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The Attuned Therapist - Page 8

The Emotional Revolution

To an outsider, it might seem as if what therapists do in their offices every day probably looks roughly the same today as it did 15 or 20 years ago, regardless of model, method, or theory. It comprises a quiet albeit often intense conversation between two people clearly sharing an intimate, if rule-bound, relationship. Yet, over the last decade and a half or so, the way a large number of therapists think about therapy, what they think happens during therapy, and how they think they should engage in this joint project have changed.

From the beginning, psychotherapy has been primarily about using words—a left-brain process—to bring the light of calm reason and insight to the dark chaos of untamed, unconsciously generated emotionality. As the old guy who started it all famously said, "Where id was, there shall ego be." For many decades, particularly after the so-called "cognitive revolution," the major focus of therapy was helping clients think rationally about their irrational, emotional impulses. Of course, therapists have always realized that emotions, particularly negative emotions, are elemental facts of human life and the reason why people seek out psychotherapy in the first place. By now, it's common knowledge that the therapeutic relationship is probably more important to clinical success than any particular method or technique.

But for many years, because there was so little knowledge about the biology of emotion and feeling—what they were, where they were in the brain, what caused them, how they influenced behavior—they were something of an embarrassment not only to scientists, but to psychologists and therapists who wanted some sort of scientific credibility for their own work. Besides talking about the inchoate, and largely unconscious processes, of emotions (what neuroscientist Antonio Damasio called "the direct expression of bioregulation in complex organisms), what else could a scientist or a therapist do with all this messy, mysterious, unpredictable psychobiological inner stuff? You couldn't really get at it directly with any respectable therapy. Only touchy-feely, new-age, "alternative" therapists, trafficking in not-quite-reputable body-based therapies—Reichian work, primal therapy, inner-child work, Rolfing—would even try. To claim genuine scientific credibility, psychological research and therapy had to focus on cognition and behavior.

But that was then, this is now: for the past 15 years or so, according to Allan Schore and other neuropsychological scientists and therapists, we've been in the throes of an "emotional revolution," which seems to be sweeping all before it. Psychology was dominated by a behavioral model during the '60s and '70s, then by cognitive models in the '80s and '90s, and now, as Schore has put it, "affect and psychobiological processes are taking center stage." Buttressed by the intense, research-driven interdisciplinary study of emotion, psychobiology, development, and relationship (attachment theory, front and center) are transforming both neuroscience and psychotherapy. "After three decades of the dominance of cognitive approaches, motivational and emotional processes have come back into the limelight," wrote University of Rochester professor Richard M. Ryan in the March 2007 journal Motivation and Emotion. "Both researchers and practitioners have come to appreciate the limits of exclusively cognitive approaches for understanding the initiation and regulation of human behavior. . . . More practically, cognitive interventions that do not address motivation and emotion are increasingly proving to be short-lived in their efficacy, and limited in the problems to which they can be applied." The emotional revolution, he wrote, is "long overdue."

Today, rather than envisioning human beings in terms of the age-old divide between mind and body, for the first time in history, science appears to be bringing mind, brain, and body together in one whole and complete human organism. It's hardly surprising that therapists should love this revolution since it has the potential to enormously raise the prestige of psychotherapy: the therapist, through the art of a certain specialized form of relationship and attuned connection, isn't just helping people feel better, but deeply changing the physical function and structure of their brains as well.

The only possible tiny fly in this sweet-smelling emollient is that it's still unclear whether these psychobiological findings about attachment, emotion, bio-regulation, right and left brain specialization, ad infinitum, can be reliably translated into a more effective therapeutic method. After all, attachment-based therapy remains more an attitude and an orientation to treatment—although a powerfully attractive one. There still isn't a particular model or body of techniques that can be codified and taught in graduate schools and validated in empirical trials.

Whether or not attachment-based approaches improve the effectiveness of psychotherapy, they do seem to have already gone a long way to transforming our notions of what constitutes the real McCoy for clinical practitioners. It's a long way from the coolly analytical, talky, left-brain therapeutic ideal of decades past to the far more intuitive, nonverbally adept, emotionally tuned-in therapist envisioned within the emerging attachment-based paradigm. After decades of cognitive and behavioral scientists purposely seeking "to put emotions out of sight and out of mind," says neuroscientist Jaak Panksepp, they're being forced to "relearn that ancient emotional systems have a power that is quite independent of neocortical processes." In our increasingly technological world, therapy seems to be directing our attention to the very core of our primeval being, the "ancient emotional systems" that are the source of love, hatred, rage, desire, compassion, of our unquenchable need for connection with others of our own species.

What really has changed isn't so much the aim of therapy, which has always been, whatever its putative goal, changing, shaping, soothing, controlling, redirecting, harnessing the emotions, even freeing some of them up for more robust expression—that's what "affect regulation" is all about. What's changing is the game of therapy—how it's done. For the first time, mainstream therapists are trying, as it were, to fight fire with fire—to get at that vast, subterranean sea of affect as much or more through nonverbal resonance as through words. Through facial expression, eye contact, tone of voice, tempo, breathing, the therapist creates a kind of wordless but dense and charged felt presence, which permeates the being of both therapist and client.

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