Why Therapy Works: Using Our Minds to Change Our Brains

by Louis Cozolino

The story of why psychotherapy actually works. That psychotherapy works is a basic assumption of anyone who sees a therapist. But why does it work? And why does it matter that we understand how it works?

In Why Therapy Works , Louis Cozolino explains the mechanisms of psychotherapeutic change from the bottom up, beginning with the brain, and how brains have evolved―especially how brains evolved to learn, unlearn, and relearn, which is at the basis of lasting psychological change.

Readers will learn why therapists have to look beyond just words, diagnoses, and presenting problems to the inner histories of their clients in order to discover paths to positive change. The book also shows how our brains have evolved into social organs and how our interpersonal lives are a source of both pain and power. Readers will explore with Cozolino how our brains are programmed to connect in intimate relationships and come to understand the debilitating effects of anxiety, stress, and trauma.

Finally, the book will lead to an understanding of the power of story and narratives for fostering self-regulation, neural integration, and positive change.

Always, the focus of the book is in understanding underlying therapeutic change, moving beyond the particular of specific forms of therapy to the commonalities of human evolution, biology, and experience.

This book is for anyone who has experienced the benefits of therapy and wondered how it worked. It is for anyone thinking about whether therapy is right for them, and it is for anyone who has looked within themselves and marveled at people's ability to experience profound transformation.

Genres: Psychology, Nonfiction, Audiobook, Counselling, Neuroscience, Mental Health, Social Work

288 pages, Hardcover

First published November 9, 2015

Reviews

[Morgan Blackledge · Rating 5 out of 5]

Another great book from Louis Cozolino.

Absolutely wonderful.

The book sets out to concretely answer the titular question, why (or rather how, precisely) does (psycho) therapy work.

The book draws upon (and integrates) a vast interdisciplinary body of information to answer that (complicated and multifaceted) question.

There is much much more to this book than I can aptly summarize in this venue.

But I would say, some of the important through lines (for me) in Cozolino’s work are:

1. First and foremost, relationships are (SUPER DUPER) important for people.

2. The attuned, empathetic therapeutic relationship is the primary driver of therapeutic benefit.

3. Psychotherapy (or more specifically the psychotherapeutic relationship) facilitates adaptive change at multiple levels, including the brain.

4. Understanding how brains work (neuroscience) is helpful for therapists and clients.

5. Neuronal and organismic processes e.g. homeostasis are recapitulated at the social (relational) level via “the social synapse” a neuronal metaphor social connectivity and social networks, and “socio-stasis” (another functional metaphor referring to homeostasis operating at the social/relational level).

6. The brain has multiple memory and executive systems (lots of taxonomic divisions - the following only to name a few - explicit/implicit, default/task positive, emotional/habitual/declarative, amygdala, hippocampus and frontal cortical).

7. These multiple executive/memory systems ordinarily function in parallel, or in tandem, or otherwise synergistically to promote survival, reproduction and (of course) adaptive psycho-social functions.

8. The same multiple executive/memory systems can also become dissociated and/or conflicted (via trauma and stuff).

9. Psychotherapy can help untangle all that.

10. Feelings, emotions, affect etc., are paramount to a persons sense of self, narrative, relationships etc.

11. Attachment quality (particularly in early relationships) is (SUPER DUPER) important to our emotional experience.

12. When loving, caring attuned caregivers mirror and reflect our emotions to us (particularly as young people, but also throughout the lifespan) it helps us develop internal “structures” (skills, concepts and language and stuff) that organize our psychological experience.

13. Mistuned (or worse) caregiving can result in a paucity of adaptive internal (psychosocial) structures.

14. Psychotherapy can help with that.

15. Insufficient emotional caregiving (or worse - think abuse, neglect etc.) can result in CORE SHAME (the visceral, implicit experience of shame at the core of the self experience, that leaves us feeling fundamentally broken, empty, incomplete, unlovable, unworthy, etc.

