In these days of evidenced-based practice and the hegemony of brain-based approaches to mental illness (e.g., psychopharmacology, rTMS, etc.), some of us feel moved to demonstrate to funders that what we do as psychotherapists and social therapists works. I believe we are moving towards developing the tools which are less invasive and which could potentially be used to explore further, on various system levels, the processes involved in long-term psychotherapeutic work with persons with a mental illness. The following is a brief description of some of these neuroimaging tools in development.

Roffman et al (2005-”Neuroimaging and the functional neuroanatomy of psychotherapy” in Psychological Medicine, 35, 1385-1398) pointed out the difficulties, technical and logistical, in using traditional fMRI, PET and SPECT scans naturalistically within the setting of individual psychotherapy. However, these authors proposed the future development of such novel neuroimaging techniques as near-infrared spectroscopy (NIRS), which allows for the measurement of cortical cerebral blood flow (CBF) less invasively than fMRI and is also more portable and less expensive than the latter. NIRS is also safe and practical for repeated measures and has been employed to measure CBF in persons with a range of neuropsychiatric conditions (Strangman et al 2002). A second optical technique in development is two-photon microscopy. This tool can potentially image deeper brain activity in vivo even on a cellular level (Miller, 2003). In the past, psychophysiological measures have been used to allow for simultaneous measurements from both patient and therapist. Likewise, these new non-invasive optical techniques could also permit simultaneous measures of patient and therapist, and would fit well with a contemporary relational approach to the psychoanalytic setting and dyad.

One of my goals is to do a long-term study on psychotherapy outcomes in persons with a severe mental illness (comparing CBT & psychodynamic therapies) using neuroimaging as one dependent measure. With the above tools (as well as traditional fMRI), one may be able to investigate patterns of relational processes occurring between both members of the dyad and see if there is a correlation with outcomes, e.g., mirror neuron activity in the dyad, synchronization of blood flow, glucose metabolism, empathic linkage reflected in certain neural regional activity, neural regions mediating insight into psychotic processes which serve to maintain the patient in an isolated and withdrawn state, etc. I would be interested in seeing if any ventriculomegaly (dilated ventricles perhaps due to the atrophic processes of surrounding neural tissue secondary to profound fear/anxiety and social isolation/deprivation) or cortical/subcortical atrophic processes present could be reversed. Some researchers (e.g., in CBT), including neuroimaging specialists at Cornell University and researchers at the University of Pennsylvania, have shown a strong interest in doing this research with me and other ISPS members. Funding is critical for this very expensive project.

Brian Koehler
Postdoctoral Faculty
New York University