Using and Understanding of Primary Process Thinking in CAT

Sacks, M., 2003. Using and Understanding of Primary Process Thinking in CAT. Reformulation, Autumn, pp.30-32.


Working clinically we notice that patients are often amazed when they realise the extent to which unhelpful beliefs can distort their lives. They can see that their ideas are not logical and yet the beliefs still retain their power. In this article I suggest that CAT therapy could usefully elucidate this phenomenon with an explanation of the logic and impact of unconscious thinking. This is consistent with the idea underlying CAT that by describing and understanding our thoughts we are enabled to step back, observe and look for ways to change. Making use of the idea of primary process thinking can contribute to the project of helping clients to help themselves.

In many cultures the working of the unconscious is given due weight and used constructively. For example, the Achuar Amazonian Indians plan their day's hunting strategy after discussing the previous night's dreams (Descola 1993). Rayner (1995) points out that the Ancient Greeks gave equal status to Rhetoric and Logic. But in more recent times unconscious thought has not been seen as useful and we are relatively unfamiliar with the workings of our unconscious.

The unconscious landscape was first explored by Freud who in the course of dissecting the unconscious meanings of his patients' utterances noticed that the processes determining those meanings did not follow the normal rules of logic. He labelled this "primary process thinking" in contrast with conscious thought, which he referred to as "secondary process thinking". He used the patterns characterising this kind of thinking to decode dreams. Freud (1915) outlined five characteristics of primary process thinking: (1) Condensation (2) Displacement (3) Timelessness (4) Absence of mutual contradiction and (5) Replacement of external by internal reality.

Matte Blanco (1975) points out that if Freud's primary process thinking has consistent characteristics then it must have rules, or there would be chaos, but the nature of the characteristics indicates that those rules must be different from conventional logic. In "The Unconscious as Infinite Sets" he proceeds to uncover these rules proposing that unconscious logic, or bi-logic, is based on two main axioms:

A) The unconscious perceives individual things as members of classes (or sets) which are in turn grouped into more general classes.
Rayner offers an example: a baby belongs to the class of babies which belong to the class of humans which belongs to the class of living things which belongs to the class of touchable objects.
B) The unconscious treats asymmetrical relationships as if they were symmetrical.

For example if we perceive that "x is bigger than y" the unconscious assumes that at the same time "y is bigger than x".

These rules combine to give us the shape of unconscious thinking. In particular they tend to suggest that the individual is identical to the wider class to which it belongs. Using the example above Rayner points out that in a psychotic state we might fail to distinguish between living and non-living things and in a disturbed state a mother might treat her child as an object.

Unconscious, or primary process thinking dominates to the extent that thinking is taken over by unconscious processes and not accessible to conscious logic. This kind of thinking can be seen most clearly in dreams and also in the thinking of people suffering a psychotic breakdown. But primary process thinking "…is not only a characteristic of unconscious activity but also of emotionality, even at more conscious levels" (Rayner). Matte Blanco suggests that: "we are always, in a given mental product, confronted by a mixture of the logic of the unconscious with that of the preconscious and consciousness".

Matte Blanco explains how his axioms give rise to the unconscious mechanisms identified in psychodynamic theory such as projection, sublimation and transference. With some thought it is also possible to see how the same axioms can be used to explain Beck's cognitive distortions. This is very useful to therapists and these ideas can also be used in a more collaborative way to help the patient understand their own thinking.

The simple idea of the existence of another, equally valid, logic can go a long way to helping people understand why their thoughts do not always make sense and a creative dialogue often follows as patients explore how this manifests in their own lives. Labels for the distortions can be taken from either the cognitive or psychoanalytic traditions or emerge in the course of the therapeutic dialogue.

One idea that I have found useful is "collapsing categories" in other words the tendency to lose distinctions between groups of things. Perhaps the alliteration makes this phrase attractive. The tendency to collapse categories can be seen to arise from both axioms A and B as described above. In CBT terms collapsing categories appears to underlie a number of Beck's cognitive distortions; namely catastrophising or minimising, labelling, and overgeneralisation. It has been suggested that collapsing of categories might have an evolutionary advantage in that it allows a fast response to danger: "…life in the raw has to be built on paranoid premises." (Wright in Rayner 1995)

An example of this can be seen in the psychotic tendency to equate symbols with reality which is referred to as "concrete thinking" in psychiatric jargon (and (5) above). For example when I declined to take home a videotape of himself offered by a patient with schizophrenia he replied: "Oh, I forgot, you are married". In his mind I had refused to take him home and he therefore concluded that I must already have a man at home.