16. Unaddressed core shame is a source of endless negative self talk, toxic (social and general) anxiety, depression and exhaustion, and drive us to procrastination, perfectionism, experiential avoidance, and can inhibit our creativity and abilities to live up to our full potential in life 😵‍💫.

17. Psychotherapy can also help with that.

NOTE: Cozolino is psychodynamically oriented. He’s part of the interpersonal neurobiology (IPNB) crew that also includes Daniel Siegel and Allan Schore. As such, he generally promotes a mindfulness based, embodied, relational, psychodynamic style of therapy that is very personalized to each client. And… IM FUCKIN HERE 4 IT! Given all that, he’s EXTREMELY open minded and eclectic (in the good way). He integrates Buddhist psychology, and stuff like EMDR in his (very interdisciplinary) style. And… IM FUCKIN HERE 4 THAT 2!!

Great (enriching, exciting, interesting, life affirming) work. Do your self a favor and read all of Cozolino's stuff. But if you had to pick just one. This one is good.

5/5 STARS ⭐️

[Reba · Rating 4 out of 5]

On the whole, I found this book interesting and edifying, written in Cozolino's usual engaging, often conversational manner.

There were a couple of things I took issue with, namely, a chapter on 'alphas' and 'betas' that seemed highly dubious and problematic to me, and the fact that some terrible, traumatic client experiences were recounted with jokey headings and 'humourous' comments.

[Ana Stanciu-Dumitrache · Rating 5 out of 5]

Foarte bună, cu multe explicații pe întelesul oamenilor care nu au studii in domeniu si vor pur si simplu sa descopere cum funcționează creierul si mai ales de ce terapia ne poate ajuta sa rescriem niste linii de cod făcute de părinții noștri, care ne aduc atat de multă suferința in prezent.

[Hossein · Rating 2 out of 5]

به نظرم بزرگ‌ترین مشکل کتاب این است که برخلاف مدعایش ویژگی‌های یک متن علمی را ندارد. جزئیات علمی‌اش کم است، خیلی جاها به جای روایت علمی داستان می‌گوید و مهم‌تر از همه آن‌که یک ارجاع هم به بیرون ندارد. این نبود ارجاع نه فقط در نسخه‌ی فارسی، که در نسخه‌ی انگلیسی‌اش هم به شکل مشابه وجود نداشت.

[Azra · Rating 4 out of 5]

Gerçekten alanda çalışmasanızda okumanın faydalı olacağı bir kitap. Sadece verilen bilgilerin kaynakları hiç paylaşılmamış. Bence bu büyük bir ihmal.

[Ozan · Rating 4 out of 5]

Bilimsel olduğu iddia edilen ifadeler kullanılan ancak kaynak belirtilmeyen psikoloji kitaplarını pek sevmem ve bir kitabın bu kategoriye girdiğini anladığımda genellikle çok geçmeden onu okumayı bırakırım.

Bu kitap da o kategoriye giriyordu ama kitabı bırakmama kitabın ismi ve alt başlığı engel oldu. Bunlar nedeniyle kitabın kredisi başlangıçtan itibaren benim için yüksekti çünkü bunlar tam da son zamanlarda kafa yorduğum konulardı.

Ve -ileride ara sıra karıştıracağımdan emin olsam da- kitabı "bitirdim". Kitap kesinlikle beni etkiledi: Gözümün önünde olan birçok şeyi fark etmemi sağladı, bu bence zor bir şey.

Kitabın içinde bağlantıları sağlayan bilgilerin (ve diğerlerinin) doğruluğundan bile emin değilim. Yine de kitapta geçen kavramlarla dünyayı çözümleyip ona bir de öyle bakmak pek çok kişiye bir şey katacaktır diye düşünüyorum.

[Joyce · Rating 3 out of 5]

Psychology abounds with theories on how to fix people, what techniques to use, how to use them and for how long. Evidence-based therapies are all the rage - CBT, DBT, MI, etc, etc. When I was in graduate school I was urged to really dig in and embrace one theory and use it as the basis for all of my work. In reality, I borrow from all of the above choices and more - like having a buffet of techniques.

