Rizq, Rosemary

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‘Tread softly’ again: a response to ‘Knowing the Brain’.Rosemary Rizq. I was delighted to read Ben Rumble’s paper and to be asked to frame a short response to such a thoughtful and beautifully written article. I think it is clear that he has, without further ado, got straight to the heart of the issue that counselling psychology as a profession currently faces: what do we do with the neuroscientific knowledge we are accruing? What are its clinical applications?  Following my reading of his paper, I found myself moved to offer some additional thoughts by way of sparking further professional dialogue on these and other issues; a dialogue that, to use his own idea, I see as contributing to a relationship to a body of knowledge, albeit one that is as yet unknown, as yet unformulated.Now, to get down to it: Rumble suggests that I see neuroscience as ‘completing the other half of a phenomenology that would otherwise be insufficient to fully understand mental events’. And indeed, whilst I do see one or the other alone as insufficient, the step from this to claiming that the two together form a total, closed explanatory system, a ‘grand narrative’ that can somehow fully account for psychological distress is about as great a challenge to my credulity as it was to Lyotard’s. I had hoped to be careful in my paper not to address the philosophical issue of consilience in too much detail, partly because of my own lack of qualification in that area but also because I think this is precisely the sort of argument that seduces us away from actually looking at the research in any detail. Grand narratives, Rumble claims, run the risk of claiming a totalistic picture that obscures what he calls ‘the necessarily incomplete body of knowledge which emerges in the setting itself’. I am not sure what he is referring to here. He seems to suggest that our relationship to neuroscience will emerge and somehow become embodied in our therapeutic presence and neurobiologically informed interventions such as ‘facilitat[ing] changes in client autonomic arousal’.  I am not at all convinced that neuroscientific research will directly inform clinical practice in this way, and I think it worth repeating what I said in my paper: that we are working with subjectivities, not synapses. For this reason, I find that some of the most imaginative and clinically plausible theoretical developments in psychotherapy are now moving away from what have been the more traditional static notions of causality, linearity and prediction and instead are focusing on notions such as emergent properties, reciprocal feedback loops and non-linear systems that take account of the inherent unpredictability and instability within the to-and-fro of relational work: welcoming the gaps, as it were.  Dan Stern’s (2003) work on ‘sloppiness and co-creativity in the therapeutic encounter’, drawing on developmental and neuroscientific research, is an exemplar of a type of theorising that incorporates a dynamic systems framework in which ‘the trajectory that will emerge from the interaction of the two partners is unpredictable and includes emergent properties that pop up from the interaction of the many variables’. (p. 697).  I would not at all disagree with Rumble’s suggestion that our particular relationship to neuroscientific discourse is a central factor in how this discourse becomes embodied and enacted within the therapeutic relationship itself. All I would suggest here is that perhaps we might usefully see this relationship as indirect, rather than literal and that Stern’s work, amongst others, is precisely the kind of sophisticated theorising that we as counselling psychologists might be more likely to engage with and relate to.Moving (carefully) on to other ways in which neuroscience might inform clinical practice, I suspect such research may also be indirectly helpful in determining which competing theories should (or, more accurately, could) inform out therapeutic interventions. For example, when we are working with trauma, we might take the view that our client’s memories have been repressed, and work towards therapeutic recovery of these memories.  Recent work on explicit and implicit memory systems suggests that such memories may not have been coded in the first place, making it unlikely that any amount of insight or exploration will result in explicit recovery of traumatic events. As Pulver (2001) advocates, we might then work with dreams, somatic sensations and fantasies to help clients implicitly gain access these episodes.  