Illustrating why and how Psychotherapy works in practice

The relevance of Neuroscience

The following information from neuroscience, offers the reader who may be interested a brief introduction to some of the science behind psychotherapy. While it is difficult to avoid the use of technical terms and concepts, I have tried to keep these to a minimum. The professional practice of psychotherapy has, since its beginnings over one hundred years ago, been attempting to explain and illustrate why and how it works. This has been a huge ongoing challenge due to the relational nature of psychotherapy and difficulties with finding workable methods of objective measurement. It is through rapid advances in neuroscience that we can now begin to illustrate why psychotherapy works and how it works. It is very important that this information is made available to people for whom the process may otherwise seem vague, immeasurable and therefore difficult to understand the value of  investing the time, trust, money and committment required.

What is Neuroscience?

Neuroscience is the scientific field of study of the activities and links between behavior and brain activity. Through neuroscience research we have come to understand that a great deal of human mood and other mental activity, originates through the activity of what are called neural networks or pathways in the brain. Psychotherapy is increasingly able to draw on the findings of neuroscience to both increase its efficacy and to explain how it takes positive effect.

The focus for the study of neuroscience is our brain, which is the center for processing information from our full body experience, through the central nervous system (CNS) and the autonomic nervous system (ANS). The brain is a highly specialised social organ of adaption. In light of very recent discoveries about how the social brain functions we now no longer talk about the brain in terms of areas of functionality but in terms of understanding neural networks or pathways though different areas of the brain and their effects when acitvated. Described simply, neural networks as the name suggests are made up of complex sequences of multiple individual neurons, of which there are 100 billion in the brain. These sequences can fire or be inihibited from firing depending on the release or withdrawal of transmittor or transmittor inhibiting substances. To illustrate this through one well known application of a discovery through neuroscience, SSRIs such as prozac and lexapro which are frequently prescribed for depression, have been specifically designed to keep the neurotransmitter ‘serotonin’ available for neural firing. It seems that prolonging such firing activity can be helpful in combating depression although the full picture of how this effects mood we have yet to discover.

Serotonin is one of several chemicals called neurotransmitters that pass messages between nerve cells that are involved in depression. Each nerve cell generally uses one of these chemicals to pass on messages to adjacent nerve cells.If there is not enough serotonin released by the first nerve cell, it won’t be able to cause the next one to ‘fire’ – the message won’t get through. This is one of the changes that appears to be important in causing depression. The nerve cells normally recycle serotonin by soaking it back up again. The SSRIs work by stopping (inhibiting) this re-uptake of serotonin. As the serotonin is not soaked up again, more will be present to pass on messages to nerve cells nearby. SSRIs work selectively on serotonin – they don’t stop the other types of neurotransmitter chemical being soaked up by the nerve cells.

Neural networks interconnect allowing for the evolution and development of increasingly complex skills, abilities and abstract functions. Neurons are social by nature and depend on their neighbours for survival. They send and receive messages from each other via chemical messengers, if they don’t do this on a constant basis they literally shrink and die. In addition to the neural networks half the volume of the brain is made up of what are called ‘glial cells’. Glial cells play a role in the construction, organisation and maintaince of neural systems. While little is yet known about them, glial cells appear to participate in neural communication both by modulating synaptic transmission and by carrying their own messages.

In understanding the social brain, the focus is less on the surface but largely on the areas hidden from view, where the earlier developing structures central to our experience of self and others reside. For social and emotional functioning it is the increasingly being illustrated that it is right hemisphere and not the left that is the dominant side of activity. Perhaps the most exciting revelation from neuroscience is that the brain is not fully formed in early life as previsouly believed, but is a dynamic structure that can undergo modification and re-development across our lifespan. This finding is referred to as brain ‘plasticity’. This means that changes in neural firing patterns can be positively directed through effective and informed psychotherapeutic interventions.

Neuroscience; taking us to the imprints of trauma and difficult experience.

The fundamental behavioural tendency of all organisms is to approach what is life sustaining and avoid that which is dangerous. The modern human brain reflects millions of years of evolutionary adaptation. Through this process of adaptation it has embodied compromises between response speed of the primitive brain with the advantages of the higher processing available through a larger, more recently evolved but slower, cortex. Although conscious input is possible during stressful situations, emotional and cognitive processes are usually directed by the primitive brain areas, where the ancient, rapid acting neural networks, that are fundamental to survival are located. It is this aspect of physiology that is center stage to understanding how and what psychotherapeutic interventions will have best effect, in addressing responses created in our efforts to survive through trauma.

Donald Hebb, a Canadian neuropsychologist coined the phrase ‘neurons that fire together, wire together‘. This is more technically referred to as experience-dependent neuroplasticity. It means, in effect, that whatever we repeatedly sense, feel, want and think slowly but surely sculpts our neural structure. 

As you read this, a trillion support cells, 80-100 billion neurons are signaling each other in a network with about half a quadrillion connections called synapses. All this incredibly fast, complex, and dynamic neural activity is continually changing your brain. Active synapses become more sensitive, new synapses start growing within minutes, busy regions get more blood since they need more oxygen and glucose to do their work, and genes inside neurons turn on or off. Meanwhile, less active connections wither away in a process sometimes called neural Darwinism: the survival of the busiest.

All mental activity in both conscious and unconscious experience is based on neural activity. Intense, prolonged, or repeated mental/neural activity will leave an enduring imprint in neural structure and how we consequently process information. Like an underground stream that can by continuous flow carve a path through solid rock, leaving the surface unchanged. In a much quoted example London taxi drivers memorizing the city’s spaghetti snarl of streets have been found to have thickened neural layers in their hippocampus, the region that helps make visual-spatial memories. These drivers by working a part of their brain in a focused and repeditive way, grew new tissue there.

