In this article I’d like to take a look at my job – my right livelihood over the past 30 years – talk therapy. And I’d like to suggest that calling it “talk therapy” misrepresents and grossly undervalues what you and I (or we if you’re part of a couple) are doing in my office (or on the phone.)
“Talk therapy” makes it sound as if words issue from our mouths and then dissipate in the air around us. As if, as the saying goes, it’s cheap – common stuff. Not so, says the renowned Mayo Clinic, who recently signed an agreement with Cooper & Lybrand, an international accounting firm, to demonstrate the cost savings of providing psycho- therapy for heart patients. The study will use the data from a 1995 study of 381 heart disease patients in which, over six months, the mean medical costs for emotionally distressed patients was $9,504 compared to $2,146 for the nondistressed.
Makes financial sense, doesn’t it? In the meantime, it looks like therapists, those low- tech metaphorical heart specialists, will have an important role in the continuing struggle with this and other “dis-eases.”
More recently, New York University neuroscientist Joseph LeDoux has been studying the emotional brain. He focuses on fear memories and how they are not just one-time inscriptions in our brain. Instead, they are reconsolidated and rebuilt every time they are retrieved.
Exciting stuff, huh? This new view of memory suggests a way to obtain conscious control of a powerful but unconscious emotion generating system. “Knowledge of re- consolidation,” says LeDoux, “opens the possibility of re-transcribing memories.” So, deeply engaging psychotherapy is not just talk therapy but involves reactivation of emotion.
Through sensitive, ably guided discussion, or through energy therapies like Eye Movement Desensitization (EMDR), emotional memories can be gently and thoroughly processed and, sometimes, reprocessed, to help the anxious person learn new associations around a fearful memory. This way, they are modulated during retrieval so they are not lodged forever under a rock in the primitive section of our brain, where they drive behavior without under- standing or consent.
As Hara Marano writes, “Genes snap to attention, fancy neurotransmitters and nuclear proteins swing into action. Nerve reactivity and circuitry is altered…” Or, as I like to say in more prosaic terms, our wires get uncrossed!
Talk therapy and EMDR provide privileged access to the cortex, the thinking brain. I often utilize cognitive behavioral therapy (CBT), which teaches anxious people to reframe how they perceive the environment, so they don’t need to emotionally react to everything negative that comes their way. By healing the brain from the top down, as it were, CBT has effects that last long after the therapy is over, protecting against relapse into anxiety in a way that drugs can’t, because pills don’t re-educate the brain.
So privileged is the access that talk therapy has to the brain that sometimes it’s the only thing that works. Last year, a large randomized controlled trial of psychotherapy versus drug therapy showed that talk therapy works in some of the most difficult cases of depression, for example, whereas pharmaco-therapy does not. It is singularly effective for those of us with a history of childhood trauma, physical or sexual abuse, or neglect. The researchers reported that “psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression or a history of childhood trauma.
EMDR is an invaluable psychotherapeutic adjunct, This complex approach combines talk therapy with bilateral stimulations such as eye movements or tones to facilitate the
brain’s natural ability to heal. EMDR promotes the mind’s ability to access, desensitize, and resolve memories and feelings that have been “stored away” or avoided because of the emotional pain associated with painful life events.
EMDR has an extremely broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma of all kinds. In my clinical experience it’s also been helpful to those suffering from anxiety, depression, addictions, phobias, and a variety of self-esteem issues.
This leads to the obvious conclusion: what you and I are doing, or have done together isn’t just talk therapy. It’s brain therapy. As Joseph LeDoux has pointed out, “It’s all about the hottest thing in neuroscience today – brain plasticity.” And, yes, heart therapy. Emotion therapy – genuine healing of memories.
Thank you for being part of what is right livelihood for me.