Conscious and Unconscious Mind

Conscious and unconscious mind are recognised as trans-theoretical core constructs with equal status. Both are part of all experiences of psychotherapy. Conscious mind is the explicit focus of cognitive and behavioural therapies, the primary focus of attachment and humanistic approaches, and deemed to be of crucial importance within psychodynamic therapy. It incorporates our conscious sensory perceptions, emotions, thoughts, beliefs, interpretations, memories, capacities for reasoning, analytic processing, creativity and decision making and directly supports our interactions with the world around us.

Unconscious mind refers to all processing taking place outside of conscious awareness. Conscious and unconscious mind are in constant mutual interaction across the boundary between them; whilst at a conscious level our thoughts, feelings, decisions and actions all appear to connect directly and immediately to each other, they are constantly being influenced by the immensely fast and smoothly harmonious processes of unconscious mind.

Unconscious mind is given primary significance by psychodynamic theory and underlies attachment theory, with psychodynamic theory considering a wide range of unconscious processes influencing conscious mind and all aspects of behaviour, particularly in the context of relationship. Its existence and relevance is supported indirectly by other theoretical approaches: the schemas of cognitive theory and the complex learning histories and processes of reinforcement and conditioning of behavioural theory all function outside of conscious awareness; humanistic theory sees aspects of self as being hidden from conscious mind, and Behavioural Activation (Kern et al., 2019), Acceptance and Commitment Therapy (Sabucedo, 2021) and Mindfulness Based Cognitive Therapy (Chintha et al., 2024) all recognise that feelings and aversive states can become hidden in the same way. The value of accessing material that is normally outside conscious awareness is recognised across therapeutic approaches. Whilst this is most clear within psychodynamic and experiential approaches it is also evidenced by the accessing of underlying automatic thoughts, conditional assumptions, rules for living and core beliefs from a CBT perspective.

Implications for Practice

Therapists always need to bear in mind the impact of underlying influences outside of conscious awareness, and the benefits of material that is normally outside of awareness becoming available to conscious experience. A general increase in connection across the boundary between conscious and unconscious mind is supported by the emotionally safe nature of the therapeutic relationship, and enough space and time for feeling and reflection. Similarly, the need for decreased connection with unconscious processes may be supported by increased structure and more consciously oriented interventions. In all contexts it is an issue of balance. Both aspects of mind, and the interaction between them influence our experiences of self, our interactions with the world around us and their outcomes.

Psychological Defences

Defences protect us from an uncomfortable internal conflict of some nature between a wish, a feeling, a need, a thought or a belief and its feared consequences. They function at both conscious and unconscious levels. In doing so they alter and distort our perceptions, feelings, memories and overall cognitive processing. They may have both helpful and unhelpful consequences. Defences follow a developmental path from the ‘immature’ pre-cognitive defences of infancy and early childhood to the more ‘mature’ defences of later childhood and adulthood. Their helpful versus damaging nature is influenced by the quality of developmental relationships, including parents’ capacities to contain problematic infant and childhood emotions, and the presence or absence of abuse and trauma. Secure developmental relationships also provide the most effective support for the transition to more ‘mature’ processes of defence. Unhelpful ‘immature’ defences, when they persist, tend to be more powerful and more distorting in their effects, and more challenging to work with in therapy.

Psychodynamic, attachment and humanistic client-centred/experiential theories most strongly recognise their self-protective functioning. Defences are also explicitly seen as having significant roles to play within psychological suffering and therapeutic change within Compassion Focused Therapy (Matos & Steindl, 2020). Mindfulness Based Cognitive Therapy (Chintha et al., 2024), Behavioural Activation (Kern et al., 2019), and Acceptance and Commitment Therapy (Sabucedo, 2021; Walser & O’Connell, 2021) all recognise that aversive experience can be avoided by being hidden from overt conscious awareness. It is also not uncommon for cognitive approaches to refer to self-serving cognitive bias in a similar context.

Implications for Practice

All therapists will be supported in their work by an appreciation of the ways in which defences may play their part in their clients’ ways of being, thinking and feeling. All unhelpful defences need to be thought about with compassion, and may be eased by empathic understanding, the exploration of potential meaning and a containing response to the emotions that may be associated with them.

