Is neuroscience an existential threat to psychotherapy and practice?

UKCP is developing a new strategy to guide our work for the next three years. We want this strategy to reflect a shared vision for UKCP, so we're talking to our members about important areas of our work and current issues that could affect the profession.

We asked writer and journalist Grace Browne to speak to experts in neuroscience to understand how neuroscience relates to psychotherapy and whether it poses a threat or benefit to the profession.

Neuroscience and therapy

The father of therapy himself was trained in the science of the brain before turning his hand to pure psychology. In the autumn of 1895, Sigmund Freud began to write Project for a Scientific Psychology, described as ‘a psychology for neurologists’, in which he attempts to ascribe neural mechanisms to psychodynamic concepts. Freud ultimately gave up on the project and never published the manuscript during his lifetime. Still, he hoped that one day, his hypotheses would be replaced by neuroscientific concepts; he later stated in 1914 that ‘all our provisional ideas in psychology will presumably someday be based on an organic substructure,’ consisting of ‘special substances and chemical processes.’

A little over a century later, some of Freud’s predictions have indeed come true. We know a great deal more about the brain, and advances in neuroscientific research in the last few decades have become impossible to ignore in the therapy field. The last decade has seen a growing call for a merging of the two. As neuroscience continues to advance, some may wonder whether psychotherapy will remain relevant.

Indeed, a discipline has emerged at the intersection: the field of neuropsychoanalysis is a synthesis of the clash between the old Freudian guard and cutting-edge neuroscientific theories. ’Neuropsychoanalysis seeks to understand the human mind, especially as it relates to first-person experience. It recognises the essential role of neuroscience in such quests. However, unlike most branches of neuroscience, it positions mind and brain on an equal footing,’ is how its founder, Mark Solms, a South African neuropsychologist and psychoanalyst, describes it.

At first blush, the two fields seem diametrically opposed, siloed off from one another. On one hand, you have the rational, evidence-based, empirical trenches of neuroscience. On the other, the amorphous, ineffable mode of therapy. It’s a debate that stretches back to ancient Greece, where some philosophers argued a materialist view – that the functions of our mind are determined by the electrochemical processes running through our brain cells – versus the personalist view, which dictates that our minds and egos can be traced back to ourselves.

‘It's the age-old problem in a sense, the mind-body problem,' says Oliver Turnball, a professor of neuropsychology at Bangor University and the first student of Solms at the inception of the discipline. ‘It's not a matter of proving Freud right or wrong, but finishing the job. And the job is, what is the brain basis of these powerful states that motivate and drive us?’

It wasn’t until much later, after Freud’s initial efforts, that scientific research did in fact begin to uncover some of his predictions. Neuroscience began to take centre stage as more research money was funnelled into it. The nineties were dubbed the decade of the brain by US President George Bush. Then came along the neuroscience of feelings: the field of affective neuroscience, coined by Estonian-American neuroscientist and psychobiologist Jaak Panksepp in the early 1990s, hinges on the idea that our emotions, both good and bad, can be explained by underlying brain mechanisms.

The biomedical model

Nearing the end of the twentieth century, neuroscientist and Nobel Prize winner Eric Kandel published his seminal paper, ‘A New Intellectual Framework for Psychiatry’, in which he argued that current biological thinking about the relationship of mind to the brain could provide a new framework for modern psychiatry.

In the United States, under the leadership of psychiatrist and neuroscientist Thomas Insel for over a decade, the National Institute of Mental Health underwent a paradigm shift. It moved towards a neuroscientific- and genetic-based model of mental health: its Strategic Plan for Research stated that ‘fundamental to our mission is the proposition that mental illnesses are brain disorders expressed as complex cognitive, emotional, and social behavioural syndromes.’ Insel penned an editorial in 2015 for New Scientist magazine entitled ‘Psychiatry Is Reinventing Itself Thanks to Advances in Biology’, which asserts that mental illnesses such as depression and schizophrenia are brain disorders related to physiological changes rather than simply behavioural ones.’

