Becoming aware of feelings: Integration of cognitive-developmental, neuroscientific, and psychoanalytic perspectives

A fundamental ingredient of psychoanalytic treatment is the ability of the analysand to become consciously aware of his or her own emotional responses. We propose that the conscious awareness of emotion is a type of information processing that can be viewedas a separate domain of cognitive function, that the transition from unconscious (implicit) to conscious (explicit) aspects ofemotion can be understood developmentaliy in the manner described by Piaget for cognitive functions generally, and that explicitemotional processes have a modulatory effect on implicit processes. We then present a parallel hierarchical model of the neuralsubstrates of emotional experience supported by recent neuroimaging work. We describe how the neural substrates of implicit andexplicit aspects of emotion are dissociable, and we discuss the neural substrates of implicit aspects of emotion, backgroundfeelings, focal attention to feelings, and reflective awareness of feelings. This framework constitutes an alternative to traditionalpsychoanalytic understandings of insight. We conclude by discussing the implications of this model for psychoanalysis, includingthe nature of clinical change, the psychological processes involved in change with and without insight, and a framework forconceptualizing how to promote emotional change in a variety of clinical settings.