Deepening The Therapeutic Experience: Interweaving Psychoanalytic And Neuroscientific Perpectives

Michelle van den Engh, MD, Discussant Maggie Zellner, PhD

Saturday May 30, 9:00 AM – 12:00 PM

The channels of therapeutic change include pathways beyond explicit verbal explanations and interpretations. Implicit processes between therapist and patient flow at deeper levels, outside our conscious awareness.

Contemporary psychoanalytic writers urge us to integrate the multilevel therapeutic exchanges occurring within the therapeutic encounter, encouraging us to include ontological aims – such as presence, aliveness and the freedom to be one’s true self – alongside classical epistemological aims of understanding and insight. To begin, we will review psychoanalytic accounts (drawing upon works by Alvarez, Bucci, Ogden, Stern, and Vermote) of deepening the therapeutic experience by engaging with patients across multiple levels of experience. From physical sensations to internal imagery to narrative representations, experience is registered, processed, transmitted, and (if all goes well) received by an attuned clinician. To complement these clinical and theoretical descriptions, the presentation will interweave findings from affective neuroscience, memory research, and the study of inter-brain synchrony (including advances by Panksepp, Alberini, and Sened), considering their role in facilitating neuroplasticity and therapeutic change. From a predictive processing perspective (as described by Friston, Friston & Firth, and Solms), we will explore how the psychotherapeutic dyad offers a new context of continuous reciprocal prediction, in which two predictive models can communicate and expand, with transformative potential. Finally, we will explore the clinical implications of these frameworks, focusing on how our attention to the full countertransference experience – including awareness of somatic, affective and cognitive responses – might enhance our understanding of what our patients are seeking to share with us, and inform more finely-tuned therapeutic actions.