Change Mechanisms from Underneath?

What are the problems psychotherapy addresses and how do they change?

Posted Apr 29, 2020

chrissie-kremer, Unsplash
Source: chrissie-kremer, Unsplash

At the Society for the Exploration of Psychotherapy Integration, there has been a conversation about consensus sparked by Dr. Marv Goldfried, a leader in the field, who asks: “ON WHAT CAN WE AGREE ABOUT HOW THERAPY WORKS?

Goldfrield also made the intriguing proposal that the organization change from the Society for the Exploration of Psychotherapy Integration to the Society for the Evolution of Psychotherapy Integration. 

As leaders of SEPI's Convergence Special Interest Group, we support this kind of discussion. We believe that there may already be broad agreement about some basic principles. We want to hear what SIG members and others think. 

Starting from the bottom, we believe that the targets of psychotherapy are maladaptive patterns of response, especially those that are entrenched enough to require professional help.

We are aware of three mechanisms by which change in maladaptive or inadequate patterns can occur in psychotherapy. Importantly, each has been demonstrated to be correlated with neuronal change; thus, they can be deeply connected to the neurophysiology of the brain.

  1. Where existing patterns are maintained due to lack of knowledge of better responses, the change process is new learning, experiential, or cognitive.
  2. Extinction (as demonstrated in work on learned fear) is a process whereby cortical learning causes inhibitory signals to be sent to subcortical areas where maladaptive responses are inhibited before they find outward expression.
  3. Memory Reconsolidation is the only known means by which neural networks can be permanently updated when activated and simultaneously exposed to prediction error (PE) in the form of corrective information or experience.

In addition to these foundational learning mechanisms, there is also significant agreement about the personal and interpersonal context for these changes to take place.

First, whether or not change happens is very much dependent on the attitude and stage of change that the client is in. Clients who are hopeful, open, and ready for change are much more likely to engage in new learning than those who are not.

Second, the therapeutic alliance provides the relational context for these foundational mechanisms to occur. The alliance includes the quality of the relationship, the shared understanding of what the problem is, and agreement about the kinds of interventions and tasks that will be helpful. Strong alliances foster effective foundational learning processes, whereas weak alliances do not.

There is, of course, much more to be said about the process of psychotherapy and the mechanisms that make it effective. Nevertheless, we believe that there is emerging consensus on both the foundational, brain-based learning mechanisms and the key relational processes that determine what works in psychotherapy.

We would like to hear what you think. Please use the "thought bubble" icon below to register your comment.