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Using Microexpressions to Understand the Unconscious

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Using Microexpressions to Understand the Unconscious Episode 17: Microexpressions to Make Microconnections Part 3 David Puder, M.D., Ariana Cunningham This PDF is a supplement to the podcast “Psychiatry & Psychotherapy” found on iTunes, Stitcher, Overcast, Google Play, or ​ ​ ​ ​ ​ ​ ​ ​ on the website PsychiatryPodcast.com ​ The last two weeks, we’ve covered using Microexpressions to Make Microconnections and the ​ ​ Microexpressions of Fear, Surprise, Disgust and Creating Connection. We discussed what ​ microexpressions are, and what each of the different emotions are, and how they look on the face. Learning about microexpressions develops a deeper connection with others—whether in therapy, or just in everyday relationships. Microexpressions are tiny facial movements that give us cues to what someone is feeling. Their eyebrows might twitch down for a moment to display anger. Or the sides of their mouth might stretch horizontally to show they are afraid. Our goal as therapists is to understand what emotion our patients are feeling, and to develop our empathy towards them through understanding the reason behind that emotion. Understanding microexpressions can lead to micromoments of connection by developing a greater closeness between you and your patient. Microexpressions happen out of our awareness, and can be great cues to what someone is unconsciously feeling. Using microexpressions to understand the unconscious Identity We are always picking up on some level of people’s microexpressions, whether we are trained in it or not. Many people intrinsically understand what others feel. This understanding can become our social mirror as we are growing up. Copyright: David Puder, M.D., 2018, Please share this without changing any of the content. Episode 17: Microexpressions to Make Microconnections Part 3 David Puder, M.D., Ariana Cunningham If we have an ability to make people smile when we are children, we may try to reinforce that reaction from others by building our interactions around humor. Then we are known as the “funny” one. These cues people give us can become a part of our identity. One of my patients had a slight facial deformity. She noticed, and internalized, the messaging that she was “disgusting” to look at, based on other people’s facial expressions when they saw her. That led to deep feelings of disgust about herself. She often showed a microexpression of disgust on her face when she was talking about herself. Over time spent in therapy, she was able to create her values, her beliefs, and determine that as a human, she was more than her deformity. Internalizing people’s microexpressions as feedback about ourselves can be helpful or harmful. When we learn more about microexpressions, we are able to develop techniques to delve deeper into people’s reactions and understand that those reactions are often not about us, but about the other person’s experience. Through understanding microexpressions, we learn that we do not need to take every reaction and internalize it as part of our identity, either positive or negative. With our patients, seeing microexpressions as they talk about themselves can help us uncover deep seated beliefs—whether it’s disgust, arrogance, or any number of other emotions. Object relations Object relations is a theory about how we internalize early attachment figures and then subsequently understand future in relationships. For example, if we have a tense relationship with our father, and then we might expect or recreate tense relationships with our male teachers, male boss, and male therapist, as a way to make sense of the world. We most often create these emotions towards early developmental relationships, then paint our beliefs about them on others throughout our lives, unless we deal with our feelings towards those people, and begin to be able to distinguish and differentiate, i.e., “not all authority figures are evil.” In therapy, microexpressions can be helpful to unearth some of these emotions. The relationship between a therapist and a patient can represent, to the patient, many different relationships. Being a safe person for them to discuss their feelings with is the most important part of therapy. Copyright: David Puder, M.D., 2018, Please share this without changing any of the content. Episode 17: Microexpressions to Make Microconnections Part 3 David Puder, M.D., Ariana Cunningham Reading microexpressions can help me understand the emotions still present that the patient feels towards early attachment figures. These may come out as they discuss a current issue, and then express a strong emotion. If you focus in on the part of the story where the emotion was present, then they might start eventually talking about early attachment figures like their emotionally distant dad or angry mother. The microexpression allows us to know where to focus in, and listen closely in their story. They are not only important to pay attention to when it comes to how a patient feels about others, but also how they feel about us. Knowing how they feel about us, as their doctors, helps to be able to identify what are overarching, negative early life experiences and how we can help them work through those feelings so that they can live more present and thriving in the present. Dreams As therapists, listening to dreams can give you a great glimpse into your patient’s inner emotional life. Studies show that memories more easily develop around negative emotions, and those negative moments can form points of organization for our memory. They found that PET scans showed that the parts of the brain that store our memories are also the ones activated during REM sleep. Dreams usually demonstrate what’s most emotionally relevant to work on during psychotherapy. As patients are telling me their dreams, they will show microexpressions while reporting the narrative of the dream. Subsequently through discussing the dream, they can talk about emotions and desires they might not have consciously allowed themself to have. For example, if a patient is feeling trapped in a job or relationship, she may have a dream she is trapped in a box, or stuck underwater. She will be able to express her emotions during the description of the dream—her fear, anger, surprise, disgust. She may not be ready to talk about ​ ​ her relationship or job, but she can unearth the unconscious emotions of the dream and feel comfortable talking about that. In the end, her thoughts will go to areas of her life where she feels stuck, and then suddenly realize what the dream might mean. As psychotherapy progresses and the person unpacks their emotions, the dreams change to be more positive. When a patient feels supported and heard, and psychologically safe, they begin to unpack deeper, unconscious emotions they once only felt in dreams. Copyright: David Puder, M.D., 2018, Please share this without changing any of the content. Episode 17: Microexpressions to Make Microconnections Part 3 David Puder, M.D., Ariana Cunningham Psychological Defense People experience psychological defense as a way of creating an alternative, safe reality for themselves. It’s an adaptive way to defend against their feelings, their reality, and the state of their mental health. Psychological defense is largely an unconscious, adaptive process. Sometimes a patient will have a thought that is too distressing to pay attention to. Their brain will then send what we call “signal anxiety,” or a message that this thought, emotion, or desire must be suppressed from consciousness. Subsequently they might have a psychological defense act as a way to adaptively defend against these thoughts. For example, they might suppress a thought to later deal with, deny that it happened, or go wash the car to get their mind off of it. Another example, where microexpressions will help, is if a patient says they aren’t angry at a person. They may believe that, or may try to believe that. Maybe that person harmed them in a ​ ​ huge way. Prior to saying, “I’m not angry,” their face may have flashed a microexpression of anger, letting you know that perhaps they are denying what is truly going on. The best thing to know here, is that psychological defenses are there for adaptive reasons, and the patient needs to feel safe enough to have them soften. If you empathize with the distress that comes with the defense you will be helping them get to what is under it. Warnings about using microexpressions in therapy Miscategorization When I first started learning about microexpressions, I would tell people, “When you told that story, you flashed an expression of anger.” Then the patient would be angry at me for assuming they were angry. Maybe the patient hadn’t even had the chance to process on their own that they were, in fact, angry. Or maybe I was just wrong about what I was assuming! Either way, I didn’t give them the space to find their own emotions. It’s important to allow people to mine their own feelings, and even discover the meaning behind the feeling. If they are telling a story and show a microexpression of anger, be curious about their feelings in that moment. Ask them to draw out the emotion and describe it. Be gentle with your word choices. Copyright: David Puder, M.D., 2018, Please share this without changing any of the content. Episode 17: Microexpressions to Make Microconnections Part 3 David Puder, M.D., Ariana Cunningham The danger is when we are wrong about what we think someone is feeling, but we aren’t accurate, and we assume we are still correct. Emotional contagion As we learn about microexpressions, we see that there are hundreds of them being expressed in any one-hour therapy session. It can be overwhelming if we take responsibility for another person’s emotional life.
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