The Essence of Psychotherapy: How Neurobiology Is Informing Psychotherapy

Recent innovations in psychological research bring to mind the plight of the gold miners who, over a hundred years ago, lived where I now live. These miners proudly excelled in the many skills of their trade. When it came to digging deep caves, following gold ore veins, creating roads in seemingly inaccessible terrain, few could best them.

There came a day, however, when the abilities of miners were no longer sufficient to advance the mining interests of the day. To the dismay of the miners, forward-looking companies began to turn to surface dwelling outsiders for help. These experts – geochemists – were people who rarely, if ever, ventured underground. They were useless as miners, but they did know how to study the underlying essence of mining: the nature of rocks and ores.

And it soon became clear that these scientists were uncovering some very valuable insights: new ores and methods for processing that ore soon followed. This resulted in the whole process of mining becoming more efficient and effective. The geochemists were not inclined to learn the trade of miners and the miners weren’t particularly prone to immerse themselves in the geosciences, but together they had created a very productive partnership.

Today, good psychotherapists, like the miners of yore, are masters of the tools of their trade: cognitive restructuring, the maintenance and creation of rapport, exposure therapy, various forms of insight development, mindfulness practices, communication skill-building, and so on. However, although these tools promise to remain critically important, psychotherapists and clinical researchers are not much better prepared to directly study that which is most fundamental to therapeutic work than the miners were able to study that which was most fundamental to mining. In the case of psychotherapy this has to do with studying those changes in brain functioning that have been shown to be the result of effective psychotherapy. The attitude of most psychotherapists toward the discoveries afforded by neuroscience might historically be summed up as … well, as a yawn: “Interesting, but not especially useful.”

At least that has been the case until recently. Like the miners, psychotherapists are beginning to realize that scientists from that other field – neurobiology ­–­ are making discoveries that promise to prove invaluable to their work. These scientists most of whom who haven’t, and likely never will, sit down with a client for a therapy session, are nevertheless, uncovering clues to potent ways in which we therapists can more effectively pinpoint and apply psychotherapy interventions.

Utilizing new brain scan technology, neurobiologists have begun to detail a fairly simple construct that could be considered to be the essence of psychotherapy: psychotherapy is a process whereby some areas of the brain are trained to moderate and bring higher functioning and reality testing to the problematic activities of other areas of the brain. More specifically, many psychological difficulties become alleviated when the neocortical regions of the brain – especially areas in the prefrontal cortex ­– become conditioned to assuage the emotional and cognitive distortions generated by subcortical regions of the brain – especially the amygdala. (This is where amygdala script theory gets its name: ‘amygdala script’ is shorthand for ‘amygdala-mediated cognitive/emotional/behavioral memory complex’ Click here for a description of an amygdala script and an example of how it can be used in psychotherapy. Click here for a scholarly definition of “amygdala script” including numerous citations from mainstream research journals).

At first blush, this may not appear particularly compelling to us psychotherapists. However, when we look a little closer at what is suggested by these insights, we, like those miners of yore, begin to learn things that steer us to ways in which we can hone and focus our interventions. In short, by embracing discoveries made in neurobiological arenas mostly unfamiliar to us, we can make our tools of the trade more powerful and much more efficient.

For example, many repetitions of moderating input seem to be required before it is possible to durably tame the types of subcortical responses that underlie most psychological problems. (In the lexicon of neurobiology: repetitive stimulation seems to be required to bring about long-term potentiation and neurogenesis – the mechanisms that result in enduring changes in the ability of the prefrontal cortex to allay well established patterns of emotional over-stimulation and cognitive distortion.) That simple proposition has two important implications for psychotherapy: the first is that we need to create practice exercises for our clients so that they can repeatedly apply the insights and tools they have learned in therapy. This means that when we teach clients to utilize tools such as cognitive restructuring, help them discover insights, teach them mindfulness practices, teach them different behavioral strategies, or some other proven tool for psychological change, we must also develop ways in which they can repeatedly practice those interventions. And encourage them to do so outside the therapy sessions.

The second implication that neuroscience strongly suggests is a more curious one. It is that our clients need to initiate their targeted dysfunctional affective and cognitive responses, before they can effectively apply those practices mentioned above. In order to establish a moderating pathway from prefrontal cortex to subcortical regions of the brain, a process of ‘long-term potentiation” or, in some cases ‘neurogenesis’ must occur. In psychological parlance this translates into ‘classical conditioning’. To create classical conditioning a targeted response must be present. Simply put: one can only link a mollifying psychotherapeutic intervention to a problematic cognitive/emotional symptom while that symptom is active.

The take home message here is that neurobiology is directing us to realize that to be more efficient psychotherapists, we must follow at least three principles: we must teach our clients to identify those affective/emotional complexes that underlie their problems; teach them ways to willfully activate these targeted responses; and, teach them how to practice new responses that will promote mastery over these painful and costly habitual thoughts and feelings, while that targeted amygdala script remains actively present.

How then can a client learn to identify and activate a particular amygdala script? Good news: because amygdala scripts are natural residents of our minds, it is surprisingly easy for us to identify and activate an amygdala script. (Click here to learn more about the concept of amygdala script, including an example of how to identify and activate a script). Once activated we can become quite creative in the many ways in which we can teach clients to condition or link therapeutic tools to their targeted amygdala scripts. Many examples of this can be found in “What Freud Didn’t Know”.

And there is more. In fact there are five simple principles that can be utilized to streamline much of psychotherapy down to its essence.

Like the miners of yesteryear who learned to modify their endeavors by embracing the discoveries of others, it behooves today’s psychotherapists to take to heart the lessons offered by neuroscience. Thanks to many years of carefully constructed clinical research, clinicians have already become adept in the use of many effective therapeutic tools. Now we can make the minor, but important adaptations, to hone and focus these tools and thereby catalyze the psychotherapeutic process.

The book What Freud Didn’t Know (by this author) is a useful resource, describing a number of ways in which neurobiology converges with psychotherapy research to inform clinical practice, including many practical examples for applying the principles described above.

 

 

Comments

  1. Wow that was odd. I just wrote an extremely long comment but after I clicked submit my comment didn’t show up. Grrrr… well I’m not writing all that over again.
    Anyway, just wanted to say superb blog!

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