The Rise and Fall of PaxMedica - Page 5

Brain-Based Therapy

It's been more than a decade since the first serious discussions of the clinical relevance of neuroscience began to appear in our field. Since then, once-mysterious terms like amygdala and hippocampus have become part of the common parlance of any reasonably hip therapist who presumes to be current with psychotherapy's latest trends. But are we ready to go beyond merely parading our more scientific-sounding professional jargon to showing that, in fact, brain science can profoundly impact the direction of clinical practice? To be sure, some critics argue that little has actually changed in the theory and methods of our field because of neuroscience. They dismiss therapists' increasing interest in the brain as yet another example of our endless search for novelty and our compulsive need to put old wine in shiny, new bottles. Where, they ask, is the research that demonstrates that talking about the brain with clients makes for more effective interventions or that new clinical methods coming out of neuroscience can extend and deepen our impact?

But to truly grasp what neuroscience means for the future of psychotherapy, it's important to recognize just how new ideas and fresh perspectives enter into a profession and transform it at a number of levels, some immediately apparent, some more abstract and obscure. The increasing role that neuroscience is likely to play in the psychotherapy field of the future will not be limited to the immediate, practical benefits of innovative interventions or mind-spinning advanced technologies. To assess what the new era of a more brain-based practice will be like, it's necessary to start by looking at how it's likely to change the perception of our profession, as well as the way it'll alter the way we perceive both our clients and our own clinical role.

Let's begin with the knowledge base that underlies everything we do. For much of its history, psychotherapy has been awash in metaphors to describe the illusive reality of how the mind works and why it goes wrong. We already know from empirical evidence that lots of therapy methods and models help our clients. Yet in the absence of specific information and insight about the physical brain, our ideas about why they help and how they affect the brain have been largely "just so" stories—plausible sounding, but unverifiable, theories and explanations—about what we think or imagine is going on inside the black box of the skull.

In the increasingly competitive world of health care, that isn't likely to be enough to make the world continue to take us seriously. Brain-based therapy promises not only to change the way we think about therapy, but also the way the entire healthcare field thinks about therapists. It'll draw its methods from neurobiology, evidence-based practice, and attachment research, thus bringing psychotherapy more fully into the scientific community.

We now know from neuroscience and attachment research that interpersonal relationships profoundly affect the physical structures and processes of the brain. Indeed, neuroscience tells us that our brains are exquisitely social in nature—as a species, we're constantly getting into each other's heads, affecting each other's moods and emotions, rewiring each other's neural networks. Therapy works primarily as a nervous-system-to-nervous-system regulator (like mother to child, mate to mate, friend to friend) that helps clients ramp down their own brains' arousal levels and reactivity, as well as activate their neural capacity for regulating their own emotions.

This fact alone makes it very difficult to dismiss old-fashioned talk therapy as some sort of feel-good, fuzzy-wuzzy, amorphous, non-scientific sideshow to the purportedly "real" mental health care provided by Pax Medica. In fact, as we understand better how to influence the subtle, deep, infinitely complex interpersonal communication between therapist and client, it's easy to imagine that the status of the therapeutic relationship as perhaps the most powerful of all clinical "interventions" will increasingly be recognized within the larger healthcare system. Instead of an expression of an "alternative " view of health care, more and more the future of an increasingly cost-conscious healthcare system will revolve around an acknowledgment that the mind directly affects the body and vice versa—in a real sense, mind is body is mind. This means that mind-body approaches—nutrition, physical exercise, relaxation techniques, yoga—will most likely be integrated into any necessarily "holistic" approach to wellness. Who knows? Such a perspective might even have an impact on the medical establishment, convincing doctors to spend more time exploring the role emotion and relationship play in the health or illness of their patients!

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