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The following paper will explore concepts of consciousness and the unconscious derived from philosophy, psychoanalysis and cognitive behavioural psychology alongside their implications for therapeutic work. In concluding there will be mention of the 'Third Wave of Behaviour Therapies', in particular Acceptance Commitment Therapy, exploring the underlying philosophical framework and its application.
Defining the concept consciousness itself can involve much ambiguity. "Anything that we are aware of at a given moment forms part of our consciousness, making conscious experience at once the most familiar and most mysterious aspect of our lives " [i] (Schneider and Velmans, 2007). There are many philosophical positions on consciousness including behaviourism, dualism, monism, phenomenalism, phenomenology, intentionality, physicalism, mysticism , and externalism Some philosophers define conscious states as being qualitative or phenomenal. Phenomenal consciousness is experience. A more common contemporary understanding comes from Tomas Nagel's 'what it is like' sense. Nagel is well known within the domain of philosophy of mind, particularly from his view that consciousness cannot be explained using science or physics and that consciousness is imbued with a subjective character, hence he states, "an organism has conscious mental states if and only if there is something that it is like to be that organism-something it is like for the organism" [ii] (Nagel, 1974). When one is in a conscious mental state there is something 'it is like' from a subjective point of view, such as smelling a flower, there is something it 'feels' like from my perspective, as opposed to an inanimate object like a chair (Rocco J Gennaro, Consciousness and Concepts, An Introductory Essay) [iii] . Philosophy of the mind refers to the study of the mind, mental functions, mental events and properties, consciousness and the relationship to the physical body, in particular, the brain [iv] . Rene Descartes (1641) in his Passion for the soul likens the body to a machine that follows the law of physics whereas the mind, being non material, does not. He proposed the human being is made up of two parts -Mind & Body with conscious experience being in the former. Descartes describes thought as "what happens in me such that I am immediately conscious of it, insofar as I am conscious of it" [v] . An argument in favor of dualism is that the mental and the physical appear to have different and irreconcilable properties [vi] where mental events have a subjective property whilst physical events do not (Jackson, F. (1982) "Epiphenomenal Qualia).
Psychoanalysis had its origin with Freud from the 1890s. His understanding of the mind was based on interpretive understanding, introspection and clinical observations. The particular focus is on resolving unconscious conflict and mental distress as psychoanalysis is based on the notion of an unconscious which influence current experiences. Freud states, "[About consciousness and the unconscious] there is nothing new to be said... the division of mental life into what is conscious and what is unconscious is the fundamental premise on which psycho-analysis is based" [vii] ( Freud, Sigmund. "The Ego and the Id" 1949). This fundamental principle of psychoanalysis being the concept of a dynamic unconscious mind, grew out of Freud's observation that the physical symptoms of patients tended to disappear after apparently forgotten material was made conscious. Freud saw the unconscious as an area of immense psychic activity, which influenced personality and behavior but operated with material not subject to recall through normal mental processes [viii] . Freud theorised that there were a variety of defense mechanisms including reaction-formation, repression, regression, displacement, and rationalization that protect the conscious mind from aspects of reality it may find difficult to accept. The major defense mechanism is repression, which induces"forgetfulness" for unwanted realities. Observing the relationship between psychoneurosis and repressed memories, Freud made conscious recognition of these forgotten experiences the foundation of psychoanalytic therapy. He asserted that conflicts between these often-opposing aspects of the human mind are crucial factors in the development of neurosis. The implications for intrapsychic models are the notion that there is an underlying psychopathology, and that therapy is not aimed at the symptoms themselves but the underlying pathology [ix] . As in medicine treatment of the symptoms is only an acceptable alternative if one is unable to identify the underlying pathology, or the underlying pathology has no known effective treatment. Psychoanalysis focused on early childhood, postulating that many of the conflicts which arise in the human mind develop in the first years of a person's life. Freud demonstrated this in his theory of psychosexuality, in which the libido (sexual energy) of the infant progressively seeks outlet through different body zones (oral, anal, phallic, and genital) during the first five to six years of life. There have been numerous criticisms and defenses of psychoanalysis (Brunner, José (2001). Freud and the politics of psychoanalysis). Critics have pointed out that Freud's models arose out of a homogonous sample group- being higher class Austrian women living in the sexually repressed society of the 19th century, somewhat invalidating Freud's focus on sex as a determinate of personality. The requirement of frequent therapy sessions over a period of years also has made the cost prohibitive in comparison to other therapies. Today, a century after Freud's first case reports, the outcomes of different psychoanalytic treatments have scarcely been compared with one another in a methodical, scientifically valid manner [x] (Bachrach et al, 1991).Beyond Freud there have been significant developments to the Freudian framework: Erikson, Klien, Kohut and Jung to name a few. Jung's concept of the 'collective unconscious' with its emphasis on myth and spirituality continues to have a strong following today. Jung considered the collective unconscious to be within all people but differed from Freud's view of the unconscious in that it is not created by repression.
