CHAPTER 20 Neuroscience, Psychotherapy, and Neuropsychotherapy It is difficult to overstate the importance BRIEF OVERVIEW _____________ of understanding mirror neurons and their function. They may well be central During the past two decades, major advances in to social learning, imitation, and the cul- neuroscience havedistribute changed our knowledge of tural transmission of skills and attitudes— the brain and the role it has in mental health and perhaps even of the pressed together clus- mental illness (Andreasen, 2001). A paradigm ters we call words. shift has takenor place from the four previous forces in psychotherapy to one involving the use of neu- —V. S. Ramachandran, The Tell- roscience to inform psychotherapy (Arden, 2010; Tale Brain: A Neuroscientist’s Quest Rossouw, 2013). It is essentially a paradigm shift for What Makes Us Human from focusing primarily on the so-called talking therapy to emphasizing the therapeutic relation- Early experience shapes the structure and ship as an engagement with the whole person, his function of the brain. This reveals the post,or her brain/mind, genetics/body, environment, fundamental way in which gene expres- and spirit. sion is determined by experience. This chapter is written to empower clinicians to —Daniel Siegel, The Developing use neurobiological information as a psychothera- Mind: How Relationships and the peutic tool in their armamentarium of interven- Brain Interact to Shape Who We Are tions. It is designed to shed light on how their work copy, in psychotherapy might change their clients’ very brains. Neuroscience provides either a new frame- The problem is, when you depend work or an additional way for conceptualizing on a substitute for love, you never get clients’ problems and presenting issues. It has the enough. capacity and the tools to reveal what is happening not —Louis Cozolino, in a client’s brain as he or she works with a thera- The Neuroscience of Human pist (Cozolino, 2010). Previously, therapists could Relationship: Attachment and the only theorize about what might be happening in a Do Developing Social Brain client’s brain. Moreover, neuroscience emphasizes 635 Copyright ©2016 by SAGE Publications, Inc. This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher. holistic treatment of individuals, treatment that theory for psychotherapy that puts recent find- involves not only their mental health issues but ings on memory reconsolidation at center stage also other factors in their environment that might (Tucker, Hully, & Ticic, 2012). Two other brain- be impinging on their mental health, such as the based theories introduced in this chapter are effects of poverty on the brains of young children eye movement desensitization and reprocessing and the influence of trauma in their homes and (EMDR), developed by Francine Shapiro (2001), neighborhood on their being able to learn in school and brainspotting, developed by David Grand (Grawe, 2007). (2013). “Brainspotting is based on the profound This chapter has four basic goals, the first of attunement of the therapist with the patient, which is to present a detailed examination of the finding a somatic cue and extinguishing it by connection between neuroscience and psychother- down-regulating the amygdala. It isn’t just PNS apy. Brief historical sketches are provided for sev- (Parasympathetic Nervous System) activation that eral key figures who have connected neuroscience is facilitated, it is homeostasis” (Robert Scaer, MD, with psychotherapy. These are not the only major “The Trauma Spectrum,” cited on the What Is Brain contributors to neuroscience and psychotherapy; Spotting website https://brainspotting.pro/page/ however, to write a factual account of historical fig- what-brainspotting). ures in neuroscience and psychotherapy is beyond the scope of this chapter. • Brainspotting is a powerful,distribute focused treatment A second goal is to provide a framework method that works by identifying, processing for neuropsychotherapy based on the principles and releasing core neurophysiological sources of that have already been established in the broad emotional/bodyor pain, trauma, dissociation and a fields of neuroscience and neuropsychology. This variety of other challenging symptoms. chapter does not attempt to provide a full-blown • A “Brainspot” is the eye position which is theory of neuropsychotherapy, primarily because related to the energetic/emotional activation of a traumatic/emotionally charged issue within I am not a neuroscientist. Instead, throughout the brain, most likely in the amygdala, the hip- this chapter, the reader will be introduced (a) to pocampus, or the orbitofrontal cortex of the various psychologists and medical doctors who post,limbic