Studies also say that what works best is the therapeutic alliance. If the psychologist and patient mesh well, good things happen for the patient. What really facilitates change is the ongoing conversation and ability of a therapist to listen carefully, use observation and assist the client in figuring things out. However, that can take years and insurance companies think therapy should solve problems in 10 or maybe 20 sessions.

So it is nice to read a book that backs the value of long-term psychotherapy. There's a lot of valuable pointers for new therapists or for those feeling weighed down by insurance demands. The author also recognizes the role of mindfulness and EMDR techniques - using all the tools at our disposal to help those venture into our offices seeking answers.

[Laura · Rating 4 out of 5]

I love a book that demystifies a thing. This brief book gave me good insights into myself and what I've experienced in therapy and has helped me consciously and deliberately reframe the stories my brain tells me. Definitely worthwhile.

[Miglė · Rating 4 out of 5]

beautifully insightful - as a therapist and as a human being.
light on neuroscience, heavy on humanity.

[Rachelle · Rating 5 out of 5]

Wow, very informative. I listened on audiobook while doing some work so couldn’t fully take everything in. I will have to read or listen to it again in future when I can give it the focus it deserves.

I am not certain I was the intended audience (often seems to be speaking to fellow therapists), but having started therapy last year, I found it fascinating.

[آوانگارد| معرفی و بررسی کتاب · Rating 5 out of 5]

پرده‌برداری از سازوکارهای تغییر درمانی
معرفی کتاب چرا روان درمانی موثر است
کتاب چرا روان درمانی مؤثر است اثر لوئیس کازولینو، که در سال ۲۰۱۵ منتشر شد، فراتر از فرض اولیه مؤثر بودن روان درمانی می‌رود و به بررسی سازوکارهای زیربنایی تغییر می‌پردازد. هدف اصلی این اثر، توضیح چگونگی و چرایی اثربخشی روان درمانی است. این کتاب به جای تمرکز بر روش‌های درمانی خاص، به بررسی نقاط مشترک ریشه‌دار در تکامل انسان، زیست‌شناسی و تجربه می‌پردازد.

:معرفی کتاب چرا روان درمانی موثر است نوشته لوئیس کازولینو در آوانگارد بخوانید
https://www.avangard.ir/blog/%D9%85%D...

[Fateme H.]

بعد از چند ماه، تموم شد. با گروه کتاب‌خوانی می‌خوندیمش و برای همین جلوتر نمی‌خوندم و از یک جایی به بعد هم یه کم تنبلی کردم و... آره خلاصه.
سرجمع به نظرم کتاب خوبی بود و به نکات جالبی اشاره می‌کرد. (البته اگر اون دو فصل مربوط به تبدیل شدن به یک شخصیت آلفا رو فاکتور بگیریم.) دقیقا همون‌طور که نویسنده تو مقدمه می‌گه، پیش‌فرض آدم تو جامعه و تو دانشگاه اینه که روان‌درمانی موثره اما کسی درباره‌ی چرایی‌ش حرف نمی‌زنه و نویسنده در این کتاب داره تلاش می‌کنه دلایل موثر بودن روان‌درمانی رو پیدا کنه و توضیح بده. نمی‌دونم چرا این حرف رو می‌زنم. تمام این‌ها دقیقا از اسم کتاب مشخصه: چرا روان‌درمانی موثر است؟

[Julian Meynell · Rating 3 out of 5]

This is a very uneven book. It claims to be for the person with a casual interest in therapy or for current or potential patients, but if anything it is even more aimed at practitioners. The book is written at a very easy reading level. For me it was a little too easy. I doubt that anyone who would want to read this could not take a slightly more complex writing style.

