How does what we are learning about the brain influence the practice of psychotherapy?

There’s a revolution sweeping through the field of psychotherapy.  Over the last 10 years with the advent of high tech brain imaging techniques such as CAT scans, fMRI and PET scans researchers are now able to look into living, thinking brains and are learning things that are causing people to reevaluate what psychotherapy is and what is possible to accomplish in psychotherapy.

The conventional wisdom was,  that by the time a child reaches their 3rd or 4th birthday the brain that they have is the brain that they will have for the rest of their life.  Based on this assumption all a person could do was learn to make the most of the brain that they had.  Luckily, we now know that this is not true. The brain is now recognized as being plastic (changeable).  Our thoughts and experiences impact the brain by creating connections which over time and through repetition become stronger and stronger.  The Canadian neurologist Donald Hebbs stated it succinctly when he said that “Neurons that fire together wire together.” That’s what learning is all about.
Anyone who’s practiced a sport knows that the more one practices, the more automatic and quicker the response will be.  At first the behaviour starts out feeling awkward but over time it becomes so familiar that it feels natural and practically automatic.

This is true in every area of our lives.  We learn over time what to expect from ourselves and other people. It’s so automatic that we don’t even question these assumptions.  To take the analogy a bit further, imagine that the athlete, perhaps a tennis player has a flaw in her forehand.  Her coach identifies that this flaw prevents her from reaching her potential so he gets her to consciously slow down and practice doing it the right way.  It’s frustrating and while she’s relearning how to hit a forehand she’s playing worse.  Ultimately though, when the new motion becomes wired in she can play better than before. In this case her brain has rewired itself with the practice of the new motion.

This is what happens in therapy. A person may react in an automatic way that creates problems.  Perhaps the person over reacts in certain situations or fears situations that don’t warrant fear. The therapist’s job is to help her client to reevaluate her reactions and to practice feeling, thinking and behaving differently.  Over time the old reactions are replaced by new more appropriate responses.  This is one reason why effective  psychotherapy takes place over a period of time, perhaps months or years.  The term we use for brain change over time is neuroplasticity.

Choosing a Therapist

Choosing a Therapist is a big decision and there are lots of factors to be considered.

Should I see a psychiatrist, a psychologist, clinical social worker?  Should I see a man or a woman? How much does experience play a role? Should I see a Therapist who specializes in what I think is my problem is or in the type of treatment I think I need?  What about family therapy, couples therapy, psychodynamic therapy, interpersonal therapy?  I think you get the picture. Choosing a therapist can be very a very complicated and confusing problem. But, perhaps it doesn’t have to be. Let’s try and simplify things a little.

 All of the factors that I’ve listed are important, but, they are all secondary to one simple yet profound fact, which is consistently borne out by the research. That one simple fact is, that the best therapist is the one who you feel most comfortable with. 

Think of it this way; if you were going into surgery all you want is the best trained surgeon. The one who has done your procedure a thousand times before. It doesn’t matter if he’s a nice guy or a jerk since you are  asleep through the process.  Psychotherapy is profoundly different and at its heart it is a collaborative process.You and your Therapist work together to figure things out - to explore your inner life. What matters most is that when you walk into that office,  you feel that you have a partner whom you can trust and who makes you feel like you’re not alone with your struggle.

Here’s another important fact.  Some people will tell you that cognitive behavioural therapy is the most effective therapy.  It has been said over and over to the point where even people in the field believe it to be true.  The truth is that it’s not any better that other forms of therapy.  At the end of the day, what matters most is the ability of the therapist, not the school of psychotherapy.  Its like saying that research has proven definitively proven that Italian cuisine is more satisfying than French cuisine.  Any reasonable person would think that that research was absurd.  Doesn’t the ability of the chef matter? How about the customer’s preferences?

So, after over 25 years in this field, this is my advice about choosing a Therapist.  Spend a session with a them and at the end of the hour (or fifty minutes) ask yourself these questions: Do I feel as though the therapist understood me?  Do I feel safe and secure with this person?  Do I have a better understanding of my dilemma than I did before? Do I feel that I’m being seen as a whole person or am I merely being seen as a symptom?  If you can answer yes to these questions, then you’ve got  a good start.  If you can’t answer yes with confidence maybe you should keep looking until you find a better fit. Remember, psychotherapy demands a significant investment in time and money and emotion.  Make sure that you give yourself the best chance of making it a positive experience.

How to choose a Therapist

Let’s begin a conversation about how to choose a therapist and start by clarifying some terms that you may run into in your search.

People often ask us, “What’s the difference between a psychotherapist and a psychologist?”  This question often comes up when people are looking at their Insurance benefits which may reimburse professionals from one discipline and not another.

Psychotherapist is a generic term, meaning that its not specific and it can be done by anyone from any background or discipline. Generally, psychotherapy is provided by clinical social workers, clinical psychologists and psychiatrists. While psychotherapy can be done by may others from diverse fields of study, we will confine our conversation to the difference between these three disciplines.

Think of psychotherapy as a specialized kind of conversation that requires specialized training.  Not every social worker, psychologist or psychiatrist provides psychotherapy.  Most social workers do other kinds of work.  Many psychologists do research or provide testing and most psychiatrists these days are trained in diagnosing and medically treating psychiatric disorders. They are also able to prescribe medication. The term “clinical” before social worker or psychologist means that this particular individual has specialized training to provide psychotherapy.

So this raises the question, “What’s the difference between a clinical social worker and a clinical psychologist for the average person seeking psychotherapy?” The answer is, a lot and not too much.  Let me explain.  Psychologists are trained as scientists.  In their extensive training they spend a lot of energy doing research, studying statistics and doing what only they are specifically trained to do - psychological testing.  They also learn to do psychotherapy.

Social workers on the other come out of different orientation.  Social workers are trained  
to study people in their environment.  Clinical social work is based on helping people to adapt to changes in their family and community. Clinical social workers who provide psychotherapy focus on the emotional aspect of coping with change.

In the day to day reality though, the difference between psychotherapists is generally based less on whether the therapist is a psychologist or social worker and more on the personal qualities of the therapist. More on that in our next post.