Affective Neuroscience and Psychotherapy

by Barbara O’Connell

Current research in neuroscience is relevant to promoting an understanding about what happens in the therapeutic setting. It provides concrete validity for what psychotherapists already know about the change that therapy fosters. Affective neuroscience supplies us with the explicit knowledge of how psychological and emotional change influences the architectural structure of the brain. It also offers evidence to support the view that the dyadic intersubjective communication process holds supremacy over structural, insight and solutions-focused approaches. Further it supports the view that the therapeutic relationship can offer positive re-parenting and reparative experiences. Primarily though, it supports work in the realm of the body and validates the importance of body based implicit processes emphasising a ‘communication’ rather than a ‘talking’ cure. Understanding what happens in the brain and how its neuronal pathways are structured early on in our development provides therapists with a more concrete foothold in the work that we do in the therapy room. Neuroscience aids the understanding of how the quality and nature of our early experiences become encoded within the neural infrastructure of the brain and how its architecture determines the shape of all of our emotional experiences and relationship patterns thereafter.

The importance of the first three years of life particularly is given primacy by neuroscience. This is when neural networks shape and organise behaviours, emotions, thoughts and sensations which set the blueprint for relating for the remainder of an individual’s life. Having a grasp of why we are unable to engage in random actions because our behaviours are guided by patterns established through previous early learnings to which we automatically return, equips us with sharper tools for client work as well as encouraging more understanding, empathy and patience for both our own and our clients’ struggles with painful, repetitive relationship patterns. It is clear that neural pathways are laid down so early in the developingbrain that they are difficult to modify. However, owing to neuroscience we now know that modification is in fact not just possible but probable given optimum conditions.

The brain continually changes in response to environmental challenges and because of this the neural architecture of the brain comes to embody the environment that shapes it. Enriched environments which encourage growth and change include the kinds of challenging educational and experiential opportunities that encourage us to learn new skills and expand our knowledge. It is in such an enriched environment that there is neuroplasticity. Neural plasticity refers to the ability of neurons to change the way they are shaped and relate to one another as the brain adapts to the environment through time. Psychotherapy is one such enriched environment which supports social and emotional development, neural integration and processing complexity by fostering learning, awareness and an opportunity to engage in new ways of being.

Trusting working at an implicit level with our clients becomes easier with an understanding that most of our important emotional and interpersonal learning occurs during our early years when our primitive brains are in control, prior to the development of the necessary cortical systems for explicit memory, problem-solving and perspective. As a consequence of this early implicit learning, many of our most important socio-emotional learning experiences are organised and controlled by reflexes, behaviours and emotions outside of our awareness. The early interpersonal environment is imprinted in the human brain by shaping the infant’s neural networks and establishing the biochemical structures dedicated to memory, emotion, safety and survival. Later these structures and processes come to serve the infrastructure for social and intellectual skills, affect regulation and the sense of self. The brain is then sculpted in ways that assist the child in surviving childhood but often become maladaptive later in life. At the heart of affective neuroscience is an appreciation of the interwoven forces of nature and nurture, what goes right and wrong in the developmental unfolding and how to re-establish healthy neural functioning.

The field of psychotherapy has emerged because of the brain’s vulnerability to these developmental unfoldings and environmental risks where one or more neural networks necessary for optimal functioning remain undeveloped, under-regulated and un-integrated and where people generally experience the symptoms for which they seek therapy. It is in these instances that a therapist attempts to restructure neural architecture in the service of more adaptive behaviours, cognition and emotion regardless of whether they are aware that this is occurring as a derivative of the therapy. It is now assumed that when psychotherapy results in symptom reduction or experiential change, the brain has in some way been altered. Therapeutic change then can and does alter neural pathways and result in neuroplasticity of the brain. Through the therapeutic process this involves understanding old patterns and updating them internally firstly and then in our relating with others.

It is the right hemisphere of the brain that is understood to be dominant in psychotherapy. While the empathic therapist is consciously, explicitly attending to the client s/he is also listening and interacting at the level of the implicit beneath conscious levels of awareness. According to Schore (2011), most impact and change happens in the right hemisphere implicit communication domain because pre-verbal experience, which is primarily right hemisphere based, makes up the core of the developing self. Therapy then is seen from this perspective as a right hemisphere to right hemisphere communication process where both the therapist and client are engaging with early experiences which will have been encoded in many and varying forms. This kind of communication can happen if we, as therapists, can create the right type of relationship with our clients.

It all hinges though on understanding the inter-subjectivity and co- creation of early attachment processes and how interactional experiences between mother and child create patterns which become fixed into “internal working models”, an element of John Bowlby’s theory, cited in Holmes (2005), that has been given fresh credence as a consequence of the explosion of neuroscience and its connected regulation and inter-subjective theories. Our ability to attach and successfully navigate the world depends on our ability to regulate our impulses and emotions and effectively attune across sensory modes. The infant requires emotionally stimulating communication to support this process. According to Fonagy and Target (2002) we can consider the whole of child development to be the enhancement of self regulation. The ability to tolerate and regulate affect creates the necessary conditions for the brain’s continued growth throughout life. This is why the enriched environment of the therapeutic relationship is so important and why it is so important to understand affect regulation as an inter-subjective collaboration since the same collaboration is occurring in the therapist client dyad. By activating processes involved in attachment and bonding as well as regulating affect in therapy, it is believed that empathic attunement can create an optimal biochemical environment for enhancing neural plasticity.

