Brainspotting and the Medicalization of Psychotherapy

Many clinicians want to take psychotherapy to the next level. Some believe that next level waits beyond talk therapy in the realm of brain-based therapies. Brainspotting is the latest such approach, focused on locating “points in the client’s visual field that help to access unprocessed trauma in the subcortical brain.” Over 13,000 trained therapists are now using it for more than trauma therapy.

Psychotherapy originated as a psychosocial intervention, but some want to move therapy into the biomedical domain. They will join psychiatrists who have long been dedicated to directly changing brain function. Psychiatry’s tools are growing as well to include new chemicals (e.g., psychedelics) and devices (e.g., TMS) that impact brain chemistry. The medicalization of our field is advancing.

Changing Brains, Not Just Minds

Many who provide Brainspotting (using eye fixation) came to this technique after practicing eye movement desensitization and reprocessing (EMDR). Each therapy posits healing mechanisms in the brain tied to its visual techniques. Consider this hypothetical formulation by Brainspotting researchers on subcortical healing:

The brain's response to the memory is "reset" so that the emotional response experienced in the body, and conveyed through the paleospinothalamic tract to the midbrain and thalamus and on to the basal ganglia and cortex, is no longer disturbing. 

While this may be wild biological conjecture, we should separate concerns about such hypotheses from the therapy itself. EMDR is instructive in this regard. Researchers now agree it is an effective therapy, and yet it was widely regarded as pseudoscientific when initially offered.

EMDR gained credibility with its clinical outcomes, and controversy lessened as focus on its presumed healing pathway decreased. It remains to be seen if Brainspotting replicates this. The criteria to be endorsed by science (positive RCTs) are the same for both new medicines and new therapies. As with medication, how a treatment works is hypothetical. It is interesting but nonessential for approved use.

These treatments seem to diverge in one way. Biological agents surely impact the brain, while the rituals of EMDR and Brainspotting seem less credible as targeted brain interventions. However, can we really sort good from bad speculation? The yardstick is empirical support, not the plausibility of a hypothesis. The evidence for fixing brain spots is like that for fixing chemical imbalances in the brain.

Reductionistic Variants of the Medical Model

The credibility of a therapy technique triggering remedial brain changes may be less important than the zeitgeist that produces such theories. Our field has long had clinicians working on both mind and body for psychological relief. For example, the human potential movement of the 1960s and ’70s included techniques focused on both. Yet today it seems we have moved from body work to brain work.

The zeitgeist evolves and dominant paradigms tend to produce increasingly extreme positions.  Reductionistic thinking is a common source of extreme views. For example, biology is widely understood as a key determinant of health. Some then progress to more extreme variants. They view biology as the only domain underlying most health issues. It may be explicit or implicit in their work.

Our times are witnessing the march of the medical model, both in reality and imagination. Psychosocial solutions like psychotherapy increasingly face biological reductionism. The logic is plain. If talk therapy is a mediating pathway to changing brain function, we should change the brain directly. While evidence may not support such a total reduction of psychosocial phenomena, the zeitgeist encourages it.

Grand ambitions often need reality testing since science is not wish fulfillment. Cancer still kills after extensive research. Psychiatric medications are not yet targeting the biological roots of disorders. Why would an ordinary, non-invasive process like Brainspotting be so powerful? Research may soon reveal a baseless fantasy, but well-intentioned speculation is treated as plausible until the research is complete.

The Infatuation with Therapeutic Techniques

Therapists are eager to offer better care. Some now believe they have direct access to the brain through commonplace procedures dressed up in biological language. The ironic twist is that psychotherapy is a unique form of interpersonal communication. Therapists can insert an idiosyncratic system of beliefs into a trusting, non-judgmental, empathic relationship and get very positive results.

Consider EMDR’s lesson about psychotherapy outcomes. Its effectiveness is validated, but research would suggest it is regardless of its techniques, not because of them. Wampold’s meta-analytic research shows that therapy is remarkably effective due to common features found in all established models. Therapists offer various explanatory models, but always within caring, healing relationships.

While effectiveness is not tied to a single model, this does not mean anything goes. Research suggests 1) the relationship is central, 2) more than one point of view can be helpful, and 3) some interventions are probably more useful than others. Research will continue to clarify this. However, it is time to surrender unwarranted belief in the power of techniques. This includes both verbal and visual varieties.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.