Interpersonal Neurobiology and Psychotherapy

There is a great deal of evidence supporting the impact of early nurturance on the shaping of the social brain.  The brain is an organ of adaptation; it can adapt to any environment, including those that are not conducive to happiness and health.  When our childhood relationships are frightening, abusive, or nonexistent, our brains dutifully adapt to the realities of our unfortunate situation.  However, there is reason to believe that these circuits retain plasticity throughout life, especially in close relationships.  For many of us, adult relationships give us a second, third, and fourth  chance at shaping our attachment circuitry and living a happy and satisfying life.

There are many clues to the nature of healing relationships that can be found by studying optimal parenting.  After all, the networks of the social brain are first built in the interactive parent-child dyad and may be changed in similar ways.  Because the core of the social brain is also the hub of our fear circuitry, negative early experiences can result in social relationships that act as a stimulus cue for troubling memories.  Not surprisingly, the biggest challenge of therapy is the establishment of sufficient trust to allow attachment and healing to take place.

In reviewing several psychotherapies, it appears that there are common elements necessary for treatment success.  An intimate relationship with the therapist reactivates attachment  circuitry  and makes it available to neuroplastic processes.  Moderate levels of arousal maximize the biochemical processes that drive protein synthesis necessary for modifying neural structures.  Then frontal systems can re-associate and re-regulate the neural circuits that  organize thinking and feeling – those most vulnerable to dissociation.  Finally, the co-construction of new narratives creates an evolving language for experience that can modify self-image, aid in affect regulation, and serve as a guide for positive behavior.

A number of important implications for the practice of psychotherapy arise from our expanded understanding of neuroscience.  Perhaps the most crucial is that therapists need to integrate a brain-based understanding of human development, mental health, and mental illness into whatever theoretical orientation they practice.

Utilizing Multiple Means of Influencing the Brain:  Everything -- from intimate relationships to medication to church attendance or spending time in nature to exercising to having an affectionate pet -- has been shown to have a positive impact on physical and mental health.  This wide range of solutions speaks to the multiple ways in which neuroplastic processes can be enhanced and healing achieved. 

Educating Clients about Their Brains:  We have boxes full of owner’s manuals for the many things we own but are clueless about the most important device we possess.  Teaching clients about how the brain works, explaining to them the impact of early learning on the brain and body, the workings of memory, the biases of the amygdala, and our vulnerabilities to prejudice and phobias can go a long way to both “depathologize” their experience and create a shared conceptual model within the working relationship.

Fostering Ongoing Optimism Based on Lifelong Plasticity:  Our increasing knowledge of the mechanisms of ongoing plasticity throughout the lifespan, the impact of enriched and enriching relationships on the social brain, and our advances in the use of these processes can all serve as valuable tools in the therapeutic relationship.  The power of what is called the “placebo effect” is not in a sugar pill or a client’s gullibility; rather, it rests in the healing effects of the social brain to connect, to believe, and to internalize the doctor’s optimism via the same neurochemical systems of attachment and bonding.  The physiological reality of ongoing neuroplasticity and neurogenisis provides us with a solid foundation for ongoing optimism with any client at any time, regardless of his or her struggle.

The Malleability of Memory and Rewriting History:  Although we know that the veridical truth of memory is always questionable, we have also learned that memory is quite malleable.  Educating clients about the peculiarities of memory and giving them permission to play with and modify memories provides tools for rewriting history in a manner that supports mental health.  As long as clients are capable of understanding the difference between accurate history and therapeutic co-constructed narratives, many clients may be able to transform their oppressive memories into healing stories.

Emphasizing the Centrality of the Therapeutic Relationship to Positive Change:  Research in social neuroscience and therapeutic outcome support the importance of the quality of the relationship to therapeutic success.  This finding is true regardless of the theoretical orientation of the therapist and whether or not he or she considers the relationship to be an active ingredient in the change process.  Therapists tend to undervalue the impact of the human relationship as they focus on diagnostics, treatment strategies, and management issues.  The research suggests that the training of therapists should include more emphasis on skills related to resonance, attunement, and empathic aspects of treatment.