Boston Graduate School of Psychoanalysis

[Nahsil]

Personally I'm not all that into psychoanalysis, but I do think there are interesting things going on in that world. Intersubjective systems theory from George Atwood and Robert Stolorow (which proposes critiques of the current paradigm, and whether you agree or not, I think it's important to take a broad view of psychology), Nancy McWilliams's stuff, etc.

It does seem like PSA is best done as an add-on to more basic training, though. Certificates and post-grad options. Not necessarily because I don't think PSA can adequately train people from the ground up, but because of money and quality of institute concerns...I'd be really careful where I went for PSA training, sounds like Boston isn't the place for it. I know there's some good institutes in California.

---

Members don't see this ad.

 

[smalltownpsych]

Personally I'm not all that into psychoanalysis, but I do think there are interesting things going on in that world. Intersubjective systems theory from George Atwood and Robert Stolorow (which proposes critiques of the current paradigm, and whether you agree or not, I think it's important to take a broad view of psychology), Nancy McWilliams's stuff, etc.

It does seem like PSA is best done as an add-on to more basic training, though. Certificates and post-grad options. Not necessarily because I don't think PSA can adequately train people from the ground up, but because of money and quality of institute concerns...I'd be really careful where I went for PSA training, sounds like Boston isn't the place for it. I know there's some good institutes in California.

From my perspective, when I am referring to the newer theorists and broader conceptualizations, I use the word psychodynamic. I would also include object relations and attachment as under that umbrella in addition to intersubjectivity. I also think understanding the neurobiology underlying all of this is crucial and Alan Schore, Daniel Siegel, Daniel Stern, and Louis Cozolino have all done some great work integrating theory with neuroanatomy and function. We need to break free from the overly simplistic CBT vs. Psychonalysis paradigm and the folks I named above are beginning to make sense of it all and are showing a pathway to find out what works in psychotherapy and why.

 

[LAPsyGuy]

From my perspective, when I am referring to the newer theorists and broader conceptualizations, I use the word psychodynamic. I would also include object relations and attachment as under that umbrella in addition to intersubjectivity. I also think understanding the neurobiology underlying all of this is crucial and Alan Schore, Daniel Siegel, Daniel Stern, and Louis Cozolino have all done some great work integrating theory with neuroanatomy and function. We need to break free from the overly simplistic CBT vs. Psychonalysis paradigm and the folks I named above are beginning to make sense of it all and are showing a pathway to find out what works in psychotherapy and why.

Not to mention folks like Wompold who are looking across orientations to glean effective common factors.

 

[WisNeuro]

Wampold stuff is great, but still has some pretty significant limitations. his work gets generalized to all treatments way too much beyond the actual data. It's all good and dandy for future consideration, just now the details of the research.

 

[LAPsyGuy]

Wampold stuff is great, but still has some pretty significant limitations. his work gets generalized to all treatments way too much beyond the actual data. It's all good and dandy for future consideration, just now the details of the research.

A lot still needs to be done, but Wampold's point is that there is greater variation among therapists than therapies in terms of effectiveness. His contextual model goes far in dismantling the medical model of psychotherapy. Even people like Barlow indirectly nod in this direction with their unified treatment protocols.

 

[WisNeuro]

I don't know how much he "dismantles" certain models of psychotherapy. Certain people like Crits-Christoph and Marcus have done a decent job outlining both analytic and methodological concerns with the research. There is a long way to go, indeed. I will allow that common factors are important, but Wampold does a lot that potentially obscures actual differences with these methodological issues. Very far from being decisive on the matter.

 

[LAPsyGuy]

I don't know how much he "dismantles" certain models of psychotherapy. Certain people like Crits-Christoph and Marcus have done a decent job outlining both analytic and methodological concerns with the research. There is a long way to go, indeed. I will allow that common factors are important, but Wampold does a lot that potentially obscures actual differences with these methodological issues. Very far from being decisive on the matter.

Crits-Christoph has also repeatedly found that all psychotherapies are similar in effectiveness. He may have issues with common factor research, but understanding what is going on by dismantling the process and content is key.

