Recent changes to accreditation standards in some parts of the world now include the need for trainee therapists to understand the neurobiological basis of behaviour. This will be challenging for some who might have leaned towards a learning bias centred on right mode processing in their teaching environment. For example, the institution where I initially trained in London had historically reacted ambivalently toward medical models for understanding client concerns and treatments. Cognitive and behavioural ideas (although they are terms that are, admittedly, often conflated) were not prioritised in the integrative course content. Such content was only briefly covered in a tick box manner and often by a non expert. The prevailing teaching and learning ethos was more centered on right mode processing with greater emphasis on intuition, emotion, creativity and divergent thinking.
Teaching and learning from a mainly right mode centric perspective had many benefits, as I was not keen to train at a purely analytical school. I had been attracted to wider integrative, as well as holistic, ideas than that offered by purist approaches. I was also sceptical of the dangers of being overly diagnostic, and rightly feared the risks of labelling people with medical model diagnostic criteria that could lose sight of the person. However, this also meant that there was increasingly more ‘felt sense’ communication during the training compared to logic and precise language. Examples of this were that students would often rely more on what they were feeling in groups than on logic and intellect, when actually reading the required reading from lectures was often shunned. Anyone who was more academic in their learning style, who actually read the course materials and the required or recommended reading, was potentially marginalised and trivalised in these environments. This all meant that the neurobiological basis of behaviour was tended to be ignored and only really addressed when the couple of lectures on trauma took place. Even then, there was more often than not, a simplistic approach to the vast area of interpersonal neurobiology.
Such shortcomings are probably not that surprising. After all, with any integration there will always be a bias in what is to be featured in the teaching programme. The trouble is, we all have an ethical obligation, accredited therapists that is, to stay informed in the field of new developments, ideas and approaches. This can, of course, be very challenging in the field of neuroscience as the literature can be so vast. However, being neuro informed has become almost sexy, as it offers the potential for some, both therapist and person seeking help, to offer and to perhaps receive silver bullet solutions to lifelong behavioural problems.
neuroscience is not a panacea
So-called neuro informed therapy can have numerous pitfalls. Neuroscience is not a panacea. The hope and expectation for change remains complex and often grounded in the person of the clinician and the quality of the relationship in therapy. Insights from neuroscience can be incredibly useful but equally such insights can potentially over-promise and often under-deliver. A neuro informed therapy can sound very science-based and can, as a result, have a seductive quality to its offering, especially for those demanding people who want a quick fix in their therapy.
Neuroscience is an evolving social construction. The following are some prominent thinkers in the field:
Dan Siegel – Interpersonal neurobiology
Louis Cozolino – Social synapse/social brain
Stephen Porges – Polyvagal Theory
Klaus Grawe – Neuro psychotherapy
Lori Russell-Chapin – Neuro counselling
Raissa Miller and Eric Beeson – Neuroeducation toolbox
I have learned a vast amount from these sources, notwithstanding the aforementioned risks associated with embracing insights from the field of neuroscience in therapy. But one key point of humility needs to be made here. The more I learn the greater awareness I have of how little I know, such is the vast nature of the learning field. The really important aspect of my learning, however, has been to try to apply any such insights towards clinical applications. A lot of therapists do this already with psychoeducation, particularly surrounding parts of the nervous system such as explaining the phenomena of fight/flight/freeze/face. But this can often be overly simplistic, and unless a therapist is trained more extensively in trauma work, there can be an absence of follow-up integration with the client. Addiction counsellors can also work with the mechanism of the reward system in the brain, but this, too, can often be in a very superficial way. It has been my experience that misconceptions and falsehoods can be commonly present when a practitioner embraces neuroscience informed therapy without much planning or forethought.
Some practitioners will be opposed to embracing neuroscience as they might, quite reasonably, suspect that it may risk violating humanistic principles by potentially being reductionist and also risk dehumanising people. Caution is definitely needed when people are being attracted to biogenetic explanations for mental health. There is also massive sensitivity required so that practitioners are aware of cultural considerations. The challenge for practitioners can be in how to honour culture but also avoid the pitfall of applying unhelpful stereotypes. Comte referred to “fervent monism” and the tendency to place a disproportionate emphasis on one explanatory level in the hierarchy of the sciences and I believe that this particularly holds true here.