Affective neuroscience offers clear explanations for understanding the emotional and biological effects of trauma, particularly dissociative and memory processes, regarding trauma which has occurred prior to the development of the complex left-hemispheric cortical structures. It explains well how the limbic and autonomic nervous systems exclude trauma and traumatic affects in the service of survival. Understanding both the hyper and hypo arousal systems and dissociation and how we can work with them as they present in the therapy room has contributed greatly to our understanding of the process of psychotherapy and how it can effect great change. Some clients worry that they are unable to explain exactly what has happened to them because their memory of their traumas are often incomplete or fragmented or completely absent. They fear that they will not heal as a consequence. Affective neuroscience explains how a lot of our experiences which remain unlanguaged and unremembered can be integrated across hemispheres. By explaining these processes to our clients they are better able to understand their own affects and how to better regulate them when they begin to intrude in their lives.

Looking particularly at how the brain manages and controls the threat responses has had the most important impact on me and my working with clients relationally. Understanding the limbic system and the amygdala has given me great insight into and a better understanding of how inaccessible the left brain is when the right brain is involved in and flooded by the freeze response. I find it useful to be able to explain this process to my clients because their survival response often frightens and unnerves them and keeps them in an anxious, hyperaroused state. Understanding what happens brings ease and lessens the natural anxiety which comes with traumatic affects from past events infiltrating the present. Managing these affects then becomes more achievable and clients are also then able to introduce their own ways of coping with and understanding these affects as well as utilising the therapist in a co-regulatory capacity.

Whilst neuroscience is deep in theory and biology it provides an excellent basis and support for integrative therapeutic work. It has contributed a scientific language to explain the process which satisfies those in the medical professions particularly, who have for years questioned the value of psychotherapy. It makes the world of psychotherapy more concrete and explicit and validates what Gestalt and Body psychotherapies have known for years: psychotherapy works and consistent, positive relational experiences heal. That they alter the physical structure of the brain through growth of neural pathways is a bonus for us as therapists who already believe in the transformative power of therapy. Affective neuroscience poses serious questions however for psychotherapy which is focused more on left brain processes such as psychodynamic and cognitive therapies. Shore (2011) speaks of a paradigm shift from conscious cognition to non-conscious processing of affect, a shift from explicit, analytical, rational, left hemisphere to implicit, non-verbal, bodily-based, emotional, right hemisphere processing. As Cozolino (2002:63) so eloquently puts it, “it is a hollow victory to end up with a psychological explanation for problems that remain unchanged”.

Of course the whole area of affective neuroscience is more complicated than I have briefly elucidated here. Its language and theories are phenomenal in both their depth and breadth. My intention is to give a flavour of some of its chief concepts as I understand them and as they relate to and enhance my work as a therapist. It may serve as a teaser for those of you who wish to acquire further knowledge in this area with a promise that it will add richly to your practice as well as fulfil a thirst for knowledge and theory. Those of you who already have an interest in this area will know what I mean.

Barbara O’Connell BA, MA, Dip in Psychotherapy, is an Integrative Psychotherapist working in private practice in Cork. She is an accredited member of IAHIP and holds a Practitioner Certificate in Affective Neuroscience and Attachment from Metanoia Institute in London.

References:

Cozolino, L. (2003) The Neuroscience of Psychotherapy. New York: Norton.

Damasio, A. (2000) The Feeling of What Happens: Body, Emotion and the Making of Consciousness. London: Vintage.
Fonagy, P. and Target, M. (2002) ‘Early Intervention and the Development of Self- Regulation’ Psychoanalytic Inquiry. 22: 307-335. As quoted by A.N. Schore in paper Why Psychotherapy Works presented for CONFER in Marino Conference Centre, Dublin on 7 October 2011.
Holmes, J. (2005) John Bowlby and Attachment Theory. London: Routledge.
Levine, P. (2010) In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. California: North Atlantic Books.
Levine, P. (1997) Waking the Tiger: Healing Trauma. California: North Atlantic Books.
Rothschild, B. The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. New York: Norton.
Ruppert, F. (2011) Splits in the Soul: Integrating Traumatic Experiences. West Sussex: Green Balloon Publishing.
Schore, A.N. (2011) Why Psychotherapy Works. Paper presented for CONFER in Marino Conference Centre, Dublin on 7 October 2011.

Schore, A.N. (2012) The Science of the Art of Psychotherapy. New York: Norton.

Siegel, D.J. (1999) The Developing Mind: Towards a Neurobiology of Interpersonal Experience. New York: Guilford Press.
Stern, D.N. (2003) The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. London: Karnac.
Wallin, D. J. (2007) Attachment in Psychotherapy. New York: Guilford Press.