How does psychotherapy work?
In short there is a wealth of evidence that therapy works, but no concrete understanding of its precise mechanisms. At last count there were approximately 480 schools or modalities. The ‘Dodo bird effect’ states that although there is evidence of benefit, there is no proof that one modality is more beneficial than another. Research published suggesting that one modality is superior to another has been shown to be suffering from researcher bias.
Current thinking suggests that it is the empathically attuned human relationship that heals. Conversely deficits in early relationships cause psychological trauma. In early years when our needs are not met, we are programmed with the expectation that this will continue to be the case. We then push these needs out of awareness and create a self-fulfilling prophecy.
Winnicott said that a child growing up with “inadequate relationships, with insufficient contact, cannot develop an adequate sense of self”
Children who do not have their emotional needs met will split off from feelings they cannot tolerate. Primitive attempts to self-stabilize and self-regulate result in the attachment patterns that stay with us for life.
The acknowledgement and validation of emotional needs can be healing. Therapists can use their own experiences to understand the client's pain on a deeply personal level and communicate that knowing back though tone of voice, facial expression, and body language.
It is thought that several common factors are involved in the healing process. These have been described as hope, corrective emotional experiences, a treatment rational, positive expectations, catharsis, therapist warmth, learning, changes in expectation, a healing ritual, and the therapeutic relationship.
Beissers paradoxical theory of change suggests that if you try and change someone they will automatically push back and that the best way to encourage growth is to fully accept who they are.
Once trust between the client and the therapist has been established, subconscious right-brain to right-brain communication is established allowing previous negative relational experiences to be overwritten. The new relationship promotes neuroplasticity and the growing new neural connections in a part of the brain called the orbitofrontal cortex. This area of the brain is responsible for defining our personality and its development allows us better socially relate and emotionally regulate.
If strong links between the prefrontal cortex and the amygdala are not formed early on, they may get pruned away leaving a connection too weak to inhibit a fear response leading to anxiety in later life. Almost all psychiatric problems result from right brain under development and emotional dysregulation.
Integration in psychotherapy can mean the integration of both the theory and the client. It is the integration of knowledge to bring about both integration of the self and the brain. Psychological integration will result in neurological integration.
Though it is an over simplification we can think about the integration of the emotional, creative, imaginative, globally aware right brain with the locally focused, logical, verbal, analytical left brain. Therapeutically the act of putting feelings into words and creating an emotional narrative of our lives can improve the integration between left and right hemispheres.
We can also consider the triune brain and the structural integration of the brain stem limbic system and human neocortex. We need a bottom-up approach in psychotherapy that integrates somatic sensations and emotions which underlie our thoughts and behaviours.
The therapist works with implicit procedural memory and allows the client to reflect and express experience verbally in a safer, more tolerant and accepting relationship.
