
visceral, motoric, and sensory representations on trace levels.

Traditional psychosomatic conditions

Medical entities that have traditionally been classified as psychosomatic,
including forms of asthma, ulcers, colitis, hypertension, and arthritis, may
now be seen as being on a continuum with conversion symptoms. Such somatic
illnesses might reflect more severe dissociations within the nonverbal schemas,
with higher levels of physiological activation of the emotion schemata, occu-
pying the same modality-​specific processing channels as are activated by the
physical event. Although the activation occurs without apparent symbolic
connection, the contents of the schema may nevertheless influence the par-
ticular form of the disability that results.

Emotional effects on immune function

In recent years, evidence has been growing that psychosocial factors dir-
ectly affect immune function, and thus have the potential to influence a very
14 Evolution of the basic theory

wide range of disorders, including allergies, autoimmune diseases, infectious

diseases, and malignancies, affecting the onset of illness and also its course.
In these terms as well, the traditional classification of specific medical entities
as psychosomatic no longer appears viable, and emotional factors need
to be considered in relation to all illness, on a continuum with the effects
outlined above.
The formulation proposed here is compatible with the construct of
alexithymia as defined by Nemiah and Sifneos (1970) and others, but provides
a new psychological understanding of this. The dissociation here is far more
complex than being without words for emotions; in some emotional-​somatic
disorders, the patient is without symbols for somatic states. It is necessary to
build connections within the nonverbal system between subsymbolic somatic
activation and images of objects before meaningful verbal communication can
occur. This formulation is also compatible with recent findings of alexithymic
characteristics among patients with a wide range of psychiatric and somatic
disorders, beyond those generally classified as psychosomatic (Taylor, 1992).
To the extent that physiological activation associated with strong emotion
occurs without corresponding activation of cognitive contents in either ini-
tial or displaced form, and thus without symbolic focus and regulation, the
activation is likely to be prolonged and repetitive, and the ultimate effects on
physiological systems tend to be more severe.

New clinical implications of the multiple code theory

Psychoanalytic theorists have consistently assumed an inverse relationship
between somatization and the ability to verbalize feelings, as between acting
out and verbalizing. This is a relatively unquestioned tenet of the theory,
derived initially from the basic principle of conservation of energy within a
closed system and retained in terms of compensatory or substitute discharge,
even where the connection to energic concepts may not be acknowledged.
Thus, Kernberg (1984) stresses the inverse relationship between aggressive
action and verbalization, and has developed his influential inpatient milieu
treatment on this basis. Similarly, McDougall (1989, p. 15) refers to soma-
tization and action as substitutes for thought, “through which one disperses
emotion rather than thinking about the precipitating event and the feelings
connected to it.”
The multiple code theory leads to a new delineation of the relationships
between acting out, somatization and verbalization, including conditions
under which a complementary relationship between somatization and ver-
balization might be expected, and also leads to different implications for
treatment. In neurosis, the repair of emotional dissociation in treatment may
be expected to follow the path of initial emotional development. The care-
taker is the primary object-​symbol organizing the emotion schemas in normal
development; in treatment, the analyst functions as a new object in the
 Symptoms and symbols 15

reconstruction of schemas that have been dissociated. However, the problem

in treating cases of severe dissociation, involving early avoidance of primary
objects—​as in disorders of somatization—​is that the avoidance is played out
again in the ongoing treatment relationship and in re-​experiencing the early
relationships in memory. Cases of this nature, as in post-​traumatic stress dis-
order or somatization, have often been seen as not amenable to dynamic psy-
chotherapy. As Krystal (1988, p. xi) points out, “Alexithymia is the single
most common cause of poor outcome or outright failure of psychoanalysis
and psychoanalytic psychotherapy.”
According to the multiple code theory, the treatment of somatizing patients
may be facilitated by focusing on whatever discrete and specific entities are
available to function as organizing symbols within the nonverbal system.
Here, specific somatic symptoms or actions may play a transitional symbol-
izing role, facilitating symbol formation and integration of schemas within
the nonverbal system itself, before other objects, images, or words can be
accepted. If a person has a particular physical disability or severe pain, this
may constitute the first available discrete entity permitting entry of the schema
into the symbolic domain. The symbolizing process might include acceptance
of the particular body part or the physical pain as an “object,” and asso-
ciations to contexts and schemas in which this figures, long before the role
of any interpersonal objects in the emotional schema can be acknowledged.
Eventually, through focusing on symptoms, in the context of the shared dis-
course some further aspects of old emotion schemas may be retrieved, new
objects may be entered as symbols in the dissociated emotion schemas, and
schemas in which the analyst figures may ultimately be formed.
The formulation proposed here is compatible with Freud’s characteriza-
tion of specific symptoms as carrying meaning, similar to the manifest con-
tent of dreams, but postulates a specific facilitative role of somatic symptoms
or actions rather than viewing them as alternate discharge modes. If this is
indeed so, symptoms and actions may be seen as adaptive and progressive
under certain circumstances, rather than regressive, as the discharge model
implies and as has generally been assumed. The patient’s concern with a par-
ticular somatic symptom may function as a transitional connection between
the implicit subsymbolic computation of the viscerosensory processing
system and the interpersonal contents of an emotion schema, rather than a
means of resistance.
From the same perspective, even the specificity of language associated
with alexithymia may, in some cases, function as an attempt to reconsti-
tute a symbolic focus for a dissociated emotion schema, rather than as
avoidant per se. The specific details of the psychosomatic narratives, like
the displaced irrelevant details of the manifest content of a dream or the
specific symptoms in hysteria, may themselves carry emotional meaning.
The patient’s focus on episodic details of time and place may be an attempt
to orient them on a piece of solid symbolic ground in emotional memory,
16 Evolution of the basic theory

rather than a means of warding off memory (Dodd & Bucci, 1987). The
basis for the fundamental rule of free association—​that the apparently
irrelevant or trivial notions that may come into focus are actually outliers
of the warded-​off schema that have escaped repression—​may apply to such
specific external details, as to verbalization of viscerosensory experience.
The therapist may then make use of these small opportunities to open the
symbolic and interpersonal domains.

Symptoms as symbols: Some empirical support

The implications of the model concerning defensive dissociation in emo-
tional schemata and initial repair of these by focus on somatic symptoms are
supported by clinical work and by empirical research. Rainer Schors in Munich
(personal communication) has based his uniquely successful treatment of
pain patients on acceptance of pain as an objective entity to which the patient
relates. James Hull (personal communication) has described the treatment of
a patient with borderline personality disorder, who experienced her tongue as
being continually cut by the edges of her teeth. It was only when Hull began
actively asking her about the minute details of this, how it happened, which
part of her mouth was affected, that the treatment began to progress and an
alliance started to emerge.
The same principle has been addressed experimentally in several studies
by Leventhal and colleagues (reported by Leventhal, 1984), in which subjects
were exposed to ischemic pain and distress produced by cold water or the
blocking of blood circulation. Subjects who were explicitly instructed to
attend to their painful sensations reported significant reduction in pain
experience, compared with control subjects who were given instructions
intended to distract them from the noxious stimulus. The findings imply that
focus on pain may be therapeutic, even though the experience may seem to be
intensified by this means. The results emerged from statistical comparisons of
reported pain levels in the two groups; the subjects themselves were not aware
of these effects. People know they feel a stressor when they attend to it and
consciously wish not to know; they are not aware of the beneficial effect of
focusing attention in this way. According to Leventhal, focus on the painful
stimulus facilitates experiencing it as an objective event, leading to a buildup
of coping processes. In multiple coding terms, this corresponds to facilitation
of the symbolizing process and its regulatory effects.
The effect of focus on somatic symptoms as facilitating symbolization,
rather than diverting it, has also been supported in recent research using
measures of referential activity (RA), developed by Bucci (1984, 1993; see
also Bucci & Miller 1993). The RA measures assess activity of the referen-
tial connections between nonverbal, particularly emotional, experience and
words—​that is, the degree to which nonverbal experience may be translated
into verbal form.
 Symptoms and symbols 17

The RA measures were applied in a study of the relationship between

somatization, acting out, and verbalization in a sample of 50 female border-
line inpatients (Okie, 1991). Based on the substitute discharge premise of the
metapsychology, Okie initially predicted a negative correlation between ver-
balization of emotional experience as measured by the RA scales and measures
of somatization, injuries to the self, and acting out based on coding of daily
nursing reports. Contrary to her predictions, Okie found significant positive,
rather than negative, correlations between RA and symptoms. Patients who
had more physical complaints, who incurred more injuries—​either accidental
or intentional—​and who showed more acting out behaviors also made greater
use of the type of language associated with access to emotional experience,
rather than turning away from such linguistic expression. Okie’s results
offer counter-​evidence to the general psychoanalytic assumption of substi-
tute discharge and provide empirical support for a complementary relation-
ship between symptoms and symbol formation. The borderline inpatients
in her study may be understood as located emotionally or cognitively at a
phase where some intrapsychic nonverbal symbolic organization focused on
symptoms and actions may be needed, before connections with other people
or to words can be achieved.
Research by Hull, Ellenhorn, and Bucci (1990) further supports this for-
mulation and its stage-​specific implications. Hull found a positive correlation
between measures of referential activity and symptom levels (measured by
weekly administration of the SCL90-​R) early in the treatment of a border-
line inpatient with hysterical paralysis. This patient produced high RA lan-
guage early in treatment, when her symptom levels were high. We suggest that
the florid, vivid, sometimes psychotic speech that she produced in this phase
operated to enhance focus on symptoms as symbols, in the sense outlined
above. This may be understood as the first step in symbol construction,
reflecting the early stages in reparation of dissociation. However, in this early
phase, Hull also found low levels of the type of patterning of RA scores that
indicates the occurrence of a referential cycle (Bucci, 1993), in which vivid
speech leads to reflection and shared communication.
Later in the treatment, as the patient improved and symptom levels were
generally lower, the expected negative correlation between symptoms and RA
was found, and levels of patterning reflecting occurrence of a systematic ref-
erential cycle increased. Here the patient used the passages of high RA speech
not only to construct symbolic connections within her own emotion schemas,
but also for reflection within the communicative discourse and for connection
to the therapist, the object now available in the interpersonal field.

Conclusions: Symptoms and meanings

The fields of psychosomatic medicine and psychoneuroimmunology now rec-
ognize pervasive interactions, on the biological level, among central nervous
18 Evolution of the basic theory

system, autonomic nervous system, endocrine and lymphatic systems, which

potentially figure to varying degrees in all physical illness. Advances at the
biomedical level do not substitute for a psychoanalytic approach, but point
to its central and increasing importance. However, somatization remains to a
large extent beyond the reach of psychoanalytic treatments. As researchers on
the biological level provide stronger evidence for the bidirectional interaction
of emotional factors with physical health, it becomes correspondingly more
crucial to develop a psychological model that will account for this interaction.
The multiple code formulation returns, by a new conceptual path, to the
notion of symptoms as carrying systematic emotional meaning that was ini-
tially claimed by Freud. As he argued (Freud, 1900, p. 636):

In view of the complete identity between the characteristic features

of the dream-​work and those of the psychical activity which issues in
psychoneurotic symptoms, we feel justified in carrying over to dreams the
conclusions we have been led to by hysteria.

The concepts of somatic symptoms as meaningful modes of expression and

as transitional symbols have pervasive implications that Freud did not pursue
and that are incompatible with traditional drive-​based theories. From the new
perspective of multiple coding, we may convert and amplify Freud’s prop-
osition; we feel justified in carrying over to somatization the conclusions
concerning the symbolizing process derived from emotional development,
free association, and dreams.

References
Beebe, B., & Lachmann, F. (1988). The contribution of mother–​infant mutual influ-
ence to the origins of self and object representations. Psychoanalytic Psychology, 5,
305–​337.
Bowlby, J. (1969). Attachment and loss, Vol. I. New York: Basic Books.
Bruner, J. S. (1966). On cognitive growth. In J. S. Bruner (Ed.), Studies in cognitive
growth (pp. 1–​67). New York: Wiley.
Bucci, W. (1984). Linking words and things: Basic processes and individual variation.
Cognition, 17, 137–​153.
Bucci, W. (1985), Dual coding: A cognitive model for psychoanalytic research. Journal
of the American Psychoanalytic Association, 33, 571–​607.
Bucci, W. (1988). Converging evidence for emotion structures: Theory and method. In
H. Dahl, H. Kaechele, & H. Thomae (Eds.), Psychoanalytic process research strat-
egies (pp. 29–​50). New York: Springer-​Verlag.
Bucci, W. (1989). A reconstruction of Freud’s tally argument: A program for psycho-
analytic research. Psychoanalytic Inquiry, 9, 249–​281.
Bucci, W. (1993). The development of emotional meaning in free association. In
J. Gedo & A. Wilson (Eds.), Hierarchical conceptions in psychoanalysis (pp. 3–​47).
New York: The Guilford Press.
 Symptoms and symbols 19

Bucci, W. (1997). Psychoanalysis and cognitive science. New York: The Guilford Press.
Bucci, W., & Miller, N. (1993). Primary process: A new formulation and an analogue
measure. In N. Miller, L. Luborsky, J. Barber, & J. Docherty (Eds.), Handbook of
dynamic psychotherapy research and practice (pp. 387–​406). New York: Basic Books.
Dodd, M., & Bucci, W. (1987). The relation of cognition and affect in the orientation
process. Cognition, 27, 53–​71.
Eagle, M. N. (1984). Recent developments in psychoanalysis: A critical evaluation.
New York: McGraw-​Hill.
Farah, M. J. (1984). The neurological basis of mental imagery: A componential ana-
lysis. Cognition, 18, 245–​272.
Fodor, J. A. & Pylyshyn, Z. W. (1988). Connectionism and cognitive architec-
ture: A critical analysis. Cognition, 28, 3–​71.
Freud, S. (1895). Project for a scientific psychology. Standard Edition, 1, 295–​391.
London: Hogarth Press.
Freud, S. (1900). The interpretation of dreams. Standard Edition, 4 & 5. London:
Hogarth Press.
Freud, S. (1923). The ego and the id. Standard Edition, 18, 12–​66. London: Hogarth
Press.
Freud, S. (1940). An outline of psycho-​analysis. New York: W. W. Norton.
Gazzaniga, M. S. (1985). The social brain. New York: Basic Books.
Holt, R. R. (1985). The current status of psychoanalytic theory. Psychoanalytic
Psychology, 2, 289–​315.
Hull, J., Ellenhorn, T., & Bucci, W. (1990). Attunement and the rhythm of dialogue in
psychotherapy: I Empirical findings. Paper presented to annual conference, Society
for Psychotherapy Research, Wintergreen, WV.
Kernberg, O. F. (1984). Severe personality disorders. New Haven, CT: Yale University
Press.
Kernberg, O. F. (1990). New perspectives in psychoanalytic affect theory. New York:
Academic Press.
Kosslyn, S. M. (1987). Seeing and imagining in the cerebral hemispheres: A computa-
tional approach. Psychological Review, 94, 148–​175.
Krystal, H. (1988). Integration and self-​healing: Affect—​trauma—​alexithymia.
Hillsdale, NJ: Analytic Press.
LeDoux, J. E. (1989). Cognitive-​emotional interactions in the brain. Cognition &
Emotion, 3, 267–​289.
Leventhal, H. (1984). A perceptual-​motor theory of emotion. In K. R. Scherer,
& P. Ekman (Eds.), Approaches to emotion. Hillsdale, NJ: Lawrence Erlbaum,
pp. 271–​291.
McDougall, J. (1989). Theaters of the body. New York: W. W. Norton.
Nemiah, J. C., & Sifneos, P. E. (1970). Affect and fantasy in patients with psycho-
somatic disorders. In O. W. Hill (Ed.), Modern trends in psychosomatic medicine, Vol.
2 (pp. 430–​439). London: Butterworths.
Norman, D. A. (1986). Reflections on cognition and parallel distributed processing.
In D. E. Rumelhart, J. L. McClelland, & PDP Research Group (Eds.), Parallel
distributed processing (pp. 531–​546). Cambridge, MA: MIT Press.
Noy, P. (1979). The psychoanalytic theory of cognitive development. The Psychoanalytic
Study of the Child, 34, 169–​215.
20 Evolution of the basic theory

Okie, J. E. (1991). Action, somatization and language in borderline inpatients. Doctoral

dissertation, Adelphi University. Dissertation Abstracts International No. 9211084.
Paivio, A. (1986). Mental representations. New York: Oxford University Press.
Piaget, J. (1950). The psychology of intelligence. London: Routledge & Kegan Paul.
Rumelhart, D. E., McClelland, J. L., & PDP Research Group (Eds.) (1986), Parallel
distributed processing. Cambridge, MA: MIT Press.
Severino, S. K., & Creelman, M. L. (1991). The effects of menstrual cycle hormones
on dreams. Dreaming, 1, 263–​275.
Scherer, K. R. (1984). On the nature and function of emotion: A component process
approach. In K. R. Scherer, & P. Ekman (Eds.), Approaches to emotion (pp. 293–​
317). Hillsdale, NJ: Lawrence Erlbaum.
Simon, H. A., & Kaplan, C. A. (1989). Foundations of cognitive science. In M. I. Posner
(Ed.), Foundations of cognitive science (pp. 1–​47). Cambridge, MA: MIT Press.
Smolensky, P. (1988). On the proper treatment of connectionism. Behavioral and Brain
Sciences, 11, 59–​74.
Solomon, G. F. (1987). Psychoneuroimmunology: Interactions between central ner-
vous system and immune system. Journal Neuroscience Research, 18, 1–​9.
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
Taylor, G, I. (1992). Psychosomatics and self-​regulation. In J. W. Barron, M. N. Eagle,
& D. L. Wolitzky (Eds.), Interface of psychoanalysis and psychology (pp. 464–​488).
Washington, DC: American Psychological Association.
Thomae, H. & Kaechele, H. (1987). Psychoanalytic practice 1: Principles. Berlin:
Springer-​Verlag.
Chapter 2

The need for a “psychoanalytic

psychology” in the cognitive
science field

In their introductory survey of cognitive science, Simon and Kaplan (1989,

p. 3) cite many influences on the field:

Therefore, if we are to understand cognitive science, we must know what

disciplines have contributed to its formation (Norman, 1981).
Among these we must certainly count experimental and cognitive
psychology, artificial intelligence (within computer science), linguistics,
philosophy (especially logic and epistemology), neuroscience, and some
others (anthropology, economics, and social psychology will also come
in for comment).

With this diversity of influence, it is striking that the contributions of psy-

choanalysis are ignored. Freud’s agenda was the construction of a theoretical
device, a “psychical apparatus” that accounted for maladaptive functioning
and its repair in treatment. In relying on inference from observable events to
mental representations and processes, and in developing a theoretical model
as a basis for such inference, Freud’s enterprise was itself a “cognitive revo-
lution,” which predated the more recent one (Baars, 1986; Neisser, 1967) by
about two-​thirds of a century. The psychoanalytic domain of investigation
is, however, virtually ignored in scientific psychology today. In the century
that has passed since Freud introduced his theory, the fields of academic
psychology and psychoanalysis have followed divergent paths. Cognitive
psychology is taught in the universities; its principles are tested primarily in
controlled laboratory settings using techniques such as computer simulation
and experimental designs. Psychoanalysis has been taught largely in its own
institutes, and in other clinical programs, insulated from general scientific
scrutiny. Analysts rely primarily on the “psychoanalytic method” as practiced
in their individual clinical work for verification of psychoanalytic propos-
itions, although the deficiencies of evidence gathered by this “method” are
now well understood (Bucci, 1989; Grunbaum, 1984).
Psychoanalysis has made unique contributions to an understanding of
human mental processes, including emotions and cognitive functions, and
22 Evolution of the basic theory

their interaction. The cognitive revolution of psychoanalysis was far broader

in some important respects than the agenda of modern cognitive science,
as I show later. Conversely, the methods and findings of modern cognitive
psychology have much to offer the psychoanalytic field. The separation of
fields does disservice to both.
In previous writings, I have covered areas of cognitive science that are useful
for providing an understanding of pathology and the processes of therapeutic
change (Bucci, 1997a). In this chapter, I emphasize the converse direction
of influence: the contributions and potential contributions of psychoanalysis
to cognitive psychology. The first section covers several basic tenets of the
psychoanalytic approach to information processing, including ideas that
are incorporated—​implicitly or explicitly—​in modern cognitive psychology,
as well as psychoanalytic ideas whose inclusion would benefit the cognitive
fields. These include the use of mental models, the interaction of mental with
somatic and emotional processes, the role of unconscious representations and
processes, psychoanalysis as inherently a dual process theory, and the reliance
on naturalistic research milieux. I also discuss possible reasons why the psy-
choanalytic roots of most of these ideas have not generally been recognized or
acknowledged. In the second section of the chapter, I show how the multiple
code theory (Bucci, 1997a), a theory of emotional information processing
that is informed by psychoanalytic concepts, provides a basis for bridging
the cognitive science and psychoanalytic fields. I also point to the need for a
subfield of psychology—​a “psychoanalytic psychology”—​that covers integra-
tion of systems within the individual as they operate in adaptive functioning,
their dissociation in pathology, and the means by which new integration may
be brought about.

The psychoanalytic approach to information

processing
The role of mental models
Psychoanalysis is concerned primarily with subjective events, which are
known directly only to the experiencer (and only partially even to them),
and which can be known to others only through inferences from what is
observed. Freud recognized the need for a theoretical model of the psych-
ical apparatus as the necessary context for such inference in precisely the
sense in which cognitive psychologists apply mental models today. Freud
(1953b)made an early attempt to develop a neurophysiological or biological
basis for his theory of the psychical apparatus, and Gill (1976) and others
have also noted occasional shifts toward the neurological levels of explan-
ation in Freud’s later writings. Overall, however, the psychological level of
explanation was dominant in Freud’s writings throughout his life. In 1900
he wrote:
 The need for a “psychoanalytic psychology” 23

I shall entirely disregard the fact that the mental apparatus with which
we are here concerned is also known to us in the form of an anatom-
ical preparation, and I shall carefully avoid the temptation to determine
psychical locality in any anatomical fashion. I shall remain on psycho-
logical ground.
(Freud, 1953a, p. 536)

Throughout his subsequent writings, up to and including his final summary

formulation, Freud continued to refer to the psychical apparatus as a theoret-
ical model. He was aware of the innovative nature of his approach:

We assume that mental life is the function of an apparatus to which we

ascribe the characteristics of being extended in space and of being made
up of several portions—​which we imagine, that is, as resembling a tele-
scope or microscope or something of the kind. Notwithstanding some
earlier attempts in the same direction, the consistent working-​out of a
conception such as this is a scientific novelty.
(Freud, 1964b, p. 145)

Like the models in use in cognitive psychology today, Freud’s model of the
mind, the metapsychology, was constructed as an analogue to a physical
domain. The metapsychology was an attempt to account for psychological
concepts on the basis of the distribution of mental energy in the psychical
apparatus, using principles of Newtonian mechanics. The energic model was
retained in the structural as in the topographic theory. Although there are
important differences between these two theories, both assume that mental
energies derive from somatic sources, from the instincts or drives; that the
psychical apparatus is inactive until stimulated; that the building up of
instinctual energy produces unpleasure; and that mental activity is motivated
toward reducing this instinctual energy by discharging or binding it. Both
assume that language is associated with binding of energy and that nonverbal
functions are associated with the more primitive component of the appar-
atus: in the topographic model with the unconscious; in the structural model
with the id; and in both cases with the primary process of thought.
The failure of the energy model as a theory of biological systems has
been discussed in detail elsewhere (Bucci, 1997a; Eagle, 1984; Holt, 1985).
In general, the usefulness of theoretical models of mind depends on their fit
to the mental operations being modeled. As Holt and others have pointed
out, the human organism cannot usefully be construed as the kind of closed
system in which the principles of energy distribution, as postulated in the
metapsychology, might apply (Holt, 1989; von Bertalanffy, 1950). For this
and other reasons, many analytic theorists have advocated rejection of the
energy theory (Gill, 1976; Holt, 1976, 1989; Klein, 1976; Rubinstein, 1965;
Schafer, 1976). Unfortunately, in the process they have also rejected the
24 Evolution of the basic theory

general enterprise of constructing a basic psychological model for psycho-

analysis. Thus, for example, Gill and Klein proposed a phenomenological
or clinical theory, Rubinstein argued in favor of a neurophysiological or
“protoneurophysiological” theory, and Schafer advocated the hermeneutic
approach.
Freud’s basic insight concerning the need for a theoretical model remains
sound. The fact that Freud’s specific model has not succeeded as a basis for
further theory development or for research should not be construed to mean
that the enterprise of model building itself is at fault. Cognitive scientists
today use a similar heuristic of basing mental models on structures derived
from other domains. The dominant approach to model building in cognitive
science was based on the architecture and function of information processing
in the von Neumann computer (Simon & Kaplan, 1989). This has been a pro-
ductive source of hypotheses concerning human mental functions, although
its limits are now being recognized to an increasing degree. Models based on
neural networks are now being developed in cognitive psychology to account
for aspects of mental function that have eluded classical symbolic theories
(Rumelhart, McClelland, & PDP Research Group, 1986), and additional the-
oretical models of body, emotion, and mind are required to carry forward both
the psychoanalytic and cognitive science enterprises. As discussed further in
the second section of this chapter, the concepts and methods of modern cog-
nitive psychology, developmental psychology, and emotion theory, along with
psychoanalytic concepts, can be used in developing such models.

Focus on mind–​b ody interaction

Freud’s model concerned the functioning—​ and malfunctioning—​ of the
human organism in the context of its adaptive goals. Such an account must
incorporate sensory, somatic, and behavioral functions, along with cognitive
and linguistic ones. This is a major respect in which the agenda of modern
cognitive science has largely fallen behind Freud’s approach.
According to Simon and Kaplan (1989), cognitive science is concerned
primarily with two classes of intelligent systems: living organisms and
computers. In their recent summary of the field, they define cognitive science
as “the study of intelligence and intelligent systems, with particular reference
to intelligent behavior as computation”:

Although no really satisfactory intentional definition of intelligence

has been proposed, we are ordinarily willing to judge when intelligence
is being exhibited by our fellow human beings. We say that people are
behaving intelligently when they choose courses of action that are rele-
vant to achieving their goals, when they reply coherently and appro-
priately to questions that are put to them, when they solve problems
of lesser or greater difficulty, or when they create or design something
 The need for a “psychoanalytic psychology” 25

useful or beautiful or novel. We apply a single term, “intelligence,” to this

diverse set of activities because we expect that a common set of under-
lying processes is implicated in performing all of them.
(Simon & Kaplan, 1989, p. 1)

From the perspective of psychoanalysis, concerned with the general

functioning of the human organism in an interpersonal world, this definition
leaves much of what is important in cognition and behavior out of account.
To provide an adequate account of human cognitive functions and even of
the functions that Simon and Kaplan cited—​the identification of “goals”
and of behaviors relevant to these—​the theories of cognitive science must be
expanded well beyond the type of intelligence that computers share to include
the study of emotional intelligence and the sensory and somatic functions
inherent in it.
Fodor and Pylyshyn (1988, p. 59) argue that the differences between com-
puter hardware and the flesh and blood “hardware” of human systems may
have implications for the organism’s mental functions:

It is obvious that its [the brain’s] behavior, and hence the behavior of an
organism, is determined not just by the logical machine that the mind
instantiates, but also by the protoplasmic machine in which the logic is
realized.

They note that the organism’s behavior is determined by the protoplasmic

hardware (the body) as well as by the operating software of the logical
machine (the mind). However, they do not see the hardware of protoplasm
as determining the operations of the logical machine itself. The psychoana-
lytic perspective enables a more adequate formulation of human information
processing, which is built on the interaction of cognitive with somatic and
sensory systems. The application of such a model is not restricted to clinical
interactions, but is required to account adequately for all types of intelligence
in human beings operating in an interpersonal world. Although the body–​
mind interaction has been neglected in cognitive science, the study of such
interactions has become increasingly dominant in the neurophysiology of the
emotions, as I have discussed elsewhere (Bucci, 2001; Damasio, 1994).
The development of a model that will account for emotional intelligence
becomes even more crucial when one is concerned with goals of which the
individual may not be aware. We thus need to distinguish situations of failure
in the operation of human intelligence from situations in which the individual
is in fact successful in meeting unacknowledged or unrecognized goals. In
other words, we may say that people are behaving intelligently when they
choose courses of action that appear irrelevant to acknowledged goals, when
they produce something that is not manifestly useful or beautiful, and when
they repeat actions that appear maladaptive rather than producing novel
26 Evolution of the basic theory

solutions. In all these instances, there may be emotional intelligence at work,

but it is operating in relation to unacknowledged rather than explicit goals.

Inference to unconscious mentation

“If Freud’s discovery had to be summed up in a single word, that word would
without doubt have to be ‘unconscious’ ” (LaPlanche & Pontalis, 1973, p. 474).
The “psychical apparatus” that Freud constructed was intended specifically
as a basis for scientific study of unconscious mental events:

Whereas the psychology of consciousness never went beyond the broken

sequences which were obviously dependent on something else, the other
view, which held that the psychical is unconscious in itself, enabled psych-
ology to take its place as a natural science like any other. The processes
with which it is concerned are in themselves just as unknowable as those
dealt with by other sciences, by chemistry or physics, for example; but it is
possible to establish the laws which they obey and to follow their mutual
relations and interdependences unbroken over long stretches—​in short,
to arrive at what is described as an “understanding” of the field of nat-
ural phenomena in question.
(Freud, 1964b, p. 158)

Consciousness constitutes the starting point for the investigation of the

psychical apparatus, but these conscious processes do not form unbroken
sequences; there are gaps in them. We must assume, Freud argued, that there
are ongoing processes that are concomitant with the conscious ones but also
more complete than those, ongoing even during the gaps in the conscious
processes.
The operation of mental processing outside of awareness is widely
recognized in psychology today. According to current views, virtually all
storage of information in long-​term memory and virtually all significant
information processing operate outside the focus of awareness, in verbal and
nonverbal modalities. Cognitive psychologists have developed a wide range
of techniques for investigating unconscious processes and have distinguished
a variety of different forms in which they may occur. Implicit memory
(Schacter, 1987) is identified through changes in performance following
experimental interventions characterized as “priming,” without explicit rec-
ollection of the intervention itself. Any type of information can in principle
be represented in implicit memory, including numbers, words, and other types
of representations. Procedural or more generally non-​declarative memory, as
characterized by Squire (1992, p. 210), refers to skillful behaviors or habits,
including motoric, perceptual, and cognitive skills; conditioning and emo-
tional learning; and all other learning that “changes the facility for oper-
ating in the world.” This contrasts with declarative memory, which affords
 The need for a “psychoanalytic psychology” 27

“conscious access to specific past events” (Squire, 1992, p. 210). Whereas con-
scious processing has previously been associated with intentional operations,
and unconscious processing with automatic functions (Posner & Snyder,
1975), processing outside of awareness has been shown to include intentional
and voluntary functions as well (Zbrodoff & Logan, 1986).
The pervasiveness and diversity of unconscious processes, as understood
today, require that the implications of the unconscious as a psychoanalytic
construct be reconsidered. The factors determining what is understood psy-
choanalytically as the systemic or dynamic unconscious, and the features
of such processing, need to be distinguished from the general modality of
processing outside of awareness. Beyond this, we may also find that it is
not the dimension of awareness or lack thereof that is most significant in
understanding psychic functioning, but the form and organization of thought.
This change in emphasis may be seen as a revisiting of the structural model in
a new light (Bucci, 2001).
From the perspective of cognitive science, we should also note an epistemo-
logical problem that was overlooked in Freud’s formulation of inference from
conscious to unconscious events. Analysts are directly aware only of their
own conscious experiences, the observations made through the medium of
their own perceptual systems. The patients’ conscious experiences, the sub-
jective representations and processes that occupy their awareness, are as
“unknowable” to the analyst directly as the contents of the patients’ uncon-
scious minds, and must themselves be inferred from their utterances and
behaviors. Here cognitive psychology has taken a more generalized and sys-
tematic step in the direction indicated by Freud, accounting for conscious as
well as unconscious mentation as occupying the same epistemological level
and as requiring similar inferential strategies.

A dual process theory

Freud’s focus on unconscious processes is related directly to the nature of psy-
choanalysis as inherently a dual process theory. The duality of the primary
and secondary processes of thought has been considered by many psychoana-
lytic scholars, as by Freud himself, as his most original and valuable contri-
bution and as central to the psychoanalytic account of the mental apparatus
(Freud, 1932; Jones, 1953; McLaughlin,1978). Here we focus on Freud’s iden-
tification of distinct forms of thought rather than their differential access to
awareness. A psychological theory that fails to account for this fundamental
dichotomy cannot be applicable to psychoanalytic concepts, as Noy (1979)
has pointed out.
Freud’s characterization of modes of thought that differ from standard,
logical forms can still be seen as a seminal contribution today. The psy-
choanalytic observations supporting a dual system model speak directly to
current issues within the cognitive science field, providing evidence for dual or
28 Evolution of the basic theory

multiple processing systems rather than single-​code or common-​code propos-

itional models (Bucci, 1985, 1993, 1997a).
The features of primary process thought are spelled out most elaborately
in Freud’s concepts of the dream work, the varied mechanisms by which
the images of the dream are generated. His identification of the operations
of the dream work constitutes viable hypotheses, well ahead of their time,
concerning the forms and processes of nonverbal or unattended thought.
On the other hand, Freud’s emphasis on the primary process as necessarily
dependent on wishful cathexis and his understanding of dreams in such terms
have contributed to the current widespread rejection of his approach by cog-
nitive and dream researchers as well as by cognitive scientists.
Although the concepts of the primary and secondary processes of
thought lay the groundwork for a dual format model of thought, they do
not in themselves provide the systematic theory we require. The distinctions
between the primary and secondary processes are rooted in the energy theory
and are determined specifically by the postulated features of energy flow.
The modes of operation of the primary process, as operating in the dream
work, are associated in Freud’s system with unbound energy seeking imme-
diate discharge in accordance with the pleasure principle. This contrasts
with the bound cathexis of the secondary process, which is governed by
the reality principle and operates with verbal symbols. In this system, the
capacity of an image to symbolize an idea rests on the operation of freely
mobile cathexis. The theory then faces a dilemma in accounting for the
complex, organized, systematic features of the dream work, as Freud him-
self characterized these within the confines of the energy model. As Holt
(1989) and others have recognized, for this and other reasons the theory
of the primary process is in “sad disarray.” Systematic information pro-
cessing in dreams, as well as organized unconscious fantasies in waking
life, “embarrass” the methodology of the classical psychoanalytic accounts
(Arlow, 1969).
The failure of the energy model has been discussed above. From the per-
spective of current research in cognitive science, we can now also see that the
features and functions that Freud postulated as determined by the energic dis-
tinction fail to show the correspondence that would be expected according to
the theory (Bucci, 2001). Implicit or unconscious thought may be either verbal
or nonverbal; it may be symbolic or subsymbolic. The contents of implicit
or nonverbal or subsymbolic thought may include complex, abstract scien-
tific and mathematical concepts and many other types of ideas other than
wish fulfillment in the psychoanalytic sense. Implicit and nonverbal forms of
thought occur throughout normal, adult mental life, in waking states as in
sleep. Explicit or conscious or verbal thought has a similarly varied range of
functions, properties, and contents. In modern terms, we would say that the
concepts of the primary and secondary processes lack construct validity. To
retain and develop the psychoanalytic theory of thought, it is necessary that
 The need for a “psychoanalytic psychology” 29

the basic concepts of Freud’s dual format model be consistently redefined in

the context of current research.

The psychoanalytic method: A “naturalistic” research design

Freud relied on the “psychoanalytic method” as necessary and sufficient for
the scientific verification of psychoanalytic propositions and for the develop-
ment of his general theory of the psychical apparatus. He devalued evidence
from other sources, such as experimental laboratory research, even where this
supported his conclusions—​as indicated, for example, in his letter of 1934 to
the experimentalist Saul Rosenzweig:

I have examined your experimental studies for the verification of the psy-
choanalytic assertions with interest. I cannot put much value on these
confirmations because the wealth of reliable observations on which these
assertions rest make them independent of experimental verification. Still,
it can do no harm.
(cited in Grunbaum, 1984, p. 1)

Although Freud’s claims may appear somewhat cavalier, core aspects of his
methodological position remain sound. The need for naturalistic designs is
now increasingly recognized within the cognitive science field, again without
acknowledging the significance of psychoanalytic contributions in this
regard. Yuille (1986), Neisser (1976), and others have pointed to the inability
of experimental paradigms to study events as they naturally occur and the
distorted views of psychological processes that result. The need for natural-
istic designs is particularly evident where interpersonal issues and emotional
factors are involved.
The current emphasis on naturalistic designs may be seen, for example, in the
method of protocol analysis, an important tool in cognitive science research.
In this method, subjects are asked to give continuous verbal commentaries—​
in effect, to think aloud—​while solving problems or performing a variety of
tasks. In gathering the protocol, the exact wording of the instructions given
to the subjects may vary with the particular task, “but the simple instruction
to talk aloud while performing the task captures the essence”:

If subjects fall silent … the experimenter may remind them to keep

talking. A non-​directive prompt (for example, “Keep talking”) is less
likely to interrupt the normal sequence of processing than a more dir-
ective prompt (for example, “What are you thinking about?”).
(Simon & Kaplan, 1989, p. 22)

Several types of verbal reports may be generated using this procedure. The
simple instruction to talk aloud naturally while performing the task is most
30 Evolution of the basic theory

effective in producing what Simon and Kaplan term “direct verbalization,”

in which subjects report what is in their short-​term memory (in the focus of
awareness) without attempting to be consistent or complete or to evaluate
this material before talking. The techniques of verbal data collection include
“concurrent” protocols, obtained by asking subjects to think aloud while
performing the tasks, and “retrospective” protocols, in which subjects are
asked to report everything they can recall about the task immediately after
completing it. As Simon and Kaplan note, retrospective protocols are gener-
ally more susceptible than concurrent ones to reconstruction and distortion,
and the danger of distortion increases with the length of delay prior to pro-
viding the retrospective report.
It seems clear that cognitive scientists have reinvented the psychoanalytic
method of free association without citing Freud (1955) or his patient Frau
Emmy von N. The task situations of cognitive science and psychoanalysis
both provide quasi-​experimental naturalistic contexts for collection of verbal
reports, with particular procedures and limits determined by the nature of
the process being investigated. Both situations include the basic instruction
to speakers to talk aloud about what is in their minds, to say whatever comes
to mind without editing or evaluating this. Cognitive scientists, like analysts,
prefer to rely on concurrent reports of what is happening in the speaker’s
mind, in the “here and now,” rather than on retrospective descriptions. In
the cognitive science research, as in psychoanalytic work, the process has
generally been found to be most effective to the extent that instructions and
interruptions are minimal. In both contexts, the speakers’ descriptions of
their mental representations and processes are not accepted as necessarily
veridical, but are used as a basis for inference to mental representations and
processes within a theoretical framework.1
There are also several major ways in which the psychoanalytic situation
differs from the task conditions of cognitive research. First, unlike the partici-
pant in a cognitive study, the patient is not given a particular problem or task.
Patients are concerned with the problems that have brought them to treatment
but are asked to put these aside as well. The basic rule is to say whatever comes
to mind, whether or not the patient understands its significance with respect
to the problems they have come to solve. The process of psychoanalysis itself
involves the formulation and reformulation of the patient’s issues; identifying
the problems is part of the creative work. Second, every aspect of the data-​
collection procedure in psychoanalysis is understood and interpreted in the
context of the ongoing, developing relationship between patient and analyst.
These special features, in the context of the procedural constraints, make the
psychoanalytic situation uniquely suited for systematic studies of emotional
information processing as it occurs in the interactions of life. The relation-
ship is the quasi-​experimental intervention that operates to arouse emotional
issues; the instruction to say whatever comes to mind without focusing on
a particular task enables a reporting of all manner of experience, including
 The need for a “psychoanalytic psychology” 31

multiple somatic and sensory representations that may operate outside of

awareness, and the relevance of which is not yet understood.
Although Freud’s “method” was, in many respects, well ahead of its time,
we should also note the scientific problems associated with this approach.
The spoken material as filtered by one observer, the analyst, cannot be the
basis for systematic investigation. A sine qua non of scientific investiga-
tion is that events be publicly accessible and that observations be shared.
Furthermore, this “observer” is not an observer but an involved participant
in the process being studied, as we see more clearly today than was recognized
in Freud’s time.
These and other methodological issues are recognized in the field of modern
psychoanalytic research. Rather than relying on the judgment of a single
observer-​participant, as in the usual case report, modern psychoanalytic psy-
chotherapy researchers use objective records—​usually audiotape recordings
of a session—​and transcribe and segment them; they then apply a wide
range of encoding schemes in a manner that is parallel to the methodology
of cognitive research. Psychoanalytic research can be seen as the psychoana-
lytic method in modern dress, informed by clinical insight and incorporating
modern scientific constraints.
In this context, psychoanalytic researchers have also been concerned with
the effects of research procedures on the clinical processes that are being
studied, as well as the inadequacy of research methods for addressing some
aspects of clinical work. The effects of observation on the behavior that
is being observed need to be considered in cognitive as in psychoanalytic
research, and psychoanalytic research can help in our understanding of these
effects.
As clinicians and researchers alike also recognize, the verbal protocol is
only a partial record of the interactions that occur in a session, and may
leave crucial aspects of expression and interaction out of account. In this
context, for example, process notes and session notes, although possibly unre-
liable taken by themselves, can contribute significant behavioral observations
missing from the verbal records, as well as observations concerning the
analyst’s own state, which impinges on the work. The integration of clinical
and research perspectives has promoted awareness of the multiple channels
of expression and communication that are used, and research methods that
enable integration of multiple recording procedures in a reliable manner are
being developed.

Summary: Comparison of the psychoanalytic and

cognitive science agendas
Freud’s scientific strategy, like that of cognitive science and all modern
science, depended on inference from observable events to hypothetical
constructs within a theoretical framework or nomological network. Mental
32 Evolution of the basic theory

and emotional events, as they figure in a scientific theory, have the same status
as particles, the “big bang,” black holes, or life in the Bronze Age: all are
theoretical entities that cannot be observed directly and that have their exist-
ence defined in relation to other concepts and to observable events. From
its beginnings, psychoanalysis has been built on the interaction of sensory,
somatic, and emotional experience with cognitive and linguistic functions,
and psychoanalysis has gone beyond cognitive science in its recognition of
the multiple channels of experience and expression and the structure and
function of unattended thought. The psychoanalytic situation, with its fun-
damental rule and its controlled interpersonal setting, constitutes a unique
naturalistic research milieu for study of these questions.
On the other hand, the promise of psychoanalysis as a theory of mind and
a research milieu has not been fulfilled. While Freud’s goal was the devel-
opment of a theoretical model as a basis for the inference that is central to
psychoanalytic work, the necessary scientific procedures of theory develop-
ment and revision have not taken place. To demonstrate the contribution of
psychoanalytic concepts to the field of information processing, we need a the-
oretical framework that makes these concepts coherent and consistent, and
amenable to empirical investigation.
The multiple code model has been constructed as such a theoretical frame-
work, a general theory of emotional information processing that accounts
for adaptive as well as maladaptive functions and that may be applied to an
understanding of pathology and its repair in treatment. In the next section,
I briefly outline the application of multiple code concepts to some central
psychoanalytic ideas, and show how these applications may help to build a
bridge between psychoanalysis and cognitive science.

A multiple code theory of emotional information

processing: Bridging the gap
The multiple code theory incorporates three major ways in which humans
represent and process information: subsymbolic, symbolic imagery, and sym-
bolic verbal codes. Subsymbolic processing is systematic processing that occurs
in analogic formats on continuous, implicit dimensions. Such processing is
complex to define and to model,2 but familiar to us all. Systematic subsymbolic
processing, operating in sensory, motoric, and somatic modalities, underlies
the toddler’s learning to walk and to climb, the tennis player’s capacity to
anticipate and return the ball, the wine taster’s ability to recognize the qual-
ities of different varietals and different vintages, and the analyst’s sensing of
patients’ inner states. All these processes occur in specific sensory-​somatic
modalities rather than in abstract form, and are based on features that cannot
be identified explicitly but are systematic nonetheless. In operating without
explicit intention or direction, subsymbolic processes and representations are
often not experienced directly or may be experienced as in a sense “outside
 The need for a “psychoanalytic psychology” 33

of oneself,” outside of the domain of the self over which one has intentional
control. Subsymbolic formats are dominant in emotional information pro-
cessing, as we shall see, and provide a systematic way to account for what we
know as empathy, intuition, and unconscious communication (Bucci, 2001).
In contrast to subsymbolic processing, symbols are discrete entities with
properties of reference and generativity. This means that they refer to entities
outside of themselves and may be combined to generate infinite varieties of
new forms. Symbols may be images or words.3 Language has been assumed to
be the primary medium of psychoanalysis (the “talking cure”), although it is
not the primary medium of thought and certainly not of emotion.
The three systems, with different contents and different organizing
principles, are connected by the referential links, which enable us to symbolize
and verbalize our emotional experience and to understand and resonate to
the words of others. Building on the work of (Paivio 1971, 1986), Kosslyn
(1987), and others, I have introduced the concept of the referential process as
the mechanism by which the multiple components of the human information-​
processing system are connected (Bucci, 1984, 1997a). The basic mechanism
of the referential process, the mechanism of transformation from subsymbolic
information to nonverbal and then to verbal symbols, may be seen in parallel
form in the child’s development of the symbolizing function and the analytic
patient’s connecting of emotional experience to words. The infant forms an
image of mother on the basis of multiple ever-​changing appearances, pro-
ducing an enduring prototypic image—​we may say a memory schema—​that
enables recognition of mother in the many varied contexts and forms in which
she appears; this enduring discrete entity can then be named. Similarly, the
analytic patient begins with arousal of subsymbolic emotional experience,
which is gradually connected to imagery and language. Prototypic images
and episodes constitute the lingua franca of the nonverbal representational
system, enabling the connection of multiple subsymbolic representations to
one another and to words.
Within the multiple code theory, emotions are defined as memory schemas
built up through repetitions of interactions with significant other people from
the beginning of life. The emotion schemas are represented as prototypic
events that share a common subsymbolic core of sensory, visceral, somatic,
and motoric experience. They incorporate our expectations of others and of
ourselves: how others will act towards us in particular circumstances, how
we are likely to act and react, and how we are likely to feel. One cannot dir-
ectly report the finely varying states of the subsymbolic components of the
schema, but one can describe instances of the prototypic events in which these
processes figure. In the narratives of such instantiations, the emotion schemas
can be told.
Within the emotion schema, any component that is activated has the poten-
tial to activate other elements, so that language or imagery may activate traces
of sensory or visceral experience or action, or the converse may occur. Like
34 Evolution of the basic theory

all memory schemas, the emotion schemas determine how one perceives
the world and are themselves changed by new perceptions. Like all memory
schemas, they may operate within or outside of awareness.
The formulation of the emotion schemas as memory schemas is built
on Bartlett’s (1932) early notion of memory schemas and is compatible
with current information-​processing approaches to emotion theory (Lang,
1994; Scherer, 1984) as well as current research on the neurophysiology of
the emotions (Damasio, 1994; LeDoux, 1989). Stern’s (1985) concept of
representations of interactions that have been generalized refers essentially
to prototypic episodes as described here. The concept of emotion schemas is
also compatible with Kernberg’s (1990) definition of affects as incorporating
symbolic representational, motoric, and visceral components. Freud’s con-
cept of transference may itself be seen as a precursor of the concept of the
emotion schema:

It must be understood that each individual, through the combined oper-

ation of his innate disposition and the influences brought to bear on
him during his early years, has acquired a specific method of his own
in his conduct of his erotic life, that is, in the preconditions to falling
in love which he lays down, in the instincts he satisfies and the aims he
sets himself in the course of it. This produces what might be described
as a stereotype plate (or several such), which is constantly repeated—​
constantly reprinted afresh—​in the course of the person’s life, so far as
external circumstances and the nature of the love-​objects accessible to
him permit, and which is certainly not entirely insusceptible to change in
the face of recent experiences.
(Freud, 1958, pp. 99–​100)

The “vicious circle” of pathology

In adaptive functioning, the emotion schemas are adjusted constantly and
flexibly in interpersonal interactions throughout life. More differentiated
expectations of others and oneself and new response patterns are formed as
schemas are activated in new contexts and as one’s own capacities develop.
Some emotion schemas, however, may represent unbearable contingen-
cies, threatening to overwhelm the self: unmanageable conflicts of response
patterns (as in wishing to destroy the person one desires) or unbearable
expectations of abandonment or loss. When such a schema is aroused for any
reason, even in the absence of an actual precipitating event, the painful sen-
sory and somatic components are also aroused. These components operate in
trace form but are painful nonetheless, and they carry the prospect of future
catastrophic events, which the person will then work to avoid. One generally
cannot regulate bodily activation directly. Most of us do not know how to
regulate our blood pressure or heart rate or other arousal systems. One can,
 The need for a “psychoanalytic psychology” 35

however, turn attention away from the triggering imagery by distracting one-
self or redirecting attention in some way.

Repression and other defensive operations may be defined in this context.

While avoidance may appear to control the emotional arousal, the individual
pays a high price. The painful subsymbolic sensory and visceral components
and tendencies toward action continue to operate, at least in trace form, but
now without emotional meaning and without capacity for symbolic regula-
tion. The individual may seek to find meaning—​conscious or unconscious—​
for the bodily activation: in some cases as having an independent somatic
source, as in somatization; in other cases as displaced to related but different
objects where the perceived connection does not threaten the self. When this
happens repeatedly, the emotion schema may then be reconstructed in this
dissociated or distorted form.
The occurrence of symptomatology and the imperviousness of patho-
logical schema to new experience may be accounted for on the basis of
the fundamental dissociation within the emotion schema and the distorted
attempts at repair. The response of avoidance is self-​reinforcing: each time
the schema is evoked, the painful somatic and sensory experience is evoked
as well. In avoiding the people, events, or places associated with a painful
schema, in reality and in imagination, individuals then cannot take in poten-
tial new information about themselves and others; they cannot learn that the
dreaded expectations will not materialize in reality. The “vicious circle” of
pathology (Strachey, 1963) can be understood in these terms (Bucci, 1997a,
1997b, 2001).

The therapeutic process in psychoanalysis

Psychoanalytic treatment is designed to permit activation of such dissociated
and distorted emotion schemas in a context where they can be tolerated,
examined, and reconstructed. If one can connect back to the subsymbolic
sensory and somatic components of the schema, one can gradually enable
opening of the schema and its reconstruction. This is what we mean by struc-
tural change.
On the basis of the sequence of the referential process as outlined above, we
have identified three stages in the process of verbalizing the emotion schemas
in free association. Optimally, the stages operate iteratively, in a deepening
cyclical pattern, over the course of a session and the course of treatment.
The process begins with activation of an emotion schema, usually a
dissociated schema dominated by its subsymbolic sensory and somatic
components, the emotional meaning of which the patient does not recog-
nize. Patients may avoid the symbolic elements of the schema if they rec-
ognize them as such, but the context constrains them to go on, to continue
36 Evolution of the basic theory

verbalizing and symbolizing whatever they can: bodily feelings, vague images,
whatever comes to mind.
The conversion of the subsymbolic to the symbolic format operates first in
the nonverbal system. The patient thinks of an event, an image, a memory, a
dream, which may seem irrelevant but which is associated with the emotion
schema. The discrete images and episodes, including memories of the past and
events of the here and now, can then be translated into words and described
in narrative form.
The power of free association can be seen most clearly here. The apparently
trivial or irrelevant images and episodes that come to mind are likely to be
peripheral symbolic components of the emotion schema. These are permitted
into awareness even when the initial objects of the dissociated schema are
avoided—​precisely because they are avoided—​so that the patient does not
recognize the emotional meaning of what they say. The subsymbolic elem-
ents of the dissociated schema may be connected to words by this means. The
narrative of the connecting phase reveals the patient’s emotion schema as it
currently exists—​as it has been retrieved from memory or played out in the
here and now. The power of the relationship may be seen here—​in providing
both objects that enable the schema to be symbolized and an environment in
which the potentially unbearable feelings can be safely touched.
In the third phase, the patient, with the analyst, reflects on the images
and stories that have been told. The analyst may take the lead at this stage.
Optimally, new connections are made—​within the patient’s emotion schemas
and between patient and analyst—​which permit the cycle to begin anew at a
deeper level. Now the patient can begin to understand the emotional meaning
of her or his narrative in new terms.
Here is where the possibility of breaking the “vicious circle” is found. The
old story in a new interpersonal context is potentially a new story, not just a
retelling. The somatic elements of the activated schema occur in the session
in modulated form. The event is represented in a code that is shared; the tools
of logical differentiation and generalization can be intentionally invoked.
The connection of the displaced object to the activated memory schema can
be recognized; the differences in one’s own capacities and in the situation in
which the activation occurs can be recognized as well. The person of the ana-
lyst and the therapeutic context constitute prototypic imagery in the here and
now that may be newly entered into the schemas. The analytic relationship
potentially plays the same role in the reconstitution of the schema that the
caretaker and the earlier context played in its initial development.

Operational indicators of the referential process:

A framework for research
The concepts of the multiple code theory, the referential process, and
the emotion schemas lay the necessary groundwork for the use of the
 The need for a “psychoanalytic psychology” 37

psychoanalytic situation in research.4 Each of the stages of the referential

process has a set of external indicators in language and behavior associated
with it, as I have discussed in detail elsewhere (Bucci, 1993, 1995, 1997a;
Bucci & Miller, 1993). Using these operational indicators, as defined within
the theoretical framework of multiple coding, we can make inferences from
the observable events of the treatment to the processes occurring within the
speaker’s mind. This research method, in effect, relies on the type of “indirect
indicators” to which Freud (1964a) referred, but with the scientific constraints
of modern psychological research. As the research proceeds, the multiple code
theory, like all scientific models, can continuously be changed and revised.

Conclusions: Toward the integration of fields

Academic psychology traditionally has been divided into separate disciplines
such as social, developmental, cognitive, and experimental psychology, with
subcomponents or specializations within each, including areas such as percep-
tion, motivation, learning, memory, and psycholinguistics. We need to recognize,
however, that functioning within each of these areas depends on integration with
other systems, including systems of somatic and emotional processes, in the
context of the individual’s overall goals, and cannot be understood in isolation.
I would suggest that a field of psychoanalytic psychology should be recognized
(or developed) whose domain of investigation includes the integration of pro-
cessing systems as these operate in adaptive functioning, as well as their dissoci-
ation in pathology, and also includes the processes by which new integration or
reintegration can be brought about. Intrinsic to such a field is investigation of
the interaction of the individual with the interpersonal world, from the level of
intimate relationships to the broader structures of society.
Scientific psychology requires such a field, and the psychoanalytic situ-
ation provides a unique setting for such investigation. The underlying goals
and organizing patterns of an individual’s life, as told in one’s narratives and
played out in the relationship, emerge in psychoanalysis as in no other con-
text. Cognitive scientists and analysts both need to realize the scientific poten-
tial of this approach.

Notes
1 This contrasts with the approach of the introspectionists (Titchener, 1915),
in which subjects’ verbalizations were taken at face value as constituting valid
representations of their own thought processes rather than as data from which
inferences may be made.
2 The type of processing that I term “subsymbolic” has features of “connectionist”
or parallel distributed processing systems based on properties of neural nets and
modeled by the mathematics of dynamical systems (Rumelhart, McClelland, &
PDP Research Group, 1986 ).
38 Evolution of the basic theory

3 Models based on symbolic processing have been dominant in cognitive science

from its beginnings (Simon & Kaplan, 1989). The classical information-​processing
models, based on the architecture of the von Neumann computer, with short-​term
and long-​term memories and modality-​specific buffer zones, are based on symbol
systems.
4 In the more than twenty years since the paper on which this chapter is based was
first published, our research on the referential process has advanced considerably,
with many new measures and applications. These are discussed briefly in Chapter 5
of this volume. A more complete presentation of empirical work on the referential
process, including experimental and clinical designs, is forthcoming in a special
issue of the Journal of Psycholinguistic Research, to be published in early 2021.

