Therapy in the Age of Neuroscience

A Guide for Counsellors and Therapists

Peter Afford

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781315512716
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Therapy in the Age of Neuroscience: A Guide for Counsellors and Therapists is an essential guide to key areas of neuroscience that inform the theory underlying psychotherapy, and how they can be applied to practice. Laying out the science clearly and accessibly, it outlines what therapists need to know about the human nervous system in order to be able to engage with the subject.

Chapters cover the neuroscience underlying key aspects of therapy such as relationships, emotion, anxiety, trauma and dissociation, the mind-body connection, and the processes which enable therapists to engage deeper aspects of mind and psyche. This book responds to the need for counsellors and therapists to have an accessible and comprehensive guide to how contemporary neuroscience views mind and body.

Therapy in the Age of Neuroscience will appeal to psychotherapists, counsellors and other mental health professionals who wish to learn more about how to integrate neuroscience into their work.

Chapter 1

Therapy meets neuroscience

Introduction

Human encounters in the therapy room are a world apart from neuroscience with its hi-tech wizardry for peering into people’s brains. Yet both disciplines explore the human nervous system, and they share common ground. Both accept the formative power of early experience and the potential for changing mature brains. Both know that the brain can’t be seen in isolation from the rest of the body. And both recognise that our cognitive capacities are frequently trumped by our affective ones.

Their meeting has history, since Freud began his career as a neurologist and speculated about the future for psychology:

Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information, and we cannot guess what answers it may return in a few dozen years … They may be of a kind which will blow away the whole of our artificial structure of hypotheses.

(cited in Solms & Turnbull 2002: 298)

Have those hypotheses been blown away yet? I suspect not. But perhaps there’s a steady process of erosion and re-sculpting happening whereby some go, some remain and others are revised. I hope this book is a useful contribution to the discussion underpinning such a process.

However you feel about neuroscience, it’s increasingly hard to avoid. Trainers and speakers at gatherings of therapists love to include morsels of neuroscience. So should therapists study neuroscience, and if so, which aspects of it? How deeply into the technical details should we go? Does neuroscience require us to change what we do? What strikes me is how the morsels are handed out without much contextual understanding of the subject. Trees are sprouting, but we lack a wood.

Objections to neuroscience

Not all therapists are sold on neuroscience, so I’ll start by examining some arguments against embracing the subject.

Why learn about the hypothalamus? A colleague in a peer supervision group once said she couldn’t see how it would help her to know about the hypothalamus. She had a point: isolated facts are useless, and potentially misleading. But an understanding of the stress response, in which the hypothalamus plays a key role, is clearly pertinent to therapy. Detail belongs in context.

Science has no place in a healing human encounter. A more vehement objection is that science should be kept apart from the art of therapy; the dialogue could be diminished by technicalities, the human soul lost. For example, clinical psychologist Richard House wrote a while back: “forgive me, but what conceivable relevance can neuroscience have to a client and me when we’re sitting in a room together, trying to co-create a healing encounter?” (2013: 42). Fair enough, but behind the therapist’s role in that encounter lie her theories guiding her interventions, and neuroscience gives her a new perspective on the client’s difficulties and what may be needed to resolve them.

Science is reductionist. A related argument is that neuroscience is reductionist (‘this is merely that’), deterministic (your biology determines your behaviour) and materialistic (soul and spirit are banished) and therefore philosophically opposed to therapy. But these supposed evils of human thinking concern the way science is done, while we can consider the results without being reductionist. Cannot science be combined with art – or craft? Also, I’m sometimes astonished how ascribing anything to the brain can be called reductionist when it’s the most complex known object in the universe!

A little knowledge is a dangerous thing. This argument carries weight, since neuroscience is an alarmingly complicated subject. Would prudence dictate that we steer clear of it? Certainly, we should beware getting too excited about individual findings and jumping to unwarranted conclusions. But however complex a subject is, it’s always possible to distil detail into a high-level summary that offers understanding without sacrificing facts.

Therapists don’t need neuroscience to do good therapy. This is true – therapists gain an intuitive understanding of how brains work from examining their own psyches (hopefully) and spending their days encountering other people’s psyches. Nevertheless, if another perspective on the human psyche brings fresh insights, why dismiss it? It can be combined with intuition, experience and psychological theory.

