Written by Efrat Ginot (with foreword by Allan N. Schore), 

We may be our own worse enemies

Review by Gunnel Minett

To understand why a person may suffer from psychological problems, why they occur and what can done about it is the essence of all forms of psychotherapy. For this to happen it is necessary to understand how the brain and mind works. Before Freud introduced his mapping of the mind we had little understanding as to what causes some people to suffer from mental, internal struggles that sometimes take over and ruin their lives for no obvious reason. Since then psychology and psychotherapy has been through a journey trying to understand the causes of psychological problems and how to best treat them. We now know that many of our adult problems begin in childhood. But we are still not clear exactly how and why. To begin with the focus was more on the conscious than the unconscious mind. The latter was dismissed as ‘basement storage’ for unwanted thoughts, emotions and behaviour, that needed to be cleared out. 

With today’s advances in neuropsychology we are now getting a more nuanced picture of the role the unconscious plays throughout our lives. As a consequence psychotherapists are beginning to be able to work with their clients in more sophisticated ways to help them understand and confront the reactions and control of the unconscious, and thereby minimise the negative and/or unwanted influence, which is causing their psychological problems.

In this book Efrat Ginot explains how the unconscious is an essential and valuable part of our brain that helps us towards a form of mental homeostasis. For instance, by reacting in certain ways, such as detecting patterns in the environment and reacting with a tendency to favour repetition. Such reactions go a long way back in our evolutionary history. They enable the brain to create ‘building blocks’ that help us deal with each new situation. This helps us find the best possible solution and strategy in situations where we otherwise could suffer irreparable damage, i.e. when we’re exposed to life-threatening situations, or suffering from mental or emotional ‘overload’. Because of the importance of our brain power (as a species) it is important that we are able to maintain a certain level of positivity as a driving force in life. (A newborn baby that is not getting enough attention from the environment even runs the risk of dying from the neglect.) So just like the signalling from the body’s systems for maintaining physiological homeostasis (or inner balance), such as hunger, sweating, shivering, etc.., we have a similar system for maintaining a mental state of homeostasis. This can consist of strategies (often developed very early in life) to adjust to the environment, which is absolutely vital for the child to develop into a fully functioning adult. This can be learning early on to be pleasing to a demanding parent, to ‘shut down system’ to prevent bad experiences from entering into awareness or to develop habits aimed finding the best solution for us in a particular situation. 

The problems with these unconscious strategies to help us through life is that they may become rigid and difficult to change or get rid of when we no longer need or want them. This is where psychotherapy comes in. To help to change what was once a useful strategy for a certain period of our lives, but which in present time may be causing psychological problems and preventing us from having a positive experience of life. Ginot writes: “The process of developing unconscious and automatic defensive systems is closely intertwined with implicit and explicit learning processes. Learning occurs when specific behaviours, emotional reactions, comforting thoughts, or soothing internal or external responses, from simple avoidance to complex cognitive machinations such as the tendency toward grandiose self-soothing, take hold in the face of an immense blow to the self. Learning is also crucial when a very negative and faulty self-evaluation develops; a child has no choice but to internalise as his own impatience, criticism, neglect, or lack of acceptance. These communications become the dominant measure of his self-worth.” (p150)

It can be a big challenge for a psychotherapist to deal with the unconscious since it may involve and trigger unconscious patterns in both client and therapist. In her book Ginot highlights some of these difficulties, such as; the lasting power of anxiety, therapeutic enactment, aspects of affective dysregulation, repetition and resistance and intergenerational enactment of trauma. In her words: “Unconscious processes are vast and ever-present, and they are characterised by learned and reinforced neuropsychological patterns that essentially form the foundation for our conscious existence.” (p229) 

It is only by understanding these processes and their influence that a person can be helped to change in a more permanent way. She writes: “Although specific therapeutic approaches may greatly differ, all therapists try to help patients achieve greater affect regulation, a sense of personal fulfilment and well-being. Undoubtedly, a neuropsychological understanding of the unconscious can provide us with more nuanced approaches to the nature of change and to its underlying factors, the potential impediments to enduring shifts, and conversely the therapeutic processes that may contribute to positive changes. ( p 163)

This is particularly important in psychotherapies that focus on accessing the unconscious (such as body oriented therapies, hypnotherapy, dream work etc). Unless the therapist has a good understanding of how and why our unconscious influences us and can assist the patient to a positive change, the risk is that unconscious remains a mystery (following an old view of the unconscious) with no or little real change for the patient. Ginot writes: “Only on recognising and becoming aware of the nature of our emotional and behavioural neural patterns, the childhood necessity for an array of defences, the emotional and interpersonal learning that took place unconsciously and without our conscious will or participation, our helplessness as children to affect through the course of events, can we start and attempt to connect with painful self-systems.” (p 125)

With this book Efrat Ginot is taking a big step to close the gap between neuroscience and psychology. It is an essential process if we are to develop the best possible strategies for helping people to move away from having the unconscious as their own worst enemy, to being fully in charge of their lives in a positive way. 

Published by W.W. Norton & Company, New York, London, 2015, 336 pp, hardcopy ISBN 978-0-393-70901-8