Developments in Brain Science Support Psychoanalytic Approaches to Therapy
by Harlene Goldschmidt, Ph.D.
Over the past several decades innovations in brain science have confirmed much of what therapists intuitively understand about our emotional life and the healing power of relationships. New brain imaging technology has provided a window on the neurophysiological underpinnings of conscious and, more importantly, unconscious mental functioning. As a result, we are beginning to better understand how relationships and brain processes are actively and mutually influential. It's becoming clearer that attachment experiences, including those that develop in ongoing psychotherapy, shape the ways in which our brains process information.
From the beginning, psychoanalysts have striven to acquire the fullest and deepest understanding of how to help patients alleviate suffering and opitimize their personal growth. Having concrete, scientific information on the brain's role in our subjective experiences offers more ways to demonstrate the unique benefits of our work to other health professionals, patients, prospective candidates, policy makers, and the general public. This growing body of brain research interfaces with clinical work, as well as developmental and psychoanalytic theory.
Sigmund Freud, who originally trained in neurology, was aware of the limitations of his era in understanding brain functioning. He "knew that any attempt to bring together neurology and psychoanalysis would be premature (although he himself made a last attempt at this time in his 1895 "Project" which he left unpublished in his lifetime)" (Solms and Turnbull, 2002, p. vii-viii). It was not until the late 20th century, when MRI and PET scans have allowed us to see the brain in action, that neural science began to address such core concepts from psychoanalysis as drives, defenses, unconscious processes, memory and the role of trauma in shaping both the brain and psychological experience.
In 2000, Dr. Mark Solms, the pioneering neurologist and psychoanalyst, founded both the International Neuro-Psychoanalytic Society and the Journal of Neuro-Psychoanalysis. Solms' work includes the influential book The Brain and the Inner World: Introduction to the Neuroscience of Subjective Experience (2002). He describes complex processes within the brain that correlate with subjective experiences such as seeking, fear, panic, bonding, and playfulness. We are beginning to understand these drive-based systems both in terms of the brain structures involved and the neurochemistry, thus touching on the role of psychopharmacology to influence these fundamental experiences. Solms further discusses the neurological basis of such stalwart psychoanalytic concepts as the repetition compulsion, dreaming and obsessive-compulsive behaviors. The prefrontal cortex, structural home to the observing ego, is emerging as a substantive area of documented change resulting from successful treatment. Most exciting is the work he describes by Panksepp and D'Amasio on the emergent sense of self and the background state of consciousness: the convergence of brain function and our most fundamental states of mind.
As the emerging field of neuro-psychoanalysis has picked up steam, increasing numbers of training institutes are incorporating this subject into their curricula. Martin Silverman, MD, a senior training analyst at CPPNJ, chaired a meeting on "The Neurosciences In The Psychoanalytic Curriculum" in New York earlier this year. The committee reported on a survey of 24 psychoanalytic institutes, of which 17 offer a neuroscience course. Ten of these were offered as required courses while the other seven were offered as "continuing education." The main reason given for not including neuroscience in the curriculum is "competition for time of training." One conclusion of the workshop was that "the dominant and unifying figure influencing interest in neuroscience within the psychoanalytic field at present is Mark Solms" (Silverman, Meeting Minutes, January 15, 2010).
This past semester, CPPNJ offered a course on neuro-psychoanalysis for the first time. Psychoanalysis and the Brain was taught by Dr. Harlene Goldschmidt for advanced CPPNJ candidates. The course incorporated readings from Solms as well as Allan Schore (Affect regulation and the Repair of the Self, 2003), Louis Cozolino (The Neuroscience of Psychotherapy: Building & Rebuilding the Human Brain, 2002) and Dan Siegal (The Developing Mind: How Relationships and the Brian Interact to Shape Who We Are, 1999). Topics included an overview and history of neuro-psychoanalysis, the unconscious, emotions, memory, dreams, attachment, projective identification and working alliance as each of these related to brain functioning. Several of the candidates taking the course acknowledged some apprehension at the beginning due to a lack of background in neuroscience. By the end of the semester, however, the understanding and integration of the material was evident in class discussions as well as the written assignment.
For CPPNJ faculty, a monthly reading group began in February of this year. The group is currently reading Allan Schore's book, Affect Regulation and Repair of the Self (2003). Discussions of projective identification, affect dysregulation and the dissociative process in patients, as well as therapists, have led to interesting and helpful exchanges. The importance of "reparative withdrawal" for the therapist in order to autoregulate himself or herself is looked at both clinically and in terms of brain processing. It is rewarding to have an increased understanding of the brain and nervous system as a means to better contain and manage difficult emotionally charged experiences of patients' suffering from early, pre-verbal and traumatic experiences. In these ways, therapists gain additional awareness of and ability to work with transference-countertransference dynamics.
The faculty group is also looking at ways to optimize the integration of neuro-psychoanalytic material into the overall training program. Some faculty members have already added relevant readings to their classes for candidates in the first three year program. Other ideas include institute seminars for faculty and candidates less familiar with the material, as well as bringing in well-regarded speakers with advanced knowledge in the field and posting links, articles and information about neuro-psychoanalytic conferences on the CPPNJ website.
One final note on this emerging field is how it provides more ways to describe the multiple benefits of psychoanalysis to people who have not had depth therapy. In ongoing psychotherapy, we help create greater understanding and empathy for the complexity of human experiences. The new field of neuro-psychoanalysis demonstrates the unique value of this process at the concrete level of brain structures and neurochemistry. Having more language, science, and a new conceptual framework to bring to the discussion can only help. It's important to note that there is still a lot more work needed to fully integrate this information. The modern attempt to bring neurology and psychoanalysis together is far from complete. Yet, it is good to know that these exciting and compelling developments, which Freud anticipated over a century ago, will allow us to better advocate and promote the therapeutic work that we do.
Cozolino, Louis. (2002). The neuroscience of psychotherapy: Building and rebuilding the human brain. NY: Norton.
Schore, Allan N. (2003). Affect regulation and the repair of the self. NY: Norton.
Siegal, Daniel. (1999). The developing mind: How relationships and the brain interact to shape who we are. NY: Guilford.
Silverman, Martin A. (January 15, 2010). "Minutes of the Institute Representative Workshop on Curriculum and Didactic Teaching," New York City.
Solms, Mark. (1997). The neuropsychology of dreams. NJ: Erlbaum.
Solms, Mark and Turnbull, Oliver. (2002). The brain and the inner world: Introduction to the neuroscience of subjective experience. NY: Other Press.