The Constructive Developmental Relationship

This trans-theoretical core construct refers to the nature of the human relationship that fosters constructive psychological growth, development and learning across the lifespan. Aspects of this relationship and their relevance to psychological development are recognized and described to some extent within all of our major theoretical approaches and are reflected to varying degrees within common factors approaches to psychotherapy integration.

The genuine, empathic, unconditionally caring relationship between therapist and client described by Carl Rogers (Bayliss-Conway et al., 2021) overlaps with the emotionally attuned, secure attachment relationship of childhood and adult life (Levy & Johnson, 2019), and is reflected in the work of Winnicott and Kohut from psychodynamic and self-psychology perspectives. We also find very clear reflection of these relational themes within Compassion Focused Therapy (Matos & Steindl, 2020). The damaging developmental impact of being invalidated as opposed to the validating context of empathic attunement is a core aspect of Dialectical Behaviour Therapy (Boritz et al., 2020); and empathy, validation and compassion are overtly valued within Acceptance and Commitment Therapy (Sabucedo, 2021) and Behavioural Activation (Kern et al., 2019). They are also powerfully advocated in the form of therapeutic presence within Emotion Focused Psychotherapy (Goldman & Goldstein, 2022).

Implications for Practice

The extent to which all therapists are able to develop their capacities for empathic and attuned connection and emotional containment, independent of their overt theoretical approach will be of benefit to their clients and can be supported by drawing on a range of literature and training experiences. All theoretical approaches are best considered and put into action from the starting point of a secure therapeutic constructive developmental relationship.

Unconscious Internal Models of Self, Others, Relationships and the Outside World

The schemas of cognitive therapy theory, the inner world of object relations of psychodynamic theory, the internal working models of attachment theory and the complex learning histories of radical behaviourism are all deemed to reflect overlapping and differing aspects of the same underlying trans-theoretical core construct, our unconscious internal models of self, others, relationships and the outside world; the system of schematic memory related structures that mediate and enable our experience of self and all our interactions with the world around us.

These models function at different levels of complexity ranging from fundamental object recognition to the nature of our selves, other people, the complexities of human relating and all aspect of our environments and associated knowledge. They follow highly interactive developmental pathways involving unconscious and conscious mind from birth onwards and in many instances are intimately associated with emotion and self-protective/defence related processes. They depend on the nature and quality of our relationships and experiential/educational environments for their healthy, epigenetically driven development, in the context of our innate capacities for growth. The quality of significant caring and attachment relationships during infancy, childhood and adolescence are of crucial importance in this respect, particularly in relation to models of self, others and relationships. Very early ‘immature’ models reflect the pre-cognitive, non-linguistic, sensorimotor and emotion-based characteristics of infancy and early childhood and contribute to our capacities for human connection throughout adulthood, particularly non-verbal and emotional relating.

Internal models continue to evolve and change across the lifespan, and always involve an individual mix of both ‘mature’ and earlier ‘immature’ models. They may accurately represent the reality of the current world around us, or they may provide us with distorted, less than accurate versions of that reality. Models vary in their overall helpful or unhelpful/damaging nature in terms of their capacities to facilitate constructive interactions with the world around us, and the nature of our sense of self. The psychological defences associated with them also reflect their own differing degrees of maturity and helpful or unhelpful characteristics.

Fig. 1

The Co-existence of a Range of Constructive and Unhelpful/Damaging Unconscious Internal Models

Figure 1 provides a simplified diagrammatic illustration of the potential range of internal models in relation to their helpfulness, their ‘maturity’ and their associated defences. Models also vary in their speed and ease of activation, their mutual associative connectivity, the particular nature of the stimuli that activate them, and the potential availability of their associated memories to conscious mind. They are probably at their most complex and most highly developed in relation to self, others and relationships.

In the context of increasingly adverse maturational environments the relative proportion of ‘immature’ models increases, both ‘immature’ and ‘mature’ models become significantly more unhelpful and are accompanied by greater proportions of unhelpful and damaging ‘immature’ defences; we start to move into the territory of significant developmental vulnerability and personality disorder. Any processes of dissociation associated with experiences of abuse and trauma will reduce the connections across models and between unconscious and conscious mind. In the extreme they may lead to aspects of dissociative identity disorder, as self-related constellations of internal models become separated from each other.

Implications for Practice

All effective therapies influence constructive change in our unconscious internal models via their overlapping and differing processes, changing their nature, and their patterns of activation and interaction.