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Neuroscience, the Person, and Clinical Pragmatism

Converging lines of study' in the science of mind continue to strengthen empirical support for the core processes of psychotherapy, validating the importance of ideas and methods across the foundational schools of thought. Growing understanding of the dynamics of attachment, implicit and explicit memory, and the mechanisms of neuroplasticity across the life course promises to strengthen the conceptual and empirical foundations of therapeutic practices.

The fields of neuroscience deepen our understanding of the connections between the brain and our changing experience of sensation, emotion, thought, and behavior, just as they strengthen our appreciation of the range of conditions that perpetuate vulnerability and problems in living. Conceptual syntheses and empirical findings offer heuristics that strengthen our formulations of what is the matter and what carries the potential to help, challenging clinicians to consider a wide range of approaches. Developments in the science of mind enrich our thinking about the ways in which various forms of therapeutic action potentially bring about change and growth, offering points of reference across the schools of thought as we consider core elements and different ways of working over the course of psychotherapy.

In more reductive renderings of help and care, some clinicians have proposed that we will come to think of psychotherapy as a biological science or “applied neuroscience” that “rewires” the brain (Cozolino, 2017). Some researchers predict that, in time, we will be able to select specific techniques of intervention and monitor the progress of psychotherapy through the methods of neuroimaging (Kandel, 2018). Such sweeping proposals are problematic in light of the pragmatic values and concerns outlined earlier. However promising scholars and psychotherapists find recent developments in the science of mind, it is crucial to challenge a “technical rationality” and avoid reductive or formulaic applications of research findings that would violate the principles and values of clinical pragmatism, realizing the complexities, ambiguities, and contingencies of therapeutic practice.

As psychotherapists our fundamental concern is not the neuron but the individual, the “human person”—“the most interesting entity known to exist in the universe,” as the novelist Marilynne Robinson reminds us in her critiques of neuroscience (2012, p. 144). We cannot expect neurobiology alone to explain the course or outcome of the therapeutic process. In accord with the principles of clinical pragmatism, we must consider a range of paradigms and a multitude of concepts as we work to understand people, problems in living, and what carries the potential to help, taking account of differences in personality and temperament, the nature of subjective experience, capacities and skills, experiential learning, and the irreducible features of the therapeutic process that defy classification or categorization. As converging lines of study in the science of mind and psychotherapy show, it is the experience of help and care—the ways in which we make use of different elements over the course of the therapeutic process—that carries the potential for healing, change, and growth. “An ounce of experience,” Dewey reminds us, “is better than a ton of theory simply because it is only in experience that any theory' has vital and verifiable significance” (1916, p. 144).

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