In this respect, then, neuroscientific research has the potential to elucidate the neurobiological constraints to our psychotherapeutic endeavours. That this may be felt as a narcissistic blow to our therapeutic omnipotence could be viewed as a necessary, if uncomfortable, side effect of the dialogue or putative relationship with neuroscience that Rumble is interrogating. As Brecht points out in his provocative and in this context rather apposite play ‘The Life of Galileo’:  ‘the aim of science is not to open the door to infinite wisdom, but to set a limit to infinite error’.I must tread even more softly when I turn to the complex issue of outcome research and the kinds of measures that are currently used to gauge clinical outcomes. It is a common complaint amongst practitioners that the outcome measures used in clinical trials (and increasingly, these days, in NHS service audit) do not reflect clients’ criteria of success. Fonagy (2004), too, has pointed out that most outcome measures used in clinical trials are oriented to symptom distress and are of most relevance to the pharmacological companies providing drugs for specific psychological disorders. Even more seriously, Luborsky et al (1999) have demonstrated that 70-80% of the variance in psychotherapeutic outcome can be predicted on the basis of the researcher’s theoretical allegiance. Unsurprisingly, Fonagy argues that we therefore urgently need non-biased outcome measures, and claims that neuroscience will ‘deliver this sooner rather than later’ (p.357). Of course, whether or not current neuro-imaging techniques will develop to the level of providing brain images of two interacting individuals, and whether establishing the neural correlates of psychotherapeutically-sponsored changes in relationship quality proves clinically useful is, I think is a question that is, as yet, up for grabs: but I think both Rumble and I are agreed that this is certainly a question that counselling psychologists will need to engage with.However, I suspect one of the reasons we find the whole issue of neuroscience so problematic is its apparent depersonalisation of the psychotherapeutic project; its ‘greedy reduction’ (Dennett, 1995) of the Socratic injunction to lead the examined life. How can knowing about neurons possibly help us in this moral mission? Here I am afraid Rumble gives me no option but to stumble headlong into the treacherous philosophical territory that he has hinted (rightly) I am avoiding.  Part of the problem as I see it is the positivist tendency to treat the language of neuroscientific research as somehow closer to ‘the truth’ or ‘the real thing’ out there in the world (ie our minds) than the subjective, metaphorical accounts generated by novelists, poets or even some counselling psychologists. But the issue it seems to me is perhaps less one of whether, for example, the images produced by fMRI scans and so forth prove to be closer to what the mind ‘actually’ is, and more of how successful neuroscientific language can be for changing how we talk about – and tend - the mind: the cash value of neuroscience, if you like, as opposed to its truth status. The neo-pragmatist Richard Rorty (1991) points out that Freud’s success in changing the way people think about themselves was largely due to his radical view of the unconscious as a ‘sensitive, whacky, backstage partner who feeds us our best lines’ (p.150), tripping us up in slips of the tongue, jokes and unexplained symptoms. This notion of the unconscious as ‘conversational partner’ (p. 149) or intellectual equal, inventing, proposing and celebrating alternative versions of the self, extends the possibilities of self-awareness by permitting and entering into dialogue with these differing descriptions and using them as persuasive means of changing the way we feel and think about ourselves. This is why, implies Rorty, vocabulary rather than physiology drives behaviour change: unlike our Freudian unconscious selves, neurons don’t demand attention, and don’t answer back. More importantly, the availability and plausibility of these different versions of the self means that there is no single, unified view of the self, no correct ‘view from nowhere’ (Nagel. 1986) about how things ‘really’ are (as neuroscience is in danger of proposing),  but rather merely competing descriptions of the self that are, at best, tools for sponsoring sought-after change.In this view, hermeneutics and neuroscience (or relativism and positivism) are merely rival vocabularies; neither one is intrinsically better or more accurate than the other in describing reality, but both can be used as instruments for understanding and dealing with the self and others. After all, the brain as far as we know has no preferred description of itself. To my mind, this very familiar argument remains one good reason why counselling psychologists need to acquaint themselves with current developments in neuroscience and confirms why the questions raised by Rumble are so crucial: for if we find that the introduction of neuroscientific discourse impedes our psychotherapeutic work, or, conversely, if neuroscientists find that their advances are clinically useless, then perhaps we will need to invent another language, another way of speaking about - and to - our clients that is better than both these competing discourses.  