References
Arlow, J. A. (1969). Unconscious fantasy and disturbances of conscious experience.
Psychoanalytic Quarterly, 38, 1–​27.
Baars, B. (1986). The cognitive revolution in psychology. New York: The Guilford Press.
Bartlett, F. C. (1932). Remembering: A study in social psychology. Cambridge: Cambridge
University Press.
Bucci, W. (1984). Linking words and things: Basic processes and individual variation.
Cognition, 17, 137–​153.
Bucci, W. (1985). Dual coding: A cognitive model for psychoanalytic research. Journal
of the American Psychoanalytic Association, 33, 571–​607.
Bucci, W. (1989). A reconstruction of Freud’s tally argument: A program for psycho-
analytic research. Psychoanalytic Inquiry, 9, 249–​281.
Bucci, W. (1993). The development of emotional meaning in free association. In
J. Gedo & A. Wilson (Eds.), Hierarchical conceptions in psychoanalysis (pp. 3–​47).
New York: The Guilford Press.
Bucci, W. (1995). The power of the narrative: A multiple code account. In J. Pennebaker
(Ed.), Emotion, disclosure, and health (pp. 93–​122). Washington, DC: American
Psychological Association.
Bucci, W. (1997a). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (1997b). Symptoms and symbols: A multiple code theory of somatization.
Psychoanalytic Inquiry, 17, 151–​172.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
21(1), 40–​70.
Bucci, W., & Miller, N. (1993). Primary process analogue: The referential activity (RA)
measure. In N. Miller, L. Luborsky, J. Barber, & J. Docherty (Eds.), Psychodynamic
treatment research (pp. 387–​406). New York: Basic Books.
Damasio, A. R. (1994). Descartes’ error: Emotion, reason, and the human brain.
New York: Avon Books.
Eagle, M. N. (1984). Recent developments in psychoanalysis: A critical evaluation.
New York: McGraw-​Hill.
Fodor, J. A., & Pylyshyn, Z. W. (1988). Connectionism and cognitive architecture: A
critical analysis. Cognition, 28, 3–​71.
Freud, S. (1932). Third (revised) English edition of the interpretation of dreams.
London: Allen.
 The need for a “psychoanalytic psychology” 39

Freud, S. (1953a [1900]). The interpretation of dreams. In J. Strachey (Ed. and Trans.),
The standard edition of the complete psychological works of Sigmund Freud, Vol. 4
(pp. 1–​627). London: Hogarth Press.
Freud, S. (1953b [1895]). Project for a scientific psychology. In J. Strachey (Ed. and
Trans.), The standard edition of the complete psychological works of Sigmund Freud
Vol. 1 (pp. 295–​301). London: Hogarth Press.
Freud, S. (1955 [1895]). Studies on hysteria. In J. Strachey (Ed. and Trans.), The
standard edition of the complete psychological works of Sigmund Freud, Vol. 2 (pp.
3–​305). London: Hogarth Press.
Freud, S. (1958 [1912]). The dynamics of transference. In J. Strachey (Ed. and Trans.),
The standard edition of the complete psychological works of Sigmund Freud, Vol. 12
(pp. 97–​108). London: Hogarth Press.
Freud, S. (1964a [1937]). Analysis terminable and interminable. In J. Strachey (Ed. and
Trans.), The standard edition of the complete psychological works of Sigmund Freud,
Vol. 23 (pp. 216–​253). London: Hogarth Press.
Freud, S. (1964b [1940]). An outline of psycho-​analysis. In J. Strachey (Ed. and
Trans.), The standard edition of the complete psychological works of Sigmund Freud,
Vol. 23 (pp. 144–​207). London: Hogarth Press.
Gill, M. M. (1976). Metapsychology is not psychology. Psychological Issues, 9,
71–​105.
Grunbaum, A. (1984). The foundations of psychoanalysis. Berkeley, CA: University of
California Press.
Holt, R. R. (1976). Drive or wish? A reconsideration of the psychoanalytic theory of
motivation. Psychological Issues, 9, 158–​197.
Holt, R. R. (1985). The current status of psychoanalytic theory. Psychoanalytic
Psychology, 2, 289–​315.
Holt, R. R. (1989). Freud reappraised: A fresh look at psychoanalytic theory.
New York: The Guilford Press.
Jones, E. (1953). The life and works of Sigmund Freud, Vol. 1. New York: Basic Books.
Kernberg, O. (1990). New perspectives in psychoanalytic affect theory. In Emotion:
Theory, research and experience (pp. 115–​131). New York: Academic Press.
Klein, G. S. (1976). Psychoanalytic theory: An exploration of essentials. New York:
International Universities Press.
Kosslyn, S. M. (1987). Seeing and imagining in the cerebral hemispheres: A computa-
tional approach. Psychological Review, 94, 148–​175.
Lang, P. J. (1994). The varieties of emotional experience: A meditation on James-​
Lange theory. Psychological Review, 101, 211–​221.
LaPlanche, J., & Pontalis, J.-​B. (1973). The language of psychoanalysis. New York:
W. W. Norton.
LeDoux, J. E. (1989). Cognitive-​emotional interactions in the brain. Cognition and
Emotion, 3, 267–​289.
McLaughlin, J. (1978). Primary and secondary process in the context of cerebral
hemispheric specialization. Psychoanalytic Quarterly, 47, 237–​266.
Neisser, U. (1967). Cognitive psychology. New York: Appleton-​Century-​Crofts.
Neisser, U. (1976). Cognition and reality. San Francisco: Freeman.
Norman, D. A. (1981). Perspectives on cognitive science. Norwood, NJ: Ablex.
Noy, P. (1979). The psychoanalytic theory of cognitive development. Psychoanalytic
Study of the Child, 34, 169–​215.
40 Evolution of the basic theory

Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rinehart & Winston.
Paivio, A. (1986). Mental representations: A dual coding approach. New York: Oxford
University Press.
Posner, M. I., & Snyder, C. R. R. (1975). Attention and cognitive control. In R. Solso
(Ed.), Information processing and cognition: The Loyola Symposium (pp. 55–​85).
Hillsdale, NJ: Lawrence Erlbaum.
Rubinstein, B. B. (1965). Psychoanalytic theory and the mind-​body problem. In
N. S. Greenfield, & W. C. Lewis (Eds.), Psychoanalysis and current biological thought
(pp. 35–​56). Madison, WI: University of Wisconsin Press.
Rumelhart, D. E., McClelland, J. L., & PDP Research Group (1986). Parallel
distributed processing: Explorations in the microstructure of cognition. Cambridge,
MA: MIT Press.
Schacter, D. L. (1987). Implicit memory: History and current status. Journal of
Experimental Psychology: Learning, Memory, and Cognition, 13, 501–​518.
Schafer, R. (1976). A new language for psychoanalysis. New Haven, CT: Yale University
Press.
Scherer, K. R. (1984). On the nature and function of emotion: A component process
approach. In K. R. Scherer & P. Ekman (Eds.), Approaches to emotion (pp. 293–​
317). Hillsdale, NJ: Lawrence Erlbaum.
Simon, H. A., & Kaplan, C. A. (1989). Foundations of cognitive science. In M. I. Posner
(Ed.), Foundations of cognitive science (pp. 1–​47). Cambridge, MA: MIT Press.
Squire, L. R. (1992). Memory and the hippocampus: A synthesis from findings with
rats, monkeys, and humans. Psychological Review, 99, 195–​231.
Stern, D. (1985). The interpersonal world of the infant. New York: Basic Books.
Strachey, J. (1963 [1934]). The nature of the therapeutic action of psychoanalysis. In
L. Paul (Ed.), Psychoanalytic clinical interpretation (pp. 362–​378). New York: The
Free Press.
Titchener, E. B. (1915). A beginner’s psychology. New York: Macmillan.
von Bertalanffy, L. (1950). The theory of open systems in physics and psychology.
Science, 3, 23–​29.
Yuille, J. C. (1986). On the futility of a purely experimental psychology of cognition.
Journal of Experimental Psychology, 82, 467–​471.
Zbrodoff, N. J., & Logan, G. D. (1986). On the autonomy of mental processes: A case
study of arithmetic. Journal of Experimental Psychology: General, 115, 118–​130.
Chapter 3

The referential process,

consciousness, and the
sense of self

The premise of dual (or multiple) systems of thought has remained central to
psychoanalytic theory through its several transformations, while the nature
of the contrasting systems has repeatedly been redefined. In developing his
successive models of the psychical apparatus, Freud shifted from qualities
(conscious, preconscious, unconscious) to structures (id, ego, superego);
he then reunited these two forms of organization uneasily in his final sum-
mary formulation (Freud, 1940). The polarities of the primary vs. secondary
processes of thought, and verbal vs. nonverbal processes, have generally been
seen as related to both the qualities and agencies of mind. Correspondence
among these dimensions has typically been assumed as a “default” theoret-
ical position, thus the contents of the id are seen as unconscious, nonverbal,
and characterized by primary process thought, and the features of the ego as
the converse of these. Analysts also recognize that there may be unconscious
functions in the ego, that there are organized unconscious fantasies and sys-
tematic communication outside of the verbal mode, and that language may
appear in dreams and images in waking life, but they cannot account for these
observations using the metapsychology in any of its forms. Such inconsist-
encies constitute a dilemma for psychoanalytic theory and “embarrass” the
psychoanalytic methodology, as Arlow (1969) points out.
Elsewhere, I have introduced the systems of multiple code theory as
accounting for the same types of clinical observations that are covered in
psychoanalytic theory, but as explaining these within the more consistent
framework provided by cognitive science (Bucci, 1997). The multiple code
theory is based on processes and forms of thought rather than dimensions of
consciousness or agencies of mind. Using current work in neuropsychology,
this chapter extends the concepts of multiple code theory as these relate to
the qualities of consciousness as well as to issues of self-​representation that
are central to the structural model. This permits elaboration of the clinical
implications of multiple code theory, particularly in relation to the develop-
ment of pathology and the process of repair in treatment and speaks, as well,
to some of the inconsistencies in the psychoanalytic concepts.
42 Evolution of the basic theory

Emotion schemas and dispositional representations

According to multiple code theory, humans (and other species) represent
and process information, including emotional information, in two basic
formats: the subsymbolic (or nonsymbolic),1 and the symbolic codes that
include nonverbal imagery as well as verbal forms; in humans, the verbal
system is operative. The three systems (the subsymbolic, symbolic non-
verbal, and symbolic verbal)2 are connected by the referential process, which
links all types of nonverbal representations to one another and—​to varying
degrees—​to words. Emotion schemas—​the psychic structures with which we
are centrally concerned—​are made up of components of all three systems.
Adaptive functioning depends on integration of systems within the emotion
schemas. Pathology is determined by dissociation among the components of
the emotion schemas and ineffective attempts at repair; different forms of
pathology are determined by dissociation of different levels and degrees, and
the different ways in which the attempts at repair misfire. The goal of psy-
chotherapy may be understood as the reorganization of the dissociated and
distorted emotion schemas; change in the schemas is what we mean by struc-
tural change. Such change occurs through the bidirectional effects of the ref-
erential process in the context of the therapeutic relationship.
The organization of the emotion schemas, and their reorganization in
treatment, depend on this connecting process. Emotion schemas are spe-
cific types of memory schemas, which are built and rebuilt through repeated
interactions with mother-​other from the beginning of life, and which con-
stitute one’s knowledge of one’s self in relation to the interpersonal world.
Like all memory schemas, the emotion schemas include components of
all processing systems—​ nonverbal subsymbolic, nonverbal symbolic,
and verbal symbolic—​ but are more strongly dominated by sensory and
bodily representations and processes than other knowledge schemas. The
subsymbolic sensory, somatic, and motoric representations constitute the
affective core of the emotion schema—​the basis on which the organization of
the schema is initially built. The affective core is the constant that identifies
emotional events and that clusters them in categories across varying contexts
and contents. Thus, we may feel the same sort of feeling, the same emotion,
the same bodily and cognitive functions, with different people, in different
places and at different times.

Emotion schemas and dispositional representations:

The neurological base
The concepts of emotional information processing and the emotion schemas
relate to current views of emotions as including cognitive, physiological,
motoric, and motivational components, as well as subjective feeling states
(Bucci, 1997; Lang, 1994; Scherer, 1984). The psychological structure of the
 Referential process and the sense of self 43

emotion schema as outlined here is also compatible with current work in

neuropsychology. Damasio’s (1994) notion of dispositional representations
in particular provides a specific neurological basis for the emotion schema.
For Damasio, all knowledge, including the organization of the emotions, is
contained in what he terms “dispositional representations.” These are sets of
dormant firing potentialities in small ensembles of neurons or “convergence
zones” that may be distributed all over the brain, and that come to life “when
neurons fire, with a particular pattern, at certain rates, for a certain amount
of time, and toward a particular target which happens to be another ensemble
of neurons” (1994, pp. 103–​104).3 When dispositional representations are
activated, they can have a range of results; they can fire other dispositional
representations to which they are related in various ways; they can generate
imagery by firing back to sensory cortices; and they can generate movements,
as well as direct the internal biochemical operations of the endocrine system,
immune system, and viscera.
The dispositional representations constitute our full store of knowledge,
both innate and acquired by experience. They include representations of
bodily experience and imagery, and may include verbal forms as well. Some
dispositional representations, primarily in the hypothalamus, brain stem, and
limbic system, are innate; these control metabolism, chemical, and hormonal
functions, and some motoric responses, but generally do not become images.
Others are acquired, determined by life experiences that cause modifications
in higher order cortices and gray matter nuclei below the cortical level. The
innate dispositional representations, the circuitry of the limbic system and
related structures, interact with, interfere with, or support the newer circuitry
that represents acquired experience. The interaction affects what is learned
and how what is learned can be used.
The dispositional representations controlling biochemical and motoric
functions constitute the component of the emotion schema that I have termed
the affective core, and are largely subsymbolic; the repeated interactions with
others in various contexts determine what is acquired. Emotional develop-
ment is based on connecting the largely innate subsymbolic processes of
the affective core to the representations of people and places registered in
imagistic and later, to some extent, in verbal form. Through operation of the
affective core, the events of one’s experience are evaluated and distinguished
as supporting or interfering in different ways with the sensory and somatic
functions that serve to maintain life; by this means, the events of life build the
interpersonal meaning for the arousal that is experienced.

Levels of consciousness and self-​r epresentation

Based on his neurological observations, Damasio has proposed a theory that
concerns the interdependence between consciousness and the sense of self,
and the relationship of these dimensions to emotions and feelings. Drawing
44 Evolution of the basic theory

Table 3.1 Consciousness, sense of self, and emotions and feelings*

State of consciousness State of self State of emotion

Nonconscious Proto-​self—​based on Having an emotion—​
neural maps representing manifests as observable
ongoing aspects of the behaviors; well-​orchestrated set
body; ensemble of brain of responses; immediate action
devices that continuously solution to a problem
and nonconsciously
maintain the body state
within the range required
for survival
Having a feeling (of an
emotion)—​manifests as internal
representations; facilitates
alertness to the problem
(“first-​order accounts”)
Core consciousness—​ Core self​—transient Knowing a feeling—​facilitates
representation of an imaged account of how planning of new responses,
object, an organism, and the organism is affected specific to the problem situation
the relationship between by the processing of an (“second-​order accounts”)
them object
Extended Autobiographical Operates at multiple levels
consciousness—​when self—​traditional notion of of complexity; incorporating
both an immediate self, built on the schemas past events, fantasies of the
object (which may be of autobiographical future, all the contents of
an external or internal memory, linked to autobiographical memory
event) and objects from concepts of identity and
autobiographical memory personhood
simultaneously generate
core consciousness
* Based on Damasio (1994, 1999).

on this theory, we can extend the concepts of the multiple code theory, par-
ticularly the notions of the referential process and the emotion schemas,
in relation to levels of consciousness and forms of self-​representation. As
outlined in Table 3.1, Damasio defines three major categories of awareness
and three corresponding types of self-​representation.

Nonconscious processing and the proto-​s elf

Damasio’s central thesis, from which the rest of his system follows, is that the
biological roots of consciousness and the deep roots of the self are to be found
in the ensemble of brain devices, the dispositional representations, that con-
tinuously and nonconsciously maintain the body state within the narrow range
and relative stability required for survival. Damasio calls the state of activity
 Referential process and the sense of self 45

within these dispositional representations the “proto-​self,” the nonconscious

forerunner of the conscious levels. There may be several levels of nonconscious
states associated with the operation of the proto-​self. These range from the
deepest level of disruption of wakefulness, as seen in coma, to levels of defective
minimal attention/​behavior in which wakefulness is preserved, as in absence
seizures, and to the most shallow level of the nonconscious state, as in epileptic
automatisms. It is an important implication of Damasio’s observations that
consciousness and attention do not necessarily correspond.
There may be states characterized as nonconscious but in which low-​level
attention is preserved; the individual is awake and retains a basic ability to
attend to objects and the capacity to navigate in space, but the sense of self
and sense of knowing are suspended. As Damasio vividly describes, the
patient can pick up a cup of coffee, drink from it, and walk around the room,
but their face has no expression, and they do not respond to their name. They
are “both there and not there, certainly awake, attentive in part, behaving for
sure, bodily present but personally unaccounted for, absent without leave”
(Damasio, 1999, p. 6).

Core consciousness and the core self

Damasio’s next major hypothesis is that consciousness—​ noticing, being
aware—​begins as the feeling of what happens within the organism when the
organism, the proto-​ self, interacts with an object. Just as there are levels
of nonconscious states, Damasio identifies two major levels or degrees
of consciousness: “core” and “extended” consciousness. The level that
Damasio terms “core consciousness” depends on activation of dispositional
representations that incorporate an object, an organism (the proto-​self), and
the relationship between them. It occurs “when the brain forms an imaged,
nonverbal, second-​order account of how the organism is causally affected
by the processing of an object” (Damasio, 1999, p. 192). Core consciousness
is a simple biological phenomenon created in pulses as objects trigger the
modification of the proto-​self. Its continuity is produced by the endless flow
of images of objects from within and without, with each object producing
a modified proto-​self to meet the next, and with multiple objects occurring
synchronously. The triggering object can be perceived or recalled; it can be
external or within the body boundaries (e.g. pain); it can be an emotion, a
memory, or an immediate event. There is a sense of self in core consciousness,
the core self, but this is a transient entity, constantly recreated for each object
with which the brain interacts (Damasio, 1999).

Extended consciousness and the autobiographical self

Extended consciousness is built on the foundation of core consciousness,
extended in time and space. It includes memories of the past, fantasies of the
46 Evolution of the basic theory

future, and the changing landscapes of one’s life. This is a complex biological
phenomenon with several levels of organization that evolve across the lifetime
of the organism. The self that is formed through extended consciousness and
that views the panorama of autobiographical memory is the autobiograph-
ical self. This is the traditional notion of self, linked to the ideas of iden-
tity and personhood, built out of the unique experiences that characterize an
individual’s life.
In neurological terms, the autobiographical self is a process of coordinated
activation and display of personal memories, based on a continuously
reactivated multisite network of dispositional representations. The images
that represent those memories explicitly are exhibited in multiple sensory cor-
tices, and they are held over time by working memory. The memories and
anticipations are treated as any other objects and become known to the simple
core self by generating their own pulses of core consciousness (Damasio,
1999, p. 221). Thus, to summarize, “Extended consciousness occurs when
working memory holds in place, simultaneously, both a particular object and
the autobiographical self, in other words when both a particular object and
the objects in one’s autobiography simultaneously generate core conscious-
ness” (Damasio, 1999, p. 222).

Emotions, feelings, and the qualities of thought

Damasio’s definitions of emotions and feelings are intrinsically related to the
nonconscious–​conscious axis. He distinguishes states of emotion, feeling, and
knowing, with gradations and variations associated with each.

Having an emotion
In Damasio’s system, emotions4 are defined as essentially regulatory
mechanisms that operate typically in a nonconscious mode. They are specific,
well-​orchestrated sets of biological responses that involve bodily and cogni-
tive functions, which are triggered by an initiating stimulus, and begin to solve
the problem triggered by the stimulus to maintain the organism within the
narrow homeostatic range capable of supporting survival. Functions related
to body state include autonomic activation, endocrine and other chemical
responses, immune system effects, and activation of muscles throughout the
body, including changes in body posture and movements of face and limbs.
Functions related to mental state include wired-​in behaviors such as bonding,
nurturing, playing, and exploring; inhibition or enhancement of body signals
and alteration of their pleasant or unpleasant qualities; and changes in
mode of processing, such as speeding up or slowing down, or sharpening
or blurring of focus. These functions are based largely on the dispositional
representations that make up the proto-​self.
 Referential process and the sense of self 47

Many of the bodily functions are observable to others, regardless of the level
of awareness of the individual experiencing the emotional state: skin flushing
or becoming pale, muscles tensing in fear, or slumping in dejection. The cogni-
tive changes may also be observable, as in the actions associated with the wired-​
in behaviors, or the racing of thought and speech in manic phases, and the
converse in depressive states. These responses may be recognized by an observer
even when the person in whom the state is activated is not aware of these effects.

Knowing a feeling
The public and physical indicators of the emotional state have an inwardly
directed and private face, which Damasio terms “feelings,” and which have
the potential to become conscious, to become known to the individual. The
knowing of feelings is the property of core consciousness, the agency of the
core self. The knowing may occur on several levels: as awareness of a bodily
change—​heart pounding, mouth becoming dry, stomach tightening; as an
immediate eruption of anger, or terror, or desire, experienced as such, leading
often to immediate action, without reflection; or with broader meanings,
leading to more complex responses.
Knowing a feeling is the gateway to the emotion schemas, or dispositional
representations, of extended consciousness, the agency of the autobiograph-
ical self, built out of sensory and somatic components as these occur in the
multiple complex events of life. While the innate physiological components of
an emotion schema are shared across humans and other species as well, the
contents and contexts of the schema are unique, determined by the events of
each individual’s life.

Implications concerning pathology and

treatment: Levels of functional dissociation
Based on these concepts, we can now extend the multiple code formulation of
the nature of pathology. Adaptive functioning depends on connections within
emotion schemas—​that is, on connections between the innate mechanisms
of the affective core that underlie the organism’s satisfaction and survival,
registered in subsymbolic forms and playing out largely on unconscious
levels, and the contents of the schema, registered in the symbolic mode.
Only with such integrated schemas can new information derived from inter-
action with others be properly classified or reclassified as supporting or inter-
fering with the regulatory functions of life, so that appropriate responses are
elicited. Thus, Damasio (1999, p. 223) says:

In those personalities that appear to us as most harmonious and mature

from the point of view of their standard responses, I imagine that the
48 Evolution of the basic theory

multiple control sites are interconnected so that responses can be

organized, at varied degrees of complexity, some involving the recruit-
ment of just a few brain sites, others requiring a concerted large scale
operation.

Conversely, different forms of pathology are characterized by dissociations

at particular levels among the multiple sites; these dissociations may have
neurological or functional etiology. The disorders on which Damasio focuses
are primarily those with a neurological basis: several variants of amnesia,
relatively early stages of Alzheimer’s, and some of the strange and exotic
disorders about which Oliver Sacks has written. Damasio also suggests that
mania may involve an expanded autobiographical self and depression a
diminished one.
I would like to emphasize the functional aspects of dissociation here and to
extend them beyond Damasio’s formulation. Dissociation can occur at mul-
tiple levels within the distributed multisite dispositional representations that
constitute the emotion schemas, blocking the intake of new information and
the eliciting of appropriate responses.
The first level of functional dissociation that may occur within the emotion
schemas involves a failure of connection of bodily experience and sym-
bolic representation at the core level. An emotion schema is activated by a
triggering stimulus; the biological and expressive components of a primary
emotion—​both bodily and mental—​play out, but they are not experienced as
related to the objects and events that constitute the triggering stimulus or in
relation to the self. The individual is not aware of the emotion, does not claim
or own it; it is not happening to one’s self. In trauma patients, for example,
there may be functional dissociation at this level—​loss of the feeling of what
happens as happening to one’s own bodily self.
The next level of dissociation that may occur within the emotion schema
involves pulses of activation of core consciousness without activation of
extended consciousness. Thus we may be conscious of an object or event in
the present without retrieval and activation of elements of autobiographical
memory in working memory. At this level of dissociation, there is a self that
is carrying out the activity, but it is not the integrated self of identity and
personhood. The feeling is experienced as happening to one’s self, but its
meaning is not recognized.
The next and most complex level of dissociation involves varying levels
of extended consciousness, connecting to some elements of autobiographical
memory within an emotion schema, while others are blocked off. I suggest
that in most neurotic patients, most of the time, we are likely to see partial
impairments of autobiographical memory. The self as claiming one’s experi-
ence is diminished in particular respects, while aspects of extended conscious-
ness and personhood remain.
 Referential process and the sense of self 49

Development of pathology
The dissociations within the emotion schemas may occur through a range of
developmental means. The somatic and sensory components of some events—​
a rage directed at the caretaker, a reaction to a caretaker’s rage, a fear of aban-
donment and annihilation or, on other levels, the terrors of war or the pain
of a physical illness—​may be experienced by a young child as potentially
overwhelming, even threatening their survival. One usually cannot control the
orchestrated playing out of the subsymbolic components of the schema. The
biological changes associated with the affective core—​changes in heart rate or
blood pressure or respiration or skin response, or the racing or slowing down
of the mind—​play out directly in response to a triggering event. Humans (and
presumably other organisms) may then resort to a variety of alternative means
to handle the arousal of intolerable affect—​to prevent or reduce it in some way.

Attempts at avoidance
One possibility is avoidance. One can run away or turn away from the triggering
stimulus—​as we move away when a snake crosses the path, or stay away from
other threatening situations when we can. One avoids the trigger, to avoid the
activation of the affective core. When the trigger is internal—​when a thought
or memory emerges that begins to arouse the painful affective core—​one can
attempt to avoid the pain by avoiding the thought. One turns attention away
from the activating image or memory, tries to stop thinking about it. In effect,
on some implicit mental level, one says to oneself, “Don’t go there,” and uses a
variety of means to try to stay away. Such avoidance may reduce the extended
consciousness of the painful event, and may reduce the core consciousness as
well. This may also in some cases actually reduce the activation of the physio-
logical and behavioral components of the schema—​although they are likely
to continue to play out to some degree. The operation of avoidance in life and
in memory will interact:

At home they tried to avoid looking at the photographs and mementos

scattered around their apartment, objects as dangerous as broken glass …
Although they developed the habit of tunnel vision, and went from room
to room with the exaggerated deliberation of the blind, there were always
unguarded moments when they suddenly confronted the smiling face of
the vanished son, or daughter-​in-​law, or grandchild … Then memory tore
the scabs off their wounds.
(Thornton, 1987, p. 14)

Through the activation of the affective core in different contexts, not

recognized or understood, the events and images associated with the painful
threatening affect expand. The categories of objects of the schema may
50 Evolution of the basic theory

broaden widely; one avoids not only the photographs, but also the room they
are in, and the apartment, and eventually the town.

Compensatory attempts at repair

Throughout life, if a triggering stimulus activates the painful emotion
schema, with its biological and cognitive and behavioral components, but the
stimulus is not recognized, the individual will try to provide meaning for the
activated state, to know why they feel this way. The attempt to establish sub-
stitute meaning, while avoiding knowledge of the actual aroused schema or
triggering event, is likely to be destructive in itself, appearing in such forms
as somatization, displacement, or acting out. The nature of pathology is
determined by both the avoidant dissociation and the particular forms of
substitute symbolizing that are imposed. A woman who was abused sexually
as a child has a variety of somatic symptoms and repeatedly visits physicians.
She may become sexually active in a self-​destructive way, or may be unable
to enjoy sexual experience, even in a loving relationship. She may remember
occurrences of the abuse, but reports them in a neutral way, without affect.
The person who is consumed with rage, without a clear image of its object, will
generate an object and a cause to provide meaning for the overwhelming wish
to attack. Fantasies and symbolic structures, including political and religious
systems, may operate in this way. The categories of objects of displaced rage
may extend to whole countries, whole civilizations, as we saw on September
11, 2001 in New York City and Washington, DC.
For persons who experience a traumatic event, such as the people who were
near the World Trade Center on that day, the emotional effects will depend
on the schemas with which they experience the world and their customary
compensatory modes. The event will activate a range of schemas with their
affective cores: some may be understood in relation to this terrible actual
event; some may have other meanings, or be given other meanings. When
the new triggering event is itself traumatic, rather than primarily evocative
of old traumas, new dissociations will occur on top of old ones. Following
the attack, therapists working in the New York City area noted a substantial
increase in the flow of patients coming into treatment with issues that were
manifestly unrelated to the attack. These patients might, in some cases, have
referred to the attack, but without emotion, while expressing considerable dis-
tress about old difficulties now flaring up, or new problems.

Phases of the referential process: Reconstruction

of the schema
Treatment fundamentally involves new integration within the dissociated
and distorted emotion schemas. This is particularly difficult because the
inherently threatening nature of the affective core restricts the nature of the
 Referential process and the sense of self 51

information that can be accepted in the treatment situation, as in life. The

difficulty is compounded by the dissociation from specific symbolic contents
of the schema, the establishment of spurious substitute meanings, and the
broadening of the sets of triggering events. The catch-​22 is that the painful
arousal that occurs when the schema is activated is real. The person does, in
a sense, take in new information each time the schema is activated, but this
new information is reinforcing rather than corrective. This is a reformula-
tion of the “vicious circle” of which Strachey (1934) has written. The painful
physical excitation, in trace form, serves as continuous reinforcement of the
dissociation, and continuous reinforcement of the spurious solution with its
broadening neurotic range.
Elsewhere, I have formulated the therapeutic process in psychoanalysis
in the terms of the referential process: beginning with arousal of emotional
experience in sensory and bodily form; leading then to emergence of an
image associated with the emotion schema and expression of this in a verbal
narrative; leading then to reflection, and ultimately, optimally, to reorganiza-
tion of the contents of the schema itself. The phases of the referential pro-
cess occur repeatedly, within a session and across a treatment (Bucci, 1997,
2001, 2002). Based on Damasio’s (1999) formulation, we can now examine
the phases of the referential process in relation to both the emergence of con-
sciousness and the emergence of the self as owning the experience.

Arousal of emotional experience in subsymbolic form

The first phase involves activation of the emotion schema in the session
itself. The patient may show behavioral, physiological, or cognitive signs
of the emotion, but without knowing the emotion, without being aware of
it as a function of one’s self. In Damasio’s (1999) terms, the dispositional
representations of the nonconscious proto-​self are dominant in this phase.

In a couples therapy session, the wife moves to the far side of her chair, and
tightens and tenses her body when her husband complains about her lack of
sexual interest.

Emergence of imagery: From protosymbolic to symbolic forms

Patients may experience the sensory and somatic components of the schema,
dissociated from the objects and images that provide the emotional meaning
for the activated state, and may begin to talk about these experiences rather
than to express them bodily; or they may describe details in the current envir-
onment or other objects and events that are part of the schema.
In a formal sense, these responses to present feelings and events, or actions
in the present, function as early or partial symbols, or “protosymbols” (Bucci,
2002), with some, but not all, the features of the symbolic mode. They are like
52 Evolution of the basic theory

symbols in that they are discrete entities that categorize or chunk the analogic
representational field into finite units. They may also be “things in themselves,”
motoric or sensory components of the presently activated schema, rather than
representations of it, thus perhaps standing for the schema itself in a meto-
nymic rather than metaphoric way. The analyst’s presence, the experiences and
responses activated in the transference, enactments of all kinds, and certain
types of bodily experience may be early symbols or protosymbols of this sort.

In the couples therapy, the therapist notices the wife’s posture and movements
and says to her: “When he spoke just now, you moved away to the corner
of the chair, as far as you could, and clenched up as if you were protecting
yourself.” The movement as marked by the therapist became an early form
of symbol for the wife, activating core consciousness; she becomes aware
of her bodily position, where she is sitting and her inner state of tension.
This would mark the beginning of a perturbation in the flow of the habitual
emotion schema of abuse and fear.

Symbolic narrative phase—​F rom imagery to words

If the first phases are successfully negotiated, if the referential process is oper-
ating effectively, the arousal of an emotion schema will activate images, not
only of the here and now but also of the person’s life, their autobiographical
memory, connected to the affective core. These may be displaced objects, but
have the value of operating within the symbolic mode. The patient thinks of
a fantasy, an episode, a memory, a dream—​which perhaps they did not expect
to tell—​and tells it in narrative form, often without knowing why it came to
mind or what it means to them.
The narratives the patient tells in free association may now be seen as
metaphors representing aspects of the emotion schemas. They may first
represent the distorted schemas in which displacements have occurred. The
distortions and displacements, with their derivative meanings, are useful
information concerning the path of development of the pathological schema.
Eventually, the patient may reach back to the earlier, prototypal stories of
her life.
The retrieval of a memory or fantasy while the patient is in a state of arousal
precisely involves the first levels of extended consciousness—​representations
of the autobiographical self in relation to the pulses of core consciousness
that include the representations of present experiences and the bodily self,
activated in working memory. While the patient is engaged in the story, they
may not as yet recognize its extended meaning; the major aspects of autobio-
graphical memory remain dissociated.

In the couples therapy, the wife becomes aware that she is feeling afraid now.
She connects the way she is feeling in the session to the way she feels at home
 Referential process and the sense of self 53

with her husband. Someone—​the therapist—​has witnessed her expressions

of fear of her husband; she now begins to be a witness of herself.

Phase of working through and reflection: Continued

elaboration of the contents of the schema
The schema that is represented in the enactment or retrieved memory is
the patient’s vision of their current interpersonal world—​ incorporating
expectations that are invalid and maladaptive. The analyst may see some
of the structure of the emotion schema that the patient does not see. The
opportunity for useful interpretation is here. In the reflection, new meanings
emerge. This is the further opening and making available the networks of
extended consciousness—​in Damasio’s (1999) terms, building the agency of
the autobiographical self.

The wife, now in individual therapy, remembers related events in her early
life with her first family as well as in her marriage, and retrieves further
aspects of her schema of fear—​that she feels powerless and alone, and that
being persecuted and abused is a way she has accepted to feel less alone.
As she recognizes her new interpersonal context and her own adult powers,
she gradually comes to respond differently—​bodily and emotionally—​to the
analyst and to her husband.

Clinical and theoretical implications

Change in an emotion schema requires simultaneous activation of bodily
representation, present imagery, and representations of the past. In Damasio’s
(1999) terms, this may be formulated as enabling extended consciousness to
occur: activation of representations of the autobiographical self—​fantasies,
memories, episodes, dreams—​in relation to the pulses of core conscious-
ness that include the representations of the bodily self, all of this activated
in working memory. In terms of multiple code theory, this plays out as the
operation of the referential process: activation of the subsymbolic bodily
and sensory experience of the affective core in the session; associated with
ongoing events in the therapeutic relationship; triggering memories of the
past; leading optimally to changes in the emotional meaning of the activated
imagery, and modulation of the bodily and emotional responses themselves.
This account has a number of implications that should be emphasized in
relation to the explanatory concepts of metapsychology. The major implica-
tion of this formulation is an emphasis on dissociation rather than repression
as the basic process of defense and as constituting the roots of pathology.
Other points follow from this: an emphasis on the activation of affective
experience in the session rather than the inhibition of desire or drive; revisions
of a number of psychoanalytic concepts such as primary process thought,
54 Evolution of the basic theory

regression, and resistance; a reexamination of the role of language in bringing

about therapeutic change; and a new perspective on the relationship between
consciousness and the representation of the self.

Dissociation versus repression

Contents that are “warded off ” are understood psychologically as dissociated
rather than out of awareness; this applies for all forms of neurosis, not only
for conditions of trauma and abuse. This is a basic premise of multiple
code theory with Damasio’s observations providing a new understanding
of this point. Memories associated with an activated schema may come
into awareness, but not as connected to the painful bodily experience of the
affective core; conversely, bodily experiences may be in awareness, but without
being associated with objects, in memory or in the present, or they may be
given displaced meanings.
The recognition of levels of consciousness is relevant here. Thus we can
speak of components of the schema in the present as coming into core con-
sciousness, but not connected to the elements of memory that would bring
them into extended consciousness. Conversely, experiences of autobiograph-
ical memory may be retrieved without connecting to present affective experi-
ence. We can understand the intellectualizing patient, or the patient who tells
stories of events that appear to be dramatic and vivid but that somehow lack
emotional connection, in terms of particular types of dissociation within the
emotion schema.

Inhibition versus arousal

An important distinction needs to be emphasized here. While pathology is
defined fundamentally in terms of dissociation rather than repression, the
repair of pathology requires some degree of extended consciousness. This
is a crucial implication of the theory of the referential process, supported
and elaborated by Damasio’s (1999) formulation. The emotion schema can
be changed only to the extent that experiences in the present and memories
of the past are held in working memory simultaneously with the pulses of
core consciousness that depend on activation of the bodily components of
the schema.
The activation of the dissociated, painful experience in the session itself
is central to the therapeutic process. This is a very different perspective from
the metapsychological principle that structure depends on the inhibition of
drive or desire. The implications of this point for psychoanalytic technique
are potentially broad and need to be explored. In the session, the threatening
dissociated affect must be activated to some degree, but in trace form, regulated
sufficiently so as not to trigger new avoidance, and with some transformation
of meaning. The questions of how much and when to activate, or to permit
 Referential process and the sense of self 55

this activation, so as to repair the dissociation rather than to reinforce it, must
be addressed specifically for each patient.
The transference plays a unique role in this respect. The power of the trans-
ference is in the evocation of the patient’s emotion schema in relation to the
analyst in the here and now. The analyst may be recognized as “standing for”
other objects, but the persona of the analyst is a present factor that changes
the balance and context of the interaction. (To the extent that the change in
the emotion schema incorporates internalization of the new, real persona, the
question arises of whether transference can ever—​or should ever—​be fully
resolved.)

New perspectives on the primary process and related concepts

In focusing on processes rather than on psychical qualities or agencies, and
in introducing the particular mechanisms of condensation and displacement,
Freud’s concept of the primary and secondary processes may be seen as a
precursor to the multiple coding formulation, but with important differences.
The primary process was conceptualized as the mode of operation of the
unconscious system or the id, associated with the free flow of psychical
energy, and leading to hallucinatory satisfaction of wishes. Subsymbolic pro-
cessing is systematic information processing, with organizational principles
of its own, that is broadly applicable in many adaptive contexts, that may
achieve high levels of complexity, that may occur within awareness as well as
in the unconscious mode, and that is necessary for human functioning, as it is
for all species, throughout life. It is not defined in relation to wish fulfillment
and is not inherently disorganized, infantile, or regressed.
Once subsymbolic processing is recognized as systematic and organized
thought—​not verbal, not symbolic, but organized nonetheless—​it follows
that concepts such as regression and resistance need to be revised as well.
The operations of the referential process are steps on the way to accessing
components of the aroused emotion schema that have been dissociated.
These operations include functions that have been characterized as regres-
sive, such as focus on somatic experience, enactments, and use of imagery.
What has been termed “regression,” even “in the service of the ego,” and
perhaps, in a different way, what has been termed “malignant regression,”
does not involve moving to a lower or earlier mode of processing, but rather
involves connecting to and using processes outside of the verbal, and even
outside of the symbolic mode. The patient feels that they are hot, or their
stomach hurts, or the therapist’s office smells strange; then they become
aware that they are angry or afraid; then they may come to recognize what it
is in the current situation that has triggered their fear. The recognition that
the bodily activation is occurring provides an opening to the development
of further emotional meaning. Other expressions that traditionally have
been characterized as resistance may play a similar role, such as apparently
56 Evolution of the basic theory

irrelevant, even obsessive, descriptions of details in the immediate environ-

ment or in past events, and many types of derivative and displaced narratives,
as well as enactments. This approach supports Freud’s later view of resist-
ance as a means of reaching the repressed, rather than an obstacle to the
progress of treatment, but is shifted here to the multiple code emphasis on
reconstruction of dissociated schemas.

The role of language

Psychoanalysis—​the “talking cure”—​has assumed a privileged role for lan-
guage in bringing about change. If, however, change ultimately requires
connection to bodily experience that has been dissociated, and redirection of
such experience, it is possible that verbal interventions are not the necessary,
nor even the optimal, therapeutic vehicle.
The difficulties in using verbal instructions to direct and change subsymbolic
bodily functions are apparent to anyone who has ever taken a dance lesson or
a tennis lesson. Such difficulties are present, but multiplied in the processes of
connecting to emotion schemas and bringing about change. Music, dance, and
art therapies are all designed to access the subsymbolic system directly; on a
different level, so is the currently popular eye-​movement therapy, and on still
another level, so are yoga and meditation. If we take seriously the endogenous
organization of the subsymbolic and symbolic nonverbal systems, we need to
examine the degree to which the multiple nonverbal modes of communication
themselves may be sufficient to bring about therapeutic change.
At the same time, we also need to recognize the power of the verbal mode in
enlarging the space of working memory, which is the basis for extended con-
sciousness, and the arena in which the habitual flow of a pathological schema
can most directly be perturbed. From a cognitive perspective, symbols have
the power to categorize and focus experience, enabling the speaker to retrieve
and hold more of the selected information in working memory. Language
may be the most efficient mechanism for categorizing the flow of experi-
ence, although, of course, language carries the corollary negative effect of
excluding material that is not selected, thus reducing exploration. Language
is also the vehicle of logical analysis, enabling both explicit discriminations
between events that have been inaccurately associated, and generalizing over
instances not previously seen as associated. Finally, verbal expressions may
have special powers to access certain types of information stored in autobio-
graphical memory. It is most likely that both subsymbolic and symbolic forms
of connection are needed: subsymbolic processing facilitates activation of an
emotion schema with its affective core; verbal intervention facilitates revision
of displaced and distorted meanings. The specific role of verbalization in the
reconstruction process remains open to question; what seems clear is that lan-
guage alone is not sufficient to bring about change.
 Referential process and the sense of self 57

Relationship among processes, qualities, and structures of

mind: An extension of Damasio’s theory
Damasio’s premise regarding the relation of bodily experience to self-​
representation is, in a sense, the reverse of the psychoanalytic position. The
term id, or “das Es,” first used by Freud in 1923, is derived indirectly from
Nietzsche’s usage, referring to “whatever in our nature is impersonal, and …
subject to natural law” (LaPlanche & Pontalis, 1973, p. 197). From Damasio’s
(1999) perspective, however, the type of bodily experience that might be
characterized as id contents is the core of the self, the central basis for the
proto-​self, on which all forms of self-​representation must build.
This opposition is, however, only apparent. In Damasio’s (1999)
hypothesis, bodily representation is necessary but not sufficient for self-​
representation beyond the proto-​self. The emergence of the core or autobio-
graphical selves depends on the juxtaposition of bodily representations with
representations of objects (in memory and in the present). The self we own
and claim is not a property of one or the other type of content, but of their
connection. Mental representations of objects that are not connected to the
proto-​self are part of “the other” (the it), as are bodily representations not
juxtaposed to objects.
We can now also return to the question—​ which remains unresolved
within psychoanalytic theory—​of the relationship between the qualities and
agencies or structures of mind. For Damasio, these functions are essentially
interdependent, as we have seen. This has also been the default position in
the psychoanalytic literature, but with the many problems referred to above.
Here I would like to propose a possible extension of Damasio’s theory of
the basis of consciousness and, by implication, a partial differentiation of
the theory of the emergence of consciousness from the theory of the emer-
gence of the self. While both consciousness and self-​ representation may
rest, to a large extent, on representations of the bodily self, it seems possible
that these are nevertheless separate dimensions that intersect only partially.
Whereas integrated emotion schemas, including self-​schemas, may neces-
sarily be rooted in bodily experience, the emergence of consciousness may
have broader roots.
There is some indication within Damasio’s (1999) work that his basic
hypothesis concerning the emergence of consciousness might be extended to
refer not only to bodily experience on the one hand and entities outside of one-
self on the other, but, more broadly, to the juxtaposition in working memory
of diverse representational structures and processes, including subsymbolic
and symbolic (or protosymbolic) formats. Thus Damasio shows that spe-
cific bodily events, such as pains or movements or sensory experiences, may
themselves serve as objects activating core consciousness. Here consciousness
may arise through juxtaposition of the ongoing flow of bodily experience,
which would be subsymbolic, to specific experiences also within the body
58 Evolution of the basic theory

boundaries, which would have symbolic (or protosymbolic) status, without

requiring connection to contents outside of the body.
Conversely, there are aspects of external experience of which we seem
to be aware without connection to any aspect of the bodily self; these may
involve memory schemas that include a broad range of contents, such as the
intricacies of analytic philosophy, nuclear physics, or corporate or estate law.
We are conscious as we read such material; some of us may sometimes even
read such material with comprehension. Such comprehension, which we may
understand in terms of extended consciousness, may be seen as a function of
relating the new material to structures or schemas that are already formed.
These memory schemas may include subsymbolic or imagistic structures, and
may, although not necessarily, include components that are bodily in form.5
These and many other questions concerning the relationships among modes
of information processing, consciousness, and the sense of self remain to be
explored using current work in cognitive science and neuroscience as well as
the observations of psychoanalysis.

Conclusions and questions: Goals of psychoanalytic

treatment
The interaction of systems has been the essential and central principle of
psychoanalysis from the beginning (to make the unconscious conscious: to
place ego where id has been). We are carrying forward this fundamental goal,
but with redefinition of the component systems and with the recognition
that connection does not mean replacement of one system by another. As
subsymbolic and symbolic representations become connected in integrated
schemas, both formats change and increase in complexity, and optimally this
change and growth continue throughout life.
The human psychical apparatus encompasses multiple diverse structures,
processes, and qualities of thought; we all live with multiple types of dissoci-
ation; adaptive functioning depends on adequate integration of these multiple
diverse forms. Access to bodily experience is central in such adaptive inte-
gration. Psychoanalysis has the potential to repair dissociations at a deeper
level than other forms of therapy, including the building of new connections
between subsymbolic bodily experience and symbolic aspects of thought.

Notes
1 The term “subsymbolic” has been used widely in cognitive science to designate the
form of processing described here. This processing is subsymbolic in the sense of
underlying symbolic representations, in an information processing sense—​that is,
subsymbolic formats may be “chunked” into units that are represented symbolic-
ally. The prefix “sub” may be misleading, however, as implying a lower or less com-
plex level of organization. The term nonsymbolic is more neutral and might have
 Referential process and the sense of self 59

been a better choice to avoid any such implication. As is clear from my presentation
of multiple coding, I see subsymbolic information as more extensive and at least as
complex as symbolic forms.
2 The possibility of a fourth system that would be characterized as “verbal
subsymbolic” remains open to question. Paralinguistic aspects of language,
including pausing rhythms and intonation patterns, and aspects of the sound
of speech, as in onomatopoeia or more generally in poetry, may operate on a
subsymbolic level, as may emotional vocalizations (e.g. sighing, giggling), but the
words of language themselves appear to be intrinsically digital and discrete elem-
ents. The operation of a verbal nonsymbolic code needs to be explored further.
3 The dispositional representations as defined by Damasio operate on a different
explanatory level from the connectionist notions of neural networks. Dispositional
representations are defined as neurophysiological structures, whereas the
connectionist neural networks have the status of psychological constructs, as
discussed above. Subsymbolic processing, as outlined in multiple coding, is modeled
specifically by connectionist systems, whereas dispositional representations may be
understood as incorporating information in symbolic as well as subsymbolic forms.
4 The terms “emotion,” “feeling,” and “affect” have been given a wide range of
different, even conflicting, definitions throughout the emotion literature. The terms
“emotion” and “feeling” are used here specifically as defined by Damasio within
his theoretical framework; the terms “affective core” and “emotion schema” are
used as defined within the theoretical network of multiple coding; the connections
between these two sets of concepts are explicated throughout this chapter.
5 The existence and nature of subsymbolic structures underlying comprehension
of logical, scientific, and mathematical relationships are vividly illustrated in
Hadamard’s interviews with Poincaré, Einstein, and others, discussed in Bucci
(1997). Einstein specifically included bodily experience along with other types of
experience as underlying his creative work: “The psychical entities which seem to
serve as elements in thought are certain signs and more or less clear images which
can be ‘voluntarily’ reproduced and combined … The abovementioned elements
are, in my case, of visual and some of muscular type” (quoted in Hadamard, 1949,
pp. 142–​143).

References
Arlow, J. A. (1969). Unconscious fantasy and disturbances of conscious experience.
Psychoanalytic Quarterly, 38, 1–​27.
Bartlett, F. C. (1932). Remembering. Cambridge: Cambridge University Press.
Bucci, W. (1997). Psychoanalysis and cognitive science. New York: The Guilford
Press.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
20, 40–​70.
Bucci, W. (2002). From subsymbolic to symbolic—​and back: Therapeutic impact of
the referential process. In R. Lasky (Ed.), Symbolization and desymbolization: Essays
in honor of Norbert Freedman (pp. 50–​74). New York: Other Press.
Damasio, A. R. (1994). Descartes’ error. New York: Avon Books.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace.
60 Evolution of the basic theory

Freud, S. (1940). An outline of psycho-​ analysis. Standard Edition, 23, 144–​207,

London: Hogarth Press.
Hadamard, J. (1949). An essay on the psychology of invention in the mathematical field.
Princeton, NJ: Princeton University Press.
Keller, H. (1908). The world I live in. New York: Century.
Lang, P. J. (1994). The varieties of emotional experience: A meditation on James-​
Lange theory. Psychoanalytic Review, 101, 211–​221.
LaPlanche, J., & Pontalis, J. B. (1973). The language of psychoanalysis. New York:
W. W. Norton.
McClelland, J. L., Rumelhart, D. E., & Hinton, G. E. (1989). The appeal of parallel
distributed processing. In D. E. Rumelhart, J. L. McClelland, & PDP Research
Group (Eds.), Parallel distributed processing, Vol. I (pp. 3–​ 44). Cambridge,
MA: MIT Press.
McClelland, J. L., Rumelhart, D. E., & PDP Research Group (Eds.) (1989). Parallel
distributed processing, Vol. 2. Cambridge, MA: MIT Press.
Reik, T. (1948). Listening with the third ear. New York: Pyramid Books.
Schank, R. C. & Abelson, R. P. (1977). Scripts, plans, goals, and understanding.
Hillsdale, NJ: Lawrence Erlbaum.
Scherer, K. R. (1984). On the nature and function of emotion: A component process
approach. In K. R. Scherer & P. Ekman (Eds.), Approaches to emotion (pp. 293–​
317). Hillsdale, NJ: Lawrence Erlbaum.
Strachey, J. (1934). The nature of the therapeutic action of psycho-​analysis. In L. Paul
(Ed.), Psychoanalytic clinical interpretation (pp. 127–​159). New York: The Free Press.
Thornton, L. (1987). Imagining Argentina. New York: Bantam Books.
Chapter 4

Symptoms and symbols revisited

Twenty years later

Papa continually emphasizes how much remains unexplained. With the

other psychoanalytic writers, everything is always so known and fixed.
(Letters from Anna Freud to Humberto Nágera)

The interaction between body and mind—​psyche and soma—​was a founda-

tional principle of psychoanalytic theory, expressed most directly in the con-
cept of drive or instinct. In “Instincts and Their Vicissitudes,” Freud (1915)
characterized drive as “a concept on the frontier between the mental and the
somatic, as the psychical representative of the stimuli originating from within
the organism and reaching the mind, and as a measure of the demand made
upon the mind for work in consequence of its connection with the body.” In
“Three Essays on the Theory of Sexuality,” Freud (1905) characterized drives
on the basis of their somatic source, their aim, and their object.
Freud’s drive theory was closely associated with the energy model. He
viewed the nervous system as functioning to reduce or eliminate stimuli, or to
keep them constant (principle of inertia). The energy theory, the principle of
inertia, and the relationship to particular erotogenic zones have been widely
criticized; the concept of drive has also been questioned on this basis. Many
psychoanalytic clinicians and theorists, including object relations theorists,
interpersonal and relational theorists, self psychologists and intersubjectivists
have tried to account for fundamental processes of motivation without
accepting the concepts of energy and drive—​but in some instances moving
away from the core idea of the role of bodily experience in mental life—​the
role of soma in psyche.
It is also the case, however, that many central psychoanalytic ideas are
built inherently as concepts on the border of body and mind, although this
influence may not be well recognized. As Auchincloss and Samberg (2012,
p. 77) state:

Indeed, in one way or another, almost all of Freud’s fundamental concepts

depended on his ideas about psychic energy, including his concepts of
drive, motivation, conflict, attention, primary and secondary processes
62 Evolution of the basic theory

and the regulatory principles of the mind, as well as his fundamental

ideas about psychopathology, including symptom formation and trauma,
and psychoanalytic treatment, including resistance and transference.

Freud’s discussion of transference provides a central example of this inherent

relationship among objects, actions and somatic satisfaction:

Each individual, through the combined operation of his innate dispos-

ition and the influences brought to bear on him during his early years,
has acquired a specific method of his own in his conduct of his erotic
life—​that is, in the preconditions to falling in love which he lays down, in
the instincts he satisfies and the aims he sets himself in the course of it.
This produces what might be described as a stereotype plate (or several
such), which is constantly repeated—​constantly reprinted afresh—​in the
course of the person’s life, so far as external circumstances and the nature
of the love-​objects accessible to him permit, and which is certainly not
entirely insusceptible to change in the face of recent experiences … If
someone’s need for love is not entirely satisfied by reality, he is bound to
approach every new person whom he meets with libidinal anticipatory
ideas …
(Freud, 1912)

Current perspectives on the interaction of body

and mind
To provide a foundation for such fundamental concepts, which are central to
psychoanalytic theory and treatment, and which have influenced most forms
of psychotherapy practiced today, new explanatory concepts are required. The
multiple code concept of emotion schemas and Damasio’s (1994) concept of
emotion, like Freud’s concept of drive, are based on a view of emotional and
bodily experience and cognitive representation as inherently related. These
concepts offer explanations for this interaction that are based on current sci-
entific developments, and also have significant implications for treatment.

The concept of emotion schemas

Emotion schemas are central concepts in multiple code theory, and are also
related to many concepts from different fields, including developmental psych-
ology and neuroscience, as well as psychoanalysis (Bucci, 1997a, 1997b). In
the context of multiple code theory, emotion schemas are defined as networks
in memory formed through repeated interactions with other people and
including bodily processes associated with such interactions. Like all memory
schemas, the emotion schemas determine our knowledge of the world; we see
all things through the lens of our memory schemas—​there is no other way
 Symptoms and symbols revisited 63

(Bartlett, 1932). They differ from other memory schemas in their focus on the
interpersonal world, and in the dominance of sensory, motoric, and somatic
processes that make up their affective core; most of these processes operate in
subsymbolic form.
From a developmental perspective, Bowlby’s (1969) concept of internal
working models and Stern’s (1985) representations of interactions that have
been generalized (RIGs) are related concepts that emphasize the interper-
sonal nature of emotion schemas and the role of the caretaker. As defined
by Stern, RIGs are based on episodes that include “sensations, perceptions,
actions, thoughts, affects and goals,” and that occur repeatedly in a particular
temporal relationship. (Stern, 1985, p. 95). As specific episodes repeat, the
infant begins to form the prototypic memory structure, the RIG, which Stern
(1985, p. 95) characterizes as “an individualized, personal expectation of how
things are likely to proceed on a moment-​to-​moment basis.” These structures
develop from the beginning of life, in somatic, sensory and motoric forms,
well before language is acquired.

Damasio’s concept of emotion: “Dispositional representations”

For Damasio (1994, 1999), all knowledge, including the organization of the
emotions, is contained in what he terms “dispositional representations”; these
are small ensembles of neurons that may be distributed all over the brain and
that come to life when triggered by an initiating stimulus. Emotions are par-
ticular types of ensembles that involve bodily and cognitive functions, that
are triggered by a stimulus, and that begin to solve the problem triggered by
the stimulus to maintain the organism within the narrow homeostatic range
capable of supporting survival. These responses include autonomic activa-
tion, changes in cardiovascular and digestive functions, endocrine and other
chemical responses, and immune system effects, as well as muscular activation
and changes in body movements. Emotions may be known to the self through
awareness of bodily changes—​heart pounding, mouth becoming dry, stomach
tightening—​or through finding oneself acting in a particular way, as an imme-
diate eruption of anger or desire, the origins and meanings of which may not
be recognized. Like emotion schemas, Damasio’s concept of emotion involves
networks in memory including sensory, visceral, and motoric systems that
are associated with images and memories developed through the experiences
of life, and that may be activated in a present moment by the occurrence of
particular events.

Comparison of concepts
The multiple code concept of emotion schemas and Damasio’s concept
of emotion based on dispositional representations share the following
components with the psychoanalytic notion of drive:
64 Evolution of the basic theory

• a somatic source, a set of bodily functions

• a pattern of response activation associated with the bodily functions
• an object—​something happening in the present or in memory or fantasy—​
that activates the bodily functions and towards whom the responses are
directed
• subjective experience of the event in bodily and other forms.

In all these systems, what we call an emotion occurs when an initiating stimulus
activates a particular emotion schema with its affective core. In all systems,
there is an underlying organization developed through life that involves bio-
logical and cognitive functions; in all these systems, some manifestation of
this organization may be activated by particular stimuli whose significance
may not be recognized. These networks and response patterns, which may
begin as adaptations to particular challenges, may become maladaptive in
different situations. The goal of psychotherapy is to modify the underlying
organization so as to redirect the response to the activating stimuli.

Emotional disorders and somatization

It was one of Freud’s great insights to recognize the interaction between
life experiences and somatic illness. As the comment of Anna Freud that
opens this chapter (Nágera, 2015) suggests, he would presumably be open
to the need for new perspectives on this relationship, based on new scien-
tific developments. Much more is known today about the interaction of
cognition, emotion, and somatization than was known more than a century
ago when Freud proposed his energy model with its various implications;
much remains to be known. I would suggest that the observations of
clinical psychoanalysis can also contribute to such knowledge. The for-
mulation offered here, based on the notion of emotion schemas, with its
neurological correlates in Damasio’s (1994) concepts, incorporates current
research on the relationship of emotional and somatic disorders, and of
their treatment.
All organisms, from amoebas to humans, need to maintain a complex
internal equilibrium to survive. External and internal factors impinging on the
organism are constantly changing, challenging this equilibrium; maintenance
of health depends on the counterbalancing or adaptive forces that function
to maintain the equilibrium. This basic need is central to the definition of the
emotion schemas within the multiple code theory, as well as to the definitions
of emotion in Damasio’s (1994) formulation and, as we have seen, to the def-
inition of drive within psychoanalytic theory. The responses that are used to
maintain this equilibrium involve all biological functions, including functions
involved in maintaining the balance of internal chemistries and governing
endocrine/​hormonal secretions, digestion, heart rate, blood pressure, and res-
piration, as well as functions affecting the immune system. These responses
 Symptoms and symbols revisited 65

also involve behaviors including immediate or reflexive reactions of approach

or withdrawal, as well as more complex reactions.
Over the last half-​century and more, considerable evidence has been developed
that illnesses associated with situations of distress arise from severe, prolonged
activation of adaptational responses used to adjust homeostasis and maintain
equilibrium in the face of potential disruption. There has been an exponential
increase in knowledge concerning interaction among the components of the
stress system in recent years, including hormonal systems, the pituitary-​adrenal
axis, and the autonomic system (Selye, 1950; McEwen & Seeman, 2003). There
is now evidence for the effects of the stress system on a wide range of psychi-
atric and physical illnesses, including endocrine and inflammatory disorders, as
well as on disorders involving reproduction, growth, and the immune system.
At this point, to my knowledge, there is no evidence for the claim of spe-
cific emotional responses as causing specific physical illnesses, as proposed
by Alexander (1950), or for specific psychic events as expressed through spe-
cific somatic entities, as in early ideas of hysterical conversion. The particular
physiological expression is viewed as depending on an individual’s areas of
organic weakness or vulnerability, not as associated with a particular uncon-
scious conflictual emotional event. This view is generally held within the psy-
choanalytic field. As Auchincloss and Samberg (2012, p. 215) state, summing
up current views:

In recent years, efforts to link specific ailments to specific underlying

conflicts have largely been abandoned in favor of a more general use of
the term to suggest only a pronounced contribution of psychological
factors to the etiology or expression of any medical syndrome.

The multiple code theory can also account for the observation that not all
states of stress or threatened homeostasis are maladaptive. In contrast to
severe, protracted, uncontrollable states of “distress,” mild, brief and con-
trollable states of stress can be experienced as pleasant, or exciting; these are
sought after, and can also stimulate emotional and intellectual growth and
development. People seek the excitement of competitive sports, to partici-
pate or to watch. They read novels and watch shows and movies that engage
and arouse them. Scientists and mathematicians seek challenging problems
to solve.
All these activities where excitement is intentionally sought and desired,
which raised questions for a drive theory based on the principle of inertia,
can be accounted for in terms of development of emotion schemas associated
with pleasure as well as with dread. The multiple code theory is neutral as
to the valence (positive or negative) of an emotion schema, incorporating
schemas of joy as well as fear and pain. As we know, Freud also recognized
problems with his energy model—​for example, that sexual activity includes
pleasurable accumulation of energy, but did not resolve these problems.
66 Evolution of the basic theory

Implications for the treatment process

In our times, the recognition of the interaction of somatic and emotional
processes has led to a focus on physiological regulation of the system—​for
example, through treatment of psychological disorders directly by medica-
tion, as dominates psychiatry today. The attempts to implement this approach
have also led to an increasing recognition that biochemical interventions are
not sufficient. In the context of multiple code theory, we look at the thera-
peutic implication of the psyche–​soma interaction from a different perspec-
tive, entering this complex interactive system through emotional connections
rather than biochemical means.
Here the multiple code theory of treatment needs to be distinguished from
some traditional psychoanalytic assumptions. The energy model implied an
inverse relationship between somatization and the ability to verbalize feelings,
as between acting out and verbalizing. McDougall (1989, p. 15) refers to
somatization, as well as action, as substitutes for thought “through which
one disperses emotion rather than thinking about the precipitating event and
the feelings connected to it.” Kernberg (1984) stresses the inverse relationship
between aggressive action and verbalization. In contrast, the multiple code
theory emphasizes the crucial role of somatic experience in therapeutic inter-
action, both as somatic expression in the moment in the session, as well as
through verbal descriptions of somatic experience that occurred at another
time and place. Such expression, in therapist as well as patient, contributes to
the therapeutic relationship, and also has power to provide an entry to sym-
bolic forms of communication, particularly when other symbolic forms such
as memories, dreams, and fantasies are not accessible.
Psychoanalytic ideas, such as the concepts of the repetition compulsion
and working through, may be understood in this context. Throughout life,
the child and later the adult is likely to confront situations that lead to acti-
vation of a painful schema, and is likely to repeat the response patterns that
have been adaptive in the past—​in many cases to ward off a threat before
it is actually realized or to avoid recognition of the caretaker as the agent.
Patients come to treatment when the responses that they have developed at
earlier times are no longer effective, or have themselves become too painful.
Therapeutic change involves activation of components of the affective core,
including sensory, somatic and motoric components in the context of the
treatment relationship, in order that new connections can be made, and new
emotional meanings developed.

