Taking off from Freud's (Reference Freud and Strachey1909/1957) influential observation that many of our patients “suffer from reminiscences,” Lane et al. offer a convincing and well-documented variation on a popular theme in contemporary psychoanalytic literature, namely that current neuroscientific models of the mind fit well with certain key features of psychoanalytic theory and practice. The authors provide similar arguments with respect to behavior therapy, cognitive-behavior therapy, and emotion focused therapy. To summarize their detailed and complex argument in the broadest terms, Lane et al. show that the potential therapeutic benefit of these four different models of psychotherapy can be supported, mutatis mutandis, with evidence from controlled studies of the nature and functioning of human memory, and more specifically, that disturbed memories, evoked under optimal conditions of emotional arousal, can be “reconsolidated” in more adaptive forms.
Lane et al. have done the field of psychotherapy a great favor by distributing the evidence equally among four such distinct, but representative, treatment modalities. In doing so, they help to move us toward a more flexible understanding of what psychotherapeutic treatment can accomplish and how. While suggesting that different and seemingly opposite approaches may actually share common mechanisms of action, the study also lends credence to a widely held intuition in the field, namely that therapeutic success is partly dependent on contextual elements, including the temperament and personality structures of both therapist and patient, and various cultural factors still awaiting specification in systematic research. The authors rightly conclude that psychotherapy education needs to become less centered on the inculcation of specific technical ideologies, more focused on the underlying principles of psychic change.
Conventionally, we think of scientific evidence as supporting or contradicting a particular treatment model. For example, psychoanalysts such as myself might well feel that Lane et al. are showing us how the psychoanalytic paradigm might be confirmed (or not) by evidence from brain science. Practitioners working in the other modalities may have similar feelings. But I think it would also be useful for us to think beyond the immediate need for methodological validation and bureaucratic credibility.
To illustrate this point, I would like to introduce a speculative hypothesis: that the role of unconscious cultural factors in shaping modern psychotherapy (and also psychotherapy research) constitutes a significant blind spot in the theory and practice of the mental health field. I would suggest that any confidence we may derive from neuroscientific evidence is vitiated by the possibility that what is really being confirmed is not an objective scientific method of psychological treatment (if such a thing exists), but rather the influence on our thinking of an underlying cultural narrative. Could it be, for example, that certain aspects of Freud's early groundbreaking work on childhood trauma, and all the various forms of psychotherapy that have ensued, including and especially psychoanalysis itself, are scientifically alloyed secular variants of the Judeo-Christian paradigm (see Kirschner Reference Kirschner1996) of life as a fall from grace, a struggle to make sense of the consequent suffering, and a hoped-for redemption through personal reintegration – what the poet Wordsworth (Reference Wordsworth and Stillworth1965, p. 460) described in secular terms as “emotion recollected in tranquility”?
The striking alignment between Lane et al. and Freud's initial hypotheses is interesting to consider in its own right. Is this apparent match a scientific confirmation of Freud's early speculations? Or is it some sort of coincidence that we should investigate further?
It needs to be remembered that Freud's early theories about treatment presupposed a simplified clinical situation in which discrete, locatable events can be singled out for what we now are calling “memory reconsolidation” and “corrective emotional experience.” Freud struggled throughout his long career to keep this relatively straightforward, objectivistic, and operationally manageable picture of treatment intact; so has the rest of the profession. But as Freud and others continued to explore the new territory of psychotherapy, this kind of thinking gave way to the pressure of more complicated and intractable forms of mental suffering whose etiology could not be traced so confidently. In this later work, Freud and later analysts postulated that the clinician is often disarmed of established techniques and needs to remain open to the irruption during treatment of bizarre and unexpected sources of emotional disturbance and/or to focus intensively with the patient on minute qualities of their emotional interaction in the therapeutic process. I suspect it will be quite some time before the scientific community will figure out how to evaluate these more intricate aspects of the psychotherapeutic situation.
I am inspired in all my work by recent scientific research into psychotherapy outcomes, the discovery of neuroplasticity, and also the fascinating developments in neonatology and developmental psychology since 1975. But this exciting new science never gives me the impression that what I am doing with my patients is “evidence based” in some glorified scientific sense. I hope that my colleagues who have been trained in the delivery of other treatment modalities share this skepticism about the “objective” truth of what they are delivering to their patients. Few things are more dangerous in the field of direct health care than dogmatic self-certitude on the part of the practitioner.
The potential for cultural over-determination of hypotheses and results, acting at many levels in the mental health field – socially, politically, institutionally, and individually (constituting a generalized pressure to conform to a certain narrative or ideological model, for whatever reason) – should become a more recognized consideration of our research agenda, even though it might resist the logic of evidence-based treatment by introducing questions whose exploration is more difficult to operationalize in terms of brain science or quantitative research alone. To address the possibility of a cultural blind spot in mental health research, we would also have to contend with the possibility that the “normal science” of the post-Freudian theory of mind – and psychotherapy has a tendency to reproduce the same basic answers, with predictable variations, to the same standard questions. That such a possibility emerges implicitly through the integrative approach of the target article is one of this paper's many intriguing features.
