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Brain-based therapy is unlikely to do away with the major schools of therapy—primarily CBT and various psychodynamic approaches—which have given most of us the basic tools we use in daily practice. What will be different, however, is that the therapeutic focus will begin inside with the client's brain, rather than outside with a set principles and practices from one of the dominant "clubhouse" therapies (the current schools of therapy that are like exclusive membership organizations). In other words, therapy drawn from an understanding of the brain will enable clinicians to escape once and for all what might be called the "theory pit." There'll be no point to declaring fundamental allegiance to any one "theoretical home" when our primary focus is on the brain. This meta-perspective will increasingly help therapists evaluate which approaches might work best with a particular client at a particular point in therapy to resolve a particular symptom or difficulty by activating a particular brain process. We'll be in a position to more effectively integrate a variety of new and old models as it becomes more apparent that what ultimately counts is what changes the brain.
Brain-based therapy has already broadened and deepened the perceptual field of many clinicians beyond the limited, overly cerebral "psychological story," that's so often been front and center in the attention of the therapist. It's a temptation of talk therapy to conceptualize everything our clients bring us in terms of the unfolding of a narrative mediated by spoken words, theirs and ours. Yet while the left brain gets a real workout in the standard therapeutic exchange, much of what drives us as human beings is unspoken, even literally unspeakable—emotional and physiological states of arousal that transcend our partial psychological stories, often going unrecognized and unheard in a word-dominated field. Indeed, little human experience can be apprehended through rational, conscious, verbal language. Brain-based therapy allows us to tap into the many other forms of personal expression—physical, emotional, spiritual—to gather information about our clients and bring into therapy a host of nontraditional modalities with an undeniable impact on the brain—meditation, of course, but also dance, music, and the visual arts.
Neuroscience offers therapists the opportunity to truly see and understand the neurophysiological wiring and activity underlying states of fear, shame, anxiety, depression, and addiction. Such a perspective provides a much bigger, more capacious view of human beings, including those humans sitting across from us, than any single therapy model allows. Rather than comprising a particular narrative—the psychodynamic narrative of unconscious motivations and repressions, the CBT narrative of entrenched cognitions driving emotions, the family systems narrative that individuals can only be understood in the context of family relationships—brain-based therapy implicitly encompasses them all, without making a religion of any. At the same time, paradoxically, it provides a more empirical, precise, and parsimonious explanation of the client's difficulties. In other words, it offers us the opportunity to wed the soft art of the therapeutic conversation with the exacting hard science of the brain.
We're well aware that marriage of brain science and therapy is still in its earliest stages and, at this point, practitioners like us who are interested in building bridges between the two are still experimenting, drawing what we can from our understanding of neuroscience and sifting through psychological theory and research to find common denominators appropriate both to our clients' psychological situation and to what appear to be the relevant brain processes. In our own work, our first brain-based "intervention" with our clients is simply to talk to them about their own brains—terra incognita for most people—and explain how therapy can help them rewire their own brains so that they feel better and get more out of life. We include information about the brain at every stage of therapy, from assessment to goal-setting to the selection of interventions and the moment-by-moment corrections in our alliance with clients.
Clients find that putting their distress into a biological context externalizes their problems, reduces shame and guilt about admitting something is "wrong" with them, and quickly lessens resistance to therapy. We say, in effect, "We're going to work together to rewire your brain so that your amygdala won't hit the panic button when there's nothing to panic about." By explaining the importance of relationships in changing the brain at every point in their lives from infancy to old age, we implicitly make the point that therapy must itself be a genuine relationship and collaboration to succeed. More subtly, bringing the brain into therapy acknowledges the biological heritage we all share.