Louis Cozolino on the Integration of Neuroscience into Psychotherapy—and its Limitations

Louis Cozolino on the Integration of Neuroscience into Psychotherapy—and its Limitations

by Sudhanva Rajagopal

Psychologist and neuroscience researcher Louis Cozolino describes the many twists, turns and theoretical orientations he's traversed in his over four decades in the field, the need for psychotherapists to be less passive, and the applications of neuroscience to psychotherapy both now and in the future.
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Neuroscience or Neuro-psychobabble?

Sudhanva Rajagopal: Lou Cozolino, you are a psychologist and professor of psychology at Pepperdine University, where you were a teacher of mine. You’re a prolific writer and researcher on topics ranging from schizophrenia, child abuse, the long-term effects of stress, and, more recently, neuroscience in psychotherapy and the brain as a social organ.

As a clinician in training, it seems like there is a lot of neuroscience talk out there in our field, and it gets used to legitimize anything from specific interventions to whole theoretical orientations. My first question to you is, for the clinician in training, how do you recommend that we see through the noise of all that to what is actually helpful in the room with a client? How does knowledge of neuroscience play out in the room and what is actually important for the clinician to know?

Louis Cozolino: There are two main realms where neuroscience can aid clinicians. One is case conceptualization and the other is for clients who aren’t really open to a psychotherapeutic framework or an emotional framework. For them a neuroscientific explanation or conceptualization of their problem is often something they can grasp while they can’t or won’t grasp other things.

People who learn a half a dozen words about neuroscience think they’re neuroscience literate.
But there’s so much psychobabble and neuro-psychobabble out there, and the thing is if you say something is the amygdala as opposed to saying it’s anxiety or fear-based, you haven’t really upgraded the quality of the discourse. You just substituted one word for another. So the risk is that people who learn a half a dozen words about neuroscience think they’re neuroscience literate.

Learning neuroscience takes dedication. It takes work to get beyond the cocktail level of conversation and clichés. It took me ten years to feel like I had any sense of what was going on and I studied it pretty intensively. So I think we all have to be careful, but even more importantly, just because you know some neuroscience doesn’t mean you know anything more than the therapist who doesn’t. It’s really about how you use that information to upgrade the quality of the work you’re doing.
SR: In your book, Why Therapy Works: Using Your Mind to Change Your Brain, you say that science in many ways is just another metaphor. Do you think there are dangers to people using neuroscience to legitimize their work?
LC: Well, sure. There’s a fellow, Daniel Amen, who does these SPECT scans of people and he’s been selling them for thousands of dollars for probably 20 years now. It’s hard to know whether any of his data has any meaning. All we know is he’s made a hell of a lot of money doing them. The danger is in selling things before you know that they have any legitimacy, so you have to watch out for snake oil salesmen just like you do when you’re buying carpets and used cars.
SR: So how do you recommend that someone like me goes about finding and learning about neuroscience in a way that’s helpful? How do I avoid the snake oil salesmen?
LC: It’s important to realize that knowing neuroscience doesn’t make you a good clinician—in fact it doesn’t make you any kind of clinician at all. So I would say for beginning therapists, it’s probably best not to pay too much attention to neuroscience.
For beginning therapists, it’s probably best not to pay too much attention to neuroscience.
Learn a few things about it but focus on getting the best supervision you can in a recognized form of psychotherapy—psychodynamic, cognitive, behavioral, family systems, etc. And avoid the passing fancy of all of the new therapies; every day there’s a new therapy with a new set of letters in front of it.
SR: Yeah there are so many different kinds of therapies these days.
LC: Try to learn something that isn’t just a fad, because the fads—I’ve watched hundreds of them come and go over my years. But if you cleave to psychodynamic training and cleave to cognitive behavioral, Gestalt, family systems training—those are the things that you can hang your hat on. Then you can learn the fads to add to your tool box. The fads are very sexy and they create the illusion of understanding because they’ve got fancy terms and nice workbooks and such, but really you’re not a thinker when you’re doing those things, you’re more of a mechanic.

