Lasting Change: How is it possible?
Psychotherapy is not just a set of strategies or coping mechanisms. Psychotherapy works with the unconscious, as it is largely on an unconscious level that we operate in the world; reacting, responding, making choices, relating to ourselves and others.
It has been proven that our brains make our decisions at least half a second before we consciously experience making our decisions. So by the time we make what we think is a conscious, considered, rational decision, the decision has in fact already been made unconsciously, out of our awareness. That is why most of the time trying to think or behave differently just doesn’t work.
To make matters worse we are actually unconsciously compelled to make choices that resonate with traumatic relational experiences from early life (known as repetition compulsion).
The Unconscious
It requires a communication with the unconscious to bring about lasting change; where unconscious bias – caught up with early life familiarity – can be changed on an unconscious level.
Unconscious mental processes and dynamics have been recognised since antiquity, and understanding has long preceded psychoanalysis; evident in the Greek tragedies, Goethe, Kant, Nietzsche, and Shakespeare. Understanding of the unconscious did not, however, extend to medicine and psychiatry until 1755 - during the Enlightenment. From the 1440s until then mental disorders and distress were generally thought to represent demonic possession.
Findings in neuroscience has brought scientific evidence to phenomena that has been discovered through experimentation with psychotherapy since the early 20th century, in the beginnings of psychoanalysis:
1) Neuroplasticity: the ability of the brain to adapt, change, reorganise, and even grow neural networks, in response to life experiences.
2) Gene expression: that genes can turn on and off, be expressed or not expressed, according to life experiences.
3) Inter-brain synchrony: that the brainwaves of multiple people having a shared experience synchronise – so they are literally on the same wavelength.
These findings bring evidence and hope to psychotherapy as a means of bringing change and healing to mental distress and suffering.
Effective psychotherapy is not just a matter of feeling better in a subjective way, but it actually changes the neurobiology of the brain and psychological functionality.
The Relational Brain
75% of the human brain develops after we are born. Mammalian brains are highly relational, developing in relation to those around us, particularly in the first three years of life. Our expectations of others, ourselves and the world are laid down by those early experiences, and built upon by family culture, relationships, school experiences, and formative experiences in early adulthood. That is why psychological change also needs to happen in relationship, and psychotherapy is a springboard for that.
Positive relationships outside of therapy can also be immensely healing and life-changing, but unfortunately they are also places we can run into trouble by unconsciously repeating relational history.
We know how an animal’s behaviour is affected when they have been abused or neglected in early life. It is the same principle with humans, only it is more complicated and nuanced due to our level of consciousness and capacity for self-reflection. Yet it is this higher level of functioning that gives us the incredible opportunity to achieve change to a far greater degree.
Why do people suffer psychologically?
If you have seen a baby you will know how utterly helpless and dependent we are at the beginning of our lives. We depend entirely on our caregivers for our survival. This is a huge vulnerability for infants, and a huge responsibility for caregivers. The intensity of this time means that often, even with the very best of intentions and efforts, things can be less than ideal; for example, external pressures on the family at that point in time, a parent’s own parenting getting in the way, an unsupportive/absent partner and no family help, addiction or mental health problems in the family.
We are adaptable animals, and psychological survival involves developing unconscious strategies to adapt to our environment.
For example, if a parent can’t tolerate their child’s feelings, thoughts or desires, the child will learn to hide them, and this hiding will be or will become automatic and unconscious. Unfortunately these strategies limit and bind us in adulthood. For example, if you habitually hide your feelings then you will have problems getting close to people, which will leave you feeling lonely, frustrated and depressed.
If you were given praise and love for looking after a parent then you might find yourself falling into that role in relationships, leaving yourself depleted, and ending up resentful of others.
Or if you had an emotionally detached, cold or absent parent, you might find yourself taking that same role in your adult relationships, or being drawn to people who behave that same way emotionally, which would cause frustration, hurt and a lack of closeness in your relationship.
What are the beneficial effects of psychotherapy?
Psychotherapy helps you relearn to live without the distortions, hiding or jumping through hoops that may currently feel necessary to make things work.
You can feel your feelings, desires and express your thoughts without hurting yourself or others, and free of the feared or actual backlash that has been avoided for so long.
You can begin to experience people for who they are (rather than projecting onto them, or screening out aspects of them).
You can respond naturally to people and situations, and in a way that means you do not cause yourself nor anyone else to suffer.
You begin to be drawn to people who are different and treat you differently to how you have known before.
You become better at standing up for yourself, more tolerant and less aggressive or helpless in reaction to others. And others will generally find you more straightforward, genuine and considerate. You will likely be treated more respectfully.
You are likely to find new aspects to yourself, resulting in new interests. Life may feel more expansive and full of possibilities. You may find yourself being more curious. And if you were curious in a way that got you into trouble before, you may find you are better at looking after yourself now.
People often find they take more pleasure in the simple things and that they appreciate their relationships more.
The more positive experiences we have, the more the new experiences override the old ones, which bolsters our confidence and trust in being able to overcome these challenges.
Trigger Warning
It is important to note that difficult life events can trigger old ways of being back into existence. For example, you may have managed to overcome addiction in therapy, and then you suffer a bereavement, which triggers a traumatic bereavement from childhood. All the trauma and associated pain from childhood reemerges, and in an attempt to defend against that pain, you find yourself back in the old addictions. This can be really disheartening, as it can feel as if you’re back where you began.
It is helpful to know this so that you can expect it and understand what is happening as and when it happens, in order to be able to bear with it with care and patience; that in time you will once again be able to make the positive choices that helped you to bring yourself to the good place you previously came to.
Psychotherapy works to heal the wounds of the past, but the scars remain, and in time you will hopefully come to accept and respect them.
Why is therapy not always successful?
There are many reasons, and often it is a combination of things. Firstly, therapy requires full commitment and care from therapist and client in order to work. It is hard emotional work, requiring courage, an open mind and persistence. It is actually not a problem if you don’t come with any of these things initially, as these qualities can be reignited through the therapeutic connection, interventions, internal conflict and even frustration of stuckness. But at some point this is what is required by both therapist and client, and change is not possible without them.
Other factors, such as a client leaving prematurely, a poor therapeutic relationship, ruptures in the relationship, an inexperienced or poorly trained therapist or an ill-suited form of therapy, are all factors that make it more likely the therapy will not have a good outcome. Most clients of multiple therapies have had a mix of positive and negative experiences, and to varying degrees.
References:
Panksepp, Jaak, Affective Neuroscience: The Foundations of Human and Animal Emotions, 2004
Cozolino, Louis, The Neuroscience of Psychotherapy: Healing the Social Brain, 2024
Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and integrative model: https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2022.955238/full
Epigenetic correlates of the psychological interventions outcomes: A systematic review and meta-analysis: https://www.sciencedirect.com/science/article/pii/S2666915322000038
Psychotherapy and Genetic Neuroscience: An Emerging Dialog: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056612/, 2018
Inter-brain plasticity as a biological mechanism of change in psychotherapy: A review and integrative model: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9458846/, 2022