THERAPEUTIC MEMORY RECONSOLIDATION:

Reprogramming the Mind and Rewiring the Brain

 

by Martha Stark, MD / Faculty, Harvard Medical School

 

 

A special THANK YOU to Bruce Ecker, David Feinstein, Bruce Lipton, Dawson Church, Joe Dispenza, Arnold Modell, Charles Krebs, Allan Schore, Dan Siegel, Marion Solomon, Ed Tronick, Bessel van der Kolk, Beatrice Beebe, Pat Ogden, Patricia Coughlin, Rob Neborsky, Jon Frederickson, Diana Fosha, Habib Davanloo, Kristin Osborn, Jim Donovan, Richard Schwartz, Peter Levine, Joan Klagsbrun, Al Pesso, and Francine Shapiro for opening my psychoanalytic eyes to so many exciting new possibilities and for providing me with the impetus and inspiration for adding a fifth Model of Therapeutic Action to my Psychodynamic Synergy Paradigm.

 

Just as Freud (1955) eventually acknowledged that perhaps the “pure gold of analysis” might have to be freely "alloyed” with the “copper” of “direct suggestion” and “hypnotic influence,” so too I have come to believe that the “pure gold of strictly psychodynamic” (as represented by Models 1 – 4 of my Psychodynamic Synergy Paradigm) might have to be “alloyed” with the “copper” of “stepping up the pace a bit,” “being a little more directive,” “taking a little more charge of the session,” “focusing a little more attention on actual symptoms,” “spotlighting not only the cognitive and the emotional but also the somatic components of the patient’s moment-to-moment experience,” and “specifically targeting entrenched inaction” (as represented by my freshly minted Model 5 – a quantum-neuroscientific approach to symptomatic relief and behavioral change).

 

 

Indeed, how is it that patients advance from refractory inertia, inaction, and thwarted potential to intentioned action and actualization of potential?  What must be overcome in order to accomplish this feat?

 

Charles Krebs (2013) reminds us that we must never lose sight of the fact that complex, adaptive, self-organizing (chaotic) systems “resist perturbation.”  No matter how compromised they might be, self-organizing systems – fueled as they are by their homeostatic tendency to remain constant over time – are inherently resistant to change; they have an inertia that must be overcome if the system is ever to evolve from psychological rigidity to psychological adaptability.

 

A few years ago, I contributed a chapter to HOW PEOPLE CHANGE – a volume of collected papers edited by Dan Siegel and Marion Solomon (2017).  But even after reading everyone else’s chapter and rereading my own, I remained confused as to what truly prompts people to change. 

 

What about patients who remain frustrated and unfulfilled in their lives, despite years of treatment and even after having acquired deep insight into their inner workings (Model 1 “awareness”), having confronted and grieved heartbreaking truths about the objects of their desire (Model 2 “acceptance”), having taken ownership of the dysfunctional relational dynamics they compulsively and unwittingly re-enact in their relationships (Model 3 “accountability”), and having dared to let themselves be found such that they can experience moments of authentic meeting with others (Model 4 “accessibility”)?

 

It could be said that such patients, who remain entrenched in their inaction despite “knowing better,” are suffering from a form of “analysis paralysis.”  They might indeed now be more aware, more accepting, more accountable, and more accessible and, on some level, their lives might indeed now be working better for them as a result; but, on another level, they are not really fulfilling their potential – and they know it.

 

Perhaps my fifth Mode of Therapeutic Action would have been helpful for the young man I saw in consultation a long time ago – a man who had been in a psychodynamic treatment for many years but was still very “stuck” in his life and desperately unhappy.  He reported to me that every single day after work, he would sit in the dark in his living room hour after hour, doing nothing, his mind blank.  By his side would be his stereo and a magnificent collection of his favorite classical music.  The flick of a switch and he would feel better – and yet, night after night, overwhelmed with immobilizing despair, he would never once touch that switch. 

