Book Reviews

The Neuroscience of Psychotherapy: Healing the Social Brain

2nd edition by Louis Cozolino
W.W. Norton

Who knew how correct my wife was when she sought a simple way to explain to our 5-year-old-granddaughter that, unlike her cardiologist father who heals hearts, her hypnotherapist grandfather heals brains?

All forms of psychotherapy actually change the structure of clients' brains according to Dr Cozolino, university professor and clinical psychologist in private practice. New neural networks are established, largely as a result of the intimate relationship between client and psychotherapist.

Were Freud alive today he would no doubt be grinning ear to ear on reading Dr Cozolino's support for all his theories and in particular, Freud's postulation that one day psychoanalytical concepts would be buttressed by evidence of biological causation in the form of neural networks.

Even the concept of an unconscious [hotly debated in some circles] is explained as "hidden layers" of neural networks. The author skillfully weaves instruction about the composition and workings of the brain with client stories from his private practice and wisdom from his own life.

While much is still speculation, Dr Cozolino makes a strong case for not only the plasticity of our brains throughout our lives but for the (to me) amazing effects that we as psychotherapists can have on the brains of our clients and ourselves.

Brain imaging with MRIs and other technologies on living human brains has yielded a lot of knowledge about how the brain works and how we can change the neural substrata, including the initial templates inculcated by parents and caregivers when we were babies.

Frightening news is that the seat of fear -- the amygdala -- begins to cause us terror and trepidation even before we are born. It takes a long time until the brain is mature enough to counteract such innate fears.

Meanwhile, of course, we find comfort in the security of loving parents or other caregivers. If we don't experience such relief then fear-based neural networks are laid down and may influence us for life -- or until intervention by a therapist helps to create new, positive neural networks.

Chapter 3 explains how various therapeutic approaches, particularly CBT (cognitive-behavioral-therapy) create changes in brain functioning. "In striving to activate cortical processing through conscious control of thoughts and feelings, these therapies enhance left cortical processing, inhibiting and regulating right hemispheric balance and subcortical activation" (p.40).

The fourth chapter describes in exquisite detail how psychotherapeutic interventions change clients' and therapists' brains.

A wonderful story from Dr Cozolino's practice in which he encourages a client to utilize a "magic tricycle" in his imagination to change his childhood wartime memories illustrates both the malleability of memory and the author's apparent unawareness that this is a common method used by hypnotherapists.

It's exciting to learn that when therapists help people to conquer stage fright part of the solution we hitherto unwittingly applied was to help balance their brain's hemispheres!(p.96).

Past lives, clairvoyance, 'deja vue' and similar paranormal beliefs may be made by the left hemisphere's attempts to "make sense of nonsense."

The placebo effect is alive and strong among therapists while almost totally ignored by physicians. Dr Cozolino expresses high hopes that such "nonspecific ingredients of a healing relationship will someday be interwoven with the technical aspects of modern medicine." (p.339). (See the placebo effect).

Memory is not the inviolable videotape analogy beloved of by many hypnotherapists. According to Dr Cozolino, there are several memory databases including the crucial networks of the hippocampi which govern new learning and the ability to make inferences from past experience.

Since many clients of psychotherapists have suffered severe stress, it is the resulting damage to the hippocampi (shaped like seahorses on either side of the brain) that negatively affects memory retrieval.

The hippocampus memory system acts as a brake on the fear-arousing memories instigated by the amygdala. "In other words, the amygdala will make us jump at the sight of a spider, while the hippocampus will help us to remember that this particular spider is not poisonous, so we shouldn't worry."

He adds that a proper balance of the two memory-systems "will allow us to stay close to others even when they cause us upset."

The implicit memory system explains why many clients as adults experience shame, a negative self-image and relationship issues. While conscious recall of abuse is absent, implicit memory is "likely to be centered around [having been] a source of annoyance, anxiety and disgust to their parents."

The author writes that silence on the part of the therapist is a tool that can bring implicit memory to the surface thus arousing the Freudian concept of transference which then (along with the therapist's self-awareness of countertransference) provides the therapist with rich information on which to base the client's emotional healing.

Before training to be a clinical psychologist Dr Cozolino spent years studying Eastern religions. This leads him to conclude ". . . . 'reality' is a construction of the mind which we take to be an external truth. So, at the heart of both dynamic psychotherapy and Buddhism is the fundamental belief that our conscious experience is a creative fiction subject to distortion."

He presents three illusions of consciousness:

1."Our conscious awareness comes together at some specific location within our heads and is presented to us on a screen." This gives rise to the concept of being a spirit inhabiting a physical shell.
2."Our experience occurs in the present moment and that conscious thought and decision making precede feelings and actions." Actually, claims Dr Cozolino, decisions are made from layers of hidden neural networks within the brain milliseconds before conscious awareness.
3."A third illusion, which relies on the first two, is that our thoughts and behaviors are under conscious control." We underestimate the influence of outside forces, chance and the unconscious.

It is well known that our prejudices persist even in the face of contrary evidence, that we seek confirmation of our biases while explaining away facts that do not fit our preconceptions. These self-delusions may be fueled, claims Dr Cozolino, by the "tenacity of fear memories stored within the amygdala and our desire to avoid the possibility of danger in the unknown."

The task of the psychotherapist is to use her social brain to connect with and modify the brains of her clients.

The Neuroscience of Psychotherapy is an excellent 21st century update to Freud's campaign to bring the unconscious to consciousness. It is a fine contribution to the growing body of literature about the social aspects of the human brain and how complex is the issue of using our neural networks to study those same neural networks.

Psychotherapists and physicians alike could benefit from absorbing the challenges posed by the author, particularly his wish to see the psychotherapy of the future integrated with neurology.

An index and many pages of references allow the reader to pursue specific questions to better understand the final chapter, "The Psychotherapist as Neuroscientist."