The biomedical model of mental disorders dictates that psychological problems can be attributed to diseases of the brain, just like heart disease or diabetes. It instils the idea that if there’s a cause, there’s a cure. Indeed, this approach has been found to reduce blame towards people suffering from these conditions from both their clinicians and themselves.

Buckets of funding and grant money were poured into research that investigated the biological mechanisms and treatments of psychiatric problems. Billions of research money later, however, the journey remains unfinished: we’ve not yet replaced psychological data with corresponding biological indices.

Within the biomedical model of mental illness, there has also been growing criticism of the pop-a-pill attitude to patients in recent years. During the pandemic, prescriptions for antidepressants in England hit an all-time high. Around 26 percent of British adults are prescribed psychiatric drugs each year. But in a country where waiting lists for therapy can stretch to years, some clinicians may feel they don’t have an alternative when faced with a struggling patient and few resources.

The idea of finding a ‘magic pill’ that could cure mental health issues by altering brain chemistry is an enticing one. Could it be that one day, psychopharmacology could overtake and replace psychotherapy? Peter Afford, a psychotherapist and author of Therapy in the Age of Neuroscience doesn’t think so: ‘If medication was to be a serious threat to the practice of therapy, it would have happened already – and it hasn't,’ he says. Pills may help manage symptoms, but they do not address the underlying issues, such as unresolved trauma, dysfunctional thought patterns, or maladaptive behaviours, that contribute to mental health problems. Therefore, a combination of medication and psychotherapy often yields the best outcomes.

Neuroscience’s application in therapy

Neuroscience insights have begun to enter the therapy room. For instance, advances in attachment theory are particularly relevant to practising therapists.

Dan Siegel, the executive director of the Mindsight Institute and founding co-director of the Mindful Awareness Research Center at UCLA, has led groundbreaking work in interpersonal neurobiology, or IPNB – also sometimes known as relational neuroscience. IPNB is the study of how your brain works and develops throughout your life as a product of the relationship between the body, mind and relationships. It can potentially deliver more biologically precise explanations of brain processes and uncover new insights into how the healthy brain functions and the mechanisms behind diseases.

Internationally, renowned neuroscientist-clinician Allan Schore has spent much of his career focused on exploring the impact of early brain development. In particular, he has argued that the right side of our brains is where the emotional epicentre lies. According to Schore, the right brain represents the psychobiological substrate of the human unconscious that was first articulated by Freud. He also has pioneered work in the parent/child relationship. This work led to his idea of regulation theory, an interpersonal neurobiological model of the development, psychopathogenesis, and treatment of the implicit subjective self. He also promoted the concept that early infant brain development occurs in the context of a relationship with the brain of another – the caregiver – which encompasses the foundation of regulation theory. ‘At the core of the theory, the developmental processes of intersubjectivity represents the communication of emotion, while attachment represents the regulation of states of affective arousal,’ he writes. These formative interactions tend to be nonverbal–nonconscious affect regulation wherein the caregiver instinctively responds to the nonverbal emotional cues of the infant's psychobiological state, helping it to regulate its internal state. With that in mind, when an infant fails to form the necessary attachment relationship with its primary caregiver, it can have resounding negative impacts on the baby’s ability to form healthy coping strategies later on in life.

Is neuroscience reshaping psychotherapy?

The work of experts such as Schore and Siegel has reshaped therapy as we know it. As the psychotherapist Aline LePierre wrote about the significance of their theories, ‘viewed from the perspective that all forms of psychological disorders are marked by affective dysregulation, and all forms of psychotherapy are forms of affect regulation, the therapist can be seen as a psychobiological regulator of the patient’s affective states.’

Following on from Schore and Siegel’s work, the American psychologist and professor of psychology Louis Cozolino employs neuroscience to support the idea of using psychotherapy as a way of rebuilding the brain. In his 2002 book The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, Cozolino once again challenges the idea of the brain as an entity that becomes impervious to change and instead promotes it as an agent of change. His takeaway is that psychotherapy can help individuals expand their neural organisation to help inhibit and regulate affect.