“what if your stress is not your fault, but it is now your responsibility?”
The really exciting aspects of neuroscience, for me, is how neuroscientific findings can inform bias. As a practitioner, one aspect of therapy work might be helping someone to release the emotional charge that someone is presenting with. We know from trauma work that it is important to not talk all day about what happened (although Hubbard probably had a point in Dianetics, that good therapeutic outcomes can be derived from repetitive recall with a trained professional). When we replay a past event, we are recollecting the last time an event was recollected, not a replay of what actually happened. Memories are malleable, and details are recorded in context. They are multi sensory, not just verbal. They can change, or may be manipulated, over a period of time such that what you ‘remember’ may not be wholly accurate. Criminal investigators know this. That is why when a group of witnesses are telling the exact same story of what happened following an incident or accident the likelihood is that it is based on lies and collusion.
I have long been fascinated by how memory works. As a therapist I can create the conditions for story telling and for someone to recall instances of past emotional wounding. Memory work is less about going back to find the why, but bringing the why and the what into the present. It is not necessarily what happened to you in the past, but what is continuing to happen to you today, as you bring that material from the past into the present. If you think about it, “today is tomorrow’s yesterday“. The best time to deal with stress would have been yesterday by engaging the enteric system so that you are only effectively dealing with a crisis today.
A useful question in therapy can be “what if your stress is not your fault, but it is now your responsibility?” This can be transformative when someone becomes more active in their self care regime. Some legacy behaviours could be deemed to be those behaviours that had a purpose in your past, to keep you safe, but which are not needed today. Therapy can look to realign behaviours towards a more positive future. This can be when integration from neuroscience knowledge helps to meet clinical applications and so, yes, to answer my own question from the start, neuroscience can fit into integrative therapy practice.
Noel Bell is a UKCP accredited psychotherapist based in London and can be contacted on 07852407140
Hello Noel, this is very interesting. I have read lots around these areas and I agree that there are risks to potentially dehumanising someone, by talking exclusively about how the brain works, but that aside it can be extremely useful as a client to have a neuro informed therapist. B.
People like Deepak Copra, who talks about neurons having consciousness, will be perhaps the ones who refer to reductionist ideas of neuroscience.
Agreed. Counselors without adequate training and kowledge are at risk of being vulnerable to neuromyths and inaccurate application of NS principles.
Interesting article that illuminates a struggle that I am having with my psychotherapy course i.e a lot of airy theories and very little interest in potential physical precursors to mental states. I am myself a person with ADHD and autism. I have worked with therapists that have (likely unconsciously) tried to silence any enquiry I had into more physical/functional causes for some of the things I was struggling with. I have found psycotherapy useful in understanding my story/view of my condition and so believe it can be very helpful in that sense but also believe that there is a real risk of psychotherapists pathologizing mental health issues as mental narrative when they actually have a physical basis. I.e low dopamine issues in ADHD. A psychotherapist that has no knowledge of the neuroscience around neurodivergency may well conclude that someone’s lack of focus is more to do with fear of self actuation via poor early emotional attunement with parents. When it may well be more to do with neurotransmitters. For all the talking in the world it has been methylphenidate that has helped me most.
I would say though that one needs to be careful with who we read as regards neuroscience. There are some people who pertain to have discovered things that on further investigation are either overblowing their results or in a sort of scientific denial. Trauma is sadly big business. I am particularly referring here to Stephen porges and his polyvagal theory. If you’re interested check out the discussion on research gate ‘after 20 years is there any evidence to support polyvagal theory’.
My own experience of the course content around neuroscience or my course has saddened me and left me somewhat distrustful of psychotherapy. The very first lecture we had on neuroscience used the lizard brain theory to describe the structure of the brain. This was debunked more than two decades ago w and is still popping up in 2023. I believe psychotherapy has a very real problem of attachment to convenient concepts and pseudoscience.
Thank you Chris. You make good points.