Monday, 10 November 2014

Neuropsychotherapy


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    Neuropsychotherapy


Acknowledging and validating Freud's psychoanalytical concepts, and based on recent neuroscientific research, Neuropsychotherapy is one of the current integrative approaches that provides a deep understanding of the interconnection between the human brain and human psychological functioning, hence, assisting clinicians to improve clients' therapeutic outcomes (Grawe, 2007, p.12).

Neuropsychotherapy was named by the clinician and researcher Klaus Grawe, and describes the combination of neuroscientific concepts with phychotherapeutic practice (Walter, Berger, & Schnell, 2009, p.180). This new science had incredible development during the last decade and has reconstructed the bridge left by Freud's work, between the biological and psychodynamic functioning of the human being, as well as between neuroscience and psychoanalytical concepts (Beutel, 2003, p.773).  

Grawe emphasizes how brain function knowledge is remarkably important to the client's assessment and therapeutic treatment (Walter, Berger, & Schnell, 2009, p. 174). The idea that psychotherapy can change people's behaviour and eliminate unwanted symptoms, was empirically validated by the new definition of the brain as a network of neurons that communicate by synapses, which are constantly modified by external experiences (Grawe, 2007, p. 32). The brain's ability to change and produce new neuronal pathways is called neuroplasticity (Draguns, 2007, p.119). When therapists facilitate change in their clients' behaviour through talking therapy, they are, actually, changing their clients' brains neural patterns (Grawe, 2007, p.23). 

The psychoanalytical theory that focus on the consequences of childhood experiences and attachment patterns with the mother as described by Freud were expanded by neuroscientific findings, which demonstrate that from early childhood years, neural connections in the brain are created to represent life experiences, and form patterns of behaviour and symptoms that can last for a life time (Draguns, 2007, p.119). 

The investigation of brain biology through neuroimages (Beutel, 2003, p. 781) also brought to light how brain structures react to external signals, as well as the effects of these reactions to the human body and mental function, especially in relation to stress response (Draguns, 2007, p.119). The origin of mental disorders is, therefore, regarded as a consequence of inconsistency in the mental process, due to unsatisfied basic human needs (Draguns, 2007, p.119).

The neuropsychotherapy treatment process is programmed and aims to decrease individual psychological inconsistencies, allowing the accomplishment of four basic human needs: the establishment of gratifying relationship bonds, a sense of control and orientation of the person's own life, increased pleasure experience by avoiding distress, and the preservation of a satisfactory level of self- esteem (Draguns, 2007, p.119). 

Therapy goals are decided by taking into consideration the type and duration of the disorder, and the inconsistency presented (Grawe, 2007, p. 410). When choosing the most appropriate interventions for long lasting problems, the empirically approved manual is recommended (Grawe, 2007, p. 410). If high levels of incongruence are detected, an “incongruence questionnaire” (Grawe, 2007, p. 410) and analysis can be applied (Grawe, 2007, p.410). Each session must have a specific and steady target in order to facilitate synapses' changes, better brain functioning and consequent psychological comfort (Grawe, 2007, p. 415). Additionally, homework is proposed to allow the continuation and retention of the new neural patterns (Grawe, 2007, p. 415).

The neuropsychotherapist's role is directive, whilst working collaboratively with the clients in deciding what desirable, specific and approachable therapeutic goals can be achieved,as well as utilising the client's strengths and means (Grawe, 2007, p. 410). Clients are encouraged to make decisions and the therapist must provide a safe environment, building a solid therapeutic alliance (Draguns, 2007, p.119). Within this secure space, the client's emotional state can be regulated, while under the guidance of the therapist, clients may feel sufficiently in control to explore their difficulties, interrupting the consistency of unhelpful patterns of behaviour, and, therefore, replacing them with more adaptive ones (Grawe, 2007, p. 418). The client's brain activity changes throughout the treatment but time and repetition is necessary to fixate the new neural patterns, thus achieving long lasting results (Beutel, 2003, p.485).

A positive therapeutic relationship experience with the therapist can facilitate an increase in the client's self-esteem, provide a restorative attachment involvement, which also generates a reorganisation of the brain activity, by creating new and helpful neural patterns (Grawe, 2007, p. 413). These pleasurable relationship therapeutic moments can be also fostered during the sessions by the application of mindfulness exercises, relaxation techniques, positive mental representations, or simply by recognition of the client's achievements (Grawe, 2007, p. 414). Throughout the treatment, the therapist can obtain better therapeutic results, and the establishment of a secure and positive therapeutic alliance, if they are able to demonstrate personal qualities such as empathy, respect, a non-judgemental attitude, genuine interest and engagement, pleasant tone of voice, appropriate body language, and communicate competency (Grawe, 2007, p. 411).

Strengths of neuropsychotherapy are an immense contribution for psychotherapeutic assessment and treatment through the provision of precise results produced by neuroimaging and other measures, as well as an alternative description of pathologies to the Diagnostic and Statistical Manual of Mental Disorders (DSM) medical model (Beutel, 2003, p. 729). Additionally, it is considered more effective than medical intervention (Beutel, 2003, p. 729)

On the contrary, this approach has been criticised for the directive therapeutic role and the greater focus on the biological side rather than on client's psychodynamic (Grawe, 2007, p. 410). Moreover, the assessment measures are too complex to be analysed by counsellors who do not have specific medical training (Beutel, 2003, p. 793).

Mrs Glaucia Barbosa,
PACFA Reg. Provisional 25212 
MCouns, MQCA(Clinical)  
ABN: 19 476 932 954



References

Beutel, M. E. (01/09/2003). "The emerging dialogue between psychoanalysis and neuroscience: neuroimaging perspectives". Journal of the American Psychoanalytic Association (0003-0651), 51 (3), p. 773-801. DOI: 10.1177/00030651030510030101

Draguns, J. G. (2007). Review of neuropsychotherapy: how the neurosciences inform effective psychotherapy and neuropsychotherapie (Neuropsychotherapy). [Review of the books Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy. & Neuropsychotherapie (Neuropsychotherapy). K. Grawe & K. Grawe]. Psychotherapy: Theory, Research, Practice, Training, 44(1), 118-120. doi:10.1037/0033-3204.44.1.118

Grawe, K. (2007). Neuropsychotherapy. how the neuroscience inform effective psychotherapy. New York-USA: Taylor and Francis Group.

Walter, H., Berger, M., & Schnell, K. (2009). Neuropsychotherapy: conceptual, empirical and neuroethical issues. European Archieves of Psychiatry and Clinical Neuroscience. V.259(2), 173-182.

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