Clinical Practice

Many years of clinical practice have still left me with intriguing questions about the nature of human struggles and about the psychotherapeutic processes we engage in to mitigate them. Some questions became quite persistent: Why are emotional and behavioral difficulties so pernicious, enduring, stubborn, and repetitive even when we gain insight and are determined to change them? I became increasingly curious as to why people continue to engage in behaviors and interactions that cause them misery. Similarly, I wondered why our minds, with all their magnificent consciousness, sense of agency, and certitude of mastery, cannot make sure we do not reexperience dysregulated self-states or repeat destructive behaviors.

Similarly, I wanted to better understand why we are so vulnerable to internal states of anxious ruminations, self-doubts, and low self-esteem. The struggles with these difficult feelings and behavioral patterns seemed practically universal. It also seemed as if our emotional and behavioral patterns, both conscious and unconscious have a life of their own; being insidious and entrenched they automatically show themselves, by-passing intent or volition.

As I was looking toward neuroscience for potential answers it gradually became clear to me that as long as our understanding of human behavior did not account for their embeddedness within our bodily properties - our brain/mind/body processes - something significant was missing. In effect, the understanding that our minds, brains, and bodies are entirely intertwined and integrated opened the door to new interventions that address the very nature of the integrated nature of our being. Mindfulness enhancement is only one example.

Additionally, the many findings coming out of neuroscience increasingly explain the prevalence of negative emotional states, the creation of anxious self-states and the tenacity of our repeated patterns. Indeed, from the very beginning of life we all develop unconscious patterns that through enaction express entwined emotional, cognitive, and emotional functions, and importantly, the defenses we used against difficult feelings. In essence these unconscious patterns underlie all our personality traits. I really understood, and with deep empathy, that our early unconscious patterns are inevitable, entrenched, and if we are inflexible, fixed. In this case, they have a hard time “learning” from reality. Our patterns inevitably become triggered and automatically enacted, as therapists we can help patients identify, recognize, understand, tolerate, and successfully live with them.

One can see how the field of neuropsychology has influenced my psychodynamic thinking and working. I have found that sharing some of the knowledge of how the brain/mind works with my patients has been of enormous help. It often relieves them of guilt, shame, and self-hatred, strengthening their empathy towards internal states that developed entirely out of their conscious control and volition.