Why Does Therapy Work?

Have you ever wondered how talk therapy could possibly help someone overcome psychological problems?

A new book by psychologist Louis Cozolino, Why Therapy Works, makes the case that the tools of psychotherapy are actually perfectly suited to the task. Because of our social nature and the way our brains work, we can be helped and healed just by experiencing a caring human relationship.

A bold claim, to be sure. But Cozolino bases his views on his extensive knowledge of neuroscience and psychology. Many psychological problems, he claims, come from misperceptions that are the result of we humans having two “brains” for processing information about our environment: the “fast brain”—the part of our brains which alerts us to potential dangers, primarily through the amygdala, and is concerned with survival needs—and the “slow brain”—the more recently evolved frontal cortex, which helps us to plan, reason, and negotiate social relationships over the long term.

“The brain is an organ of adaptation that predicts and controls outcomes in the service of survival,” writes Cozolino. “As such it has to learn from experience, organize automatic responses to all eventualities, and anticipate the future as fast as possible.”

If our fast brain assesses our surroundings and sees “danger”—whether the danger is real, like a seeing a poisonous snake in our path, or merely a disappointment or stressor, like being rejected by a potential suitor—it sets off an automatic fight, flight, or freeze response in us to help us survive. But, when the danger is not real and our slow brains neglect to calm us quickly, we can become overly anxious, impulsive, and reactive in ways that can harm our relationships and our physical and mental health.

For better or worse, the slow brain comes online much later in human development than the fast brain; so early experiences of stress and trauma require soothing by caring, consistent parental figures. When that care isn’t available early in life or when stressors are chronic, it can wreak havoc with our worldview, making us feel unsafe and hyper-vigilant. But, a therapist who acts as a kind of positive “parental figure” can help clients calm their over-reactive amygdala response, which otherwise would interfere with perception and new learning.

“Successful therapists learn to be ‘amygdala whisperers’ by leveraging the social brain in order to help clients face their fears,” writes Cozolino.

Therapists makes use of our basic human need for connection, understanding, and belonging—needs that are hardwired in us. By creating a relationship where clients can feel safe enough to let go of misperceptions of themselves and others and to try out new behaviors, therapists open the door for clients to discover and accept a more nuanced view of themselves and their situation, which aids them in healing.

“In listening to our clients, we reflexively analyze their narratives for inaccurate, destructive, and missing elements,” writes Cozolino. “We then attempt to edit their narratives in a manner we feel would better support their adaptation and wellbeing.”

Some of the tools used in psychotherapy—uncovering unconscious patterns of thought and behavior, story-telling to create a healing narrative for one’s life, unconditional positive acceptance, and reinforcement for positive change—can alter patterns of thinking in clients, and ultimately their brain chemistry, for the better. And, because of neuroplasticity—or the brain’s ability to change in response to experience—a client’s neural patterns can become less reactive and more adaptive, resulting in less stress and healthier responses to challenging situations.

Though Cozolino’s book is aimed primarily at therapists, it’s an interesting read for anyone who has wondered about the mechanics of therapy and why it seems to work, no matter the therapeutic approach. He believes that the essence of therapy is “to connect with our clients in an exchange of emotions and information,” so that, “like neurons, we send and receive messages from one another across a synapse—the social synapse.”

In other words, therapists need to be aware of the fact that humans are social animals, uniquely primed to respond to social cues, and use that to advantage. Simply providing a positive relationship, where clients feel heard and valued, might be as important for healing as any possible approach to therapy. And, that’s good news.

“Fortunately for us, the same evolutionary processes that gave rise to the sources of our emotional suffering also provided us with the tools to heal: our abilities to connect, attune, and empathize with others,” he writes.