You have
Access
Taking off from Freud's (Reference Freud and Strachey1909/1957) influential observation that many of our patients “suffer from reminiscences,” Lane et al. offer a convincing and well-documented variation on a popular theme in contemporary psychoanalytic literature, namely that current neuroscientific models of the mind fit well with certain key features of psychoanalytic theory and practice. The authors provide similar arguments with respect to behavior therapy, cognitive-behavior therapy, and emotion focused therapy. To summarize their detailed and complex argument in the broadest terms, Lane et al. show that the potential therapeutic benefit of these four different models of psychotherapy can be supported, mutatis mutandis, with evidence from controlled studies of the nature and functioning of human memory, and more specifically, that disturbed memories, evoked under optimal conditions of emotional arousal, can be “reconsolidated” in more adaptive forms.
Lane et al. have done the field of psychotherapy a great favor by distributing the evidence equally among four such distinct, but representative, treatment modalities. In doing so, they help to move us toward a more flexible understanding of what psychotherapeutic treatment can accomplish and how. While suggesting that different and seemingly opposite approaches may actually share common mechanisms of action, the study also lends credence to a widely held intuition in the field, namely that therapeutic success is partly dependent on contextual elements, including the temperament and personality structures of both therapist and patient, and various cultural factors still awaiting specification in systematic research. The authors rightly conclude that psychotherapy education needs to become less centered on the inculcation of specific technical ideologies, more focused on the underlying principles of psychic change.
Conventionally, we think of scientific evidence as supporting or contradicting a particular treatment model. For example, psychoanalysts such as myself might well feel that Lane et al. are showing us how the psychoanalytic paradigm might be confirmed (or not) by evidence from brain science. Practitioners working in the other modalities may have similar feelings. But I think it would also be useful for us to think beyond the immediate need for methodological validation and bureaucratic credibility.
To illustrate this point, I would like to introduce a speculative hypothesis: that the role of unconscious cultural factors in shaping modern psychotherapy (and also psychotherapy research) constitutes a significant blind spot in the theory and practice of the mental health field. I would suggest that any confidence we may derive from neuroscientific evidence is vitiated by the possibility that what is really being confirmed is not an objective scientific method of psychological treatment (if such a thing exists), but rather the influence on our thinking of an underlying cultural narrative. Could it be, for example, that certain aspects of Freud's early groundbreaking work on childhood trauma, and all the various forms of psychotherapy that have ensued, including and especially psychoanalysis itself, are scientifically alloyed secular variants of the Judeo-Christian paradigm (see Kirschner Reference Kirschner1996) of life as a fall from grace, a struggle to make sense of the consequent suffering, and a hoped-for redemption through personal reintegration – what the poet Wordsworth (Reference Wordsworth and Stillworth1965, p. 460) described in secular terms as “emotion recollected in tranquility”?
The striking alignment between Lane et al. and Freud's initial hypotheses is interesting to consider in its own right. Is this apparent match a scientific confirmation of Freud's early speculations? Or is it some sort of coincidence that we should investigate further?
It needs to be remembered that Freud's early theories about treatment presupposed a simplified clinical situation in which discrete, locatable events can be singled out for what we now are calling “memory reconsolidation” and “corrective emotional experience.” Freud struggled throughout his long career to keep this relatively straightforward, objectivistic, and operationally manageable picture of treatment intact; so has the rest of the profession. But as Freud and others continued to explore the new territory of psychotherapy, this kind of thinking gave way to the pressure of more complicated and intractable forms of mental suffering whose etiology could not be traced so confidently. In this later work, Freud and later analysts postulated that the clinician is often disarmed of established techniques and needs to remain open to the irruption during treatment of bizarre and unexpected sources of emotional disturbance and/or to focus intensively with the patient on minute qualities of their emotional interaction in the therapeutic process. I suspect it will be quite some time before the scientific community will figure out how to evaluate these more intricate aspects of the psychotherapeutic situation.
I am inspired in all my work by recent scientific research into psychotherapy outcomes, the discovery of neuroplasticity, and also the fascinating developments in neonatology and developmental psychology since 1975. But this exciting new science never gives me the impression that what I am doing with my patients is “evidence based” in some glorified scientific sense. I hope that my colleagues who have been trained in the delivery of other treatment modalities share this skepticism about the “objective” truth of what they are delivering to their patients. Few things are more dangerous in the field of direct health care than dogmatic self-certitude on the part of the practitioner.
The potential for cultural over-determination of hypotheses and results, acting at many levels in the mental health field – socially, politically, institutionally, and individually (constituting a generalized pressure to conform to a certain narrative or ideological model, for whatever reason) – should become a more recognized consideration of our research agenda, even though it might resist the logic of evidence-based treatment by introducing questions whose exploration is more difficult to operationalize in terms of brain science or quantitative research alone. To address the possibility of a cultural blind spot in mental health research, we would also have to contend with the possibility that the “normal science” of the post-Freudian theory of mind – and psychotherapy has a tendency to reproduce the same basic answers, with predictable variations, to the same standard questions. That such a possibility emerges implicitly through the integrative approach of the target article is one of this paper's many intriguing features.