 

In any event, it is this young man’s story and the sobering accounts of so many others who find themselves “paralyzed” in their efforts to make actual behavioral changes in their lives that prompted me to expand my Psychodynamic Synergy Paradigm to include a fifth Model, one that would more explicitly address the importance of symptomatic relief and behavioral change in promoting mental and physical well-being, that is, one that would more explicitly privilege not just “thinking” and “feeling” differently but actually “doing” differently.

 

 

Last weekend I attended an intensive 3-day conference on Intensive Short-Term Dynamic Psychotherapy (ISTDP) and, not unexpectedly, the question arose as to what exactly accounts for the “extraordinary effectiveness” – when done right and well! – of the various short-term intensive treatments, such as Intensive Short-Term Dynamic Psychotherapy, Eye Movement Desensitization and Reprocessing, Accelerated Experiential Dynamic Psychotherapy, Acceptance and Commitment Therapy, Right Brain Psychotherapy, Somatic Experiencing, Sensorimotor Psychotherapy, Psychomotor Psychotherapy, Neuro-Linguistic Programming, Emotion-Focused Therapy, Internal Family Systems, Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy, Energy Psychology, Emotional Freedom Techniques, Narrative Therapy, Motivational Interviewing, to name only a few – and with deepest apology for having left so many out!

 

All of these treatment methods have had, in the right hands, impressive and documented success in the relief of problematic symptoms and, more generally, in the treatment of psychological and physical disorders across a broad spectrum.

 

Rather than the long-term, incremental, step-by-step psychodynamic process, with its ongoing cycles of disruption and repair as the patient gradually evolves from illness to wellness, from rigid defense to more flexible adaptation, these short-term intensive treatments, whatever their specific approach, all appear to rely upon a mechanism of action described by neuroscientists as “therapeutic memory reconsolidation.”

 

Therapeutic Memory Reconsolidation is a “process” whereby the brain can update itself on the basis of new experience.  A number of cutting-edge neuroscientists (Ecker et al., 2012; Feinstein, 2015) consider it to be a “transformational” dynamic that “transcends” the theories and techniques of the different schools of psychotherapy – a neuroscientifically-based process that, under the right circumstances, can happen in almost the blink of an eye, or, sometimes, with just the tapping of fingertips on an acupoint.

 

As I have come to understand it, neuroscientists had long believed that once a new learning was consolidated in long-term memory (“long-term potentiation”), it would be permanently installed – and indelible.  Perhaps it could then be “eclipsed” by subsequent experiences, but it would nonetheless remain intact, lurking beneath the surface and ever vulnerable to being reactivated.

 

With neuroimaging techniques, however, over the course of the last 10 or 15 years reconsolidation researchers have been able to demonstrate that, if specific conditions are met after reactivation of a previously consolidated, negative learning (memory / program), then the neural synapses encoding that learning can be returned to a “labile” (“sensitive” / “plastic”) state in which they can be “modified” or even “erased” and new neural synapses “locked in,” thereby replacing the old, negative program with a new, positive program.

 

Reprogramming of the mind and rewiring of the brain.

 

More specifically, if new, empowering narratives can be co-created by patient and therapist as countermeasures to the old, disempowering mental schemas and if these mismatches (“prediction errors”) happen convincingly enough and repeatedly enough, a therapeutic window will be created for the neural synapses encoding the old, reactivated memories to become temporarily “deconsolidated” or “labile” (“plastic,” as in “neuroplasticity”) and for neural synapses encoding new, updated, present-focused, more adaptive, more reality-based, and more empowering narratives to become “locked in” or “reconsolidated”!!  Therapeutic memory reconsolidation.

 

Whether conceptualized as involving “vagal stimulation of the corticolimbic (limbic-paralimbic-neocortical) system,” “deactivation of limbic arousal,” or “unlocking the synapses encoding the old learnings,” the claim is that this process of “depotentiating” the neural pathways that encode core beliefs, emotional learnings, implicit relational expectations, and mental models can result, under the right circumstances, in the elimination of all manner of deeply ingrained, longstanding symptoms – because their very basis will no longer exist!

 

And, again, instead of an incremental evolving of the system through recursive cycles of destabilization and restabilization, if there are “juxtaposition experiences” whereby “actual or envisioned experiences disconfirm learned expectations,” therapeutic memory reconsolidation can happen in a heartbeat – the “more evolved” perspective enabling “new meanings” (“transcripts”) to be made from the old, outdated memories, emotional learnings, and implicit (procedurally organized) relational expectations.

