The second line of thinking in brain research supporting psychodynamic treatment is inferential, and it goes like this:  certain brain areas are associated with certain psychological capacities. For example, the orbitofrontal cortex (OFC) with its cortical and subcortical connections (i.e., anterior prefrontal cortex, the limbic system, and the basic arousal systems in the brainstem) is associated with emotional modulation and reflective functions. These psychological capacities are underdeveloped or impaired in psychological disorders. Psychodynamic psychotherapy is both explicitly concerned with increasing these capacities and is documented to produce such improvement (Shedler, 2010). The neural science literature demonstrates that the development of these capacities is tied to development in their associated brain areas during infancy and early childhood. We may infer that if psychotherapy produces improvements in these psychological capacities, there are corresponding positive changes in the functioning of the relevant brain areas (Schore, 1994, 2003; Siegel, 1999; Solms, 2002)

In terms of development, the OFC starts “wiring up” in the brain around 12 months – Mahler’s practicing phase, when the baby begins relating independently to the mother and the external world. This is an important development in laying the foundation for a differentiated sense of self (Schore, 1994).  The OFC continues to actively establish connections deep within several key areas of the brain until age 25 or so, although it retains some plasticity through the end of life:  hence, the opportunity for psychotherapy to continue to effect functional brain change. This self -observing part of the mind is one of the most important neural regulating centers of the brain.  Anatomically, it is perfectly situated to control the linkages between higher cortical functions, emotions and the body.   The OFC provides top-down regulation of the brain stem (involved with basic organic functioning ie breathing, heart rate, sleep) and  the autonomic nervous system (involved, among other things, in fight, flight or freeze). The OFC is also extensively interconnected with the limbic system, which is intrinsic to emotional life as well as learning and memory.  The OFC integrates both emotional and bodily information with the planning, symbolizing and problem-solving functions of the prefrontal cortex, making it a powerful seat of reflective functioning.  Reflective functioning is, in turn, a core concern of psychodynamic psychotherapy.