As Siegel notes, “The therapist must always keep in mind that interpersonal experience shapes brain structure and function, from which the mind emerges” (1999, p. 300).  Siegel and Schore both attribute this to the ability of the therapist to be psychobiologically attuned to the patient’s internal state, both emotional and physiological.  By virtue of this attunement, patient and therapist are able to make verbal, cognitive meaning via left hemisphere analytic, interpretive functioning out of the more implicit, sensing right hemisphere autobiographical representations.  In other words, we make the unconscious become conscious.  Schore (2003) explains, “’It is not the past we seek, but the logic of the patient’s own state regulating strategies.’”

One of the most important learning and healing experiences occurs when the patient and therapist both become dysregulated in session, and then after a time the disruption is repaired. This healing interaction is mediated by the right brain to right brain attuned therapeutic connections. The impact on the patient’s internal working models for attachment relationships is stored as implicit, unconscious memory. Through attunement, mis-attunement and re-attunement cycles, the unconscious memory of dysregulated states become more conscious.    Schore notes that “opportunities for dyadic interactive repair are expanded in longer term treatment.  In the context of an extended relationship, interactive transactions can be internalized, allowing for the emergence of an adaptive mechanism that can, under periods of stress, be accessed for self-comforting” (1994, p. 473).

Concluding Remarks
Science is not the only way of knowing how to make sense of events:  the scientific method is one way of understanding, as is intuitively responding to a patient’s communications.   Both logical thinking and intuitive knowledge are valuable tools in clinical work.  In this spirit, we attempt to describe some of the emerging brain science that supports the challenging work we do as psychodynamic therapists. It is possible to speculate on Shedler’s report not only of lasting changes from psychodynamic psychotherapy but of continued improvements beyond termination. We might infer that these gains are supported by ongoing neuroplasticity and neurogenesis (the growth of new neurons later on in life).  Certainly there is controversy in adopting this line of thinking:  some writers caution against being overly reductionist in attributing psychotherapeutic change to functional changes in the brain.  Any discussion in this area must contain the tension between the desire to understand as well as a great respect for the infinitely intricate nature of both our brain and our psyche.

References

Kandel, E.R.  (2006). In search of memory:  The emergence of a new science of mind. NY:  Norton.

Schore, A.N.  (1994). Affect regulation and the origin of the self:  The neurobiology of emotional development. Hillsdale, NJ:  Erlbaum.

Schore, A.N.  (2003). Affect regulation and the repair of the self. NY:  Norton.

Shedler, J.  (2010, February). The efficacy of psychodynamic psychotherapy. American Psychologist.

Siegel, D.J.  (1999). The developing mind:  How relationships and the brain interact to shape who we are. NY:  Guilford.

Solms, M. and Turnbull, O.  (2002). The brain and the inner world:  An introduction to the neuroscience of subjective experience. NY:  Other Press.