Affective Neuroscience in Psychotherapy

A Clinician's Guide for Working with Emotions

Francis Stevens, Francis L. Stevens

• Publisher: Routledge
• Year: 2021
• Print ISBN:
  9780367714420
• eBook ISBN:
  9781000460049
• Topic: Psychology
• Subtopic: Cognitive Neuroscience & Neuropsychology
• Index: Psychology

Most psychological disorders involve distressful emotions, yet emotions are often regarded as secondary in the etiology and treatment of psychopathology. This book offers an alternative model of psychotherapy, using the patient's emotions as the focal point of treatment. This unique text approaches emotions as the primary source of intervention, where emotions are appreciated, experienced, and learned from as opposed to being regulated solely.

Based on the latest developments in affective neuroscience, Dr. Stevens applies science-based interventions with a sequential approach for helping patients with psychological disorders. Chapters focus on how to use emotional awareness, emotional validation, self-compassion, and affect reconsolidation in therapeutic practice. Interventions for specific emotions such as anger, abandonment, jealousy, and desire are also addressed.

This book is essential reading for clinicians practicing psychotherapy, social workers and licensed mental health counselors, as well as anyoe interested in the emotional science behind the brain.

Part I
Introduction and Scientific Background

DOI: 10.4324/9781003150893-101

How to Read This Book and Contents Outline

The goal of the book is to make better use of emotion in psychotherapy. The first chapter is on why I believe this book is needed. The next two chapters provide the background and foundations of affective science and affective neuroscience. The book then shifts to the practice of clinical affective neuroscience. Starting with the section on emotional awareness and mindfulness, the book explains how to apply these techniques in using emotion effectively in therapy. I start with the topic of mindfulness because a patient must be aware of what they are feeling before taking steps to work with feelings. Once aware of feeling(s), it’s often important to validate the feeling(s) and provide self-compassion for them. After this, the focus is often on regulating emotions to a moderate level of arousal, which is most effective for change. In the next chapters, I cover individual emotions, and finally, the technique of affect reconsolidation is introduced. The book presents these topics in a sequential format from the basic first steps moving towards deeper, more holistic change approaches. However, readers are encouraged to apply the techniques in the order that is most useful to them or their patients. Different individuals need different things. Some patients may be quite aware of what they are feeling, others may be strong at emotional regulation, while some may need help with self-compassion. For this reason, the reader is encouraged to refer to each chapter or section as it may be helpful for them or their patients.

You can read the book from start to finish, as some explanations build upon previously presented material, but it is by no means necessary to go in order. The book can also be used as a reference guide or manual when working with a certain emotion or trying to understand the neurobiological background of a certain phenomenon. Feel free to skip around; additionally, some sections refer to other sections in the book, because just like the brain, the concepts in the book are not linear. Readers may find it useful to move from section to section in addressing some overarching psychological concepts. Some parts have a scientific orientation; other parts are more practitioner orientated, and these perspectives change throughout the text. Some readers may be interested in fundamental science, while other readers may prefer the more practical concepts. The reader is encouraged to skim through parts that are less relevant for them. In blending the science with my personal experience as a psychologist, I tried to make it clear when I am offering my perspective and when the perspective is based in science. Citations exist throughout the text supporting the science when presented; these can be used for further reference as well. A challenge in writing a book like this is blending the science with the art of psychotherapy. Psychotherapy itself is a nebulous practice. Whenever I help a patient, I often think I know why they got better, but of course, this is only my assumption: not wrong, but not empirically proven. However, if I were to write this book without my subjective voice, I think I would miss a lot of what has worked for me in therapy and could help other clinicians. In focusing on emotion within psychotherapy I am offering a new perspective, so many of the ideas presented have yet to be empirically tested. It doesn’t mean they are wrong; it just means I cannot definitively say they are correct. The rationale is based in part on my subjective experience and in part on an educated understanding of where the science is leading, albeit not yet at the point of empirical certainty. In psychotherapy, unlike other scientific disciplines (say physics or chemistry), empirical certainty is often harder to reach. Affective neuroscience is easier, but in translating it into its therapeutic significance, certainty is harder to establish. In the text, I will often say, “What I’ve done,” or “What works for me,” and generalizations are made based on this. That means this likely works in most cases but will not always work for all patients. I think we should approach psychotherapy with the best scientific information, while recognizing that humans are complicated and we shouldn’t overly aggregate them. For example, self-compassion seems to be of high therapeutic value, but I’ve had patients tell me “Don’t try that garbage on me.” I listen and try not to argue. Perhaps they experienced extreme condescension as a child and self-compassion feels like a reenactment to them. So, while I will say self-compassion works for many of my patients, in psychotherapy there is probably an exception to every rule. I tell my patients, “We are going to try different things until we find something that works.” From a therapeutic perspective, be open to failure or changing tactics for the benefit of the patient. What is probably most important is that we treat our patients like human beings. So, start from that point. Beyond that, we are going to need some treatment interventions and a strong understanding of what is happening in the brain when a patient struggles with psychopathology. I have had much success with this form of therapy, and I hope you can learn for yourself a new emotional approach to psychotherapy. At this point, you may be thinking, “How did I get here? There are so many therapy books; why write one more?”