 

 

In the words of Soren Kierkegaard (2000): “Life can only be understood backwards; but it must be lived forwards.”

 

Only recently have I come to appreciate the fact that “going forward” is just as important as “looking backward.”  By the same token, we are not simply defined by our past and ever struggling to become more aware (Model 1), more accepting (Model 2), more accountable (Model 3), and more accessible (Model 4); rather, it is important that we embrace our power to create our future.

 

My Psychodynamic Synergy Paradigm therefore now involves a complex interplay of all five Models, each Model gaining momentum by virtue of the therapeutic action in the other four.  In other words, all five Models are interdependent.

 

In order to optimize therapeutic effectiveness, there should be continuous shifting back and forth from one Model to the next based on what the therapist, moment-by-moment, intuitively senses is the "point of emotional urgency" for the patient, that is, whether it is the patient's "resistance to awareness" (Model 1), "relentless pursuit of the unattainable" (Model 2), "re-enactment of unmastered early-on relational traumas" (Model 3), "relational absence and retreat from the world" (Model 4), or "refractory inertia and refusal to change" (Model 5).

 

In a subsequent email blast, I will attempt to put my money where my mouth is by offering examples of the “quantum disentanglement” statements that are at the heart of the therapeutic action in my Model 5 – a quantum-neuroscientific approach to facilitating transformation of refractory inertia and refusal to change into action and actualization of potential – a therapeutic model that involves quantum decoupling of the toxicity of the past from the present and envisioned possibilities going forward.

 

“Quantum science suggests the existence of many possible futures for each moment of our lives.  Each future lies in a state of rest until it is awakened by choices made in the present.” ~ Gregg Braden (2008)

 

 

Paraphrasing only slightly the (2007) words of Carol Kauffman, PhD, “As a therapist, I follow the trail of tears to healing <Models 1-4>; as a coach, I follow the trail of dreams to actualization <Model 5>.”

I am eager to hear any and all thoughts, challenges, or reflections that you might have found yourself having as you were reading this!!  Thank you in advance!!

 

 

REFERENCES

 

Braden, G. (2008). The divine matrix. Carlsbad, CA: Hay House.

 

Ecker, B., Ticic, R., & Hulley, L. (2012). Unlocking the emotional brain: Eliminating symptoms at their roots using memory reconsolidation. New York, NY: Routledge.

 

Feinstein, D. (2015). How energy psychology changes deep emotional learnings. In Dahlitz, M., & Hall, G. (Eds.) Memory reconsolidation in psychotherapy. New York, NY: Routledge.

 

Freud, S. (1955). Lines of advance in psychoanalytic therapy. In Strachey, L. (Ed. & Trans.) The standard edition of the complete psychological works of Sigmund Freud (Vol. 17, pp. 157-168). London, UK: Hogarth Press. (Originally published in 1919.)

 

Kauffman, C. (2007). From clinical to positive psychology: The journey to coaching psychology. In O’Connor, J., & Lages, A. (Eds.) How Coaching Works. London, UK: A & C Black.

 

Kierkegaard, S. (2000). The essential Kierkegaard. Princeton, NJ: Princeton University Press.

 

Krebs, C. (2013). Energetic kinesiology: Principles and practice. East Lothian, United Kingdom: Handspring Publishing Limited.

 

Modell, A. (1990). Other times, other realities: Toward a theory of psychoanalytic treatment. Cambridge, MA: Harvard University Press.

 

Solomon, M., & Siegel, D. (Eds.) (2017). How people change: Relationships and neuroplasticity in psychotherapy (Norton Series on Interpersonal Neurobiology). New York, NY: W. W. Norton & Company.

© 2020  Martha Stark, MD ~ Founder / CEO, SynergyMed for MindBodyHealth ~ 617.244.7188 ~ MarthaStarkMD@HMS.Harvard.edu


www.SynergyMed.Solutions ~ www.MindBodyHealth.Solutions

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