How the Brain Learns
People come to a therapist because they want something to change: they want to feel or act differently, understand themselves or others better, or relate to things that won’t change in a more spacious and accepting way. These changes of mind, of course, require changes of brain. Psychotherapists are in the business of changing the brain for the better, which means building up the neural substrates of inner strengths, including character virtues, executive functions, perspectives, attitudes, positive emotions, and capabilities. These positive traits are the resources we draw upon to soothe ourselves, lower anxiety, feel loved and worthy, be appropriately assertive, contribute to others, and choose the higher road over the lower one. In many ways, the essence of therapy is developing inner strengths. But what does it take to grow strengths in a client’s brain?
It takes learning—the alteration of neural structure and function—which proceeds in two stages. First, there must be an activated mental state: a thought, perception, emotion, desire, sense of action (such as speaking assertively), or combination of these. Let’s say you’re talking with a client about her partner’s alcoholism. In her mind, the activated positive state could be a thought, such as It’s not my fault he drinks too much. Or there could be the sensation of relaxing, a feeling such as relief or self-compassion, the intention to go to an Alanon meeting, or practicing out loud what she could say to her partner. So far so good. Then the critical second stage begins, the installation of this passing mental state into a durable trait—a lasting neural structure. For example, fleeting thoughts, like It’s not my fault he drinks too much, need to become stable, bone-deep convictions, such as I’m not responsible for anyone’s alcoholism.
Positive traits—inner strengths—come from positive states. It’s easy to dismiss positive experiences as lightweight, New Age, pie-in-the-sky fluff, mere “positive thinking.” But these good moments are in fact the building blocks of self-regulation, secure attachment, self-esteem, and positive mood. We grow inner strengths by having experiences of them. If you want to be more mindful, have more experiences of mindfulness; if you want to be more confident, have more experiences of reaching goals (even simple ones, like finishing an email) or being appreciated by others.
But, again, merely having positive experiences isn’t enough: they must be installed in neural structures to have any lasting value. Otherwise, they’re momentarily pleasant—better than a stick in the eye—but with little or no enduring benefit. A positive experience must be held in short-term buffers long enough to start getting encoded in long-term storage. “Long enough” depends on the experience and the person, but it’s at least a few seconds (and usually longer) of staying with and really registering a beneficial thought, perception, emotion, desire, or action. Without this sustained immersion in a positive mental state, its conversion rate to positive neural trait will likely be low at best.
How often does this sustained immersion in the positive experience actually happen in therapy, or outside it? In general, not often enough. There could be a stream of positive experiences, interspersed with neutral ones, running through someone’s awareness, but each incoming experience—the next mental state—dislodges the current one in short-term buffers before it has much chance to sift down into long-term storage.
Some therapies do this installation explicitly, such as focusing, coherence therapy, and eye movement desensitization and reprocessing (EMDR). There are, of course, therapists intuitively gifted at installation. They encourage a sustained and richly felt engagement with key positive experiences so they really sink in. But on the whole, I think we waste a lot of positive experiences that could lead to lasting learning in our clients. (For a long time, I sure did.) During the past 30 years, many new ideas and approaches have entered the world of psychotherapy, but the average response to treatment—as measured by outcome studies—hasn’t improved significantly. I believe that’s because we’ve gotten much better at activating beneficial mental states, but no better at installing them in the brain.
Yes, psychotherapy stacks up pretty well against other interventions, including medications, for issues such as depression, trauma, stress, and interpersonal conflicts. But think about all the people who don’t get better during treatment and soon relapse when it’s over, or all the people who heal and grow much more slowly than they’d like. We’ve all had clients experience a hard-won breakthrough in a session and then be back to square one the next time we see them. It’s disheartening when this happens for clients and therapists alike. It certainly was for me—until I began regarding the installation phase of acquiring good traits as the crux of effective therapy (and other paths of healing and growth). That was when I began to see more deep-seated and long-lasting changes in my clients. Activating useful thoughts and feelings is certainly good, but installing them in neural structures is even better, and learning how to do this by overcoming the brain’s negativity bias has made me a better therapist.