Why therapy works is a very interesting question to me. I have no doubt that therapy can produce at least small miracles and I know this from personal experience. An unfortunate aspect of the book is that it is presented as if many or most of the problems with this are well known. I think that any reasonable person with a passing interest would look at what we know about therapy, and would realize that we are still in the early days of understanding therapy theoretically. This is equally true of cognitive neuroscience. Where the two disciplines intersect almost all is a mystery and the book does not take a realistic attitude to this. Instead it presents the subject as if it was well known and it also presents speculations as facts a lot. A little more honesty about the fact that we know at most 1% of the answer to the question of why Therapy works would have been welcome in the presentation.

The actual theoretical work is very mixed. I found some of the material on PTSD interesting for example but very sketchy. There are some plausible speculations about Borderline Personality Disorder and some vague but probably right comments on narrative for instance. However, some of it is wrong and even offensively wrong. The two chapters on Alpha's and Beta's are the clearest example of this. Cozolino divides everyone into Alpha's and Beta's (he is thinking primarily of the employment context whether he realizes that or not). He slightly nuances this by adding Aspirational Alpha's and Pseudoalpha's. We are then told that Alpha's will naturally rise to the top of any group and told a list of what Alpha's are, which follows:

1) Alpha's are confident
2) Alphas Take Responsibility for Outcomes
3) Alpha Don't fear Failure
4) Alphas Keep Their Own Council
5) Alphas are able to Regulate Their Emotions
6) Alphas have Goals and a Plan to Get There
7) Alphas Understand and Utilize the Power of Words
8) Alphas Accept Their Vulnerability
9) Alphas Select their Partners Consciously
10) Alphas Are Not Afraid to Be Quiet or Alone

Wow. Good for Alphas! And Wow those Betas sure do suck! No wonder they are at the bottom in this perfectly good and just world. This list is so totally divorced from reality that I hardly know what to say about it. It represents an actively delusional belief set, that is by its very nature oppressive. The one thing that I feel confident of is that Cozolino must derive some of his income from well to do clients or in given speeches to companies or else why spend so much time setting up masturbatory frenzies for the powers that be. However, for someone who has been traumatized by a toxic work environment, therapy based on this would be actively re-traumatizing. Cozolino is engaging in victim blaming whether he realizes that or not. Furthermore it is based on a very simple schema that cannot possibly represent even a troop of Bonobos, let alone early Homo Sapiens or any other developed hominid. In addition, I spectacularly do not fall into this scheme (I am by nature egalitarian and independent in an extreme way and do not seek out or want dominant positions, but respond dramatically to attempts to dominate which rarely go well for the "Alphas" despite their amazing and to me utterly ridiculous claimed abilities.)

This brings us to a further criticism of the book which in many ways is a criticism of Therapy and indeed Psychology as a whole. Therapy is an attempt to make people "better". It is often a cure. In physical health everyone agrees on what health means, but in therapy this is bound to differ because it involves value judgments about what an ideal life or an ideal person looks like. My background includes extensive training in philosophy including Ethics and a theory of what a good life is. Therapists tend to simply project their values onto therapy and this is more spectacularly the case because there has been almost no critical evaluation of values in the entire history of therapy (Freud for instance tried to do this but failed spectacularly and operated at a C- level for a beginning philosophy student). Cozolino is very bad in this regard and to a disturbing degree just accepts uncritically the values of the contemporary United States of America even at their most ridiculous. And this book is a great example of very specific and dubious cultural norms being injected into the therapeutic process. That's fairly avoidable in my experience but it takes a flexible and sensitive therapist with at least an innate ability to think critically about values.

Having said all of these spectacularly negative things about the book, I am still giving it three stars because there is a lot of fascinating material and the intersection between therapy and neuroscience is so interesting and there is not much out there in what is practically a brand new field.

I wanted to love this book, but I just can't. It gets three stars for the field.

[Lore LongSoulSystem · Rating 2 out of 5]

No recuerdo por qué lo tenía sin terminar y cuando lo retomé recordé por qué. Porque metió demasiado el tema del "macho alfa".
Heteronormado además, del problema de las mujeres terapeutas ante "hombres alfa". ¡Puaj!
Lo demás está medio ok, pero nada del otro mundo.

