From Synapse to Psychotherapy: The Fascinating Evolution of Neuroscience
Grosjean, Bernadette, American Journal of Psychotherapy
This paper reviews neuroscientific advances across the therapeutic disciplines and outlines new potential insights into understanding the biology of the psychotherapeutic processes. In a quest to understand the modus operandi of psychotherapy, the author reviews the evolution of the biology of psychotherapy. The mechanisms involved in learning processes, such as memory and priming, attachment, and long-term consequences of early life trauma, demonstrate how brain structures can be affected by environmental changes, finally, the author proposes that verbal and non-verbal aspects of the psychotherapeutic process mediate their therapeutic effects through biological changes as they work on primitive emotional reflexes and stimulate mentalization processes.
My reflection regarding the relationship between biological and psychological variables in psychotherapy started years ago in clinical practice. A general practitioner referred a patient, Ms. F., to me for treatment. Ms. F. was a successful, intelligent, professional woman in her early fifties. When I met her for the first time she was deeply depressed, practically in a state of "psychological death"- helpless and hopeless, although not suicidal. Three months prior to starting psychotherapy, she made the heartbreaking decision to leave her husband. A few weeks after that decision, she was diagnosed with breast cancer, which was treated by mastectomy and chemotherapy. One week after chemotherapy was initiated, a business associate of 15 years informed Ms. F. that he could not continue his professional relationship with her.
My goal for the patient, with her cooperation, our collaboration, and long-term psychotherapy, was to bring her "back to life." Her strength was an incredible resilience, supplemented with a daily antidepressant (fluoxetine), and a weekly (later biweekly) blend of supportive and psychodynamic approaches. From the very beginning of the treatment, Ms. F. expressed conscious apprehension and resistance regarding too "analytical" an approach (perceived by her as intrusive and almost dangerous). I respected her feelings by offering only sporadic and carefully weighed instances of confrontation and interpretation. She survived. She went back to life, to work, and to her relationships. As the patient improved, I tried to stop the antidepressant. But soon Ms. F. became more depressed and less able to process past and present life events. She would regress into an ominous withdrawal state. When the frequency in the sessions changed, the patient would complain of diverse somatic issues (abdominal pain, allergy symptoms). Clearly both drug therapy and psychotherapy were helping this patient. How exactly they worked together was not easily comprehensible, although such a synergy has been noted in a variety of psychiatric problems.
Since Sigmund Freud's pioneering work in the late 19th century, differences in the efficacy of psychotherapy compared to placebo have been proven. However, researchers have repeatedly failed to find convincing evidence of significant differences in efficacy among mainstream psychotherapies. As early as 1936, Saul Rosenzweig suggested that common factors were responsible for the effectiveness of various kinds of psychotherapies, and he also proposed that all therapies were equally effective. He named this phenomenon "The Dodo Bird Effect" (Rosenweig, 1936, pp. 412-415). In 1976 Lester Luborsky and Barton Singer reviewed the psychotherapy outcome literature and agreed with that conclusion. Further meta-analyses reported no differences in outcome among diverse types of therapies (Grissom, 1996; Wampold, Minami, Baskin, & Callen Tierney, 2002; Wampold, 1997). To make some sense of these findings, it is necessary to understand more thoroughly the operative mechanism behind therapeutic processes. The first question I considered was: What is encompassed in the term psychotherapy? In 1978, Hans Strupp described it as "an interpersonal process designed to bring about modification of feelings, cognitions, attitudes and behavior which have proved troublesome to the person seeking help from a trained professional. …