The referential process in the therapeutic context

Rather than activation of the affective core interfering with therapeutic
work, treatment builds on such activation in the interpersonal context of
 Symptoms and symbols revisited 67

the relationship. The sensory, somatic and motoric contents of the affective
core are largely in subsymbolic form; connection of these contents to lan-
guage is needed for treatment to proceed. The communication of emotional
experience is a complex, multi-​level process, which I have termed the referen-
tial process, and which includes three basic phases: arousal, symbolizing and
reflection/​reorganization. The multiple levels of thought must occur in ther-
apist as well as patient in order that effective communication can take place.
I have discussed these functions elsewhere, and will review them briefly here.

Arousal
The patient knows something is bothering them, something has brought
them to treatment. Traces of a problematic dissociated emotion schema are
activated within the relationship, in the interaction of the two participants
and in different ways in the subjective experience of each. The experience of
each participant is largely in subsymbolic form in this phase, involving acti-
vation of the affective core of a schema, and their communication occurs
primarily on sensory, bodily, and motoric levels. The patient, like any person
trying to communicate emotional experience, has difficulty in connecting
their experience to language. The problem is particularly acute for the patient,
who is struggling with schemas that are dissociated, and who is likely to try
to avoid connection to painful experience rather than seek to formulate and
communicate it.

Symbolizing/​n arrative
Images or sequences of images associated with the affective core come to
mind, perhaps in fleeting or disconnected form, perhaps in waking fanta-
sies or in events of the treatment relationship, perhaps as they appeared in
a dream. The images constitute instantiations of an emotion schema that
has been activated—​one of the cluster of events that activate a similar set of
feelings and involve similar responses. In the optimal operation of the refer-
ential process, the patient can then go on to describe the image or event in the
kind of vivid and detailed language that indicates connection to emotional
experience in the speaker and is capable of evoking corresponding experience
in a listener.

Reflection/​r eorganization
Once the material is shared, and the affect is present but sufficiently contained,
there is opportunity for a reorganizing phase in which the meaning of the
events that make up the schema may be further explored, new connections
may be discovered, and new schemas constructed.
68 Evolution of the basic theory

Occurrence of the phases

The phases may occur within sessions, and across periods of the treatment;
they may occur in the specified order; or the order may be interrupted.
The process will play out differently for different patients, with different
presenting problems, and in different treatment forms; but, as I have argued,
the basic process may be identified in all types of psychotherapy (Bucci,
2013). Computerized linguistic measures of the phases of the referential
process have been developed as will be outlined in Chapter 5. Working with
colleagues in Rome and Milan, Italian versions of the measures have also
been developed.

Transition from arousal to symbolizing phase

Once the patient has moved into a symbolizing phase, the pathway for the
treatment is fairly clear and well understood, as Freud noted and as Loewald
described:

According to the description in this early paper (Freud, 1893) a cure

occurred if the exciting event was brought to clear recollection, the
accompanying affect aroused with the recollection, and if the patient
related the event in as detailed a manner as possible and expressed his
accompanying affects in words.
(Loewald, 1980, p. 40)

Kris also outlined this optimal patterning of treatment in his description of

the “good hour”:

Many a time the “good hour” does not start propitiously. It may come
gradually into its own, say after the first ten or fifteen minutes. Then, a
dream may come, and associations, and all begins to make sense. In par-
ticularly fortunate instances a memory from the near or distant past, or,
suddenly, one from the dark days may present itself with varying degrees
of affective charge. And when the analyst interprets, sometimes all he
needs to say can be put into a question. The patient may well do the
summing up by himself, and himself arrive at conclusions.
(Kris, 1956, p. 446)

The problem, as clinicians know all too well, is that the first ten or 15 minutes
to which Kris refers may become 10 or 15 hours or weeks or even more.
The concepts of the emotion schemas and the referential process, in the
framework of the therapeutic relationship, provide a new perspective on
this transition phase. This is a phase of subsymbolic activation; much is
happening inside the patient, but not much that can be shared in symbolic
 Symptoms and symbols revisited 69

form. Gestures and body movements contribute to subsymbolic communica-

tion; speech rhythms and vocal tones also carry emotional information.
For many patients, detailed descriptions of physical symptoms that are at
the forefront of awareness may provide entry to a shared symbolic mode,
when recollections of exciting events, memories, dreams or fantasies do not
come to mind. This is part of the lengthy and difficult process of building
connections within dissociated emotion schemas; it is also part of the lengthy
and difficult process of building connections within the relational context of
the therapy. For many patients, this process has to occur before the “good
hour,” with its richness of memory, fantasy, and dreams, can happen.
It is possible that in some cases the physical expression may operate like a
dream, to be interpreted. I emphasize that interpretation of symptoms, like
interpretation of dreams, does not involve uncovering latent contents that
have already been formulated, but requires constructing new meanings.
Here I will present two examples of this process, which show the role of
somatization in the therapeutic relationship as facilitating communication of
emotional experience and therapeutic change.

Solano’s case of Stefano

In his 2010 paper in the International Journal of Psychoanalysis, Luigi Solano
describes the case of Stefano, who asked for analysis when he was 37 years
old. Dr. Solano says, “The extreme vagueness of his motivations for treatment
struck me from the start.” As he describes the treatment—​three times a week
on the couch—​“The early period was characterized by a sequence of acting
out that he seemed to go through as though he were protected by armour”
(Solano, 2020, p. 1457). Stefano left his wife and three-​year-​old daughter,
seemed to be carrying on a passionate affair with a new woman, left her
after two months apparently without regret, returned to his wife, then began
another affair. Dr. Solano’s attempts to interpret his actions were superficially
accepted, but with a feeling of compliance; Stefano’s emotions and responses
to the analytic situation generally seemed quite flat. Dr. Solano found himself
feeling quite hopeless with respect to possible internal change in Stefano, or
in their relationship.

We can see this as a prolonged arousal phase for both patient and analyst.

After just over a year of the analysis, Stefano came back from their second
summer break with a dark, worried look that Dr. Solano had never seen him
exhibit before. For once, Stefano seemed genuinely emotionally engaged;
when they shook hands at greeting, Dr. Solano had the feeling that he was res-
cuing someone who had been shipwrecked. The evening before, Stefano had
noticed a swelling on his neck; he went to the hospital where a thyroid nodule
with lymph node involvement was found. Stefano’s wife reacted by saying to
70 Evolution of the basic theory

him that now he would have to care about himself. Stefano’s brother, who
suffered from psychiatric problems, said, “At last something has happened to
you as well” (Solano, 2020, p. 1458).
With the help of the analysis, which provided a secure base, Stefano was
able to control his attempts at denial in this situation and to take appropriate
medical action to treat the nodule, which was ultimately found to be benign.
Dr. Solano says:

The episode marked the beginning of Stefano’s renewed capacity to take

what happened to him seriously—​to deal with it—​in regard to his ana-
lysis, his work, his wife and daughter, and his disturbed brother, possibly
because for the first time he was genuinely in contact with himself (that
is, the disconnection between the subsymbolic and symbolic systems was
abating).
(Solano, 2020, p. 1459)

The focus on the somatic event played a transitional role enabling entry into
a symbolic mode

In time, they connected the emergence of the nodule on his neck with
the summer break in the analysis, presumably as an effect of the threat of
loss of the relationship, whose value Stefano may have felt but not expli-
citly recognized. His noticing the nodule just the evening before his return to
treatment, although it was presumably apparent before that, suggested that
he was able to bear his fear in the context of anticipation of Dr. Solano’s
support. In the process of working through this experience, Stefano also
became aware that avoidance of negative feelings entailed loss of contact
with positive ones.

This is the reflection phase of the referential process, enabling reconstruc-

tion of dissociated schemas and construction of new emotional meaning.

Ogden’s case of Mrs. B

Ogden (1994) describes a case where somatic symptoms played a central role
in the analyst’s experience as well as for the patient. The patient, Mrs. B,
began analysis for reasons that were not clear to either of them. He describes
the first year and a half of analysis as characterized by “a labored and vaguely
unsettling feeling.” Mrs. B discussed what appeared to be “important”
themes, but the analysis did not seem to come alive. She talked about “not
feeling fully present”; she had increasing difficulty finding “things to talk
about.” By the end of the second year, “the silences had become increasingly
frequent and longer in duration, often lasting fifteen to twenty minutes”
(Ogden, 1994, p. 13).
 Symptoms and symbols revisited 71

Ogden’s attempted interventions concerning the relationship between par-

ticular silences and events in their relationship didn’t help. She repeatedly
apologized; there was a growing feeling of exhaustion and despair, conveyed
less by spoken apologies and more by facial expression, movement, and tone
of voice. At this point in the analysis, Mrs. B “also began to wring her hands
throughout the analytic hours, and yet more vigorously during the silences.
She pulled strenuously on the fingers of her hands and deeply kneaded her
knuckles and fingers to the point that her hands became reddened in the
course of the hour” (Ogden, 1994, p. 14).
Ogden found his own fantasies and daydreams were unusually sparse
concerning this patient and he experienced less feeling of closeness to her
than he would have expected. He found himself doing things just before the
sessions so that he was occasionally a minute or so late beginning. During
this period, he developed what felt like a mild case of flu; he was able to keep
his appointments, but continued to feel physically unwell during his meetings
with Mrs. B, “experiencing feelings of malaise, nausea and vertigo” (Ogden,
1994, p. 14). He felt like a very old man and, for reasons he could not under-
stand, took some comfort in this image of himself, while at the same time
deeply resenting it. He was not aware of similar feelings and sensations during
other parts of the day.

This can be seen as an extended arousal phase in both participants, similar

to that described by Solano in the case of Stefano.

Ogden reports that Mrs. B seemed to look at him intently at the beginning
and end of each hour; when he asked her about that, she said she was not
aware of doing it. Shortly after an intervention concerning the patient’s self-​
doubts about her value as a mother and as an analysand, an incident occurred
in which she became terrified at the sound of a movement of his. She abruptly
turned around on the couch, for the first time in the analysis. She had a look
of panic on her face and said, “I’m sorry, I didn’t know what was happening
to you.” Ogden writes:

It was only in the intensity of this moment, in which there was a feeling
of terror that something catastrophic was happening to me, that I was
able to name for myself the terror that I had been carrying for some time.
I became aware that the anxiety I had been feeling and the (predomin-
antly unconscious and primitively symbolized) dread of the meetings
with Mrs. B (as reflected in my procrastinating behavior) had been dir-
ectly connected with an unconscious sensation/​fantasy that my somatic
symptoms of malaise, nausea and vertigo were caused by Mrs. B, and
that she was killing me. I now understood that for several weeks I had
been emotionally consumed by the unconscious conviction (a “fantasy
in the body”: Gaddini, 1982, p. 143) that I had a serious illness, perhaps
72 Evolution of the basic theory

a brain tumor, and that during that period I had been frightened that
I was dying.
(Ogden, 1994, pp. 14, 15)

The connection from subsymbolic to symbolic modes appeared to emerge at

a particular dramatic moment. It is likely that there were moments leading to
this connection that were not explicitly recognized—​such as Mrs. B wringing
her hands and looking intently at Ogden at the beginning and end of each
hour, which she does not acknowledge and he does not explicitly interpret.

For each of them, the powerful diffuse unacknowledged feelings of the

arousal phase connected to experiences within each of their lives that they
were able to share in symbolic verbal form.

As the treatment progressed, Mrs. B talked about memories and fantasies

of her early life: that her mother had not wanted to have children; that she
had needed to behave “like an adult” and not make an “emotional mess” of
his home (his office), as she had needed to protect her parents. The bodily
expressions of these dissociated experiences activated responses in him long
before their meanings in her life emerged, and he also connected his work
with his patient to experiences of his own life:

In retrospect, my analytic work with Mrs. B to this point had sometimes

felt to me to involve an excessively dutiful identification with my own
analyst (the “old man”). I had not only used phrases that he had regu-
larly used, but also at times spoke with an intonation that I associated
with him.
(Ogden, 1994, p. 16)

As Ogden describes the case, “the analyst’s somatic delusion, in conjunction

with the analysand’s sensory experiences and body-​related fantasies served
as a principal medium through which the analyst experienced and came to
understand the meaning of the leading anxieties that were being (intersub-
jectively) generated” (Ogden, 1994, p. 3).

Conclusions: Some main ideas presented here

Emotion schemas are inherently mind–​body constellations connecting the
sensory, physiological, and motoric processes of the affective core to the
experiences of life. They are built on repeated experiences of interactions
with the significant people of one’s life, from the beginning of life. Concepts
such as object representations and self-​states may be understood in these
terms. An emotion is an instance of the schema; it occurs when something
happens—​in one’s life, in fantasies, memories, or dreams—​that activates the
 Symptoms and symbols revisited 73

affective core. What we call a feeling of anger, or dread, or joy, or more fre-
quently a feeling we cannot name is such an instance of an emotion schema
that has been activated. The concepts of the emotion schema, and an emotion
as an activation of the schema, are based on current neurological findings
and related to many concepts in developmental and emotion theory, as well
in psychoanalysis.
Emotional and bodily health depends on connections within the emotion
schema enabling people to use the bodily information provided by the
affective core to determine what is good or bad for them. Emotional disorders
arise when schemas are dissociated; the strategies people use to maintain
the dissociation and to regulate the painful dissociated experiences of the
affective core, as well as the bodily effects of failures of regulation, become
the problems that bring people to treatment.
The physiological functions that make up the affective core of the emotion
involve adaptive processes that operate constantly to maintain physical
health. There is considerable evidence that prolonged and intense activation
of these processes in response to stressor events will lead to physical illness,
depending on each individual’s areas of vulnerability. There is no evidence
that specific events of life will lead to particular illnesses, or that recovery of
a specific memory will have a related curative power.
A major distinction that I hope I have made clear throughout this chapter,
and that I want to emphasize particularly here, is that symptoms may operate
as symbols—​have symbolic functions—​in the sense that their expression may
enable entry into a symbolic mode. In therapy, somatic symptoms may pro-
vide a pathway to symbolizing emotional experience that has been dissociated,
particularly where other modes of expression, such as memories, fantasies,
and dreams, may not be accessible. The pathway operates in the referential
process, playing out in both participants in the treatment process and in the
communication between them. Such functions need to be distinguished clearly
from Freud’s formulation of hysterical symptoms as symbolic expressions of
repressed unconscious wishes. This distinction has ramifications throughout
psychoanalytic theory that need to be addressed fully.

Acknowledgment
This article is a revised version of a paper presented at a conference of
the Italian Psychoanalytic Society and the International Psychoanalytical
Association, Rome, 2007.

References
Auchincloss, E. L., & Samberg, E. (Eds.) (2012). Psychoanalytic terms and concepts.
New Haven, CT: Yale University Press.
Alexander, F. (1950). Psychosomatic medicine. New York: W.W. Norton.
74 Evolution of the basic theory

Bartlett, F. C. (1932). Remembering: A study in social psychology. Cambridge:

Cambridge University Press.
Bowlby, J. (1969). Attachment and loss, Vol. I. New York: Basic Books.
Bucci, W. (1997a). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (1997b). Symptoms and symbols; A multiple code theory of somatization.
Psychoanalytic Inquiry, 17, 151–​172.
Bucci, W. (2013). The referential process as a common factor across treatment modal-
ities. Research in Psychotherapy: Psychopathology, Process and Outcome, 16, 16–​23.
Damasio, A. R. (1994). Descartes’ error. New York: Avon Books.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace.
Freud, S. (1893). On the psychical mechanism of hysterical phenomena. Standard
Edition, 2, 3–​17. London: Hogarth Press.
Freud, S. (1905) Three essays on the theory of sexuality. Standard Edition, 7, 123–​246.
London: Hogarth Press.
Freud, S. (1912) The dynamics of transference. Standard Edition, 12, 97–​108.
London: Hogarth Press.
Freud, S. (1915) Instincts and their vicissitudes. Standard Edition, 14, 109–​40.
London: Hogarth Press.
Gaddini, E. (1982). Early defensive phantasies and the psychoanalytic process In
E. Gaddini, A psychoanalytic theory of infantile experience: Conceptual and clinical
reflections (pp. 142–​153). A. Limentani (Ed.). London: Routledge.
Kernberg, O. F. (1984). Severe Personality Disorders. New Haven, CT: Yale
University Press.
Kernberg, O. F. (1990). New perspectives in psychoanalytic affect theory. New York:
Academic Press.
Kris, E. (1956). On some vicissitudes of insight in psychoanalysis. International Journal
of Psychoanalysis, 37, 445–​455.
Loewald, H. W. (1980). Papers on psychoanalysis. New Haven, CT: Yale University Press.
McDougall, J. (1989), Theaters of the body. New York: W.W. Norton.
McEwen, B. S., & Seeman, T. (2003) Stress and affect: Applicability of the concepts of
allostasis and allostatic load. In R.J. Davidson, K.R. Scherer, and H. H. Goldsmith
(Eds.), Handbook of affective sciences (pp. 1117–​ 1137). Oxford: Oxford
University Press.
Nágera, H. (2015). Anna Freud in the Hampstead Clinic: Letters to Humberto Nágera.
D. Benveniste (Ed.). New York: International Psychoanalytic Books.
Ogden, T. H. (1994). The analytic third: Working with intersubjective clinical facts.
International Journal of Psychoanalysis, 75, 3–​19.
Selye, H. (1950). Stress and the general adaptation syndrome. British Medical Journal,
1(4667), 1383–​1392.
Solano, L. (2010). Some thoughts between body and mind in the light of Wilma Bucci’s
multiple code theory. International Journal of Psychoanalysis, 91, 1445–​1464.
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
Chapter 5

The power of language

in emotional life

The difficulty of connecting emotions and words is widely recognized in

everyday language, in popular music and in literature. We are “struck dumb”
with awe or horror; something is “too wonderful for words.” Popular songs
are full of expressions of the failure to express emotion in language: “I
can’t begin to tell you how much you mean to me.”1 The use of language
to organize emotional experience and to bring about change is equally mys-
terious, as I discussed in an early paper focused on the treatment process in
psychoanalysis:

Only the sounds of speech pass back and forth between analyst and
patient; ultimately the treatment seeks to reach beyond words, to the
diverse elements of experience—​imagery, feelings, desires—​which have
never been verbalized or have been wrongly named. The experiences
represented in the patient’s memory must be represented again in his
spoken language, and then re-​represented in the analyst’s mind. A basic
question that psychoanalysis shares with other disciplines, including psy-
cholinguistics and cognitive psychology, as well as philosophy, concerns
the correspondence between these representational domains, and the val-
idity of the inference to experience that may be drawn from words.
(Bucci, 1985, p. 571)

In his influential work on the development of language, Vygotsky viewed

thought and vocalization as following separate lines, independent of one
another, in ontogenetic as well as phylogenetic development. In human devel-
opment, “at a certain point these lines meet, whereupon thought becomes
verbal and speech rational” (Vygotsky, 1986, p. 83), but Vygotsky excluded
emotions from this intersection:

The higher, specifically human forms of psychological communica-

tion are possible because man’s reflection of reality is carried out in
generalized concepts. In the sphere of the emotions, where sensation and
76 Evolution of the basic theory

affect reign, neither understanding nor real communication is possible,

but only affective contagion.
(Vygotsky, 1986, p. 8)

The problem of connecting emotion and words is, ironically, well articulated
in literature. In the moments after Vronsky and Anna Karenina’s desires for
one another had been fulfilled for the first time, Anna was distraught. Count
Vronsky “stood before her, pale, his lower jaw quivering, and besought her
to be calm, not knowing how or why.” He speaks of his happiness, but she
experiences the word as a violation:

“Happiness!” she said with horror and loathing and her horror uncon-
sciously infected him. “For pity’s sake, not a word, not a word more.” … She
felt at that moment that she could not put into words the sense of shame, of
rapture and of horror at this stepping into a new life, and she did not want
to speak of it, to vulgarize this feeling by inappropriate words. But later too,
and the next day and the third day, she still found no words in which she
could express the complexity of her feelings; indeed she could not even find
thoughts in which she could clearly think out all that was in her soul.
(Tolstoy, 2000, p. 150)

There are many such examples in literature. It seems that it is possible to write
or talk in an emotionally evocative way about why and how it is not possible
to write or talk—​or even think—​about emotion. Yet the great literature of the
world is built on the power of language to express all manner of emotional
experience in words, as Tolstoy shows. T. S. Eliot has formulated this process
in his concept of the objective correlative:

The only way of expressing emotion in the form of art is by finding an

“objective correlative”; in other words, a set of objects, a situation, a
chain of events which shall be the formula of that particular emotion;
such that when the external facts, which must terminate in sensory experi-
ence, are given, the emotion is immediately evoked.
(Eliot, 1950, p. 100)

This chapter examines the function of communicating emotion as this

develops from the bodily and sensory experiences that are the core of emotion to
imagery and words, and the converse process of connecting the words of others
(or of oneself) back to bodily and sensory forms. This process is discussed in the
context of multiple code theory, with its corollary concepts of emotion schemas
and the referential process. The multiple code concept of emotion schemas will
also be examined in relation to several current theories of emotion.
The referential process includes the three functions termed arousal, sym-
bolizing and reflecting/​reorganizing as defined below. A previous paper (Bucci,
 The power of language in emotional life 77

Maskit, & Murphy, 2016) focused on the symbolizing component of the ref-
erential process; this chapter expands that discussion to include new work on
the reflecting/​reorganizing function. Empirical support from linguistic, experi-
mental and clinical perspectives concerning the concepts of emotion schemas
and the referential process is reviewed, and linguistic measures for the functions
of the referential process that are in current use in our research are presented.

Outline of multiple code theory

Bucci (1997, p. 321) characterizes the human information processor as an
imperfect device:

the new and powerful representational system of language has been over-
laid on a set of other representational systems that were previously avail-
able, but without the mechanisms for adequate integration of systems
being fully in place.

From an evolutionary perspective, Stone (2006, p. 55) describes humans as

“an odd combination of emotion and reason” in whom “some very abstract
cognitive abilities that are unique to our species are layered on top of phylo-
genetically older social capacities and emotions” (2006, p. 56). Similarly,
Tattersall (1998, p. 234) characterizes the human mind as a particular kind
The author
of complex is saying that the human mind is not like
apparatus:
a machine that is designed with different parts
not in the sense
working that an engineered
together machine is, with
for one purpose. many separate
Instead, parts
our mind
working smoothly together in pursuit of a single goal, but in the sense
is made
that up of of
it is a product reflexes and emotions
ancient reflexive and emotionalthat have been
components, over-
around for a long time, and these are covered by a
lain by a veneer of reasoning.
layer of reasoning.
The multiple code theory provides a view of human information processing
as encompassing disparate formats, characterized as verbal and nonverbal
symbolic and subsymbolic forms, which are only partially interconnected. The
model was based initially on the dual code theory of Paivio (1971), which
distinguished verbal and imagery codes in long-​term memory (Bucci, 1985),
then expanded to incorporate subsymbolic as well as symbolic processing
formats. Given the multiplicity and variety of processing modes, questions
arise concerning the degree to which the various forms are connected—​or need
to be connected—​in human functioning, and how such connection occurs.

Modes of processing
Symbolic processing
We are most familiar with symbol systems; they are the systems that we asso-
ciate with thought, and that we can most readily manipulate and control.
78 Evolution of the basic theory

From an information processing perspective, symbols are defined as discrete

entities with properties of reference and generativity—​that is, symbols are
entities that refer to other entities, and that may be combined to generate an
infinite variety of new forms. Language is the quintessential symbolic mode.
Words are discrete entities that refer to other entities, including images and
other words, and that are combined in rule-​governed ways to generate the
myriad varieties of linguistic forms that we speak or write. Images, like words,
are discrete entities that refer to other entities. They may be broken down
into their elements and may be combined to create new forms, as the police
put together combinations of features to construct a composite visual image
that approximates a suspect’s face. Images occur in all sensory modalities;
in addition to visual images, we may have auditory, tactual, kinesthetic, and
other sensory imagery, although sighted people tend to be less aware of these
modalities. Helen Keller (1908, p. 41) knew the world directly through her
“three trusty guides, touch, smell, and taste,” as well as through her experi-
ence of action and space, and had imagery in all these modalities.

Subsymbolic processing
People are less likely to acknowledge the subsymbolic modes as processes
of systematic thought, yet they are central in mental life, within as well as
outside of awareness. Subsymbolic2 processes operate in continuous formats
based largely on analogic relationships rather than on the combination and
manipulation of discrete elements or features. From the beginning of life,
people experience gradations in sensations and feelings to which they are able
to attend, generally without attempting to label them. This applies for all sen-
sory modalities and for bodily and motoric experience. Subsymbolic functions
are involved in many everyday activities. The task of changing lanes on a
highway requires judging the speeds and distances of vehicles approaching
and passing, in relation to one’s own speed, in the real time of driving, and
then directing one’s steering, accelerating, and braking motions using those
judgments. The dimensions of speed and distance are inherently continuous;
the driver directs attention to the process, often pauses in an ongoing conver-
sation to focus on it, but does not explicitly compute any of the variables that
are involved. While skills are needed that must be acquired, and that improve
with practice, each situation that is encountered is unique. An expert mathem-
atician, given simulations and metrics, would be challenged to carry out the
multiple interacting computations even without time constraints, and could
not consider such computations in the real time of driving.
These types of processes occur in many situations: in hitting a moving
target from a moving base as in naval warfare; for the tennis player, who
visualizes where the ball is going to land, and starts running to that place even
before the ball leaves the opponent’s racket; in juggling and walking a tight-
rope; in creative cooking and tasting wine; in all forms of art; and in creative
 The power of language in emotional life 79

scientific and mathematical work—​wherever complex skills and knowledge

are required beyond digital, discrete computation. Such processes operate in
other species, like the driver changing lanes, or the tennis player tracking and
returning a ball, the tiger stalking and pouncing on a moving prey must regu-
late its own speed and direction in relation to the speed and direction of the
fleeing victim and the nature of the terrain. Such phylogenetically older cap-
acities, like those referred to by Stone and Tattersall, reached highly complex
processing levels well before the emergence of the earliest formal indicators
of symbolic functioning, estimated at between 100,000 and 80,000 years ago.
Subsymbolic processes are sometimes characterized as implicit: we argue
that people in fact are able to focus intently and intentionally on their
subsymbolic bodily, sensory and emotional processes without necessarily
connecting them to discrete symbolic forms. The state of mind that has been
characterized as a “flow” experience (Csíkszentmihályi, 1990) is a state of
consciousness with features of subsymbolic processing that is highly prized
by athletes, artists, musicians, and dancers.

Alternate theories of multiple systems

The need for hybrid models of mentation has been addressed by a number
of scientists from different perspectives. Several types of two-​system (or
dual process) models have been identified that contrast intuitive judgments
characterized as automatic, involuntary and largely effortless with operations
that are controlled, voluntary, and effortful (Evans, 2007; Kahneman and
Klein; 2009). While these models distinguish different processing modes in the
human information processing system, they emphasize dimensions of inten-
tionality and effort, whereas multiple code theory emphasizes differences in
format of processing, and the difficulties in connecting the different represen-
tational modes that result from these differences.
The features of subsymbolic processing, operating in continuous rather than
categorical modes, are similar to functions modeled by parallel distributed
processing models. We note that researchers within the PDP approach have
pointed to the need for hybrid or dual system models, incorporating features
of symbolic processors along with parallel processing modules (Norman,
1986; Schneider, 1988), and have also emphasized the difficulties involved in
connecting the disparate systems.
cognition and emotion works together. we
The concept of emotion schemas get afraid at night and our hearts beat
faster.
Emotion schemas are particular types of memory schemas that are built as
clusters of memories of events of one’s life. They include subsymbolic sen-
sory, visceral, and motoric processes activated in relation to different people
in different contexts. Emotion schemas are distinguished from the overall cat-
egory of memory schemas in two major ways: (1) they are primarily relational,
80 Evolution of the basic theory

focused on the events of the interpersonal world; and (2) they are organized
on the basis of the subsymbolic processes of the affective core, particularly
including processes associated with the maintenance of well-being, such as
changes in the functioning of circulatory, respiratory, visceral, endocrine,
and other physiological systems, as well as motoric processes associated with
action tendencies. Thus, episodes with similar affective core components will
cluster to form an emotion schema.
For example, an emotion schema may include related experiences of
arousal, heart beating faster and blood pressure rising in response to different
life events such as hearing footsteps late at night in a dark street, visiting a
doctor’s office, giving a public performance, or beginning a yearly holiday
visit to one’s family. The bodily experiences may occur in particular combin-
ations and may be joined with tendencies to actions such as running away,
hiding, attacking, which may be managed in a range of ways. The schemas
that are constructed are specific to each individual’s life, and also have elem-
ents that are culturally and socially shared.
The concept of the schema may be characterized as a combined exemplar-​
prototype model, following the distinctions made by Ross and Makin (1999).
On the one hand, it may be characterized by an exemplar, a detailed descrip-
tion of a specific episode in which the constellation of bodily experiences
are activated with particular people in a particular time and place context
or alternatively, in more general terms, at varying degrees of generality and
abstractness. These contrasting modes of characterizing the schema will lead
to different modes of verbal expression and different bodily effects.
Some clusters of exemplars are given labels (such as anger, fear or shame
in English), or combinations of labels—​ as Tolstoy combined the terms
shame, rapture and horror to try to describe Anna’s state. In many or most
cases, people cannot find words to adequately label the schema that has been
activated.
Like all memory schemas, the emotion schemas involve active and con-
structive processes, constantly changing with new input and determining how
one sees the world (Bartlett, 1932). New episodes are continually incorporated
into the schemas, and the components and structure of the schemas change
throughout life. In retrieving an emotional memory, one does not retrieve a
fixed scenario, but activates a network of potential connections.
In neurological terms, memory schemas—​including emotion schemas—​
may be understood as dispositional representations (Damasio, 1994), sets of
dormant firing potentialities in ensembles of neurons distributed all over
the brain. The networks that make up the emotion schemas include sensory,
visual, and motoric features, and conceptual interpretation and evaluation.
The schemas may be activated by any of their components—​the places,
people, sensations, and concepts that figure in them—​and may in turn activate
any component. They can generate imagery by firing back to sensory cortices;
they can generate movements, and they can direct the internal biochemical
 The power of language in emotional life 81

operations of the endocrine system, immune system, and viscera. The for-
mulation of emotion schemas as types of memory schemas based on varied
and distributed components is compatible with current evidence concerning
interaction among brain networks (Pessoa 2008; Phelps 2006), contrasting
with views of affect and cognition as separate systems.

Related concepts of interpersonal schemas

Many types of memory schemas associated directly or indirectly with know-
ledge of one’s interpersonal world have been proposed. Some examples
(among many) include self-​schemas, conceptualized as prototypes containing
collections of features describing oneself (Rogers, 1981), relational schemas,
characterized by Baldwin (1992) in terms of patterns of interpersonal related-
ness, and the concept of scripts, developed as prototypes of sequences of
events or actions in social situations (Schank & Abelson, 1977).
Stern’s (1985) concept of representations of interactions that have been
generalized (RIGs) and his later analogous concept that he terms the schema-​
of-​a-​way-​of-​being-​with another person (Stern 1994) come close to the mul-
tiple code formulation of emotion schemas. Stern’s later concept is based
on what he characterized as temporal feeling shapes, which are proposed as
formats for representing affective experience, and which include shifts in acti-
vation/​arousal, hedonic tone, intensity of affect, and strength of motivation.
These would be classified as subsymbolic functions in the context of mul-
tiple code theory, although Stern did not use that term in his writing. From a
similar perspective, Bretherton (1994) emphasizes the importance of Stern’s
ideas concerning the “symphonic nature” of subjective experience and the
dynamics of feeling, and the significance of these ideas with respect to the
problem of expressing emotional experience in language.

Relation of the concept of emotion schemas to current

emotion research
Emotions as episodes or states
In current emotion research, emotions are typically understood as time-​
limited episodes in the life of an individual, which unfold dynamically with
a beginning and an end, although their exact duration is difficult to specify
(Mulligan & Scherer, 2012). Yet, as Mulligan notes in that paper (which
incorporates dialogue between the two authors), many philosophers take a
different view:

many philosophers distinguish between two types of emotion: episodes

and emotional states or dispositions, between a momentary outburst of
anger or a fleeting admiration of an elegant ankle, on the one hand, and
82 Evolution of the basic theory

the long-​lasting hatred of the nationalist or the reverence of the religious

believer, on the other hand … Indeed some philosophers prefer to reserve
the term emotion for long-​lasting states or dispositions.
(Mulligan & Scherer, 2012, p. 346)

Emotion schemas as defined here provide a link between the two approaches;
they are enduring networks of connections that may be activated in particular
contexts, and they are built on clusters of specific episodes represented in par-
ticular places and times. Each of these two faces of emotion, the enduring
and the momentary, has a particular relation to the expression of emotion in
language, as will be discussed.
The distinction between emotion states and episodes noted by Mulligan
and Scherer (2012) may be seen in relation to the distinction between semantic
and episodic memory as formulated by Tulving (2002) and others. As forms
of semantic memory, the emotion schemas are part of the individual’s general
body of knowledge, in subsymbolic as well as symbolic forms, concerning the
interpersonal world as this impinges on them. In contrast, the specific mem-
ories from which the schemas are constructed, like many episodic memories,
carry with them actual arousal of the components of the schema, including
the bodily components—​usually in trace form. Suddendorf and Corballis
(2007), Tulving (2002) and others refer to episodic memory as mental time
travel; here the concept is extended to emotional time travel, involving acti-
vation of the affective-​bodily-​cognitive assembly associated with exemplars
of emotion schemas, playing out in specific memories or fantasies of oneself
with particular people, in a particular time and place.

Emotion schemas and current theories of emotion

The core understanding of emotion schemas proposed here, as based on
bodily and sensory responses to people and objects in the world, and the role
of episodes in the formation and organization of emotions, is compatible with
many current theories; here we’ll briefly review several different approaches
that incorporate these concepts.

Scherer and the “intentional object”

According to the formulation of Scherer and his colleagues (Deonna &
Scherer, 2010; Scherer, 2001), emotions are elicited when something happens
that people appraise as linked to their needs, goals, values, and general well-
being. They discuss this “something happening” as the intentional object: spe-
cific stimuli or events that may be perceived, remembered, or imagined. The
emotion-​evoking events produce states of action readiness, which may lead
to action or suspend action, and which involve several subsystems, including
preparation of somato-​visceral and motoric systems. Emotions may be (but
 The power of language in emotional life 83

are not necessarily) felt subjectively, and may exert control over attentional
pathways.
The subsystems combine to form emotional episodes. The profiles of emo-
tional episodes may correspond to emotions that are given category labels
in ordinary language, but are not restricted to limited sets of prototypical
patterns:

Obviously, the small number of basic or modal emotions (something

between 6 and 14 depending on the theorists) is hardly representative for
the range of human (or possibly even animal) emotionality. I have argued
… that there are as many different emotions as there are distinguishably
different profiles of appraisal with corresponding response patterning.
(Scherer, 2005, p. 707)

Core affect, the object and the emotion episode: Russell’s conceptual framework
From a contrasting perspective, Russell (2003) proposes a conceptual frame-
work whose two primitives are core affect and perception of affective quality;
his other concepts are defined in terms of those. For Russell, like Scherer, the
component processes are seen as cohering in emotion episodes. In Russell’s
formulation, the episodes begin with an antecedent event that is perceived in
terms of its affective quality, and that dramatically alters core affect. Other
components of an emotional episode identified by Russell may include
appraisal, based on perceptual-​cognitive processing of the Object; instrumental
action directed at the Object; physiological and expressive changes, including
facial, vocal, and autonomic changes; and subjective experiences, including
metacognitive judgments.
As Russell states, some emotional episodes may sufficiently fit a prototype
of a specific or basic emotion to count as an instance of that emotion. As he
also emphasizes, however, the components of emotion concepts are not as
closely associated as has generally been assumed, even for what appear to be
prototypic instances of supposedly unified emotion categories such as sur-
prise (Reisenzein, 2000) and fear (LeDoux, 1996). Thus, Russell (2003, p. 166)
says:

To describe emotional life adequately, it is necessary to go beyond

prototypes. Emotional life consists of the continuous fluctuations in core
affect, in the frequent attribution of core affect to a single Object, in per-
vasive perception of affective qualities, in behaviors in response to the
Object. If these components are but weakly correlated, then very many
patterns occur. On occasion these ingredients happen to form a pattern
that fits the prototype. More often, the pattern formed does not fit any
specific prototype well. Instead the actual pattern fits various prototypes
to varying degrees …
84 Evolution of the basic theory

In a related formulation, Wilson-​Mendenhall and colleagues (2011, p. 1107)

characterize emotion concepts as “loose collections of situated exemplars.”
The contents of situated exemplars will include particular settings, agents,
objects, actions, and internal states. As the authors note, each of these
components is also represented by relevant concepts, which may be accom-
panied by various forms of limited abstraction.
The theory proposed here is compatible with these approaches (and others
that could be mentioned) in: (1) viewing emotions as based on and constructed
from specific episodes; (2) defining the class of emotional episodes as involving
sensory and bodily experience related to people or objects; and (3) recog-
nizing that emotional experience is not bound by discrete categories that can
be labeled, as represented by emotion words. The multiple code theory adds
the concept of subsymbolic experience as providing a systematic format of
information that is incorporated in emotional memory and emotional experi-
ence, and that cannot be connected directly to language. The theory of the
referential process also adds the concept that emotional experience can not
only be communicated, but can in some instances be reorganized through
verbal interaction.

Verbalization of emotion: The referential process

The challenge for verbal communication of emotion is to carry the subsymbolic
bodily and sensory processes of the affective core, realized in their continuous
format, in the discrete elements and single channel capacity of the symbolic
verbal code. In their outline of the speech chain, Denes and Pinson (1993)
describe the different forms taken by a spoken message: from the contents
of the linguistic message to the physiological speech production systems in
the speaker; from there to the physical acoustic signal; then to the listener’s
physiological reception systems and reconstruction of the linguistic message
in the listener’s mind. In our characterization of verbal emotional commu-
nication, we expand the ends of this chain to incorporate the activation of
emotional experience underlying the construction of a linguistic message by a
speaker or writer, and its connection with subsymbolic experience in a listener
or reader. We are also concerned with the inverse process, the power of lan-
guage to open new connections to imagery and subsymbolic representational
modalities in the speaker (or thinker), and to lead, potentially, to reorganiza-
tion of emotional life.
The three systems, subsymbolic, symbolic nonverbal, and symbolic
verbal, with their different contents and different organizing principles, are
connected—​ partially and to varying degrees—​ by the referential process.
This is a central human function that is necessary for adaptive functioning
and that seems to operate smoothly in most familiar, everyday contexts, but
is actually quite partial and limited in its power. The subsymbolic sensory
and somatic representations can be expressed only indirectly by the discrete,
 The power of language in emotional life 85

abstract symbols of the verbal code. The limitations of the referential process
become apparent when one attempts to verbalize an experience that one has
never verbalized before, to describe a taste or smell, or to teach an athletic or
motoric skill: Anna could not find the words to express her feelings; she could
not even find her thoughts.
Three major functions of the referential process have been identified: an
arousal function that involves activation of experience with its subsymbolic
core; a symbolizing function that includes imagery and narrative; and a
reflecting/​reorganizing (R/​R) function. The functions may often proceed
sequentially, producing the process in its full form, but may also be interrupted,
or operate recursively.
The process operates in any conversational situation and in thought for
oneself, and may also be observed in literature. The bidirectional and inter-
personal nature of the process, at both subsymbolic and symbolic levels, and
the functions of reorganization of the emotion schemas, are seen most clearly
in psychotherapy. Each of the functions of the process is characterized by
recognizable and measurable features of language style. We will first describe
these functions and review empirical evidence for them, then describe sev-
eral computerized language measures that have been developed to trace this
process.

Arousal of a schema
The process begins with arousal of an emotion schema with its bodily
components. The schema may be activated by a smell, a song, a sight, or
another event, sometimes without the person being directly aware of the source
of the feeling, and often without being able to name an emotion. Emotion may
be communicated on the subsymbolic level in this phase, through modalities
such as body movement, gesture and facial expression, without the experi-
ence being formulated in verbal form. In response to Anna’s distress, Vronsky
becomes pale, his lower jaw trembles; Anna bows her head, becomes limp,
and falls to the floor at his feet. Anna certainly has thoughts at this time, but
she does not recognize them as such because they are subsymbolic in form.

Symbolizing: Connection to the symbolic mode

In the activated networks of the emotion schemas, the bodily and sensory
experiences may lead to retrieval or construction of imagery of a specific
event. These may be autobiographical memories with varying degrees of ver-
idicality, or constructions such as fantasies or daydreams built on elements of
such experiences. The emotional time travel that is associated with episodic
memory is central to this phase. The person may describe the event in words
without knowing its emotional meaning or why it has come to mind. A young
man comes home from work upset. His friend asks what happened; he says
86 Evolution of the basic theory

“Nothing really,” then describes an incident at a department meeting: “and

when my boss spoke to me like that, she didn’t say very much, and I can’t
really describe how I felt, the only thing I can think of was that it felt like
I was in kindergarten and wet my pants and the teacher made me stand in
front of the room.”
Here is where the emotional language chain may play out; the listener
or reader is likely to feel some degree of bodily and sensory activation in
response to such descriptions of specific events. The degree of activation will,
of course, depend on each individual’s own life experience, and the degree to
which the social and cultural context of speaker and listener are shared.

Reflecting/​r eorganizing
Following the reliving of an event, and its verbal description, the speaker (or
writer) may enter a more reflective mode, perhaps recognizing relationships
among events or distinctions between them that had not previously been iden-
tified, and modulating reactions in some way. Thus new emotional meanings
may be developed and emotion schemas may be modified. In some instances,
the reflection may also include generalized descriptions or emotion category
labels. After reliving the painful event, the person may see the situation dif-
ferently: “At first I just felt terribly humiliated, but now I understand that she
was very upset about something else.” In the process of emotional experi-
ence and communication, this phase is likely to play a modulating rather than
activating role.

Evidence for the phases of the referential process

The claims concerning the referential process—​that detailed descriptions of
specific images and events are associated with activation of emotion circuitry,
while use of emotion terms and other forms of reflective language tend to
regulate and control activation—​have been supported, directly and indirectly,
in a wide range of empirical research, from different theoretical perspectives.

Effects of detailed narratives on emotional activation

Detailed descriptions of episodes, either provided by experimenters or
generated by participants, have constituted the intervention of choice for
activating emotional experience in many experimental and clinical studies.
These studies have provided evidence for the connection of such descriptions
with neural and bodily activation, and have identified some of the circuitry
involved in this activation.
In studies by appraisal researchers that are designed to map the profiles
of different emotional states, the basic design involves activation of the
emotion under study by asking participants to relive events in which the
 The power of language in emotional life 87

emotion had occurred. In procedures for administration of the Geneva

Appraisal Questionnaire (Version 3.0, 2002),3 participants are instructed to
“recall moments when you experienced an intense emotion” and to “recall as
many details as possible.” Their recall of a specific event is then the basis on
which the emotional appraisal is made, including evaluation of the emotion’s
valence and intensity, its causes and consequences, and the significance for
their lives.
In a positron-​ emission tomography (PET) experiment carried out by
Damasio and colleagues (2003) to examine the relation of emotions and
feelings to neural mappings of body states, participants were asked to think
of a particularly powerful emotional episode from their lives, to “think in
great detail about the specific episode, and to bring forth all the imagery they
could so that the emotions of that past event could be reenacted as intensely
as possible” (Damasio, 2003, p. 98). Significant patterns of activation were
found in the predicted brain regions, varying among the feelings represented
in the emotional episodes.
In several experiments by Wilson-​Mendenhall and colleagues comparing
effects of dimensional and discrete emotion classifications on neural organ-
ization (Wilson-​ Mendenhall et al., 2011; Wilson-​ Mendenhall, Barrett &
Barsalou, 2013), participants listened to detailed and vivid descriptions of
events designed to induce particular emotion states in training sessions. They
then listened to shorter core versions containing the central components of
the full scenarios when in a scanner. The findings showed neural activity
in predicted brain regions correlated with ratings of subjective valence and
arousal related to the emotion categories targeted by the scenarios.
Researchers studying the neuronal circuitry underlying hyperarousal and
dissociative responses in PTSD, predominantly that associated with childhood
abuse, use a related design, characterized as a script driven, symptom-​
provocation paradigm (Lanius et al., 2006). In this paradigm, patients are
asked to construct a narrative of their traumatic experience including as many
sensory details as possible (Brand et al., 2012). The narratives are later read to
the patients during an fMRI scan, to examine patterns of corticolimbic acti-
vation associated with different forms of PTSD.
The same basic assumption concerning the impact of vivid and specific
narratives is central to many forms of exposure therapy for PTSD and other
anxiety disorders (Foa et al., 2002). Patients are asked to remember and tell
or write about their trauma memories, and instructions emphasizing specific
sensory detail are given. The power of vivid and specific narratives—​for good
or ill—​can be seen clearly here. The re-​experiencing of a traumatic experience
that is activated by the narrative may include autonomic dysregulation, intru-
sive sensory experiences, somatic symptoms, and involuntary movements,
any of which may involve extreme distress; patients may in some cases with-
draw from treatment to protect against these symptoms (Schottenbauer
et al., 2008).
88 Evolution of the basic theory

Effects of the reflecting/​r eorganizing function

In the process of reflecting/​reorganizing (R/​R), the emotional meaning of the
activated experience can be explored and perhaps understood in a new way.
The sensory and bodily activation may be attenuated. The person may be
able to step outside of the experience and see it from a different perspec-
tive; the listener (or therapist) may be able to engage with the speaker in
the process of reorganization. In Russell’s conceptual framework, the pro-
cess of self-​perception “helps place one’s current state and situation within a
broader body of knowledge, including social norms and roles,” and serves the
function of self-​regulation. In research by Lieberman and colleagues (2007),
the use of emotion labels such as “scared,” “angry,” and “happy” was found
to reduce the response of the amygdala and other limbic regions to nega-
tive emotional images. Tabibnia, Lieberman and Craske (2008) found that
affect labels produced both short-​and long-​term reduction of autonomic
reactivity. Izard et al. (2008) found that learning to label emotions facilitated
children’s emotion regulation and self-​control. This reduction of reactivity
when using emotion labels contrasts with the arousing effects of storytelling,
as outlined above.

Linguistic measures of the referential process

The theory proposed here has provided a framework for empirical linguistic
research. Each of the phases of the referential process is associated with
characteristic features of language style (Bucci & Maskit, 2007). The basic
indicators of fluctuation in the referential process are measures of the sym-
bolizing function, based on the concept of referential activity (RA), defined
in general terms as activity of the system of referential connections between
verbal and nonverbal representations; and measures that capture linguistic
qualities associated with the reflecting/​reorganizing function.
High RA language is vivid, specific, full of imagery, and evocative, the way
people speak when describing an episode that is part of a currently activated
emotion schema. RA was initially scored by trained judges using scales based
on attributes that are conceptually associated with the RA dimension: specifi-
city (quantity of detail), imagery (degree to which language evokes imagery),
clarity (organization and focus), and concreteness (degree of reference to
sensory and other bodily experience) (Bucci & Kabasakalian-​McKay 1992,
2014). Scores for the four attributes may be averaged to yield an overall RA
measure. The RA scales have been applied to many types of texts, including
brief monologues, early memories, and Thematic Apperception Test (TAT)
protocols, as well as transcripts of therapy sessions—​in studies including
populations varying on demographic and clinical dimensions. In a meta-​
analysis of 23 studies, Samstag found important relationships, with moderate
to strong effect sizes, between RA scales and capacity to connect cognitive,
 The power of language in emotional life 89

linguistic, and emotional experience, summarized in Bucci (1997). Results of

additional clinical and experimental studies using the RA scales and showing
engagement in emotional experience as represented in language style are
summarized in Bucci (1997, 2011), and Mergenthaler and Bucci (1999).

Computerized RA: The Weighted Referential Activity

Dictionary (WRAD)
Computerized procedures have been developed to model the scales, to enable
assessment of RA in large sample and longitudinal studies, and to provide
micro-​analytic tracking of fluctuation in RA within various forms of com-
municative discourse. The major computerized measure in current use, the
Weighted Referential Activity Dictionary (WRAD), is a list of 697 lexical
items, mainly extremely common function words such as pronouns, articles,
prepositions, and conjunctions that together account for approximately
85 percent of tokens in spoken language. As described in Bucci and Maskit
(2006, 2014), the WRAD was developed empirically by modeling the RA
scales on a set of 763 text segments that had been scored for the RA scales.
While the WRAD was empirically derived and its composition was not
predicted, examination of the lexical contents indicates that many of the
most frequent words with highest WRAD weights are those with the types
of functions required for describing images and telling stories.4 The five most
frequent words with weights of +1 (the highest possible weight) are the con-
junction and, the definite article the, the past tense verb was, the spatial pre-
position in, and the personal pronoun she. These are terms with the pointing
and connecting functions that are needed in describing episodes—​to locate
the objects of discourse in place and time, and to join together or relate
objects or ideas, as well as past-​tense copulative and auxiliary verbs that serve
as indicators of memory retrieval and third-​person pronouns that are used to
refer to specific other people figuring in an episode. The most frequent words
with low WRAD weights are associated with focus on oneself (the word I)
rather than pointing to objects and describing events; indicators of present
rather than past tense (such as the word is); general and abstract usage (it and
that); and disfluency indicated by the filled pause term (mm)5.

Measures of the arousal and reorganization/​

reflection phases
The arousal function
This aspect of the process is necessary for the connection of emotion and
language, but is as yet not well understood or measured. Some aspect of the
emotion schema must be activated in order to be connected to language, but
the schema is likely to be dominated by subsymbolic, bodily experience that
 90 Evolution of the basic theory

cannot be expressed in words. The speaker is likely to talk about the struggle
itself, or may attempt to label a feeling that has been activated, but with little
or no connection to what the feeling is about, or to the objects or events that
have evoked it. The following is an example from a therapy session of the lan-
guage of this phase:

There are really two things on my mind right now. One is that yesterday
sınavda after leaving, no, before I came too, I felt sort of upset and probably ner-
cıkabilir vous and then after I left, I felt, I thought I’d be alright but I felt even
worse. And, again it was almost as if I were fighting even just letting
things come into my mind that were beginning to come into my mind.
I don’t know …

A computerized measure of disfluency (DF) has been considered conceptu-

ally as an indicator of this function. The DF dictionary consists of a small
set of words that people use either when they are having difficulty commu-
nicating experience, or in some cases avoiding such communication, or that
they may also use when planning what they will say. The list includes the items
kind, know, like, mean, well, and mm (including variants such as hm, uhm) as
in passages such as, “well, mm, it’s kind of like, well, mm, you know what
I mean …,” along with incomplete words and repeated words. The speaker
may also attempt to label a feeling, but without as yet being able to express
its personal meaning or complexity. An affect dictionary has been developed
that contains words with positive valence (AFFP), including words such as
elated and playful; negative valence (AFFN), including words such as fury
and shame; and neutral affect (AFFZ), including words that involve some
kind or degree of activation without positive or negative valence, such as
excite and need. A total affect dictionary has been developed as a sum of
these components (AFFS).

Reflecting/​r eorganizing (R/​R )

The earlier measure of the reflecting/​reorganizing function was the reflection
dictionary (REF), constructed using standard procedures for computerized
content analysis, based on judges’ ratings of single words as to degree of
association with mental functions. As applied in several studies, REF has
been interpreted as an indicator of regulating emotional experience, or in
some instances as distancing or even avoiding such experience, related to
processes of intellectualizing. (Bucci & Maskit, 2007; Bucci, Maskit, &
Hoffman, 2012).
The new Weighted Reflecting/​Reorganizing List (WRRL) has now been
developed as a more comprehensive measure of the R/​R function, using an
approach similar to that applied in development of the WRAD. The WRRL
was designed to capture the style of language associated with the functions
 The power of language in emotional life 91

of exploring and reflecting on emotional meanings. The construction of the

WRRL involved an iterative process of writing and rewriting a scoring manual
and having judges score sets of texts and computing reliability. A description
of this process, along with the resulting manual, judges’ scores, outline of the
final WRRL dictionary, and tests of its validity, can be found in Zhou and
colleagues (2021, in press). As outlined in the WRRL manual, the measure
assesses the degree to which a speaker (or writer) is trying to recognize and
understand the emotional significance of an experience or image that they
have thought or talked or written about.

Validation of the computerized measures

In a study by Zhou, Maskit, Bucci, Murphy and Fishman (2021, in press),
WRAD and measures derived from WRAD have been shown to be highly
correlated with a widely used measure of episodic memory based on amount
of detail in narrative description (Levine et al., 2002). The WRAD measures
have also been shown to be highly correlated with a measure of narrativity
indicated by temporal sequence (two past-​tense main clauses spoken in the
temporal order of remembered events) (Labov, 1997; Nelson, Moskovitz &
Steiner, 2008; Nelson et al., 2009).
A study was conducted by Kingsley (2009) to examine the validity of
the computer measures in relation to the theory of the referential process.
Clinical judges rated excerpts from psychotherapy sessions for each of the
three functions of the process, using standard definitions of the functions.
The data were reanalyzed using the modern version of DAAP and including
the new WRRL measure, which was not available at the time of Kingsley’s
study, as well as WRAD, affect, disfluency and other measures. As shown
by Maskit (2021, in press), the only measure showing a positive relationship
to the arousal function was the affect sum (mean AFFS) with a moderate
correlation of .368. As expected, mean WRAD showed a strong positive cor-
relation with judges’ ratings of the symbolizing function (r = .624) and nega-
tive correlations with the other functions. The reflecting/​reorganizing (R/​R)
function was characterized by strong positive correlations with mean WRRL
(r = .570) and mean AFFS (also r = .570). These results support the value
of the WRRL measure in representing the process of stepping back from
immersion in an emotional experience that has been activated, and seeking
new meaning for this experience.
WRAD, DF, and other computerized language measures were applied to
both patient and analyst speech in a study of sixteen fully transcribed sessions
of a recorded long-​term psychoanalysis (Bucci & Maskit, 2007). Patient mean
WRAD showed a positive correlation (r = .538) with judges’ ratings of session
effectiveness based on processes such as exploration, integration, and devel-
opmental progression, indicating greater activity of the referential process in
sessions judged by clinicians as more effective.
 92 Evolution of the basic theory

Studies of notes of treatments by candidates under supervision at the

New York Psychoanalytic Society and Institute were carried out by Bucci,
Maskit, and Hoffman (2012). A strong positive relationship (r = .73) was
found between variation in mean high WRAD (MHW)6 and a composite
measure of treatment effectiveness based on the Global Assessment of
Functioning (GAF) and the Psychodynamic Functioning Scales of Høglend
and colleagues (2006). The findings support a relationship between the nature
of the candidate’s subjective experience of the case as represented in their
notes and the effectiveness of their clinical work.
The computerized measures have also been applied to verbatim transcripts
of the complete nine session treatment of the client known as Miss Vib,
conducted by Carl Rogers. The treatment was referred to by Rogers (1947)
to illustrate his theory of personality, and discussed by Rogers and Kinget
(1965) as illustrating Rogers’ view of the phases of the therapeutic process. As
reported by Bucci and Crisafulli (2021, in press), the mean WRRL measure
applied to client speech showed a significant increase over the course of the
treatment, and a positive correlation with the clinical measures that were used
to evaluate the client’s progress in the case, in agreement with Rogers’ discus-
sion of the case.

The Italian versions

An Italianbetween
- The connection version of WRADemotional was constructed
experience using and
techniques similar to
language is intricate
those used to construct the English-​language WRAD (Mariani et al., 2013).
The same techniques and thatinvolves
were used multiple
to constructsteps
and validate the English-​
- Emotion schema, which includes bodily and and
language WRRL were also used by Negri, Mariani sensory
others tocomponents,
construct is
and validate an Italian-​ l anguage WRRL
activated in the process (Maskit, 2021, in press). Italian
versions of unweighted DAAP dictionaries, including affect sum (AFFS) and
- Describing an image
disfluency (DF) haveor also
event beenthat embodies the schema is an important
developed.
aspect of this connection
- There are cases where individuals move away from immersion in the
Conclusions
experience
The connection to gain
of emotional a newand
experience perspective
language is aon it pro-
complex
- Images play a crucial role in representing the analogic processes
cess that involves activation of an emotion schema, including its bodily and of the
sensory components; description of an
subsymbolic system in the verbal code image or event that is an instanti-
ation of the schema; and then, in some cases, moving away from immersion
- As discrete representational
in the experience to look at it elements,
in a new way.images are connected
In representing the analogic to the
symbols of the verbal code
processes of the subsymbolic system in the discrete elements of the verbal
code, images play a pivotal role. As discrete representational
- Images, in all modalities, have sensory aspects and can operate elements, they in
connect to the symbols of the verbal code. In their sensory aspects, images,
continuous
in all modalities, connect to theas subsymbolic
well as discrete
mode, andforms
may operate in con-
- Albert Einstein's creative vision may have been enhanced
tinuous as well as discrete forms. Einstein’s creative vision by his ability
may have rested
in part on his ability to attend to and use a variety
to utilize a variety of imagery types, including both continuous and of types of imagery,
including continuous as well as categorical modes. In the famous story of
categorical modes.
 The power of language in emotional life 93

Einstein’s discovery of relativity, his insight emerged through imagining

himself running alongside a light beam. As he described his processes of
discovery in general terms:

The psychical entities which seem to serve as elements in thought are

certain signs and more or less clear images which can be “voluntarily”
reproduced and combined … taken from a psychological viewpoint,
this combinatory play seems to be the essential feature in productive
thought—​before there is any connection with logical construction in
words or other kinds of signs which can be communicated to others …
The abovementioned elements are, in my case, of visual and some of
muscular type.
(quoted in Hadamard, 1996, pp. 142–​143)

Corballis (2009) suggests a relation between episodic memory, including

mental time travel into the future as well as the past, and the evolution of
syntactic language. As he notes, communication of present shared events may
simply involve using signals to direct attention to a situation or elements of
it. In contrast, references to events at different times (or where the receiver of
the communication is not present) will require reference to particular times,
places, persons, and events. According to Corballis (2009, p. 556):

In order to represent or refer to episodic elements that are not available

in the present, we need very large vocabularies of concepts, as well as
of words to represent them. And we need rules to represent the way in
which the elements of an event are combined, and corresponding rules to
convey these combinations to others in the form of language.

In terms of Eliot’s concept of the objective correlative, the words with high
WRAD weights are those that must be used in describing a “set of objects,
a situation, a chain of events which shall be the formula of that particular
emotion.” While the objects, situations and events may vary widely, a limited
set of function words is needed to point to objects and join events, and place
them in situational contexts, “such that when the external facts, which must
terminate in sensory experience, are given, the emotion is immediately evoked”
(Eliot, 1950, p. 100). The WRAD is dominated by the deictic and other
function words that point to, locate, and join together words representing
people, places, and events that make up episodes, applying across contents.
From an evolutionary perspective, we suggest that a deictic term such
as the serves the purpose of the gesture of pointing, while the conjunction
and functions as if physically placing things together; spatial prepositions
such as in and on, and tense markers position entities in specific contexts
of place and time. In this sense, function words, like gestures, and like the
rhythms and intonation patterns of speech, are themselves transitional
94 Evolution of the basic theory

between subsymbolic and symbolic forms. The WRAD identifies these points
of connection in discourse, although the speaker or writer does use these
function words intentionally, and the listener or reader does not attend dir-
ectly to them. Similar categories, modified by the different grammatical forms
of the language, have also been found in the Italian versions of this dictionary
(Mariani et al., 2013).
The new WRRL dictionary follows the same procedure of identifying
aspects of language style associated with different mental and emotional
functions. An initial analysis of how these stylistic features operate to
reorganize and modulate emotion is presented by Zhou and colleagues (2021,
in press). Emotion category terms, such as anger, fear, or shame, can also
enable people to learn from previous instances, distinguish among different
experiences or find relationships among them that they have not seen before.
The power of language to activate and express emotion, and to change emo-
tional meanings, has been recognized, explicitly and implicitly, by scientists
and psychotherapy researchers, and by poets and writers. The processes of
retrieval and the neural pathways involved in these functions have been traced
by some researchers mentioned here and many others. As our research has
begun to show, variations in emotion circuitry find their way to functional
terms of language that are not intentionally chosen by speakers; these elem-
ents of language style also have the power to feed back to enable rewiring
of the emotion schemas themselves. The theory of multiple coding and the
referential process offers a theoretical context and a framework for empirical
research into these effects.

