The Relationship is the Therapy: Applying Interpersonal Neurobiology in Psychotherapy
In 1978, when I was 13 years old and struggling with the vicissitudes of puberty, I was fortunate to be taken under the wing of my middle school vice principal. He listened to me and asked questions, sometimes giving advice that did not resonate for me, but his attention and concern had a profound positive impact. Luckily for me, he also offered me experiences to develop affect regulation through a practice of focusing my energy and attention in my belly while breathing and listening to Gregorian chants. A year of this relationship launched me from depression to empowerment and from isolation to connection, fostering enough resilience in me to help me thrive, despite difficulties at home.
Now, with nearly 30 years practicing relational psychotherapy and 15 as a clinical supervisor, I have observed that the experience of the therapy relationship, and especially what unfolds within it, offers powerful transformative potential for our clients. While psychoanalytic thinkers have explored, theorized and refined their approaches to the therapeutic relationship for more than a century, we now have the powerful added benefit of two decades of research within various fields of neuroscience. This research illuminates the interpersonal neurobiological underpinnings of development across the life span, the roots of psychopathology, and the nature of the psychotherapy relationship (Badenoch, 2018; Cozolino, 2010; DeYoung, 2015; Schore, 2012; Siegel, 1999, 2010; Wallin, 2007).
Still, there is persistent over emphasis in the therapy world upon technique-driven approaches to psychotherapy that rely on the left-hemisphere processes of the brain and minimize or ignore right-hemisphere processes. Every day my inbox is inundated with invitations to attend free webinars that teach techniques to address suffering. Even much of what is considered experiential in psychotherapy is also technique driven, and these approaches, while helpful to varying degrees, are missing the salient and central focus on the embodied-self-with-other dimension that is growing less and less attended to in our modern, fast-paced, global, wired and wireless world.
I know I’m in good company with many who believe that today, more than ever, we therapists need to anchor our attention in the present, emergent moments in therapy, fully tending to the vital, too often unmet, relational needs that people have for presence that is open, receptive, attuned, inclusive, not controlling, and not walled off. Technique-based psychotherapy methods increase the likelihood of relational intrusion and/or abandonment, with the risk of re-wounding our clients. Even therapists who intuitively offer the qualities of attuned relationship to their clients may get too focused on what they have so often been trained to do (apply techniques) and lose sight of the necessity to connect with the client’s current state. Lou Cozolino (2010) states that:
Psychotherapy can be thought of as a specific type of enriched environment that promotes social emotional development, neural integration, and processing complexity. The way the brain changes during the therapy will depend on the neural networks involved in the focus of treatment. (p. 20)
A neuroscientist, mental health nurse and survivor of complex relational trauma, Haley Peckham (2017), made powerful statements about neuroplasticity and reparative experiences in her keynote address at the Victorian Collaborative Mental Health Nursing Conference, explaining how therapeutic conversations impact biology. In the following excerpt, she passionately and humbly describes how the talking cure is biological:
The new paradigm of neuroplasticity recognizes that early experiences of relational trauma (including chronic invalidation, neglect and abuse) in infancy and childhood, biologically shape the brain and all neural systems defensively, to anticipate similar experiences. If we want to change what we anticipate in the world we may have to seek out reparative experiences, to give our brains and neural systems some new data to adapt to, and to anticipate a new future from.
Peckham also states that “experience is the invisible sculptor of brains” (2017, para. 1) and makes the case for empathy as the essential reparative experience that supports outcomes that may include growing capacity for affect regulation and reduction of toxic shame.
Since our therapeutic models influence the kinds of changes that people make in therapy, let us move increasingly toward models that support the kinds of change that our world needs; namely, to become more relational, collaborative, and inclusive. Relational psychotherapists focus specifically on the reparative experience of the therapeutic relationship. Pat DeYoung (2015) states:
The relationship between client and therapist matters so much because the client’s early relationships are the genesis of this distress. Psychoanalytic and psychodynamic therapists have believed this to be true since Freud. Now, as Allan Schore does with reference to hundreds of brain studies, relational therapists can support their belief with neuroscience. (p. 60)[Content protected for subscribers only]