The In-Session Breakthrough Fantasy

Rich Simon

Therapists have always loved stories about dramatic in-session breakthroughs, those rare times when clients unexpectedly experience what seem like epiphanies—sudden insights about themselves and their lives, after which nothing will ever be the same for them. This kind of transformative moment can make the slow, painful slog of therapy feel worthwhile, and it’s a welcome counterbalance to the frustrations of a difficult, underpaid, underappreciated vocation. As a teary-eyed, beaming client waves a grateful good-bye, “That,” we can say, “is why we do therapy!”... Or so the fantasy goes.

The idea that such breakthroughs really happen has taken a beating over the past few decades. The cognitive-behavioral tradition, in particular, has represented a standing reproach to this kind of romanticism. Any sensible person knows that therapy is about the steady acquisition of cognitive skills that help clients override their self-destructive thoughts and runaway emotions. Change happens as a result of setting reasonable goals and engaging in the dogged practice of good thinking habits. The idea that the therapist can somehow flip a switch and evoke a kind of psychological rebirth smacks of New Age gurus who practice woo-woo tactics.

Or does it? There seems to be something of an enthusiastic revival of the idea that sudden, remarkable breakthroughs—to use the b-word—can occur during therapy, and that significant change can happen in a remarkably short time. Part of the evidence for this new–old idea is emerging from brain science. After all, what new thinking about therapy doesn’t have at least one foot in neuroscience?

The more we learn about neuroscience, the more we realize that human beings aren’t driven by our ability to analyze and cogitate about our lives. Instead, we’re moved by our viscerally immediate, bottom-up responses to events and relationships. Our memories, our sense of ourselves, our plans and desires, the way we interpret what happens to us, and even our ability to think logically are all basically propelled by our emotional responses to lived experience. The key word here is experience. In other words, as a growing body of research shows, deep change doesn’t come when clients just talk about their problems; it results from the impact of an emotionally arousing therapeutic experience on the structures and biochemistry of the brain.

Therapists have always known that good therapy is far from a bloodless, abstract discussion about the client’s issues; if treatment works, the client must feel it at the center of his or her being. What this may mean for clinical practice is the idea that breakthroughs can and do happen, but only if the therapist can create an attention-riveting, visceral emotional experience in session.

Check out the new July/August issue of the Networker to hear what some of the leading minds in the therapy world have to say about the great therapeutic “aha” moment.

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Topic: Professional Development | Aging

Tags: brain science | breakthrough | neuroscience | psychotherapy | science | therapeutic breakthrough | therapist | therapists

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1 Comment

Tuesday, November 12, 2013 9:53:49 PM | posted by diana marder
Psychotherapy Networker classes and article often support the myth of Christmas Carol therapy and in-session breakthroughs. After I took your course on Attachment, I felt like a lousy therapist for a couple of months because I couldn't replicate the kind of miraculous breakthroughs described in the course.