system. Located by eye position, paired are using neuroscientific principles and findings with externally observed and internally experi- and infusing these findings within their already enced reflexive responses, a Brainspot is actually established psychotherapy frameworks and (b) to a physiological subsystem holding emotional psychotherapists who are working on developing experience in memory form. (https://brainspot- a theory of neuropsychotherapy. For the first cat- ting.pro/page/what-brainspotting) egory of psychotherapists, who infuse neuroscien- tific principles in their psychotherapy, I refer the The developers of these new brain-based reader to consider the work ofcopy, Eric Kandel (1998, approaches had the fascinating idea that there 2005), Louis Cozolino (2010), Daniel Siegel (1999, are brain-based procedures therapists can use to 2010, 2013), and Rick Hanson (2013). These writ- assist clients in actually erasing—not just coping ers have incorporated neuroscientific principles with—painful memories. One does not have to within their alreadynot established psychodynamic spend the rest of one’s life grappling with the issue approach to therapy. of a rejecting parent, sexual abuse, and other trau- Additionally, this chapter discusses the work matic events in one’s life. These authors believe that of several individuals who have developed what they have uncovered how the brain circuitry works is termedDo in the neuroscience literature as brain- in memory consolidation as well as in memory based therapies. For example, I present in sum- reconsolidation and have developed a process of mary form the work of Bruce Ecker and his activating a distressing memory, destabilizing it, colleagues (2012) on coherence therapy, a new and reconsolidating a new memory in its place so 636 PART V THE FIFTH FORCE IN PSYCHOTHERAPY Copyright ©2016 by SAGE Publications, Inc. This work may not be reproduced or distributed in any form or by any means without express written permission of the publisher. that the terrifying memory no longer has its power A disclaimer Inner Reflections to create problems for the person. should be made In presenting a beginning framework for regarding the content When you hear the word developing a theory of neuropsychotherapy, I con- of this chapter. For neuroscience, what comes sider key concepts such as neuroplasticity, implicit instance, the chap- to mind? memory, explicit memory, memory reconsolida- ter does not pretend Do you feel that tion, mirror neurons, and right-brain to right-brain to be an exhaustive your background in therapy. The chapter also examines mental health examination of the neuroscience is sufficient and illness from a neuroscientific perspective, the field of neuroscience, enough for you to role of the neuropsychotherapist, and therapeutic and it does not deal incorporate some of its techniques that some neuroscientists use in their with rehabilitation principles in your work clinical practice. of the brain due to with clients? A third goal of this chapter is to explore the traumatic injury or concept of cultural neuroscience. What is the neurologic injury. It What would you like to impact of our culture on our brains? Are the brains does, however, pres- learn about neuroscience of people raised in an Eastern culture different ent a fairly readable and psychotherapy? from those reared in a Western culture? Do cultural introduction to neu- values condition people to prefer using the right- roscientific thinkingdistribute brain hemisphere over the left? that holds the promise of revolutionizing how psy- Finally, Goal 4 is to present the case study of chotherapy is conducted and tested for its efficacy. Justin from a neuropsychotherapy perspective. or Because the neuroscientific perspective empha- MAJOR CONTRIBUTORS _______ sizes holistic counseling, factors such as Justin’s wellness, his diet, the environment in which he The current neuroscientific paradigm is not con- lives, and his level of brain development are con- nected to a single person, and therefore, this sec- sidered in this case study. Two implicit questions tion presents three key individuals who have a link raised in the case study are “What might be helpful with neuroscience and psychotherapy: Sigmund for the counselor to know about Justin’s developingpost, Freud, Donald Hebb, and Eric Kandel. Only a brief young brain?” and “What might be the relationship description of their contributions is provided. between Justin’s impulsive behavior and his adoles- cent brain development?” Sigmund Freud (1856–1939) This chapter raises some ethical issues for therapists and helping professionals in general. For When most people think of Sigmund Freud instance, does a therapist have an ethical respon-