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How Does Psychotherapy Work?

Neuroimaging findings corroborate that structural changes (neural circuits, size and volume of specific brain areas) and changes in metabolic rate in the brain occur as a result of psychotherapy. With advances in neuroscience we now understand that psychotherapy is a biological treatment. As with medication treatments, there is a dose effect with psychotherapy. Most individuals with unstable mood and a history of traumatic life events obtain greater benefit from longer-term treatments. Episodic  psychotherapy  could be  beneficial when a commitment to long term therapy is not possible.

What are the common curative factors in psychotherapy? Research studies validate the clinical observations that specific aspects of psychotherapy practice are curative. These include: empathy (with sub-components of compassion, affective sharing, synchronized mirroring, listening to expressed intense emotions while maintaining composure and serenity), goal consensus and collaboration, establishing a therapeutic alliance (through safety, consistency, attunement, properly anticipating and attending to emotional needs), positive regard and affirmation, mastery, congruence/genuineness, and mentalization (developing the capacity to understand nuances of emotions, the emotional world of the self, the emotional world of others, and how emotions drive actions and one’s actions impact the emotions of others, resulting in either proximity, intimacy or alienation). These factors constitute the main transformative elements in psychotherapy.


A psychotherapeutic stance is interactive but serene, attentive, consistent, absolutely non-judgmental (always neutral to the material discussed in a warm and humane way), respectful of privacy, confidentiality and self-determination, and aligned with other bioethical principles such as beneficence, nonmaleficence, and social justice.


In addition, in all psychotherapies affective regulation (regulation of emotional reactions, decreasing amplitude and over reactivity that may interfere with successful relationships) is of essence, and therapy offers the opportunity to master this task. In cognitive behavioral therapies maladaptive patterns are identified and cognitive distortions corrected, such as catastrophic thinking. Traumatic memories are often remembered in disjointed ways when emotional memories surge and overwhelm the person. Putting feelings into words allows persons who experienced trauma to effectively release negative emotions and decrease hyperarousal and avoidance. In psychodynamic therapies conflicts that may be outside of conscious awareness are uncovered and processed. Revisiting past experiences, especially traumatic ones, helps understand how to connect past events with present concerns in order to forge a better future. Therapy in this way oscillates from dealing with the here and now, doing retrospective analyses and narrative reconstructions, and prospective planning with special attention to the developmental milestones that are relevant to each phase of life. These include trust, autonomy, initiative, identity formation, self-esteem, intimacy, generativity, integrity, prosocial endeavors, and balancing self-reliance with interdependence.

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