Acknowledgment
This chapter was initially published in Italian translation as “Il ruolo del
linguaggio nella vita emotiva”, Psicoterapia e Scienze Umane, 53 (2019), 379–​
404. It is an updated and expanded version of earlier work (Bucci, Maskit &
Murphy (2016).

Notes
1 Lyrics of popular song by M. Gordon, 1945; information downloaded from
wikipedia.org, September 5, 2013.
2 The term “subsymbolic” was taken from connectionist and parallel distributed
processing (PDP) approaches; it is used here to mean nonsymbolic, not to charac-
terize this form as less systematic or complex than symbolic forms.
3 Geneva Appraisal Questionnaire (GAQ): Format, development, and utilization
www.affective-​sciences.org/​researchmaterial. Also see Scherer (2001).
4 The full list of WRAD words in alphabetical order with their dictionary weights
can be found in Bucci and Maskit (2014).
5 The DAAP software transforms most filled pauses, such as uhm or hm, to the
word mm.
 The power of language in emotional life 95

6 This variant of the WRAD measures, also known as the Intensity Index, is
defined as the mean amount in a segment by which the WRAD curve is above its
neutral value.

References
Baldwin, M.W. (1992). Relational schemas and the processing of social information.
Psychological Bulletin, 112(3), 461–​484.
Bartlett, F. C. (1932). Remembering: A study in social psychology. Cambridge: Cambridge
University Press.
Brand, B. L., Lanius, R., Vermetten, E., Loewenstein, R. J., & Spiegel, D. (2012).
Where are we going? An update on assessment, treatment and neurobiological
research in dissociative disorders as we move toward the DSM-​5. Journal of Trauma
and Dissociation, 13(1), 9–​31.
Bretherton, I. (1994). Infants’ subjective world of relatedness: Moments, feeling
shapes, protonarrative envelopes, and internal working models. Infant Mental
Health Journal, 15(1), 36–​42.
Bucci, W. (1985). Dual coding: A cognitive model for psychoanalytic research. Journal
of the American Psychoanalytic Association, 33(3), 571–​607.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (2011). The role of subjectivity and intersubjectivity in the reconstruc-
tion of dissociated schemas: Converging perspectives from psychoanalysis,
cognitive science and affective neuroscience. Psychoanalytic Psychology, 28,
247–​266.
Bucci, W., & Crisafulli, G. (2021 in press). Linguistic measures of the therapeutic
process in Carl Rogers’ case of Miss Vib. In special issue: “Empirical and Clinical
Studies of the Referential Process”, Journal of Psycholinguistic Research.
Bucci, W., & Kabasakalian-​McKay, R. (1992). Instructions for scoring referential
activity (RA) in transcripts of spoken narrative texts. Ulm: Ulmer Textbank.
Bucci, W., & Kabasakalian-​McKay, R. K. (2014). Manual for scoring RA scales.
Retrieved from http://​dx.doi.org/​10.6084/​m9.figshare.962956
Bucci, W., & Maskit, B. (2006). A weighted dictionary for referential activity. In
J. G. Shanahan, Y. Qu, & J. Wiebe (Eds.), Computing attitude and affect in text
(pp. 49–​60). Dordrecht: Springer.
Bucci, W., & Maskit, B. (2007). Beneath the surface of the therapeutic interaction; The
psychoanalytic method in modern dress. Journal of the American Psychoanalytic
Association, 55, 1355–​1397.
Bucci, W., & Maskit, B. (2014). Weighted Referential Activity Dictionary (WRAD).
Retrieved from http://​dx.doi.org/​10.6084/​m9.figshare.962957
Bucci, W., Maskit, M., & Hoffman, L. (2012). Objective measures of subjective
experience: The use of therapist notes in process-​outcome research. Psychodynamic
Psychiatry, 40(2), 303–​340.
Bucci, W., Maskit, M., & Murphy, S. (2016). Connecting emotions and words: The
referential process. Phenomenology and Cognitive Science, 15(3), 359–​383.
Corballis, M. S. (2009). Mental time travel and the shaping of language. Experimental
Brain Research, 192, 553–​560.
96 Evolution of the basic theory

Csíkszentmihályi, M. (1990). Flow: The psychology of optimal experience. New York:

Harper & Row.
Damasio, A. R. (1994), Descartes’ error. New York: Avon Books.
Damasio, A. (2003). Looking for Spinoza: Joy, sorrow and the feeling brain. New York:
Harcourt.
Denes, P.B., & Pinson, E.N. (1993). The physics and biology of spoken language.
New York: W.H Freeman & Co.
Deonna, J. A., & Scherer, K. R. (2010). The case of the disappearing intentional
object: Constraints on a definition of emotion. Emotion Review, 2(1), 44–​52.
Eliot, T. S. (1950 [1920]). Hamlet and his problems. In T. S. Eliot, The Sacred Wood
(pp. 95–​103). London: Methuen.
Evans, J. (2007). Hypothetical thinking: Dual processes in reasoning and judgment.
Bristol: Psychology Press.
Foa, E. B., Zoellner, L. A., Feeny, N. C., Hembree, E. A., & Alvarez–​Conrad, J. (2002).
Does imaginal exposure exacerbate PTSD symptoms? Journal of Consulting and
Clinical Psychology, 70, 1022–​1028.
Hadamard, J. (1996) The mathematician’s mind: The psychology of invention in the
mathematical field. Princeton, NJ: Princeton University Press.
Høglend, P., Amlo, S., Marble, A., Bøgwald, K.-​P., Sørbye, O., Sjaastad, M. C., &
Heyerdahl, O. (2006). Analysis of the patient–​therapist relationship in dynamic
psychotherapy: An experimental study of transference interpretations. American
Journal of Psychiatry, 163(10), 1739–​1746.
Izard, C. E., King, K. A., Trentacosta, C. J., Laurenceau, J. P., Morgan, J. K.,
Krauthamer-​Ewing, E. S., et al. (2008). Accelerating the development of emotion
competence in Head Start children. Development & Psychopathology, 20, 369–​397.
Kahneman, D., & Klein, G. (2009). Conditions for intuitive expertise: A failure to dis-
agree. American Psychologist, 64(6), 515–​526.
Keller, H. (1908). The world I live in. New York: Century.
Kingsley, G. (2009). The clinical validation of measures of the referential process.
Doctoral dissertation. Retrieved from ProQuest, AAT 3377938.
Labov, W. (1997). Some further steps in narrative analysis. Journal of Narrative and
Life History, 7, 395–​415.
Lanius, R. A., Bluhm, R., Lanius, U., & Pain, C. (2006). A review of neuroimaging
studies in PTSD: Heterogeneity of response to symptom provocation. Journal of
Psychiatric Research, 40, 709–​729.
LeDoux, J. (1996). The emotional brain. New York: Touchstone.
Levine, B., Svoboda, E., Hay, J.F., Winocur, G., & Moscovitch, M. (2002). Aging
and autobiographical memory: Dissociating episodic from semantic retrieval.
Psychology and Aging, 17(4), 677–​689.
Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., &
Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala
activity in response to affective stimuli. Psychological Science, 18(5), 421–​428.
Mariani, R., Maskit, B., Bucci, W., & DeCoro, A. (2013). Linguistic measures of the
referential process in psychodynamic treatment: The English and Italian versions.
Psychotherapy Research, 23(4), 430–​447.
Maskit, B., Bucci, W., & Murphy, S. (2021, in press). Referential activity as a measure
of episodic memory. In special issue: “Empirical and Clinical Studies of the
Referential Process”, Journal of Psycholinguistic Research.
 The power of language in emotional life 97

Maskit, B. (2014). The Discourse Attributes Analysis Program (DAAP) operating

instructions. Retrieved from http://​dx.doi.org/​10.6084/​m9.figshare.947740
Maskit, B. (2021, in press). Computer measures of the referential process. In spe-
cial issue: “Empirical and Clinical Studies of the Referential Process”, Journal of
Psycholinguistic Research.
Mergenthaler, E., & Bucci, W. (1999). Linking verbal and nonverbal representations:
Computer analysis of referential activity. British Journal of Medical Psychology, 72,
339–​354.
Mulligan, K., & Scherer, K. R. (2012). Toward a working definition of emotion.
Emotion Review, 4(4), 345–​347.
Murphy, S. M. (2012). Components of the referential process as measures of
therapeutic change: Development of normative and psychometric properties.
Dissertation, Adelphi University, Institute of Advanced Psychological Studies.
Nelson, K. L., Moskovitz, D. J., & Steiner, H. (2008). Narration and vividness as
measures of event-​specificity in autobiographical memory. Discourse Processes, 45,
195–​209.
Nelson, K. L., Bein, E., Huemer, J., Ryst, E., & Steiner, H. (2009). Listening for
avoidance: Narrative form and defensiveness in adolescent memories. Child
Psychiatry and Human Development, 40, 561–​573.
Norman, D. A. (1986). Reflections on cognition and parallel distributed processing.
In Rumelhart, D.E., McClelland, J.L., & the PDP Research Group (Eds.), Parallel
distributed processing: Explorations in the microstructure of cognition (pp. 531–​546).
Cambridge, M: MIT Press.
Paivio, A. (1971). Imagery and verbal processes. New York: Holt, Rinehart and
Winston.
Pessoa, L. (2008). On the relationship between emotion and cognition. Nature, 9,
148–​158.
Phelps, E. A. (2006). Emotion and cognition: Insights from studies of the human
amygdala. Annual Review of Psychology, 57, 27–​53.
Reisenzein, R. (2000) Exploring the strength of association between the components
of emotion syndromes: The case of surprise. Cognition and Emotion, 14(1), 1–​38
Rogers, C. R. (1947). Some observations on the organization of personality. American
Psychologist, 2(9), 358–​368. doi:10.1037/​h0060883
Rogers, C., & Kinget, M. (1965). Psychothérapie et relations humaines. théorie et prat-
ique de la thérapie non-​directive. Paris: Editions Béatrice Nauwelaerts.
Rogers, T.B. (1981) A model of the self as an aspect of the human information pro-
cessing system. In N. Cantor & J.F. Kihlstrom (Eds.), Personality, cognition and
social interaction (pp. 193–​214). Hillsdale, NJ: Lawrence Erlbaum.
Ross, B. H., & Makin, V. S. (1999). Prototype versus exemplar models in cogni-
tion. In R. J. Sternberg (Ed.), The nature of cognition (pp. 205–​241). Cambridge,
MA: MIT Press.
Rumelhart, D.E., McClelland, J.L., & PDP Research Group (Eds.) (1986). Parallel
distributed processing: Explorations in the microstructure of cognition. Cambridge,
MA: MIT Press.
Russell, J. A. (2003). Core affect and the psychological construction of emotion.
Psychological Review, 110, 145–​172.
Schank, R. C, & Abelson, R. P. (1977). Scripts, plans, goals, and understanding.
Hillsdale, NJ: Lawrence Erlbaum.
98 Evolution of the basic theory

Scherer, K. R. (2001). Appraisal considered as a process of multi-​level sequential

checking. In K. R. Scherer, A. Schorr, & T. Johnstone (Eds.), Appraisal processes in
emotion: Theory, methods, research (pp. 92–​120). Oxford: Oxford University Press.
Scherer, K. R. (2005) What are emotions? And how can they be measured? Social
Science Information, 44(4), (pp. 695–​729). Thousand Oaks, CA: Sage.
Schneider, W. (1988). Structure and controlling subsymbolic processing. Behavioral
and Brain Sciences, 11, 51–​52.
Schottenbauer, M. A., Glass, C. R., Arnkoff, D. B., Tendick, V., & Gray, S. H. (2008).
Nonresponse and dropout rates in outcome studies on PTSD: Review and meth-
odological considerations. Psychiatry, 71(2), 134–​168.
Stern, D.N. (1985). The interpersonal world of the infant. New York: Basic Books.
Stern, D.N. (1994). One way to build a clinically relevant baby. Infant Mental Health
Journal, 15(1), 9–​25.
Stone, V. (2006). The moral dimensions of human social intelligence: Domain-​specific
and domain-​general mechanisms. Philosophical Explorations, 9(1), 55–​68.
Suddendorf, T., & Corballis, M. C. (2007). The evolution of foresight: What is mental
time travel, and is it unique to humans. Behavioral and Brain Sciences, 30, 299–​351.
Tabibnia, G., Lieberman, M. D., & Craske, M. G. (2008). The lasting effect of words
on feelings: Words may facilitate exposure effects to threatening images. Emotion,
8, 307–​317.
Tattersall, I. (1998). Becoming human: Evolution and human uniqueness. New York:
Harcourt Brace.
Tolstoy, L. (2000 [1878]). Anna Karenina. R. Pevear & L. Volokhonsky (Trans.).
New York: Penguin.
Tulving, E. (2002). Episodic memory: From mind to brain. Annual Review of
Psychology, 53, 1–​25.
Vygotsky, L. (1986 [1934]). Thought and language. Cambridge, MA: MIT Press.
Wilson-​Mendenhall, C. D., Barrett, L. F., Simmons, W. K., & Barsalou, L. W. (2011).
Grounding emotion in situated conceptualization. Neuropsychologia, 49, 1105–​1127.
Wilson-​Mendenhall, C.D., Barrett, L.F., & Barsalou, L.W. (2013). Neural evidence
that human emotions share core affective properties. Psychological Science, 24(6),
947–​956.
Zhou, Y., Fishman, A., Maskit, B., Bucci, W., & Murphy, S. (2021, in press).
Development of WRRL: A new computerized measure of the reflecting/​reorgan-
izing function. In special issue: “Empirical and Clinical Studies of the Referential
Process”, Journal of Psycholinguistic Research.
Part II

Clinical perspectives
on emotional communication
Chapter 6

Converging perspectives
on emotional change in the
interpersonal field

According to Loewald (1980), the process that Freud (1893) outlined as

abreaction through recollection, affective discharge, and verbalization is
beyond and deeper than the undoing of repression and involves a lifting
of unconscious processes onto a higher level of integration. As Loewald
discusses, Freud recognized in his early writings on hysteria that what is
viewed as “recovery” of a childhood memory is in fact not the recall of some-
thing forgotten, but a creative event in which something is put into words for
the first time. Because of trauma, or because of the early state of organization
of the psychical apparatus, or both, the memory was registered initially as a
body memory, on a level of integration that did not render it available for pre-
conscious or conscious integration; however a memory trace of the traumatic
event remains that may be activated in a more mature state in the treatment
process. Loewald (1980, p. 40) says:

According to the description in this early paper [Freud, 1893] a cure

occurred if the exciting event was brought to clear recollection, the
accompanying affect aroused with the recollection, and if the patient
related the event in as detailed a manner as possible and expressed his
accompanying affects in words.

Bringing the event to clear recollection with arousal of the accompanying

affect is related to what Freud talked about as abreaction, according to
Loewald: the telling of the event, expressing feelings in words, is part of what
Freud referred to as “associative absorption.” Loewald (1980, p. 40) says in a
footnote that the term “associative absorption” is a translation of the German
term assoziative Verarbeitung, containing the verb arbeiten used in the later
expression “working through”—​that is, durcharbeiten. For Loewald, and he
claims for Freud, the concepts are closely related. As Loewald emphasized,
the processes that Freud called abreaction and associative absorption remain
core elements of the therapeutic process, supplemented and often made
102 Clinical perspectives

possible, but by no means superseded, by the interpretation of defenses and

instinctual derivatives.
The theory of multiple coding and the referential process provide a general
psychological framework for understanding these processes. A vast amount
of new information is now available, particularly in the fields of cognitive
science and affective neuroscience that has helped to advance the theory and
its application in adaptive functioning, in pathology, and in the treatment
process. The first part of this chapter covers recent work on emotion activa-
tion and regulation as related to integration of schemas and different forms
of dissociative processes; the second part focuses on the functional role of
subjective and intersubjective experience as this applies to reconstruction of
dissociated schemas in the therapeutic process.

Organization of the emotion schemas: Integration and

forms of dissociation
As presented elsewhere (Bucci, 1997, 2002, 2007a, 2007b), the theory of mul-
tiple coding is based on the premise of the human organism as a multistate,
multiformat information processor with substantial but limited integration
of systems. The major systems are subsymbolic and symbolic; both may have
nonverbal and verbal components. Subsymbolic processes are systematic,
organized forms of thought, with their own formats and their own operating
systems that continue to develop throughout life, and that may occur within as
well as outside of awareness. They operate in all sensory and somatic systems,
and contribute to verbal processing as well, in forms such as prosody, speech
rhythm patterns, and modulation of intensity and pitch. The special nature of
subsymbolic processing is the continuous flow: such experience may operate
within awareness but is not broken down into discrete elements; the felt simi-
larities and relationships are known through patterning and analogy.
Symbols (in the semiotic sense used here) are discrete representations with
properties of reference and generativity—​that is, they are representations
that refer to other entities and that may be combined to generate an infinite
array of new forms; symbols may be images in all sensory modalities, or
verbal forms.
Emotion schemas are types of memory schemas, derived from repeated
interactions with other people from the beginning of life, and incorporating
all elements of the human information processing system. They differ from
other memory schemas in the dominance of the subsymbolic sensory, som-
atic, and motoric processes that make up the affective core. They are encoded
as prototypic image scenarios representing repeated interaction patterns that
involve activation of the affective core in relation to the people and events
of life: what someone did, how I felt in response, what I did, how the other
responded. People communicate emotional experience most effectively
not by saying I feel sad, I feel happy, but by telling or enacting instances
 Converging perspectives on emotional change 103

of these scenarios, the narratives of their lives. The instances of experi-

ence, told in narrative form—​like metaphors—​have the capability to carry
across the subsymbolic components of the affective core, and to arouse these
subsymbolic experiences in the other, the listener or reader.
Schematic representations of this nature are similar to the concepts we
know as object representations, or Bowlby’s (1969) concept of working
models, or Stern’s (1985) concept of representations of interactions that have
been generalized (RIGs). They are also similar to Freud’s formulation of the
concept of transference:

Let us bear clearly in mind that every human being has acquired, by the
combined operation of inherent disposition and the external influences in
childhood, a special individuality in the exercise of his capacity to love—​
that is, in the conditions which he sets up for loving, in the impulses he
gratifies by it, and in the aims he sets out to achieve in it. This forms a
cliché or stereotype in him, so to speak (or even several), which perpetu-
ally repeats and reproduces itself as life goes on, in so far as external
circumstances and the nature of the accessible love-​objects permit, and is
indeed itself to some extent modifiable by later impressions.
(Freud, 1912, pp. 105–​106)

Embedding of emotion schemas in the interpersonal context

Clusters of the emotion schemas, with their bodily, affective core, constitute
the organization and representation of the self in relation to others. We know
other people through the subsymbolic systems of the affective core. Recent
research in the areas of mirror systems (Rizzolati et al., 2002), enactive
perception (Kinsbourne & Jordan, 2009), and embodied communication
(Jordan, 2009) provides new evidence for the bodily and interpersonal foun-
dation of emotion schemas, as I discuss in detail elsewhere (Bucci, 2011b). As
this research has shown, the act of perception through which one experiences
other people inherently involves activation of one’s own motoric, sensory, and
somatic systems. The perception of an attended object (thing or person) itself
incorporates the response possibilities associated with the object, including
simulation of the experience of the other, anticipation of the other’s actions
and planning of responses to these actions. The operation of these processes
in a dyadic context enables people to plan responses to actions of others that
are pending but have not yet occurred—​in some cases, to ward off or forestall
such actions; in other instances, to facilitate or cope with them. This new
understanding of the embedding of simulation and anticipation in perception
goes well beyond traditional notions of theory of mind that involve cognitive
inference and provides a new scientific foundation for the function of inter-
subjectivity as this operates in development and in therapy (Beebe et al., 2005;
Trevarthen, 1993).
104 Clinical perspectives

The source of what is characterized as personality can be found in the

specific structure of the emotion schemas. The source of pathology can be
found in these structures as well. This is a much more individual level of
understanding personality structure than is involved in any diagnostic pro-
cedure. We need some categories for diagnostic purposes, but for treatment
purposes any categorizing procedure necessarily leaves much of the
individual’s functioning unexplained. Neither patient nor analyst can know
the structure of the individual’s emotion schemas until they play out in the
therapeutic interaction.

Integration of the emotion schemas: Evidence from

neuroscience
Healthy functioning depends on integration of the emotion schemas:
connection of our emotional and bodily feelings to the people and events of
the world so that we can use our feelings to know what is good or bad for us
and to direct our responses.1 It also depends on flexibility of the schema, the
capacity to take in new information—​to modify and elaborate the schemas in
different contexts and as our powers change.
When we consider the large and complex nature of the human associative
system, we can see this continual integration of new experience into existing
schemas as a remarkable feat. A representation of a person or an object is
processed all over the human neocortex in different sensory systems representing
multiple perceptual features such as color, shape, sound, smell, and texture, as
well as location and orientation. This information is then integrated in multi-
modal systems, forming representations of objects and events; we see and rec-
ognize and name apples, dogs, people, and places, and respond to them. These
midlevel convergence zones then feed into the hippocampus, which functions
as what Mesulam (1998) calls a superconvergence zone. It is the hippocampus,
located in the temporal lobe, that allows us to form integrated memories,
including what people say and do, and the context in which the event occurs.
Here we need to look also at the neural circuitry underlying emotional
aspects of experience, and the operation of this within the overall informa-
tion processing system. The amygdala, an almond-​shaped structure in the
limbic system with extensive connections to the hippocampus and to sensory
and prefrontal cortical areas, has a major role in the processing of emotional
information (LeDoux, 2002; Phelps, 2006). The amygdala has both innate
and learned systems for detection of dangerous and other emotionally signifi-
cant stimuli, and for responding to them, including the behavioral responses
of freezing (i.e. behavioral immobility), fight or flight, and the associated
physiological changes, including changes in blood pressure and heart rate,
and release of stress hormones such as cortisol. All these stress responses are
useful in the short run, in mobilizing bodily resources to cope with danger or
to avoid it.
 Converging perspectives on emotional change 105

When emotional arousal is moderate, activation of the amygdala also

functions to support and strengthen the encoding and consolidation of mem-
ories through connections with the hippocampus and other regions of the
explicit memory system. That is why emotional memories are more vivid and
easily retrieved. We remember our wedding day, the birth of children; we all
remember where we were on September 11, 2001; we in the United States
remember election night 2008 and inauguration Day 2009, following Barack
Obama’s election as President. The nature, intensity, and valence of the
memories are also altered continuously by events of the intervening period,
as I discuss below. The amygdala also supports its own memory system,
encoding implicit, subsymbolic and fragmentary information about emotion-
ally arousing events and the circumstances associated with them in a manner
that supports implicit learning.

Varieties of dissociative processes

Given the complexity of human information processing, we can see dissoci-
ation within the emotion schemas as inherent in the system, a function of
the same extensive and complex associative structures that give humans their
capacity for plasticity and flexibility. Convergence of different modes of pro-
cessing is only partial; the subsymbolic flow of experience can be expressed
only partially in the discrete symbolic medium of language.

Adaptive dissociation
Dissociation may occur within and between emotion schemas. In adaptive
dissociation within schemas, the subsymbolic contents of the affective core
of the schema may play out to a large extent without direction by language,
and even without attentional focus. We see such instances of adaptive and
complex subsymbolic flow in many actions of everyday life, in sports, in the
arts, as well as in emotional interchange. Natural and adaptive forms of dis-
sociation occur between as well as within emotion schemas; different contexts
activate different schemas, leading to different states of being and feeling
and different modes of response. We have different personas as professional
people, mothers (or fathers), wives (or husbands), and in the many activities of
our lives. When I am with my students, I have or try to have a role of authority
or expert; when I am taking my tango lesson, I am a novice; in either of these
situations I am very absorbed and during that period of absorption I can put
the various anxieties and concerns of my personal life out of my mind.
Many of the young Black and Latino people who move from the ethnic
and social contexts in which they have their roots to enter elite institutions
have acute experiences of complex identity shifts. The experience was particu-
larly intense for those young students who were recruited for the Ivy Leagues
in the first waves of affirmative action in the late 1960s and early 1970s.
106 Clinical perspectives

Nicholas Leman (cited by Helene Cooper) refers to a “double consciousness”

that allowed the children of 1969 to flow more easily between the world that
their skin color had bequeathed them and the world that their college degree
opened up for them (Cooper 2009). That is the group that Henry Louis Gates
refers to as the crossover generation; he was one of them:

I can’t wear my Harvard gown everywhere I go. We—​all of us in the

crossover generation—​have multiple identities …
(Henry Louis Gates, Jr. quoted in the New York Times, July 26, 2009)

Clinicians have particular personas as therapists; the nature of these per-

sonas, and the degree of their dissociation from the other personas of their
beings, is developed to some extent in their training and is a matter of interest
in itself.

Types of avoidant dissociation

In healthy functioning, the shifting that occurs in response to different situ-
ations is also embedded in a representation of an integrated self—​integrated
in the representation of one’s body in response to others, integrated in the
subjective timeline of one’s life. In contrast to adaptive dissociation, where
the schemas remain flexible, able to shift in response to different contexts,
and able to take in new information, emotional disorders are characterized
by what I call avoidant dissociation, where integration of new information
and flexibility of response are blocked. We should note that the use of the
term “avoidant” here refers to a basic process of attention being turned away
from events associated with painful experience (rather than to a particular
attachment category), and may result in a broad range of difficulties, involving
underregulation as well as overregulation of affect, as will be discussed. We
can distinguish two major types of avoidant dissociation that I term primary
and secondary dissociation.2

Primary dissociation
Primary dissociation occurs when the regulation of behavioral response to
threat is disrupted, as in extreme trauma, so that the system remains in emer-
gency mode with potentially damaging effects on bodily systems. Cortisol
dysregulation and related processes weaken the capacity of the hippocampus
to regulate the stress response, and also affect its convergence function, inter-
fering with the formation of memories. Thus the ability of the hippocampus
to regulate stress is impeded, while the operation of the amygdala to stimu-
late stress is enhanced. Images of events may be encoded in the amygdalar
memory system, but these are likely to be dissociated and fragmented to some
 Converging perspectives on emotional change 107

degree, while encoding of organized memories through hippocampal medi-

ation is disrupted.
Benjamin Busch, who was an infantry officer in the Marine Corps and
served two tours of duty in Iraq, recently wrote about his experiences under
attack in his memoir Dust to Dust:

The air was instantly gray and full of objects moving at different speeds,
some rising and others falling. Pieces of things. My arm suddenly hurt.
Time slowed. I looked at the men in the truck bed with me and saw
mostly blank expressions. Disbelief. It wasn’t until they saw their own
blood everywhere that they responded.
(Busch, 2012, p. 273)
Later he says:

Even now, as I think back on the moment, I can remember no flash or

flame. It was as if the explosion had been made entirely of dust and
sound. Just the shock of the concussion and the color of the air. The
peculiar stutter of time. The truck slowing to a stop and the impossibility
of retaliation. Cordite and dirt.
(Busch, 2012, pp. 274–​5)
Then, back at the camp:

I thought I should jump another convoy out and go ice my arm, but
a Marine looked through the holes in my sleeve and saw blood. I had
to look to be sure it was my own … I remember a low audible static in
my head. It didn’t seem to be in my ears but rather somewhere inside
my mind.
(Busch, 2012, p. 276)

This gives some idea of the form of registration of experiences where the
level of physiological stress is such as to directly affect the encoding of events.
The information is not fully oriented to time and place, it is not connected
to the self; it remains in isolated and fragmentary form, registered mostly
through amygdalar memory and within sensory association areas, not
incorporated into coherent organized episodes. The narrative is difficult for
the reader to follow, difficult to bear.
LeDoux (2002, p. 225) says about amygdalar memories:

The good news is that even when the ability to form explicit memory is
impaired, we can store useful information about harmful situations. The
bad news is that if we don’t know what it is we are learning about, those
stimuli might on later occasions trigger fear responses that will be diffi-
cult to understand and control.
108 Clinical perspectives

There is evidence that memories laid down early in life, before the hippocampal
memory system is fully developed, are also of this fragmentary nature.

Secondary dissociation
In secondary dissociation, the direct physiological effects are less acute, but
the encoding of events is impaired because of their specific meanings. The
memory may initially have been formed to some degree in integrated form,
so may be potentially available for retrieval; then aspects of the event are
avoided, rather than the integrated memory never having been encoded. The
child avoids recognition or acknowledgment of the caretaker on whom they
are dependent for love and life as also the source of their terror and the object
of their rage. There are psychic as well as physical mechanisms that enable this
avoidance. The amygdala has output connections to areas involved in motor
control that underly physical actions of flight. The amygdala also has output
connections to the prefrontal cortex that motivate and direct the organism
to turn attention away from the source of the threat; these are central to the
dissociation process. Later, when events associated with the threat occur, the
avoidant pattern will spread to these. The dilemma is that while knowledge
of the threat may be avoided, the painful or conflictual affective responses to
the source will nevertheless be activated to some degree. While the immediate
physiological effects of the threatening experience may be reduced to some
extent by this turning away, these effects are likely to occur in chronic, perva-
sive forms that are at least as damaging.
The point I want to emphasize here is that whether the dissociation is primary,
involving fragmentary memories generated by the amygdala, or secondary, the
product of avoidance, turning away from knowledge of the threat, the person is
left with unexplained bodily or motoric or affective responses that are likely to
be activated in many contexts, by stimuli that are unrecognized, whose source
cannot be known—​overwhelming arousal of feelings and response tenden-
cies, without any reason or any meaning, and without mechanisms of regula-
tion being available. The person is, in a sense, psychically lost—​having lost the
connection to what they desire or fear, and the knowledge of how to respond.

Varieties of emotional disorders

The varieties of emotional disorders may be understood as ways by which
people seek to contain or regulate painful affect, to provide meaning for their
lives, to maintain a sense of self and some connection to others while avoiding
knowledge of the connections of the affect to events in their individual lives.
Avoidance and spreading of avoidance to more and more aspects of the
world constitute the most obvious means. The person will not enter close
relationships, will not attempt demanding careers; phobias are specific cases
of such avoidance.
 Converging perspectives on emotional change 109

Even with such a widening scope of avoidance, situations associated with

the threatening events will inevitably occur, in fantasy and dreams as well as in
reality. There are multiple ways that people have devised to regulate the painful
activation, and to treat themselves when it is evoked. These include strategies
that may be generally adaptive under expectable circumstances, such as the rit-
uals on which athletes or performers rely, or patterns of immersion in social or
work activities. On a more problematic level, the many types of rigid and closed
self-​schemas that limit life can be seen as motivated to maintain dissociation or
to regulate affect when it occurs: the vision of oneself as constantly at fault, and
striving to do better; or oneself as constantly a victim, requiring special care;
the patterns of needing to be in control; or being dependent and compliant.
These may have served as life-​sustaining solutions to the problems of an earlier
time and place, but are not needed or appropriate in the individual’s current life
context. In more acute form, attempts at self-​regulation emerge as symptoms
that directly threaten life, such as addictions, somatization, eating disorders,
and self-​cutting, or violent expressions that are dangerous to others and to
society, such as religious and political fanaticism. People come to treatment
when they realize that the solutions they have devised or the scenarios they have
constructed have broken down, or are too limiting or destructive in themselves.
The various treatments that are available today operate on different levels of
the neural circuitry underlying emotional disorders. Drug treatments have a
range of effects, including regulation at the level of chemical, hormonal and
behavioral response, as well as effects on encoding of memories. Exposure
treatments aim to extinguish the conditioned responses to the situations
associated with the source (in behavioral terms, the conditioned stimulus or
CS); CBT treatments generally focus on cognitive reappraisal, restructuring the
individual’s understanding of problematic situations.
Psychodynamic therapies have been criticized by LeDoux (2002) and others
as dependent on talk or insight, involving cortical functions, and less effective
for disorders that involve amygdala related conditions and implicit functions,
compared with treatments based on forms of conditioning. As I have outlined
here, in contrast to such critiques, we now understand that all emotional
disorders involve amygdala-​related conditions, all involve subsymbolic or
implicit functions, so all treatments must be responsive to these. Freud seemed
to recognize this in the terms of his 1893 formulation as discussed by Loewald
(1980) above. In the active construction and reconstruction of the theory that
is currently underway, psychoanalytic theory and treatment have been turning
back to this understanding.

Reconstruction of dissociated schemas:

The referential process
In the framework of multiple code theory, the goal of treatment is defined
most basically as change in emotion schemas that have been dissociated. This
110 Clinical perspectives

involves taking in new knowledge about events in the world that have been
perceived as threatening in relation to one’s current situation and current
powers, but the particular nature of dissociated schemas is that they are set
up precisely to avoid such knowledge. The person will first use all means at
hand to avoid situations associated with the dreaded schema, in reality or
in imagination; then to avoid knowledge of emotional meanings should the
affective core of the schema be activated in trace form. This is a version of the
vicious circle of treatment about which Strachey wrote in 1934.
What we are now beginning to understand is that the vicious circle is the
impasse that is the opportunity—​not an obstacle to treatment, but a pathway
into the rigid and dissociated schema, although one that is tangled and full of
briars and thorns (like the Prince’s journey to awaken the Sleeping Beauty).
The trace of the dreaded schema must be activated in the session and in the
relationship in order for change to come about, but activated in such a way
that the tangle of avoidance and protection can be penetrated to some extent,
and the schema can potentially be reconstructed rather than the dissociation
being reinforced.

Phases of the referential process

The referential process involves activation and exploration, potentially leading
to change. This has three major components, characterized as arousal, sym-
bolizing and reorganizing.

• In the arousal phase, traces of the problematic dissociated emotion

schema are activated within the relationship, in the interaction of the two
participants and in different ways in the subjective experience of each.
The affective core is communicated primarily on bodily and motoric
levels; this is what I have termed emotional communication (Bucci, 2001,
2009). There is likely to be a fairly continuous flow of language during this
phase, but the language that the patient speaks—​or at least the semantic
level of the language—​is largely dissociated from the affective core that
has been aroused. The language that the analyst speaks needs to be
connected to the patient’s affective core; this must be through the analyst
experiencing the patient in their own self (Bucci, 2011; Cornell, 2007).
• In the symbolizing phase, the person talks about an episode of life, or tells
a dream or fantasy whose connection to the problematic schema may not
be recognized, or focuses on an event in the treatment relationship. The
images and narratives bring elements of the problematic emotion schema
into explicit and shareable symbolic form. The power of this phase is to
open new connections to the meaning of the painful affects; the risk is to
touch on dreaded dissociated elements of the affective core.
• Once the material is shared, and the affect is present but sufficiently
contained, there is opportunity for a reorganizing phase in which the
 Converging perspectives on emotional change 111

source and meaning of the events that make up the schema may be fur-
ther explored, new connections may be discovered, and new schemas
constructed.

The three components make up a schematic model; we look for patterning

of phases in which components of arousal, symbolizing, and reorganizing are
dominant within a session or a treatment. We do not expect the phases to
occur in clear and orderly progression throughout a session—​for example,
the movement between arousal and symbolizing is likely to be recursive as
the patient opens up small corners of the dreaded schemas, and pulls back
to absorb—​or deflect—​the effects. We are developing measures to identify
and characterize these phases in our psychoanalytic process research (Bucci
& Maskit, 2007).
To illustrate this process, I will use the case of Kurt, reported by David
Mark (2009), one of several cases presented in a symposium that included
Mark, Richard Chefetz and myself (Bucci, 2009), and will briefly explicate
some of the case material in the context of the extended version of the refer-
ential process offered here. Mark describes Kurt as an explosive and humor-
less 50-​year-​old man. For much of their work, Mark felt under tremendous
pressure to understand him; Kurt would become enraged if he did not. At the
same time, Mark says:

Kurt would insist that his experience, his pain, was beyond human com-
prehension. It didn’t help that his words, he felt, could not begin to convey
the dimensions of his experience; they inevitably trivialized it.
(Mark, 2009, p. 410)

As Mark describes their interactions in this phase of the treatment, he

found himself turning away from and becoming turned off by Kurt’s “nearly
bottomless despair and pain”; when Kurt sensed that, “he felt so abandoned,
ashamed, and enraged, that he ‘fragmented’ into rapidly shifting dissociated
self-​states” in a way that Mark experienced as disorienting and terrifying.

We can see this as a version of the activation of painful affect without

specific meaning that is associated with the arousal phase, in each
participant.

Sometimes, after such an event, Kurt would tell Mark that it felt “simple and
pure” to hate him, or to feel so unjustly injured by him. Mark says that he
would want defensively to appeal to Kurt’s overall sense and history of him,
but as he knew, there was no such “overall sense”; Kurt was entirely “in the
moment.”
Here, in focusing on a specific emotion (“simple and pure” hatred), Kurt
is providing a source for his painful activation and using the therapist in this
112 Clinical perspectives

role. The theory would define this as a move toward the symbolizing phase;
Mark does not at this point describe the process in this way.
About three months into their work, Mark received a phone call from
Kurt; as they both knew, Kurt said, he had to quit therapy because Mark was
making things worse for him. They both knew this wasn’t going to help him;
in fact it was making him crazier. Here Kurt’s avoidance is being breached; the
connection to awareness of specific threatening events is experienced as going
too far, as potentially unbearable. This is a classic danger point for dropout
from treatment, in psychodynamic and other treatment forms.
Mark asks him to consider coming back for one more session. His con-
scious thought was that he was doing the professional thing by urging Kurt to
return; he says that he was less aware at the time that he needed him to do so:

He did return and told me that in the previous session, the one that
convinced him that therapy was making him crazier, he’d had the repeated
image of a small, though unidentifiable and indeterminate, animal who
would disappear through a “funnel, a black hole.” Then, at some point
in that session, in a way that felt terrifyingly numb, he was disappearing
through that black hole. Kurt was so disoriented after that session that
even in our subsequent one, he could not recall, nor even imagine, how he
was able to return home.
(Mark, 2009, p. 411)

Over the next several years of the treatment, Kurt experienced many similar
images, always within the session; he did not experience images outside of
the session and generally felt he was not able to visualize intentionally. He
always conveyed the images angrily; they horrified and humiliated him. In his
dissociated state, Kurt was not able to think of these images as the products
of his mind or as mental products at all; he experienced them as coming from
outside himself “as meaningless, sadistic intrusions into his mind.”
The images are nonverbal manifestations of the symbolizing phase. They
are carrying out the function of this phase—​connecting to components of
the dissociated schema and arousing feelings of threat and humiliation,
almost unbearable but contained in the context of the relationship, reson-
ating in complex ways for the therapist. The images are not accepted by Kurt
as connected to the timeline of his autobiographical memory. Partly because
of this disconnection, Mark does not at first see the images as productive.
Mark’s goal for some period was to cure the patient of his images, to eradi-
cate them by explaining them away, but after a period of complex struggle
within himself he shifts to a process of using the images, helping Kurt feel
his way into them. Kurt proves to be willing and able to do this; the images
become more organized by the experience of their interaction. A pattern
occasionally emerged in their sessions in which Kurt would become silent,
and begin to look off in a way that signaled he was experiencing such an
 Converging perspectives on emotional change 113

image, having what Mark called a “waking dream.” Typically, during this
period, Mark would feel what he described as “something generic, something
between eerie amazement, interest, and mild anxiety.” At times, however, he
would find himself feeling a particular affect, which seemed unrelated to what
was going on but would “fit” with the image that Kurt would subsequently tell
him. Mark says, “I would experience an affect that felt devoid of context, of
symbolization, while he would have a visual image that, for him, was equally
devoid of feeling or cognitive meaning.” In one such instance, Mark’s feeling
was sadness, a deep sense of loss. Kurt then describes an image of Popeye
jumping on a miniature platform, flexing his muscles and sticking his tongue
out, maybe in Mark’s direction, then lying down with an implement through
his heart.
Here the symbolizing phase incorporates a simultaneously intermodal
(subsymbolic/​symbolic) and intersubjective connection. This is not mystical
but can be seen as a specimen case of the anticipatory power of embodied
communication: Mark’s perceptions incorporate feelings of sadness and loss
that are responsive to Kurt’s experience, which he has not yet told.
Kurt then has the association to a neighbor’s child who “proudly paraded
around like some action figure.” He initially experienced the association as
pleasurable, then his experience turned to sadness. He said that he felt that the
child’s parents were overly concerned with suppressing the behavior that they
saw as unruly, “maybe like his own parents had been with him” (Mark, 2009,
p. 412). From this they go on to a series of associations around Kurt having
been able to enjoy a recent social occasion, and feeling proud about this but
not having been able to express the pride explicitly in the session because
Mark saw him as more ill than he was.
Here they are expanding their associations, exploring Kurt’s fears about
what will happen to him if he feels proud—​an implement through his heart—​
and relating this to events of Kurt’s present and past life, and to aspects of
Kurt’s feelings about Mark and their relationship that had not previously
emerged. This represents extension of the narrative symbolizing into the
reorganizing phase. Through these connections, Kurt becomes able to own
his images, to see them as related to his history and himself.

Subjective awareness in the referential process

Here I want to introduce a dimension of the referential process that I have
not discussed in detail before: the operation of different forms of subjectivity,
different levels of awareness, in the several components of the process and
in both participants. Until recently, subjective awareness has remained out-
side the psychological scientific domain. Mainly because of epistemological
difficulties, level of awareness has been viewed as an epiphenomenon emer-
ging from variations in processing modality, rather than as having a particular
functional role. I have previously followed this approach, characterizing the
114 Clinical perspectives

phases of the referential process in terms of dominance of subsymbolic and

symbolic processes and degree of connection between them, independent of
subjective state.
The field of cognitive science has taken a major step forward in recent years,
finding ways to look scientifically at shifts in awareness and their implications.
LeDoux (2002, p. 191) says:

Though cognitive science provided a way of studying the mind without

getting entangled on the controversial question of consciousness, it has,
in the process of accounting for working memory, also provided a prac-
tical approach for understanding how consciousness works.

I think we need to recognize these advances in the investigation of conscious-

ness as a paradigm shift, with crucial importance for understanding the pro-
cess of change in psychoanalysis and in all psychotherapy. In addition to the
basic research by Baddeley (1986, 2000) and his colleagues on the concept of
working memory, the new approach also includes work by Tulving (2002),
Wheeler, Stuss, & Tulving (1997) and others on the concepts of autonoetic
and noetic consciousness, and Damasio’s (1994, 1999) work on levels of con-
sciousness as related to the connecting of bodily awareness and perceived
events in the world. Putting together some of this research, we can begin to
examine how consciousness plays out in the phases of the referential process,
and the role of consciousness in bringing about change in emotion schemas
that have been dissociated.

The concept of working memory

The experience that is within the domain of attention, the attentional zone,
was characterized in earlier work in cognitive psychology as short-​ term
memory and in more recent work by Baddeley (1986, 1994) and others as
working memory. In this view, working memory is not just a temporary
holding area as short-​term memory was initially conceived; rather, as its name
indicates, working memory underlies mental activity. It has the capacity to
keep different kinds of information temporarily within attention, and by so
doing enables the mental operations of integration of information across
multiple systems, including current perceptual experience, memories of the
past, and emotional activation.
On the neurophysiological level, working memory is identified as a function
of the prefrontal cortex, an overarching convergence zone that receives
connections from specialized cortical systems, from the convergence zone of
the hippocampus, and from the amygdala, and then sends connections to areas
involved in movement control. The point to emphasize here is that the same
neural region that is associated with a subjective state of attention underlies inte-
gration of multiple systems in present and past experience, including encoding
 Converging perspectives on emotional change 115

of information in long-​term memory. It is not clear that attending causes inte-

gration or that the process of connecting systems activates awareness; there is
much to say either way. The important point is that the process that enables
integration of new experience into existing emotional schemas, involving
hippocampal and amygdalar activation is associated with a particular sub-
jective state. The variation in subjectivity and the function of working memory
operates in each of the phases of the referential process, and is important for
both participants in the analytic interchange.

Role of subjective experience in the arousal phase

Looking first at the arousal phase, it is oversimplifying the nature of this
phase to characterize the processing as implicit; there is an enormous amount
of complex processing going on, at different levels of subjectivity, with
different functions. Damasio has identified several levels of nonconscious and
conscious states; his concepts of core and extended consciousness are par-
ticularly relevant to the nature of processing in the phases of the referential
process, as I have discussed previously (Bucci, 2002). According to Damasio,
consciousness—​noticing, being aware—​begins as the feeling of what happens
within the organism when the organism, the proto-​self, interacts with an
object. Core consciousness occurs “when the brain forms an imaged, non-
verbal, second-​order account of how the organism is causally affected by the
processing of an object” (Damasio, 1999, p. 192).
Following Damasio’s theory, I suggest that the particular kind of awareness
that occurs in the arousal phase of a session primarily involves connection
of one’s subsymbolic bodily and affective experience to the perception of
the other who is listening and responding. These are the specific moments
in which the patient recognizes that they are understood or not understood,
or some other interaction plays out that may not be verbalized, but that
is recognized by both. These moments will occur in working memory and
have the potential to enter and change the emotion schemas that have been
aroused, in small, incremental, usually nonverbal steps. We can see these as
the miniconnections underlying the stages of building the relationship, which
operate in awareness but whose meaning is not made explicit verbally.
Daniel Stern’s distinction between present moments of which one is simply
aware, which he calls “relational moves,” and present moments that enter con-
sciousness, which he calls “now moments,” is consistent with these differences
in the nature of subjectivity and their effects. According to Stern (2004,
p. 150), “One is aware of a relational move while it is being performed. But it
does not enter into long term memory and does not later show up in narrative
accounts as a recalled autobiographical event.” The present moments that
enter memory are what he calls the now moments and moments of meeting, in
which, Stern says, the two parties achieve an intersubjective meeting. In some
ways similar to the concept of core consciousness, Stern defines these “now
116 Clinical perspectives

moments” as events of relatively short duration (usually several seconds) that

involve some sense of self, and function to pull sequences of small, split-​
second events into coherent units. We can see these moments of awareness as
zones of working memory, with potential for integration of systems mediated
by frontal lobe activation, and consequent entry into long-​term memory.
These moments are within awareness, but not verbal, generally not readily
expressible in language, and essentially interpersonal. Each participant
experiences their recognition of the other, and also the degree to which the
other recognizes or misrepresents them, and their own reaction to that, all
largely on a subsymbolic level. The arousal phase in the early sessions of David
Mark’s treatment of Kurt can be understood in these terms: Mark describes
himself as turned off, turning away from Kurt; nevertheless, it is likely that
the embodied communication between them carried to Kurt a message of rec-
ognition that began the process of reconstructing his emotion schemas, and
provided a foundation for their subsequent mutual explorations.

Episodic memory and autonoetic awareness in the

narrative phase
The distinction between episodic and semantic memory, originally introduced
by Tulving in the 1970s and developed considerably since that time, is central
in explaining the variations in types of subjectivity that occur in treatment and
their implications. Episodic memory is knowledge of specific events, registered
on the timeline of one’s life, in the context of self-​experience. Semantic
memory is general knowledge, the representation of the encyclopedias and
dictionaries of our minds, including facts about our own life history. Both are
characterized as representational systems whose contents can be expressed
in verbal or nonverbal form, as narratives or images. (The term “semantic”
is misleading as indicating a verbal mode; this is a vestige of earlier versions
of Tulving’s model.) Remembering one’s first visit to Rome and seeing the
Coliseum at sunset from a friend’s terrace involves activation of episodic
memory; having a postcard like image of the Coliseum or knowing its history
draws on semantic memory.
According to Wheeler et al. (1997), Tulving (2002) and others, activation
of the episodic system is distinguished from semantic memory by a par-
ticular kind of subjective state that they term autonoetic awareness, a form
of awareness associated with recollecting a prior episode or state as it was
previously experienced, in its specific context of time and place, in relation to
the self. This contrasts with noetic awareness associated with the more gen-
eral state of information retrieval characterized as “knowing.” Rubin et al.
(2003) refer to a sense of reliving an experience, which they term “recollec-
tion,” as central in distinguishing autobiographical memory from generalized
retrieval of facts about the self. Episodic memory is now understood as part
of a more general mechanism that allows travel forward as well as backward
 Converging perspectives on emotional change 117

in time; Suddendorf and Corballis (1997, 2007) and Tulving (2002) refer to
this as “time travel.” Fantasies of the future, like memories of the past, can
be episodic—​specific situations occurring in a particular time and place in
relation to the self—​or semantic—​previously formulated, emerging as more
general and abstract without emotional connections. The difference in level
of awareness applies to the present—​the “here and now”—​as well (Tulving,
2002). Particular types of interactions in the session would be experienced
as autonoetic and characterized as episodic in this sense. On the neuro-
logical level, we know that episodic narratives, told in the state of autonoetic
awareness, involve activation of the prefrontal cortex with widely distributed
cortical and subcortical networks including connections to hippocampus and
amygdala. This is compatible with Damasio’s notion of extended conscious-
ness, associated with complex processing of emotional information:

Extended consciousness occurs when working memory holds in place,

simultaneously, both a particular object and the autobiographical self, in
other words when both a particular object and the objects in one’s auto-
biography simultaneously generate core consciousness.
(Damasio, 1999, p. 222)

We can see this as the basic process underlying what Bromberg (1998) writes
about in “Shadow and Substance” as allowing motoric, affective, imagistic,
and verbal elements to coalesce with narrative memory in the context of a
perceptual experience of the patient–​analyst relationship. In contrast, the
network of connections underlying semantic memory largely involves cor-
tical zones. Information stored in semantic memory might be retrieved with
lower levels of hippocampal activation and without activation of emotional
circuitry.
The difference between episodic and semantic or prototypic memory is
apparent to clinicians. There are instances in which a patient tells a story—​
which may be about a manifestly trivial event—​in vivid language as if reliving
it, sometimes feeling intense affect, more than they anticipated. The telling
is likely to open some new connections for the speaker and to evoke intense
complex feelings in the listener. There are also contrasting instances in which
patients describe experiences of abuse or trauma that are in themselves hor-
rific and shocking, and that may be consciously accessible to them, but that
are told in a way that seems strangely flat. In such instances, therapists listen
with complex emotion of a different nature—​often with horror at the situ-
ation that is depicted, but also often with discomfort, sometimes not experi-
encing the emotion that they would expect to feel in response to such terrible
experiences; sometimes feeling lethargic, even sleepy; sometimes feeling other
bodily responses that they do not understand.
In an APA demonstration tape by Jeremy Safran (2008), developed as
a demonstration of relational psychotherapy, a woman is seeking help
118 Clinical perspectives

concerning problems in her second marriage. About 10 minutes into the

session, following discussion of the second marriage, Safran asks about her
first husband; she says that he was murdered by her father; her father’s story
was that he was protecting the children, that her husband was beating them.
Safran responds that he did know about this before the taping; still, he says, it
sounds pretty traumatic and they are both talking about it in a matter of fact
way. The patient says, “It happened a long time ago, 13 years, now it is like it
happened to someone else.”
The story is told in a flat and factual way; viewers of the tape tend to hear it
with a sense of unreality, even a tendency to laugh. This is an extreme example,
but not a contrived or unrealistic one; patients have been known to tell stories
of horrendous trauma and abuse in the same flat way. From the perspective of
cognitive science, it is clear that such memories are a product of the semantic
rather than episodic memory system, known rather than remembered; told
in a state of noetic rather than autonoetic awareness, “like it happened to
someone else,” as Safran’s patient says. From the perspective of multiple code
theory, such narratives are seen as fixed scenarios registered in verbal form,
told and retold like rerunning a tape, dissociated from bodily and emotional
experience, not activating hippocampal connections to emotional systems.
Freud accounted for such memories as indicating the defense of isolation,
in some respects the converse of hysteria—​that is, rather than the traumatic
experience being repressed into the unconscious, “it is deprived of its affect,
and its associative connections are suppressed or interrupted” (Freud, 1926,
p. 120). Given the characterization of episodic memory as time travel, it is
interesting that LaPlanche and Pontalis (1973, p. 233) emphasize the loss of
the temporal context in their definition of “isolation”:

In our view, in fact, there is a good case for using the term “isolation”
solely to denote a specific defensive process which ranges from compul-
sion to a systematic and concerted attitude and which consists in the
severing of the associative connections of a thought or act—​especially its
connections with what precedes and succeeds it in time.

There are many possibilities for what a therapist might do on hearing a story
of this nature from a patient, depending on the therapist’s sense of the patient’s
capacity for affect regulation, the therapist’s own feelings and the nature of
the relationship that has been built. Even after thirteen years, a question such
as, “Where were you, where were your children, when you first heard about
this?”, which places the event in the context of time and place, might initiate
retrieval of episodic memories with the potential for opening connections to
dissociated components of the memory. The therapist will need to rely on
experience, knowledge, and subsymbolic intuitive processing to decide how to
proceed—​to encourage the retrieval of the memory, with its powers and risks
of emotional arousal—​or to maintain the dissociation.
 Converging perspectives on emotional change 119

Even where the therapist does not seek to activate the connection to epi-
sodic memory, they need to activate and reinforce the connection for their
own self. At the very least, the therapist needs to acknowledge, nonverbally or
verbally, the effect of the story on him. Not to do so would leave the patient
unacknowledged, in the same isolated interpersonal situation that contributed
to their present state. Safran appropriately does not try to open emotional
exploration in the context of the demonstration tape, but does validate his
own emotional response by reflecting on the matter-​of-​fact way in which they
are talking about this catastrophic event.
In the treatment process, moments of interaction, including moments of
disconnection or impasse that are acknowledged and worked through like
narratives, provide opportunities for the connecting processes of the symbol-
izing phase to occur—​connecting one’s own experience to the experience of
the other in the moment. Such events occurred frequently, in different forms,
in Mark’s treatment of Kurt; they may be seen as episodic events in the pre-
sent, in Tulving’s (2002) terms. The movement to episodic events incorporating
memories of the recent or distant past, with ownership by Kurt as related to
himself, on the timeline of his life, took a long time to achieve in that treatment.

The reorganizing phase

Once a story has been told, shared in an evocative form, or a moment of
impasse has been recognized, the therapist and patient together can reflect on
the emotional meanings that have been articulated. In the reorganizing phase,
the powers of language to explicate, compare, differentiate, generalize, cat-
egorize, and more may be applied; optimally, this leads to emotional know-
ledge that facilitates the generating of new memories, leading then to further
activation of emotional circuitry and a deepening of the therapeutic relation-
ship. The notion of a genetic interpretation in the context of the transference
would apply in this phase; interpretation has the capability to integrate new
emotional information into memory schemas only if episodic representations
have been activated in both participants in different ways (Bucci, 2011);
without such activation, new information may be encoded without connection
to emotional systems.

The referential process, time travel and therapeutic change

In his paper “Episodic Memory: From Mind to Brain,” Tulving (2002) elo-
quently expresses his sense of wonder at the function of episodic memory,
as a “true, even if as yet generally unappreciated, marvel of nature,” and the
power of mental time travel associated with that function:

When one thinks today about what one did yesterday, time’s arrow is bent
into a loop. The rememberer has mentally traveled back into her past,
120 Clinical perspectives

and thus violated the law of the irreversibility of the flow of time. She has
not accomplished the feat in physical reality, of course, but rather in the
reality of the mind, which, as everyone knows, is at least as important for
human beings as is the physical reality.
(Tulving, 2002, pp. 1, 2)

I suggest that the power of episodic memory is even more marvelous than
is represented in Tulving’s account. First, what Tulving calls the “reality of
the mind” needs to be viewed as the reality of the affective-​bodily-​cognitive
assembly that underlies the sense of self; the mind does not enter on its travel
in an unembodied state. The travel to the past or to the future involves the
whole system of the self, including activation in the present of sensory and
bodily experience associated with the past memory or fantasized future event.
Second, and equally crucial—​although not emphasized in Tulving’s paper—​
it may be true that remembering the past requires some form of time travel,
but it is travel to a place that has not existed as such before. The playing out
of past memory in the present is a new event in a new emotional context—​a
living, not a reliving. A major aspect of episodic memory, emphasized by
Corballis (2009), Neisser (2008) and others, is its generativity. Episodic mem-
ories are not stored or retrieved in previously constructed units; according to
Corballis (2009, p. 555), “Our memories for episodes are made up of combin-
ations of people, actions, objects, places—​along with qualities such as time of
day, weather, season, mood, emotional states and the like.”
From the perspective of the referential process, however, we can see that
the construction of episodic memory requires more than combinatorial
operations connecting elements of a memory. It is a more complex process
in which something that has been in analogic subsymbolic format emerges
as a new shape; this may be in nonverbal imagery or verbal form. The role
of such a reconstructive process is clear for schemas where primary dis-
sociation has occurred—​that is, where amygdalar memories were registered
without connection to their source—​but it also applies to all memories that
have been dissociated. This formulation, based on current research, is similar
in many ways to Freud’s early (1893) description of recollection as discussed
by Loewald (1980, p. 41) as originating in something old: “inscribed into the
organism as an unconscious memory trace (body memory),” leading to the
“creation of something new” which “had not existed in this form before.”
What is left out of Freud’s early formulation (and also of Tulving’s account)
is that the activation of an emotion schema, and the telling of a narrative, are
inherently relational acts: the speaker relates to the people who figure in the
memory or fantasy or dream, and also relates to the person who is listening
in the present. In the context of the psychoanalytic process, the patient does
not travel to the past (or future) alone. There has to be a reason and a value,
beyond self-​exploration, to telling the story in the present context. The pur-
pose and effects of telling depend on the state of the listener; the referential
 Converging perspectives on emotional change 121

process needs to be operative for both participants. Both need to be in a state

of autonoetic awareness, the mode of consciousness in which the convergence
zones are open—​experienced as an underlying core of aliveness and interest
in the moment—​and these allow the connecting process within and between
them to operate. David Mark’s patient Kurt experienced his images in the
session itself, not outside; Mark experienced Kurt’s narratives in the context
of his own emotion schemas, dominated by the past interactions with this
patient, but including a broad range of related experiences as well. Following
these interactions, the emotion schemas of both participants undergo change.

