The Clinical Relevance of Psychophysiology: Support for the Psychobiology of Empathy and Psychodynamic Process
Marci, Carl, Riess, Helen, American Journal of Psychotherapy
Psychophysiologic measures, such as skin conductance and heart rate, have been used in both psychotherapy process research and clinical practice. We present a case report of a patient and therapist who participated in a process-oriented psychotherapy research protocol using simultaneous measures of skin conductance. Data from the research protocol were used to broaden an empathic understanding of the patient, which facilitated insight and enhanced the exploration of conscious and unconscious processes that originated in the past and have come to dominate the present-the core of psychodynamic theories of change. The case illustrates the clinical relevance of psychophysiology and its use as a potential bridge between psychotherapy research and the theory and practice of psychotherapy. The implications of the case in support of the role of empathy in psychotherapy are discussed.
Despite decades of psychodynamic psychotherapy research, few psychotherapists practice in a way that is informed by research (Luborsky, 1992). In particular, the gap between research and practice in psychodynamic psychotherapy is as wide as any gap in the health sciences (Strupp, 1989). This gap is, in part, due to pressure to provide "empirical support" using manual-driven therapy and randomized controlled trials forcING psychotherapy research away from how therapy is most commonly practiced (Westen, Morrison, & Thompson-Brenner, 2004). Meanwhile, the explosion of knowledge in the neurosciences has led to calls to inform models of therapeutic change with neurobiology. This advancement in knowledge serves to widen the gap even further as increasingly complex technologies, research practices, and languages that describe them emerge (Kandel, 1998). We present the case report of a patient and therapist who participated in a naturalistic, process-oriented psychotherapy research protocol using simultaneous measures of skin conductivity. Data from the research protocol were used clinically and had a significant positive impact on the process and outcome of the case. The results support the clinical relevance of psychophysiologic measures and the role of empathy in the psychodynamic psychotherapy process.
Historically, psychophysiology has been used in a variety of ways in psychodynamic psychotherapy research and practice. In a review of the literature, Glucksman (1981) divides the uses of psychophysiology into three categories: (a) to explore the relationship between physiologic responses and psychopathologic and psychodynamic concepts, (b) to investigate physiologic correlates of the patient-therapist interaction, and (c) to monitor physiologic patterns within and across psychotherapy sessions (Glucksman, 1981). Multiple physiologic measures have been employed in psychotherapy research, including skin conductance, heart rate, blood pressure, skin temperature, respiratory rate, muscle tension and electroencephalography. The goal of using physiologic indices during psychotherapy is to create an objective measure of emotional and autonomie responses to conscious and unconscious as well as internal and external stimuli. Described in the context of a research protocol exploring the relationship between patient-clinician physiology and perceived empathy, the present case uses psychophysiology as a clinical and diagnostic aide that moves the therapist toward a richer, deeper understanding and appreciation of the patient's anxiety.
A large number of research studies use psychophysiology in the study of psychopathology (Keller, Hicks, & Miller, 2000). Two consistent findings in the literature involve depression and anxiety disorders. Depressed patients show consistent changes in skin conductance including decreased overall levels, decreased frequency of response, and decreased amplitude of response when compared with non-depressed patients (Iacono et al., 1983; Thorell, Kjellman, & D'Elia, 1987; Ward, Doerr, & Storrie, 1983). …