Now neuroscience is sort of like a sidecar to conceptualization, but you’ve got to remember the motorcycle is the real tried and true way of thinking about clients. You know, what is a particular problem? What is mental distress or mental illness? Where does it come from developmentally and what are the tried and true ways of approaching it and treating it?
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Every Therapy is Embedded in Culture

SR: Speaking of tried and true ways of thinking, you say in your book, “Psychotherapy is not a modern invention, but a relationship-based learning environment grounded in the history of our social brains. Thus the roots of psychotherapy go back to mother-child bonding, attachment to family and friends, and the guidance of wise elders.” My question is, where do you think psychotherapy fits in to the context of healing traditions that have been around for millennia?
LC: Well, I think one thing that seems to be different over the last hundred years in psychotherapy is a kind of structured recognition of the fact that the therapist is imperfect and contributes in a lot of different ways to the problems. The tradition of wise elders was one of an authoritarian stance: This is the truth and I’ll take you on this journey with me to change you into my likeness. To whatever degree psychotherapy has evolved past that has to do with the self-analysis of the therapist and the recognition that whatever pathology exists in the relationship between client and therapist, some—hopefully not the majority, but some—pathology in the relationship comes from the therapist.

That type of recognition is a step forward. There are probably some steps backward too. Often psychotherapy is ahistorical and acultural—or at least tries to be—but every therapy is embedded in culture. There is a kind of pretense about an objective scientific stance that is just a fantasy. So in some ways, wise elders in a tribal context with a long history are probably advantageous for some people as compared to psychotherapy.
SR: I was flipping through the index of your book and noticed the word “culture” appears exactly once, though you do talk about the wisdom of the ancients, about Buddhism and Confucianism and some of the Indian traditions. Seems to me that once we start relying on these kind of generalized, evolutionary, and biological forces as explanations for things, there’s a risk of painting people’s lived experience with a pretty broad brush. What’s your take on the importance of culture as it relates to neuroscience and psychotherapy?
LC:
I think that culture needs to be interwoven into every sentence of every book, not just included in some special chapter of a book.
From an evolutionary perspective, a basic principle is biodiversity, and culture is too blunt an instrument to understand people because there are so many differences within culture. I think in terms of every individual being an experiment of nature. Every family is a culture in and of itself, and the more different someone’s cultural background is from mine, the more there is for me to learn. I think that culture needs to be interwoven into every sentence of every book, not just included in some special chapter of a book.
SR: From my point of view, many of these older cultural practices have been repackaged and rebranded as psychotherapy theories and techniques. The “mindfulness revolution” and transcendental meditation are based on ancient cultural traditions, but they are marketed as if they are especially effective because they are “new” and “evidence-based.” What is your stance on that?
LC: Having studied religion and philosophy and Sanskrit starting back when I was in college in the 70s, the self-awareness of meditation has been part my worldview since long before it became a cottage industry. But even back then there was the Maharishi Mahesh Yogi and the Beatles, and it was coming into the cultural context. Now people have figured out how to package it as a way to sell more therapy, which isn’t all bad, but runs the risk of becoming “the answer.”

I think we’re in a race between global destruction and global consciousness, so we’ll see who gets to the finish line first.
What I’ve been hoping for since I first discovered Buddhism in the 1960s, is that as the world gets smaller and as people from different cultures communicate more, the wisdom of the ancient Eastern philosophies will be interwoven with Western technology and we’ll come to some higher level synthesis of understanding and consciousness. I think we’re in a race between global destruction and global consciousness, so we’ll see who gets to the finish line first.
SR: Can you say more about that?
LC: Well, it’s a slow evolutionary process for the types of awareness that people four or five thousand years ago discovered in India and Tibet, in China, in Japan, to penetrate Western culture. The Western world view is so different—for so many people it’s almost impossible to conceptualize an internal world; everything is external. Everything is about creation, growth, and, in a more destructive sense, conquering and genocide.

