Neuropsychotherapy is simply an orientation to psychotherapy that incorporates the knowledge of neuroscience.
How to apply neuroscience to psychotherapy models
Neuroscience is a cross-cutting concern that is applied to other psychotherapy models used in therapy. In this regard, neuropsychotherapy can be considered an integrated model. To create a model of neuropsychotherapy, four categories of neuropsychotherapy must be considered.
Four categores of neuropsychotherapy
The four categories of neuropsychotherapy include:
1. Techniques related to the brain. This category contains all of the current and future knowledge we gain in the field of neuroscience including our understanding of neurons, neurotransmitters, mirror neurons, memory, left and right hemispheres, neuroplasticity, the brain, and the mind.
2. Techniques related to the therapeutic relationship. For building the relationship between therapist and client, my orientation focuses on a relational psychoanalytic model that is sensitive to transference and countertransference. This also includes basic counseling skills of reflections, summaries, deep listening, etc.
3. Techniques that involve integration of the left and right hemispheres of the brain. For this category of neuropsychotherapy I utilize neuroscience-based sensorimotor techniques, as well as Hakomi and Compassion Focused Therapy mindfulness practices.
4. Techniques related to the client’s emotional state. For instilling hope, emotional balance, and self-efficacy, I draw upon a strengths/solutions-based model. I also use ACT's psychological flexibility model.
My personal flavor of neuropsychotherapy
For working with the four categories of neuropsychotherapy, I draw upon psychodynamic (relational psychoanalytic), existential, ACT, mindfulness (Hakomi & Compassion Focused Therapy), and strengths-based models. This encapsulates my integrated model that aligns with the categories of neuropsychotherapy, but is informed by the other models when dealing with each category individually.
Techniques related to the brain
A neuropsychotherapy model appeals to me because our understanding of the biological structures and scientific findings of our human mind and brain is the epistemological core. This is what distinguishes justified belief from opinion. While Freud created the concepts of the id, ego and superego, he realized these were guesses and that at some point in time, a biological explanation for each aspect of the human mind would be found. I agree and that is why I must use a model that uses neuroscience as the epistemological base.
This model can be applied in diverse settings since we all share a common anatomy. By explaining to clients that their experiences and feelings aren’t the result of character flaws, but are because of levels of neurotransmitters being imbalanced, or brain structures being unhealthy, or epigenetic effects. By treating patients from this model, stigma can be more easily removed. A truly postmodern approach, a neuropsychological approach understands that our language, culture, and environment has shaped us from birth, and so our worldviews will all be unique. However, by working with the patient to build more healthy neural connections, improved levels of neurotransmitters, and integration of the subsystems of the mind, the neuropsychologist can find common ground with most cultures and all gender spectrums. This is essentially the summary of the first category of neuropsychotherapy. Our ultimate concern is an integrated mind and brain.
Techniques related to the therapeutic relationship
If neuroscience is the epistemology of my flavor of neuropsychological model, psychodynamic and existential theories inform the ontology and phenomenology. Existentialism forms the basis of the second category, the relationship between the therapist and client. In particular, the existentialism of Irvin Yalom informs my approach. Yalom’s four core concerns of death, isolation, freedom, and meaninglessness—to some degree—are ultimate concerns for all of us, no matter the extent of our consciousness. This latter point is one of the criticisms of an existential approach. “Although Yalom suggests a universal, albeit individual, nature of the experience of groundlessness at the end of life, this does not imply that existential concerns will be paramount, conscious, or even open for discussion by all patients or health care providers. (Bruce et al., 20011, p. 7).
Nevertheless, my aim is a relational approach where the therapist attempts to get below the cleavage between the therapist and client in order to see the world through the client’s subjective experience. If the therapist can approximate the phenomenology of the client, not only can empathy and compassion flourish, but the therapist can more fully understand how each individual patient sees the world. This can only lead to better results.
The neuropsychotherapy model departs from the DSM-centered approach where the therapist looks for symptoms to eliminate based upon the artificial diagnosis created by consensus of opinion, rather than on actual scientific findings.
“The problem is that biologists have been unable to find any genetic or neuroscientific evidence to support the breakdown of complex mental disorders into separate categories,” Adam, D. (2013).