I suspect one future task for counselling psychologists will be to contribute to just such a venture; a vocabulary by which we can forge a compromise between – or better still, replace - the polarities of an extreme positivism on the one hand and a radical relativism on the other; a lexicon that is perhaps capable of conveying both the scientific and the subjective, one that can both account for mental phenomena as well as incite feeling and evoke creative associations. I concur with Rumble that the specific locus of this will always be the therapist and his or her embodied relationship to this endeavour; but would argue that that the assumption of a ‘necessarily incomplete body of knowledge’ emerging within the psychotherapeutic context presupposes the existence of some essential non-verbal aspect of how things really are for which words are ineluctably insufficient. Instead of trying to ‘crawl under the net’ of language, as the novelist and philosopher Iris Murdoch evocatively terms this attempt to get closer to ‘reality’, I prefer to think of Rumble’s ‘vertical relationships’ or ‘listening with the body’ as simply one more way of describing and accounting for clinical experience; a sort of ‘knowing’ that is no less and no more based on fact or reality than the fMRI images provided by neuroscience. On this basis, I would tentatively suggest that we might profitably concern ourselves with the linguistic interstices inherent within some of the currently available clinical vocabularies; and the ways in which they variously inhibit and frustrate, or alternatively expand and enlarge our capacity for creative re-description and self-transformation.  In this sense, by reminding us that counselling psychology is located ‘on the borders of empirical science and the humanities’ I think Rumble points to a substantial opportunity afforded to few other psychotherapeutic disciplines: that of acquainting ourselves with as wide a range of discourses as possible - including that provided by neuroscience. In this way we may (perhaps) be in a better position to compare and adjudicate the uses to which these competing discourses are put.  Along the way, perhaps this will help us to formulate and circulate more enabling, more hopeful self-descriptions and metaphors; vocabularies that may sponsor what E. M. Forster suggestively calls ‘a new system of lighting’ that illuminates ourselves - and therefore others - differently.I could go on, although I suspect I have trampled quite ineptly enough for now. But all these issues circle around the central point that Rumble is making: that we, as a profession, haven’t yet determined our relationship with neuroscientific discourse andthat how we relate to this body of research, the nature of our dialogue with it, will ultimately determine what, if any, use we make of it within our theory, research and clinical practice. One way of forwarding this potential relationship is for counselling psychology training courses to include and interrogate contemporary developments in neuroscience within their curricula, as, indeed, some already do; we must also continue to debate these epistemological issues and their implications within the profession and across interdisciplinary divides. I am most grateful to my very eloquent colleague for forwarding that debate. That he is a counselling psychology trainee can only bode well for the profession.Rosemary RizqResearch Centre for Therapeutic EducationSchool of Human and Life SciencesRoehampton UniversityWhitelands CollegeHolybourne AvenueLondon SW15, 4JDEmail: rosierizq@tiscali.co.uk References.Dennett, D. (1995). Darwin’s dangerous idea: Evolution and the meanings of life. US: Simon & SchusterFonagy, P. (2004). Psychotherapy meets neuroscience: a more focused future for psychotherapy research. Psychiatric Bulletin, 28, 357-359.Forster, E. M. (1927)  Aspects of the Novel. Reprinted (2005) London: Penguin Books.Luborsky, L., Diguier, L., Seligman, D. et al (1999). The researcher’s own therapy allegiances: a wild card’ in comparison of treatment efficacy. Clinical Psychology: Science and Practice, 6, 95-106.Murdoch, I. (1954). Under the Net. Reprinted (2005) London: Penguin Books.Nagel, T. The View From Nowhere. New York: Oxford University Press, Inc., 1986.Pulver, S. (2001). On the astonishing clinical irrelevance of neuroscience. Plenary address, American Psychoanalytic Association, New York, 21 DecemberRorty, R. (1991). Freud and Moral Reflection. In: Essays on Heidegger and Others. Philosophical Papers. Cambridge University Press.Stern, D. Sander, L., Nahum, J., Harrison, A., Lyons-Ruth, K., Morgan, A., Bruschweiler-Stern, N., and Tronick E. (2003) The ‘something more than interpretation’ revisited: sloppiness and co-creativity in the  psychoanalytic encounter. Journal of the American Psychoanalytic Association, 53, 3: 694-727

Tread softly, again::A response to 'Knowing the brain, unknowing the body'

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Tread softly, again::A response to 'Knowing the brain, unknowing the body'

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