So there are forces of destruction—of each other and of the planet—on the one hand and then there are the forces of consciousness and wholeness and a sense of oneness of the species on the other. So will we understand that we’re all brothers and sisters on a spaceship before we destroy the spaceship?
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“There only needs to be a piece of you that’s a psychologist”

SR: How can psychotherapy play a positive role in this race you’re talking about? Or psychotherapy as we know it in the Western world?
LC: Well, one of the problems with psychotherapy as I see it is that psychotherapists tend to be sort of passive—they retreat from the world of leadership and create very insulated relationships in their consulting rooms. But for the field of psychotherapy to have any impact, it has to be expressed politically and socially. The types of ideas and theories that we’ve researched and studied, like the importance of early child rearing, self-awareness, authoritarian personalities, positive psychology and so much else, need to become part of political discourse both to elevate it and also have an impact on how resources are distributed.

One of the problems with psychotherapy as I see it is that psychotherapists tend to be sort of passive—they retreat from the world of leadership and create very insulated relationships in their consulting rooms.
Evolution is a slow, meandering process. All you have to do is watch the Republican debates to see that. It reminds me of junior high school in the Bronx in New York where we used to engage in chop fights, which was all about humiliating the manhood of other guys just to get a one-up. It doesn’t make me optimistic about the evolution of consciousness, but we’ll see what happens.
SR: I want to move onto something you said in your preface that I liked a lot: “Like monks and soldiers, therapists of all denominations assume that God is on their side.” What do you think are the limitations of psychotherapy and where does it come up short against the human condition, cultural walls or seemingly immovable, systemic injustice? In other words, when do we have to admit that psychotherapy is just not helpful or effective?
LC:
The risk with psychology and psychotherapy is that it can lean too much in the direction of helping people tolerate rather than fight against oppression.
The risk with psychology and psychotherapy is that it can lean too much in the direction of helping people tolerate rather than fight against oppression. Self-awareness and self-compassion are crucial experiences and skills that we foster as psychotherapists, but there needs to be a balance there. You can’t become too much of a psychologist. There only needs to be a piece of you that’s a psychologist and there’s another piece of you that has to be willing to go out and fight for systemic change.

As I said before, psychologists tend to watch from the sidelines, and that’s why as a field it has relatively little impact. In fact, the profession gets a lot of bad press because there are plenty of famous psychologists who do staggeringly immoral and unethical things. They are the basis of the cartoon version of the therapist nodding their head and going, “uh huh.”
SR: You talk about psychology as being an essentially solitary profession. Are there people you can think of who aren’t standing on the sidelines?
LC: Psychologists you mean?
SR: Yeah, psychologists.
LC: No. Can you?
SR: Not off the top of my head.
LC: Psychologists are really good at telling other people they should do something. It’s sort of like life by proxy.
SR: Indeed.
LC:
Another problem in psychotherapy is a lack of appreciation or respect for anger; anger is always something you’re supposed to manage.
Another problem in psychotherapy is a lack of appreciation or respect for anger; anger is always something you’re supposed to manage. Or you’re supposed to learn how to behave appropriately in society, but that’s not always an appropriate response, especially if you’re a member of an oppressed group. It’s really important sometimes to go on picket lines and carry bricks and defend yourself and make a lot of noise.

I very much respect the Black Lives Matter movement and I watch them in these Trump rallies, and they’re getting pushed around. It breaks my heart because it reminds me of a lot of bad memories from childhood during the Civil Rights Movement. And I’m sure you’ve seen pictures too of what happened in India with the British, of people being hosed and slaughtered. There’s a tendency in human behavior to objectify differences and we really need to fight against and not tolerate that. I’m hoping that, given that Trump is consolidating and activating the anger of people in this culture against immigrants and foreigners and God knows what else, that it also energizes the liberal base and brings out a new progressive movement as well.
SR: Absolutely, but this idea of psychologists carrying bricks and taking up arms seems really at odds to me with this image we have of psychologists as dispassionate observers, people who are sitting in their therapy chairs saying, “uh huh.”

