There are many theoretical orientations of psychotherapy, and certainly, many things can be considered therapeutic, yet they all have one thing in common – a change in the nervous system.

In his new book, The Neuroscience of Psychotherapy: Healing The Social Brain (3rd Edition), Louis Cozolino explores the neuroscience that characterizes relationships and how, under the right psychotherapeutic conditions, a person’s underlying neuroplasticity can change.

“At the heart of the interface of neuroscience and psychotherapy is the fact that human experience is mediated via two interacting processes,” writes Cozolino.

These two processes, according to Cozolino, are the evolutionary nervous system, which is comprised of billions of neurons organized into neural networks, and the present, which impacts the way in which our neural networks are shaped through our relationships and environment.

Mild to moderate stress triggers neural plasticity and supports new learning – especially in therapeutic environments. On the other hand, stress that overwhelms the system, disorganizes it, which often leads to a disconnection between thoughts, feelings, sensations and behaviors.

“As a therapist, one of my primary goals is to shift my clients’ experience of anxiety from an unconscious trigger for avoidance to a conscious cue for curiosity and exploration,” writes Cozolino.

Much like positive interactions with parents, therapy involves an integration of sensory experience, emotion, and cognition that ultimately lays the foundation for new, more adaptive self-narratives.

One important development is the awareness and exploration of the inner world. As our inner worlds allow for mentalization, metacognition and self-reflection, they also help us find ways to consolidate our sense of self.

Quite often, however, we also come to see and experience the ways in which we interpret the world, and the perceptual biases we carry. It is through therapy that we begin the process of coming to terms with these biases.

“At the heart of psychotherapy are two interwoven processes. The first is the way in which our brains and minds construct reality, while the second is our ability to modify these constructions to support mental health and well-being,” writes Cozolino.

And much of how we interpret the world evolves through the stories we tell ourselves.

“Stories are powerful organizing forces that serve to perpetuate both healthy and unhealthy forms of self-identity,” writes Cozolino.

A well-told story shifts the neural experience, often in powerful ways. Cozolino describes Trevor, a young boy who learned to repeat the words, “I think I can, I think I can” as a way to internalize the powerful story of The Little Engine That Could, which had first been told to him by his grandfather.

Relationships such as this underscore the importance of attachment.

“If therapists and adoptive parents can create an environment that minimizes fear and maximizes the positive neurochemistry of attachment through human compassion, attachment circuitry can be stimulated to grow in ways which are not only healing, but that also allow victims of abuse and neglect to risk forming a bond with another,” writes Cozolino.

In the best conditions, the therapeutic alliance that develops between client and therapist not only emulates what Cozolino calls, “professional altruism,” but also gives way to the client’s own use of altruism as a way to improve life satisfaction, happiness and physical health.

“Altruistic behaviors could potentially drive the development of brain regions dedicated to attachment, self-efficacy, perspective-taking, and compassion, all of which would be extremely beneficial to positive change in psychotherapy,” writes Cozolino.

One interesting suggestion Cozolino offers is the use of guided altruistic acts as an aspect of therapy, which may be particularly important in cases of trauma, where high levels of glucocorticoids have a catabolic effect on the nervous system, predisposing a person to disorganization of the nervous system and an impaired ability to respond to and regulate stress.

As the stress response is an innate biological response, Cozolino argues that there is an evolutionary basis for psychotherapy. Conscious and unconscious processing of fear and anxiety pervade our identities, our attachments to others and our experience of the world. The role of psychotherapists, Cozolino writes, “is to use their social brains as a tool to connect to and modify the brains of their clients.”

Acting as an external regulatory circuit, the psychotherapist stimulates and enhances neural plasticity. Instilling hope, optimism, and empathy, the therapist uses the most powerful tool available to any healer – the relationship with the client – to effectively reshape the brain.

It is the dynamic tension between what is and what is desired, between habit and adaptation, between avoidance and approach, and between constriction and expansion and that lies at the heart of psychotherapy.

“If we can tolerate this anxiety and stay on our journey, change is inevitable,” writes Cozolino.

Therapy is not just clinical, it is relational. Beautifully organized and artfully presented, Cozolino provides an expansive and insightful account of the neuroscience that transpires between two individuals on a healing journey, and why this neuroscience cannot be ignored.

The Neuroscience of Psychotherapy: Healing The Social Brain (Third Edition)
Louis Cozolino
W.W. Norton (2017)
Hardcover
434 Pages
$49.95

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