Good reasons for embracing neuroscience

Clients present for therapy because their brains don’t function as they wish, and therapists use their brains to help them function better. So what are the arguments in favour of therapists embracing neuroscience?

Our psychology is rooted in our biology. Psychology and neurobiology can’t be separated without straying into dualism, the separation of mind from body for which Descartes is endlessly berated. We needn’t wonder which comes first, like chickens and eggs, for we can dance with both. Biology offers another perspective.

Neuroscience makes the implicit explicit. Everyone has an implicit understanding of how minds work, their own and others’ – we’ve been figuring them out from day one. Therapists are meant to have a particularly well developed implicit understanding, informed by self-reflection and psychological theory. If we say we rely on intuition rather than theory, we’re probably guided by implicit principles that could be called ‘theories of human nature’. Neuroscience makes the implicit a tad more explicit, allowing us to wonder what effect our interventions might have on our clients’ nervous systems. We can cross-refer between implicit understanding and an appreciation of the nervous system.

Neuroscience provides a check on psychological thinking. Psychological thinking usually starts with experience and observation, and then we build theoretical edifices on top. Now we can test the validity of these edifices against neuroscience. A good example is trauma and dissociation: with what’s now known about the nervous system, our understanding of these important topics is, I think, considerably clearer (the proof of the pudding lies in Chapter 7).

Neuroscience has an integrative influence. The therapy world is divided into many camps. Neuroscience studies the human nervous system that applies to everyone, individual variations notwithstanding, and it gives us pointers that therapists of all persuasions can use. It provides a shared knowledge base to refer to. It’s also integrative in that it encompasses the body as well as the brain, since the nervous system reaches everywhere inside. And although cognitive neuroscience has dominated the field, there’s affective neuroscience as well. So I’ll address body as well as mind, and feeling as well as thinking.

Neuroscience can normalise the problem. Explaining something a person struggles with, and feels shame around, in neurobiological terms can help them accept themselves as they are (“oh! that makes sense – I thought there was something wrong with me”).

Neuroscience is interesting! I think this is the best argument for embracing neuroscience. Here are revelations, not about a faraway universe, but about what goes on in our own heads, minds and bodies – under the bonnet.

The nature of the beast

It’s easy to imagine neuroscience is something that it isn’t. Some caveats are in order.

Beware seeking certainty. I’m often asked questions that assume that neuroscience has the answer to everything (and that I know a lot more than I do). It doesn’t. It offers a body of knowledge (of which I know only a fraction) that complements psychology. Even brain scanning is not as exact a method as you might imagine. The reality is that neuroscience hasn’t discovered the holy grail of human nature, and we don’t know exactly what’s happening in people’s brains in the therapy room. Your clients may not want to put their head in a brain scanner, or even sit with a hairnet of electrodes wiring them to a machine. Instead, neuroscience provides a framework that allows you to reflect on might be happening.

Anything you do will change the brain. Enthusiastic proponents of new-fangled therapeutic techniques often claim that they ‘change the brain’ (as distinct from those that don’t!). But our brains are changing all the time anyway, so on its own this statement doesn’t mean much. The question to ponder is “what sort of effect might this technique have on my client’s brain?”. Then you can follow a line of thought. And when someone’s brain does change, which we can deduce from their changed behaviour and experience, we can speculate about its nature. One day, people may have routine brain scans at the beginning and end of therapy, but that day is in the future.

Don’t reduce, associate. Learning about the brain can tempt us into the dreaded reductionism. For example, hearing that mystical experiences involve the right temporal lobe might lead you to think that such experiences are merely the result of activity in this part of the brain. But there’s no need to state things in such bald terms, and anyway such a conclusion isn’t warranted. What we can say is that there’s an association between mystical experiences and activity in the right temporal lobe, and be curious about it. Then we open the discussion up, rather than use science to close it down.

Correlation usually beats causation. We can also be tempted into thinking in simplistic causal terms. For example, depression involves chemical imbalance in the brain, so you might think the imbalance causes the depression. But neuroscience doesn’t say that chemical imbalance causes depression, it says the two are correlated: a depressed brain is one with different neurochemistry from a healthy brain. This may tell us something about depression and about the role antidepressants can play in alleviating it.