Summary and conclusions

In applying the concepts of episodic memory and time travel to the integra-
tion of emotion schemas that have been dissociated, several basic implications
emerge. First, time travel is not only mental but also bodily; the speaker (or
writer) travels in an embodied state. Next, in telling a narrative of past or
future, the traveler does not travel alone. The reality of the experience depends
on connections within each participant and between them. Further, the places
to which they are traveling, past or future, have never existed in the form that
is remembered or imagined. In the referential process, as in Freud’s early
formulations of recollection and “associative working-​over,” something that
has been in analogic subsymbolic format emerges in a new form, in nonverbal
imagery and eventually in shared verbal form.
A major claim of this chapter is that therapeutic change requires activation
of working memory. Each of the stages of the referential process involves
particular states of subjective experience, associated with activity of working
memory in both participants, and underlying particular aspects of change.
Awareness in the arousal phase is based on connection of one’s subsymbolic
bodily and affective experience to the perception of the other, and builds the
recognition of the patient that she is understood (or not understood). This is
related to core consciousness in Damasio’s terms or Stern’s concepts of “now
moments” and moments of meeting. The symbolizing phase is characterized
by autonoetic awareness, a particular kind of subjective state associated with
bringing to mind specific episodes, experienced on the timeline of autobio-
graphical memory; here, the patient begins to experience the episodes as
happening (or having happened, or fantasized as happening) to one’s self. This
involves entry into extended consciousness, in Damasio’s terms. The reorgan-
izing phase involves elaborated forms of extended consciousness, potentially
furthering integration of bodily, imagistic, and verbal elements and using the
unique powers of the verbal system to bring experiences of the past into the
shared present context.
These processes, which are inherent to psychoanalysis, constitute basic
processes of change that I claim are shared to some degree in other treatment
forms. The various stages of the process and their specific features can
122 Clinical perspectives

potentially be examined in more or less effective treatments using process

research measures, as we are doing in our research, and in basic research in
cognitive science as well.
Humans are complex beings—​ conflicted, dissociated, only partially
integrated. I would argue that psychoanalysis is the field, more than any
other, that has addressed this complexity—​at levels well beyond the marvels
of complexity that are recognized in cognitive science research. The theory
of emotional organization and emotional change that has been presented
here, like all working theories, is provisional, partial, and in need of con-
tinuing examination, elaboration, and revision. The study of the basic psy-
chological processes incorporated in this theory, with their sensory, bodily,
and relational aspects, requires arousal of affect in an interpersonal con-
text. While experimental studies are needed to address aspects of the theory,
laboratory contexts are necessarily limited with respect to such activation.
The therapeutic situation potentially provides a unique naturalistic context
for systematic study of emotional processes in a relational context. In my
own scientific time travel to the future, I have a fantasy in which knowledge
of basic psychological processes may contribute to development of more
effective treatments, and the study of these basic processes from a psychoana-
lytic perspective can contribute to the scientific knowledge of human emo-
tional information processing in its multidimensional—​partially integrated,
partially dissociated—​form.

Acknowledgments
Some of the material presented in this paper was previously presented in a
keynote address at Div. 39 of the American Psychological Association in San
Antonio, TX, in April 2009, and at the Conference within a Conference of
Division 39 of the American Psychological Association in Toronto, Canada,
in August 2009.

Notes
1 It should be emphasized that multiple code theory is a psychological model; the
concepts of the theory are psychological constructs, not neurological ones. To date,
however, the major advances in understanding emotional processes have come
from the field of affective neuroscience rather than from psychology. The theories
and observations of neuroscience are presented here as providing a source of evi-
dence for multiple code theory, along with evidence from clinical work and experi-
mental and developmental research. As in all fields, the implications of these data
are open to revision and discussion based on further evidence.
2 The multiple code concept of primary dissociation is comparable to the descrip-
tion of primary dissociation as given by van der Kolk, van der Hart and Marmar
(1996): “Memories of the trauma are initially experienced as fragments of the sen-
sory components of the event—​as visual images; olfactory, auditory, or kinesthetic
 Converging perspectives on emotional change 123

sensations; or intense waves of feelings.” (cited by Frewen & Lanius, 2006, p. 113).
These responses, cued by reminders of past traumatic events, are seen by van der
Kolk and colleagues as representing a defining diagnostic feature of PTSD and
are often associated with psychophysiological arousal, as indexed by increased
heart rate and electrical skin conductance. The multiple code concept of secondary
dissociation involves a more integrated level of initial encoding and subsequent
potential for retrieval of a memory that has particular relevance for psychosocial
treatment and is not addressed by van der Kolk and colleagues.

References
Baddeley, A. D. (1986). Working memory. Oxford: Oxford University Press.
Baddeley, A. D. (1994). Working memory: The interface between memory and cog-
nition. In D. Schacter & E. Tulving (Eds.), Memory systems 1994 (pp. 351–​367).
Cambridge, MA: MIT Press.
Baddeley, A. D. (2000). The concept of episodic memory. In A. Baddeley, J. P. Aggleton,
& M. A. Conway (Eds.), Episodic memory: New directions in research (pp. 1–​10).
Oxford: Oxford University Press.
Beebe, B., Knoblauch, S., Rustin, J., & Sorter, D. (2005). Forms of intersubjectivity in
infant research and adult treatment. New York: Other Press.
Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.
Bromberg, P. M. (1998). Shadow and substance: A relational perspective on clinical
process. In Standing in the spaces: Essays on clinical process, trauma, and dissociation
(pp. 165–​187). Hillsdale, NJ: The Analytic Press.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
20, 40–​70.
Bucci, W. (2002). The referential process, consciousness, and the sense of self.
Psychoanalytic Inquiry, 22, 766–​793.
Bucci, W. (2007a). New perspectives on the multiple code theory: The role of
bodily experience in emotional organization. In F. S. Anderson (Ed.), Bodies in
treatment: The unspoken dimension (pp. 51–​77). Hillsdale, NJ: The Analytic Press.
Bucci, W. (2007b). Dissociation from the perspective of multiple code theory: Part
I. Psychological roots and implications for psychoanalytic treatment. Contemporary
Psychoanalysis, 43, 165–​184.
Bucci, W. (2009). The sleeping analyst, the waking dreams: Commentary on papers by
Richard Chefetz and David Mark. Psychoanalytic Dialogues, 19, 415–​425.
Bucci, W. (2011a) The role of subjectivity and intersubjectivity in the reconstruction
of dissociated schemas; converging perspectives from psychoanalysis, cognitive
science and affective neuroscience. Psychoanalytic Psychology, 28, 247–​266.
Bucci, W. (2011b) The role of embodied communication in therapeutic change. In
W. Tschacher, & C. Bergomi (Eds.), The implications of embodiment: Cognition and
communication. Exeter: Imprint Academic.
Bucci, W., & Maskit, B. (2007). Beneath the surface of the therapeutic interaction: The
psychoanalytic method in modern dress. Journal of the American Psychoanalytic
Association, 55, 1355–​1397.
124 Clinical perspectives

Busch, B. (2012) Dust to Dust: A Memoir. New York: HarperCollins.

Cooper, H. (2009). Meet the new elite; not like the old. New York Times, July 26.
Corballis, M. C. (2009). Mental time travel and the shaping of language. Experimental
Brain Research, 192, 533–​560.
Cornell, W. F. (2007). Self in action: The bodily basis of self-​ organization. In
F. S. Anderson (Ed.), Bodies in treatment; The unspoken dimension (pp. 29–​49).
Hillsdale, NJ: The Analytic Press.
Damasio, A. R. (1994). Descartes’ error: Emotion, reason and the human brain.
New York: Avon Books.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace & Co.
Freud, S. (1893). On the psychical mechanism of hysterical phenomena. Standard
Edition, 2, 3–​17. London: Hogarth Press.
Freud, S. (1912). The dynamics of transference. Standard Edition, 12, 97–​108.
London: Hogarth Press.
Freud, S. (1926). Inhibitions, symptoms and anxiety. Standard Edition, 20, 87–​174.
London: Hogarth Press.
Frewen, P. A., & Lanius, R. A. (2006). Psychiatric Clinics of North America, 29,
113–​128.
Jordan, J. S. (2009). Forward-​looking aspects of perception-​action coupling as a basis
for embodied communication. Discourse Processes, 46, 127–​144.
Kinsbourne, M., & Jordan, J. S. (2009). Embodied anticipation: A neurodevelopmental
interpretation. Discourse Processes, 46, 103–​126.
LaPlanche, J., & Pontalis, J. B. (1973). The language of psychoanalysis. New York:
W. W. Norton
LeDoux, J. E. (2002). The synaptic self. New York: Viking.
Loewald, H. W. (1980). Papers on psychoanalysis. New Haven, CT: Yale University Press.
Mark, D. (2009). Waking dreams. Psychoanalytic dialogues, 19, 405–​414.
Mesulam, M.-​M. (1998). From sensation to cognition. Brain, 121, 1013–​1052.
Neisser, U. (2008). Memory with a grain of salt. In H. H. Wood, & A. S. Byatt (Eds.),
Memory: An anthology (pp. 80–​88). London: Chatto & Windus.
Phelps, E. A. (2006). Emotion and cognition: Insights from studies of the human
amygdala. Annual Review of Psychology, 57, 27–​53.
Rizzolati, G., Fadiga, L., Fogassi, L., & Gallese, V. (2002). From mirror neurons to
imitation: Facts and speculations. In A. Meltzoff & W. Prinz (Eds.), The imitative
mind (pp. 247–​266). New York: Oxford University Press.
Rubin, D. C., Schrauf, R. W., & Greenberg, D. L. (2003). Belief and recollection of
autobiographical memories. Memory & Cognition, 31, 887–​901.
Safran, J. D. (2008). Relational psychotherapy. Series 1: Systems of Psychotherapy
video series. Washington, DC: American Psychological Association.
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
Stern, D. N. (2004). The present moment in psychotherapy and everyday life.
New York: W. W. Norton.
Suddendorf, T., & Corballis, M. C. (1997). Mental time travel and the evolution of the
human mind. Genetic, Social, and General Psychology Monographs, 123, 133–​167.
Suddendorf, T., & Corballis, M. C. (2007). The evolution of foresight: What is
mental time travel, and is it unique to humans? Behavioral and Brain Sciences, 30,
299–​351.
 Converging perspectives on emotional change 125

Trevarthen, C. (1993). The self born in intersubjectivity: An infant communicating.

In U. Neisser (Ed.), The perceived self (pp. 121–​ 173). New York: Cambridge
University Press.
Tulving, E. (2002). Episodic memory: From mind to brain. Annual Review of
Psychology, 53, 1–​25.
van der Kolk, B. A., van der Hart, O., & Marmar, C. R. (1996). Dissociation and
information processing in posttraumatic stress disorder. In: B. A. Van der Kolk, A.
C. McFarlane, & L. Weisaeth, (Eds.), Traumatic stress: The effects of overwhelming
experience on mind, body, and society (pp. 303–​327). New York: The Guilford Press.
Wheeler, M. A., Stuss, D. T., & Tulving, E. (1997). Toward a theory of episodic
memory: The frontal lobes and autonoetic consciousness. Psychological Bulletin,
121, 331–​354.
Chapter 7

The primary process as a

transitional concept
New perspectives from cognitive psychology
and affective neuroscience

Behind all these uncertainties, however, there lies one new fact, whose
discovery we owe to psychoanalytic research. We have found that processes
in the unconscious or in the id obey different laws from those in the
preconscious ego. We name these laws in their totality the primary process,
in contrast to the secondary process which governs the course of events in
the preconscious, in the ego. In the end, therefore, the study of psychical
qualities has after all proved not unfruitful.
(Freud, 1940, p. 164)

In this chapter, I present a brief summary and critique of psychoanalytic

views of the primary process, then propose a new perspective on this concept
in the context of current research in cognitive psychology and affective neuro-
science. I will then go on to examine the extent to which this new formulation
accounts for psychoanalytic ideas about the primary process, and whether
and how much these ideas need to be questioned.
In their classic glossary of psychoanalytic terms, Laplanche and Pontalis
(1973) distinguish the primary and secondary processes from both the topo-
graphical and economic-​dynamic perspectives. From the topographical per-
spective, “the primary process is characteristic of the unconscious system,
while the secondary process typifies the preconscious-​ conscious system”
(1973, p. 339). From the economic-​dynamic viewpoint, the processes were
distinguished in terms of differences in the flow of psychic energy:

In the case of the primary process, psychical energy flows freely, passing
unhindered, by means of the mechanisms of condensation and displace-
ment, from one idea to another …; in the case of the secondary process,
the energy is bound at first and then it flows in a controlled manner.
(Laplanche & Pontalis, 1973, p. 339)

As they also note: “The opposition between the primary process and the
secondary process corresponds to that between the pleasure principle and the
reality principle” (Laplanche & Pontalis, 1973, p. 339). Whereas the aim of
 Primary process as a transitional concept 127

the unconscious process was to establish a perceptual identity with the original
experience of satisfaction “by the shortest available route,” through “wishful
cathexis to the point of hallucination,” the secondary process seeks thought iden-
tity “with the connecting paths between ideas, without being led astray by the
intensities of those ideas” (Freud, cited by Laplanche and Pontalis, 1973, p. 340).
From a contemporary and more eclectic perspective, Auchincloss and
Samberg (2012) define the primary and secondary processes as “two funda-
mentally different modes of representation and/​or organization of psycho-
logical life, which, at the descriptive level account for two types of ‘thought’,
different in both form and content.” As they outline these modes of psychic
life, the primary process is associated with dreams, fantasies, infantile levels
of thought, neurotic symptoms, psychotic states, and processes of free associ-
ation in treatment, as well as with creative forms of mentation in the arts and
religious rituals. The secondary process is associated with adaptive, active,
rational, mature, waking life.
Freud’s view of psychic structure and function may also be seen in rela-
tion to the ideas of philosophers, at least from Plato onward, as well as the
German philosophers of the late eighteenth and nineteenth centuries. In
The Republic, Plato describes a complex soul made of several parts—​logical,
spirited, and appetitive—​operating in more or less integrated ways. Kant’s
(2007) views concerning a tripartite model of mind, with elements of reason,
understanding, and sensibility, were prominent in German intellectual life in
the 1890s, when Freud was developing his theory in the Project for a Scientific
Psychology (1895), and in The Interpretation of Dreams (1900). Each of these
formulations struggled with related distinctions in different ways.
In Freud’s view, the different components of mind were distinguished
within a conceptual framework based on flow of psychic energy. From his
earliest formulations, and throughout the development of the metapsych-
ology, Freud continued to view the overall function of the mental apparatus
as the regulation and discharge of mental energy, and to account for the
distinction between the primary and secondary processes within this frame-
work. This is where we confront one of the central questions discussed in
this chapter. Many—​perhaps most—​contemporary analysts have rejected
the notion of psychic energy, “criticizing it as: based on multiple tautolo-
gies; misusing metaphor as fact; pervaded by contradiction, confusion and
imprecision; lacking explanatory value; reinforcing mind-​ body dualism;
and presenting a false link between psychoanalysis and neurophysiology”
(Auchincloss & Samberg, 2012, p. 78). The rejection of the energy theory
leaves the concept of the primary process without a systematic foundation. As
Holt (2002, p. 462) states, “There is no intrinsic reason why the various prop-
erties of disordered thought described by Freud constitute a theoretical unity,
once we abandon the notions of free and unneutralized cathexis.”
The association of the primary process with unconscious thought has also
been widely questioned. According to Laplanche and Pontalis (1973, p. 339),
128 Clinical perspectives

“Freud’s distinction between the primary and secondary processes is contem-

poraneous with his discovery of the unconscious processes, and it is in fact
the first theoretical expression of this discovery.” However, contemporary
analysts now recognize that both primary and secondary process thinking
occurs at all levels of awareness, as Auchincloss and Samberg (2012) note. As
Holt (2002, p. 462) states, “Freud conceded that effects of primary processing
may be seen in conscious thought products; thus occasional statements by
him limiting it to the unconscious may be disregarded.”
The association of the primary process with infantile forms of thought
has been questioned by contemporary writers as well. Dorpat (2001) views
primary process cognition as an essential aspect of relatedness, occurring
throughout life. According to Holt (2002, p. 462), “Neither primary nor sec-
ondary process is present at birth; both emerge in a child’s development.”
A paradoxical situation appears to exist, in which the defining features of
the primary process have been questioned and largely rejected by many—​
perhaps most—​contemporary psychoanalytic theorists, and in some cases
by Freud himself. Yet clinicians continue to use the concept, particularly in
accounting for the interpretation of dreams and the flow of associations.
Theorists in the humanities and related areas also continue to apply the con-
cept of primary process thought to the nature of creativity in literature and
the arts.
In attempting to provide a systematic formulation of the primary process
that is consistent with current views as understood by clinicians and as gen-
erally accepted in the humanities, I kept thinking of a discussion of measures
of transference by Lester Luborsky (1988). In his comparison of several such
measures, Luborsky said:

There might be some differences of opinion about how closely they

approximate the concept. Apropos of that, I was amused by an experi-
ence I once had. I heard two men telling riddles to each other. One riddle
seemed very appropriate to our difficulty of matching the transfer-
ence concept with each operational measure of it. The first man, Sam,
said: “I have a riddle for you. What is it that is green, hangs on a wall and
whistles?” The second man, Joe, sitting next to him, thought a while and
said: I don’t know, what?

Sam: A herring.
Joe: A herring isn’t green.
Sam: So you paint it green.
Joe: But it doesn’t hang on a wall.
Sam: So you hang it on the wall.
Joe: But it doesn’t whistle.
Sam: So who cares if it whistles?
(Luborsky, 1988, p. 136)1
 Primary process as a transitional concept 129

Here is my attempt to transpose the riddle to a characterization of the pri-

mary process. Sam says: “What kind of thought has its own systematic and
specific mechanisms, is based on the unbounded flow of psychic energy and
operates in unconscious, nonverbal, infantile and psychotic thought?” Joe
reflects for a while and then says: “I don’t know, what kind?”

Sam: The primary process, defined in terms of unbound psychic energy.

Joe: But clinicians have largely abandoned the concept of psychic energy.
Sam: So we can call it unconscious thought.
Joe: But the same processes can occur in conscious thought.
Sam: So it’s associated with nonverbal, infantile and psychotic forms of
thought.
Joe: But clinicians use the concept to account for systematic mechanisms of
thought, as in the dream-​work, and in the verbal associations of their
adult analysands.
Sam: So who cares as long as it works?
Joe sighs.

Luborsky left his riddle regarding the concept of transference essentially

unsolved. As he noted, each of the measures he was comparing embodied
“some reasonable approximation between the concept of transference and
their particular measure of it. But there might be some differences of opinion
about how closely they approximate the concept” (Luborsky, 1988, p. 136).
Here I attempt to address the riddle of the primary process as a concept
that is not defined in terms of energy flow, not necessarily associated with
unconscious thought, and not fulfilling many other features assumed to be
associated with this mode, yet viewed by many psychoanalytic clinicians as
central to clinical work.
Several writers have attempted to retain and systematize the psychic
function represented in these concepts on theoretical and clinical grounds
without reliance on energic concepts (Noy, 1969; McLaughlin, 1978). Arlow
(1958) characterizes the primary process as “a general aspect of mental
life, characterizing id, ego and superego under certain conditions” (cited
by Auchincloss & Samberg, 2012, p. 200). As Holt (2002) argues, although
Freud defined the primary process in metapsychological terms, based on
properties attributed to psychic energy, he also described clinically observ-
able properties associated with the products of this mode of thought. In his
research, Holt characterizes the primary process in terms of the intersection
of contents of wish fulfillment and formal properties of thought; he has
carried out a very extensive program of research examining the relationships
among several operational indicators of these functions, particularly as
applied to Rorschach responses.
In their discussion of current concepts that might be related to the psy-
choanalytic notion of the primary and secondary processes, Auchincloss
130 Clinical perspectives

and Samberg (2012, p. 201) refer to the multiple code theory (Bucci, 1997a,
1997b):

Borrowing from the methods of cognitive psychology, Bucci … proposed

a “multiple code theory” of processing that moves beyond the concepts
of primary and secondary process to include a symbolic verbal mode, a
symbolic nonverbal mode, and a subsymbolic mode … In Bucci’s view,
while both symbolic nonverbal and subsymbolic modes of processing
have features in common with primary process, they are neither intrinsic-
ally primitive nor associated with either wish or conflict; all three modes
of processing can be either intentional or automatic and can operate both
within and outside of awareness.

Here I examine what seems to be missing, from the perspective of clinicians,

from the formulations concerning the primary process, and its theoretical
framework by myself and others. Back to Sam and Joe:

Sam: Holt has a scoring system including concrete descriptions of primary

process functions, such as condensation and displacement, as consti-
tuting an intercorrelated cluster. Bucci has talked about distinct modes
of thought, including subsymbolic nonverbal modes, as well as imagery,
and she claims to account for some of the mechanisms of the dream-​
work in this context.
Joe: But what does all this have to do with energy, and the pleasure principle,
and unconscious and infantile modes of thought? Where is the “primary”
in primary process? Why not just discuss modes of mental organization
as psychologists do?
Sam: I’m having trouble answering you; but I know that something is missing
in what Holt and Bucci and other researchers have said.

Cognition, affect and the processes of thought

The framework of the energy model has now been widely discredited or
at best ignored by most clinicians. On the other hand, as Auchincloss and
Samberg (2012, p. 78) state:

Whatever the problems presented by the concept of psychic energy,

psychoanalysts find it hard to describe mental life without some language
for the experience of intensity or quantity, without which it is impossible
to convey aspects of any number of clinical phenomena.

I suggest that what is needed to provide an adequate account of the modes of

thought associated with the primary process, and what is missing in previous
 Primary process as a transitional concept 131

accounts is the “language for the experience of intensity or quantity” that

Auchincloss and Samberg (2012) sought.
Freud distinguished two modes of management of energy in the mental
apparatus: one in which the activation plays out directly, and the other
with the capacity to regulate and direct the arousal for advanced mental
operations. Here I propose that a new model can be developed based on
current concepts of affect activation and regulation, and their relationship to
cognitive functions, to account for the central role of emotional intensity in
psychoanalytic work, without relying on energy concepts.

The inherent role of affect in all mental operations

The nature of the interaction of affect2 and cognition is a major focus of
research in psychology and neuropsychology today. Here we confront contro-
versies and questions that parallel the problems addressed in the development
of psychoanalytic theory, and may throw some light on them as well. The early
work in cognitive psychology, inspired by computer models, viewed mental
operations as based on abstract, symbolic codes, not including representa-
tion in sensory and bodily forms, and not accounting for emotion. In recent
years, there has been increasing recognition that knowledge and reasoning are
grounded in bodily states and sensory systems, and that there is inherent inter-
action between affect and cognition (Barsalou, 2008; Niedenthal et al., 2005).
In emotion theory, functions generally classified as cognitive, including per-
ception, attention, evaluation, and others, are included in the overall category
of appraisal, defined roughly as “cognitive processes that are directed toward
what is important for the self ” (Lewis, 2005, p. 170). As Lewis also notes
(2005, p. 170):

Many theorists view emotions as response systems that coordinate

actions, affective feeling states, and physiological support conditions,
while narrowing attention to what is important, relevant, or available
to act upon … As can be seen the working definitions of appraisal and
emotion are partially overlapping, especially in terms of evaluating “what
is important.”

In previous work (Bucci, 1997a, 1997b, 2002), I have defined the organization
of emotional experience in terms of the concept of emotion schemas, types
of memory schemas built as “clusters of memories of events of one’s life
in which subsymbolic sensory, visceral, and motoric processes are activated
in relation to different people in a variety of contexts” (Bucci, Maskit, &
Murphy, 2015, p. 365). My formulation also included the role of language in
the representation of the emotion schemas. I will return to this point in the
discussion of psychoanalytic concepts of primary process thought.
132 Clinical perspectives

The recent psychological recognition of the interaction of emotion, cogni-

tion, and language is paralleled from a neurobiological perspective. The trad-
itional view of brain organization, at least since Broca’s discovery of a speech
production area, emphasized localization of function in the brain, including
distinctions between separate zones underlying emotion, cognition, and sev-
eral linguistic functions. Researchers in neuroscience, as in psychology, now
recognize pervasive integration of these functions in the brain (Damasio,
2003; Lewis, 2005; Pessoa, 2008, 2010; Phelps, 2006). According to Pessoa
(2008, p. 148), “There are no truly separate systems for emotion and cogni-
tion because complex cognitive-​emotional behavior emerges from the rich,
dynamic interactions between brain networks.” He argues (2008, p. 148) that
“emotion and cognition are only minimally decomposable in the brain, and
that the neural basis of emotion and cognition should be viewed as strongly
non-​modular”—​that is, separate brain regions cannot be uniquely identified
as specific to emotional or cognitive processes.
As discussed in detail by Pessoa, brain areas that have been viewed gener-
ally as core emotional regions do not map directly or exclusively onto affective
processes, but are involved in a wide range of functions. For example, the
amygdala, which has been viewed as an affective region strongly linked to
fear processing, is a complex structure containing more than a dozen nuclei
that are richly interconnected with many cortical areas. Amygdala activa-
tion is involved in attention, value representation, and decision-​ making,
which are generally characterized as cognitive functions (Pessoa, 2008, 2010;
Phelps, 2006).
Conversely, areas such as the prefrontal (PFC) and parietal cortices that
have been strongly associated with cognition have now been shown to be
strongly involved in emotion (Davidson et al., 2003; Nauta, 1971; Pribram,
1967). For example, Davidson and colleagues have proposed that the left PFC
is involved in approach-​related appetitive goals, and the right PFC is involved
in situations that require behavioral inhibition and withdrawal. Several func-
tional studies of the left PFC and other PFC areas have provided evidence
that cognition and emotion are integrated in these regions. Overall, there is
now considerable evidence that brain areas traditionally viewed as supporting
emotional and cognitive functions are highly interconnected in the brain,
providing strong support for the claim that affect is involved in all mental
operations.

The relation of arousal and regulation

The process of arousal begins with a psychically significant stimulus that may
be within or outside of awareness, and that leads to a complex organized
system of response including autonomic activation, endocrine and other
chemical responses, immune system effects, activation of muscles throughout
the body, focusing of attention, changes in direction and sharpness of
 Primary process as a transitional concept 133

perception, and changes in rate of response. The activating stimulus may

involve a physical threat—​a bear appearing on a mountain trail—​or may be
an important goal to be achieved—​a problem to be solved or a performance
to be given (Bucci, 2001, 2002; Damasio, 1999). To some extent, the physio-
logical and metabolic activation, including secretion of the so-​called stress
hormones, facilitates performance; the person is more alert and responsive,
senses are heightened, heart rate increases, more oxygen is available. From an
evolutionary perspective, these responses were crucial in enabling survival in
situations of extreme threat; they remain valuable in facilitating performance
in any situation.
In optimal responses, when the immediate threat has gone the organized
system of perception, autonomic activity and other bodily and psychic
activity will shift as well. There is evidence that the ability to shift attention
in response to situational demands is an important aspect of self-​regulation
(Porges, 2007). In some cases, however, people are unable to shift flexibly as
the situation changes, leading to continued high level of activation and disor-
ganization of function rather than focused response.
The relation of processes of arousal and regulation and their effects on
mental and physical health and social behavior constitute an active field of
current research. The findings in this area do not support Freud’s formula-
tion of a process of unbound arousal contrasting with a different and sep-
arate reality oriented process. There is considerable research indicating that
adequate and modulated levels of arousal are necessary for mental and behav-
ioral functioning. Kogan et al. (2014) and others have reported a quadratic
(inverted u-​shaped) relationship between level of arousal and appropriate
cognitive and social behavior. In Kogan’s research, parasympathetic activity,
measured as the degree to which the vagus nerve exerts control over heart
rate, showed a quadratic relationship to measures of prosocial functioning,
including compassion and emotional expression. According to these findings,
very high levels of vagal activity may interfere with adequate social and cog-
nitive functioning, while sustained low levels are associated with failures of
self-​regulation. This is an open and active field of research, which has the
potential to provide a systematic account for the role of affect activation and
regulation in mental life.

The role of arousal and regulation in different forms

and contents of thought
In the psychoanalytic theory of the primary process, free-​flowing energy
was associated with nonlinear, nonverbal processes, disregarding logical
connections and relation to reality, while bound and controlled energy was
associated with the operations of rational mature waking life. In attempting
to develop a new model of the relation between affect and cognition, the issue
arises concerning the operation of arousal and regulation in different modes
134 Clinical perspectives

of thought arises. Here I’ll look at this issue in relation to the several modes of
thought as specified in multiple code theory (Bucci, 1997a, 1997b).

Modes of psychic functioning in multiple code theory

Multiple code theory provides an account of human information pro-
cessing as encompassing disparate formats, characterized as subsymbolic
and symbolic, each of which may be either verbal or nonverbal. The several
modes may operate within or outside of awareness, and incorporate verbal
and nonverbal components. Each operates in its own format throughout
normal, rational adult life; the different modes are connected to a limited
degree. The connection of modes occurs through the referential pro-
cess; components of the several modes are also organized into relatively
enduring interconnected systems in memory that I have termed emotion
schemas. I briefly discuss several aspects of these concepts that are relevant
to the topics of this chapter.

Symbolic codes
Symbols are defined in multiple code theory from a general semiotic perspec-
tive as discrete representations with properties of reference and generativity—​
that is, they are representations that refer to other entities and that may be
combined to generate an infinite array of new forms.3 Symbolic forms may be
words or images in all sensory modalities. People are familiar with the con-
cept of symbolic processing; there is an implicit assumption that thought is
generally verbal, and some recognition that we may think in pictures as well.

The subsymbolic system

The subsymbolic system is less widely recognized, but is ubiquitous and dom-
inant in our daily lives. Like symbolic processing, subsymbolic processes are
systematic, organized forms of thought, with their own formats and their
own operating systems that continue to develop throughout life, and that may
occur within as well as outside of awareness. Subsymbolic processes operate
in continuous formats based largely on analogic relationships, rather than as
the representation of discrete entities or features of them. From the beginning
of life, people experience gradations in sensations and feelings to which they
are able to attend, generally without attempting to label them. This applies for
all sensory modalities and for bodily and motoric experience. Subsymbolic
processing is involved constantly in the activities of daily life, from recog-
nizing a familiar voice to entering a lane of traffic, and also accounts for com-
plex skills in sports and for creative work in sciences and the arts. Performers
in many fields and people engaged in all types of creative fields—​painters,
sculptors, musicians, athletes, dancers, actors, mathematicians, physicists, and
 Primary process as a transitional concept 135

many others—​operate in highly complex, systematic, and differentiated ways

in the subsymbolic mode.
The operations of affective arousal and regulation, their interactions, and
their effects can be seen in each of the modes of psychic functioning, including
subsymbolic, symbolic nonverbal, and symbolic verbal forms. Here I give
examples of how these play out in several types of functions that are seen as
widely different: sports, which depend on networks of largely subsymbolic
motoric and perceptual functions; creative scientific work, which generally
is viewed as the highest level of abstract thought; creative writing, which
depends on connection of affective experience to language; and in the psy-
choanalytic situation, which depends on similar processes of activation and
regulation in an interpersonal context.

The sporting scene

Serena Williams is serving for the match in the women’s final at Wimbledon
in June 2016. This is the oldest tennis tournament in the world, and widely
viewed as the most prestigious. If she wins this game, she wins her 22nd grand
slam tournament and ties the record previously set by Steffi Graf for total
grand slam wins for women in the open era. She has had a chance to tie this
record in several previous tournaments—​in the 2015 US Open, where she lost
in the semifinals to an unseeded opponent, and in the Australian and French
Opens. The announcers, themselves all former tennis stars, comment end-
lessly on the degree of pressure she must be feeling in the Wimbledon match.
Members of the viewing audience, as well as the announcers, are holding their
breath as they watch Serena, generally considered to have the all-​time best
serve in women’s tennis, begin this game. Many great players have reached
such a point in a crucial game with a significant lead and have gone on to lose
the match. Serena serves four essentially perfect points in a row, a combin-
ation of aces and net winners, wins the game and the match, and goes on to
win the tournament.
What was truly remarkable was how she was able to control her technique
perfectly at this point of intense pressure. Her skills of control, direction, dis-
guise, her feelings of her body in relation to the ball, and her opponent’s poten-
tial movements are all highly complex mental operations that have carried her
to the highest level of tennis stardom, but that have failed her many times in
the past. Speaking of her US Open loss the previous year, her coach Patrick
Mouratoglou said, “So many things were on the line, like the calendar Slam,
the 22nd, the fact that it was in New York, I mean all those things together,
this hurt her much too much” (Perrotta 2016). Serena reported having had
some sleepless nights: “Coming so close. Feeling it, not being able to quite
get there.” Then, a few days after her loss in the French Open final, Williams
told a small group of reporters that her mood had changed in an instant: “I
promise you one day I woke up and I just felt different,” she said. “I felt a
136 Clinical perspectives

relief, maybe it was like, ‘I’m not going to worry about anyone or anything,
I’m just going to worry about tennis.’ ” I suggest that whatever happened
internally enabled Serena to put aside the “many things” that were “on the
line,” to which Mouratoglou referred, and to “just worry about tennis”; this
allowed the organization of her subsymbolic processing system to operate in
an optimal manner in her crucial game at the Wimbledon final.
We can contrast Serena’s experience with the experience of the Scottish
tennis player Andy Murray. He is a hero to the British people (at least those
who care about tennis); in 2013, he was the first British man to win Wimbledon
in 77 years. According to writer Louisa Thomas, he is also “a walking existen-
tial crisis” (Thomas, 2016a).
In the second round of the 2016 Wimbledon, he played Matthias Bourgue,
an unseeded player ranked 164 in the world. As Thomas described it:

The match … began straightforwardly enough. Bourgue showed a few

flashes of flair in the fourth game, but Murray handled it—​easily, if not
calmly—​and went on to win the first set, 6–​2, and the first two games of
the second. Then came the plague of locusts, the weak forehands into the
net, the drop shots that hung in the air, the backhands curving wide, the
double faults. Murray lost the next eight straight games. For most of
the next three sets, Murray failed to put away easy winners. He hit junky
forehands and sprayed his backhand—​normally one of the very best in
the game. He netted easy volleys. His serve was a mess. He played in his
old, crouched, passive style, moving in a jerky way. He berated himself;
he gnashed his teeth; he clenched his fists and grimaced in despair. Why?
he seemed to howl. Why?
(Thomas, 2016b)

Murray eventually struggled through to win this match and went on to win
the tournament. After his victory in the final, he broke down in tears, and for
several minutes the sobbing wouldn’t stop; he was barely under control when
he stepped up to receive his trophy. It was, he later said, a happier moment
than his original Wimbledon win in 2013, when he first felt the relief of so
much pressure. Presumably, he was sufficiently able to put aside the pressure
in 2016 and, as Serena described it, just worry about his tennis. But as Thomas
said, Andy knows that he will never be able to escape the position in which the
public in his country has put him, the stage on which he must live.
Like Serena Williams and all athletes, Andy operates best at a level of acti-
vation integrated with, but not overwhelming, his great skill and technique—​
the complex, highly developed processes existing in his subsymbolic bodily
and sensory systems. The tennis announcers are constantly commenting on
the need for intensity of activation integrated with such complex mental
processes. In describing a great match, they make comments such as, “The
 Primary process as a transitional concept 137

adrenalin is pumping for both guys; such a mental battle between these
two.” On the other hand, when a player makes many errors, announcers say
something like, “The adrenalin is flowing, he needs a little more control.” As
one of the announcers at the 2016 Olympics said about Madison Keys, the
powerful young American tennis player who is beginning to come to terms
with the demands of international tennis on center court, “She is showing
more maturity; rather than pulling the trigger with her nerves, she is being
more patient with her power.” It is not that she needs to bind or discharge her
power (in the old energic terms); she needs to be more patient with it, to know
how to use her power, to let it work.

Creative scientific work

The mental processes of athletes—​like dancers, or musicians, or painters—​are
examples of mature conscious rational thought in the subsymbolic system. In
contrast, one can look at the interaction of affect and cognition in a type of
processing that generally is viewed as highly advanced in an abstract symbolic
mode, creative scientific work. Here is an excerpt from a personal interview
with a mathematician who has made a number of discoveries in his field:4

Scientific work is infused with desire. Science has to be driven; you have to
want it; it’s like being in love. The solution to the problem is the object of
desire; you have to be hungry for it. In the broadest sense, I know that a
and b are connected, I have to know how. That is all of science—​knowing
there is a connection, not knowing what the connection is, wanting to
know, having to know.

Here he focuses on the experience of activation: the objects of desire, having

to know, articulated in the terms of his area of research. The process depends
on the large body of knowledge and skill that he has accumulated in his years
of work in his field, and the activation plays out in those terms. The pro-
cess of scientific discovery requires both the activation of desire and the body
of knowledge in which it can play out. If the desire diminishes, the explor-
ation will not proceed. If the desire overwhelms the scientist’s knowledge
and reasoning powers, they may turn away temporarily, in an intuitive pro-
cess of self-​regulation. Many examples of such activation and regulation
of affect have been described by well-​known mathematicians and scientists
(Hadamard, 1945).

Connecting nonverbal experience to words in creative writing

One can see a parallel process in a writer attempting to generate an article
or a story. In his article “Draft No. 4,” The New Yorker writer John McPhee
138 Clinical perspectives

(2013) refers to the “masochistic self-​inflicted paralysis of a writer’s normal

routine”:

You are writing, say, about a grizzly bear. No words are forthcoming. For
six, seven, ten hours no words have been forthcoming. You are blocked,
frustrated, in despair. You are nowhere, and that’s where you’ve been
getting. What do you do?

As McPhee described it, the so-​called writer’s block is inherent to being a

writer: “How could anyone know that something is good before it exists?”
As he also pointed out, it isn’t all painful, only the first draft. He refers
to a “four-​to-​one ratio in writing time—​first draft versus the other drafts
combined” that has been consistent for him:

There are psychological differences from phase to phase, and the first is
the phase of the pit and the pendulum. After that, it seems as if a different
person is taking over. Dread largely disappears. Problems become less
threatening, more interesting. Experience is more helpful, as if an ama-
teur is being replaced by a professional. Days go by quickly, and not a few
could be called pleasant, I’ll admit.
(McPhee, 2013)

Just as Serena was able to stop worrying about records and slams and
New York crowds, and focus on her tennis, the creative writer moves away
from his state of dread to a state in which he can use his knowledge and skills.
On the other hand, if the work does not go well, the writer, like the creative
scientist, will turn away to regulate himself and to allow his thoughts to open
up. In a letter to his daughter, also a writer, McPhee wrote:

Dear Jenny: What am I working on? How is it going? Since you asked, at
this point I have no confidence in this piece of writing. It tries a number
of things I probably shouldn’t be trying … After four months and nine
days of staring into this monitor for what has probably amounted in
aggregate to something closely approaching a thousand hours, that’s
enough. I’m going fishing.
(McPhee, 2013)

Connecting nonverbal experience to words in the therapy

situation
The process of change in the psychoanalytic situation involves activation of
what I have termed emotion schemas. These are memory schemas that are
built up on repeated episodes of life involving connection of networks of
 Primary process as a transitional concept 139

bodily and sensory experience with people and events—​repeated instances

of feelings of desire or terror or rage or shame in relation to the people of
one’s life, starting from the beginning of life, long before language is acquired.
Instances of such connections appear in forms such as memories, fantasies,
and dream reports, and also play out in the therapeutic relationship; many of
these connections have never been represented in words. Treatment depends
on activation of an emotion schema in the context of the therapeutic rela-
tionship and its communication in language as well as in gesture, movement,
facial expression, and vocal tone.
The patient is, in some respects, in the same psychic state as the scientist
or creative writer: knowing on some level that there are connections among
several feelings or ideas, and needing to find them. Like the scientist or writer,
they are trying to construct and communicate a structure that doesn’t yet exist
in verbal, or often even in symbolic form. They tell a story that is an instance
of the activated schema, often without knowing why it comes to mind, or may
play out the schema in the relationship with the therapist. The tension and the
intensity of the psychoanalytic process for the analyst, as well as the patient,
is a product of this process.
The difference for the patient in the therapy situation is that the connection
is itself likely to be threatening; once a hint of it emerges, the patient may
not want to see it.5 The new connection to particular ideas or images may
threaten to disrupt a previous psychic organization that has provided stability
for a person’s life. The patient whose father abused her tells a dream in which
a woman plays a role. She does not want to see that her mother knew; she has
built her life on the image of a loving, protective mother. She wants to under-
stand, but the understanding threatens to destroy her psychic organization. In
many instances, as a patient associates to a dream, or as a related event plays
out in the therapeutic relationship, the painful activation becomes too intense.
The patient will do some form of turning away from the painful activation,
shutting down the connections that have been opened up, resenting the ana-
lyst, perhaps missing the next session or talking about ending the treatment.
At some point, if the process is going well, the activation will resume, leading
to new emotional meanings that are bearable, often in the context of work in
the therapeutic relationship. A reorganization of the emotion schema may
then emerge; the patient comes to see her mother’s role in a new way that
breaks through the idealization and reconstructs the loss.
In several papers, I have discussed the process of change in therapy in
terms of the referential process, which includes three major phases—​termed
affective arousal, primarily in subsymbolic form; symbolizing as nonverbal
(imagery) and verbal (narrative); and reflection/​reorganization—​in which the
patient (and therapist) seek to find meaning in the material that has been
expressed. Each of these phases requires activation of affective forms of men-
tation, without being overwhelmed by them.
140 Clinical perspectives

Summary and conclusions: What is left of the concept

of the primary process?
The basic position that affect is inherently involved in all mental operations
provides a potential meeting ground for psychoanalytic ideas with psycho-
logical and neurological research. According to current views, as I have
discussed here, affective functions are inherently involved in all we do and
think, in skilled performance and creative exploration, in areas from sports
and the arts to scientific discovery, and in every function of life. Affect is not a
function we have to restrain to think productively; it is inherently part of pro-
ductive thought. This can be seen clearly in a therapeutic context. The prob-
lematic emotion schemas, with their bodily and sensory components, need
to come alive in the session itself to enable deep emotional exploration and
allow new information to be taken in. Insight is sterile without such activa-
tion, as many analysts recognize. Stated in very general terms, when the acti-
vation is too low, the work doesn’t get started; if the activation gets too high,
the system becomes disorganized or shuts down. The therapeutic relationship
functions to facilitate emotional activation in a new context that can be seen
as different from that in which the initial threat was experienced, allowing the
arousal to be sufficiently powerful but not overwhelming. The playing out of
these functions in the referential process is the object of much of our current
empirical work on the psychotherapy process. (Bucci & Maskit, 2007; Bucci,
Maskit, & Hoffman, 2012).
The view of affect activation as needing to be bound or discharged to allow
productive thought underlies the problems with the concept of the primary
process that I have discussed in this chapter. The mechanisms of the dream
work, such as condensation with its manifestation as metaphor, are highly
developed aspects of mentation; the process of free association requires
focus and modulation, following the path of affect in memory and thought.
Freud’s insight into a form of mental organization not recognized by the clas-
sical psychology of his time was a central conceptual contribution that has
intrigued analysts and stimulated work in many fields. This is a complex type
of function that is not primary in most of the accepted senses of the word: It
occurs in adaptive, mature, rational, waking life; is associated with highly
advanced forms of reasoning and problem solving; and may develop in com-
plexity as the individual matures.
In attempting to understand the forms of thought that have been associated
with the primary process, we can be inspired by Freud’s initial conception of
primary process thought, but not limited by it. A systematic understanding
of organized thought operating outside of standard abstract verbal forms
and integrated with functions of affective arousal was not available in Freud’s
time; study of such forms of thought is now ongoing in many areas, including
neuroscience and cognitive psychology, as well as psychotherapy process
research.
 Primary process as a transitional concept 141

Notes
1 As his friends and colleagues knew (and miss very much now), Lester Luborsky
was a master at illustrating complex conceptual issues with very old jokes.
2 In this discussion, I use the words affect and emotion interchangeably, without
distinguishing between them. There is considerable controversy concerning the
definitions of these terms (and others such as feelings) that will not be discussed here.
3 This is a general definition of symbolic processing to be distinguished from Freud’s
concept of symbolism, as denoting a “mode of indirect and figurative represen-
tation of an unconscious idea, conflict or wish” (Laplanche and Pontalis, 1973,
p. 442).
4 Bernard Maskit (personal communication), whose areas are geometry and top-
ology (and who also, in the interests of full disclosure, is my husband).
5 This could be, in some sense, a difficulty for the scientist as well—​the connection,
when discovered, may contradict previous networks of knowledge and be
experienced as disruptive to intellectual organization. In many cases, for the scien-
tist, such discovery is eventually greeted with even greater excitement and desire.
In rare instances, it is possible that the scientist might choose not to recognize this
discovery if it contradicts their life’s work.

References
Arlow, J. (1958). Panel: The psychoanalytic theory of thinking. Journal of the American
Psychoanalytic Association, 6, 145–​153.
Auchincloss, E. L., & Samberg, E. (Eds.). (2012). Psychoanalytic Terms and Concepts.
New Haven, CT: Yale University Press.
Barsalou, L. W. (2008). Grounded cognition. Annual Review of Psychology, 59,
617–​645.
Bucci, W. (1997a). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (1997b). Symptoms and symbols: A multiple code theory of somatization.
Psychoanalytic Inquiry, 17, 151–​172.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
20, 40–​70.
Bucci, W. (2002). The referential process, consciousness, and the sense of self.
Psychoanalytic Inquiry, 22, 766–​793.
Bucci, W., & Maskit, B. (2007). Beneath the surface of the therapeutic interaction: The
psychoanalytic method in modern dress. Journal of the American Psychoanalytic
Association, 55, 1355–​1397.
Bucci, W., Maskit, M., & Hoffman, L. (2012). Objective measures of subjective
experience: The use of therapist notes in process-​outcome research. Psychodynamic
Psychology, 40(2), 303–​340.
Bucci, W., Maskit, M., & Murphy, S. (2015). Connecting emotions and words: The
referential process. Phenomenology and the Cognitive Sciences, 15(3), 359–​383.
Damasio, A. (1999). The feeling of what happens. New York: Harcourt Brace.
Damasio, A. (2003). Looking for Spinoza: Joy, sorrow and the feeling brain. New York:
Harcourt.
142 Clinical perspectives

Davidson, R. J., Pizzagalli, D., Nitschke, J. B., & Kalin, N. H. (2003). Parsing the
subcomponents of emotion and disorders of emotion: Perspectives from affective
neuroscience. In R. J. Davidson, K. R. Scherer, & H. H. Goldsmith (Eds.), Handbook
of affective sciences (pp. 8–​24). New York: Oxford University Press.
Dorpat, T. (2001). Primary process communication. Psychoanalytic Inquiry, 21,
448–​463.
Freud, S. (1895). Project for a scientific psychology. Standard Edition, 1, 295–39.
London: Hogarth Pres.
Freud, S. (1900). The interpretation of dreams. Standard Edition, 4 & 5. London:
Hogarth Press.
Freud, S. (1940). An outline of psycho-​ analysis. Standard Edition, 23, 144–​207.
London: Hogarth Press.
Hadamard, J. (1945). The psychology of invention in the mathematical field. Princeton,
NJ: Princeton University Press.
Holt, R. R. (2002). Quantitative research on the primary process: Method and findings.
Journal of the American Psychoanalytic Association, 50, 457–​482.
Kant, I. (2007 [1781]). Critique of pure reason, trans. F. M. Muller. Harmondsworth:
Penguin.
Kogan, A. et al. (2014). Vagal activity is quadratically related to prosocial traits, pro-
social emotions, and observer perceptions of prosociality. Journal of Personality and
Social Psychology, 107(6), 1051–​1063.
Laplanche, J., & Pontalis, J.-​ B. (1973). The language of psychoanalysis, trans.
D. Nicholson-​Smith. New York: W. W. Norton.
Lewis, M. D. (2005). Bridging emotion theory and neurobiology through dynamic
systems modeling. Behavioral and Brain Sciences, 28(2), 169–​194.
Luborsky, L. (1988). A comparison of three transference related measures applied to
the specimen hour. In H. Dahl, H. Kaechele, & H. Thomae (Eds.), Psychoanalytic
process research strategies (pp. 109–​116). New York: Springer-​Verlag.
McLaughlin, J. (1978). Primary and secondary processes in the context of cerebral
hemispheric specialization. The Psychoanalytic Quarterly, 47, 237–​266.
McPhee, J. (2013). Draft No. 4. The New Yorker, April 29.
Nauta, W. J. H. (1971). The problem of the frontal lobe: A reinterpretation. Journal of
Psychiatric Research, 8, 167–​187.
Niedenthal, P. M., Barsalou, L. W., Winkielman, P., Krauth-​Gruber, S., & Ric, F.
(2005). Embodiment in attitudes, social perception, and emotion. Personality and
Social Psychology Review, 9, 184–​211.
Noy, P. (1969). A revision of the psychoanalytic theory of the primary process.
International Journal of Psycho-​Analysis, 50, 55–​170.
Perrotta, T. (2016). Serena Williams makes history with Wimbledon win, her 22nd
Grand Slam title. Wall Street Journal, July 9.
Pessoa, L. (2008). On the relationship between emotion and cognition. Nature Reviews
Neuroscience, 9, 148–​158.
Pessoa, L. (2010). Emotion and cognition and the amygdala: From “what is it?” to
“what’s to be done?” Neuropsychologia, 48, 3416–​3429.
Phelps, E. A. (2006). Emotion and cognition: Insights from studies of the human
amygdala. Annual Review of Psychology, 57, 27–​53.
 Primary process as a transitional concept 143

Porges, S. W. (2007), The polyvagal perspective. Biological Psychology, 74, 116–​143.

Pribram, K. H. (1967). The new neurology and the biology of emotion: A structural
approach. American Psychology, 22, 830–​838.
Thomas, L. (2016a). Andy Murray versus the French. The New Yorker, May 25.
Thomas, L. (2016b). Serena Williams, Andy Murray, and a political Wimbledon. The
New Yorker, July 11.
Chapter 8

The interplay of subsymbolic

and symbolic processes
in psychoanalytic treatment
It takes two to tango, but who knows the
steps and who is the leader?

Here I explore three contrasting perspectives on the interplay of implicit

and explicit processes—​ or more basically, in my view, the interplay of
subsymbolic and symbolic systems: the concepts of maybe and extra possi-
bilities in Argentine tango as taught by my tango teacher, Dardo Galletto;
Philip Bromberg’s formulation of “ineffable” processes in the therapeutic
interaction; and concepts from phenomenology and hermeneutics building
on Freud’s concept of the nonrepressible part of the unconscious.
I will start briefly with the perspective of Argentine tango, then return in
more detail to that later. Dardo knows that I am a psychologist, so he often
calls on me in class to be a translator—​not from Spanish to English, although
that is needed as well, but somehow to help him to get from the subsymbolic
experience in his body, via language, to the bodies of his students. Since I have
devoted considerable time to investigating that process, I take it as a serious
challenge. Of course, in all cases he shows what he means through his own
movements, but he recognizes that this is not enough; he wants the right
words as well.
Dardo tells his students just to feel, not to think, not to use their minds—​
but he knows that is not exactly what he means. I cannot find a way to explain
subsymbolic processes to him or to the class, but I try to tell him that we do
have to think, but in a different way. He also frequently directs us to “feel the
ground,” use the “floor energy,” and “feel our centers,” and he assumes that
these concepts communicate something to us. He tries to have us distinguish
between focus on the vertical direction—​ankle, knee, hip, and center within
our bodies—​and horizontal moves, which involve responding to the partner
and moving together around the room. He tries to explain that we must feel
the other person, but we have to feel our own bodies first, and then feel the
other in our own bodies; that is the only way to feel the other. The center is the
point where the horizontal and vertical intersect and also where self and other
connect. Then he asks me to explain how all that works. I cannot explain
the new work on mirror neurons and embodied communication and tell him
that he seems to have discovered that, but I try to explain that psychologists,
 Interplay of processes in treatment 145

neuropsychologists, and psychoanalysts know quite a bit now about what he

is discovering in trying to communicate how to dance.
He has frequently used the concepts of “maybe” and “extra possibilities,”
and struggles to explain what they mean, or what he means by them. Both mean
we need to explore inside ourselves and feel our partners to know what to do
next. In the dance, we need to have a moment of waiting, not knowing what
is coming next (the moment of maybe) for the dancing to be real. What we do
next is not known, in a sense does not exist until the two partners construct it,
each with their separate roles. In order to let this moment happen we (tango
dancers) need to be balanced and grounded in our own bodies, and to be open to
the other at the same time, and we need to wait to know ourselves and the other
before we move. We need first to feel the parts of our bodies, how they work,
how to strengthen them; this is what allows us to be balanced and grounded.
Dardo also helps us trust that it is okay to have the moment of not knowing
what will happen next; in fact, we must have that moment. Sometimes we will
make mistakes, feel awkward; that is necessary if we are really exploring.
Once you can do all that—​feel your own body, be grounded and balanced,
feel the other, wait to move until all that comes together and connects to a
pattern—​then you can do a different kind of exploration. That is where the
extra possibilities come in. When the maybe moment is part of you, accepted
by you, happens naturally, then you will want to experiment with the steps,
to create new patterns. Here there are many interesting questions about how
the new patterns are created in both partners’ minds. Like all new ideas, the
mystery is where the new patterns come from, since they will be a surprise to
the leader as well as to the one who follows.
In my struggles to provide a connection from bodily experience in tango
to language, I have realized that tango provides a prime example of the dis-
tinction between subsymbolic and implicit or unconscious processes. We
focus intensively and explicitly on the bodily experiences and movements of
tango, within oneself and in relation to the other (and to the music, the role
of which I do not discuss here). The experience is conscious, focused, and
organized, not implicit. I will trace the significance of this process of focused
subsymbolic exploration in relation to psychoanalysis, and then return to the
tango connections.

Bromberg’s uncertainty principle and the concept of

the ineffable
In “The Analyst’s Self-​Revelation,” Philip Bromberg (2006, p. 147) says that
change “takes place not through thinking, ‘If I do this correctly, then that will
happen’ but, rather, through an ineffable coming together of two minds in an
unpredictable way.” I have referred to this as Bromberg’s uncertainty principle
(Bucci, 2010). I’ll try to deconstruct this principle and also extend it a bit:
146 Clinical perspectives

• For ineffable read subsymbolic but more than that.

• For coming together read emotional communication but more than that.
• For mind read emotion schema—​including processing in sensory and
somatic systems, not the intellectual entity sometimes thought of as mind.
• For the concept of the unpredictable, we need to distinguish several
levels: the necessary uniqueness of the moment and what the analyst
knows and brings to the moment that may help to negotiate it.

The concept of ineffable was the central theme of the panel where a previous
version of this chapter initially appeared (and of the 2008 Division 39 con-
ference as a whole). There was a related conference in Rome in July 2007 on
Psychoanalytic Theories of Unconscious Mental Functioning and Multiple
Code Theory. Two of the speakers, Giuseppe Moccia and Giuseppe Martini,
both members of the Italian Psychoanalytic Society, took us on a scholarly
guided tour of psychoanalytic and philosophical thought concerning the
domain of implicit or unconscious processes, starting with Freud’s (1915,
p. 166) original insight concerning the nonrepressible part of the uncon-
scious: “Everything that is repressed must remain unconscious; but let us state
at the very outset that the repressed does not cover everything that is uncon-
scious. The unconscious has the wider compass: the repressed is a part of the
unconscious.” Since Freud’s time, the fields of phenomenology and hermen-
eutics have more deeply studied and valorized that wider compass, as Martini
(2007) and Moccia (2007) pointed out, giving it many labels and emphasizing
many different aspects:

• the unrepresentable; the perturbing and ineffable sphere that escapes the
clarifying ambition of interpretation (Martini, 2007)
• the reality that escapes the word (Heidegger, 1982)
• the enigmatic question (Gadamer, 1989)
• the untranslatable (Ricoeur, 1970)
• the incomprehensible (both on a psychopathological level as referring to
delirium, but also in more general philosophical terms, as referring to
bodily experience) (Jaspers, 1963)
• the unthinkable, the unknown, unknowable, infinite without form
(Bion, 1962)
• the unthought known (Bollas, 1987).

There are also related concepts in the writings of Ferenczi, Winnicott, Piera
Aulagnier, Loch, Matte Blanco, Ferrari, and many others.
All these writers, philosophers, and psychoanalysts are attempting to char-
acterize the same epistemological domain, but their characterizations are
divergent and to some extent contradictory. The known that is unthought of
Bollas is different from the unknown, the unknowable of Bion. And both are
different from the incomprehensible of Jaspers and the unrepresentable of
 Interplay of processes in treatment 147

Martini. The untranslatable of Ricoeur, and Heidegger’s concept of the reality

that escapes the word are similar to one another but different from the rest.
I suggest that the conceptual struggle that we see here arises because all
these writers are still trapped in the implicit contradictions of the classical
psychoanalytic metapsychology, while explicitly they may reject this frame-
work. Freud’s formulation of two distinct systems of thought within the
psychical apparatus, including a system of thought outside the verbal cat-
egorical domain, was certainly one of his most profound insights. But in char-
acterizing this system, Freud was caught in the inconsistencies of the energy
theory that he himself had formulated, as well as in his implicit valuing of
language over nonverbal forms. On one hand, he characterized the primary
process as a systematic mode of thought, organized according to a set of
principles that he specified as the laws of the dreamwork. On the other hand,
he also characterized this system as the mode of thought associated with
unbound energy, the forces of the id, chaotic, driven by wish fulfillment and
divorced from reality. You can see this inconsistency throughout psychoana-
lytic theory, as in the comments of the writers I have mentioned here. We need
to work through some of these implicit assumptions to develop a more ver-
idical understanding of emotional meaning and emotional communication.
In the context of the cognitive psychology and neuroscience of today,
in the theoretical framework of multiple code theory, I have pointed to a
world of complex thought that is nonverbal and even nonsymbolic, that
occurs in its own systematic and organized format, primarily continuous
and analogic, that is rooted in our bodies and sensory systems, and that
can be consciously experienced and comprehended but is not directly repre-
sentable in words. Such nonsymbolic, or what I call subsymbolic, processes
occur in perception and as imagery, in motoric, visceral, and sensory forms,
in all sensory modalities. Subsymbolic processing is required for a vast array
of functions from skiing to musical performance and creative cooking—​
and for the interactions of ballroom dancing, especially Argentine tango.
Subsymbolic processing in visual and other modalities is central in creative
scientific and mathematical work; research mathematicians and physicists
understand this very well. Einstein referred to sensory and bodily, particu-
larly muscular, experiences as the basic elements of his thought (quoted in
Hadamard, 1949, pp. 142–​143).
Of greatest interest to psychoanalysis, subsymbolic processing is dominant
in emotional information processing and emotional communication—​reading
facial and bodily expressions of others, experiencing one’s own feelings and
emotions. All of these functions call for processing that is analogic and con-
tinuous, not discrete, and that occurs in specific sensory modalities, not in
abstract form. We know this processing as intuition, the wisdom of the body,
and in other related ways. The crucial information concerning our bodily
states comes to us primarily in subsymbolic form, and emotional communi-
cation between people occurs primarily in this mode. Reik’s (1964) concept of
148 Clinical perspectives

“listening with the third ear” relies largely on subsymbolic communication, as

I have discussed in detail elsewhere (Bucci, 2001).
In the context of the cognitive science of today, subsymbolic processes are
understood as organized, systematic, rational forms of thought that con-
tinue to develop in complexity and scope throughout life. They are modeled
by connectionist or parallel distributed processing systems (McClelland,
Rumelhart, & Hinton, 1989), with the features of dynamical systems.
All processing, including symbolic as well as subsymbolic processing,
may operate either within or outside of awareness. Subsymbolic processing
often operates within awareness, but we may not be able to capture it. Most
of us have not developed the skills of focusing attention on this processing
mode, although one can perhaps begin to learn to do this in meditation and
using certain feedback mechanisms, as in the devices used for self-​regulation
of blood pressure, where people learn to listen to their bodies. We are not
accustomed to thinking of processes, including sensory, motoric, and vis-
ceral processes that cannot be verbalized or symbolized, as systematic and
organized thought; the new understanding of subsymbolic processing opens
the door to this reformulation. It changes our entire perspective of pathology
and treatment when we are able to make this shift.
This formulation cuts the theoretical pie in a new way. Subsymbolic
processes are lawful and systematic, not chaotic. They are not driven by
wish fulfillment; they can be both thought and known, in the senses of Bion
and Bollas. But the specific psychical terrain that we are trying to explore
can be mapped only partially onto words; if we try to place the signposts
prematurely—​apply general mappings that have been used in other terrains—​
we will find ourselves blocked or lost. The subsymbolic processes constitute
the untranslatable, in the sense of Ricoeur; the reality that escapes the word,
in the terms of Heidegger. They are not unrepresentable but do exist in what
Martini (2007) referred to as the “perturbing and ineffable sphere that escapes
the clarifying ambition of interpretation.”
Returning to Bromberg’s uncertainty principle, I have formulated the con-
cept of “ineffable coming together” as emotional communication, which
is largely subsymbolic. For “minds,” I refer to a more complex structure,
the emotion schema, which includes components of all three processing
systems: subsymbolic processes, symbolic imagery, and later language.

