Contents
I have been nurturing one thought for a long time and now I wanted to collect details about it in one text.
It is intended more for me, but if you are interested, I’m all for it.
So, here’s my thought — the work of a psychologist with a client is not a treatment. We don’t heal, we re-educate. This is an educational activity.
Now the details.
Where do the problems in the head come from?
There are many studies that show that psychiatric problems (autism, schizophrenia, bipolar affective disorder) are associated with brain disorders. At least some of these disorders are caused by genes [1, 2].
Alas, it is unfortunately impossible to correct brain dysfunctions (say, neurodegeneration) with the help of conversations in a psychologist’s office.
Of course, it is better to work with a psychologist than nothing at all. For example, one British study found that working with a psychologist helps people cope better with the consequences of schizophrenia [3].
In general, in the case of psychiatric and neurological diseases, psychologists are powerless. Weakening the course of the disease, somehow helping to adapt — yes, this can be done, but the chances are not very high, alas [4].
On the other hand, people do not always have psychiatric problems. When a person is afraid to go on stage, when he is constantly jealous, or when he explodes with rage at the slightest failure, these are not diseases.
Then what?
It’s — that’s my idea — just wrong teaching. A person once learned to behave like this and now uses the acquired skill — there is no other.
Therefore, you just need to master another skill and things will go smoothly.
It is quite possible to do it yourself, of course, but there is a catch, even two — firstly, a person does not always know exactly where and how exactly to retrain.
Secondly, relearning is difficult — it’s twice as much work as learning. It is necessary not only to learn one skill, but also to «unlearn» the second. Double work. Any sports coach or teacher in a music school knows how difficult it is to “rewind” a wrong skill in a student.
And here comes a psychologist who is specially trained to remove these two dirty tricks.
Psychologist is an instructor
I am against the use of the term «psychotherapy». Firstly, psychotherapy is a treatment of the soul (as phytotherapy is a treatment with herbs, and phototherapy is a treatment with light). The soul in the old days was called the psyche (hence the term «insane» to describe a person with a psychiatric illness). How the psyche can treat something is a mystery to me.
Even if the translation is wrong and psychotherapy is considered to be the treatment of the soul, that is, the psyche, it is all the same — doctors, not psychologists, are involved in the treatment. Psychologists, as studies show, are almost powerless here (and certainly more powerless than doctors).
The psychologist is teaching. These are not my inventions. Here are two excerpts from textbooks on cognitive behavioral therapy (yes, the word “therapy” is not appropriate here, but in this case it is just part of the name).
The first passage: “In many ways, this is what therapy comes down to — multiple rehearsals of behavior, support and the desire to form new standards of behavior” [5].
Second passage: “Cognitive Behavioral Therapy is an educational therapy; its goal is to teach the patient to be his own therapist” [6].
As you can see, it is directly postulated that the psychologist does not heal with the soul, but teaches. Or, if you look more closely, then it retrains. That is, a psychologist is not a doctor, but an instructor.
«What is your evidence?»
Claiming that working with a psychologist comes down to retraining a person, to moving from one skill to another, it would be nice to provide evidence, right?
And I have them.
I’ll start a little from afar. When London taxi drivers learn the grid of city streets, their brains change — not fatally, but still noticeable. They have an increase in gray matter volume in the posterior parts of the hippocampus. And when they retired and stopped using these skills, the brain gradually rebuilt itself [7].
This is normal for any learning — it always causes changes in the brain.
Please pay attention — people learn, and therefore their brain changes. That is, without any surgery or pharmacology, you can change the interaction of brain systems.
Here are some studies on the subject.
For example, in a 2006 study, the author took a lot of papers on this topic, studied them and came to the following conclusion: working with a psychologist (I will avoid the term «psychotherapy») leads to changes in the brain.
As the author writes, “the change in symptoms and non-adaptive behavior of patients at the level of reason with the help of psychological methods is accompanied by functional changes in the brain in the corresponding brain circuits” [8].
In an earlier study, other authors found that in the case of depression, people who worked with a psychologist experienced brain changes that differed from those caused by the antidepressant paroxetine. I quote: «increases in the hippocampus and dorsal cortex (Brodmann area [BA] 24) and decreases in the dorsal (BA 9/46), ventral (BA 47/11), and medial (BA 9/10/11) frontal cortex» [ nine].