1 The Need for a New Approach to Therapy

DOI: 10.4324/9781003150893-1

There are a variety of modalities of psychotherapy to choose from in treating psychological disorders. However, in my experience, I’ve found that many of these modalities are helpful to treatment in some regards, but are never comprehensive. Worse, I’ve felt that many of these modalities have a single approach to treatment, which lack flexibility when they don’t work. Research supports the idea that for many people, psychotherapy remains ineffective (Driessen, Hollon, Bockting, Cuijpers, & Turner, 2015; Dragioti, Karathanos, Gerdle, & Evangelou, 2017), with little explanation as to why. Although this book is not written with the intention of being based solely upon my experience, I think it’s important to share my background, as much of it has influenced my thinking and clinical work. In my master’s program, like many students, I was trained in Cognitive Behavioral Therapy (CBT). CBT has a wealth of evidence demonstrating its effectiveness as a modality of psychotherapy (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012), so it makes sense that so many programs train students according to its principles. While CBT offered some benefits to me as a therapist, I found that many of the patients I saw were not improving much from my Socratic questioning, and at times they felt misunderstood or patronized. I found myself leaning back on the “basic” clinical skills I was taught, like open-ended questioning or active listening as a way to help patients. Upon entering my Ph.D. program, I was excited to focus on a different modality of therapy. My Ph.D. program was organized around psychodynamic therapy for the most part, with a specific focus on object relations theory. Many of my professors in this program looked down upon CBT and saw it as a beginner’s type of therapy. The program’s psychodynamic focus greatly improved my understanding of the human psyche, and my ability for case conceptualization vastly improved under my professors. However, as a clinician during this time I still felt I lacked the tools to fully help my patients. While I now had a much better understanding of why my patients were suffering from mental illness, I still felt I lacked strong interventions to improve their condition. In many ways, I felt stuck. I’m not sure if it was because of this or some other related interest, but I started studying the neuroscience of the human brain. Perhaps I felt I could find the answers I was looking for if I just went back to a more basic level. It was during this time I read Lou Cozolino’s The Neuroscience of Psychotherapy (Cozolino, 2002) and Alan Schore’s Affect Regulation and the Origin of Self (Schore, 2015). These books provided a grounding for all the theoretical concepts I had learned and inspired me to study neuroscience during my post-doctoral fellowship. At this point, I was interested in affective neuroscience: how the brain responds to and processes emotion. I studied the anterior cingulate cortex — an area I’ve found to be important in the conscious awareness of emotion (Stevens, 2016). Affective neuroscience helped me place in context all the various modalities of psychotherapy I had previously learned. After my post-doc, I continued practicing and training in the different modalities of psychotherapy. I was trying to understand how to optimize psychotherapy, long considered a black box treatment that is poorly understood as a science. I studied psychoanalytic treatment for a year at the Boston Psychoanalytic Society and Institute. I learned from some excellent teachers who had tremendous insight into patients’ pathologies. However, when it came down to the mechanism of change, it was typically assumed that improved patient insight would solve their problems. This was not something I agreed with, nor could I find any empirical support for the matter. It seemed to be a holdover from Freud’s original theory that making the unconscious conscious solves problems. I’ve seen many people both personally and professionally who have great insight into their psychopathology, but are still depressed or anxious. Needless to say, I was disappointed by this approach, but I found the more contemporary approach of CBT inadequate as well. Behavioral therapy worked well for phobias and other psychological problems with a clear external stimulus, like avoiding a party for someone with social phobia. However, what is the avoided stimulus for someone with depression or p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Part I: Introduction and Scientific Background
• Part II: The Practice of Clinical Affective Neuroscience: Emotion-Based Interventions
• Index