The Rational-Choice Theory of Neurosis: Unawareness and an Integrative Therapeutic Approach

In agreement with Freud (1915a, 1915b), patients' unawareness regarding the underlying causes of their behavior seems to be the key to understanding the development and treatment of neurotic disorders. However, Freud's concepts of the unconscious and repression have encountered serious problems that do not allow for their maintenance (see review by Rofé, 2008). An additional issue concerns the fact that none of the available theories can integrate the therapeutic effects of various interventions under a single theoretical framework. Both of these issues are addressed in this article by the rational-choice theory of neurosis (RCTN). RCTN maintains that patients consciously and deliberately adopt neurotic disorders when confronted with intolerable levels of stress. Unawareness is created through sophisticated cognitive processes, by which patients forget their own self-involvement. Subsequently, patients develop a self-deceptive belief that rationalizes the neurotic behavior, thereby preserving unawareness. According to this new theory, all therapies exert their effect either by disrupting patients' ability to preserve unawareness, increasing the cost of the symptom, decreasing the patient's emotional distress, or eliminating the stressor.