A neuropsychotherapy approach doesn’t entertain the DSM more than that which is required by the clinical setting or third-party payers as it isn’t scientifically valid. In fact, in 2013, the National Institute of Mental Health announced that it will stop funding any research that uses DSM criteria rather than a new diagnostic approach. “Conducting research based on DSM categories is essentially building on a faulty foundation. The NIMH is not proposing any alternative categorizations, but they are expecting all future research applications to utilize their Research Domain Criteria, which transform[s] diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system,” Contemporary Sexuality (2013). Similarly, in my model, I will be treating each person based upon their individual presentation, not based upon non-scientific DSM criteria. I will look forward to more neuroscience research that better describes our diagnosis.
Techniques that involve integration of the left and right hemispheres of the brain
For the third category of neuropsychotherapy, integrating the mind, brain, and body, I draw upon neuroscience-based practices as well as Hakomi and Compassion Focused Therapy mindfulness practices. Trauma and PTSD can be successfully treated with EMDR (Eye Movement Desensitization and Reprocessing) and a technique called Brainspotting. Through neuroscience, many new techniques are at the forefront of clinical practice, transforming the prior talk-therapy approach into one that includes somatic experiencing and full-body engagement using practices such as yoga and taiji.
“Regardless of theoretical orientation or method of practice, neurobiological research and understanding appear to be at the cutting edge of therapy and, therefore, many emerging trauma treatments as reflected by the work of researchers and writers such as Siegel, Perry, Schore, Pollak, and Teicher. An element of the neurobiological focus is a fundamental shift in how the mind body connection is viewed,” Gurda, K. (2015).
There is much evidenced-based research that proves the validity of mindfulness-based practices in dealing with many psychological issues. “A wealth of individual studies, summarized in meta-analytic reviews, indicate that MBIs (mindfulness-based interventions) are effective in reducing different forms of psychological distress, such as depressive symptoms and anxiety, in clinical and nonclinical samples,” Henriksson, J., Wasara, E., & Rönnlund, M. (2016). These techniques also align with the neuropsychotherapy goal of integrating the subsystems of the mind with the body.
“Researchers from several universities explored whether meditation might bring about structural changes in brain tissue. Using magnetic resonance imaging, they found that 20 experienced practitioners of one type of Buddhist meditation had a greater volume of brain tissue in the prefrontal cortex (Brodmann areas 9 and 10) and the insula than a control group did (graphs). These regions play a role in processing attention, sensory information and internal bodily sensations,” Ricard, M., Lutz, A., & Davidson, R. J. (2014).
“A growing body of neuroscientific literature has shown that activity of the neurotransmitter dopamine in a part of the brain called the nucleus accumbens is common to states of craving, including both pharmacologically induced addictions and activities such as gambling,” Ekman, P., Davidson, R. J., Ricard, M., & Alan Wallace, B. (2005).
In addition, some neuropsychotherapy innovators have created specific techniques for brain integration. Dan Siegel created “the wheel of awareness,” for helping clients to stimulate neuronal activation and growth. Another technique is called HEAL where H = positive experience, E = enrich it, A = absorb, and L = link it with positive and negative experiences.
Techniques related to the client’s emotional state
For the fourth category of neuropsychotherapy, particularly around cultivating hope and self-efficacy, I will use strengths-based approaches. There are “seven areas of competence that are empirically correlated with resilience and might serve as foundations for resilience: (1) good health and an easy temperament; (2) secure attachment and basic trust in other people; (3) interpersonal competence including the ability to recruit help; (4) cognitive competence that encompasses the ability to read, capacity to plan, self-efficacy and intelligence; (5) emotional competence including diverse emotional skills such as the ability to regulate one’s emotions, delay gratification, maintain realistically high self-esteem and employ creativity and humor to one’s benefit; (6) the ability and opportunity to contribute to others; and (7) holding faith that your life matters and life has meaning, including a moral sense of connection to others,” Padesky, C. A., & Mooney, K. A. (2012).
Why is resilience so important? In Dr. Dan Siegel’s neuroscience model, the prefrontal cortex is responsible for regulating emotions, specifically by using resilience not blocked by fear or shame. In a neuropsychotherapy model, building resilience is a critical component for helping the client with emotions and using strengths to build resilience is an empirically-validated process for doing so.
To draw upon techniques that not only focus on client strengths, but are also effective in diverse populations, I use strengths-based solutions therapy techniques. “When providing therapy for Asian populations, social workers may consider using SFBT because studies suggest that SFBT is being successfully applied in diverse Asian countries, such as Taiwan, China, Japan, and Korea, with promising results,” Franklin, C. (2015).
