The newest edition of the Diagnostic and Statistical Manual
has more than 900 pages describing the different kinds of disorders that people have, but not a single page telling us what to do to resolve them. As therapists, we’re useless to our clients if all we can do is describe what’s wrong with them. We need to create vivid, living experiences for them that’ll help them change. All the expert knowledge in the world about therapy or different psychiatric conditions isn’t worth a thing if we don’t know what to do with it.
Nothing reflects this fundamental truth more than the current infatuation with brain science. I think it’s wonderful that we now have at least some understanding of neural connectivity, synapses, brain chemistry, and mirror neurons---all of which help us understand our ability to change the way we think and act, and to experience empathy and compassion. I have great respect for the value of doing valid research in such an inherently complex field. However, the key question remains: What can neuroscience tell us about what to do
differently when we’re working with a client?
Brain science has yet to translate its findings into effective or practical recipes for therapists. For instance, a lot of therapists are enthusiastic about the fact that they now know that a panic attack involves overactivation of the amygdala, but this knowledge doesn’t make them better therapists. Would they do their therapy any differently if they were told that a panic attack actually involved overactivation of the liver—or even the pineal gland, which Descartes believed to be the seat of the soul and the place where all thinking originated? I don’t think so.
Many of our clients’ problems are far simpler than most people realize, and the therapeutic interventions needed to resolve them are often equally simple. Current neuroscience is irrelevant to our understanding of both the problems and their solutions. After all, therapists were doing helpful, healing work long before neuroscience made its official debut at psychotherapy workshops and conferences and the field developed a collective case of “brain fever.”
Good therapists have always known that to help people change the way they feel and behave, we have to help them change the way they use their brains every day, not tell them about
their neural processes. By actively creating vivid, impactful therapeutic experiences, we can transform our clients’ perceptions of their own reality, shifting the way they think and feel about themselves and their capacity for change.Becoming a Bystander
John was a drug and alcohol counselor and a Vietnam vet. His worst experience during the war occurred in the marketplace in Pleiku while waiting to join his troops. When a teenage boy reached for the wallet in John’s hip pocket, he grabbed the boy’s arm. Suddenly, he heard someone shout, “Grenade!” and felt something push hard against his back. When he regained consciousness, he was leaning against a tree, still holding the boy’s arm. “But that’s all I was holding,” he said, “because the rest of him was gone.”
After returning home, John had all the symptoms of post-traumatic stress disorder (PTSD). He regularly woke from nightmares of being back in Vietnam, thrashing and screaming. Sometimes his wife had to sleep in another room to avoid being hit. And he had an exaggerated startle response: if anyone unexpectedly touched or spoke to him from behind, he’d jump and have to restrain himself from hitting them.
John had struggled with these symptoms for years and had tried every kind of therapy he could find, yet after a single session with my wife, Connirae, he experienced immediate relief from his symptoms after going through a simple process that taught him how to view his worst memory as if he were a distant bystander. A one-trial learning, not a treatment based on some complex neurological insight, transformed his life.
In brief, Connirae asked John to imagine being in a movie theater sitting way back from the screen and then to float out of his body and up to the projection booth, from which he could see both the movie screen and himself sitting in the theater below. From this position, she told him to watch a black-and-white movie of himself that spanned the incident in that marketplace in Pleiku but ended later, giving him a longer perspective. Finally, she instructed him to leave the projection booth, step inside the movie at the end, and run it backward in color very quickly, in about a second and a half. This step reverses the cause-and-effect stimulus–response sequence, so that the feeling responses come before the triggers for them, changing their meaning.
In a videotaped follow-up interview about a month after the session, John said that the day after the session, he went to a weekend seminar with his wife. At the end of the first day, she said to him, “What’s happened with you? You’re different. You used to jump when people came up behind you, and you’re not doing that anymore.” Thinking back, he realized that she was right, but he hadn’t noticed it. This response is typical for people who make a thorough and congruent change: the new normal is so unconscious that they often don’t notice the difference unless someone else points it out.
Of course, we could describe the therapeutic process John went through in neurological terms by calling it memory reconsolidation. He did, in fact, recode his past traumatic memories. But that wouldn’t tell us how to do anything we don’t already know how to do, and it wouldn’t help us get the same results with someone else suffering from PTSD. Even if we assume that most of our current neuroscience information is valid, as the proponents of memory reconsolidation do, it remains to be seen how any part of this knowledge could have improved on the changes that John experienced from a simple visualization process.
This approach isn’t rocket science, nor is it neuroscience. Instead, it’s a simple matter of finding out exactly what the structure of someone’s personal experience of a problem is---rather than the content within that structure---and then experimenting with useful ways to change it.This blog is excerpted from “Therapy Isn't Brain Science". Want to read more articles like this? Subscribe to Psychotherapy Networker Today!