By Nel Walker
According to recent neurobiological findings, if you are a counsellor or psychotherapist, then you are a Brain Organiser, as you are involved in a process that changes neural organisation, structure and functioning. Neuroscience is providing us with an increasing understanding of what happens in the brain during psychotherapy, and strongly validates it.
The therapeutic relationship, whether one thinks about it or not, has always had the effect of changing the client's neural organisation. The art of psychotherapy, which has evolved quite separately from scientific knowledge, seems to be doing mostly the 'right thing', according to brain scientists, who's work is bringing knowledge and understanding of what happens at the neural and physiological levels in the therapeutic relationship. These affirmations of what psychotherapists and counsellors have already been doing, largely intuitively, may have many benefits including the following:
A greater feeling of confidence in what we are doing by providing a safe, empathic, attuned and containing relationship, thus helping one to hold steady and stay grounded even when times are challenging beyond the norm.
One would be working from a firmer foundation from which the thinking and choice of intervention is likely to be more helpful. For instance, if we understand how the interaction with the client can have a regulatory effect on the client's affect system then we will be able to refine what we are doing and so do it better. We will be more able to help clients themselves to understand, where appropriate, what is happening in their own brain, mind and body when, for instance, he or she is triggered and has a panic reaction, or what is happening when experiencing disturbing ambivalence in the relationship with the therapist. Insights such as these can help to empower the client, to normalise their symptoms and help them to be more of a curious observer of those symptoms rather than being caught up in and taken over by them. When clients begin to understand that their problems and symptoms in the present are based on normal and recognised responses and adaptations to their abnormal early experiences they are likely to feel more self-accepting and hopeful of a way forward.
New understanding of how the mind-body system works is opening up new ways of working which can be even more effective and focused without minimising what we have always known about the importance of the relationship. There is a buzz of excitement caused by the growing synthesis between the art and the science of psychotherapy, as it appears to be offering potential for greater strides forward in working with very damaged people.
There is an energising and empowering bridging of the gap between the clinical field of mental health and the independent field of neuroscience. Margaret Wilkinson, a Jungian analyst and author, presents counsellors and therapists with a challenge. She writes: "Sound therapy requires an understanding of mind, brain and body. Now such knowledge is available, nothing less will do." (Wilkinson 2006) She also asserts that knowledge of current neuroscience can enable clinicians to, "come to a clearer understanding of why they do what they do, especially in relation to the unconscious, empathic, dynamic aspects of work in the transference and counter transference".
Here are some quotes I came across recently describing psychotherapy in terms of this new conceptual framework: "Psychotherapy is currently conceptualised as being directed towards the mobilisation of fundamental modes of development and the completion of interrupted developmental processes." (Schore, 2006 Workshop)
Cozolino proposes that people who seek psychotherapy have, at the basis of their needs, the problem of neural networks, which have been underdeveloped, unregulated or un-integrated. "At the heart of psychotherapy is an understanding of the interwoven forces of nature and nurture, what goes right and wrong in their developmental unfolding and how to reinstate healthy neural functioning. When psychotherapy results in symptom reduction or experiential change, the brain has, in some way, been altered." (Kandel 98, from Cozolino 2002)
"Psychotherapy is an attachment relationship capable of regulating neurophysiology and altering underlying neural structure." (Amini et al, Psychiatry 1996) This is what we are doing!
Almost all of the above, applied to psychotherapy, is parallel with the relationship between mother and baby and the shaping of the developing brain in that interaction, for better or worse.
But a client is not a baby!
Of course, we are not just dealing with the problem of 'underdeveloped, unregulated or unintegrated' neural networks. Our severely damaged clients' brains have been badly messed up, by the effects of neglect, misattunements, trauma, shaming, lack of safe containment and so on. In the developing brains quest to bring order, meaning and adaptation out of harmful and inadequate experiences, development will naturally have taken place, but dysfunctionally, affect would be dysregulated and many neural networks would remain unintegrated and prevented from integrating by conditioned fear. The inadequate and traumatising raw materials of experience offered by such toxic parenting and/or other damaging cultural forces, have led to the many problems and symptoms we see in clients with dissociative identity disorder or complex posttraumatic stress disorder, symptoms that affect every level of functioning of the brain, mind and body.
The science of psychotherapy is holistic
Knowledge from the field of science underlines the interconnectedness of body, brain and mind, and the significance of involving all three brain levels (cognitive, limbic and sensorimotor), and the body in psychotherapy. It has also helped to shift the emphasis of where we need to work towards the sensorimotor and limbic structures of the brain, as being key in understanding what is happening, and away from the previously assumed greater significance of the cognitive areas, although all areas are important and interrelated.
The challenge of neuroscience
Traditional good psychotherapy models that are based on a safe, reliable, attuned, and contained relationship have been validated by neuroscience and the field is also being offered the tools for developing more effective psychotherapy. Could psychotherapists improve on the effectiveness of neural reorganisation by providing more clear raw materials, especially in some areas of experience such as affect regulation or the sense of continuity through time, in order to help the client towards a clearer reorganisation of their internal map or sense of self? Some of the most exciting developments that I have come across recently that seem to offer such ways forward, which are practical as well as grounded in current neuroscience, are in the following areas:
There are many others too who are developing ways forward in psychotherapy and counselling based on the new synthesis between the art and the science of psychotherapy. It may be useful to share more knowledge of different developments with each other. Perhaps you could add to this list, keeping us in touch with ways in which an increasing synthesis with the world of science is affecting the theory and practice in your areas of work and experiences. Wilkinson suggests that the integration of neuro-scientific data and psychodynamic models will lead to a resurgence of imaginative and thoughtful clinical work. Allan Schore adds, "What better outcome of a paradigm shift than that?" (Wilkinson 2006, Foreword)
Amini et al (1996) 'Affect, attachment, memory: contributions towards psychobiologic integration' Psychiatry, 59, 213-239
Cozolino L (2002) 'The Neuroscience of Psychotherapy: Building and rebuilding the human brain.' Norton, New York.
Wilkinson M (2006) 'Coming into Mind: The mind-brain relationship: a Jungian clinical perspective. Routledge, London.
Schore A (2006 Workshop) 'The Art and the Science of Psychotherapy.'
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