25/10/2021
đżâWe would rather be ruined than changed" (W.H. Auden). đż
Excellent article exploring how therapy actually works - suggesting the answer may lie with attachment theory and the right hemisphere. Great to see the work of Jeremy Holmes, Peter Fonagy, Allan Schore, and John Bowlby referenced.
âEarly interactions with caregivers can dramatically affect your beliefs about yourself, your expectations of others, and how you cope with stress and regulate your emotions as an adult.
When you delve into it, the question of how people change through therapy can make your head swim. Hereâs a psychological intervention that seems to work as well as drugs (and, studies suggest, possibly better over the long term), and yet what is it, precisely, that works? Two people sit in a room and talk, every week, for a set amount of time, and at some point one of them walks out the door a different person, no longer beleaguered by pain, crippled by fear or crushed by despair. Why? How?
Things get even more puzzling if you consider the sheer number of therapies on offer and the conflicting methods that they often employ. Some want you to feel more (eg, psychodynamic and emotion-focused approaches); others to feel less and think more (eg cognitive behavioural therapies, or CBT). Across more than 400 psychotherapies available today, your shrink can take the form of a healer, a confidante, a clinical expert, a mental-fitness coach or any combination, shade and hue of these.
To complicate matters, numerous studies over the past few decades have reached what seems a counterintuitive conclusion: that all psychotherapies have roughly equal effects. This is known as the 'dodo bird verdict' â named after a character in Alice in Wonderland (1865) who declares after a running contest: 'Everybody has won and all must have prizes.'
That no single form of therapy has proved superior to others might come as a surprise to readers, but itâs mightily familiar to researchers in the field. 'There is so much data for this conclusion that if it were not so threatening to specific theories it would long ago have been accepted as one of psychologyâs major findings,' writes Arthur Bohart, professor emeritus at California State University, Dominguez Hills, and author of several books on psychotherapy.
Even so, this alleged equivalence among various therapies is a product of statistics. It says nothing about what works best for each specific individual, nor does it imply that you can pick any therapy and obtain the same benefit.
A lot of researchers, however, believe that this is not the only explanation. For them, the deeper reason why no single psychotherapy seems to provide unique advantages over any other is that they all work because of shared elements. Chief among these is the therapeutic relationship, connected to positive outcomes by a wealth of evidence - The emotional bond and the collaboration between client and therapist.
According to Holmes, Bowlby saw in attachment theory 'the beginning of a science of intimate relationships' and the promise that 'if we could study parents and children, and the way they relate to each other, we can begin to understand what happens in the consulting room' between client and therapist.
Early interactions with caregivers can dramatically affect your beliefs about yourself, your expectations of others, and how you cope with stress and regulate your emotions as an adult.
Research on attachment theory suggests that early interactions with caregivers can dramatically affect your beliefs about yourself, your expectations of others, and the way you process information, cope with stress and regulate your emotions as an adult.
A similar process occurs in therapy. After a while, clients internalise the warmth and understanding of their therapist, turning it into an internal resource to draw on for strength and support. A new, compassionate voice flickers into life, silencing that of the inner critic â itself an echo of insensitive earlier attachment figures.
But this transformation doesnât come easy. As the poet WH Auden wrote in The Age of Anxiety (1947): 'We would rather be ruined than changed.' It is the therapistâs job, as a secure base and safe haven, to guide clients as they journey into unfamiliar waters, helping them stay hopeful and to persist through the pain, sadness, anger, fear, anxiety and despair they might need to face.
Over the past three years, Iâve talked to dozens of therapists from various schools, trying to understand how therapy works â and by this I mean 'heals'.
According to Schore, over time the nonverbal attachment communications from the therapist can become imprinted into the clientâs right brain, revising stored coping patterns, and giving rise to more flexible and adaptive ones.
The chief value of psychotherapy, Fonagy says, lies in its potential to rekindle our epistemic trust and jumpstart our ability to learn from others in our social environment. By restoring attachment security, therapy lowers our social vigilance and opens us to trusting one person â the therapist â which eventually allows us to go out into the world and trust other people."
Why therapy works is still up for debate. But, when it does, its methods mimic the attachment dynamics of good parenting