Emotion schemas
Emotion schemas are types of memory structures that constitute the organ-
ization of the self in the interpersonal world. They are formed on the basis of
repeated interactions with caretakers and others from the beginning of life.
The subsymbolic sensory, somatic, and motoric representations and
processes constitute the affective core of the emotion schema—​the source
of the varieties of arousal and pleasure and pain that constitute emotional
 Interplay of processes in treatment 149

experience. In each event of life, the processes of the affective core will be
activated in relation to the people, places, and activities that figure in that
event; thus we build memories of people and events that give us pleasure or
pain, that activate happiness, or dread, or a wish to attack. Autobiographical
memory is built out of such events; this is the basis for the organization of the
self in the interpersonal world.
The emotion schemas develop in an interpersonal context; the baby who
laughs and smiles and has feelings of joy can see and hear the other person also
smiling and laughing and making the corresponding sounds; the expressions
of the other become incorporated in the schema of joy. If the child who cries
hears sympathetic sounds and sees a particular facial expression, along with
feeling a soothing touch, the child’s schemas of pain or fear will develop to
incorporate responses of turning to others and expectations that others can
help. If the caretaker typically responds to the child’s cries with annoyance or
withdrawal, schemas of negative expectations and associated responses will
develop.

Dissociation within the emotion schemas

Every person has multiple emotion schemas, including schemas of self and
schemas of others, integrated to varying degrees. Dissociations may occur
within the schemas, and among them. Some degree of dissociation is nor-
mative and necessary to allow us to function smoothly in our lives; not every
desire or expectation or response will be formulated in symbolic form (Bucci,
2007a, b). In some cases, however, dissociations occur in response to events
that are extremely painful, experienced as threats to life or to the organ-
ization of the self. With such dissociation, it is not only that we have not
made a connection to symbolic forms, not only that the schema may never
have been formulated, but that we avoid such integration. If the parent is the
source of the negative affect, acting in such a way as to elicit pain or rage
or terror in the child, this type of avoidant dissociation will occur and will
be crystallized and reinforced. We must avoid knowing who or what is the
source of the extreme pain in order to go on with life, to retain the connection
to the caretaker that is emotionally and physically essential for survival, and
to maintain a sense of self. The initial dissociation is a life-​saving event; if
the dissociation is crystallized so that new emotional information cannot be
taken in, it becomes the problem that interferes with life and brings patients
to treatment.

The unpredictability of the analytic interaction

Analyst and patient each come to the session with a set of emotion schemas,
developed in the course of their lives, affected by events of life outside
the session as well as by events within it. The interaction is inherently
150 Clinical perspectives

unpredictable, as Bromberg has said. The meeting of the emotion schemas

that have been activated is new and unique; this particular interaction with
activation of these particular emotion schemas in each participant has never
existed prior to the moment. The schemas that are activated are dominated
by the somatic and sensory experiences of the affective core rather than by
images of people and events, and in some cases will be dissociated—​certainly
for the patient, and also to a certain degree for the analyst. In such cases,
the affective core of sensory and somatic experience is not connected to the
source of the activation and the connection is avoided; thus both participants
may be aroused in particular ways and may not know why. This interactive
arousal, which is largely unsymbolized—​feelings of rage or humiliation or
despair, whose meaning is not known or is wrongly known—​is the potential
source and content of the therapeutic work; it is also the potential threat.
In a more general sense, the interaction is also unpredictable in that
therapists today must negotiate this terrain largely without the explicit trad-
itional guides of theory and technique. The analyst can no longer assume that
there is a particular repressed scenario that is guiding the patient’s experience,
that they are avoiding, and that can be uncovered. The analyst can also not
assume a set of rules and parameters that define the correct way to work.
These changes bring freedom from theories and techniques that do not fit;
they also bring the uncertainty of freedom.
Subsymbolic experience is the guide to the uncharted terrain of the analytic
interchange. Both participants must learn to follow this, to receive and send
signals that are outside the symbolic domain.

The uncertainty principle of tango

In tango, the leader and follower generally do not follow a specified sequence
of steps; tango differs from other ballroom dances in that respect. Bodily
communication is crucial; the leader needs to feel the follower’s position at
every moment to enable them to signal the next moves; the follower needs to
be poised to receive and respond to the leader’s signals. This involves a type
of normative dissociation for both partners; the interaction occurs primarily
in the subsymbolic bodily zone; verbal guidance is too slow, too limited, vio-
lating the flow of the dance. At every moment, both participants need to
be in the activated and open state that tango teacher Dardo Galletto calls
“maybe.” The leader tries to signal a move—​maybe it will work, maybe it will
not; each partner needs to continuously receive bodily information from the
other and continuously test and shift the signals to produce a response. The
concept of maybe is Dardo’s uncertainty principle in tango, a true dynamical
system in a technical sense, dependent on transmission of sufficient informa-
tion to override uncertainty and exceed the response threshold. The state of
“maybe” involves the capacity to rely on analogic information without sym-
bolic guideposts, to remain suspended—​sometimes on one foot—​focused on
 Interplay of processes in treatment 151

the zone of subsymbolic processing, without the usual support of symbolic

images or words. The interaction, following the track of the subsymbolic
information, is usually more difficult when dancing with a new partner; each
has to endure the risk of not knowing or misinterpreting the signals that are
sent. Some people cannot bear the uncertainty: they want to repeat fixed
routines; the fear of losing one’s balance and the humiliation of miscommu-
nication feel too great. They do not get far in learning tango.
The subsymbolic communication, the state of “maybe,” the capacity to
endure a stare of uncertainty, are necessary for tango, but it is also true that
they are not sufficient. Tango dancers also need to bring at least two add-
itional psychic supports to the milonga, the dance: one is basic knowledge
of steps and techniques; the other is attitude. It is all very well to be open
and suspended on one foot, but without some movement vocabulary, some
knowledge of the positions, the communication cannot work. Here is one
place where the symbol system must enter tango, as for any dance and sport.
Teachers try to break down the sequences into their elements, to analyze the
steps and techniques, to teach the names of the steps. They also analyze the
ways to use the body and the feet—​relax the hips, feel the upper and lower body
separately, keep the upper body facing the partner—​and the movements that
are needed to signal the lead.
To a large extent, teachers work by showing their own movements as images.
Dardo demonstrates a specific way of holding the body and of moving; the
students watch and translate the moves to their own bodily systems. Dardo
also emphasizes metaphor to characterize the movements, then goes beyond
that to characterize attitude as well: we must delight in our partner as in a deli-
cious meal of grilled meat; we must feel our partner, not just love and delight
but a far more complex range of feelings including aspects of dominance and
submission and their consequences. We not only relax our hips and turn our
upper bodies; we walk like an Argentine woman (or an Argentine man, which
is quite different). Dardo demonstrates how to do both; it is interesting to see
a class full of New York professional women and men shifting (more or less)
into those modes.
This symbolic communication is necessary for learning and teaching, and
also may be necessary between partners when there is miscommunication.
Was the lead unclear; was the follower misattuned. (I can tell you now, as all
of us Argentine women know, in tango when something goes wrong, it is the
leader’s fault—​whatever the Argentine men say.)
I have only presented the surface of the bodily and emotional complexity
of tango here. Once all this and more begins to be in place, once the focus
on parts of the body, or on particular steps or movements, is assimilated as
part of the self, the extra possibilities between the partners can emerge. The
two together can explore and develop ideas of action and interaction that go
beyond what they have been taught. The learning process is a wavelike function
for tango, as for any subsymbolic interaction; learning new movements will at
152 Clinical perspectives

some points interfere with the flow of the experience and at other times will
facilitate it.

The choreography of the analytic interchange

In analysis as in tango, the subsymbolic exploration and the connection to the
symbolic domain, within the relationship, as well as within each participant’s
autobiographical memory, are necessary for both participants. The patient
is struggling to talk, or is not talking, or talking about not wanting to talk,
or talking about how the analyst looks, or how the room smells, or whether
the room is too cold or too hot. We can see the patient as beginning to enact
a dissociated schema that represents a particular expectation about another
person.
The analyst will be having their own struggles with this, determined, like
those of the patient, by the emotion schemas that are activated. There is a
flow of subsymbolic experience going on within the analyst, linked to sym-
bolic representation to varying degrees.
With the synergy of the moment, an interaction will occur that is both
old and new: old in that it is based on the emotion schemas with which each
participant habitually interacts with the interpersonal world, and with which
each has entered the session, and new in that each is confronting a particular
person, at a particular time and place, in a particular role, for the first time.
For both participants, it is necessary not only to be focused on subsymbolic
experience and to respond to it, but also to be willing to endure some degree
of painful activation; the willingness to endure the activation in turn requires
some capacity to contain it. As the arousal and the interaction proceed,
both participants will be searching and exploring in their associations and
responses, in their past lives, and in their present interactions; both will be
attempting to talk about experience, to construct formulations that will
enable them to explore together. The connections from the subsymbolic to
the symbolic mode are necessary to enable understanding and communica-
tion of shared experience, to put down signposts in the shared terrain, and to
open new exploration.
The view of treatment proposed here, in which both participants enter with
schemas that are dissociated to varying degrees, both engage in exploration
of subsymbolic domains, both make new connections to symbolic experi-
ence, is very different from a model in which a patient is viewed as coming in
with unconscious experience that has been previously formulated and then
repressed, the analyst has a neutral affective stance, and the analyst interprets
the patient’s associations with the goal of insight and uncovering the repressed
contents.
To work in the mode of uncertainty, the analyst, like the patient, needs to
develop the skills of operating in the subsymbolic interactive mode. By virtue
of experience and training and perhaps other factors, the analyst may develop
 Interplay of processes in treatment 153

this to a relatively high degree and may have somewhat more of a sense of
safety in negotiating the troubled waters.
What does the analyst bring, what does the analyst need, to support work
in this mode? Here are a few possibilities:

• In tango, the teacher or the experienced dancer has an advantage in sym-

bolic vocabulary, not necessarily verbal. He knows a set of sequences
and how to direct his moves. Similarly, the analyst has more symbolized
emotional categories with which to identify what is occurring—​ not
necessarily more categories with diagnostic names, not even more verbal
categories, but more schemas, more meanings: this patient is like others
I have seen, or others I have known or read about; this tangle is like others
in which I have been caught.
• There are obvious differences in feeling states between therapist and
patient on many levels: differences in degree of fear, of risk, and of
pain with which they enter the therapeutic relationship. Beyond these,
there is also a general difference in attitude that is not so obvious. I have
suggested elsewhere (Bucci, 2007a, 2007b) that analysts have developed,
implicitly, a capacity for flexible shifting in self-​states, a capacity to find
different parts of themselves that are genuine but context determined.
This involves a particular analytic attitude that I characterize as a nor-
mative and adaptive dissociated mode, not unlike the mode of the actor
who is immersed in a role, but with more uncertainty. The state that is
activated in the therapist in the session, the love or hate or fear or shame,
is fully genuine in the moment, necessarily open to some degree of risk,
but in the context of a background knowledge that it is only one way of
being, that there are other ways of being that will be activated in different
contexts, and that they are all held within one overall autobiographical
frame. It is that background knowledge that is likely to be subsymbolic
and may be implicit, that allows the immersion in the moment that is
necessary for analytic exploration.
• Beyond this, to support the freedom of emotional exploration, I suggest
that analysts also require a systematic general psychological theory that
specifically accounts for the unique and unpredictable interactions of the
analytic interchange—​that makes them, in fact, more predictable in cer-
tain respects. If analysts do not have an explicit theoretical framework
to guide them in a situation of uncertainty and risk, they will draw on
an implicit one. The problem with implicit theories is that they may tend
to lead clinicians in ways that are unrecognized and unexamined, down
the slippery slope of assumptions concerning specific repressed scenarios
to be uncovered, or techniques involving interpretation of resistance
or, from another perspective, projective identification as involving the
patient’s intolerable affects placed in the therapist. In place of such ill-​
defined ideas, we need a systematic theoretical framework that provides
154 Clinical perspectives

an understanding of the arousal of subsymbolic processes within each

participant; how each connects these processes to symbolic forms within
himself or herself; how each connects to the other on several levels; how
each connects the events of the present to memories of the past; and how
all these connecting processes can be used to bring about change.

Beginning with uncertainty and risk, psychoanalysis requires the capacity

to focus on and be open to subsymbolic experience, to find new ground to
explore—​the extra possibilities—​in both participants while also increasing the
zone of the symbolic and the predictable. The analyst’s discovery of unex-
pected and undirected levels of experience within their own self provides the
setting for the dance of emotional exploration in the therapeutic relationship.

References
Bion, W. R. (1962). A theory of thinking. International Journal of Psycho-​Analysis,
43, 306–​310.
Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known.
New York: Columbia University Press.
Bromberg, P. M. (2006). The analyst’s “self-​revelation”: Not just permissible, but
necessary. In Awakening the dreamer: Clinical journeys (pp. 128–​150). Mahwah,
NJ: The Analytic Press.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
21, 40–​70.
Bucci, W. (2007a). Dissociation from the perspective of multiple code theory: Part
I. Psychological roots and implications for psychoanalytic treatment. Contemporary
Psychoanalysis, 43, 165–​184.
Bucci, W. (2007b). Dissociation from the perspective of multiple code theory: Part
II. The spectrum of dissociative processes in the psychoanalytic relationship.
Contemporary Psychoanalysis, 43, 305–​326.
Bucci, W. (2010) The uncertainty principle in the psychoanalytic process. In J. Petrucelli
(Ed.), Knowing, not-​knowing and sort-​of-​knowing: Psychoanalysis and the experience
of uncertainty (pp. 203–​214). London: Karnac Books.
Freud, S. (1915). The unconscious. Standard Edition, 14, 166. London: Hogarth Press.
Gadamer, H. G. (1989). Hermeneutics and psychiatry. In H. G. Gadamer (Ed.), The
enigma of health: The art of healing in a scientific age. J. Gaiger & N. Walker, Trans.
Stanford, CA: Stanford University Press.
Hadamard, J. (1949). An essay on the psychology of invention in the mathematical field.
Princeton, NJ: Princeton University Press.
Heidegger, M. (1982 [1959]). On the way to language (P. D. Hertz, Trans.). San
Francisco: Harper & Row.
Jaspers, K. (1963). General psychopathology. J. Hoenig & M. W. Hamilton Trans.
Chicago, IL: University of Chicago Press.
Martini, G. (2007). New prospects on unconscious mental functioning and their
reflections on the clinical practice. Paper presented at Conference of the Italian
Psychoanalytic Society and the International Psychoanalytical Association, Rome.
 Interplay of processes in treatment 155

McClelland, J. L., Rumelhart, D. E., & Hinton, G. E. (1989). The appeal of parallel
distributed processing. In D. E. Rumelhart, J. L. McClelland, & PDP Research
Group (Eds.), Parallel distributed processing: Explorations in the microstructure of
cognition (Vol. 1: Foundations, pp. 3–​44). Cambridge, MA: MIT Press.
Moccia, G. (2007). Psychoanalytic theories of unconscious mental functioning and
multiple code theory. Paper presented at Conference of the Italian Psychoanalytic
Society and the International Psychoanalytical Association, Rome.
Reik, T. (1964 [1948]). Listening with the third ear: The inner experience of a psychoana-
lyst. New York: Pyramid.
Ricoeur, P. (1970). Freud and philosophy: An essay on interpretation. New Haven,
CT: Yale University Press.
Chapter 9

Dissociation from the perspective

of multiple code theory—​Part I
Psychological roots and implications for
psychoanalytic treatment

Humans have evolved as complex organisms, with multiple states, multiple

functions, multiple ways of processing information, and substantial but
limited integration of systems. We are all more dissociated than not. The dis-
sociation among systems is the basis for our vulnerability and also, in some
respects, our strength in negotiating our worlds. The adaptive human cap-
acity for encompassing multiple and shifting states is what makes possible the
absorption of a scientist in their creative thought; the phase of maternal pre-
occupation in late pregnancy and during the period of infancy; the capacity
of an athlete to enter the zone in which “everything seems to work” and they
can “play incredible,” as Federer said following his winning the U.S. Tennis
Open; the altered state of romantic love; the “place” that jazz musicians
describe themselves as “going to,” in which improvisation somehow flows.
Sometimes the same person can be mother, athlete, jazz musician, lover, and
even scientist, at different times and in different states.
There is a theoretical tension, we may say dissociation, that pervades the
field, and that needs to be explicitly acknowledged, between our modern rec-
ognition of the inherently complex nature of human psychic organization and
the time-​honored view of dissociative processes as having their roots in the
response to trauma, stress, and anxiety. With all the changes in theory from
Janet, to Freud, to Fairbairn, Ferenczi, and Sullivan, beautifully summarized
by Howell (2005), the assumption remains that dissociative processes emerge
as the organism (human or otherwise) attempts to protect its own stability
in response to trauma, with the corollary assumption that somehow, if there
were no stress, we would all be whole.
To understand dissociative processes as they occur in response to particular
events that may be characterized as traumatic, it is first important to under-
stand the more general and ubiquitous operation of these processes in a nor-
mative psychological sense; we also need to examine the nature of traumatic
experience and its impact in the context of the inherently complex and multi-
faceted nature of human psychological and biological organization.
The first major point that I emphasize throughout this chapter is that dis-
sociation does not emerge first or necessarily from negative roots. A person
 Dissociation Part I: Psychological roots 157

without an adequate capacity for multiple states and functions will lead a
limited life. People call on a pool of dissociative and integrative processes to
manage the wide range of challenges and problems of life; these may involve
positive explorations or retreat from experience. Sometimes the solutions
that are adaptive in one context will turn out to be maladaptive in others;
treatment may also involve further dissociation as well as new integration.
My second major point concerns our understanding of the nature of trau-
matic experience, its challenge to personality organization, and the various
ways in which people use the tools of adaptation that they possess to respond
to this challenge. Just as we see a theoretical tension in the definition of dis-
sociative processes, we must also recognize a similar kind of tension in the
definition of trauma and traumatic events.
The specific nature of trauma is a psychic injury that remains unhealed.
The process begins as an adaptive response to danger; the human organism,
like all organisms, mobilizes its defenses against a threat, with immediate
responses of fight or flight, in their many variations. In adaptive functioning,
the emergency response is regulated when the external danger is past. In some
cases, however, the regulation, resetting the response system to nonemergency
mode, does not occur or occurs only partially. The person appears unable to
register changes in their situation and continues to respond as if danger were
present or imminent; thus the initial response patterns of avoidance or attack
are replayed in a broadening range of situations, rather than modulated in
the context of the person’s current circumstances and current powers. The
expectations of danger and the protective responses may become dangers in
themselves, preventing the healing of the psychic wound that might occur nat-
urally over time. Treatment may activate the threat of danger and elicit further
defense; this is the “vicious circle” of the treatment of traumatic disorders.
Before I address the mechanisms underlying this vicious circle of treatment,
however, I wish to make a general point about the circularity of diagnosis that
complicates the problem further, but also provides a potential escape.

The logical quagmire of diagnosing stress-​ and

trauma-​related disorders
Post-​traumatic Stress Disorder (PTSD) is the only psychiatric entity for which
an external event is one of the necessary criteria for diagnosis. According to
the DSM-​IV (American Psychiatric Association, 2000), the first criterion for
PTSD is exposure to a serious stressor as defined within the system. It is also
true, however, that the inclusion criteria for the stressors identified as trauma
are so broad as to render the criterion essentially meaningless. According to a
national survey published in the Archives of General Psychiatry, 61 per cent
of men and 51 per cent of women reported experiencing at least one major
trauma in their lifetimes, and in most cases more than one event (Kessler
et al., 1995). In a study using the Traumatic Experiences Checklist (TEC),
158 Clinical perspectives

a self-​report questionnaire developed by Nijenhuis et al. (1999), over 90 per

cent of a sample of general psychiatric outpatients reported one or more
traumas, and the mean number of traumas reported was six. Yet the preva-
lence of PTSD in the general population has been estimated at 3 to 6 per cent.
Clearly, what is necessary for the diagnosis is not sufficient; what is trauma for
one is not trauma for all.
We also recognize that long-​term, chronic situations, such as childhood
sexual and physical abuse, produce symptoms with features of PTSD. In
some classifications, psychological abuse has been added to the categories
of chronic abuse; thus the set of potentially traumatic events may be seen
as encompassing the human condition—​a view that may be accurate in our
times, but does not help very much for psychiatric diagnosis.
From a converse perspective, we also know that the events people do not
remember, those that are severely dissociated or warded off, may have at least
as much impact as those they report. If a patient shows the symptom picture
of PTSD, but lacks an explicit memory of exposure to a stressor, will we not
suspect a traumatic event for which the person is amnesic and proceed to treat
the patient accordingly?
We are left with a definition of a traumatic stressor as an event to which a
person has a posttraumatic response, and an assumption that occurrence of a
post-​traumatic response must imply some prior exposure to a traumatic event.
If we do not know this event as yet, we seek to help the patient to remember
it—​with all the dangers of this directed recollection. Further confounding the
issues of diagnosis are questions concerning the large proportion of people
who show apparent resilience in the face of known and documented trauma
and who appear to be functioning well: survivors of concentration camps;
survivors of known sexual or physical abuse in childhood; people who were
present at catastrophic events. There is now some indication that these well-​
functioning survivors may be paying a complex psychological price for their
resilience—​holding components of their selves hostage to maintain their psy-
chic balance. Thus the nature of possible response to trauma is in danger of
becoming as broad as the definition of traumatic events.
My main point in putting a foot in the logical quicksand of diagnosis
of PTSD is not so much to address the many problems of the DSM-​IV
or ICC criteria as to underscore my claim that in order to understand
and treat these disorders, we need to go beyond psychiatric categories
and try to understand the psychological processes that intervene between
purported precipitating events and observed symptomatic (or asymptom-
atic) responses. Freud (1926, p. 166) made this point three-​quarters of a
century ago, when he wrote that the psychic effects of any danger depend
on the person’s “estimation of his own strength compared to the magnitude
of the danger and his admission of helplessness in the face of it.” From the
perspective of mental health, it remains true that it is psychic, not material,
 Dissociation Part I: Psychological roots 159

reality that is the important kind. What we define as trauma or stress is

an internal psychic condition, determined not only by a particular envir-
onmental situation, but by how an organism reacts to this, as their own
powers and capacities allow.
The focus on basic psychological mechanisms has several major
implications: first, we can see these mechanisms as operating on a continuum
with varying degrees of severity in all disorders; and second, we can see the
processes of treatment also as operating on a continuum and by this means
work toward our escape from the vicious circle of definition and treatment of
trauma related disorders.
Current work in cognitive science and neuropsychology provides a new
basis for understanding the psychological mechanisms underlying adaptive
and maladaptive patterns of response to stressful events. The multiple code
theory (Bucci, 1997) provides an account of these mechanisms and their vari-
ation in response to stressful events that is compatible with psychoanalytic
views and that provides a basis for treatment. Once we examine these general
mechanisms, we can also attempt to distinguish particular features that may
vary with the severity and quality of the precipitating events. I will assume
the reader has some familiarity with the theory and review it only briefly here,
focusing on the application to the understanding and treatment of severe
disorders associated with traumatic events.

Brief review of multiple code theory

The human organism is a multi-​code, multi-​system emotional information
processor, with substantial but limited integration of systems (Bucci, 1997).
The systems are characterized as subsymbolic, symbolic nonverbal, and sym-
bolic verbal codes. Symbols—​in the sense used here, not the psychoanalytic
sense—​are discrete entities that refer to other entities and can be combined
to make an essentially infinite variety of forms. Words are the quintessen-
tial symbolic forms. Symbols also include imagery in any sense modality,
although the visual modality may dominate.
The subsymbolic system is less familiar conceptually and difficult to describe
technically, but most familiar to us in our daily lives. Subsymbolic processing
may be characterized as continuous or analogic, in contrast to the discrete
representational entities of the symbolic mode. Thus computations on con-
tinuous dimensions are required for a vast array of functions, from skiing to
musical performance and creative cooking; analogic processes are used in the
characterizations of wines and perfumes and teas, where dimensions of con-
tinuous experience that cannot be broken into discrete elements are seen to
correspond.
The phenomenon of affective attunement described by Daniel Stern (1985)
is basically a type of analogic and continuous emotional communication.
160 Clinical perspectives

In the following example, the mother provides a nonverbal analogy in con-

tinuous format to her ten-​month-​old girl’s emotional expression:

The girl opens up her face (her mouth opens, her eyes widen, her eyebrows
rise) and then closes it back, in a series of changes whose contour can be
represented by a smooth arch. Mother responds by intoning “Yeah” with
a pitch line that rises and falls as the volume crescendos and decrescendos
… The mother’s prosodic contour has matched the child’s facial-​kinetic
contour.
(Stern, 1985, p. 140)

Subsymbolic processes occur in motoric, visceral, and sensory forms, and in

all sense modalities. They are organized, systematic, rational forms of thought
that continue to grow in complexity and scope throughout life. Unlike the pri-
mary process as characterized in psychoanalytic theory, subsymbolic processes
are not chaotic; not driven by wish fulfillment or divorced from reality.
Subsymbolic processing is modeled in cognitive science by connectionist or
parallel distributed processing (PDP) systems (McClelland, Rumelhart, &
Hinton, 1989), with the features of dynamical systems (Bucci, 1997). (I should
emphasize that this is a psychological model, not a neuropsychological one,
although it is fully compatible with neuropsychological findings.)
In such dynamical systems, memory and learning are determined by
connections among the elements of the network; knowledge is distributed
over the interconnected nodes of the network; retrieval of memories,
including emotional memories, is understood in terms of changing patterns
of activation, continually reforming, rather than as retrieval of fixed and
stable contents. The model accounts in a systematic way for organized pro-
cessing in the subsymbolic system, functioning with its own rules, outside
of the symbolic mode; such processing is dominant in emotional informa-
tion processing and emotional communication. We are not accustomed to
thinking of processes, including somatic and sensory processes, that cannot
be verbalized or symbolized as systematic and organized thought; the new
understanding of subsymbolic processing opens the door to this reformula-
tion. It changes our entire perspective of pathology and treatment when we
are able to make this shift.
We know this processing as intuition, the wisdom of the body, and in other
related ways. The crucial information concerning our bodily states comes to
us primarily in subsymbolic form, and emotional communication between
people occurs primarily in this mode. Reik’s (1948) concept of “listening with
the third ear” relies largely on subsymbolic communication (see Bucci, 2001
for a detailed discussion).
My claim is that the disjunction between subsymbolic and symbolic pro-
cessing formats is inherent in human emotional and mental functioning, not
restricted to pathology. The “theoretically perfect person whose development
 Dissociation Part I: Psychological roots 161

had been optimum,” referred to by Fairbairn (1952, p. 7), would neces-

sarily share the same organization based on multiple processing systems and
inherent dissociations among them. In emotional disorders, these inherent
dissociations are exacerbated and transformed in particular ways, as I will
discuss.

The referential process

Connecting the multiple systems
The continuous and analogic formats of the subsymbolic system can be
mapped only partially onto the discrete elements of the symbolic code. On
the simplest level, the limitations of the connecting process become apparent
when one attempts to verbalize an experience that has not previously been
formulated, describe a taste or smell, or teach an athletic or motoric skill, or
when one struggles to express an emotion and can’t “find the words.”
The referential process is the integrating function of the multiple code
system; imagery, which is symbolic and nonverbal, plays the pivotal role in this
integration. Images of the episodes of our lives, which incorporate all sense
modalities, connect in their sensory aspects to the analogic sensory contents
of the subsymbolic code. As discrete representational elements, they are also
capable of mapping onto the discrete elements of language; thus images pro-
vide the necessary link between the subsymbolic nonverbal and symbolic
verbal codes.

The emotion schemas and the referential process

Adaptive functioning requires some degree of coordination (we may say
“good-​enough”) between subsymbolic and symbolic systems in the service
of a person’s general functioning and overall goals. We need to bring together
information from our bodies and emotions, with information from past and
present experience, to make decisions about how to act at any given time, and
to express how we feel.
The fundamental organizing structures of human emotional life—​ and
probably of other species—​are emotion schemas. Like all memory schemas,
emotion schemas include components of all three processing systems—​
subsymbolic processes, imagery, and later language—​but emotion schemas
are more strongly dominated by sensory and bodily representations and
processes than other knowledge schemas. The subsymbolic sensory, som-
atic, and motoric representations constitute the affective core of an emotion
schema, the basis on which the organization of the schema is initially built.
The objects and settings of time and place constitute the specific contexts
and contents of the emotion schemas, which continue to be elaborated
throughout life.
162 Clinical perspectives

Emotion schemas are built through registration in memory of spe-

cific episodes of one’s life. They represent the characteristic form of one’s
interactions with other people from the beginning of life. Interactions with
caretakers play the central role in these constructions. The interactive events
bring together sensory, somatic, and motoric processes with images of people,
in a specific time and place, and build emotional memory by this means.
Emotion schemas, like all memory schemas, are active and constructive
processes, not passive storage receptacles. They determine how we experience
all the interactions of life and are themselves changed by each new inter-
action. We see all things through the lens of memory schemas; there is no
other way, no view of reality outside of this lens.
This formulation of emotions as schemas built and rebuilt through
representation of the episodes of one’s life is compatible with current views of
emotions. According to Lang (1994, p. 218), a memory of an emotional epi-
sode can be seen as an information network that includes units representing
emotional stimuli, somatic or visceral responses, and related semantic (inter-
pretive) knowledge. The memory is activated by input that matches some of its
representations. Because of the implicit connectivity, the other representations
in the structure are also automatically engaged, and as the circuit is associa-
tive, any of the units might initiate or subsequently contribute to this process
The schemas of emotional memory are organized and reorganized
throughout life on many dimensions. They may be connected by a common
object, as in the multiple schemas of mother. Schemas that we characterize as
fear or love or control or rage will involve complex circuitry based on episodes
that are connected through a common core of somatic and sensory experience
and motoric response, with some shared and some unique contextual infor-
mation. Emotion schemas are also organized in autobiographical memory
on dimensions of time and place to develop the multiple schemas of the self.
The basic concept of internalized object representations, or object relations,
is essentially a form of emotion schema, as is Stern’s (1985) concept of
representations of interactions that have been generalized (RIGs) or Bowlby’s
(1969) working models, and many others. Damasio’s (1994, 1999) notion of
dispositional representations provides a neurological basis for the construct
of the emotion schema, and supports and extends this concept: dispositional
representations exist as potential patterns of neuronal activity distributed
throughout the nervous system, connecting sensory and association cor-
tices with limbic structures and structures subserving motoric and visceral
response. The structure of the schema provides the conceptual basis for the
processes of transference (and countertransference). The patient plays out
with the analyst the expectations and responses encapsulated in the emotion
schema (as the analyst necessarily does—​perhaps in a different way—​with
the patient.)
We express and represent emotion schemas in two major ways: as narratives
of specific episodes from our past, drawn from memory; or as enactments, a
 Dissociation Part I: Psychological roots 163

playing out of the schema in the present, the here and now. In either case,
whether through retrieval from memory or as enactment, the activation of an
emotion schema involves not only words and images, but also some degree
of arousal of the sensory and bodily experiences of the affective core. Just as
visual images are now known to activate the same neural pathways involved
in visual perception, the activation of the affective core of a schema involves
actual physical pathways of pleasure and pain happening in the body in the
present, to varying degrees.
The activation of the affective core in connection to the people and events
of life is crucial to the emotional information-​processing system, to enable
emotional evaluation of events as they occur in terms of their impact on the
person’s well-being. The person perceives an element of the event—​an object
in a particular place and at a specific time—​or retrieves it from memory; the
emotional information about this event comes from the activation of the
subsymbolic sensory and somatic functions of the affective core. In adaptive
functioning, that is how we use feelings to evaluate events, to know whether
something is good or bad for us.

Occurrence, reactivation, and reconstruction of

threatening and painful events
Characterization of pathology
Pathology is determined by dissociation and distortion within the emotion
schema, so that the emotional evaluation of the events of life is not effective.
Thus new events are perceived in distorted ways, and the new information
that is taken in does not correct the distortion, but rather reinforces it.
Threats to the integration of the emotion schemas occur throughout life,
primarily involving upsurges of arousal that are overly intense in relation
to a person’s capacity for self-​regulation. In healthy-​enough development,
upsurges of arousal are regulated initially through the relationship with the
caretaker; the child gradually develops mechanisms of self-​regulation and
self-​soothing in this relational context. Where arousal is overwhelming or the
caretaking is dysfunctional, effective mechanisms of self-​regulation do not
develop.
The failure of integration is particularly severe when the caretaker is a
source of threat to the child’s well-being—​terrifying, humiliating, or other-
wise destructive. A schema of the caretaker as a threat, activating a response
of terror in the child, is unbearable, in part because of the intensity of the
experience, which overwhelms the child, and, most crucially, because the
caretaker is the one to whom the child must turn for protection in time of
danger. The schema of mother as a danger to oneself is incompatible with
the schema of mother as protector; the child is under attack and there is no
place to turn.
164 Clinical perspectives

The child then attempts to deal with the threat in some way. They cannot
realistically attack or escape physically; they are small and weak and fear
being abandoned. What the child can do is turn attention away from the
threat and from the perception of the caretaker as the source of terror; dis-
sociation of the emotion schemas occurs through such a process. Bromberg
(2001, pp. 904–​905) writes about a patient who says:

When I was little and I got scared—​scared because Mommy was going to
beat me up—​I’d stare at a crack in the ceiling or a spider web on a pane
of glass, and pretty soon I’d go into this place where everything was kind
of foggy and far away, and I was far away too, and safe. At first, I had to
stare real hard to get to this safe place. But then one day Mommy was
really beating on me and without even trying I was there, and I wasn’t
afraid of her. I knew she was punching me, and I could hear her calling
me names, but it didn’t hurt and I didn’t care. After that, anytime I was
scared, I’d suddenly find myself there, out of danger and peaceful. I’ve
never told anybody about it, not even Daddy. I was afraid to because
I was afraid that if other people knew about it, the place might go away,
and I wouldn’t be able to get there when I really needed to.

Dissociation and distortion within the emotion schemas may occur in

response to acute external traumatic events at any time in life, as well as
through more chronic problems of the caretaking situation. The development
of general structures of dissociation in the context of chronic early stress will
render the individual more vulnerable to the later events of life. We may see
the processes of avoidance and dissociation in response to aversive threatening
stimuli as having their roots in generally expected organismic responses to
such events. The major types of response to threat for all organisms have
been characterized as flight, freeze, and fight (Nijenhuis, Vanderlinden, &
Spinhoven, 1998; Timberlake & Lucas, 1989); these operate at different points
in the occurrence of the threat and in response to different types of danger.
Flight or freezing responses are most characteristic of a child who is power-
less to attack the caretaker; freezing has the added physiological benefit of
associated analgesia, reducing the level of pain. We see this in the example of
Bromberg’s patient quoted earlier. Threats occurring later in life or in other
circumstances may activate the particular patterns of fight, flight, or freezing
that constitute the characteristic organization of a person’s response to threat.
In all cases, the response to threat involves some form of dissociation within
or between the emotion schemas; these dissociations may take several major
forms. Dissociation within schemas may emerge as arousal of the subsymbolic
components of the affective core of terror with associated flee or attack or
freeze responses, without recognition or acknowledgment of the object that
is the source of the activation; or a distorted image of the object may be
experienced as split off from the subsymbolic components of the affective
 Dissociation Part I: Psychological roots 165

core. Dissociations within schemas also lead to dissociations between them.

My claim is that such dissociative processes underlie all emotional disorders,
whether or not a specific trauma is identified.
This formulation of dissociation within and between the emotion schemas
as underlying emotional disorders is compatible with clinical observations
and also with biopsychological data. Van der Kolk (1994) describes the
occurrence of fragmentary memories with vivid, intrusive, unmodulated
affect, not oriented to space and time, or generalized feelings of anxiety, anger,
fear, or uneasiness, which he refers to as body memories. Such feelings have
been characterized by van der Kolk and Fisler (1995) as disconnected images
and waves of disjointed sensations and emotions. In multiple coding terms,
these are accounted for as dominance of the subsymbolic components of the
emotion schema while avoiding acknowledgment of their source. Payne and
colleagues (2004) have identified this form of dissociation with the defense of
“undoing” (Freud, 1926), in which autobiographical information associated
with the trauma is pushed out of awareness, leaving persistent, generalized,
free-​floating anxiety without an apparent source.
Clinicians have also identified the converse form of dissociation in which
a person retains memories of abuse or trauma but affect is flat. This form
of dissociation is related to the mechanism characterized by Freud (1926)
as “isolation of affect,” and may be described by clinicians as emotional
blunting or emotional numbness. As Chefetz (2004, p. 251) characterizes this
phenomenon, the idea of a feeling is dissociated from the bodily or emotional
experience of it; thus a patient may say, “I know I am angry, intellectually;
I just can’t feel it, none of it.” In such cases, symbolic elements of the schema
remain accessible without connection to the associated bodily states.
The psychological formulation of dissociation within emotion schemas as
underlying pathology is directly supported by biological evidence. Memories
of specific events are experienced and stored in multiple systems, including
all sensory modalities, motoric systems, and visceral and autonomic systems.
Operation of emotional memory and emotional information processing
depends on communication among hippocampal, amygdalar, and cortical
networks. There is no single anatomical location for the representation of
the stressor events; they are widely distributed throughout the limbic system
and cortical zones. The hippocampus and adjacent medial temporal regions
are critical to the integration of components of information from these mul-
tiple systems in episodic memory, and to orientation of episodes in space
and time in autobiographical memory. Stress affects integration of informa-
tion through direct impairment of hippocampal and cortical functions, and
through disturbance in their modulation of the amygdalar functions.
According to Jacobs and Nadel (1985), in the absence of an intact
hippocampus-​based memory system, the amygdala-​based system stores emo-
tional information unbound to the spatiotemporal context of the relevant
events. This process results in a pool of emotional memories—​essentially a
166 Clinical perspectives

population of sensory and perceptual fragments—​which are acquired during

the traumatic event but encoded without a coherent spatiotemporal frame to
organize them.
There is also evidence that the brain regions and hormonal effects that
are activated during encoding of stressful events are activated as well during
retrieval of these memories (Damasio, 1994, 2003). Just as visual images
are now known to activate the same neural pathways involved in visual per-
ception, the arousal of the affective core of a schema involves actual phys-
ical pathways of pleasure and pain happening in the body in the present,
to varying degrees, and may elicit responses that are similar to the actual
event. This process accounts for continued proliferation and elaboration of
these maladaptive perceptions and response patterns long after the external
stressor is past, and is a crucial factor in treatment.

Attempts at self-​r epair

The affective core of an emotion schema is likely to be activated when elem-
ents associated with the schema occur in a person’s life. If the schema is
one in which dissociation has occurred, these upsurges in arousal may have
no apparent source. People seek to provide emotional meaning for these
feelings of agitation and arousal in many ways, and will attempt to regu-
late and contain them. The regulatory and control strategies range from the
apparently effective modes of resilience to the myriad forms of emotional
disorders, from neurotic to severe post-​traumatic forms. In apparent resili-
ence, for example, the arousal may operate as motivation for achievement
or may stimulate a lifetime of devotion to the welfare of others. In generally
less adaptive modes, a person may attempt to seek meaning for the painful
arousal in somatic complaints, in identifying potential aggressors, or by
reinterpreting the arousal—​for example, interpreting unacceptable anger as
anxiety; or by turning it against the self in depression and suicidal attempts.
The many complex constructions of pathology, including addictions,
phobias, eating disorders, and even psychotic symptoms, may be accounted
for by such attempts at managing the affect of a dissociated schema and
providing some symbolic meaning for the subsymbolic response; they may
be seen in a metaphoric sense as disorders of the immune system in the psy-
chic domain.
Dissociations within the emotion schemas can lead to dissociations
between them. In reasonably adaptive functioning, we maintain multifaceted
complex images of others and of ourselves, coexisting in memory on a single
autobiographical timeline. In some cases, however, the attempts at repair of
the schemas lead to splitting of the representations of others and to break-
down of the self-​representation and interference with the organization of
autobiographical memory. An elaborated schema of one’s mother as benevo-
lent and the source of sustenance cannot exist in autobiographical memory
 Dissociation Part I: Psychological roots 167

alongside an image of mother as threatening one’s life. An image of oneself as

rageful and powerful that may be developed later in life as part of one’s body
armor is not compatible with an early image of oneself as helpless and alone.
Thus one may experience oneself as having separate parts of the mind that
function with some autonomy; the syndrome of dissociative identity disorder
(DID) may be understood as involving such dissociations among the emotion
schemas, along with other features.

Summary of pathological processes

To summarize this very brief and oversimplified characterization of path-
ology in multiple coding terms, I would like to emphasize several major
points with respect to the several forms of dissociation that have been
identified here.
First, it is the integrative function of the multiple code system, the ref-
erential process, connecting subsymbolic and symbolic processes within the
emotion schemas, that is impaired by trauma or chronic stressors, not one
or the other of the processing systems. The individual continues to process
information on the subsymbolic and symbolic levels, and both modes of pro-
cessing may occur within awareness but without connections among these
experiences. A young woman suffers from severe lower body pain, including
stomach or menstrual cramps, which appears to have no organic basis, and
visits gynecologists repeatedly for this condition, even demanding surgery.
She also has memories of sexual abuse by her brother, largely devoid of
affect, but does not connect her current bodily experiences with her memories
of abuse. A young athlete finds himself unable to perform adequately in a
particularly important game, and the self-​doubt reverberates to destroy his
coordination further; he remembers being beaten by his father and is grateful
to his father for the discipline, but does not connect the experience of failure
with the beatings.
Second, the nature of pathology and the crucial problems for treatment
are determined not only by the initial dissociations that occur in response to
threat, but also by the secondary effects, the attempts at self-​protection and
development of emotional meaning for upsurges of arousal that a person
employs once the dissociation has occurred. We see this process in both cases
just described: the somatizing in the first case; the self-​doubt and failure of
physical coordination that is preferable to rage at the father in the second.
These attempts at self-​repair add layer after layer to the onion of pathology
that must be addressed before the initial avoidance can be understood.
Third, to emphasize again: there is a spectrum of dissociative processes
that apply in all aspects of life, adaptive as well as maladaptive. It follows that
analyses of the psychological processes of dissociation and their biological
correlates apply to varying degrees and in different ways for all emotional
disorders.
168 Clinical perspectives

Implications for treatment

For all psychic disorders, the minimal goal of treatment may be stated as
enabling more adaptive and effective regulation of the painful hyper-​arousal
of the affective core of the emotion schema so as to provide a functional
space for the patient to go on with life with reasonable satisfaction and
without overwhelming pain. This may also require that the patient give up
the modes of self-​cure that have proven maladaptive. There are two major
alternative therapeutic strategies for achieving these goals: one is to enable
more adaptive means of affect regulation without addressing the initial
sources of the dissociation. The other approach is to to work toward integra-
tion of the schema; this would necessarily involve some reactivation of the
initial threat. In actual clinical work, the two approaches are likely to interact
to varying degrees.
To the extent that the affect is experienced as overwhelming, actu-
ally threatening homeostatic regulation, maintenance of the dissociative
processes may be appropriate. This may apply for all patients at certain times.
The approaches of symptom management—​developing mechanisms of self-​
soothing, building a sense of mastery, and prescribing medication—​may also
have positive secondary effects; patients learn to be less afraid of the emer-
ging upsurges of arousal as they acquire better mechanisms of managing
their effects, and may develop new and positive associations to the contexts
in which such tension reduction occurs. They may then gradually become
more amenable to techniques involving titrated activation of the schema’s
affective core.
There are obvious problems if treatment ends without addressing the dis-
sociation to some degree. What patients are able to avoid at certain times,
in certain contexts of life, remains alive to trouble them later when their life
situation has changed. The zones of relative comfort may diminish as more
experiences become colored by expectations of dreaded events. Through the
activation of the painful affective core in different contexts, not recognized or
understood, the events and images that need to be avoided will expand. This
is the developmental proliferation of pathology—​the tunnel vision—​that
narrows the possibilities of life.
Bromberg’s (1998) portrayal of his patient Christina, “a beautiful and tal-
ented poet in her early 50s,” illustrates the process of survival by maintaining
a rigid dissociative structure and its effects. Christina was a survivor of brutal
childhood trauma; Bromberg describes her as going seamlessly through the
actions of life like a very effective wind-​up toy, doing what was expected of
her, entirely repudiating spontaneity of response. Her inner world remained
vulnerable to sudden violent disruption in response to such events as
thunderstorms and other loud and sudden noises, which she managed to
some degree by a series of rituals. As Bromberg describes her, “Christina
was a patient for whom life was a series of rituals to be performed while she
 Dissociation Part I: Psychological roots 169

was waiting for death, and therapy was simply one more ritual among many”
(1998, p. 323).
The second major strategy of treatment, working toward the goals of reinte-
gration, requires the patient to break through the rituals and confront the
demons, to allow the activation of the dreaded schema in the present to some
degree, with its potential risks and rewards. Elsewhere (Bucci, 2002, 2003),
I have discussed in detail how the referential process works in the context of
the treatment relationship to bring about changes in the emotion schema—​
changes in what we perceive and feel, and what we expect from others, not
only changes in what we do. This basic process applies in any uncovering
treatment, with variations depending on the nature of the emotional disorder.
The referential process involves three major phases: (1) arousal of the
affective core of the emotion schema; (2) experiencing imagery of a spe-
cific episode and telling it in concrete detail or reenacting aspects of it; and
(3) some reflection and examination of the episode. Reintegration of the
dissociated schemas requires repeated playing out of these phases in the inter-
personal context of the relationship, so that the affective core itself gradually
undergoes change in relation to perception of the present, memories of the
past, and expectations of the future. The change in the subsymbolic processes
of the affective core in relation to imagery and perception of objects and
events is what we mean by working through.
The referential process applies in treatment of all disorders, whether or not
specifically trauma related; the following specific issues need to be confronted
when one is working with patients with severe disorders reflecting massive
dissociation within and between the emotion schemas:

• Actual change—​reintegration or reconstruction of emotion schemas—​

requires actual activation of the affective core of the dissociated schema
to some titrated degree in relation to a new object and in a new context
with a new recognition of the capacities of the self. We need to recognize
when it is useful to facilitate such activation and when it is not. We also
need to keep in mind that the analgesic function of the freeze response
to the original threat may not operate at the time of memory retrieval;
survivors have described how the retelling of an event is experienced as
more painful than the actual occurrence.
• The protective processes that people have developed throughout life to
shield themselves from the emergence of the dreaded affect will continue
to operate in the treatment.
• In many cases, particularly in instances of long-​standing and chronic
abuse, the protective processes have become intrinsic components of the
person’s self-​schema, sense of self, and view of the world in relation to
the self. The patient may experience any challenge to these protective
processes not only as a risk of activation of the physiological components
of the dreaded affective core, which have the potential to threaten life,
170 Clinical perspectives

but also as threatening their sense of self. The anticipation of loss of

self, with its component of shame and helplessness, is in some respects
as painful or more painful than anticipated danger to life, as Bromberg
(1998) emphasizes.
• If activation of a schema does occur to a relatively intense degree, even in
a new context, there is the danger that the new context will be drawn into
the schema, rather than the schema being perceived as new.
• Focus on general themes that do not involve the referential process and
do not activate the affective core will leave the schema largely unchanged,
although new strategies for avoidance may be enhanced by such means.
• The danger exists that pathology may be reinforced rather than alleviated
through activation of the affective core. The danger is greater to the extent
that the treatment situation actually shares elements with the initial trau-
matic events; as, for example, when a therapist maintains a neutral or dis-
tancing mode or focuses on interpretation of resistance with its element
of blame—​thus resonating unintentionally with the feelings of humili-
ation and powerlessness that are at the core of the patient’s distress.

Bromberg’s (1998) description of Christina’s treatment illustrates some of

these issues. He reports that after about four years of treatment, experienced
largely as hopeless by both analyst and patient, but with a few breaks in the
wall of futility, Christina’s long-​anaesthetized appetite for life began to find
voice and life began to seem worth the risk. At this point, Christina reported
the following dream, which provides a good metaphor for the vicious circle of
treatment of trauma and dissociation, with perhaps some hope:

She was walking along the top of a seawall that began to get narrower
and narrower until she was at a place she couldn’t go forward without
falling into an abyss. But she couldn’t go back because she couldn’t turn
around. The scene then shifted to her looking at herself in a mirror and
suddenly noticing a second head growing out of the side of her own head.
The face wasn’t there yet, and she was terrified of it appearing. She didn’t
want to see it.
(Bromberg, 1998, p. 325)

Bromberg (1998, p. 325) writes that:

In allowing herself to dream the dream, she was conveying that although
she felt her analysis might be leading her toward ‘the black hole’ of
madness she was no longer accepting the existential deadness of dissoci-
ation as the price for escaping potential retraumatization.

In time, over the course of the analytic work, Christina was able to experi-
ence anxiety for the first time and distinguish it from the traumatic dread that
 Dissociation Part I: Psychological roots 171

had been her constant companion, telling her she was always on the edge of
the “black hole.” She could now recognize anxiety as something unpleasant
but bearable—​as something she felt rather than a way of addressing the
world. She recognized that she was now taking the risk of pursuing a life that
included self-​interest, and that in choosing to live life rather than wait for it,
she had accepted the inevitability of loss, hurt, and ultimately death as part
of the deal (Bromberg (1998, p. 328).
Strachey (1934) discusses the “neurotic vicious circle.” Issues similar to
those noted by Strachey apply in different ways to the broad range of patients
whom analysts see today. We need to recognize the risks and the rewards
of this uncovering process. The tradeoff of psychic numbness coupled with
chaotic intrusion on one side, against vulnerability to pain that is viewed
as unbearable on the other, exists to varying degrees and in different ways
for patients with all emotional disorders, not only for victims of abuse. The
challenge of the treatment is determined by the intensity of the threat and its
meaning for the individual. The challenge also depends on the mechanisms
of repair that were overlaid on the initial dissociation to enable the person to
go on. The circle will be broken as both the estimate of the magnitude of the
danger and the estimate of one’s own strength are revised through explor-
ation in the new context of the treatment relationship. The reward includes
vulnerability to pain and fear, but also feelings like bravery, love and joy—​a
sense of self, a connection to others, and a sense of life.

Acknowledgment
Earlier versions of this chapter and Chapter 10 were presented in Palermo,
Italy in November 2005, at an international congress on the assessment
and treatment of traumatic experiences. Portions of these chapters were
also presented in April 2006 at an all-​day seminar on “The Dissociative
Mind: Psychological Roots and Psychoanalytic Processes in Action”, at
Adelphi University, Garden City, Long Island. The collaborative research
and clinical perspective presented in this chapter has roots in a panel on
“Trauma, Dissociation and Conflict: The Space Where Neuroscience,
Cognitive Science, and Psychoanalysis Overlap,” held at the April
2002 meeting of the Division of Psychoanalysis (39) of the American
Psychological Association

References
American Psychiatric Association (2000). Diagnostic and statistical manual of mental
disorders IV (DSM-​IV). Washington, DC: American Psychiatric Association.
Bowlby, J. (1969), Attachment and loss: Vol. 1: Attachment. New York: Basic Books.
Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and
dissociation. Hillsdale, NJ: The Analytic Press.
172 Clinical perspectives

Bromberg, P. M. (2001). Treating patients with symptoms—​ and symptoms with

patience: Reflections on shame, dissociation, and eating disorders. Psychoanalytic
Dialogues, 11, 891–​912.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
20, 40–​70.
Bucci, W. (2002). The referential process, consciousness, and the sense of self.
Psychoanalytic Inquiry, 22, 766–​793.
Bucci, W. (2003). Varieties of dissociative experiences: A multiple code account and a
discussion of Bromberg’s case of William. Psychoanalytic Psychology, 20, 542–​557.
Chefetz, R. A. (2004). The paradox of “detachment disorders”: Binding-​disruptions
of dissociative process. Psychiatry: Interpersonal and Biological Processes, 67,
246–​255.
Damasio, A. R. (1994). Descartes’ error: Emotion, reason and the human brain.
New York: Avon Books.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace.
Damasio, A. R. (2003). Looking for Spinoza. Orlando, Florida: Harcourt.
Fairbairn, W. R. D. (1952). Psychoanalytic Studies of the Personality, Boston,
MA: Routledge & Kegan Paul.
Freud, S. (1926), Inhibitions, symptoms and anxiety. Standard Edition, Vol. 20 (pp.
87–​174). London: Hogarth Press.
Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.
Jacobs, W. J. & Nadel, L. (1985). Stress-​induced recovery of fears and phobias.
Psychological Review, 92, 512–​531.
Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M. & Nelson, C. B. (1995).
Posttraumatic stress disorder. Archives of General Psychiatry, 52, 1048–​1060.
Lang, P. J. (1994). The varieties of emotional experience: A meditation on James-​
Lange theory. Psychological Review, 101, 211–​221.
McClelland, J. L., Rumelhart, D. E. & Hinton, G. E. (1989). The appeal of parallel
distributed processing. In D. E. Rumelhart, J. L. McClelland & PDP Research
Group (Eds.), Parallel Distributed Processing: Explorations in the Microstructure of
Cognition (Vol. 1: Foundations) (pp. 3–​44). Cambridge, MA: MIT Press.
Nijenhuis, E. R. S., van der Hart, O. & Vanderlinden, J. (1999). The Traumatic Experiences
Checklist (TEC). In E. R. S. Nijenhuis (Ed.), Somatoform Dissociation: Phenomena,
Measurement, and Theoretical Issues. Assen, Netherlands: Van Gorcum.
Nijenhuis, E. R. S., Vanderlinden, J., & Spinhoven, P. (1998). Animal defensive
reactions as a model for dissociative reactions. Journal of Traumatic Stress, 11,
243–​260.
Payne, J. D., Nadel, L.., Britton, W. B., & Jacobs, W. J. (2004). The biopsychology
of trauma and memory. In D. Reisberg & P. Hertel (Eds.), Memory and Emotion.
Oxford: Oxford University Press.
Reik, T. (1948). Listening with the third ear: The inner experience of a psychoanalyst.
New York: Pyramid Books.
Stern, D. N. (1985). The interpersonal world of the infant. New York: Basic Books.
Strachey, J. (1934). The nature of the therapeutic action of psychoanalysis. In L. Paul
(Ed.), Psychoanalytic Clinical Interpretation. New York: The Free Press.
 Dissociation Part I: Psychological roots 173

Timberlake, W., & Lucas, G. A. (1989). Behavior systems and learning: From misbe-
havior to general principles. In S. B. Klein, & R. R. Mowrer (Eds.), Contemporary
Learning Theories (pp. 237–​275). Hillsdale, NJ: Lawrence Erlbaum.
van der Kolk, B.A. (1994). The body keeps the score: Memory and the evolving psy-
chobiology of posttraumatic stress. Harvard Review of Psychiatry, 1, 253–​265
van der Kolk, B. A., & Fisler, R. (1995). Dissociation and the fragmentary nature of
traumatic memories: Overview and exploratory study. Journal of Traumatic Stress,
8, 505–​525.
Chapter 10

Dissociation—​Part II
The spectrum of dissociative processes in
the psychoanalytic relationship

In introducing his vision of a multisystem psychical apparatus, with separate

and distinct processes of thought, Freud opened a new understanding of
human inner life. He was also well ahead of his time in recognizing the role of
emotion and bodily experience as aspects of thought. The influence of these
ideas can be seen today in affective neuroscience and cognitive psychology,
although their psychoanalytic roots are generally not acknowledged (Bucci,
2001; Williams et al., 2007).
In Freud’s (1900) formulation, the mechanisms of the primary process of
thought, such as condensation, displacement, and imagery, are explained in
terms of unbound psychic energy pressing for discharge and carry all the
implications of the energic framework. They are determined by the motiv-
ation of forbidden wishes and drives; associated in the first topography with
the unconscious, the system UCS and in the second topography or structural
model with the instinctual energy of the id; and characterized by these associ-
ations as nonverbal, irrational, chaotic, infantile or regressed, and dominant
in altered states.
Freud himself recognized, to some degree, the contradictions inherent in
these formulations. The first model assumed a necessary association of the
features of thought with level of consciousness (referred to by Freud as the
qualities of mind); but phenomena such as organized unconscious fantasies
and unconscious defenses, the operation of language in dreams and fantasies,
and the presence of primary-​process forms in waking life, as in parapraxes,
violated this premise. The structural theory, based on the agencies (id, ego,
superego), rather than the qualities, of mind, was formulated to address these
issues, but raised difficulties of its own.
In developing his second model, Freud was never fully reconciled to giving
up the first; he never abandoned his emphasis on the crucial role of the sys-
temic unconscious in the organization of the psychical apparatus (Arlow &
Brenner, 1964; Bucci, 1997; Laplanche and Pontalis, 1973). In his final work,
Freud (1940, pp. 162–​163) wrote about the distinction of the qualities of
mind as entirely parallel with the agencies:
 Dissociation Part II: Dissociative processes 175

The inside of the ego, which comprises above all the intellective processes,
has the quality of being preconscious. This is characteristic of the ego
and belongs to it alone … The sole quality that rules in the id is that of
being unconscious. Id and unconscious are as intimately united as ego
and preconscious; indeed, the former connection is even more exclusive.