 

[WisNeuro]

Crits-Christoph has also repeatedly found that all psychotherapies are similar in effectiveness. He may have issues with common factor research, but understanding what is going on by dismantling the process and content is key.

Yes, but these aren't dismantling studies by and large, they're meta-analyses. And they do funny things, like collapsing all diagnostic conditions, collapsing types of treatments into a category even though they are vastly different, using a q-statistic that is generally underpowered for what it is being used to detect, etc. They are important, sure, but very far from perfect and not at all decisive in the area. They're a good starting point, but we haven't really gotten very from from the original Luborsky work, to be honest.

 

[Nahsil]

Got to see Wampold's keynote at the Div 32 conference in Chicago, nice guy.

 

[smalltownpsych]

Crits-Christoph has also repeatedly found that all psychotherapies are similar in effectiveness. He may have issues with common factor research, but understanding what is going on by dismantling the process and content is key.

and I think that a big part of the key to understanding how these common factors work is by looking at the research on how human brains interact with each other because a lot of what goes on in the therapy room is just that. Tone of voice, affective intensity, affect regulation, accurate empathy, timing of interventions, eye contact, proximity... I could probably go on and on with factors that are part of the therapeutic encounter and are often central to the work.

 

[LAPsyGuy]

and I think that a big part of the key to understanding how these common factors work is by looking at the research on how human brains interact with each other because a lot of what goes on in the therapy room is just that. Tone of voice, affective intensity, affect regulation, accurate empathy, timing of interventions, eye contact, proximity... I could probably go on and on with factors that are part of the therapeutic encounter and are often central to the work.

I see what you mean, but it's reductionistic in a way that isn't particularly helpful for me. Brains don't exist in a vacuum, and they aren't simply brains, as you point out. Voice, eye contact, social context, the rest of the physiology, etc. all play a role in this, and narrowing it down to brains seems to ignore much of this.

 

[smalltownpsych]

I see what you mean, but it's reductionistic in a way that isn't particularly helpful for me. Brains don't exist in a vacuum, and they aren't simply brains, as you point out. Voice, eye contact, social context, the rest of the physiology, etc. all play a role in this, and narrowing it down to brains seems to ignore much of this.

I did not say only the neuroscience, but I do feel that is the basis and when a clinician doesn't have a solid understanding of how brains interact with and influence each other and how that comes into play in psychotherapy, I think you (the general you, not you specifically ) are flying a little too blind. Unfortunately, I don't think we devote enough time to understanding that as a field and it can lead to inferior therapeutic practices.

 

[LAPsyGuy]

I did not say only the neuroscience, but I do feel that is the basis and when a clinician doesn't have a solid understanding of how brains interact with and influence each other and how that comes into play in psychotherapy, I think you (the general you, not you specifically ) are flying a little too blind. Unfortunately, I don't think we devote enough time to understanding that as a field and it can lead to inferior therapeutic practices.

I find this claim specious at best. Understanding interpersonal dynamics does not require direct understanding of neuroscience.

 

[smalltownpsych]

I find this claim specious at best. Understanding interpersonal dynamics does not require direct understanding of neuroscience.

The only response I can come up with is that you can't know the importance of what you don't know and I think it actually makes my point that many in psychology don't understand the biological underpinnings of behavior enough.

 

[LAPsyGuy]

The only response I can come up with is that you can't know the importance of what you don't know and I think it actually makes my point that many in psychology don't understand the biological underpinnings of behavior enough.

I've done all the reading, and had all the classes, so I know it. I'm poorly making the point that our interpersonal dynamics are, at least in part, a result of our biology. Some would say that it is our biology. Having done all that studying I cannot imagine how brain science informs your interpersonal therapeutic relationship. Perhaps it's just a frame like psychoanalytic theory.

 

[smalltownpsych]

I've done all the reading, and had all the classes, so I know it. I'm poorly making the point that our interpersonal dynamics are, at least in part, a result of our biology. Some would say that it is our biology. Having done all that studying I cannot imagine how brain science informs your interpersonal therapeutic relationship. Perhaps it's just a frame like psychoanalytic theory.

