La psychothérapie à la lumière des neurosciences

Objective

What is psychotherapy today? Why evaluate its therapeutic mechanisms? How can these practices be taught? These are the three essential and complementary questions that the journal L’Évolution Psychiatrique invited us to answer.

Method

The elucidation of therapeutic mechanisms, “Why and how does psychotherapy produce effects?” has already been a focal point for questioning practices and theories at the beginning of the twentieth century. Pierre Janet and Sigmund Freud both sought a scientific answer to this question. Janet approached it through a historical study of psychotherapy methods and their results, justified by various mechanisms. Based on 250 cases that he himself treated through hypnotic suggestion, he considered that it was not about creating new resources but rather about using those that the mind already possesses. Freud, during the same period, saw psychotherapy as a process that allows the unconscious to become conscious. He noted that although he had abandoned hypnosis, he rediscovered suggestion in the form of transference. He expressed doubts about the reception that evaluation might receive and predicted the upcoming importance of biology. The elucidation of change processes and their mechanisms became the central question in psychotherapy research in the early 2000s (Kazdin, Kraemer et al.). Developmental psychopathology and methodologies applicable to psychotherapies conducted in natural settings are included. Medical and psychological methodologies for evaluative research are quickly distinguished. Two major developments are noteworthy during this period. The first is the broadening of psychotherapy's scope to include childhood disorders, severe personality disorders, as well as psychotic and psychosomatic disorders. These are revealed to be complex multifactorial disorders. The second is the development of research in biology and then on the brain in relation to the context of reality, including early developmental phases, stress, and trauma. What are the consequences of this evolution on current theories and practices?

Results

To answer these questions, we approached this evolution by associating the history of psychotherapy methods (P. Janet) with four major actors in the neuroscientific field who have published on: evolution, development, and consciousness (G.M. Edelman); modern biology and psychoanalysis (E. Kandel); clinical and neurobiological psychotherapy of complex disorders (A.R. Schore); and the socialization of sensorimotor contingencies (A. Lübbert). These five authors have engaged in a multidisciplinary approach open to psychotherapy.

Discussion

Their work significantly contributes to understanding the conditions that influence the effects and mechanisms of psychotherapy. They shed light on the changes it produces and help grasp their origin and part of the cause. Biology and psychology work well together. Their reciprocal influence provides clinicians with information about what concretely intervenes not only in the therapeutic alliance but also in the transition from one developmental reality and level of consciousness to another. A major principle here is the importance of attachment and early developmental phases, as well as the possibilities opened by neuroplasticity adjusted by experience. Neuroplasticity accompanies the re-characterization of neuronal groups in current experiences, including that of psychotherapy.

Conclusion

The knowledge regarding the influence of early negative experiences and relational traumas, as well as the possibility of positive reorganization, is sufficiently compelling and confirmed to be taught and included in practice. Much remains to be done in the field of training and practices.