In that passage, the insights that motivated Freud to revise his theory are
somehow lost. Freud’s unresolved struggle in characterizing the domain of
thought outside of standard linguistic and logical forms remains with us today.
We have difficulty emerging from the shadow of the energy model, playing
out in the concepts of unconscious, id, and primary process forms associated
with forbidden wishes and drives. Psychoanalysis retains a deep-​rooted, but
somewhat unacknowledged, view of the nonverbal as the “other,” in the post-
modern sense of the other—​the alien, the outsider, the not fully known, with
a corollary assumption that the full sense of knowing, in consciousness, must
involve standard logical principles and verbal thought. Within this frame-
work, the goal of treatment is to occupy that alien domain—​to make the
unconscious conscious, to place ego where id has been.
Outside psychoanalysis, in cognitive science, neuroscience, and related
fields, there is now widespread recognition of multiple modalities of thought,
and more complex views of the features of the different systems. The char-
acterization of the systems and the basis for their differentiation has been
a matter of intensive empirical investigation and revision during the past
several decades. As I discussed in Chapter 9 (Bucci, 2007), the new findings
concerning the organization of thought that have emerged in empirical
research need to be considered in developing the psychoanalytic theory and
as a guide for treatment.
The multiple code theory retains the core psychoanalytic premise of
diverse modes of mentation, without basing the systemic distinctions on par-
ticular contents associated with fantasies, wishes, or desires on one hand, or
principles of reality on the other. The multiple code theory also retains the
fundamental psychoanalytic insight concerning interaction among cognition,
emotion, and bodily experience without calling on drives or related energic
concepts.
In contrast to the assumptions of the metapsychology, the modalities
characterized as subsymbolic and symbolic nonverbal and verbal forms of
thought are not distinguished as more or less dominant, higher order and
lower order ways of knowing, or as more or less alien, but as operating dif-
ferently from one another, following different principles. Status of conscious-
ness is not a determining factor in this differentiation; the relationship of
the different modes of thought to conscious or unconscious states and to
wishes and bodily needs is complex. Different states, different ways of being
and knowing may be activated and may be within awareness at certain times;
176 Clinical perspectives

other ways of being exist as potentials, to be activated in particular contexts,

with different purposes and functions. From this perspective, there is not an
insider or an outsider in this population of potential states that constitute
human personality organization; there is not a privileged mode of processing
with special access to consciousness or reality; there are diverse domains with
different features and functions, operating in different ways at different times.
A crucial corollary of this new view of multiple systems, and multiple
ways of being operating within the psychical apparatus, is that there are also
different degrees of integration of the various systems with some extensively
connected to others and some proceeding largely in their own modalities. The
degree of integration is determined to some extent by neural structure and
function, and is further influenced and modified by life events. The variations
of connection and disconnection, integration and dissociation may be seen
in normal adaptive functioning as well as in the variations of pathology.
Dissociation should not necessarily be understood as separation of zones of
functioning that are normally integrated but, in many cases, involves systems
operating effectively in their own forms without the need for interaction.
The shift in theory has specific implications with respect to treatment goals
and methods. The goals of treatment are not to replace one system with
another, with the ultimate ideal of developing a single dominant processing
mode operating in consciousness or dominated by what are characterized as
“ego functions.” The multiple systems remain active and functional throughout
life; pathology is determined by particular types of dissociation that are mal-
adaptive in the context of a person’s current life. The goals of treatment, then,
concern reorganization among the systems, with their different functions and
forms. Optimally, treatment facilitates integration of subsymbolic and sym-
bolic components of emotion schemas to allow adaptive evaluation of new
experience, while also retaining and eventually enhancing the capacity for
effective functioning of these systems in their own modalities.
Given this formulation of goals, we can identify two modes of emotional
communication that are needed in the treatment situation (as throughout
life): intrapsychic communication among systems—​ subsymbolic, symbolic
nonverbal, and symbolic verbal—​within each individual; and interpsychic com-
munication on any of these levels between people. To a not inconsiderable degree,
the extent of which we do not yet know, these are faces of the same inherently
dyadic process of emotional communication. Intrapsychic communication
among the various modes of thought within each person is based on emotion
schemas that are inherently relational; emotional communication between
people is determined by the connections activated within each individual.

The neural circuitry of the emotion schemas

The model of pathology and treatment based on multiple code theory, as
proposed in Chapter 9 (Bucci, 2007), is compatible with current work in
 Dissociation Part II: Dissociative processes 177

affective neuroscience and also with biopsychological observations. Here

I emphasize certain aspects of the neuroscientific basis for emotional arousal
and emotional communication that have particular significance for the thera-
peutic process.
An emotional response can be activated directly by sensory features in
perception or drawn from memory: we see something that frightens us; we
get bad news; something makes us angry; a smell or a song arouses a set of
feelings; some fragment of imagery comes to mind in a memory or a dream.
Damasio (2003) terms such an object or event, which has the power to arouse
an emotional response, an emotionally competent object, or emotionally com-
petent stimulus (ECS). An ECS can be actual, as a perception, or recalled
from memory, as an image; in either case, it must be represented in one or
more of the brain’s sensory systems.
Once an ECS has been received, there are two processing routes. LeDoux
(1998) has studied these routes particularly in the case of the fear response.
One route, which LeDoux (1998, p. 164) characterizes as the “low road” to the
amygdala, passes from the stimulus through the sensory thalamus directly to
the emotion triggering sites, which include particularly the amygdala as well as
the prefrontal cortex. The triggering sites then activate a number of emotion
execution sites that lead to the playing out of the somatic and motoric and
visceral components of the emotion response—​changes in body chemistry,
heartbeat, respiration, facial expressions, vocalizations, body postures, and
specific behavior patterns such as attack, freezing, and flight in response to
threat. These are components of what I have called the affective core of the
emotion schema, playing out very rapidly, largely in subsymbolic form, in
response to an emotional stimulus.
The connection between trigger and execution is built into the system, both
instinctually and later through the experiences of life. Once a trigger site has
been activated, in reality or in imagination, the physiological components of
the emotional response will play out to some degree, even where we do not
recognize the source of an emotion or its meaning. The system of response
to threat operates throughout the animal kingdom; we share these emo-
tional patterns with our phylogenetic ancestors. In humans the categories
of events that may serve as the ECS extend more widely and become more
complex, and the responses of avoidance or attack also take a variety of
complex forms.
The other route, the indirect road that LeDoux (1998, p. 164) characterizes
as the “high road,” also passes from stimulus through sensory thalamus, but
then connects through the hippocampus to the cortical association areas, the
source of our general knowledge of the world and the source of our indi-
vidual autobiographical memories, registered on the timeline of our lives.
The activation of these cortical areas is what permits appraisal of a situation
and enables delay, modulation, regulation, and redirection of the immediate
affective response.
178 Clinical perspectives

For instance, a woman takes an immediate dislike to a new co-​worker,

finding him rude and unfriendly. They are assigned to work together on a pro-
ject; the co-​worker turns out to be hard-​working and helpful. Now she sees
him as maybe a little odd, funny rather than rude, shy rather than unfriendly,
perhaps uncomfortable in the unfamiliar situation. They turn out to have
many interests in common. She helps him to feel more at home in the new
environment. They work well together.
The hippocampus and related processes constitute the pivot of a well-​
operating integrated emotion system that permits people to take in new emo-
tional information, to see others in a new light, and to use this new knowledge
to direct how to respond. The hippocampus connects in one direction to the
cortical association areas and, in the other, to the emotion-​triggering and
emotion-​execution sites of the amygdala, limbic systems, and brain stem. The
pathways join here: the cortical hippocampal system enables regulation and
modulation of the thalamic-​amygdalar activation, based on the experience of
life; the affective activation feeds back to provide the emotional evaluation of
new situations.

Effect of stress on the emotional circuitry

Stressor events, whether chronic or acute—​neglect or abuse in childhood,
early loss of parents, the traumas of war—​specifically affect this integra-
tive process by which new emotional information is taken in, through direct
impairment of the hippocampal and related functions and disturbance in the
modulation of the amygdalar functions. Such impairment contributes to the
various forms of dissociation that I outlined in Chapter 9 (Bucci, 2007).
The effects of stress on the emotional circuitry are well known (Payne
et al., 2004). Stress is specifically defined as activation of a physiological
system that functions, primarily through release of the adrenocorticotropic
hormone (ACTH), to facilitate organismic response to threat. There are
dense concentrations of stress hormone receptors in the pivotal hippocampus
system. Activation of these receptors in the hippocampal system contributes
centrally to the cognitive and emotional effects that are observed.
If a threat is experienced, activating an emotion schema, the triggering
and execution sites will play out in humans as in all species, and lead to the
various emergency responses of attack or avoidance, including freezing and
flight. In the normal course of events, again across all species, when an acute
threat has passed, the response pattern shifts; the flight or attack is halted
and the freezing lifts. The naturally induced analgesia associated with the
freezing response, mediated by endogenous opioids and other mechanisms,
may also dissipate, leading to an increase in pain. In adaptive functioning,
and in well-​operating interpersonal contexts, the return of pain perception
instigates recuperative behaviors, including self-​care and soothing as well as
 Dissociation Part II: Dissociative processes 179

social supports. The person (or other organism) then gradually returns to the
pre-​threat state, the normal way of being.
Elizabeth Howell (2005) describes her experience on the morning of
September 11, 2001: exiting the subway at the station before the World Trade
Center, seeing the “twin towers three short blocks away, burning rapidly, like
matchsticks”; rushing across the Brooklyn Bridge to her home in Brooklyn;
closing her windows “against the now arrived black cloud of soot and burned
remains.” She says, “I remained calm. It was a heartrendingly emotional
time, but I thought that psychologically, I was fine.” We can see this as the
analgesia of the freezing state, the built-​in physiological protection against
overwhelming arousal. Howell knew it was a “heartrendingly emotional time,”
but she was somehow insulated from it.
The freezing response gradually lifted; the impact of the experience then hit
her a few days later:

I realized that I narrowly missed being caught in the conflagration …

I worried about all the people in the subway, some with whom I had
spoken, who had not left … When I realized how imminent the danger
had been, I couldn’t stop telling anyone who would listen … Fortunately
for me, I received enough understanding that my mild posttraumatic
stress symptoms abated.
(2005, pp. 14–​15)

We see the mechanisms of affect regulation and the importance of social

supports in Howell’s recovery from her traumatic experience. As she says,
“Although I felt like Coleridge’s Ancient Mariner (who had to wander from
town to town, endlessly telling his story), I began to heal” (2005, p. 16).
The individual schemas that define a person’s expectations and beliefs
about the interpersonal world will determine the management of such crisis
states from the beginning of life. If the child has been able to experience
painful arousal in a context of emotional support, schemas of affect regu-
lation that serve well later in life will be developed. In some cases, however,
where pain is overwhelming, the stress is chronic, or the situation is adverse
in other ways, the person lacks sufficient means—​intrapsychic or social—​
to heal in this way. We can see the effect of stress on the organization of
emotion schemas in sharp relief in the memories of Holocaust survivors.
Each stage of the process of response to trauma, as I have outlined, may be
traced in their words.
The freezing response is dominant in their reports. Kraft (2002, 2004)
analyzed more than 200 hours of oral testimony given by survivors of the
Holocaust.1 In these testimonies, Kraft (2004) reports, more than 75 per cent
of the survivors who described their emotional state during the horrors said
that they were numb:
180 Clinical perspectives

They use a variety of phrases to elaborate this state of numbness: “in

a trance,” “like a piece of wood,” “frosted over,” “like a stone,” “hiber-
nating,” “like a vegetable,” “like robots,” “in a catatonic state” … The
numbness is so alien and so pervasive that some survivors say they were
given drugs.
(2004, p. 357)

The numbness persisted throughout the war and into the liberation
(Kraft, 2004):

There is one thing I have to say: that throughout my experience then,

I don’t remember feeling fear … What I remember feeling is numbness
[Testimony of Meir V., 1992, p. 350].
I didn’t feel anything. I didn’t even feel the elation that I thought I was
going to feel … It really didn’t make any difference. So we are liberated,
so what? [Testimony of Daniel F., 1980, p. 350].
They retained this dissociation during the decades following the war;
the demands of daily life provided meaningful distraction from the poten-
tial triggers of painful affect:
Alan Z. says that he suffered great fears and nightmares after liber-
ation, but these fears and nightmares went away with the distraction of
work and family. He says, “After I came to the United States, and I started
to work, everything disappeared. I mean, my life changed drastically …
My work, I was involved in my busines. And raising my family. And it just
moved away from me” [Testimony of Alan Z., 1984, p. 374].
For some of them, the avoidance was an intentional decision, and they
varied in degree of awareness of the dissociative processes:
I believe I am a successful professional in my field … But as a person,
as a Jew, I feel I’m sitting on a volcano [Testimony of Karl S., 1980,
p. 375].

The survivors referred in many different ways to the dissociations in their

experiences of themselves. They spoke of a double life, two different worlds.
One referred to “two separate units in one’s experience … the me that is the
wartime and pre-​wartime me and me that is the post-​wartime”; another said
that her children did not know the “real me,” that she was playing a part. They
talked of “emotional masks,” behind which they hid their Holocaust selves
(Kraft, 2004, p. 380).
Even during the active period of their middle lives, during which the
distractions were most effective, events would occasionally intrude to trigger
an affective response. The sight of large dogs or men in uniform, a bonfire in
the park, or news reports of war or devastation or famine triggered responses
of disorientation and panic that were physical and overwhelming. The emo-
tional responses that were activated in memory were in some cases experienced
 Dissociation Part II: Dissociative processes 181

as more painful than the original events; the responses of numbing and anal-
gesia that accompanied the actual onslaughts of terror were not in place.
For many of the survivors, the strategies of distraction became less effective
as the demands of life eased:

Alex H. says that for many years after the war, he was so involved in the
fight for a new existence that he did not think about the past. Beginning
with no family, no schooling, and the wrong language, Alex says the daily
fight to establish himself used all his energy. In fact, he suppressed his
time in the concentration camp until 3 years before he came in to give
testimony. He describes the result of having accomplished his goals. “My
past is starting to haunt me … and I feel so depressed, very often. That
I actually feel that I—​very often feel that I lived long enough.” [Testimony
of Alex H., 1985, p. 376]

The torment of memories returning was described by many of the survivors

and may have been partly what motivated them to agree to give their testi-
mony. For many, their testimony was their first extended recall in more than
40 years. We hear the conflict—​wanting to distract themselves, not being able
to; not wanting to talk, but needing to—​over and over in their testimony as
well (Kraft, 2004):

The operation of dissociation in the emotion schemas is seen in the

nature of the survivors’ memories. Many survivors remembered emotion
without specific event information and recalled events without emotional
experience:
Arnold C. flatly describes the aftermath of allied bombing at
Zeldenlager: “In the morning, there were arms and legs all over the place,
on the wires, on the barbed wire, got caught. I must admit that it was
the first and only place where I saw cannibalism. I saw two people take
a piece of meat from a body and try to make a fire and cook it. The
German officer who walked by, who saw it, shot them immediately.” [He
then gives an affirming nod to the camera, as if to say, I witnessed this
and I can talk about it.] [Testimony of Arnold C., 1983, p. 364].

As Kraft notes, Arnold C. did not talk about his emotional response or show
the disgust or anger that might have been activated in him by the narrative
(and that is generated in the listener or reader). “His motivation is to tell the
events clearly and directly” (Kraft, 2004, p. 364).
For many of the survivors, however, the retelling of specific episodes in the
oral testimony had the effect of activating emotional experience that had been
dissociated and the reliving was experienced as intolerable. There are many
examples of survivors who cry during testimony while describing a specific
event, express surprise at their emotions and then often apologize, indicating
182 Clinical perspectives

that they cannot control the pain of the memory and attributing it to the recall
of the specific event. There were some survivors who gave testimony more
than once. At the second interview, as Kraft (Kraft, 2004, p. 364) describes,
they all reported that giving testimony was deeply distressing, and they were
all surprised at the intensity of their distress. One said, “I didn’t realize that
it’s going to take me to the depths of depression for months. I didn’t realize
it.” Another reported that she needed to be tranquilized afterward because of
the powerful emotion that was released.
When they could tell their stories in general terms, they experienced the
value of educating new generations and commemorating the lives of those
who were lost. They may have gained a sense of purpose, hope, and sharing:

Alan Z. said he does not cry when he talks to individuals and to larger
groups about the loss of his family during the Holocaust: “Only when
I go back that far is there a lot of detail. You see, when you go to speak
somewhere to a school or to the synagogue, I don’t go into these details
where it makes me emotional.” [p. 364].
They learned to avoid the triggers, internal or external, in memory or
in life, that had the potential to activate the schemas.
I think the problem is … I’m afraid if I open it up, I’m going to have
nightmares that I had for years and years, and I will not allow this … I’m
afraid it might destroy me [Testimony of Martin S., 1988, p. 351].
We see the avoidance of detail throughout the testimonies, in many
cases stated quite explicitly:
The only question was, “Where were you during the war?” “I was in a
concentration camp.” That’s it. “I was in the partisans.” That’s it. “I was
hiding in the—​some place.” That’s it. Nobody spoke any details. It seems
that the people wanted to block it out from their mind [Testimony of
Ruth A, 1994, p. 365].

The conflict concerning the value of talking about emotional experience,

and by implication the nature of treatment that is most helpful for survivors
of traumatic experience, remains unresolved. This has been an issue for
mental health workers in the aftermath of all tragedies. As Kraft (2004,
p. 365) observed, the retrieval and retelling of specific memories in the con-
text of the testimony does not facilitate new understanding or even release
of tension: “Traumatic memory seems to be a self-​generating source of
emotional pain … [and] the power of emotional memory is not diminished
through the release of emotions during testimony.”
Opening the wound may be experienced as devastating, but without
opening it, healing may not occur:

Certain people, they stay with you and they can’t get away, they can’t,
they just can’t get away. Anyone, if he thinks, he sees the hole in his heart,
 Dissociation Part II: Dissociative processes 183

is—​not getting smaller, is getting bigger [Testimony of Abe L., 1990,

p. 375].

A broader view of traumatic events

The patterns of response to extreme assault and stress that are seen in rela-
tively pure form in the testimonies of the Holocaust survivors can also be
traced in a broad range of emotional disorders. We can identify similarities
and differences between the effects of specific, acute trauma and those of more
chronic stress, abuse, and neglect, with corollary implications for treatment.
For acute traumatic events, the source and nature of the trauma are known
publicly and to individual survivors, and are shared by members of the sur-
vivor group to some extent. In cases of chronic abuse and neglect—​usually
within families—​the events that constitute the source of the trauma are often
not identified and are largely specific to the individual situation. The identifi-
cation of a caretaker as an abuser would be a source of devastating anxiety,
leaving the child with no safe place to be. The emotion schemas are organized
to avoid this knowledge.
Even for the survivors of known catastrophic events, however, the
experiences include not only shared and public elements, but also aspects that
are specific for each individual, and perhaps not identified. The events affect
each person in different ways; the nature of the person’s responses at the time
of the event will differ depending on their situation and capacities; and will
affect their memories of the events in crucial ways. Hints of such individual
responses—​involving such affects as guilt, shame, and humiliation—​appeared
in the testimonies of the Holocaust survivors. Part of the unbearable affect
that threatened to emerge in telling the specific episodes lay not in activating
the traumas that were acknowledged and shared, but in connecting to private
emotional meanings that had been warded off.
For all survivors, of chronic as of acute trauma and stress, when the ini-
tial threat is past, the patterns of response and attempted self-​regulation—​
the numbing, the dissociative strategies that are developed to maintain
the numbing, the inevitable intrusion of triggers that activate the dreaded
schemas, the resultant extension of the strategies of dissociation—​become
the problems that interfere with life and that need to be addressed.
In general, treatment needs to address the maladaptive means of self-​
regulation as well as the source of the initial threat. It is also necessary to
recognize that these strategies of avoidance and self-​regulation, which may be
damaging in current life, were the means that enabled the person to survive in
the past; they have become components of the person’s self-​schema, part of
the structure underlying their sense of self.
One may enter the circuitry of the emotion schemas at various levels to
achieve particular therapeutic goals. Different modes of treatment may
be required for different goals, for different individuals, and at different
184 Clinical perspectives

phases of the treatment. Psychotropic medications operate directly on the

physiological circuitry of the trigger and execution mechanisms; methods
of exposure and desensitization operate primarily on the feedback loops
among these mechanisms. Behavioral and supportive treatments may be
useful in providing means of self-​regulation that are more effective and less
damaging than some of the strategies—​such as addiction, eating disorders,
somatization, self-​inflicted injury, and emotional isolation—​that people have
developed to regulate themselves. Alternative methods, such as meditation
and yoga, also provide mechanisms that enable regulation of the arousal and
related response patterns.
The various procedures that operate directly on the regulatory mechanisms
may also help to establish an emotional environment of reduced stress in which
the possibilities of exploration inherent in psychodynamic treatment may be
attempted, but the goal of psychoanalytic treatment goes beyond the develop-
ment of such regulatory mechanisms. Ultimately, where possible, the psycho-
analytic objective is to bring about change in the emotion schemas in such a
way as to enable registration of new information concerning the individual’s
interpersonal world and their self in relation to this; to identify the triggering
mechanisms; to enlarge the range of affective experience, including painful
affect, without being overwhelmed; and to differentiate threats that are real
from ones that are no longer potent in the context of the individual’s current
interpersonal situation and current powers.
As discussed in Chapter 9 (Bucci, 2007), these objectives ultimately require
that the patient experience some aspects of the affective core of the dissociated
schema in vivo, in the session. The process will involve representation of spe-
cific events associated with the schema in memory or in the relationship. The
patient will report an episode, memory, or fantasy whose connections to the
schema may not be recognized and will also enact elements of the frozen rela-
tionship that the schema represents.
It is precisely here, through representation of specific events in the present
or as retrieved from memory, that the opportunities for change in the emotion
schemas as well as the risk of overwhelming affect arise. Specific events
occurring in the present, and also as retrieved from memory, are powerful
cognitive-​emotional operations. They are the activators of the hippocampal
pivot, enabling interconnection of components of the emotion schemas and
enabling connection of affective arousal in the present to autobiographical
memory. The schemas of self and other in autobiographical memory are built
on specific events and are vulnerable to their activation. One cannot bring
about change in the emotion schema without the connecting process, but as
the connections come alive the freezing lifts, so the pain increases.
Clinicians are familiar with the phenomenon in which a session of powerful
exploration and discovery is followed by one of avoidance, anger, or self-​
injury. This was illustrated clearly in a case example presented by Richard
Chefetz (2006):
 Dissociation Part II: Dissociative processes 185

She reported by telephone the next day that she’d had all of one hour
of really feeling good after that session. She said that she could feel her
body, her mind was clear and crisp, and she had a lot of energy. But she
was reporting this in the context of “Is that all that I get, one hour?!”
What she went on to say was that as soon as the hour had passed her
mind was flooded with new thoughts, images, sensations, and other pieces
of memory from an abortion, as a teenager. She was terribly distraught,
miserable, and the feeling of her suffering was again the most salient
experience in talking with J.

Bromberg (2001) also provides a clear example of this process:

After a session that seemingly went well, a depressed patient with a

longstanding eating disorder left a message on my answering machine
late that night: “Memories are beginning to come up that I’ve never
had before, and it’s very disturbing. It’s like I’m watching them from a
different part of my brain,” she said. “It’s very weird.” Her voice sounded
upset, but not in a panic. Next morning, someone I hardly recognized
showed up for her session, and growled menacingly:
“I’m the one you need to ask the permission from! Who do you think
is going to pay the rent if you keep going the way you are going? You said
that I would be able to carry on with my life and my work if we agreed
to do this therapy. This is bullshit! There is nothing to be gained from
this. This work changes nothing. It’s expensive and a waste of time. You
remind her of how alone she is, how alone she has always been, and this
is supposed to be of help? She’s nothing but a fat, ugly, poor kid in pain,
and she has suffered enough! I won’t let her suffer anymore! She knows
that no one will support her if I don’t. Not even the shrink will be there
if the bills don’t get paid.
Who do you think pays the bills anyway? I won’t allow this! I will not
allow this! I will not allow this! As long as you threaten to disable me,
I will not allow this. I am not nice and I don’t care what you think of me.”
(Bromberg, 2001, p. 910)

We need to recognize and respect the extreme power of the activation of a

specific event in memory or enactment. The arousal that occurs in response
to imagery is physical and real, operating through activation of the thalamic
amygdalar route; it is similar to the response to the actual threat itself, but
may be worse because of the absence of a compensatory numbing component.
To be helpful in achieving a new integration of the emotion schemas that
have been dissociated, the telling or the enactment of specific memories
requires an interpersonal space in which the arousal of painful affect can
be managed while the schema of threat and the processes of protection and
avoidance can play out. This basic therapeutic process applies for survivors
186 Clinical perspectives

of all forms of emotional assault, chronic as well as acute, in different forms

and to varying degrees.
As memory is evoked and new connections are opened, there is continuous
danger that the current context will be drawn into the schema, rather than
the schema being perceived as new. We see this in the examples from the work
of Chefetz (2006) and Bromberg (2001). The patient may experience any
challenge to these protective processes not only as threatening his life, but
also as threatening his sense of self, evoking dread of a different sort—​for
example, the therapist will be seen as the predator, the aggressor, the seducer,
the humiliating agent. This is an opportunity as well as a threat; what happens
next is the question: how is this activation used?

The role of the analytic relationship in bringing

about change
Here I want to focus on what we can understand about the role of the thera-
peutic relationship in this process of change. Emotion schemas are intrin-
sically relational. Change in the emotion schemas, like their development,
depends on connections between internal affective experience and the emo-
tional expressions of other people. If the schemas are to be changed rather
than reinforced, the new interpersonal context must be genuinely new, different
from the interpersonal context in which the initial dissociations occurred.
As indicated by the outline of neural circuitry given earlier, behavioral
expressions of affect—​ particular facial expressions, vocalizations, body
postures, and patterns of behavior—​are inherent elements of an emotion
schema. We have limited control over the execution of these expressions; we
are not aware of carrying out most of these expressions; we cannot carry
them out in the absence of the feeling state; and we cannot avoid them once
the feeling state has been activated. The inherent link between affective
arousal and expression determines the nature of emotional communication
in all interpersonal contexts, including the psychoanalytic situation.
Damasio (1999, pp. 48–​49) describes this linkage very specifically and
clearly:

Once a particular sensory representation is formed … whether or not it

is actually part of our conscious thought flow, we do not have much to
say on the mechanism of inducing an emotion. If the psychological and
physiological context is right, an emotion will ensue. The nonconscious
triggering of emotions also explains why they are not easy to mimic
voluntarily … a spontaneous smile that comes from genuine delight or
the spontaneous sobbing that is caused by grief are executed by brain
structures located deep in the brain stem under the control of the cingu-
late region. We have no means of exerting direct voluntary control over
the neural processes in these regions. Causal voluntary mimicking of
 Dissociation Part II: Dissociative processes 187

expressions of emotion is easily detected as fake—​something always fails,

whether in the configuration of the facial muscles or in the tone of voice.

What this means is that analysts are necessarily genuine in their emotional
communication. The analyst is communicating what they feel, independent
of what they might say, even when they are not explicitly aware of what they
feel; and the actual emotional meaning of their expression is received by
the patient even when the patient may not be explicitly aware of what that
meaning is.
We are now beginning to know more about the wiring that connects
internal experience with perception of the expressions of others. Neurons,
termed mirror neurons, have been found in the frontal cortex of monkeys
and humans. These mirror neurons represent, in an individual’s brain, the
movements (or expressions) that the brain sees in another individual, and
produce signals to sensory and motoric structures so that the corresponding
movements or expressions are either “previewed” in simulation mode or actu-
ally executed in trace form by the viewer (Rizzolati et al., 1996; Rizzolati,
Fogassi, & Gallese, 2001). The implications of these new findings are poten-
tially enormous for understanding emotional communication in development
and throughout life.
Change in the emotion schemas depends on the connection between what
the patient knows emotionally about their own self, about the analyst, and
about their relationship, and what the analyst is expressing. What the patient
knows emotionally that is invalidated by the analyst raises the risk of reinfor-
cing the dissociated schema rather than enabling new connections. Bromberg
(1994, p. 356) expresses this precisely:

A pattern of pointless re-​traumatization in analysis can take as many

forms as there are analytic techniques, and any systematized analytic
posture holds the potential for repeating the trauma of nonrecognition,
no matter how useful the theory from which the posture is derived.
Nonrecognition is equivalent to relational abandonment, and it is that
which evokes the familiar and often bewildering accusation “you don’t
want to know me.” In other words, it is in the process of “knowing” one’s
patient through direct relatedness, as distinguished from frustrating,
gratifying, containing, empathizing, or even understanding him, that
those aspects of self which cannot “speak” will ever find a voice and exist
as a felt presence owned by the patient rather than as a “not-​me” state
that possesses him.

Analysts can decide how to work in treatment, while recognizing that what
they feel will be communicated on some level. This communication will occur
in a range of channels in face-​to-​face treatment and will occur in auditory
channels, paralinguistic as well as linguistic, when the patient is on the couch.
188 Clinical perspectives

Implication regarding the analyst’s engagement in the

therapeutic situation
The analyst, like the patient, views all things through the lens of his emotion
schema; there is no other way. Countertransference is ubiquitous—​ as is
transference—​in this sense. The analyst will bring their own self, with their
dissociated as well as integrated schemas, into the therapeutic encounter; they
differ from the patient in that part of their emotional baggage, for good or ill,
also derives from their training and their theory, and they will presumably be
continuously monitoring their actions and state.
The issue of the analyst’s authentic engagement with the patient, and the
expression of this engagement, is a complex question at the center of our psy-
choanalytic controversies. Our understanding of emotional development and
emotional interaction and their neuropsychological base have thrown new
light on this question, but have also made the issue more crucial and more
controversial, rather than resolving it.
Freud went through many changes in his views on the analyst’s engage-
ment, gradually moving from his early view that the treatment required a
whole human relationship to his later view of the analyst’s engagement as
a danger to the treatment. In discussing the case of Frau Hirschfeld, his
“Grand-​patient and Chief-​tormentor,” Freud wrote to Jung:

I gather … that neither of you [Jung and Pfister] has yet acquired the
necessary coolness in practice, that you still engage yourselves, give away
a good deal of yourselves in order to demand a similar response. Permit
me, the venerable old master, to warn that one is invariably mistaken
in applying this technique, that one should rather remain unapproach-
able, and insist upon receiving. Never let us be driven crazy by our poor
neurotics.
(From Falzeder, 1994, p. 314; discussed by Friedman, 1997, p. 27)

The patient must be emotionally engaged, under the influence of the ana-
lytic situation, yet Freud (in his somewhat burnt state following the treatment
of Frau Hirschfeld) was saying that the analyst must remain unengaged.
Friedman (1997, 2005) has addressed these issues from a somewhat clas-
sical perspective in two searching (and engaged) papers. In the more recent
paper, he examines many aspects of the analyst’s involvement and response
or nonresponse to the patient’s appeal. He addresses the question of whether
“there might be a universal and peculiarly psychoanalytic something in the
analyst’s feelings that somehow deserves the name of love, since analysts
through the generations have seemed to think so”:

The patient may look for ordinary (forthright) love … but the classical
analyst hopes to avoid it, because, as Nussbaum points out, the pressure
 Dissociation Part II: Dissociative processes 189

of love is always, to some extent, confining and demanding of the beloved

… Psychoanalytic treatment was born in the discovery of the unique
effects of not wanting anything from the patient—​or at least trying not
to want anything.
(Friedman, 2005, p. 385)

Martha Nussbaum (2005, p. 379; italics added), referring to the Stoic view
of the emotions, has argued that all major emotions have one central feature
in common: “the thought that the emotion’s object matters greatly for the
life of the person experiencing the emotion.” It is this element that Freud in
his writings on technique, like the Stoics, felt it important to avoid, as setting
oneself up for damages and reversals; putting oneself at the mercy of fortune,
as Nussbaum describes. It is this element that patients truly seek, and the
absence of this element, the absence of longing and suffering, of true human
vulnerability, is experienced by the patient, correctly in Nussbaum’s terms,
as the absence of actual “real” love. Friedman (2005, p. 386) concludes on a
note of failure concerning his attempt to identify a particular psychoanalytic
“something” that may be characterized as love: were the analyst to settle into
a love relationship in the ordinary sense, Friedman says, the patient’s freedom
would be at risk, since love is, to varying degrees, necessarily “confining and
demanding of the beloved,” and would in any case not be the idealized love
for which the patient yearns (p. 386).
The new work in affective neuroscience brings the question of the authen-
ticity of the analyst’s response front and center in a new way. The stoic
solution of avoidance is not sufficient. The analyst needs to experience
real activation, longing, suffering, vulnerability; to really care; to really feel
attacked; not in an “as if ” sense. The analyst’s experience must be real in
the moment.
Here is where our new understanding of dissociative processes as normal,
adaptive, and indeed necessary in emotional functioning provides a possible
resolution of the dilemma posed by Freud, and by Friedman, Nussbaum, and
many others. The analyst’s emotional experience, their schema of interaction
with the patient, could be fully genuine in the moment, but in a local and
dissociated form.
The fundamental analytic attitude that is needed here is to recognize that
there could be other emotional states and will be others while subjective con-
sciousness, working memory, is engaged with any given state. The particular
nature of this dissociation that makes it both tolerable and effective is that,
while one emotion schema is aroused and dominant in working memory, the
analyst knows that there are others in the wings. The schema that is activated
is genuine in the moment, but in the context of a different emotional frame-
work, including background knowledge that it is only one state, and that there
are others that will be activated in different contexts, and that they are all held
within one overall autobiographical frame.
190 Clinical perspectives

All of our self-​states are self in relation to others. We each have a pool
of affective components and response patterns that emerge in different situ-
ations, just as we can know we are different with different people and hold
this knowledge within a more or less unitary sense of an autobiographical
self. Sometimes, of course, for everyone, the internal worlds collide; nothing
is simple.
I think we can talk about effective analytic work in this way—​the power to
maintain diversity in one’s persona, expressed in particular forms in particular
contexts, connected sufficiently to the spine of autobiographical memory. It is
not only emotional authenticity in interaction with the patient, but also emo-
tional insight that is facilitated for the analyst by the capacity to enter flexibly
into different states that are activated by the actual interpersonal context. The
analyst can know emotionally only what they can feel, and they can process
and work only with what they can know.

The role of language remains

Finally, I want to add here that for effective therapeutic work it is necessary
but not enough to know emotionally. The paradigm shift that is now occurring
in psychoanalysis involves the increasing recognition of the role of nonverbal
thought and communication. We are still, however, in a transitional phase
of this shift; we are experiencing, in some psychoanalytic approaches, a pen-
dulum swing to emphasis on the importance of the nonverbal domain at the
expense of the role of language.
The fundamental argument that I have tried to make concerns the equal as
well as separate status of all systems. In trying to develop a common psycho-
logical language for psychoanalysis, and to develop a new theoretical frame-
work, we need to recognize the role of all the systems of thought, symbolic
verbal as well as bodily, emotional, subsymbolic, and nonverbal; the need
for their integration in certain aspects of functioning; and the fundamentally
partial nature of such integration in adaptive functioning.
Given the reformulation of the psychical apparatus that I have proposed
here, the problem we face is like that of the analytic patient: “It has long been
recognized that every patient enters psychoanalysis with the same ‘illogical’
wish—​the wish to stay the same while changing” (Bromberg, 1998, p. 170). In
developing our theory and methods of treatment, we need to face a similar
question: How can the field change in significant ways while retaining its iden-
tity as psychoanalytic? I have proposed that our core psychoanalytic identity
lies in the recognition of multiple systems and multiple ways of being. In the
context of new scientific findings, we need to carry through this core idea
more fully by investigating the features of the multiple systems of thought
and examining their implications with respect to such concepts as transference
and countertransference, regression, resistance, conflict, and even repression
 Dissociation Part II: Dissociative processes 191

itself. As for the patient who is able to open new connections, the reward of
our psychoanalytic self-​examination will be new discoveries and a more vital
and expanding field.

Note
1 Drawn from a collection of more than 4000 testimonies held at the Fortunoff
Video Archive for Holocaust testimonies at Yale University.

References
Arlow, J. A., & Brenner, C. (1964). Psychoanalytic concepts and the structural theory.
New York: International Universities Press.
Bromberg, P. M. (1994). “Speak! That I may see you”: Some reflections on dissoci-
ation, reality, and psychoanalytic listening. The Journal of Analytical Psychology,
4, 517–​547.
Bromberg, P. M. (1998). Standing in the spaces: Essays on clinical process, trauma, and
dissociation. Hillsdale, NJ: The Analytic Press.
Bromberg, P. M. (2001). Treating patients with symptoms—​ and symptoms with
patience: Reflections on shame, dissociation and eating disorders. The Journal of
Analytical Psychology, 11, 891–​912.
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
21, 40–​70.
Bucci, W. (2007). Dissociation from the perspective of multiple code theory—​Part
I: Psychological roots and implications for psychoanalytic treatment. Contemporary
Psychoanalysis, 41, 132–​184.
Chefetz, R. (2006). Suffering as relatedness and affect regulations. Presented at
Seminar of International Society for the Study of Dissociation, Garden City, NY.
Damasio, A. R. (1999). The feeling of what happens. New York: Harcourt Brace.
Damasio, A. R. (2003). Looking for Spinoza. Orlando, FL: Harcourt.
Falzeder, E. (1994). My grand-​patient, my chief tormenter: A hitherto unnoticed case
of Freud’s and the consequences. Psychoanalytic Quarterly, 63, 297–​331.
Freud, S. (1900). The interpretation of dreams. Standard Edition, 4 & 5. London:
Hogarth Press.
Freud, S. (1940). An outline of psycho-​ analysis. Standard Edition, 23, 139–​207.
London: Hogarth Press.
Friedman, L. (1997). Ferrum, ignis and medicina: Return to the crucible. Journal of
the American Psychoanalytic Association, 45, 20–​36.
Friedman, L. (2005). Is there a special psychoanalytic love? Journal of the American
Psychoanalytic Association, 53, 349–​375.
Gee, J. P. (1986). Units in the production of narrative discourse. Discourse Processes,
9, 391–​422.
Howell, E. F. (2005). The dissociative mind. Hillsdale, NJ: The Analytic Press.
Kraft, R. N. (2002). Memory perceived: Recalling the Holocaust. Westport, CT: Praeger.
192 Clinical perspectives

Kraft, R. N. (2004). Emotional memory in survivors of the Holocaust. In D.

Reisberg, & P. Hertel (Eds.), Memory and emotion (pp. 347–​389). Oxford: Oxford
University Press.
Laplanche, J., & Pontalis, J.-​B. (1973). The language of psychoanalysis. New York:
W. W. Norton.
LeDoux, J. (1998). The emotional brain: The mysterious underpinnings of emotional
life. New York: Touchstone Books.
Nussbaum, M. C. (2005). Analytic love and human vulnerability: A comment
on Lawrence Friedman’s “Is there a special psychoanalytic love?” Journal of the
American Psychoanalytic Association, 53, 377–​383.
Payne, J. D., Nadel, L., Britton, W. B., & Jacobs, W. J. (2004). The biopsychology
of trauma and memory. In D. Reisberg, & P. Hertel (Eds), Memory and emotion
(pp. 76–​128). Oxford: Oxford University Press.
Rizzolati, G., Fadiga, L., Gallese, V., & Fogassi, L. (1996). Premotor cortex and the
recognition of motor actions. Cognitive Brain Research, 3, 131–​141.
Rizzolati, G., Fogassi, L. & Gallese, V. (2001). Neurophysiological mechanisms under-
lying the understanding and imitation of action. Nature Reviews Neuroscience, 2,
661–​670.
Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E., &
Dalgleish, T. (2007). Autobiographical memory, specificity, and emotional disorder.
Psychological Bulletin, 133, 122–​148.
Chapter 11

Embodied communication
and therapeutic practice
In the consulting room with Clara,
Antonio, and Ann

Therapists today, in all treatment approaches including empirically supported

and manualized treatment, need to be aware of what is going on emotionally
and bodily in the patient, in themselves, and between the two of them. As
Robert Leahy (2009, p. 187), a leading cognitive therapist, writes:

many novices in cognitive-​ behavioral therapy (CBT) rely heavily on

“empirically supported treatments,” manualized approaches, agenda-​
setting, or targeted behaviors and cognitions, but fail to recognize appro-
priately the role of the therapeutic relationship … Empirically supported
treatments “work” … but only if the patient enters therapy, maintains a
therapeutic relationship … Many patients drop out prematurely. If the
patient is not in treatment, then no help is found.

The core of psychotherapy is the dyadic interchange. The patient must

first and foremost be “in treatment”—​in as full a sense as possible—​in order
for the treatment to work; this requires that a relationship be developed and
sustained. Experienced clinicians have remained aware of this basic premise
of psychotherapy through all the requirements of manualized treatments;
psychotherapy researchers are becoming increasingly aware of this as well.
The relationship—​in some contexts referred to as the therapeutic alliance—​
has been recognized as a crucial factor in outcome across a range of therapies.
(Crits-​Cristoph, Gibbons, & Mukherjee, 2013).
Psychotherapy approaches differ regarding the degree to which the experi-
ence and exploration of the relationship are viewed as central to the processes
of therapeutic change, or a means of keeping a patient “in treatment” so that
other processes may be employed, but the basic premise of psychotherapy as
a dyadic interchange remains. The work on subsymbolic, bodily communica-
tion that has been outlined here opens pathways for a new understanding of
processes that figure in this therapeutic interaction.
Clinicians, at least from Freud onward, have struggled with the question of
how one can know in some valid way what is in another person’s mind. Freud
194 Clinical perspectives

addressed the question in terms of the unconscious mind and was not par-
ticularly troubled by the problem. He saw this communication as immediate
and direct, similar to the mechanism of the telephone:

Just as the receiver converts back into sound waves the electric oscillations
in the telephone lines which were set up by sound waves, so the doctor’s
unconscious is able, from the derivatives of the unconscious which
are communicated to him, to reconstruct the unconscious, which has
determined the patient’s free associations.
(Freud, 1912, p. 115)

Reik (1948) attempted to place these processes in a scientific context in his

prescient work on emotional communication, and also drew on concepts of
introjection, projection, and reprojection to account for more complex aspects
of the analyst’s understanding of the patient’s experience. In the intervening
years, some psychoanalytic explanations of these processes have grown
increasing abstruse. As I have argued (Bucci, 2001, p. 41):

The emphasis on projective identification and related concepts has

deepened the epistemological mystique surrounding the question of how
the analyst can “know” the patient’s experience and further widened the
gap between psychoanalysis and scientific psychology.

The new findings in the fields of affective and social neuroscience offer
a more systematic understanding of such perception of the experience of
another person, including an emphasis on the therapist’s recognition of
factors within their own self, as well as in the patient, that may contribute
to such perception. These findings have been influential in developing the
multiple code theory, including the concept of the referential process with its
three functions of arousal, symbolizing/​narrative, and reflecting/​reorganizing.
So as to illustrate in more detail the operation of this process, I offer
here three case examples drawn from recent papers. In these examples, the
therapists are working from quite different theoretical frames of reference,
and yet each is demonstrating a keen sense of the centrality of somatic and
subsymbolic experience—​within themselves as well as their patients.1
In presenting these cases, I want to focus on the interactions that are
associated with embodied communication; these are dominant in the arousal
phase of the referential process and also remain active throughout the
treatment. This bodily communication provides the emotional context for
associated exploration in narrative and also in the enactments of the schema
in the therapeutic relationship. The patient “knows” the other and their own
self in relation to the other in their own subsymbolic system; the therapist
also “knows” the patient through the complementary entrainment. The
therapist’s response, in their own emotion circuitry, to the playing out of the
 Embodied communication in consulting room 195

patient’s expression, is the best available source of knowledge and entry into
further shared knowledge of the patient’s dissociated and distorted schema.
This “knowing” of oneself is unlikely to be explicit for the therapist, at least
at first; they will need to go through a version of the referential process to
recognize the nature of their own experience. In this process, the therapist
will have associations and memories and will also reflect on these—​including
examination of the way in which the experiences of their own life contributes
to their perception of the patient’s experience.
The converse of this, which needs to be recognized in all treatment
approaches, including the various forms of cognitive and behavioral and
exposure treatments, as well as experiential and client-​centered approaches,
is that the therapist’s real emotional experience of the patient, including
experience of which they may not be aware, will necessarily be received by
the patient and responded to within their embodied emotional system. All
therapists need to recognize that this is occurring when making their decisions
regarding how to work.
I will first discuss the complex story of the treatment of Clara, which was
presented by her therapist, Dr. Marina Amore, in Milan in November 20172
and has been developed further in Amore (2012). In my comments at that
conference, in response to Dr. Amore’s presentation, I discussed Clara’s
emotional issues from the theoretical perspective of multiple code theory.
I also raised several questions concerning the treatment process, including
Dr. Amore’s experience of herself as well as her experience of Clara and their
relationship. My discussion here will include changes in the therapist as well
as the patient in the interactive field of the therapy, and in the drama of the
termination phase. These comments refer both to the initial presentation and
to Amore (2012).

Clara’s history and the treatment process

Clara came to treatment at the age of 30, suffering from severe “episodes
of perceptual dysmorphism, as ‘releasing air from her eyes,’ as if her eyes
were two holes from which the air moves inside and outside her body, disper-
sing her vital energy. These episodes trigger violent affective reactions, which
Clara calls ‘panic attacks’ in which she experiences the deep terror of losing
the integrity of her body and dying” (Amore, 2012). Dr. Amore works in
collaboration with a psychiatrist who prescribes medication to enable Clara
to come to treatment. Clara continues to take the medication for only three
months, but carries it with her for over a year.
In the first session, Clara also talks about the recurrent trigeminal neuralgia
from which she has suffered since the age of 6. The episodes of severe facial
pain associated with this disorder recurred regularly and heavily affected her
life. The symptoms did not occur in the sessions during Clara’s analysis until
the termination phase, as will be discussed later.
196 Clinical perspectives

Clara describes her mother as being unable to establish an empathic rela-

tionship with her, and as easily disorganized by minor problems, including
physical ones. She tells a memory of a childhood incident in which she cut
herself severely during a fall. Her mother’s reaction was such as to draw the
family to care for her rather than the child, while Clara looked on, unattended
and frightened, her blood running down her face.
Through repeated occurrences of such events, from early in life, in many
contexts, Clara learned that her mother was not available, in fact not capable
of comforting or caring for her. She also learned that calling for help made
things worse. Her father did not tolerate requests for reassurance and coldly
rationalized emotional experience. It seems likely that early in life Clara not
only recognized her parents as unavailable or destructive, but also attempted
to avoid this recognition, so as to maintain whatever relationship with her
parents was available for her. This is an example of dissociation within the
emotion schema. As a very young child, Clara experienced painful activation
of the bodily core of the emotion schema, while avoiding connection to the
events that caused the activation. Her body and her mind would then swing
into action to account for these feelings and to manage them. Part of this
reaction would involve prolonged activation of adaptational responses, as in
the generalized stress response initially described by Selye (1950). As Selye
(1950, 1956), McEwen and Seeman (2003) and others have shown, in cases of
such prolonged and repeated activation it is not only the external challenges,
but the body’s continuing attempt to adapt to the challenges, that lead to the
physical disorders associated with stress.
Facial pain, as in the trigeminal neuralgia from which Clara suffered, is
known to be associated with such stress responses. When the symptoms of
neuralgia came, she lay on the sofa in the family home, not complaining or
crying, waiting in silence for the painkillers her parents gave her to take effect.
Her intelligence and competence enabled her to care for herself sufficiently to
avoid the more painful and devastating experience of her parents’ emotional
abuse and neglect. She strived to function so as to see herself as “consistent,
strong and brave”; also as “uninhibited,” “brave,” “intellectual.” Expressing
emotional or physical needs carried great dangers for her. Not only would she
lose her connection to her parents by calling on them for the help that they
would not or could not give, but she would also lose her construction of her
competent self that had supported her from early in her life. Her attempts to
maintain this image of herself would be likely to intensify the stress response.

Repair of dissociated schemas in Clara’s treatment

Clara comes to treatment as this construction of herself as consistent and
brave is breaking down. While she needs and seeks help, she also carries her
expectations of others as potential sources of danger and her strategies of
response through avoidance of connection to her own needs. As Marina
 Embodied communication in consulting room 197

describes it, “the flow of words is continuous” between them, but “words are
never enough to grasp and describe the ‘dark’ experiences that pervade her
inner world.” Clara talks about herself, but is frustrated by a sense of not
being able to understand what she really feels; she has the impression that her
speech is always incomplete, that she is incomplete. She is not able to describe
the horror she feels that leads to the panic attacks; not able to connect to the
specific experiences that distress her.
Marina suggests that they increase the frequency of the sessions from two
to three times a week, and includes the possibility of calling on the weekend.
The new setting changes the patterns of communication in the session and
provides a stronger foundation for their relationship. Here we can begin to see
the playing out of the phases of the referential process in the session and in
the treatment. This period of the treatment is dominated by increased arousal
of experience in the context of the new relationship. Clara is constantly testing
her experience of Marina in small incremental ways, seeing that Marina does
not react in ways that she learned in her childhood to expect. Yet Marina
senses that Clara continues to keep her at a distance from important aspects
of her experience.
During this period, Clara reports a dream in which they are climbing a
high mountain together, “as in a pilgrimage, to reach a sacred place where
an uncovered sarcophagus rests.” As they near the edge of the sarcophagus,
Clara puts her hand on Marina’s eyes. As Marina reports:

For both of us, the exploration of the dream makes explicit the thought
that the vision of what is her most intimate feeling, experienced fear-
fully as shapeless and unrepresentable, can somehow be intolerable and
harmful to me. If this happened as it happened when the mother saw her
blood, she would find herself alone again.

To enable Clara to make some connection to the painful experience that is

“shapeless and unrepresentable” in the context of the session, Marina invites
Clara to “focus the conscious attention on the bodily sensations matched
with feelings of inadequacy” and to explore them. As discussed earlier,
patients may be able to focus on and talk about elements of bodily experi-
ence, while narratives involving other people or events are not accessible to
them; such reports of specific bodily and sensory experience may begin to
build connections to the symbolic and verbal mode. The patient’s experience
of the analyst’s presence may also be protosymbols of this sort (Bucci, 2001).
Clara talks about the cracks that distort her voice, her rigid posture and
movements; she also talks about her experience of Marina. In the movement
from the arousal to the symbolizing mode, the subsymbolic interaction that
has been going on continuously between them begins to be articulated; now
Clara focuses on Marina’s expressions and is able to talk about how they
make her feel. Marina has always been very cautious in her use of words;
198 Clinical perspectives

she knows that Clara is easily influenced by her every word. She knows also
that Clara is very sensitive to all of Marina’s nonverbal expressions, often
interrupting her talk to stare at Marina as if confused. In time, they under-
stand how Clara is responding to Marina’s frown, or a moving of her gaze, or
her smile, or her body movements from one position to another. Any of these
and other of Marina’s nonverbal expressions became unknown factors that
needed to be interpreted in order for Clara to proceed with her self-​disclosure
in safety. (See Amore 2012 for more detail on these interactions.)
Clara’s comments also lead Marina to focus on her own bodily experience.
In some situations, Marina feels that her leg muscles are contracted “as if
prepared for a sudden jump forward”; she associates that with her fear that
because of the intensity and tension of their interaction, Clara may experi-
ence a sudden psychotic break. In other instances, when they focus on aspects
of their shared womanhood, Marina is able to experience her own body in a
stronger way and to convey this strength to Clara.
Three years into the work, Clara is no longer suffering from symptoms
of neuralgia or the panic attacks. She has become increasingly able to talk
about life experiences that had previously been felt as unbearable, as these
now emerge in memories and dreams. She connects the occurrence of the
attacks of neuralgia to a painful and annihilating sense of loneliness in her
childhood. She reports re-​experiencing these feelings as an adult while lying
on the sofa in her living room, waiting in vain for someone to come and
reassure and comfort her.
Here we see evidence that movement into a symbolic narrative phase is
occurring more consistently in the sessions during this period of treatment,
and that she is more able to report fantasies, dreams and narratives of past and
future events. As Clara is building new connections between her somatic and
sensory experiences and her representations of others in the treatment, the
therapist is becoming a new “other” connected to Clara’s self-​representation.
During this process, Clara is also building new connections in her memory of
early life events, and in her current relationships to others; she is able to form
a relationship of love and become a mother.
The development of the functions of the referential process in the treatment
was associated with Clara’s movement from the couch to a face-​to-​face pos-
ition with Marina. A reduction in the frequency of sessions also occurred
at this time. In the initial phases of the treatment, the use of the couch had
proven effective in helping Clara to maintain a closer contact with her own
volatile and intense inner experience. As the treatment progressed, the couch
and its implications themselves became objects of their exploration, serving
as indicators of changes within each of them and in their relationship. As they
discovered together, the use of the couch initially functioned for Clara to pre-
serve Marina as a supportive presence. As Marina observes (Amore, 2012),
“In this way, not even I could see, reflected by the frightened-​frightening
 Embodied communication in consulting room 199

expression on her face, her frailties. Clara needed to preserve me, as we had
also seen in the sarcophagus’s dream in which she covered my eyes from
something that could not be looked at.” The shift from the couch to face-​
to-​face contact reflected their shared observation that Clara had over time
come to feel more confident about Marina’s emotional solidity in the face
of her frailties, and more safe and confident in their relationship. As Marina
described in her conference paper:

This awareness now made her eager to look at me; defying the risk of
seeing the negative responses that she had fantasized for so long a time.
Now she could meet my gaze where finally she could see herself being
seen in her frailties. This shift in setting made possible a long phase of
comparison and mirroring that followed.

This can be seen as a time in which Clara was more able to talk about her
experience and reflect on it, and in which more lasting changes in her emotion
schemas may be seen.

The referential process in the termination phase

The therapist’s experience
Although the shift in the nature of their interaction was apparent, Marina
is surprised when, after they had worked together for about 10 years, Clara
expresses her feeling that it is time to end the treatment. Marina is aware of
the considerable gains that Clara has made but also recognizes significant
areas of fragility that remain. As they explore the prospect of termination,
Marina becomes more aware of her strong feelings of emotional connection
to Clara. She also explores parallel feelings that she is experiencing in the
process, ongoing at the time, of weaning her daughter. Like Marina’s own
daughter, Clara was growing and separating. For Marina as analyst and also
as mother, both situations, to different degrees, involve the complex feelings
associated with such separations: mourning a loss; pleasure and pride in the
growth of a person whom she has nurtured; the fears that one has when a
patient—​or child—​must confront the world on their own. Marina believes
that it is time for Clara to meet life on her own, but remains concerned that
she may not be ready, and also concerned that her worry may be undermining
Clara’s faith in her own capacity to function independently. We may see this as
a version of the referential process in the analyst’s experience: first, Marina’s
increasingly strong feelings and her awareness of them; then her association
to the process of weaning her daughter; followed by her exploration of the
pain of separation, and the conflicting meanings of pride in the growth of the
other and fear for the other’s capability.
200 Clinical perspectives

The patient’s experience of the termination phase

When Marina has agreed to the termination, and they have set a date for the
last meeting, Clara’s attacks of neuralgia return, as crippling as they were in
the past. The planning for termination has replayed for Clara the situation of
early stress; her body has responded with the pattern of physiological activa-
tion to which she had been vulnerable for much of her life.
One day Clara comes to the session suffering from an attack of neur-
algia. This is an exceptional event; she has not previously had the symptom
in Marina’s presence. We may see this as evidence of the change in Clara’s
emotion schema; she is now able to show her pain directly to Marina; she no
longer needs to cover Marina’s eyes to prevent her seeing into the darkness of
the sarcophagus—​but she is not yet confident of the potential effects of the
event. Clara’s expression of need is presented in the context of the impending
termination of the treatment that she herself has chosen, as if she is testing
whether she can now be independent in a different and sustainable way,
whether she will lose the gains she has made in her life when the separation
from Marina occurs.
In the terms of the referential process, as it played out in this session, the
activation of the symptom is part of the phase of arousal, activation of the
affective core of an emotion schema of pain and loss in the context of the rela-
tionship. Marina encourages her to focus on her bodily feelings and commu-
nicate them to her, as she has done many times in the course of treatment. As
Clara experiences the pain and talks about it, she describes “an explosion”
inside her head, generating “a beam of blinding white light.” The beam of
light gradually forms the shape of a white box trapping her head.
As Marina (Amore 2012, p. 250) describes:

Now Clara moves among images. The white box becomes a white room,
empty and isolated from the rest of the world. She sees herself as a little
girl, with her back turned, standing in front of an old radio that used to
belong to her grandparents. She is surprised by the memory. She wonders
why her parents gave it away; she is sorry they did. She watches herself
turn the knob trying to tune into a station. Then her attention is caught
by something little Clara is holding in her hand. “Oh my God … I forgot
all about it … It’s a dog … my stuffed animal! I never parted with it …
How could I have forgotten about it all these years?”

This is movement into the symbolizing phase, from proto symbol to symbol.
She moves on from talking about the pain to visual imagery and then to
images retrieved from the past. She smiles as she tells Marina how much com-
fort this stuffed animal had given her when she felt frightened and in danger.
She remembers that, “like the radio, one day it was simply gone: her parents
had given it to a younger cousin because, as they later explained, she had
 Embodied communication in consulting room 201

outgrown it” (Amore 2012, p. 250). She has no recollection of how she felt at
that moment, or whether she cried, but now she is able to mourn the loss of
this object that was so important to her. Marina writes (Amore 2012, p. 250):

At the end of the session Clara’s neuralgia is gone and she feels she has
recovered an important part of her experience. I feel the same and am
deeply moved by the process I have witnessed and shared. I’m touched by
this unexpected finding, Clara can see it by my wet eyes.

I suggest that what was occurring here in Clara’s experience was activation
of the affective core of her early dissociated emotion schema of pain and
dread. It seems likely that the visual images she experienced in the moment in
Marina’s office, along with the attack of neuralgia, were components of the
painful experiences of her childhood, part of the affective core of an emotion
schema that were activated in the session at the point of termination. Visual
events, including the episodes of perceptual dysmorphism, were aspects of her
initial presenting complaints at the onset of her treatment, and visual events
such as flashes, and momentary brightening, which are associated with anx-
iety and prolonged stress (Sabel et al. 2018), may have been associated with
her attacks of neuralgia. Now she experiences these painful and frightening
feelings in the context of the new relationship with Marina, who cares for her
and is able to mourn with her. This type of experience may have happened
repeatedly in the treatment, perhaps in less dramatic and clear ways, and has
presumably also happened in her relationships outside the treatment, so that
new schemas involving new representations of her own self in relation to
others were gradually being built.

Shame, affiliation and sexual desire

Part of Clara’s management of her ongoing difficulties involved construc-
tion of a competent, brave, intellectual self who did not need to call out for
help. Each time a painful experience occurred that Clara was able to manage
adequately, this construction of her own self would be supported. Conversely,
a failure to manage the situation could be devastating—​leaving her in a state
of pain and danger, perhaps expecting criticism or punishment, but also with
a devastating failure of her competent self-​image. It seems likely that such
experiences of shame and humiliation would have contributed to Clara’s early
withdrawal from expressing emotional need. Such expression would leave her
not only with a loss of connection to her caretakers, but also to her sense
of self.
The emergence of the memory of the transitional object, the stuffed dog, at
the very end of treatment, is centrally related to the change that has occurred
during Clara’s treatment. The object presumably played a supportive role
in her schema of how to survive as a child; there was perhaps some shame
202 Clinical perspectives

associated with that as well. Her parents took it away: she could do without
it; she did not need it. As the end of the treatment approaches, she is able to
let the memory and the sense of need return. She now has an “object”—​the
new relationship with Marina has been internalized—​that she can keep with
her, while still being a competent, brave self.
An explicit reference to shame emerges in Marina’s conference paper
with respect to the sexual advances from the professor who apparently
raped Clara; she is ashamed to have been a passive object of a man’s sexual
pleasure, ashamed to have been sexually disappointing to him. Her strategy
of distancing and normalizing the event doesn’t work; the teacher becomes
cold and detached. The first episode of dysmorphism happens in this
period; she also begins to engage in promiscuous sexual encounters without
desire or pleasure. Her attempt to write a thesis is compromised and she
withdraws from the work, although still maintaining some connection to
her university.
A recurring dream that Clara reports of a child pretending to be asleep
while being abused by an unknown adult couple who claimed to be her parents
seems relevant here; this is associated with the total numbness of her body
during her sexual encounters. I would be interested in the relationship of this
and other dreams to the avoidance of shame in her early self-​representation.
In further examination of this complex case, I would also be interested in an
association between her relationship with her father, whom she might have
hoped to please by being strong, brave and intellectual, and her later self-​
abnegating submission to her professor, who uses and then abandons her.
Presumably the working through of the bodily numbness and associated fan-
tasies, perhaps involving her father, could be a topic for another paper.

Conclusions: Some main ideas I’ve presented here, as

illustrated in the case of Clara
Emotion schemas as mind–​body constellations
Emotion schemas are types of memory schemas that connect the sensory,
physiological, and motoric processes of the affective core to the events of
life, particularly to the people who figure in these events; an experience of
emotion involves an activation of a schema with its bodily core. This view
of emotions is compatible with current views of emotion systems in affective
neuroscience and related fields (Pessoa, 2008).