My interests lie in political action as well and I do remember, at least from my dad’s generation and my grandfather’s generation, thinking about British rule and the independence movement in India and the idea of people really taking a stand. But that doesn’t seem like something psychologists really do. Even in the room with a client, we’re not taught to take a stance on things, you know?
LC: In fact it’s the opposite. Everything that we believe is interpreted as countertransference and non-neutral. It creates a real rift in people. It’s hard to imagine that a lot of younger psychologists with any sort of a political drive would be attracted to psychology. It will continue to attract people who want to stay on the sidelines in the world or avoid the conflict.
SR: How is that going to change?
LC:
It’s hard to imagine that a lot of younger psychologists with any sort of a political drive would be attracted to psychology. It will continue to attract people who want to stay on the sidelines in the world or avoid the conflict.
In truth I don’t know. In the 60s we had something called community psychology, which was very radical at the time and which still exists, but it’s not prominent at all anymore. One of the main focuses of community psychology was to identify those people in the community or in the tribe that other people went to for assistance—people like hairdressers and bartenders and cab drivers. These are the people that folks in trouble tended to talk to, so community psychology emphasized educating people in the community that were sort of hubs of interaction. The field has gotten so much more insular since then.
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Transitioning From a Beta to an Alpha

SR: I want to go back to something you said about anger that intrigued me. I’m just thinking back to discussions and supervision I’ve had in training, and whenever anger comes up, you’re told there’s something “behind” the anger. You know, there’s shame behind the anger, or sadness behind the anger. How do you feel about anger as just a primary kind of emotion? And do you think it has value both for the therapist and for the client?
LC:
If you’re going to become empowered, if you’re going to transition from a beta to an alpha in your life, you really need to be able to get back in touch with your anger because it can be very propulsive, very helpful in life.
If you’re going to become empowered, if you’re going to transition from a beta to an alpha in your life, you really need to be able to get back in touch with your anger because it can be very propulsive, very helpful in life. It evolved along with caretaking and nurturing because it’s not just necessary to feed and nurture babies, but to protect them.

Anger is the only left-hemisphere emotion that we consider negative, but anger is a social emotion, unlike rage. It can be engaging, relational, constructive. In order to combat the social programming that leads to shame, we have to get at least somewhat angry—at both the voices in our head and out in the world that shame us, disempower us, keep us from speaking up.

When I think of somebody like Gandhi or Martin Luther King, Jr., I think of the courage it took to walk into angry crowds. It’s so moving to me and such a powerful act. We can’t just be passive about these voices in our head and in society. We have to get angry because our anger and our assertiveness and our power are all interconnected. If you give up your anger, you give up your power.
SR: Agreed. Tell me a little bit about your idea of the social synapse.
LC: The more I studied different physiologies, social psychologies, organisms, the more I realized that there is a very complex highway of information that connects us via pupil dilation and facial expression and body posture and tone of voice, and probably a hundred things that we haven’t even discovered yet.

What we’re doing in psychotherapy, and in any relationship where we’re trying to be soothing and supportive and nurturant, is connecting across the synapse between you and someone else. You’re trying to create a synergy between the two of you and have an effect on their internal biochemistry that enhances their physical health, their brain development, their learning. If you’ve ever been with a really good teacher, you know that in part because you feel a lot smarter because you’re connecting with someone who’s stimulating your brain to work better. If you’re with a bad teacher, you feel dumber, and you get pissed off and angry. And there are not a lot of good teachers out there so you’ve got to cleave to the good ones.

But also there’s a different chemistry between different people. Someone who’s a good teacher for one person may not be a good one for another. Same thing with therapists. Every therapeutic relationship creates a new organism—a dyadic field— and sometimes it works and sometimes it doesn’t. The chemistry part we often don’t have any control over.
SR: Going back to the brain and neuroscience, where do you think we are in right now in the field and where are we headed?
LC: Well, we’re all over the place in brain science, but there is a great deal of focus right now on genetics. In other words, looking at the relationship between experience and interactions and how the molecular level of the brain gets constructed and changes over time in relation to the others and the environment. I think that the translation of parenting and relationships in psychotherapy into actual protein synthesis and brain building is an incredibly complicated but very important paradigm shift that is going to be playing out probably over the next century at least as we uncover those things.