Beware the fatal attractions of pop psychology. Our minds can run off with neuro-nuggets we hear about. It takes discipline to be patient and not rush to conclusions. An example of pop psychology causing trouble is the left and right hemispheres business. When new insights arose from split-brain research in the 1960s, pop psychology ideas took hold: some people (logical thinking types) were ‘left-brained’ and others (intuitive creative types) were ‘right-brained’. This is an over-simplification, and the real differences between the hemispheres are subtler and much more interesting (Chapter 3).

Neuroscience doesn’t explain everything. There are some things people bring to therapy that lie beyond the scope of neuroscience – such as synchronicity, subtle energies, chakras, telepathy. But there are plenty of other things that regularly come to therapy about which it has much to say, including memory, ‘the unconscious’, stress, anxiety, trauma and dissociation – all subjects I’ll address.

We need contextual understanding. Writers and speakers love to dispense morsels of neuroscience as if everyone knew enough to appreciate their significance. For example, I just read in Daniel Levitin’s The Organised Mind, a book written for a general audience, about “neurons with nicotinic receptors located in a part of the brain called the substantia innominata” (2015: 47). A nice example of the impressive Latin names given to brain areas, but who’s heard of this area (I haven’t)? And who understands how nicotinic receptors work – is this about smoking? Similar statements about the details of brain areas that are entirely opaque to the layperson abound these days.

So let’s first have a wood before we inspect the trees, an overview to help us make sense of the detail. It makes the whole subject more interesting, because you can do more with it.

Neuroscience enters therapy

So what should therapists do with neuroscience?

Some people now claim that their therapeutic methods are ‘neuroscience-based’, but I’m sceptical. It seems more likely that they’ve devised their techniques and then looked for some neuroscience to validate them. If you started out only with neuroscience, you could soon be lost in seeking new directions for therapeutic interventions – we need psychological ideas to find our way around.

Here’s my perspective on the question.

We don’t need neuroscience to validate what we do. Psychotherapy has been practiced for a long time, and we can be confident that how we work is grounded in theory and affirmed by our experience in the therapy room. If we needed validation from neuroscience and brain scanners, rather than from clients’ feedback and our own observations, we’d be in deep trouble.

Neuroscience doesn’t tell you how to do therapy. I’m sometimes asked, in effect, “can you skip the technical detail Peter and just tell us what we should be doing differently?” No, I can’t! If you imagine that neuroscience is able to do this, you’re much mistaken – it’s a jungle lacking clearly marked paths through it. We need to bone up on neuroscience and then discuss its bearing on how we work.

Don’t try to apply neuroscience – absorb it. Looking for quick ways to apply neuroscience in the therapy room is, I think, a mistake. Neuroscience can’t be reduced to bullet points for therapists to follow. Rather, I recommend growing your understanding and allowing it to influence your thinking about what your clients bring and how you might respond to them. Your learning curve will be more rewarding. And discussing neuroscience with supervisors and colleagues before ‘applying’ it in the room will give you more confidence.

Neuroscience doesn’t replace psychological theory. It’s a different kind of theory, and we can have both alongside each other, dancing between them to see what neuroscience can add to what we already know. We can hypothesise and speculate, reflecting on our experience in the light of the science. Perhaps some of it will make more sense than some psychological concepts do, since it’s rooted in our biology – which we can find in our experience.

Neuroscience is a different kettle of fish. We can adopt psychological theories that resonate with us and adapt them in creative ways, but we can’t play with scientific concepts in the same way. They’ve grown via a different route so that if you want, for example, to argue with Panksepp about his list of fundamental emotions (Chapter 5), you need to do your own lab research into neural pathways and neurochemicals. We have to take neuroscience as it is – we don’t have the luxury of believing whatever we want to believe.

Don’t let neuroscience dictate. People sometimes ask if neuroscience says that the brain of someone suffering a condition can change. This is putting the cart before the horse. First, we should engage with our clients to get a sense of whether they might change, and then we can cross-refer with neuroscience. If the person changes, their brain changes. If neuroscience were pessimistic about a particular condition, we might be stopped from trying; and if it were optimistic, it would be talking about an average...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• Acknowledgements
• Introduction
• 1. Therapy meets neuroscience
• 2. The brain is a nervous system
• 3. One brain, two minds
• 4. Relationships and social engagement
• 5. Emotions, feelings and the felt sense
• 6. Stress, anxiety and depression
• 7. Trauma and dissociation
• 8. Mental health matters
• 9. The mind-body connection
• 10. Engaging the mind
• 11. Meaningful experiences
• Epilogue
• Glossary
• References
• Index