Emotional disorders as dissociations within the

emotion schemas
Emotional difficulties involve disconnection between the subsymbolic bodily
and sensory components of the affective core of a schema and the events
 Embodied communication in consulting room 203

that activate it. For Clara, a dreaded schema involved her parents’ coldness
and rejection, her experience of this, and her expectation of abandonment
or abuse. Throughout Clara’s life, situations occurred, in many contexts with
many people, that activated this schema, and her painful and frequently
unsuccessful responses, without her recognition of the emotional meaning
of these events.

Therapeutic change as reconstruction of emotion schemas

Rather than recovering unconscious memories that have been repressed, we
can account for Clara’s experience as reconstructing schemas that have been
dissociated. Such reconstruction occurs through repeated activation of the
referential process in the context of the therapeutic relationship. In very early
years of treatment, trace activation of events associated with a dissociated
schema, within and outside of the session, bring with it repetitions of the
painful affective core, with its dangers and threats; the connections are
quickly closed down. As the therapeutic relationship builds, and the patient
becomes more aware of her own powers, instances of events associated with
the dreaded schema may occur, but now with somewhat reduced activation
of pain and danger. The patient can begin to recognize the meaning of these
events, and eventually to recognize that her expectations of distress are not
realized in her new interactions. It is necessary for some degree of activation
of the affective core to occur in the session itself in order for the emotional
change in the schema to occur.

The referential process in dreams and screen memories

Marina’s emphasis on activating bodily components of their shared experi-
ence was central to allowing the new connections to be built. This is similar
to the contrast I have proposed earlier in relation to dream interpretation; the
interpretation of an image or an event as of a dream does not involve activa-
tion of previously stored latent meaning but a new construction in the context
of one’s current life situation and current powers. This may also be seen in
relation to Freud’s (1899) characterization of a screen memory as a recol-
lection that represents thoughts of a later date, whose content is connected
with the earlier event by symbolic or similar links: “Whenever in a memory
the subject himself appears as an object among other objects, this may be
taken as evidence that the original impression has been worked over.”3 Clara’s
memory vividly included such a representation of herself as a participant in
an earlier event. As in the interpretation of a dream, she is not recovering
latent organized memories that have been repressed; she is building new
meanings, organizing new schemas, making new connections, in the context
of the new relationship. Freud’s comments concerning screen memories are
compatible with this point.
204 Clinical perspectives

The referential process in termination

During the phase of termination, Clara experienced her neuralgia in the
session for the first time, and Marina helped her to work with it. The termin-
ation of treatment is a potent source of activation of the emotion schemas
for both participants, particularly for such long and intense treatments, and
raises important questions concerning the therapeutic process. How does
each participant work with, and work through the painful but desired pro-
cess of separation? How does each participant go forward with the changes
in the emotion schemas, the changing expectations and beliefs about the
world of other people and about oneself, that have come about through the
treatment?

Emotional communication in the case of Antonio

Jane Lewis (2018) presents her work with Antonio4 in the context of her
attempts to understand the unworded, embodied dialogue that emerged
between them, “to find ways to understand this realm beyond words that Freud
relegated to the unconscious.” As she notes, many therapists—​particularly
those working with traumatized patients—​are struggling with such attempts.
She discusses their embodied connection in the context of Barthes’ descrip-
tion of a photograph as “a sort of umbilical cord which linked the body of
the photographed thing to my gaze.” In this context, Lewis notes:

I have long thought there is an aspect of the “mystical” in our work,

such as when a patient can sense something in our history, or we seem to
anticipate our patient’s exact words even before any have been uttered.

As Lewis also notes, Barthes also characterizes a photograph “as having the
capacity to wound him but only when ‘the wound is already in me, some-
where in my history’.” Barthes (1981) refers to this particular experience of
shared wounding as punctum and describes it as “irreducibly subjective, unin-
tentional and unpredictable,” related to experience of traumatic loss.
Here I take up the processes of “unworded, embodied” dialogue to which
Lewis refers in the context of the theory of multiple coding and the referen-
tial process (Bucci, 2008, 2011a, 2011b). From this perspective, I frame the
therapeutic interactions in terms of emotional communication rather than
unconscious communication; such interaction is characterized by forms of
nonverbal processing, which may occur at varying levels of awareness. Based
on this approach, I will provides an account of how Antonio and Lewis moved
back and forth between silence and words, and the nature of the connections
between and within them. I will also discuss both the metaphor of the umbil-
ical cord and the experience of shared wounding (or “punctum”) in relation
to the therapeutic process as described here.
 Embodied communication in consulting room 205

Emotional health depends on connections within the emotion schemas,

between the affective core and the associated events, so that people can rec-
ognize the source of their feelings—​what events or people make them feel a
particular way. In healthy emotional development, the emotion schemas will
constantly be revised and reorganized, as one’s life situation and one’s powers
change. Emotional disorders arise from disconnections within the schemas,
so that the information provided by arousal of the affective core is no longer
interpreted in a useful way; and new information that would be useful in
revising the schemas is not taken in.

Emotion schemas in Antonio’s development and in the

treatment
The outline of Antonio’s history suggests many possible sources of
trauma: neglect by his parents, who were “not the least bit interested in caring
for another child,” and some forms of physical abuse by his mother, who often
forced him “to comply with physically invasive and rigorous health regimens.”
He experienced his parents’ sense of terror and exhaustion, and the danger to
them through their involvement in the anti-​fascist movement in Italy in the
1970s, and himself witnessed violent riots as a very young child—​wandering
the dangerous streets alone, hearing the sounds of battle in which his parents
might be involved. A surrogate caretaker, an older sister, herself developed a
history of drug abuse and psychological problems as a teenager, and is cur-
rently dependent on him; he sees her demands as a source of his current agi-
tation and depression.
Antonio’s manifestation of a lifeless frozen body position in the early days
of the treatment suggests a strategy that he might have used to protect him-
self against the threats he encountered in his childhood. Freezing is the com-
ponent of the 3F (fight, flight, freeze) response to danger most available to
children, who early learn they cannot fight back and do not wish to harm
the caretaker, or to leave them and be alone. This extreme disconnection that
Antonio developed in response to the terrors of early childhood now seems
to characterize his way of being in relation to the people and events of his life
and his way of being in the treatment.
Lewis comes to the treatment with her own set of emotion schemas and
her own strategies, built out of the experiences of her life. Her experiences
of Antonio become instantiations within the clusters of events that make
up her emotion schemas, activating connections to her own life, and
experienced and interpreted in the context of these connections. The
degree to which the new situation, the new relationship can be experienced
as truly new by the patient depends heavily on the therapist’s own emotion
schemas, including patterns of experience and behavior, as they play out in
the treatment.
206 Clinical perspectives

Operation of the referential process in the case of

Antonio, in both participants
The first year as mainly an extended shared arousal phase
Lewis describes the first year of the treatment as “the beginning of a dialogic,
embodied connectedness.” In the first session, Antonio says he is willing to
give her a summary of his history, but then does not plan to revisit his past
again. When he finished the outline of his family, his very troubled childhood,
and his current situation, he “sat back in his chair, stretched out his legs and
closed his eyes.” Jane finds this presentation “unsettling, to say the least”: “I
watched with increasing alarm as his eyes closed; his arms which were by his
side; and his legs which were stretched out in front of him, seemed to freeze”
(Lewis, 2018, p. 495). She asks how she might be of help. He opens his eyes,
stares at her, and responds that her question sounds like a sexual one.
As Jane describes their work together, the sessions generally followed the
pattern that was set in this session. Antonio remains in this frozen, silent pos-
ition for many months, usually speaking no more than five minutes during
each session. At some point, as she struggles to work with him in his silent,
frozen, closed position, she asks whether it would be easier if she asked him
questions. He responds, “Why would you need to do that?”
I would suggest that, in these early months, emotion schemas associated
with the painful events of his past are being activated for Antonio. He sees
Jane through the lens of these schemas, and responds as he has in the past.
His pattern of response can be seen in his lifeless frozen body position, while
he remains essentially silent. It is possible that he does not (cannot, will not)
experience specific images and memories associated with his frozen, wounded
state. This may be because his emotion schemas have been dissociated, or
because, as in some cases of extreme trauma, in what I have termed primary
dissociation, the discrete instantiations based on repeated connections to
people and events may not have been formed, so that the memory schemas
exist only in fragmentary form (Bucci, 2011c).
Rather than being seen as resistance to the treatment, the frozen stance and
the silence provide information about the strategies that Antonio has used to
take himself out of the painful situations of his childhood, either mentally or
perhaps to ward off actual attack. These bodily expressions may be the only
form in which he has access to information concerning these events and these
strategies, registered in subsymbolic form. His response to Jane’s wondering
whether it would be easier if she asked him questions—​“Why would you need
to do that?”—​may be at least partially understood from these perspectives;
perhaps he has no access to emotional experience other than this embodied
form. It is also possible that he experiences the question as an attack on a
particular mode of interacting that he has used to protect himself—​and both
may be true.
 Embodied communication in consulting room 207

His response to her earlier question of how she might be of help, saying
that her question sounded like a sexual one, at first seems to be a mani-
festly inappropriate, somewhat provocative (perhaps even passive-​aggressive)
response to what seemed to be a standard question; however, this response
also provides information about his mode of interaction that needs to be
understood. In this context, I was struck by Jane’s description of Antonio as
“tall, stunningly handsome, with thick, curly dark hair and a dashing smile.”
He wasn’t just attractive; he had the wow factor—​presumably he knew that.
I wondered how this affected their interaction, and how her reaction might
have been communicated to him. Jane acknowledges to herself that she finds
him very attractive, but she feels most concerned about how to work with
him in his silent, frozen, closed position; how to help him and whether he will
return. She acknowledges to him that issues of sexuality are likely to arise and
that her job will be to maintain a safe therapeutic space for him.
In general, Jane stays with his experience, does not question or direct. As
she continues to watch Antonio, in many sessions in the early months, she
feels herself freezing and disappearing; she tries to slow down her breathing
and heart rate, as one might do to stabilize oneself under conditions of threat;
she questions what is wrong with her. She associates her feelings with the
astronauts described by Kohut (1982), “who found unbearable the thought of
circling alone forever in space, ‘deprived of human meaning, human warmth,
human contact, human experience’ ” (cited by Lewis, 2018, p. 496).
In the context of current research on emotional communication, we can
suggest that some of what Antonio is feeling is being directly activated in her,
as she watches and listens and perhaps responds in sensory and bodily modes.
These feelings include physiological functions that she does not yet recognize,
which provide a potential wealth of information concerning Antonio’s experi-
ence, and which are also associated with emotion schemas developed in the
context of her own life. It is not that she is making inferences to Antonio’a
experiences; she is feeling them directly, in herself, in the context of her own
network of emotion schemas.

The symbolizing phase

For Antonio, we can’t know what imagery, in memory or fantasy, may
have come up for him in the early months of the first year of treatment.
We can speculate that perhaps, in some way, he also felt himself “circling
alone forever in space”—​not seeing any neighboring planets. There are only
a few instances in which he communicated verbally during that period: a
brief discussion concerning his sister; a report of a daydream about sexual
experience.
Eventually he begins to talk about some of his early experiences, speaking
in Italian, his native language, which Jane does not understand. This indicates
208 Clinical perspectives

a transitional phase in Antonio’s symbolizing process and is the point in the

treatment that Jane characterizes as its turning point. It is likely that he began
this exploration of memory within himself prior to his communicating to
Jane. He is presumably able to connect to his own emotional experience for
himself more directly in his native tongue; this may be the only way he can
connect language and experience (although he is apparently fully bilingual,
speaking fluent English). At the same time, through use of a language that is
not shared, he is also continuing to distance himself from her and the threats
that she represents. As he begins his story, she cannot understand the words,
but can experience the prosody—​the speech rhythms and intonation patterns
that carry emotional experience and that mediate between the subsymbolic
functions and the verbal forms.
Later, Jane begins to recognize some words, and he translates some. As she
says, it has been impossible for them to find words to describe the continuing
terror with which Antonio lived as a young child. The expression, translated
from Italian as “I was petrified (or frozen) with fear,” now represents a cen-
tral embodied connection between them, a symbolic indicator of their shared
experience.
By the fourth year, Antonio was able to communicate more easily in sym-
bolic form. He reports a dream in which a young girl, whom he associates
with the analyst, at first was frightened of him, then realized he meant no
harm, which relieved him. The dream focused on the shift from the young girl
jumping rope, to his gift of a new and stronger rope which they could enjoy
together. Jane chooses not to interpret this “pleasant dream,” sensing that this
would have disrupted the “umbilical attachment” Antonio desired.

The symbolizing phase in the analyst’s experience

For Jane, we have access (from her report) concerning the imagery that comes
to mind for her and that serves to connect her own subsymbolic sensory and
physiological experience in the session to the symbolic mode. At some point,
apparently after many months, her dominant experience of freezing and
disappearing gives way to a sudden and pervasive sadness. She says that, with
much surprise, she recalled her “imaginary camera,” a frequent childhood com-
panion that she had not thought of for many years. She begins to revisit her
“photo” collection, containing the images of her life, including a visit to her
father in the hospital when he was recovering from a life-​threatening surgery.
The mental photo collection is a direct illustration of the process of sym-
bolizing an emotion schema through imagery, thus providing instantiations
of emotion schemas that can eventually be expressed in words, shared and
reflected upon. She goes on to use the process of taking imaginary photos of
Antonio’s “lifeless” body in the session; these connect to specific memories
of losses in her own life. She senses that Antonio has similar terror-​driven
images within him.
 Embodied communication in consulting room 209

A shared event in the symbolizing process

At a point in the course of the treatment, as they are moving in and out of the
“wordless, embodied dialogue” of the arousal phase, Antonio suddenly opens
his eyes and stares at Jane, startling her. She asks what happened; after a long
silence he tells her he thought she had been sleeping; she replies that she was
not, that she is here with him. He then tells memories of his mother coming in
exhausted and falling “asleep in her chair, her chin resting on her chest … he
would listen for her breathing, terrified that she had died.” This image, which
connected to the many experiences of loss that Antonio had suffered, also
connected to images and memories in Jane’s life, and carried them forward in
their joint explorations.

The third phase of the referential process: Reflection and

reorganizing
As Jane characterizes it, the effectiveness of the treatment emerged from
Antonio’s recognition that she could know and endure the unspeakable
experience that was central to his emotional life; the shared experience was
the “umbilical attachment” represented in his dream. She could do this only
because she was able to explore and accept corresponding experiences within
herself.
The fact that Jane could share and endure his experience in a deep, bodily
way appeared to change Antonio’s emotional world; he was able to recognize
their relationship to some extent, as indicated by his dream report. The fur-
ther implications of this change with respect to Antonio’s self-​organization
remain unspoken—​both in the discussion between Jane and Antonio and in
her article. Jane chooses not to interpret Antonio’s dream report; they do not
address the emotional meaning of what seemed to be a shift in roles in the
dream, with Jane in the role of a young girl who realized she did not need to
be frightened of him; then as a young girl jumping rope, with Antonio pro-
viding the stronger rope that they could enjoy together. We don’t know what
changes may have occurred in the emotional meanings of his experiences (or
of hers); or whether the “unspeakable” became more able to be spoken, to be
understood in new ways as the treatment progressed.

The umbilical cord, punctum and the referential process

The communication in the early sessions was dominated by shared experiences
of despair and fear in several different forms: Antonio’s central unspeakable
terrors that formed the core of his experience of his interpersonal world and
his organization of his self; Jane’s fear that she would not be able to help
him and that she would lose him; the terrors that characterized her memories
of the past. To some extent, all these and other feelings were communicated
210 Clinical perspectives

directly between them through the neural circuitry that allows individuals to
experience the actions and emotions of others. Keysers (2011) uses the term
“shared circuits” to describe the family of neural processes underlying such
communication. Barthes’ (1981) notion of the umbilical cord can be under-
stood as a metaphor for this process.
The communication that involves seeing (or hearing) others perform cer-
tain actions or showing certain bodily or facial expressions (as in a photo-
graph) involves subsymbolic experience, to a large extent within awareness.
What may not be accessible to awareness as connected to those feelings
are the representations of the people and events of life that evoked them.
In the referential process, the activation of the affective core connects to the
instantiations of an emotion schema in each person’s life—​the events in which
these sensory and visceral experiences and actions were activated in relation
to other people in other places. Antonio and Jane had related experiences in
their lives—​the contexts and specific instantiations were different but similar
components of the affective core had been activated. In Barthes’ terms,
similar wounds are already in each of them, somewhere in their history; still
mainly in subsymbolic form but connected to a schema of being wounded in
a particular way. This is the quality that he calls “punctum.”
For Antonio, the emotion schemas were severely dissociated, or perhaps
the traumas of his life were so intense that organized schemas had never been
formed, so that, in the early phase of treatment, he was apparently unable
to trace the connection of his feelings of pain and dread to the people and
events associated with them; he could not find the emotional meaning for
the feelings that had been aroused. Jane was able to trace connections within
her emotion schemas, to imagery and then in words. This allowed her to find
emotional meaning for her own experience, and presumably, as the treatment
continued, to enable Antonio to find emotional meaning for his.

Somatic exploration in the case of Ann

Therapeutic change involves working through the strategies of protection
and avoidance that have been developed, eventually leading to taking in new
emotional information and reorganization of emotion schemas. Change
requires that components of the affective core be activated, tolerated, and
communicated. The activation needs to be powerful enough to connect to
the networks of emotional experience, but not so powerful as to trigger
new protective responses. The relational context of the therapy needs to be
experienced as different from the situations in which the schemas were ini-
tially formed. This can be a lengthy and difficult process; the trace activation
of a dreaded situation can be sufficiently painful in itself to activate strategies
of avoidance and block new connections.
The strategies of interaction and avoidance that formed the schemas
will play out with the therapist, as in any interpersonal context. Given the
 Embodied communication in consulting room 211

processes of embodied, emotional communication as outlined above, we now

recognize that the inner experience of each participant in the therapeutic situ-
ation will be experienced, to some extent, by the other. William (Bill) Cornell,
whose clinical work and writing draw upon transactional analysis, body-​
centered psychotherapy, and psychoanalysis, often brings the actions as well
as the felt experience of one’s body into the therapeutic process. He describes
an encounter with a patient he calls Ann,5 with whom he had been working
for several years in weekly psychotherapy (Cornell, 2008). He describes
her as deeply anxious, hypersensitive to approval or disapproval, and often
withdrawn:

She was also sweetly naive and maintained a subtly ironic sense of humor
about the struggles in her lonely life. I knew that she was profoundly
lonely, but I never quite understood how she kept herself so socially
isolated.

One evening, he happens to see Ann as she enters a movie theatre where he
is seated:

In the theater, I barely recognized this woman hunched down into her
overcoat, arms held tightly at her sides, unkempt hair over her face,
moving like a street person with the thorazine shuffle. She walked up
and down the aisle several times before choosing a seat far from others.
I could not tell if she had seen me.
(Cornell, 2008, p. 41)

As he watched Ann, Bill saw someone very different from the woman he usu-
ally saw in his office, and began to have a sense of the mechanisms that kept
her so alone.
In the next session, Ann indirectly acknowledged having seen him in the
theatre—​asking what he thought of the movie. After responding to that,
he told her that he had seen her in the theater but couldn’t tell whether she
had seen him. She said that it looked like he was with a friend so she didn’t
want to intrude. “I was alone, as usual,” she said. With considerable care, Bill
then tells her that if he hadn’t known her, he would have found her way of
coming into the theater rather frightening, that her whole demeanor seemed
to emanate “Leave me the fuck alone.” Even knowing her, he said, he didn’t
feel he could approach her to say hello; all he could feel was the signal to stay
away. He asked her if that was what she was feeling and if that was what she
wanted to communicate. Ann was startled:

NO! Is that really what I look like? What I’m feeling is that everybody else
is at the movies with a friend, a partner, a boyfriend, a family, and I’m
alone, always alone, and people are staring at me. I hate it. I try to find
212 Clinical perspectives

a seat where I won’t bother anybody, and where I don’t have to see the
couples. I hate it so much that most of the time I can’t even get out the
door to go to the movie. But I didn’t know I looked so weird.
(Cornell, 2008, pp. 41–​42)

He could see her anxiety and shame overwhelm her. He tells Ann that it felt
important to describe to her what he experienced, that he was worried that
it might shame her, but thought there was a lot they can learn from this. He
then suggests that “they bring the body that was in the theater” into his office:

I suggested that she put her coat back on, hunch into it, and shuffle into the
office. I felt sick to my stomach as I watched. I wanted to move to her, to tell
her to pull the hair out of her face, to look at me, or to do or say something
kind to her. I asked her to notice any feelings that came up in her and to
allow her body to move in any way it needed. Gradually, she became still and
then slumped to her knees, curling over, pulling her coat over her head. She
looked to me now like she was awaiting a beating. I thought of her stories
of beatings by her father, the teasing and taunting by her brothers, the delu-
sional ravings of her mother. But I did not feel compassionate. I felt irritated.
(Cornell, 2008, p. 42)

Bill was moving from his complex, subsymbolic bodily responses of revul-
sion and caring to begin to process the enactment in his symbolic system, by
connecting to stories of her childhood and her family. His perception of Ann
may also be arousing in him the feelings and associated responses she elicited
in her family at that time:

She just knelt there, curled over and inert. I wanted to kick her. I got
bored. I started thinking ahead to my evening after work. My bladder
began to ache. I wanted the session over. I felt I’d made a mistake in
talking to her about the theater, in intervening this way.
(Cornell, 2008, p. 42)

He does not act on the response plan that is aroused; he recognizes it expli-
citly and manages it through various processes of avoidance, defense and
reflection:

Still, she did not move. I forced myself to look at her inert form. She
looked like a supplicant. I began thinking of my Catholic upbringing
(Ann was also raised Catholic)—​forced to genuflect, to kneel, to pray
for forgiveness, awaiting the sound of the nuns’ clickers informing us we
could stand up and move on. Submission . Defeat. Hatred. An object of
derision and disgust.
(Cornell, 2008, p. 42)
 Embodied communication in consulting room 213

Again, Bill is involved in a referential process, entering the symbolic mode,

now making associations to his own life, naming the feelings as experienced
in himself. The process begins to take a different form.

Do I speak to Ann? Do I wait? I waited in silence.

Ann began to stir. She placed her hands on the floor and pushed her-
self upright, brushing the hair out of her face. “This is a relief,” she said.
“This is what I feel all the time, but I’ve been afraid if you knew it you
would give up on me. Did I scare you this time, too? I feel like a freak
when I’m outside. But I’m glad we did this. I’m glad I could show you
this. This is how my body feels all the time.
(Cornell, 2008, p. 43)

The interaction of Ann and Bill illustrates the recursive and interactive
sequence of perception/​action mirroring, emotional experiencing, and antici-
pation that is associated with embodied communication, and how this may
play out and be used in the therapeutic context. Ann’s perception of the inter-
personal world has grown to incorporate the experience of people as staring
at her, shaming her, ridiculing her, abusing her. She has learned to respond
to that before it happens. Her anticipatory response is self-​fulfilling; Bill feels
sick to his stomach, he is bored, he wants to kick her, to get away from her,
he suffers physically. He has learned through his body how Ann feels and the
feelings that Ann’s demeanor excites in the people around her. These lead him
as well to explicit imagery and associations to her life, and to his own life,
including the Catholic upbringing that he and Ann share, and the associated
feelings.
The occurrence of his negative reactions in a sense seems to raise questions
concerning the claim I made earlier that the therapist’s feelings would neces-
sarily be communicated to the patient. Bill does not kick her as he has the
urge to do, but he does feel boredom, anger, and the wish to escape. There are
a number of additional distinctions that need to be made, which he does not
explicate. This interaction occurred in the context of several years of work
together, several years of countless interactions in which he has seen and
reacted to multiple aspects of her—​her sweet naiveté, her sense of humor;
countless times in which he has perceived her differently, reacted differently
from the reactions of her family in her early years. He is distressed in many
ways, some of which he explicitly recognizes, some of which he may not. He
wants to get away but does not, he endures his distress, manages it somehow,
explores it, stays with her.
She recognizes that she has evoked distress in him, that she has “scared
him” again, as she did in the theatre; perhaps she intended to do so, per-
haps it is one of her strategies of attack or warding off attack. She also sees
that he has allowed her to show this depth of feeling that she has seen as
unspeakable and has stayed with her. The treatment doesn’t end with the
214 Clinical perspectives

bodily communication, but moves on to exploration of experiences of the

present and past.
As Cornell also emphasizes in his discussion of the case, this is both an
exploration within each of them and a communication between them. The ther-
apist explores within his own body, the patient within hers—​to find the hidden
bodily expectations of the past that have shaped her current confrontations
with the world. The therapist reflects as well on the contributions of his own
life experience to his response to the patient. What is happening in him is a
response to Ann’s communication, but also determined by who he is.

Concluding reflections
It has become increasingly clear that the way of knowing the experience
of others as usually understood in traditional theories of mind, by making
inference from observation of others to their inner experience, needs to
be revised. The multiple code theory, with its component of subsymbolic
processing, was developed in large part in recognition that human know-
ledge and information processing are not adequately modeled as symbol-​
manipulating systems. This is a broader formulation that goes beyond the
emphasis on action seen in theories of embodied communication but is com-
patible with those theories, and may provide some elaboration of the under-
lying psychological model.
It is also important to recognize that while the therapist “knows” the other
immediately through their own bodily experience, this knowledge may be
valid or invalid. Therapists need constantly to examine the contribution of
their own life and bodily experiences to their knowledge of the other. The new
findings should not lead psychodynamic therapists to say they have found a
scientific basis for the elusive—​and seductive—​concept of projective identifi-
cation, but rather a more nuanced understanding of factors in themselves as
well as the patient that contribute to what they perceive.

Notes
1 In all these reports, since the patients are referred to by their first names, I use
the therapists’ first names as well when they are talking about themselves as
participants in the context of shared experience; the therapists’ surnames or both
names are used in their discussions of the case, or in reference to their publications.
This is current procedure for reports of interpersonal and relational treatments.
2 Paper presented at conference “New Perspectives on Symptoms and
Symbols: Neuroscience and Applications in Clinical Dissociation, Milan, Italy,
2017.” An earlier version of Clara’s case appeared in Amore (2012).
3 Cited from Abstracts of the Standard Edition, International Universities
Press, p. 89.
4 An earlier version of the case of Antonio appeared in Bucci (2018).
5 An earlier version of the case of Ann appeared in Bucci (2011b).
 Embodied communication in consulting room 215

References
Amore, M. (2012). Clinical scenarios of “remembering”: Somatic states as a pro-
cess of emerging memory. Psychoanalytic Dialogues: The International Journal of
Relational Perspectives, 22(2), 238–​252.
Barthes, R. (1981). Camera lucida: Reflections on photography. NewYork: Farrar,
Strauss and Giroux.
Bucci, W. (2001). Pathways of emotional communication. Psychoanalytic Inquiry,
20, 40–​70.
Bucci, W. (2008). New perspectives on the multiple code theory: The role of
bodily experience in emotional organization. In F. S. Anderson (Ed.), Bodies in
treatment: The unspoken dimension (pp. 51–​77). Hillsdale, NJ: The Analytic Press.
Bucci, W. (2011a). The interplay of subsymbolic and symbolic processes in psychoana-
lytic treatment: It takes two to tango—​but who knows the steps, who’s the leader?
The choreography of the psychoanalytic interchange. The Journal of Analytical
Psychology, 21, 45–​54.
Bucci, W. (2011b). The role of embodied communication in therapeutic change: A
multiple code perspective. In W. Tschacher & C. Bergomi (Eds.), The implications
of embodiment: Cognition and communication (pp. 209–​ 228). Exeter: Imprint
Academic.
Bucci, W. (2011c). The role of subjectivity and intersubjectivity in the reconstruction
of dissociated schemas: Converging perspectives from psychoanalysis, cognitive
science and affective neuroscience. Psychoanalytic Psychology, 28, 247–​266.
Bucci, W. (2018). Emotional communication in the case of Antonio. Psychoanalytic
Inquiry, 38, 518–​529.
Cornell W. F. (2008). Self in action: The bodily basis of self-​ organization In
F. S. Anderson (ed.), Bodies in treatment: The unspoken dimension (pp. 29–​49).
Hillsdale, NJ: The Analytic Press.
Crits-​Cristoph, P., Gibbons, M. C., & Mukherjee, D. (2013). Psychotherapy process-​
outcome research. In M. Lambert (Ed.), Handbook of psychotherapy and behavior
change (6th ed., pp. 298–​340). New York: Wiley.
Freud, S. (1899). Screen memories. Standard Edition, 3, 301–​22. London: Hogarth Press.
Freud, S. (1912). The dynamics of transference. Standard Edition, 12, 97–​108.
London: Hogarth Press.
Keysers, C. (2011). The empathic brain. Cambridge, MA: Social Brain Press
Kohut, H. (1982). Introspection, empathy, and the semi-​circle of mental health.
International Journal of Psychoanalysis and Self-​psychology, 63: 395–​407.
Leahy R. L. (2009). Resistance: An emotional schema therapy (EST) approach. In
S. E. Gregoris (Ed.), Cognitive behavior therapy: A guide for the practising clinician,
Vol. 2. (pp. 187–​204). New York: Taylor & Francis.
Lewis, J. (2018). Bodies in dialogue: Empathic connectedness in the realm of the
unspeakable. Psychoanalytic Inquiry, 38(7), 493–​501.
McEwen, B. S., & Seeman, T. (2003). Stress and affect: Applicability of the concepts of
allostasis and allostatic load. In R. J. Davidson, K. R. Scherer, & H. H. Goldsmith
(Eds.), Handbook of affective sciences (pp. 1117–​1137). Oxford: Oxford University
Press.
Pessoa, L. (2008). On the relationship between emotion and cognition. Nature Reviews
Neuroscience, 9, 148–​158.
216 Clinical perspectives

Reik, T. (1948), Listening with the third ear: The inner experience of a psychoanalyst.
New York: Pyramid Books.
Sael, B. A., Wang, J., Cárdenas-​Morales, L., Faiq, M., & Heim, C. (2018). Mental
stress as consequence and cause of vision loss: The dawn of psychosomatic oph-
thalmology for preventive and personalized medicine. EPMA Journal, 9, 133–​160.
Selye, H. (1950). Stress and the general adaptation syndrome. British Medical Journal,
1(4667), 1383–​1392.
Selye, H. (1956). The stress of life. New York: McGraw-​Hill.
Chapter 12

Nobody dances tango alone

The choreography of the analytic
interchange

The tango can be debated, and we have debates over it, but it still encloses,
as does all that which is truthful, a secret.
The tango is a direct expression of something that poets have often tried to
state in words: the belief that a fight may be a celebration.1

In a previous paper, I focused on the interaction of subsymbolic and symbolic

processes in the analytic situation and in Argentine tango. In the years since
that paper appeared, I have learned more about this interaction as it occurs
in both these situations—​from new research on emotion and movement,
and from my own experience trying to learn from Dardo Galletto how to
dance tango.
A few years ago, in 2016, several colleagues and I gave a colloquium at
the William Alanson White Institute in New York City with the title of this
chapter.2 Here is the description that appeared in the announcement of the
colloquium:

How do two become one while remaining two? How does each person
experience the other within oneself while finding new parts of oneself
as well? The knowing—​and not knowing—​these multiple selves as they
impact one another is often center stage in our analytic work. Tango, like
the psychoanalytic relationship, requires trust, attunement, presence and
in-​the-​moment awareness, as both partners are constantly counterbalan-
cing each other and sharing the other’s weight. We plan to discuss the
many parallels of analytic work and the dance of Tango, and along the
way invite you to experience a feeling that is danced.

This chapter, which is an expansion of my presentation at that colloquium,

focuses on the special nature of the relationship between body movements
and emotion that we can see in tango, and the different types of interaction
that occur between the two partners.
In my introduction to this volume, I emphasized the inherent interaction of
emotional and bodily functions. This is not a new idea. At least since the time
218 Clinical perspectives

of Darwin, scientists have argued that different emotions give rise to specific
body movements, and are expressed through such movements in humans as
in all species. Feelings of joy and sadness, and all sorts of multiple complex
feelings that cannot be easily or directly named, are expressed in a person’s
face and body, and then communicated to others through activation of their
own bodily responses—​perhaps in trace form. This kind of embodied emo-
tional communication is central to the psychoanalytic interaction, as I have
discussed in detail.
Here I am talking about a different idea—​part of the same interactive cycle,
but starting in a different place. Particular body movements can give rise to
different emotional states—​not just that we express how we feel through facial
expression and body movement, but that by moving our bodies in a certain
way we can make ourselves feel a certain way.
The recognition and use of the effects of certain types of movement on
emotion is directly related to body therapy, and also related to all forms of
psychotherapy. In psychology and neuropsychology, we are beginning to
learn more about these bidirectional connections. There is now evidence from
neural imaging studies that feedback from muscle movement is associated
with activation in brain regions such as the amygdala and underlies produc-
tion of neurotransmitters that elicit particular feeling states (Hettenlotter
et al., 2008; Kim et al., 2014). In very general terms, we can say that by moving
muscles in certain ways, a dancer might be doing the equivalent of giving their
body a shot of some neural transmitter, perhaps in some cases endorphins,
the body’s own self-​produced opiates; in some cases oxytocin, the chemical
associated with yearning and love; in some cases transmitters associated with
anger, aggression, or passion.
I suggest that in tango we have a set of movements that activate a range of
different emotional experiences, including sadness, yearning, and anger, and
others that defy one’s attempts to name them, and that also activate memories
and fantasies—​all communicated between two people. There are moments of
risk and uncertainty, not knowing what is coming, being on the edge. All of
this is happening in a limited specified time and place, the time of a song or a
few songs, and all of this may happen with a person who plays no other role
in one’s life, perhaps whom one knows only in the dance world.
There is some research concerning how particular body movements are
related to particular feeling states, including how specific movements commu-
nicate emotion to others (Melzer et al., 2019), and how particular movements
contribute to recognition of certain feelings within oneself (Maxwell &
Davidson, 2007). Here I want to suggest some hypotheses about these effects
specifically from the perspective of tango, as developed by Dardo, and also
experientially, as I have learned from him. In his own dancing and in his
teaching, Dardo is studying the effects of movement from the inside, teaching
what he finds out in himself. He gives instructions such as, “Be quiet and
experience your Achilles; you can feel where you come from, where you are
 Nobody dances tango alone 219

going.” As he explains, from his own exploration inside his body, the Achilles
tendon connects to the inside; the toe-​ball of the foot connects to the out-
side; one side moves the other. This is part of how the spiral of the dance
happens, the interplay of horizontal and vertical. The vertical direction—​
ankle, knee, hip, and center—​within our bodies is what makes the connection
of the ground to the self; the horizontal goes across to the other and involves
responding to the partner and moving together around the room. The center
is the point where the horizontal and vertical intersect, and also where self
and other connect.
This is not mystical. As a potential scientific direction, I could see this kind
of articulation of the experience of movements as a basis for hypotheses
concerning the relationship between certain combinations of body movement
and complex emotions, and also for hypotheses concerning communication
of emotion to others. At some point, I think it could happen that researchers
studying the relation of body movement and emotional communication could
use experts like Dardo in designing psychophysiological studies. For example,
the researcher might ask participants to focus on stretching the Achilles
tendon or pressing the toe-​ball of the foot into the ground, then report how
they feel now, or perhaps report events of the past or fantasies that come to
mind. I could also foresee a study examining which parts of the brain light up
when participants view movements with characteristics such as those defined
by Dardo.
I think the relation of different kinds of movements to different emotional
states within oneself and to communication of emotion states to others is
part of the reason why tango becomes so addictive. Dardo’s instructions are,
“Follow yourself, feel your body, follow your body, learn from your body.”
Then he also says, “Take care of yourself in order to take care of others.”

What can tango teach us about the challenge of

partnering?
Yes, leaders must follow. That is the greatest paradox of a good dancer—​
men are leaders, but they follow women; it is a woman who defines the
style of dancing, distance, intimacy, speed, and rhythm.
(Igor Polk)3

This leads to the next unique aspect of tango, the nature of the partnering.
In tango, there is a basic set of movements and steps that can be learned, but
the sequence is not fixed. Tango is improvisational, there are no fixed combin-
ations. In finding a joint direction together, the leader has to know where the
follower is, and the follower has to know what the leader will do; the leader
signals intent through their body movement before they know; the follower
feels the direction in their body. They are not connecting experience to words,
but to movements that they share. They may follow particular steps, but they
220 Clinical perspectives

still have to create together, explore together. The art of the tango lies not so
much in what steps are taken as in how they are taken.
Here is where a new question emerges: one person (the designated leader)
must generate a sequence of steps so the two participants in the couple move
together as a kind of unit. The partner—​the designated follower—​has to feel
within their body what the other is generating. This is a particular kind of
talent—​the talent of being a sensitive receptor tuned into another person,
feeling the other in one’s own body. But as Dardo is also teaching us now,
the moment of waiting, opening oneself to the other, is not enough. It is
also necessary, at the same time, for the partner to open to their own self, to
bring not only their energy but also their own creative sense of the movement,
to integrate their sense of the experience with the sense that the partner is
sending. Together they need to make a space into which each participant can
bring their creative energy, while the structure and flow of the dance remain.

The therapeutic space

I take two kinds of lessons with Dardo: individual lessons and lessons
in which he teaches my husband and myself as a couple. In my individual
lessons, he dances with me, directly teaching movements and steps. In that
situation, he says, “Now my brain is leading your body; later you will have it
in yourself; your brain will lead you.” When my husband and I take lessons
as a couple, Dardo focuses on each of us having to search for and create
our movements. Contrasting with the macho Argentinian man, Dardo talks
about an “Argentinian woman” who has her power, has something she wants
to express. The leader needs to leave space for the follower to do that, to find
and express what they need to express.
In the therapeutic relationship, the therapist has several roles: as the one
who has been trained, and who knows movements and steps, and determines
where and when and to some degree how they will operate; and as the partner
who works within the structure and direction that has been formed by the
patient, while necessarily bringing their own structure and their own creativity
from their own lives. The patient is the one who brings the stories, makes the
structure, but the therapist must bring their creative sense of the structure and
meaning of story that is being told, in the light of their own experience.
This perspective further explores the view of the analytic relationship that
was described in previous chapters; this also considerably extends my view of
therapy as described in my 1997 book (Bucci, 1997). In the last paragraph of
the last chapter of that book, I said:

Psychoanalysis is about the building of autonomy. In psychoanalysis, the

one who brings the tale, and shares it, then owns the symbol in a special
way. The owning of the symbol, rather than being haunted by it, is the
only genuine autonomy one can achieve.
 Nobody dances tango alone 221

This paragraph now seems depressing and dampening to me. The new
perspective on psychological organization that constitutes the framework
of this volume goes beyond the concept of autonomy. Just as there is no
infant without the one who cares for them, as Winnicott says, there is no
person without connections to others throughout life. We are all built on the
representations of the connections held within us; these connections continue
to be built continuously throughout life, and need to be examined where they
are interfering with life. It is not “autonomy,” but this new and different and
perplexing world of connections that needs to be built, in the organization of
memory and in current life. To some extent, at some points as in my lessons
with Dardo, the therapist’s “brain” leads; later, when new connections are
made, the patient can build the structures, in their relationships with others as
well as within the therapy.
In this small chapter to end this book, I have taken another look at the
tango floor to view the development and playing out of these connections in
microcosm. Nobody dances tango alone; no one knows quite what step will
happen until it does; each dance comes to life in the interaction between the
participants. As I am writing this closing chapter, in the terrible spring of
2020, it is also clear that no one knows quite what challenge will happen until
it does; the different meanings of anxiety as of other feelings emerge in the
interactions between us, in life situations as in treatment. Creative exploration
into the unknown is the essence of psychoanalytic treatment and perhaps a
source of hope. Such exploration gives psychoanalysis its unique potential—​a
healing profession that is also a healing art.

Notes
1 Two quotes from Jorge Luis Borges, taken from www.azquotes.com
2 The colloquium was organized by Cleonie White and moderated by Anita
Lanzi; both are members of the White Institute. The presenters included
Velleda Ceccoli, a psychoanalyst and Clinical Associate Professor at the NYU
Postdoctoral Program in Psychotherapy and Psychoanalysis; Dardo Galletto,
master tango dancer, choreographer and teacher; and myself. Following the
formal presentations, the audience was invited to experience the dance with
members of Dardo’s company.
3 Argentine Tango—​Igor Polk Dancing Site. Retrieved from www.virtuar.com/​tango

References
Bucci, W. (1997). Psychoanalysis and cognitive science: A multiple code theory.
New York: The Guilford Press.
Hettenlotter, A., Dresel, C., Castrop, F., Cebellos-​Baumann, A.O., Wohlschläger,
A.M., & Haslinger, B. (2008). The link between facial feedback and neural activity
within central circuitries of emotion: New insights from botulinum toxin-​induced
denervation of frown muscles. Cerebral Cortex, 19, 537–​542.
222 Clinical perspectives

Kim, M. J., Neta, M., Davis, F. C., Ruberry, E. J., Dinescu, D., Heatherton, T.
F., Stotland, M. A., & Whalen, P. J. (2014). Botulinum toxin-​ induced facial
muscle paralysis affects amygdala responses to the perception of emotional
expressions: Preliminary findings from an A-​B-​A design. Biology of Mood & Anxiety
Disorders, 4(11). Retrieved from https://​biolmoodanxietydisord.biomedcentral.
com/​articles/​10.1186/​2045-​5380-​4-​11#citeas
Maxwell, J. S., & Davidson, R. J. (2007). Emotion as motion: Asymmetries in approach
and avoidant actions. Psychological Science, 18, 1113–​1119.
Melzer, A., Shafir, T., & Tsachor, R. P. (2019), How do we recognize emotion from
movement? Specific motor components contribute to the recognition of each
emotion. Frontiers in Psychology, 3 July. Retrieved from www.frontiersin.org/​art-
icles/​10.3389/​fpsyg.2019.01389/​full
Index

affective core see emotion schemas sensibilitas xxxiii; unthought

alexithymia 14, 15 known 146
amygdala, amygdalar functions 104–​5; Bowlby, J. 11, 63
alternate routes to 177, 185; cognitive Bromberg, P. 117, 150, 164, 185–​7,
functions of 132; connections with 190; case of Christina 168, 170–​1;
hippocampus 105; dissociation and uncertainty principle 145, 148
106, 108; in emotional arousal 105, Busch, B. 107
218; memories 105, 107, 120; and
reflection 88; and stress 165, 178; and case studies see Amore, M.; Bromberg,
subsymbolic processes 109; in working P.; Cornell, W. F.; Lewis, J.; Mark, D.;
memory 114–​5 (see also LeDoux, J. E; Solano, L.
Damasio, A. R.; Pessoa, L.) Chefetz, R. 111, 165, 184, 186
Amore, M. xxii; case of Clara conflict 12; see also defense, defenses;
195–​202 dissociation
Arlow, J. 28, 41, 129 consciousness: in arousal phase 115;
arousal of affect: in cognitive functions autonoetic and noetic 114–​18, 121;
131; regulation of 132; role of core, extended and autobiographical
vagal activity 133 (see also emotion 44–​9, 57; in dissociative processes
schemas) 48, 174, 189; double 106; emergence
attention: affect in 131; directing of 93, of 57; Freud on xxxi, 26–​7, 128;
133, 148; levels of 45; in subsymbolic in reflection phase 53; relation
mode 78; turning away of 35, 49, 106, to ego functions 176; relation to
164 (see also working memory; short repression 54; and self-​representation
term memory; consciousness) 43–​5; subjective 109 (see also implicit
autobiographical self 45–​6; see also memory; multiple code theory;
consciousness; Damasio, A. R. primary process; referential process;
autonoetic awareness 116; see also working memory)
consciousness; episodic memory Corballis, M. C. 82, 93, 117,
120
Baddeley, A. D. xxx, 114 core self 45; see also consciousness;
Baldwin, J. xxvii, xxix, xxxix, 81 Damasio, A. R.
Barrett, L. xxix, 87 Cornell, W.F. case of Ann 210–​14
Barthes, R. 204, 210 countertransference 162, 188–​90
Bartlett, F. C. xxxiv, 34, 63, 80 Csíkszentmihályi, M 79
Bion, W.R., xxxvii; field theory xxxiv;
‘unknown, unknowable’ 146–​8 Damasio, A. R. xxix, 34, 53–​4, 57, 63,
Bollas, C. xv; ‘cracking up’ function 114–​5, 186; definitions of emotions
xxxix; dream process xxxviii; 46–​7; emotionally competent stimulus
224 Index

(ECS) 177; levels of consciousness all treatment approaches 195 (see also
43–​6 (see also consciousness; case studies; mirror neurons)
dispositional representations; emotion emotions 72; category terms 94; and
schemas) emotional intelligence 62; as episodes
defense, defenses: as forms of or states 81–​3; labels of 80, 83–​4,
dissociation 12–​13, 53, 157; in 88; language of 190; as regulatory
isolation of affect 118, 165; as mechanisms 46; and somatization
undoing 165 (see also dissociation; 64; verbalization of 84–​6 (see also
unconscious processes) Damasio, A. R.; Russell, J. A.;
dissociation: adaptive 105–​6, 156–​7; Scherer, K. R.)
avoidant, primary and secondary emotion schemas xxxiv–​v, 10–​11, 33, 42,
106–​8, 149; biological substrate of 62–​3, 72–​3, 79–​81, 102, 131, 148–​9,
165–​6; double consciousness in 106; 161–​3; activation in therapy process
in emotion schemas 48, 149, 165; in 120, 138–​40, 188; affective core of
emotional disorders 48–​9, 108–​9, 167; 63, 79–​80, 102, 161, 166; change in
freezing response in 179–​80; levels 69, 169, 187; as clusters of episodes
of 47–​8; in memories of Holocaust 80, 162; in countertransference and
survivors 179–​83; multiple code transference 34, 162; as dispositional
theory of 159–​61, 175–​6; in pathology representations 42, 63, 80, 162;
37, 42, 47–​8, 163–​7; reconstruction in dissociation within 49, 149; 165,
referential process 50–​3, 161–​3, 202–​3, 210; effects of stress on 178–​9;
169–​70; relation to repression and information processing in 104–​5,
defenses 12, 54; relation to trauma 122; integration of 185; and internal
156–​9, 164, 183–​5; self-​repair of 50, working models 63; interpersonal
166–​7; in somatic disorders 12–​13; context of xxxvii–​viii, 81, 103; as
treatment of 58, 168, 186–​8 (see also memory schemas 33–​4, 62–​3, 102–​3,
Bromberg, P.; Chefetz, R.; Mark, D.) 138; as mind-​body constellations 202;
dispositional representations 43, 63 in multiple code theory 7, 10, 40, 76;
dreams: connection to symbolic mode and narratives 103; neural circuitry
69, 73, 85; dream work xxxii, 28, 140; of 43, 104, 176–​8; object relations as
referential process in 10, 203 (see also 162; and referential process 161–​3;
case studies; primary and secondary relation to consciousness 44; relation
processes) to drive theory 62–​5; reorganization
dual code theory see Paivio, A. of 85; representations of interactions
drives 8; in Freud’s energy theory 23, that have been generalized (RIGs)
61–​2, 174–​5 63; role of caretaker in 14, 63;
dynamical systems xxxiii, 160; see also symbolic connections in 17; and
subsymbolic processes transference 103
emotional information processing 9–​10,
Eagle, M. 3, 23 30, 32–​4, 147, 160, 165; and emotional
Einstein, A. xxvii–​ix, 59n5, 92–​3, 147 intelligence 25
Eliot, T. S.: objective correlative 76, 93 episodic memory 82, 85, 91, 93; and
embodied communication 194–​5; autonetic and noetic awareness
anticipatory power of 113; in case 116–​7; hippocampal function in 165;
of Ann 213; in tango 144 (see also in therapeutic change 118–​21 (see also
emotional communication) emotion schemas, narrative)
emotional communication 186–​7; in exposure treatment xxxix
arousal phase 51, 67, 194; as empathy
32; in episodic memory 121; in Ferro, A.: Bionian perspective xxxvii;
formation of emotion schemas 103; symbolizing process xxxviii
gestures in 69, 85, 93, 139; projective flow experience 79; in subsymbolic
identification as 214; in tango 144; in processing 102
 Index 225

free association xxxix, 10, 16, 18, Keysers, C. shared circuits xxx, 210
35–​6, 52, 127, 140, 194; protocol Kris, E. good hour 68
analysis as 30 Krystal, H. 12, 15
Friedman, L. 189, 197
Freud, S. 3, 4, 21, 29, 41; on language: in alexithymia 15;
consciousness xxxi; drive theory of disconnection from bodily functions
61; energy model 23; on hysteria 56; emotional expression in 82–​4, 86,
101; primary process 5, 174; screen 92–​4; in energy model 23; measures
memories 203; stereotype plate 34; of 85, 88–​92; in multiple code theory
structural model xxxii, 4, 23, 174; 77–​8; as objective correlative 76;
topographic models 4–​5, 174; on paralinguistic aspects of 59n2; in
transference 34; on the unconscious referential process 37, 86, 88, 110–​11;
xxxi, 174–​5 (see also defenses; in therapeutic process 33, 54, 56, 67,
unconscious processes) 75, 190; in working memory 56 (see
also episodic memory; referential
Galletto, D. 144, 150, 217, 221n2 activity; referential process)
Gates, H. L.; cross-​over generation 106 LeDoux, J. E. 8, 34, 83, 104, 109;
amygdalar memories 107–​8; fear
hippocampus, hippocampal functions: response 177; working memory and
and explicit memory system 105; and consciousness 114
stress response 106–​7; in working Leventhal, H. 16
memory 114–​15, 117–​18, 165, Lewis, J. case of Antonio 204–​10
177–​8, 184 Loewald, H. W. 68, 101, 109, 120
Heidegger, M. 146–​7 Luborsky, L. 128–​9
Howell, E. F. 156, 179
Holt, R. 3, 28, 128–​30 Mark, D. case of Kurt 111–​13
Mariani, R. 92, 94
instincts 61–​2; see also drives Martini, G. 146
internal working models 63; see also McDougall, J. 12, 14, 66
emotion schemas memory: autobiographical 112, 149;
interpersonal processes 81–​2, 85, 193–​5; declarative 26–​7; episodic and
in autobiographical memory 149; semantic 116–​20; implicit 26; and
in development 11, 34; in emotion narrative 117; short-​term or working
schemas 15, 63, 79–​80, 148–​9, 179, 114–​6; long-​term 115–​16; procedural
184; intrapsychic vs. interpsychic or non-​declarative 26 (see also
communication 176; mirror neurons working memory; episodic memory;
in 103; in subsymbolic system 135; memory schemas)
in treatment context xxxvi–​viii, memory schemas see Bartlett, F. C.;
16–​17, 32, 66–​7, 85, 116, 119, 152, emotion schemas
169, 185–​7, 190 (see also Cornell, mental models: role in cognitive
W.F. case of Ann; Lewis, J. case of science and psychoanalysis 22–​4;
Antonio; Schilbach, L.; Stern, Daniel; developmental 11; dual process theory
Stern, Donnell) 27; metapsychology as 23 (see also
intersubjectivity see interpersonal Freud, S.; multiple code theory)
processes; mirror neurons mentalization based treatment xxxix
mirror neurons xxx, 144, 187; see also
Jaspers, K. 146 interpersonal processes
Jones, E. xxviii Moccia, G. 146
multiple code theory 42, 77, 102–​3,
Kaechele, H. 3 159–​61; clinical implications of
Keller, H. 78 14–​16; emotion schemas in 7–​8;
Kernberg, A. 14, 34, 66 major concepts of xxxiii–​vi, 5, 32–​4;
226 Index

model of pathology in 22, 32–​5, 41, proto-​self 44–​6; see also consciousness;
102, 176; nonverbal system in 6–​7; Damasio, A. R.
origins of xxxii; processing modes in psychoanalytic psychology: as
77–​9, 134; in psychoanalytic process integrative field 37
10–​12, 35; referential process in 8–​10; psychoanalytic situation: as research
somatization in 3, 12–​14, 16–​18; milieu 32, 37; therapeutic process
structural change in 42; subsymbolic in 35–​6
thought in xxxiii; verbal system in 5–​6 Psychotherapy Action Network xli
(see also emotion schemas; referential
process) referential activity: measures of 16–​17,
88–​9; see also narrative; referential
narrative: computerized measures of 91; process
in dreams 10; episodic memory and referential process xxxv–​vi, 10, 33,
116, 120–​1; in exposure therapy 87; in 66–​9, 76–​7, 84–​6, 109–​10, 139, 161,
free association 52; as metaphor 103; 169–​70; activation of affective core
in referential process xxxv, 36, 51, 87, in 67; arousal of emotion schema
139, 194, 198; as symbolizing 33, 67, 85; in dreams 203; evidence for xli,
85, 113 86–​8; in interpersonal context xxxvi;
Negri, A. 92 measures of 38n4; 88–​92; Italian
Neisser, U. 21, 29, 120 measures of 68, 92, 94; narratives as
noetic awareness 116; see also episodic metaphors in 52–​3; phases of 50–​3;
memory, consciousness 67–​8, 85–​6, 110–​11; protosymbols in
51–​2, 197, 200; reorganizing in 86,
object relations see emotion schemas 88; as therapeutic process 35–​6, 66–​8;
Ogden, T. H.: example of emotion subjective experience in 113–​7; in
schema xxxv–​vi, xli; case of Ms. B termination phase 199–​201, 204; and
70–​2; reverie xxxv working through 102 (see also Amore,
M.; Cornell, W.F.; Lewis, J.; narrative)
Paivio A. xxxii, 9, 33, 77 Reik, T. 147–​8, 194
parallel distributed processing see regression 54–​5, 190
subsymbolic processing repression 12, 35, 101; compared to
pathology 42, 163–​4; biological evidence dissociation 54; see also defense,
165; forms of 166; development of defenses
49–​50; and emotion schemas 104, resistance 8, 15, 54–​6, 62, 170, 190, 206
165; multiple code formulation of Ricoeur, P. 146–​8
47–​8, 167, 176–​8; repair of 54; roots Rogers, C. 92
of 163; vicious circle of 34 (see also Russell, J. A. 83–​4
dissociation)
Pessoa, L. xxviii, 81, 132, 202 Safran, J. 117–​8
Phelps, E. A. xxviii, 81, 104, 132 Schacter, D. 26
primary process thought 55, 126; affect Scherer, K. R. 82–​3
activation in 131–​2; in awareness 128; Schilbach, L. xl
condensation and displacement in secondary process: revision of 130;
55; contradictions in 128–​30, 174; in Freud on 5, 28, 126–​8
creative writing 137–​8; dream work in Selye, H. 65
28, 147; emotion schemas in 131–​2; in semantic memory 82
energy model 126–​7, 130, 133; Holt’s short-​term memory 30, 114; see also
scoring system of 130; in scientific working memory
work 137; in sports 135–​7; Freud on Solano, L. case of Stefano 117–​18
126–​7; multiple code reformulation of Solms, M. xxxi
53–​5; 130–​1, 133–​5, 140 somatization 35; in case of Stefano
projective identification 153, 194, 214 69–​71; in case of Mrs. B 70–​2, 76;
 Index 227

and emotional disorders 64 (see also (see also emotion schemas;

emotion schemas; multiple code multiple code theory; referential
theory; embodied communication) process)
speech chain 84
Stern, Daniel: on affective attunement tango: partnering in 219–​20; uncertainty
159–​60; on ‘now moments’ 115, 121; principle of 150; subsymbolic
on RIGs 11, 34, 63, 81, 103, 162 communication in 151; emotional
Stern, Donnel: on unformulated complexity of 151; relation to analytic
experience xxxiv interaction 152–​4, 220
Strachey, J. 35, 51, 110, 171; see also Taylor, G. 14
vicious circle therapeutic process 35; activation of
stress 178; components of 65; in painful experience in 54, 185; in
dissociative processes 156; effects psychoanalysis 35, 102; reconstructing
on emotional circuitry 178; effects schemas 203; as referential process
of trauma 157–​9, 183; generalized xxxv–​ix, 51, 102; role of language in
response 196; hippocampal regulation 54, 131, 190–​1; role of relationship
of 106–​7, 133; physiological effects in 184–​90; retraumatization in
104; and post-​traumatic disorder 15; 170; Rogers’ view of 92; termination
stressor events 73, 165–​7; visual effects phase 199; uncertainty in 150
of 201 (see also somatization; time travel 82, 93, 119; see also emotion
trauma) schemas, episodic memory
structural change: multiple code Thomae, H. 3
definition of 42 Tolstoy, L. 76, 80
subsymbolic thought 32–​3, 78–​9, 116, transference: and countertransference
134–​5, 147–​8; analogic format of 188; as emotion schemas 34, 103, 162;
121; in analytic interchange 150; enactments as protosymbols 52; and
functions of xxxiii; levels of awareness energy model 62; internalization of
in xxx, xxxii–​iv, 8, 26–​7, 31, 34, analyst in 55; in reorganizing phase
44, 54, 210; modeled by parallel 119; ubiquitous nature of 188
distributed processing (PDP) systems trauma 157–​9, 183–​4; acute vs. chronic
6, 37n2, 79, 94n2, 148, 160 (see also 108, 158, 164, 169, 178–​9, 186; as
embodied communication; emotional body memories 101; diagnosis of
communication; emotion schemas; PTSD 157–​8; dissociation 48, 54,
multiple code theory; referential 106, 122n2, 156, 165, 183, 206;
process) exposure treatment of 87; fight,
symbols, symbolic processes 33, 77–​8; flight and freezing responses to 104,
distinguished from symbolism 73, 164, 177–​9, 184, 205–​8; numbness
141n2; in dreams 203; in emotion response to 165, 171, 180–​5, 202;
schemas xxxvii, 8, 33–​4, 42, 47–​8, referential process in treatment of 169;
102, 148, 164–​5; in imagery 32, 42, in testimony of Holocaust survivors
51; in information processing sense 179–​83; treatment of 183–​6 (see also
5; levels of in somatic disorders Bromberg, P. case of Christina;
12–​16; in mental models 38n3, 131; in Lewis, J. case of Antonio; stress)
multiple code theory 134, 159–​60; in trieb xxviii
narrative 52, 198; in nonverbal system Tulving, E. 82, 114, 116–​17, 119–​20
6, 7; as objects of arousal 50–​1; in
primary process 135–​9; in referential uncertainty principle: of Bromberg 145,
process xxxvi, 5, 36, 68–​9, 77–​8, 84–​5, 148; in tango 150
110, 161; symptoms as 16–​18, 73; in unconscious processes 26–​9, 101, 128,
teaching 151; in treatment process 66, 174–​5; in communication 33, 194;
113, 144, 152; in unconscious thought distinguished from subsymbolic
28; in verbal system 5, 8, 56, 190 processing 145–​8, 152; dynamic
228 Index

unconscious xxxiv, 8, 27; in emotion weighted referential activity dictionary

xxxi; nonrepressible part of 144; in (WRAD) 89
primary process 5, 126–​30; as quality weighted reflecting/​reorganizing list
of mind 41; relation to id 5, 55, 175; (WRRL) 90–​1
transcending concepts of xxx (see also Winnicott, D. xxviii, 146, 221; on
emotional communication) psyche-​soma xxix
working memory xxx–​xxxi, xlin2,
van der Kolk, B.A. 165 46–​8, 52–​4, 114–​16, 189; activation
vicious circle of pathology 34–​5; of in therapeutic change 121; and
breaking the 36; multiple code consciousness 57, 117; language in 56
formulation of 51; as opportunity (see also attention)
in treatment 110; in treatment of working through 53, 66, 70, 101–​2,
traumatic disorders 157, 170 169, 202, 210; see also referential
Vygotsky, L. 75–​6 process