A more accessible illustration is provided by an agoraphobic patient with a history of child sexual abuse who could not go out when there were people around because she felt that all men were abusers. The class of abusers was equated with the class of all males in an unconscious symmetrization.
The rational part of the patient knew that this was not true and she was reluctant to reveal her thoughts for fear of being labelled mad. When, eventually, she was able to talk about her belief she found the explanation of primary process thinking, focussing on collapse of categories, helpful in making sense of her experience

Another useful expression has been "confusing who owns thoughts" which can be seen to stem from axiom B: symmetrization. This merging has its positive side in empathy and Rayner suggests that: "we are probably most prone to this emotional symmetrization or identicalization when we are at our most intimate and emotionally involved with another person". At other times however this confusion can be damaging, such as in the socially anxious patient who imagines that people are thinking critical thoughts about them, or the agoraphobic who believes that people can read their mind.

In primary process thinking time and space do not exist and one implication of the loss of a sense of time is that difficult situations can feel as though they have lasted and are going to last forever. In the middle of a depression it is hard to imagine anything else, a panic attack can seem like a permanent state of affairs. It can be useful to point out to people that this is one of the impacts of unconscious thinking so that they are in a position to identify when and why this occurs.

In the context of CAT we can understand why some reciprocal roles have the power that they do when we remember that when strong emotion is involved primary process thinking becomes combined with conscious thinking. In the logic of the unconscious "I have failed at this task" becomes "I have failed at all tasks" and even "I am a failure" (Rayner).

Two clinical examples show how primary process thinking can magnify the impact of reciprocal roles. One patient had "judging / judged" as a central reciprocal role and found it unbearable if he and his partner disagreed about anything, even taste in music. It seemed that he felt that if his partner did not agree with him about something that must mean that he disapproved not just of that one opinion but of all his thoughts and even of him as a person.

Another patient who had been responsible for an alcoholic mother and had a "chaotic/controlling" reciprocal role put herself under pressure to do everything perfectly all the time. She felt that if she made one error then her whole world would fall apart and catastrophe would ensue.

In CBT the route to mental health is to identify and correct distorted thinking but this categorisation tends to imply that there are good and bad ways of thinking, acceptable thoughts and unacceptable ones. It is not always obvious what makes thoughts bad and the patient is limited by the list of unhelpful thoughts offered by the therapist. In harnessing an understanding of unconscious logic we have two equally valuable modes of thinking with contrasting strengths and weaknesses. Unconscious thinking enables us to feel, act quickly, identify patterns, make links, empathise and understand metaphors while conscious thinking allows us to solve problems. We can learn to see how unconscious logic might create difficulties at times while still valuing the positive aspects of this side of ourselves. Difficulties can be seen to arise when unconscious processes intrude into conscious thinking under the influence of strong emotion.

Once alerted to unconscious logic the patient is in a position to observe it for themselves and develop their own understanding, spotting new instances and drawing their own conclusions. Understanding provides the patient with a viewing platform from which they are able to notice instances of this type of thinking and bring them for discussion. This promises to be more creative and enabling than either a finite list of distorted thoughts, as in CBT, or interpretation of unconscious meanings without explanation as in analytic therapy. An explanation of the underlying mechanism allows the patient to discover unhelpful thinking patterns for themselves and also offers a reason why these patterns occur, drawing their attention to the impact of, possibly ignored, emotions.

A patient realised that for him the interference of bi-logic took the form of overgeneralisation; he tended to assume that one failure meant that he could do nothing. He then noticed that not only did he generalise from instances of failure, he even generalised from imagined failures. He decided, having been ill for some time, to take the bus instead of letting his wife drive him. He managed this well but during the journey found himself ruminating on what would have happened if he had failed and what this implied about his ability to cope while his wife was away. On reflection he realised that perhaps his wife's planned trip abroad was causing him more anxiety than he had realised.

Knowledge of unconscious logic offers a bridge between psychodynamic and cognitive thinking that contributes a more coherent explanation of distorted thinking than either on its own. At present limited use is made of Matte Blanco's theory in psychoanalytic work, where theories are anyway not shared with patients and CBT, while working collaboratively, limits itself to considerations of conscious thinking. CAT offers the potential to use this knowledge in a collaborative way. In CAT the experience of homework tasks can help the patient to learn the limits of their beliefs as can logical discussion and challenging of beliefs. In addition it might sometimes be useful to outline the nature of primary process thinking. Once we understand that emotional thinking has a different kind of logic we can simultaneously learn to appreciate this different kind of thinking and begin to work with it towards change.

Maxine Sacks


 

 

References

Beck, Aaron. (1976) "Cognitive Therapy and the Emotional Disorders"

Descola, Phlippe. HarperCollins (1996) "The Spears of Twilight: life and death in the Amazonian Jungle"

Freud, Sigmund. (1915) "The Unconscious"

Matte Blanco, Ignacio. Duckworth (1975) "The Unconscious as Infinite Sets, an essay in bi-logic"

Rayner, Eric. Routledge (1995) "Unconscious Logic, an introduction to Matte Blanco's bi-logic and its uses"

Full Reference

Sacks, M., 2003. Using and Understanding of Primary Process Thinking in CAT. Reformulation, Autumn, pp.30-32.

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