The reality that ‘neurons that fire together wire together‘ is both good and bad as it means that while we can adapt to positive environment and stimulation we can also adapt to negative unhealthy environments and pathological others. The resulting adaptation may help us survive difficult experiences but this very adapting can impede later healthy development. Because the first few years of life are a period of exuberant brain development, early negative interpersonal experiences become a primary source of the symptoms for which people seek relief in psychotherapy.

Optimal sculpting of the pre-frontal cortex through early healthy relationships allows us to think well of ourselves, trust others, regulate our emotions, maintain positive expectations, and utilise our intellectual and emotional intelligence in moment-to-moment problem solving. The transformative power of intimacy has its roots in the evolution and development of the brain through parenting, friendship and other relationships. It is this power that is harnessed and applied to create the conditions which through brain plasticity can be used to shape positive neural network change, through the focused relational process of psychotherapy.

Neuroscience; Psychotherapy and implicit memory

The sources of most psychological difficulties are framed by memory. The everyday firing patterns of neural networks that are triggered by various stimuli and events will evoke particular associations held in memory, this process is largely unconscious. We need this so that we don’t have to learn everything anew everyday (a concept played with in the films ‘Groundhog Day’ and ’50 First Dates’). When neural firing happens in response to a trigger, it will travel a network that will link up many relevant pieces from memory to help us to create context and formulate an appropriate response. However we don’t usually have consciousness access to nor objective management of this. For example, there is a loud bang outside, one person rushes out because they fear the large tree they were concerned about has fallen, meanwhile their neighbour who likes quiet rushes out angry that someone is making noise. It is the same sound (which turns out to be a firework) yet it has set off a different set of assumptions and responses for each person. It is through memory that we assess, perceive and create expectations essential to our survival and well being, thus carving particular firing patterns. We now know that there are two forms of memory, explicit (consciously known) and implicit (unconsciously known). From a scientific perspective, we understand explicit memory better and frequently use therapeutic methods such as CBT and other issue-focused counselling approaches to work at this level. When it comes to implicit memory however, there is a need for therapeutic methods that can access the unconscious triggers that underly entrenched, returning or profound difficulties, stuckness or developmental blocks. As our earliest memories are implicit, this level of memory underpins all experiences and has already begun assimilating experience in uterus, before birth. Primary associations between intimacy, anxiety, love and shame are forged in early implicit memory and become the core of our attachment schema and our ability to regulate emotions. It is important therefore that we can find ways and methods that reach this level of therapeutic engagement to redress traumatic or difficult experience.

Research has shown that when meeting a new person or situation sensory experience takes at least 400-500 milliseconds to reach conscious awareness, implicit memory is significantly faster, registering its assessment in about 14 milliseconds.

As implicit memory is not conscious it cannot therefore be thought about or talked about. It can only be expressed through underlying aspects of attitiudes, beliefs and behaviours etc. Issue focused therapies that address the presenting symptoms work largely with explicit memory. They are therefore unlikely to have a language to support or address non-verbal expression of implicit memory.

If the source of the difficulty is in implicit memory it is here that we must get to in order to effect real change, long term. The implicit experience is sensed first and creates a frame through which the explicit information will be shaped, met and interpreted. Issues and difficulties that are addressed through counselling and cognitive methods and may gain short term or situation specific improvements. However if the difficulty lies in implicit memory they may remain unaddressed at source and so will likely carve a new route to surface expression. As implicit memory is outside of conscious awareness the person is unaware of its influence and effects on their perception of people and events and the restricted experiences they may live in.

Jungian Sandplay as a method for reaching implicit memory

We need to have the participation of our entire brains to fully process experience. When we are overwhelmed by traumatic experiences or experiences that are for some reason difficult to process, our brains loose the ability to maintain neural integration. As a result memories may be stored implicitly in sensory and emotional networks but dissociated from those that organise cognition, knowledge and perspective. We then become vulnerable to intrusions of past experiences that are triggered by environmental and internal cues. In addition heightened stress and trauma have an inhibitory effect on language production and also the encoding of conscious memory. It can then interfere with the development of coherent narritives that serve to process experience and lead to neural network integration and psychological healing. In the process of psychotherapy it is intended to reintegrate these dissociated networks by consciously or symbolically processing traumatic memories within a safe and proteted space. This reintegration in turn allows the networks of conscious cortical processing to develop the ability to manage and contain the affects of past traumatic memories.

Jungian Sandplay as the name suggests, is the use of sand in a tactile sensory experience of play that by its nature engages right brain activity, which is associated with unconscious experience. This method involves the coordinated use of words, emotions and bodily expression, a combination that requires the simultaneous participation of both brain hemispheres. The client also has access to shelves of objects and figurines which may also be used in the experiential play and image creation. While a particular object may be choosen by the client for its specific and conscious personal meaning or purpose or no particular reason at all, it will also activate other important symbolic possibilities, creating a language for implicit memory expression and reintegration.

Containing this process within the context of Jungian thought and developmental psychology, creates an environment where connections can be made, and unmet needs recognised in a felt, sensory or consciously known way. The therapeutic process is primarily a relational experience with a therapist. Held in a professional and warm way, it can effectively change neural firing patterns, creating long term positive affect. Access to particular methods such as Jungian Sandplay can greatly enhance this.

Through recent developments in neuroscience, we are begining to understand why the therapeutic relationship is key to positive long term change and how this happens, including the process effects of mirror neuron firing and affect regulation. Those of us following these developments can now be present with our clients, in ways that maximise therapeutic effect. Our understanding of mirror neuron firing and their connections to human relationships has continued to expand and deepen. What is becoming increasingly apparent is that human self awarenes is a more recent development in our evolutionary history arising out of our experience in relationships with others, our ability to symbolise and the tools provided to us by culture.