How to Vitalize Your Therapeutic Style
By Courtney Armstrong
The more we learn about the emotional brain, the clearer it becomes: to have real therapeutic impact, we need to create experiences that help clients learn to relate to themselves and the world in entirely new ways.
It’s no secret that therapists have become enamored with brain science over the past 15 years. In fact, we’re so “brain-crazed” it seems you can’t go to a clinical workshop these days without having the presenter regularly use terms like amygdala, hippocampus, or neuroplasticity, once thought to be arcane. Many therapists even think that explaining clients’ brains to them is an essential feature of therapy, as if a basic understanding of brain science is enough to promote real change in their everyday lives. Ironically, this approach is contrary to the one clinical insight from brain research that’s most important to effective therapy: human behavior and motivation are driven mostly by the emotional brain—the brain centers that mediate “primitive” emotions and instincts and respond to sensory-rich experiences, not intellectual insights.
How many times have you surprised yourself by jumping at the scary part of a movie or shouting something hurtful at someone you love when you feel angry? You know the villain in the movie isn’t real and the insult to your loved one will only make things worse, but your emotional brain ignores this logic and leaps into action. In essence, the emotional brain is our unconscious mind, and scientists estimate that it controls about 95 percent of what we do, think, and feel at any given moment.
The emotional or mammalian brain, as pioneering neuroscientist Paul MacLean called it, learns from experience and association. Rather than being moved by complex sentences or analytical arguments, it’s stirred by movement and novelty, by sounds, sights, smells, tastes, and textures—whatever unconsciously evokes emotion. These emotional responses cause hormones and neuromodulatory chemicals, like norepinephrine and dopamine, to be released in the brain, instantly binding and fusing new neural networks together. Thus, no matter how brilliantly our prefrontal cortex delivers insights and plans elegant coping strategies, the emotional brain is primed to override it all with neural patterns that persist until we intervene with something our emotional brain can understand—a compelling felt experience.
All of this is now brain science 101, yet therapists, who ought to know better, are still trying to appeal to the cognitive mind—much as Freud did—with quiet, rational conversation, largely ignoring the importance of creating felt emotional experiences for clients. That isn’t to say the standard methods of interpreting, reflecting back, validating, reassuring, instructing, and giving homework aren’t useful; they just aren’t enough to create that felt experience. It takes more than logic, kindness, and support to spark the emotional brain to create new neural pathways to fire up the healing process.
If people could simply think their way out of emotional problems, wouldn’t they do it? Instead, by the time they come to us, many intelligent clients have already spent hundreds of hours and thousands of dollars attending therapy sessions, taking medications, or pursuing other traditional routes for healing. They’re experts on their problems, yet they still get hijacked by their emotions. Should we decide that they subconsciously want to remain trapped and write them off as “resistant”? Or should we recognize that the treatment they’ve received hasn’t addressed the emotional brain, where most maladaptive patterns are stuck?
Take my client Saundra, for example. She was an attractive, talented surgeon with a Mensa-level IQ who’d graduated from an Ivy League school at the top of her class. She’d struggled most of her life with waves of severe depression and anxiety, but recently, her mood swings had become stormier and more frequent, affecting her personal life and threatening to wreck her career. She was consumed with the obsessive worry that working long hours prevented her from being an adequate mother; yet when she asked for time off to be with her children, she felt guilty for not working. Her intense feelings of anxiety and resentment resulted in angry outbursts toward her coworkers and daily arguments with her husband. Even worse, she couldn’t enjoy time with her children without bursting into guilt-ridden crying jags.
In our first session, she told me, “Intellectually, I understand what causes my depression and anxiety. Trust me. I’ve had years of therapy and tried dozens of medications. I realize my thoughts are irrational, and know I’ve developed these patterns because my family of origin was critical, abusive, and chaotic. But I’m 40 years old! When am I going to get over it?”
I realized that, like many clients, Saundra had an excellent grasp of her issues and didn’t need assistance recognizing cognitive distortions: she saw them staring back at her in living color. She’d put a lot of energy into reframing them, but her attempts to reason her way out of her feelings only added to her frustration and sense of inadequacy. It occurred to me that what she was really seeking was a new experience of herself—an experience that would cause her to believe there was more to her than negativity. As we talked, I began to search for subjects that elicited a smile on her face, passion in her voice, or movement in her body, all of which I saw and heard when she talked about walking outside in nature, painting with acrylics, and watching her children play.