Therapy: an Artful Science?

There was a time when it was difficult to see how Art and Science could work together to shape the world of therapy.

Sigmund Freud,  a medic by training, wanted to create a scientific perspective on how people with psychological and emotional issues might be helped.  This proved tricky given the level of understanding of neuro-science at the turn of the 20th century.  As I hear it, he would have loved to have been a 21st century neuro-scientist but he arrived before his time. Consequently, he filled the unavoidable gaps in his understanding with metaphors and stories – often from Greek mythology. Fortunately, he got some results and a school of therapy was born –  it was called psycho-analysis.

However, the success rates obtained by therapy, and from all the ‘schools’ that followed on from Freud, stubbornly refused to improve over the decades. Fortunately, neuro-science made rapid progress and helped to build bridges.

Today, it seems to me, the sciences and the arts informing ‘good’ therapy are coming closer together. Neuro-science, in particular, has established that ‘neuro-plasticity‘ means humans can make internal changes to their neural architecture more readily than was once supposed.  Neurons may remain much the same, but the connections they create are many and varied – and changeable.

For information, ‘neuroplasticity’ is a term that refers to the brain’s ability to change and adapt as a result of experience;  neuro-  refers to our neurons – the nerve cells that are the building blocks of the brain and nervous system. Plasticity refers to a malleability in our neural networks.

These more modern findings help to make it evident that the connections between two people – a necessity in therapy – are complicated. Two times 80 billion neural connections: Wow. Even so, such connections make up a ‘relationship’.  The good news is that effective therapy requires a very individual approach to understanding how any one relationship emerges. We can study these processes by noticing how effective and fragile relationships compare. Fragile relations are less able to absorb or shape change.

It is evident, as well, that ‘neuroplasticity’ enables people to recover, at least to some extent, from strokes and brain injuries. If it can do that, then it should enable people to change in therapy.  This presents a problem: if our ‘plastic’ frontal lobes, and lower brain, enable change outside the therapy room then is ‘life’, alone, the good therapist. Is the therapy experience just a small part of that life change? Is the 6 days and 23 hours not spent in the therapy room more important than the therapies on offer or as therapy trainers might think?

Even so, It seems to me that there is something special about the therapy room; it offers something that is different – not easily found in other areas of our lives, e.g. a shared, non-judgmental reflection.  This active process brings art to therapy as well as science. It starts with some values, and art and science both have them!

Consider this: what is non-judgmentalism? Therapy may depend on it, but science requires something different; ‘good’ judgment in the design and implementation of the respectable scientific experiment?

 

It’s not even that therapists have special knowledge and skills; solicitors and doctors have all this. True, knowledge and skills can make a difference, but only so far. The key difference is that good therapy depends on creating a very unusual relationship – one in which wisdom and hope are shared.  Most relationships in the ‘outside’ world comprise two egos negotiating their way around conflicting needs and interests.

The effective therapeutic relationship melds those two egos into a very different working alliance. This melding consists of a constant tension which subordinates ego to the relationship to a different relationship: you-and-me.  It’s a meld that respects who can contribute what by shaping and respecting boundaries between one another. BUT it does this negotiation of those boundaries without laying claim to the territory. In the outside world there can be too much uncertainty about my boundary with you. There can be too much conscious or unconscious temptation to claim territory.  In the everyday, it is too easy simply to put our blanket on the ground and claim it as ours. One of the problems with model building I mention a great deal, is that it is a good example of putting the blanket on the ground and reminding folk to whom it belongs.  This is fine, if you are all spread out on Rhossili beach in South Wales, but not so helpful at Brighton in July and August.  Even at Rhossili it can be an abuse of power and it takes discipline to avoid such abuses. Many folk fail at the task.  In the wider world, the police help sustain the boundaries; in the world of therapy it is an unknown that needs attention.

The Evolution of Neural architecture

The answer seems to lie in mammalian and human history. Like Stephen Porges, Peter Afford, in Therapy in the Age of Neuroscience, says that brains have evolved from the bottom up, with new bits added as needed, and old bits conserved and continuing to evolve.  Rather like Windows, the add-ons have not always worked well and there was seemingly no option to start again. I understand that evidence of The Flood suggest that God tried – maybe more than once, but it seems humans have still got a tricky Operating System.

Afford, and others, suggest an exploration of the brain’s architecture along three axes: the vertical from top to bottom, the horizontal from front to back, and the horizontal from left to right.

Elsewhere, I have presented maps of the ‘bits’, including  comments on the ‘reptilian’ and ‘mammalian’ brain, as popularised by MacLean (1990).