Written by The Science of Psychotherapy 

Where to next? This question spurs my curiosity.  Like explorers searching for new frontiers, the counseling and psychotherapy field is at a critical moment in its history. We have moved from narrative descriptions of client scenarios to inform diagnosis and treatment, to the operationalization of symptom clusters into socially constructed categories, and now to the search for more discrete underlying components of all human functioning.  But, to what end?

Some might say the answer to the former question is only as important as the outcomes produced.  Others might say the quest for new knowledge is important enough, but it is about the journey, not the destination.  Regardless of your perception, this new era of science in counseling and psychotherapy is stimulating reservation from the establishment and optimism among the explorers. Continued exploration of what has been and what could be, is what’s next.

Theoretical concepts have guided our practice, and science has sought to support those theoretical suppositions. The current iteration of scientific advances exists within the tension between what we “know” and what we hope to “know.” We seem to be in the age of neuroscience, and there needs to be a balance between technical accuracy of the science with accessible translation into practice. As practitioners, we might not need to know which precise voxels in the brain work with other voxels to form complex networks of millions of brain cells that drive memory formation and retrieval, but this science has already informed new translational theories of memory formation and reconsolidation that shifts the way we understand fear-based responses. This translational process requires a certain humility so that science is not overstated. Accurate and ethical translations of science into practice, is what’s next.

New science regarding memory reconsolidation, cortical-subcortical information processing, and the impact of socio-cultural variables (e.g., racism, discrimination) on nervous system development provides new insights into long standing concepts from cognitive behavioral therapy (CBT). We have new questions. What if schemas, cognitive distortions, and core irrational ideas are really memory traces that have been reconsolidated and strengthened throughout the lifetime? What if traditional CBT creates competing memories rather than reconsolidating existing memory networks? What if we really do act before we think?  How can we evaluate thoughts using cortical structures when blood flow is localized in subcorticol regions of the brain? What if we miss enduring activating events (e.g., racism) and promote shame by evaluating superficial thoughts about someone’s reaction to social stereotypes and bias?What’s next? is more about the quality of the questions than the answers.

Where to next?  I call the field to move from using advances in science to justify what we have been doing for decades and use advances in science to inform what we do next.  I pose a phrase to guide this process:  Because we know this, now we need to….  As we fill in this blank, can we use science to guide and inform our practice, dismantling preconceptions that prove to be incorrect, and search for new ways of knowing and being?  New science is an opportunity to inform new theories, which continues the process of scientific discovery. Where to now? is to become explorers in this exciting era of science in counseling and psychotherapy.

Keywords; counseling, psychotherapy, neuroscience, cognitive distortions, memory reconsolidation, cortical-subcortical information processing,