The reason I think it is crucial is it guides me in my work, especially regarding trauma. Way too many therapists and psychologists appear to be oblivious to how this all works and it shows in their work with patients and their misconceptualizing. At the very least psychotherapists need to umderstand CNS arousal, how the limbic system and frontal cortex interact, startle response, and how our own physical state affects others. We should also know way more about the development of the cortex in adolescence and the significance of social context in that development, but we haven't started that research really.

 

[deleted343839]

When I think of neuroscience informing psychotherapy and vice-versa, a good example are the groups who are studying mentalizing and mentalization-based psychotherapy (eg, Fonagy). Whether you fully "buy" that approach or not, it's clear there is synergy between neuroscience and clinical research in that area.

 

[LAPsyGuy]

The reason I think it is crucial is it guides me in my work, especially regarding trauma. Way too many therapists and psychologists appear to be oblivious to how this all works and it shows in their work with patients and their misconceptualizing. At the very least psychotherapists need to umderstand CNS arousal, how the limbic system and frontal cortex interact, startle response, and how our own physical state affects others. We should also know way more about the development of the cortex in adolescence and the significance of social context in that development, but we haven't started that research really.

Agreed, but you now seem to be backing off of the interpersonal component of your initial claim.

 

[LAPsyGuy]

When I think of neuroscience informing psychotherapy and vice-versa, a good example are the groups who are studying mentalizing and mentalization-based psychotherapy (eg, Fonagy). Whether you fully "buy" that approach or not, it's clear there is synergy between neuroscience and clinical research in that area.

Yes, Fonagy used neuroscience in formulating MBT. I'm a huge fan of MBT, but in using the techniques within therapy there is no reference to the neuroscience that informed the theory. Instead you focus on whether the client is mentalizing, bringing them back to the last time they did so, etc. This is much different than the earlier claim of the tw0-brain model mentioned above. Similarly, Cozolino's work is mostly about supporting psychoanalytic and psychodynamic therapies using more current science, though it has influence his work around re-writing trauma narratives.

 

[Nahsil]

I'd argue that people can know very little neuroscience and still have a nuanced and informed view/understanding of psychological life. There are good models out there based on "lived experience" that don't refer back to causal biological mechanisms (which by the way are pretty crude in their current form applied to the multivariate complexity of mental life). Personally I like neuroscience a lot and want to study it more, but I don't think it's a necessity for being a good therapist (any more than I think knowing modern psychoanalytic models is a necessity--different approaches that offer different interpretive schemas and stuff).

Some people choose to work "from the inside" and I don't see that that's really a problem.

 

[smalltownpsych]

Yes, Fonagy used neuroscience in formulating MBT. I'm a huge fan of MBT, but in using the techniques within therapy there is no reference to the neuroscience that informed the theory. Instead you focus on whether the client is mentalizing, bringing them back to the last time they did so, etc. This is much different than the earlier claim of the tw0-brain model mentioned above. Similarly, Cozolino's work is mostly about supporting psychoanalytic and psychodynamic therapies using more current science, though it has influence his work around re-writing trauma narratives.

I had clinical supervision with Cozolino and much of what I am trying to say I learned from him. He hasn't written it all up yet, but he very much believes that is the direction we need to go, i.e., strong understanding of the neursocience and the interactions between two not quite separate neurochemical communication systems. His concept of the social brain is what I am alluding to, the subtitle of his work is Healing the Social Brain so am not sure how you miss that aspect of it.

 

[deleted343839]

Some people choose to work "from the inside" and I don't see that that's really a problem.

It's not a problem. However, it does not negate the fact that psychologists need a firm grounding in the biological basis of behavior, cognition, perception, and emotion. Though neuroscience may not directly inform our clinical techniques and therapeutic skills, it grounds our understanding of phenomena that can be observed and understood in scientific terms. We take this for granted a lot of the time, and that's fine, but when you start to look at the fringes of the "helping professions" (crystal healing, past life regression, etc.) it becomes very clear why this foundation matters.

