SUSAN VAUGHN Putnam. 1997. 203pp. ISBN 0-399-14229-0
TED BEGINS HIS session with a dream. "I'm driving a large, red speedboat to my company picnic," he says. "I drive it right up to where my boss is standing and I beach it on some soft sand .... When I cut the engine, everybody is silent; they all stare at me in this impressive craft." A traditional therapist would see this dream as evidence of Ted's emotional conflicts. But, according to psychiatrist Susan Vaughn, author of The Talking Cure: The Science Behind Psychotherapy, Ted's dream is more than just a clue to his unconscious. It also hints at the actual hard-wiring of his brain. And the job of therapy, says Vaughn, is to change not just a client's dysfunctional ideas and emotions, but the neuronal patterns that hold them as well.
Using findings from neurobiology, Vaughn, both a psychoanalyst and a researcher, proposes that the brain's cortex serves as a "story synthesizer," fitting new experience into deeply learned plots from early experience. Ted may have learned as a child to fear his own power, for example, or that powerful figures, like a boss or a father, have to be placated. He carries that "plot" with him even now expecting superiors to crush his attempts at assertiveness while still longing for the sleek motorboat of his own power. Of course, this is all second nature to many clinicians, especially those with an object-relations bent. Where Vaughn stretches our current understanding is in her assertion that the plots that organize our lives become, literally, neurologically wired over time. Integrating findings from developmental psychology, neurobiology and psychotherapy research, Vaughn theorizes that repeated experiences in the emotionally charged environment of childhood strengthen certain patterns of activity in the cortex, while leaving alternative patterns undeveloped. Ted, for example, may have had the repeated experience of trying unsuccessfully to please his father, and his neurons formed a "not good enough" circuit. This circuit is activated easily by even a slight reminder of his inability to please, while his "good enough" circuit, never adequately developed, is easily overpowered. The result? New experience gets filtered to fit the old story and Ted never feels good enough, despite years of experience to the contrary.
So how does therapy change Ted's brain? Vaughn's answer is a psychoanalytic one. Over the course of treatment, Ted's "not good enough" circuit will begin to tell him he cannot please his therapist. Talking about this feeling, even dreaming about it, brings the content of his neural plot to light, where it can be questioned and changed. Confronted often enough with evidence that he is "good enough," Ted can slowly construct a new, and more useful, plot for his life. As he does so, more than just his ideas and emotions change. Vaughn is convinced that his neural circuits change, too.
Although not a family therapist, Vaughn helps us understand how intensive therapy of any kind works, it seems to me. If Ted came to therapy with his wife, for example, his "not good enough" assumptions would eventually be revealed in their interactions, and the therapist could help him question those assumptions and shift them. As those new assumptions began to play out in the marriage, we can imagine that Ted's cerebral map would change as well.
While The Talking Cure begins to map out this new understanding of therapy, it leaves some questions unanswered. Vaughn sees intense and lengthy therapy as necessary for cortical changes to occur and doesn't address the evidence that brief therapy can have a dramatic impact on people's lives. We certainly are not at a point where we can rule out the possibility that brief therapy changes hard-wired patterns, too. Vaughn's biggest contribution in The Talking Cure is to lend intellectual credence to things we already know clinically. Considering clients' stories about themselves isn't just a metaphorical exercise. …