[Jessica Nowachek · Rating 2 out of 5]

This book was a decent look at some of the more technical neurophysiology of the brain, but it was heavily slanted from an evolutionist, naturalistic worldview and tied a lot of the information back to our supposed history as primates and even fish.

[Emma Devine · Rating 4 out of 5]

would be 5 stars but I think the author would have an easier time if he believed in God

Also the cover is giving 70s when this is in fact from 2016

[Kyle Lisowski · Rating 4 out of 5]

Didn’t love the Alpha/Beta stuff, but aside from that, really great!

[Nan Rockey · Rating 2 out of 5]

A bit directionless in its structure and the in-depth discussion on pseudo science alpha/beta paradigms felt really dated. The beginning chapters had a lot of insight into neurobiological responses and I wish it had kept that same scientific view throughout.

[La Rayo · Rating 5 out of 5]

Highly recommended
البته نقاط ضعف زیادی هم داشت.

مهمترین نقطه‌ی قوتش: ساینس روان‌درمانی رو توضیح میده. درمورد بخش‌های مختلف مغز صحبت میکنه و توضیح میده تکنیک‌های مختلف روانشناسی دقیقا رو کدوم بخش اثر میذاره و چرا اثر میذاره.
داستان‌ تجربیات کیس‌های مختلفش رو تعریف میکنه. و نظرات مختلف رو برسی میکنه.

یکی از نقاط ضعف مهمش هم این بود که زیاد انسجام نداشت.
ولی خب باید لحاظ کرد که توی این دسته کتابها، نگارنده، نویسنده نیست.
قرار نیست اصول نویسندگی رو رعایت کنه. هدف چیز دیگه‌ایه.
میتونه ایده خوبی باشه که افرادی باشن که به این تیپ نگارنده‌ها کمک کنن تا کتابی منسجم و در قامت یک نویسنده بنویسن.

تجربه‌ی شخصی من درمورد کتاب؟
روزی که داروم قطع شد رفتم پیش کیمیا.
اشک ریختم و خبر خوشو بهش رسوندم.
بهش گفتم که تراپیستم افیشالی بهم گفت اگر روندت ادامه‌دار باشه میشه گفت تو بالاخره درمان شدی. اما من هنوز سوالهای زیادی دارم. هنوز نمیتونم بفهمم که چیشد که من "درمان" شدم؟ اصلا این درمان یعنی چی که من هنوز نمیفهمم بهش رسیدم یا نه؟ چطور تعریف میشه؟
و کیمیا این کتاب رو بهم پیشنهاد کرد. گفت میتونه اختتامیه‌ی خوبی باشه بر پروسه‌ی درمان.
واقعا هم بود.
و از اون کتابهایی شد که قراره بارها و بارها برش دارم و بخونم.

کتابهای روانشناسی میتونن واقعا کتابهای خوبی باشن.
یه سریاشون مثل این میتونن باعث بشن بفهمی چرا باید خودتو بیشتر دوست داشته باشی. و بفهمی در عین همه‌ی افتضاحات و باگ‌ها و ایرادات جوری که هستیم، درد را چاره نیست و رنج کشیدن اختیاریست.

[Ashgus · Rating 4 out of 5]

Very interesting book. I enjoyed the interwoven elements of neuroscience, psychiatry and psychology, all of which combine to explain why psychotherapy works. I like how this book explores the importance of social relationships, especially during early childhood, to healthy development of the whole person.

[Maria Grigoryeva · Rating 5 out of 5]

Part of me is always struggling what if this whole therapy thing is just another hype.. does it really work or something of inflated and subjective value like modern art? This book has added one of the missing bit to my puzzle, sufficiently detailed but still pretty comprehensive explanation what exactly is physically happening with our brain when we go to the therapy.