What do these insights mean for working therapists today? These advances have influenced the work of Graham Music, a consultant child and adolescent psychotherapist at the Tavistock and Portman Clinics and an adult psychotherapist in private practice. For instance, he is ‘constantly aware’ of his embodied response to his patients – the idea that our bodies have somatic experiences during a therapeutic encounter through the mind-body connection. ‘If somebody's very excited, if I feel my heart racing … quite often it’s because I picked something up in their nervous system,’ he says.

Echoing this interest is Afford, who ran courses for practising therapists called ‘Neuroscience for Therapists’, based on material in his book. Afford began his journey into neuroscience literature in the late 1990s when he stumbled upon a book called The Feeling of What Happens, written by scientist and clinician Antonio Damasio. In his bestseller, Damasio explores the origin of our emotions and what it means to be conscious. ‘I got hooked,’ Afford says. But Afford thinks the insights wrought by neuroscience haven’t integrated into the world of therapy as much as it could. And that’s despite his best efforts; he’s spent almost two decades teaching how neuroscience and therapy intersect to both qualified counsellors and students.

One example of how neuroscience research influences his practice is his integration of polyvagal theory. Developed in the 1990s by Stephen Porges, a professor of psychiatry at the University of North Carolina, it describes the role our nervous system plays in emotion regulation and responding to certain situations, such as stress, danger or safety. In particular, it pointed to the pivotal role that the vagus nerve – the main component of the parasympathetic nervous system – plays in regulating our responses to stress and social interactions. Therapists have incorporated these insights into understanding and working with patients dealing with trauma and to centre the mind-body connection. This movement was solidified through the work of Bessel van der Kolk, author of the massively successful book The Body Keeps the Score and who, in 1985, proposed the first neurobiological model of PTSD. His book espouses the idea that no matter what we may think or say, our physiology maintains the scars of past trauma.

Some therapists have introduced a psychotherapy intervention called eye movement desensitisation and reprocessing, or EMDR, as a treatment for trauma. It involves the patient engaging in bilateral stimulation—often moving their eyes a specific way—as they focus on a traumatic memory. The bilateral stimulation serves to reduce the vividness and emotion associated with the trauma memories. EMDR purports to anchor the brain in the current moment as a patient recalls the past and reduces the impact of negative memories.

Although appreciation for the mind-body connection in therapy has increased in recent years, neuroscience will never fully revolutionise therapy, Afford says, because 'you can only make psychotherapy scientific up to a point.’ Afford says. 'It's an art.' Something he says to his students is 'that you've got to treat neuroscience differently from all the psychology books – you can't argue with it the way you can argue with psychology.’ A common attitude that Afford sees as a misunderstanding is that neuroscience is another model for psychotherapy. 'It's a whole different body of knowledge to refer to all the models of therapy,' he says.

Bringing neuroscience-derived insights into the psychotherapeutic practice offers valuable opportunities for enhancing mental health treatment. By understanding the brain’s role in psychological processes, therapists can develop more targeted and effective interventions and help clients achieve better outcomes by aligning therapy with the brain's natural capacities for change and healing.

'People will ask me: Okay, what does neuroscience say I should be doing or not doing in the therapy room?' Afford says. To him, that’s the wrong question.' Neuroscience doesn't and cannot say what you should or shouldn't be doing. You've got to learn some neuroscience and figure it out for yourself.'

Now you’ve read this piece, we have a few questions we’d love your thoughts on:

Do you agree with the current direction and advancements in neuroscience?
Have you seen neuroscience integrated into psychotherapeutic practice?
What impact do you think neuroscience is going to have on psychotherapy in the future?

Please share your views in an email to startegy@ukcp.org.uk.

For more information on the UKCP strategy, please visit our strategy webpage.