 

[LAPsyGuy]

I had clinical supervision with Cozolino and much of what I am trying to say I learned from him. He hasn't written it all up yet, but he very much believes that is the direction we need to go, i.e., strong understanding of the neursocience and the interactions between two not quite separate neurochemical communication systems. His concept of the social brain is what I am alluding to, the subtitle of his work is Healing the Social Brain so am not sure how you miss that aspect of it.

I didn't miss it. I just don't buy it. If we think of people as brains, we think of them less as whole, integrated humans. It's distancing. These brains have bodies, social lives, and socioeconomic contexts. I find the brain frame to be an unhelpful frame for providing therapy. It's a frame, nothing more or less. It's one way in among many ways in, but it's not a factual necessity to provide good psychotherapy.

 

[LAPsyGuy]

Take a look at
Robert A. Burton
A Skeptic's Guide to the Mind: What Neuroscience Can and Cannot Tell Us About Ourselves

Or

Neuromania by Paolo Legrenzi. Neuroscience has a lot of promise, but I'm not convinced it's able to tell us what Siegel, Cozolino and others are trying to convince us it's telling us. They still can't prove that some of these correlative events in the brain aren't simply epiphenomena. And all it does is reinforce Descartes' false dichotomy.

 

[Nahsil]

It's not a problem. However, it does not negate the fact that psychologists need a firm grounding in the biological basis of behavior, cognition, perception, and emotion. Though neuroscience may not directly inform our clinical techniques and therapeutic skills, it grounds our understanding of phenomena that can be observed and understood in scientific terms. We take this for granted a lot of the time, and that's fine, but when you start to look at the fringes of the "helping professions" (crystal healing, past life regression, etc.) it becomes very clear why this foundation matters.

Should we make room for healing practices based on things like belief and ritual? Or in more scientific terms, placebo?

At any rate, science isn't the only bulwark against ungrounded fantasy. There are grounded theories of mind/self/society that don't look to neurobiology and I think it would be a big mistake to think that only biology has validity/can be a solid reference point. It's certainly true that a great deal of interpretation goes on when "biological facts" get passed down the line. For example we use spatiotemporal metaphors linked to our own embeddedness in the world and in the body to interpret how cells and atoms behave, etc. See people like Lakoff and the other cognitive scientists dealing with embodiment. Not arguing that science doesn't observe an actual world or that its findings aren't real, but positing it as the objective savior and anchoring of the world, and pitting it against all other forms of knowing, is a little too far, I think.

 

[smalltownpsych]

This is frustrating. I never said that the neuroscience is the answer to all. I said it's a good solid foundation that can help bridge some of these theories and I think that too many therapists and theories don't integrate it enough. Quit exaggerating my premise so that you can attack it. Last week I had a great discussion with a new patient about their spiritual and cultural practices and how that has been integral in their recovery from the extremely abusive relationship they escaped. I also know some of the more basic dynamics of how her CNS will respond to the trauma and how that will affect her functioning. A good psychologist can walk and chew gum at the same time.

 

[deleted343839]

Should we make room for healing practices based on things like belief and ritual? Or in more scientific terms, placebo?

At any rate, science isn't the only bulwark against ungrounded fantasy. There are grounded theories of mind/self/society that don't look to neurobiology and I think it would be a big mistake to think that only biology has validity/can be a solid reference point. It's certainly true that a great deal of interpretation goes on when "biological facts" get passed down the line. For example we use spatiotemporal metaphors linked to our own embeddedness in the world and in the body to interpret how cells and atoms behave, etc. See people like Lakoff and the other cognitive scientists dealing with embodiment. Not arguing that science doesn't observe an actual world or that its findings aren't real, but positing it as the objective savior and anchoring of the world, and pitting it against all other forms of knowing, is a little too far, I think.

Can you go back to the part where anyone said that "only biology has validity"? Or that science is "the objective savior and anchoring of the world"? Hopefully we all had some readings on philosophy of science as first-year grad students and can appreciate the fallacies of logical positivism and scientism.