A 2018 meta-analysis based on work with people suffering from depression found the same.
People who worked with psychologists had lower activity in some areas of the prefrontal cortex — this means that they stopped “winding” themselves and imagining the worst possible situations.
At the same time, brain areas associated with the rostral anterior cortex (pregenual anterior cingulate) were more activated. This area is involved in the processing of emotions (in particular, muffling them). Increased activity in this zone means that people have learned to manage unpleasant emotions, which is very important for people with depression [10].
Finally, an article from 2010 provides evidence that working with a psychologist reduces the activity of areas of the brain that “produce” negative emotions and increase the activity of areas of the frontal regions that are more “intelligent” and control emotions [11]
Neurocognitive relearning
So, working with a psychologist leads to changes in the way the brain works.
Based on this, I believe that another term is needed, not “psychotherapy” (it does not reflect the tasks and work process of a psychologist in any way).
I suggest this one — neurocognitive reeducation.
This term is new, formed by analogy with neuromuscular reeducation. Neuromuscular retraining helps a person to make correct movements instead of wrong movements.
For example, a person had a knee pain, he did not treat it for some reason, because of this he limped. Then he had an operation, the knee was repaired, you can not limp, but the person cannot return to the correct movements.
This is where the need for neuromuscular retraining comes in. Moreover, they retrain even in case of problems with the facial muscles [12].
Neurocognitive retraining is about the same. Here is a man. Its neurons have formed into certain ensembles that participate in different functional systems, which in turn lead a person to the wrong results that a person wants — for example, they “make” a person so scared that he is afraid to speak in public.
The man comes to me.
And with the help of cognitive methods (that is, speech, thinking, imagination, etc.), we retrain neural ensembles. Or, to be absolutely precise, we are not so much retraining as we are forming new, more efficient ones. And not so much us, but the man himself under my, hmm, guidance.
For example, with the help of imagination, you can help a person become more cheerful and generally spend their day more fun [13]
And if you retrain a person from a very attentive attitude to his thoughts to a very superficial one, then there will be less unpleasant experiences [14].
It all sounds rather heavy, but in fact it is much simpler and clearer than “treatment by the soul”. This is a kind of briefing — do this three times a day, this is every other day, and this is only on Fridays.
Then there are fine adjustments — after all, each person is unique, and not always one instruction is suitable for everyone. It is necessary to select instructions for each specific person, without this, nowhere.
As a result, we get the main thing — a person knows how to retrain, using cognitive methods for this (well, a little bodily — why give up the possibilities of neuromuscular retraining?).
Neurocognitive reeducation is a clear, understandable, operationalized term in which everything is as transparent as possible.
That’s why I’m using it now.
I hope you enjoyed reading this article — at least I enjoyed writing it. I’m not sure that I stated everything as clearly and transparently as possible, so feel free to ask questions.
And I have everything, thank you for your attention.
By the way, about how to independently engage in neurocognitive retraining, I go into great detail here.
1. http://science.sciencemag.org/content/362/6420/eaat8464
2. http://science.sciencemag.org/content/360/6395/eaap8757
3.https://www.sciencedirect.com/science/article/pii/S0140673613622461
4. https://www.cambridge.org/core/journals/psychological-medicine/article/adapted-cognitivebehavioural-therapy-required-for-targeting-negative-symptoms-in-schizophrenia-metaanalysis-and-metaregression/5CAF1F3E1ACE4BB541DF768A0B40BCF0
5. http://zygmantovich.com/?page_id=17572, p. 170
6. Judith Beck Cognitive Behavioral Therapy. From basics to directions”, St. Petersburg, 2018, p. 26
7.https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3268356/
8. https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/do-psychotherapies-produce-neurobiological-effects/AF9CA3767296F3EB81043A944085BA83
9. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/481941
10.https: //www.sciencedirect.com/science/article/pii/S0925492717303323
11.https: //www.sciencedirect.com/science/article/pii/S1364661310001440
12. https://www.metroatlantaotolaryngology.org/journal/oct08/Facial%20Rehab.pdf
13. https://www.frontiersin.org/articles/10.3389/fnhum.2016.00664/full
14. https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00031/full