Competing Visions of the Implications of Neuroscience for Psychotherapy

Abstract

In this third and final article of a series on the confluence of neurobiology and psychotherapy, we consider three current, influential interpretations of the implications of neuroscience for psychotherapy: pharmacological treatment, reparative attachment therapy, and the cognitive regulation of emotion and behavior. We critically examine these clinical strategies, reviewing efficacy data, neuroscientific research, and the model of symptom production by coherent implicit memory as articulated in coherence psychology. We argue that according to current knowledge, (a) each of the three clinical interpretations of neuroscience implements only part of the brain's known capabilities for change; (b) those capabilities are more fully utilized and can yield greater clinical effectiveness for the majority of psychotherapy clients through a therapeutic strategy of selective depotentiation of implicit memory, as exemplified by coherence therapy; and (c) the strategy of counteracting an implicit memory, whether cognitively or psychopharmacologically, is only moderately effective, is inherently susceptible to relapse, and entails a range of undesirable collateral effects.

The authors are grateful to Laurel Hulley and Timothy Desmond for many helpful discussions and clarifications of drafts of this article, and to Bret Lyon for influential critiques of our arguments regarding reparative attachment therapy. Much benefit came also from critiques provided by this article's anonymous reviewers, whom we thank sincerely.

Notes

1. Symptoms that have been dispelled by coherence therapy include depression, anxiety, panic, agoraphobia, low self-worth, attachment problems, sequelae of childhood abuse, sexual problems, food/eating/weight problems, rage, attention deficit, grieving, fidgeting, codependency, underachievement, procrastination, and a wide range of interpersonal, couple, and family problems.

2. Monoamines are a class of neurotransmitters that include serotonin, dopamine, and norepinephrine.

3. This efficacy alone does not indicate Lipitor as a treatment of choice. For instance, using a dietary intervention based on whole plant foods, Jenkins et al. (2003) found no difference between the effects of their regimen and a drug of the same class as Lipitor. The dietary intervention was also accompanied by a range of positive effects, in contrast to the array of negative side effects and medical risks attendant to the drug.

4. An example of depression caused by implicit memory was given in the example of Tina in our prior article (Ecker & Toomey, 2008) and is described more fully in Ecker and Hulley (2002a). For numerous examples of anxiety and panic caused by implicit memory, see Ecker (2003) and Ecker and Hulley (2002b).

5. It is when the client–therapist relationship is subjectively relevant to an attachment schema that a transference projection tends to arise. Use of transference remains central to therapies of the psychoanalytic school, but not to the more recently developed, experiential, neuroscience-oriented therapies of reparative attachment, as represented by Fosha (2001) and by Lewis, Amini, and Lannon (2000). The latter emphasize the healing effect of the client's experience of the therapist's noninterpretive, accurate empathy, regardless of the presence or absence of a transference projection. Coherence therapy likewise can use, but does not rely on, the arising of client transference. Coherence therapy also differs significantly from reparative attachment therapies regarding the curative role of the therapist's empathy.

6. A video example of imaginal work on an attachment-defining prosymptom position can be viewed, along with transcript and commentaries, in an online short course available at www.coherencetherapy.org/training/courses.htm. Scroll to Course 700: Obsessive Attachment to Former Lover.