Subliminal stimulation research and its implications for psychoanalytic theory and treatment.

As a tribute to Freud's genius, he was able to recognize not only the importance of implicit unconscious learning but also the way it currently impacts on the patient in psychoanalytic therapy. He prevented the patient from viewing the analyst's facial expressions by placing the patient on the couch. In addition, the analyst was instructed not to say too much, to be neutral, nonjudgmental, and calmly reflective. Thus the patient's response to the facial expressions and voice tone of the analyst, even when subliminally perceived, were minimized. This may be even more significant in women, who seem to be more sensitive to nonverbal cues of emotional states. Ferenczi further elaborated on the importance of establishing a connective empathic relationship, using a kindly, soothing voice tone and being emotionally available. Sandler and Sandler (1994) also emphasized the importance of tolerance and acceptance when making interpretations. These clinical instructions diminish external threats to survival and thereby minimize the activation of the amygdala. These procedures in psychoanalytic treatment seem similar to a subliminal MIO message and to the subliminal exposure of a happy face, as mentioned above in the fMRI study by Whalen et al. (1998). The empathic responses of the therapist need to create a condition of safety. In turn, this decreases the patient's vigilance and defensiveness and allows for the emergence of unconscious material that can be worked through verbally and rectified by explicit memory. Another fascinating finding is that Freud (1914) became aware, in his paper on the repetition compulsion, that repressed traumatic and conflictual relationships are acted out behaviorally outside of conscious awareness. He then considered that the focus of analysis should be on analyzing the transference relationship, where this enactment was manifested. Brockman (1998) notes that modern empirical findings confirm Freud's clinical hypotheses regarding the repetition compulsion. Repressed traumatic emotional memories are encoded in the amygdala, and they are unconsciously enacted through behavior, especially in the transference. In summary, childhood and other traumatic memories become encoded in the amygdala and are later enacted and expressed behaviorally, especially in the transference relationship. Working through of the emotional trauma makes these implicit memories explicit and exposes them to adult judgment. When the therapist creates a condition of safety, old memories are reexperienced and detoxified. The memories are experienced as nonthreatening now, thus calming the amygdala and diminishing its activity. Biologically, new neural pathways from the cortex to the amygdala can be established, since the cortex is plastic. This process is slow and may account for the need to repeatedly work through in analysis old conflicted relationships that had threatened security and survival. As imaging techniques improve, we may soon be able to evaluate therapy outcomes scientifically by measuring these actual brain changes. We are on the threshold of establishing a scientific psychoanalysis, as empirical research is providing us with data that integrate the mind and the brain. Subliminal stimulation and brain imaging techniques provide us with important tools for developing an empirical base for psychoanalytic theory and treatment. These techniques were not available to Freud at the turn of the last century, and as we center the new millennium Freud's dream of psychoanalysis having a firm scientific foundation is becoming a reality.