Most models of psychology are based on the philosophy of mechanism, which treats the mind like a machine that consists of multiple parts. Problematic thoughts are seen as a dysfunction of the mind or machine. Thus the aim of most approaches is to 'repair' or replace the 'faulty parts' so the mind/machine can function properly. Mechanistic models make the assumption that there are inherently dysfunctional thoughts, feelings (including emotions, core beliefs, and memories) that are fundamentally 'maladaptive' or 'problematic', likened to a 'faulty chair' that needs to be fixed or replaced.
Behaviorism is a psychological movement that can be contrasted with philosophy of mind. The main premise of radical behaviorism is that the study of behavior should be a natural science, such as physics, without any reference to the internal states as causes for behavior [xi] . This approach claims that people, alongside their actions and problems, can be understood by observing their behaviour. This theory assumes that after birth all human beings have similarities. The development of personality is greatly related to the surrounding environment, which is to shape and bring up the future individual. This idea is based on the experiment of Ivan Pavlov, a Russian physician and psychologist. In the course of the experiment a dog was taught to associate a bell's ring with food. Therefore, the scientists concluded that an individual's actions are based on external factors (Alla Kondrat, Behavioural & Cognitive Approach in Psychology 2009) [xii] . The followers of the behavioral approach reject retrospective methods, and claim that behaviour is determined by external factors, such as stimuli of the outside world. Consciousness, according to the behavioral approach, is an artificial set of religious ideas such as 'soul' or 'spirit', and is absolutely rejected. The approach of modern behavioral psychology throws out any and all concepts of consciousness, awareness, thought, will, responsibility, etc., because to the behavioral psychologist none of these things can be observed by a second party. The approach has come under criticism due to its lack of theoretical basis and due to lack of value base. Since behaviouralists believe truth or falseness of values, such as freedom or democracy cannot be scientifically measured they are beyond the scope of legitimate inquiry.
The fundamentals of cognitive therapy can be traced back to the ancient Greeks. The idea that our perceptions determine the reality that we experience was a focus of Plato' idealism. Modern cognitive psychology arose in part due to the dissatisfaction with the behaviouralists view which focused on visible behaviours without an understanding of the underlying internal processes. Cognitive psychologists tend to apply a scientific view to human behaviour, reductionist to an extent, in that it doesn't differentiate between individual differences which make people behave differently, as opposed to a humanistic viewpoint. There are parallels to the human mind working in a similar way to computers. A criticism is that does not take into account genetic factors; for example hereditary correlations of mental disorders. Cognitive behavioural therapy is a treatment approach based on the idea that the way a person thinks about an event determines, to a degree, how they respond to it in terms of behaviour and affect. Cognitive theory asserts that dysfunctional beliefs and maladaptive behaviours lie at the root of many psychiatric disorders and that through assistance from the therapist a person can learn to identify and correct false beliefs and assumptions with the intention of reducing distress and enhancing coping mechanisms.
The essence of CBT involves people being encouraged to treat their unhelpful or unrealistic beliefs as hypotheses to be tested through a goal oriented, systematic procedure, gradually facing activities which may have been avoided, and trying out new ways of behaving and reacting. The underlying principle of CBT implies that people often suffer as a result of their misperceptions without having any underlying motivation for doing so other than the very fear they may come true. An example could be a person suffering depression who has a tendency to exaggerate the magnitude of the problems they face and who holds an erroneous belief that they lack the skills to achieve identified goals or to enjoy the rewards if they do. Consequently they fail to initiate goal orientated behaviours based on the belief that they will fail, interpreting subsequent 'failure' as evidence of their own incompetence, likened to a 'self fulfilling prophecy'.
Features of CBT assessment include an emphasis on the 'present', with an examination on current problems rather than a preoccupation with events of the past. Historical information is relevant insofar as it assists the understanding of the evolution of previous occurrences of the current set of issues without working directly with memories such as in psychoanalysis. There is particular focus on experimentation where much of the therapy involves collaboration between the therapist and consumer, testing out hypotheses, which in turn determines the next step to take. There is a strong focus on measurement such as specific, measurable, achievable, and realistic and time framed goal setting (SMART Goals). CBT assessment will vary according to the context and presenting issue of the client and consequently be reactive to the cues that emerge throughout the assessment.
The key elements of CBT assessment include defining and clarifying the problem i.e. what exactly is causing the problem; examining the historical context; an examination of the observable antecedents and consequences of the problem in order to observe the consumers response in terms of behaviour, cognitions and physiology and an exploration of thoughts and beliefs, emotions and actions. Data is also gathered by self report questionnaires such as used on self esteem, symptom inventories or coping inventories. CBT is usually a short term treatment with therapy typically lasting up to six months. It has demonstrated effectiveness in treating both psychotic and non psychotic disorders including clinical depression, bipolar affective disorder, schizophrenia, anxiety, panic disorder, phobia disorders, drug use/dependence, post traumatic stress disorder, obsessive compulsive disorder, weight loss and lifestyle changes in long term illnesses such as diabetes [xiii] .