[Betül Bozkurt · Rating 5 out of 5]

Ba-yıl-dım! Belki psikolojiyle ilgilenmeyenlere ağır gelebilir ama ben yapışkan not kağıtlarıyla, kalemle, defterle okudum resmen bu kitabı. Özellikle sosyal statü ile ilgili çözümlemeler çok ilgimi çekti. Nefis.

[K Hue · Rating 5 out of 5]

another fantastic book by Cozolino. a great read in the Interpersonal Neurobiology series. Social Schema attachment section was fascinating...

[Rafael Felix · Rating 5 out of 5]

Clear, direct, simple to understand quickly gets to the point. Very good

[Caleb · Rating 4 out of 5]

Really great material. A great summary of attachment theory.

I wasn’t a huge fan of the social theory (alphas/betas). Also, why was nothing cited in this book.

[Sebastian · Rating 3 out of 5]

Some really fascinating stuff, some iffy stuff.

The notions of "Alphas" and "Betas" feel outdated, I felt like there was something interesting behind those words but the connotations of such terms tainted the whole thing for me. Also whilst he says that people can be secure betas, he never explores what a happy life as a "beta" would look like, only focusing on how to be an alpha and how much being a beta sucks. As someone who wants to both self advocate more and take control of my life, but not in a traditionally Capitalist way, it missed the mark with me. Am I an insecure beta wanting to be an alpha? Am I an alpha already? Am I a secure beta? All of these terms don't fit. They're reductive and more harmful than useful.

(Side note- I was both seeing the terms Alpha and Beta through the toxic masculinity lens but also... A/B/O, lol. I giggled through the whole chapter, I won't lie)

Additionally, I wasn't a fan of the "Machine Gun Kelly" exercise, where Cozolino tells therapists to help clients with repressed anger to "imagine gunning down an abusive alpha in your life".
In extreme detail, gore and all. It could be a useful exercise, but it didn't feel right for me personally.

[Zahra Sadat · Rating 5 out of 5]

What I'm going to write about this book might be a bit weird, but I like to share my experience anyway.
Besides all the interesting information the book contains (which I loved reading and highly recommend, especially for beginner therapists, such is myself), I just enjoyed how the writer explained everything. You know how there are these momemts in therapy when your therapist puts your feelings into words that perfectly fit your experience? How good it feels? I had moments like these while reading this book, but rather than capturing my emotions and puting them into words, the writer put my ideas, suspicions and questions into words that perfectly fit what I (as an amateur therapist) had in mind.
Also, he wrote about topics I have read about a billion times, such as attachment theory, but again, the writer explained them with a slightly different phrasing that made me feel I'm reading this topics once again for the first time.

I guess in short, I should say: he has a way with words.😅

[Harry · Rating 4 out of 5]

Therapy does work, and an understanding of how it works is a wonderful gift to possess. Louis Cozolino describes the ways in which psychotherapy addresses and meets the complexities of our brains and nervous systems with sensitivity and his own vast knowledge and experience.
The book is written with clarity and in language that is accessible to all readers. If you've been in therapy, are contemplating or just curious about therapy, or thinking about a career as a therapist, add this to your reading list.

[C · Rating 5 out of 5]

This was excellent. I found the section on alpha vs beta people really interesting. On social media (and what you hear in the manosphere) the discussion of alphas versus betas is so steeped in utter nonsense. Alphas will eat raw meat, lift heavy weights, own guns, blah/blah/blah--just ridiculous. I love the way Cozolino describes what real alpha men and women are like--and they are nothing like the authoritarian-following, wanna-be alpha types who *think* they are alphas just because they peacock around, loudly bullying others. This book is so good. Highly recommend.

[Nicole · Rating 4 out of 5]

I'm not totally sure. Some chapters I really enjoyed and others I didn't really relate to. I appreciated learning that the naming of emotions and sensations increased cortical control of the amygdala and other such neuroscience. However, the portion on alpha and beta social schema didn't totally resonate for me. I do think trauma was explained well and interestingly. Yet I found myself feeling fairly often that I just wasn't feeling terribly grabbed and engaged by the book. I'd maybe say 3 1/2?