Monday, April 15, 2013

Neuroscience and Psychoanalytic therapy

In his talk How Understanding Some Neuroscience Can Increase Empathic Attunement on April 13, 2013, Max Harris, PhD presented to the Tampa Bay Psychoanalytic Society on ways neuroscience informs our clinical work. We now understand that mother’s right brains develop their babies’ right brains, in regulation of emotions and coordination of intentions. It is hopeful to know that psychotherapy, too, confirmed by neuroimaging, also can modify neuronal networks. This is due to the plasticity of the brain, and brought about partly through modification of dendritic branching (growth of new connections or pruning of older ones). New experiences rearrange neural networks!

Relational Trauma can come about from abuse, neglect, or chronic misattunement. Trauma, through the HPA (hypothalamic-pituitary-adrenal) axis, can decrease blood flow to the hippocampus and increase it to the amygdala, such that language and context are decoupled from  sensory and procedural memory, and dissociation can ensue. (Trauma can also turn genes on and off via methylization.)  Dissociated experience, often a result of dysregulation of affect, of the patient or the analyst may be communicated through a co-created enactment. This dyadic dissociative process can vitiate reflective function.   The therapist , using self regulation, can serve as ‘container’ (Bion) in helping to regulate patient affect.

Because there are cortical (cognition) connections to the subcortical limbic system (emotions) and limbic connections to the gut (with its chemical messengers the same as some neurotransmitters) and body via vagal nerve, Harris reminded therapists to attend to facial and bodily expressions and right brain, nonverbal  communications, including one’s own.  Mirror neurons may also be a mechanism by which we can feel our way into others’ experience. Harris enumerated three aspects of empathy:  Reflective, Affective, and Intersubjective: the thinking about experience through reflective function, mentalization and theory of mind; vicarious affective matching where one feels oneself into the experience of another; and the intersubjective, where therapist and patient negotiate experience through shared dialogue. Empathic attunement, then, relies on the social right brain, mirror neurons, the parasympathetic and enteric systems’ emotional experience, as well as on the left prefrontal cortex’s reflective function. 

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