Beyond these techniques, ACT techniques will be used to help the client deal with difficult emotions. ACT posits that “private experiences such as thoughts and emotions are viewed as not causing other behaviors, except under the influence of context, which suggests therefore that it is the context rather than the content of such experiences that should be addressed in the therapy,” Bolderston, H. (2013). In essence, ACT sees people imprisoning themselves in their internal dialogue and fusing themselves to specific outcomes or emotions. By recontextualizing, or looking at the thoughts from other perspectives, ACT attempts to allow clients to accept their thoughts and emotions but create distance from them by looking at their cognitions from different perspectives.
What is Neuropsychotherapy? Conclusion
To summarize, my primary model of treatment is neuropsychotherapy. There are four categories of techniques in this model and I draw upon several evidenced-based techniques from other models as well using techniques created specifically from neuroscientists who are clinical practitioners such as Dan Siegel. I’m not considering this a completely integrated model because I will follow the prevailing guidance of the neuropsychotherapy model and add and subtract other techniques as evidence produces new awareness around what works and what doesn’t.
Nevertheless, regardless of what we discover in neuroscience, there’s nothing more important to the individual than their own experiences of life. No mechanical explanation of the brain, body, or mind can replace that. Cognitive science, nor any other mechanistic breakdown of experience, will substitute for how each person experiences life. Using these techniques to describe life can similarly be thought of as breaking down the technique of a painting brush stroke by brush stroke. While that exercise can elucidate how the painting was created, it is no replacement for the experience of taking in the painting itself as a whole. While an examination of technique can lead to breakthroughs in artistic technique, there’s something bigger than the technique which makes a particular piece of art what it is. This is why I still feel that an existential view of therapy is preeminently important. I can tell someone what the results of an fMRI means, or what parts of their brains are doing what, but that information is still second fiddle to how that person is experiencing life. Neuroscience will provide heuristics for more research that will no doubt prove useful, but we cannot forget that technology and science isn’t a replacement for how we each experience life as human beings, no matter what the brain scans say. If this stance seems contradictory to my choice of neuropsychotherapy as my primary model, then so be it. We must use science to guide our research, but science is only one perspective. The most important perspective is how each of us experiences life as a human.
What is Neuropsychotherapy? References
Adam, D. (2013). Mental health: On the spectrum. Nature, 496(7446), 416-418. doi:10.1038/496416a
Bolderston, H. (2013). Acceptance and commitment therapy : cognitive fusion and personality functioning.
Bruce, A., Schreiber, R., Petrovskaya, O., & Boston, P. (2011). Longing for ground in a ground(less) world: a qualitative inquiry of existential suffering. BMC Nursing, 10(2).doi:10.1186/1472-6955-10-2
Ekman, P., Davidson, R. J., Ricard, M., & Alan Wallace, B. (2005). Buddhist and Psychological Perspectives on Emotions and Well-Being. Current Directions In Psychological Science, 14(2), 59-63. doi:10.1111/j.0963-7214.2005.00335.x
Franklin, C. (2015). An Update on Strengths-Based, Solution-Focused Brief Therapy. Health & Social Work, 40(2), 73-76.
Gurda, K. (2015). Emerging Trauma Therapies: Critical Analysis and Discussion of Three Novel Approaches. Journal Of Aggression, Maltreatment & Trauma, 24(7), 773-793. doi:10.1080/10926771.2015.1062445
Henriksson, J., Wasara, E., & Rönnlund, M. (2016). Effects of Eight-Week-Web-Based Mindfulness Training on Pain Intensity, Pain Acceptance, and Life Satisfaction in Individuals With Chronic Pain. Psychological Reports, 119(3), 586-607. doi:10.1177/0033294116675086
National Institute of Mental Health Abandons the DSM. (2013). Contemporary Sexuality, 47(5), 11.
Padesky, C. A., & Mooney, K. A. (2012). Strengths-Based Cognitive-Behavioural Therapy: A Four-Step Model to Build Resilience. Clinical Psychology & Psychotherapy, 19(4), 283-290. doi:10.1002/cpp.1795
Ricard, M., Lutz, A., & Davidson, R. J. (2014). Mind of the meditator. Scientific American, 311(5), 38-45.
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