Brain researchers are beginning to understand how psychotherapy alters brain chemistry.

While empirical evidence and many studies confirm the helpfulness of psychotherapy, until recently no one really understood the mechanism of change. Current brain research is helping us to understand why attunement and emotional resonance between the client and therapist are crucial to successful therapy.

With current imaging and MRI technology, doctors are able to study the development and function of healthy brains. They also are understanding the importance of multiple neural pathways and seeing the problematic process of "neural pruning". Multiple neural pathways allow for the transportation of information, in the form of impulses, among specialized regions of the brain. If the neural pathways are reduced or truncated, an individual is limited in whether they react habitually in one particular manner or whether they can choose a behavioral response among many.

It is helpful to review brain anatomy in order to understand how psychotherapy impacts neural pathways and interactions of different regions of the brain. The brain consists of several regions. The prefrontal cortex allows abstract thought and reasoning; the midbrain (limbic system) processes emotions and makes split second relational decisions based on patterns of information received in the early stages of brain development; and the brain stem (reptilian brain) regulates the autonomic nervous system and creates the fight or flight response. Across these regions, there are two hemispheres: the right brain hemisphere is the locus of emotion, relational response and creativity; and the left hemisphere solves abstract and practical problems in the world. There are many complex substructures. Science is showing us that fluid transmission of impulses among these regions and hemispheres directly influences our behavior, our self-control, our self-soothing capacity, our knowledge of ourselves and our relationships with others.

The fluidity and functionality of the therapist's brain has been shown to resonate in the client's neural pathways, thus attunement, empathy and mirroring are both physiologically as well as psychologically impactful. More detailed information can be found in Allan Schore's "Affect Regulation and the Repair of Self" and in "A General Theory of Love" by Lewis, Amini, and Lannon.

Clients generally come to therapy because they have been suffering in some way. Often they are experiencing relationship problems and unmanageable emotions including rage, depression, anxiety, or prolonged grief, they seek relief and change. Therapists who have felt some similar challenges may have implicit internal experience of how to make the necessary internal regulation in themselves and can both talk through the challenges on the conscious level as well as deliver helpful neural messages to the client's unconscious brain. This process has been shown to resemble the experience of a mother regulating the nervous system of an infant, promoting the growth of multiple neural pathways.

How can we be the most effective therapist given that many of the mechanisms of healing are unspoken and unconscious? It seems that the quality of the relationship with the client is more important than the modality or even the content of the work done together. The research implies that the more skillful the therapist is at managing her inner process of self regulation and self soothing, the more impactful we are. Understanding early brain development helps clarify this point.

From birth to two years, the brain develops the complex structures supporting the intellectual and emotional complexity of adult life. Brain researchers now realize that the quality of the Infant/Caretaker relationship is principally responsible for the healthy growth of the brain prior to age two. MRI scans show the emotional resonance or lighting up of the right hemispheres of both the mother and the infant dyad. Without this consistent dynamic process brain development is stunted. The attunement creates an emotional resonance that over time allows the child to process and manage her responses to her inner sensations and external stimuli. When the caretaker is able to regulate emotions well, they teach the infant through an unconscious process, as well as their verbal communication that internal and external stimulation can be tolerated. If a caretaker is able to calm and soothe both nervous systems, neural pathways flourish and emotions are well regulated in the developing individual. Deficits in neural functioning can be addressed in adults due to the plasticity or growth potential in the adult brain.

Brain researchers now know that new neural pathways are formed in infants and adults by certain experiences right hemisphere to right hemisphere.This seems to be how psychotherapy heals. An individual cannot think themselves out of psychological and social dilemmas, but need to have an emotional connection with an attuned other, so that the prefrontal cortex and limbic brain can have an integrative, regulating experience. Clients can need relational exercise to create satisfaction and change in their emotional lives. Therapists do well to develop their own relational selves so they can offer the most optimal repairative match.