As mentioned earlier the first wave of behaviour therapy (Burrhus Frederic Skinner, founded 1913) was primarily focused around visible behaviours, without focus on internal processes. Second wave treatments involved the addition of cognitive components known as CBT. Third wave approaches include Dialectical Behaviour Therapy, Function Analytical Psychotherapy, Mindfulness Based Cognitive Therapy and Acceptance Commitment Therapy. Third wave models focus more on contextual behaviour, emphasise flexibility of skills rather than pathology and function rather than form. Values, spirituality, relationship and mindfulness are key components as opposed to the emphasis on immediate problems. A CBT therapist may take the approach of understanding and challenging a clients cognitions where a third wave approach may focus on understanding and accepting cognitions and the connection with a persons values. Steve C Hayes states in his ABCT President address Address: "Grounded in an empirical, principle-focused approach, the third wave of behavioral and cognitive therapy is particularly sensitive to the context and functions of psychological phenomena, not just their form, and thus tends to emphasize contextual and experiential change strategies in addition to more direct and didactic ones. These treatments tend to seek the construction of broad, flexible and effective repertoires over an eliminative approach to narrowly defined problems, and to emphasize the relevance of the issues they examine for clinicians as well as clients. The third wave reformulates and synthesizes previous generations of behavioral and cognitive therapy and carries them forward into questions, issues, and domains previously addressed primarily by other traditions, in hopes of improving both understanding and outcomes" [xiv] .
ACT is based on relationship frame theory, a theory of language and cognition connected to behavioural analysis. It helps throw light on how "language entangles clients into futile inner wars" [xv] . It differs from CBT in that it attempts to teach people to observe or notice thoughts, leading to acceptance of private events which have been avoided or feared. Integral to ACT is the sense of 'observing self' or 'self in context' - that there is a you that is always there observing and experiencing but distinct from the thoughts, feelings, memories etc.
ACT is developed within a framework of functional contextualism, a modern philosophy of science derived from pragmatism and contextualism. It emphasises the importance of predicting and influencing psychological events such as thoughts, feelings etc. It looks at how things function in specific contexts. From the viewpoint of functional contextualism no thought or feeling is inherently problematic or pathological (unlike mechanistic psychology). Conextualists strive to maintain contact with the whole event and its context and retain the holistic nature when conducting analysis.
The core conception of ACT is that psychological suffering is usually caused by experiential avoidance, cognitive entanglement, and resulting psychological rigidity that leads to a failure to take needed behavioral steps in accord with core values In ACT the purpose of predicting and influencing behaviour is in order to create a rich, full and meaningful life through valued, mindful living whilst accepting the inevitable pain that goes with it. Most models of western psychology have a primary focus on symptom reduction, assuming the reduction of symptoms is necessary for clients to live a better life. ACT's approach assumes quality of life is based on mindful, values guided action which is possible irrespective of the existence of symptoms, provided one responds to symptoms with mindfulness. Thus the teaching of mindfulness skills aim is to change ones relationship with symptoms so that they no longer prevent one from experiencing valued living. Interestingly, symptom reduction is a by product of the processes of ACT.
As of 2006 there have been 30 randomised controlled trials for a number of client problems and when compared to other treatment approaches has demonstrated medium effect. Being a relatively young therapy it has nevertheless shown preliminary evidence of being effective in treating a number of problems such as chronic pain, depression, anxiety, psychosis, diabetes management and smoking cessation [xvi] . The emphasis of ACT on present-mindfulness, valued direction and action has similarities to other approaches within psychology that aren't as focused on outcome research, being more humanistic in approach, such as narrative psychology. Concerning a randomized control effectiveness trial of CT & ACT in 2007 found "Overall, the results suggest that ACT is a viable and disseminable treatment, the effectiveness of which appears equivalent to that of CT, even as its mechanisms appear to be distinct" [xvii]
The influence of psychoanalytic theory upon contemporary thought is difficult to overstate, and equally difficult to quantify. Concepts of a dynamic unconscious, repression, ego, infantile sexuality, and the Oedipus complex have become imbedded in modern thought and psychology. Psychoanalysis is the root of all contemporary forms of psychotherapy, and has had an immense impact on the treatment of mental illness and on the fields of psychology and psychiatry. Philosophically ACT has borrowed ideas from eastern cultures and traditions such as Hinduism and Buddhism. Mindfulness, human suffering, the role of attachment in suffering, right action and self (all Buddhist concepts) are examined in ACT. Additionally, the current context of clinical practice has the appearance of moving towards an 'eclecticism where many therapists incorporate cognitive behavioural principles in their practice, including the previously mentioned 'third wave' therapies, incorporating values and spirituality which have largely been ignored to date.