I'd like to discuss what therapists do for a living--talk therapy. And I'd like to suggest something heretical--that calling it "talk therapy" misrepresents and grossly undervalues what you do. It may even mislead others about what psychotherapy is and how it affects people. "Talk therapy" makes it sound as if words issue from your mouth or the client's and then dissipate in the air around you. As if, as the saying goes, it's cheap--you know common stuff.

WHAT'S TO TALK ABOUT?

This is something I've been thinking about for some time. But the idea really crystallized for me a week or so ago. I was at the Saturday morning Neuro-Psychoanalysis Lecture Series held monthly at the New York Psychoanalytic Institute. New York University neuroscientist Joseph LeDoux had just made a presentation on the amygdala and the emotional brain. He focused on fear memories and how they are not just one-time inscriptions in our brain. Instead, they are reconsolidated and rebuilt every time they are retrieved.

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WHAT REALLY GOES ON

As the discussant, international neuroscientist-psychoanalyst Mark Solms, Ph.D., director of the institute's Neuro-Psychoanalysis Center, pointed out; this new view of memory suggests a way to get conscious control of a powerful but unconscious emotion-generating system. "Knowledge of reconsolidation," said Solms, "opens the possibility of retranscribing memories." And then he said what really started a chain of thoughts in my brain. He was talking about psychoanalytic therapy, but he could have been talking about any deeply engaging psychotherapy.

"Psychoanalytic therapy is not just talk therapy but involves reactivation of the emotion. Maybe we should call it transference therapy." Through sensitive, ably guided discussion, emotional memories can be thoroughly processed. That way, they are modulated during retrieval so they are not lodged forever under a rock in the amygdala, where they drive behavior without understanding or consent.

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THE SCENE OF THE ACTION

In other words, good therapists use transference-generated emotions to help a client learn new associations around a distressing memory. They can do this repeatedly, until the troublesome memory is extinguished. This doesn't take place in the air. Through the medium of talk, the brain itself undergoes change. Every time a memory is retrieved, it is synthesized and rebuilt in line with kindler, gentler associations with what is going on at the time. Genes snap to attention, fancy neurotransmitters and nuclear proteins swing into action. Nerve reactivity and circuitry is altered. This, ladies and gents, is classy stuff, and it sits right at the cutting edge of science.

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GOING FIRST CLASS

Talk therapy has privileged access to the brain. It works its changes on nothing less than the cortex, the thinking brain. Cognitive behavioral therapy, for example, teaches people to change how they monitor the environment, so they do not need to emotionally react to everything negative that comes their way. Brain scans show that talk therapy literally changes blood flow and metabolic activity in the cortex. By changing the brain from the top down, as it were, it has effects that last long after the therapy is finished, protecting against relapse into distress in a way that drugs can't, because they don't re-educate the brain.

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WHEN ONLY TALK WILL WORK

So privileged is the access that talk therapy has to the brain that sometimes it's the only thing that works. Last year, a large multicenter randomized controlled trial of psychotherapy versus pharmacotherapy showed that talk therapy works in some of the most difficult cases of depression, for example, whereas drug therapy does not. It is singularly effective for those with a history of early childhood trauma, such as loss of parents at an early age, physical or sexual abuse or neglect. "Psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma," the researchers reported in the Proceedings of the National Academy of Sciences. And it is so essential because some distressing memories can be safely accessed and reprocessed only via talk therapy.

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CALLING IT WHAT IT IS

That leads to the obvious conclusion: It isn't just talk therapy. Done well, its brain therapy.  And, yes, mind therapy. And emotion therapy. Memory therapy. And, as Mark Solms said, transference therapy. It's all about the hottest thing in neuroscience today--brain plasticity. I just want to make sure you are as much in awe of the magic a therapist can do as I am.
 

Hara Estroff Marano
Editor at Large, Psychology Today
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