How do different areas connect to regulate each other and synergize? The next step will be figuring out how two or more brains interact and stimulate each other.
Another shift in neuroscience is getting past the phrenology of looking at individual brain regions related to specific tasks and starting to look at these new technologies that measure brain connectivity. In other words, how do different areas connect to regulate each other and synergize? The next step will be figuring out how two or more brains interact and stimulate each other.

I don’t know where the technology to research that is going to come from but I think it’s on the horizon. We’ve got to get beyond thinking about brains as individual organs and think about how they weave into relational matrices so we can understand human connection and have a scientific view for the types of things that Buddhists and Hindu meditators and Tibetan scholars have been thinking about for the last several thousand years or so.
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Why Does Neuroscience Matter?

SR: How would you explain to an existential psychotherapist why these advances in technology and in brain science are at all important to what they do?
LC: I don’t know if they are important to what they do. I don’t think neuroscience is more important than Buddhism—it’s basically just another narrative.
SR: Interesting.
LC: It’s just another way of looking at things. Think about when you’re at a museum looking at an exhibit and you’re walking around it trying to experience it and appreciate it from a number of different angles.
I don’t think neuroscience is more important than Buddhism—it’s basically just another narrative.
That’s pretty much what reality is. We walk around it and we have these different ways of thinking about it and explaining it that are partially satisfying and partially unsatisfying. Buddhism is incredibly satisfying a lot of the time and very unsatisfying some of the time. So when you get bored with one way of looking, you want to look at something in a different way. For me it’s interesting to combine and integrate different perspectives but I don’t think that you have to subjugate one to the other.

In the 1950s Carl Rogers was talking about how to create a healing relationship. Fast forward 65 years and now neuroscience is discovering pretty much what Rogers was talking about. Am I better off talking about it from that perspective than listening to Carl Rogers? I don’t know. But it makes me appreciate what Rogers says even more and in a deeper way when I can see it from this scientific perspective.
SR: That makes sense.
LC: If Buddha were alive, he’d say, “Of course,” right? “There’s 5,000 research studies you did, but all you needed to do was read the Sutra and you would have figured it out.”

But I think it’s interesting to just keep learning about life from as many points of view as possible. When have your read enough novels?
It’s interesting to just keep learning about life from as many points of view as possible. When have your read enough novels?
Each novel you read is a new way of capturing the universe, and they’re entertaining and stimulating and make you feel human. I feel the same way about the sciences, which is why I love reading E.O. Wilson’s work on ants, because I learn a lot about humans by reading about ants. So many things we do are very ant-like. Plus, ants are interesting.
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Nobody Has the Answer

SR: Ants are very interesting. That’s a great way to look at it and I completely agree. Moving away from neuroscience for a moment, I’m curious about how your clinical work has changed over the years.
LC: It’s changed constantly. When I started as a student of pastoral counseling at the Harvard Divinity School, Carl Rogers was one of my teachers, so my first real training was Rogerian. The reason I got interested in counseling in the first place was reading Fritz Perls’ Gestalt Therapy. Then when I ended up at UCLA I realized you have to learn cognitive behavioral therapy whether you like it or not. So I was trained in that. I did a couple of years at a family therapy institute in Westwood in L.A. My supervisors were psychodynamic and my therapist at the time was a Jungian, and then I had a couple of other therapists who were psychodynamic and Gestalt.

I was working with people who had been severely traumatized as kids, so I got interested in neuroscience through a study of memory, trying to figure out what the heck was going with the memories of people who’d suffered severe trauma.

Since then, my heart is more in the object relations world, I think mostly because it matches my personality and the type of relationships I like to create with people. But I’ve woven in neuroscience, attachment theory, a bit of EMDR, some meditation and self-awareness exercises. It’s a hodgepodge of all the different things that I’ve learned, but I don’t really feel like I’ve got a hammer and everybody who comes in is a nail. It’s more like I’ve got a toolbox of 30 or 40 years of things that I’ve been collecting and I try to figure out how to match as best I can to the needs and the interests of the client.
SR: Is there a certain population or certain pathologies that you’ve been working with more lately or that you’re more interested in?
LC: Not really. My practice is pretty general and I like to keep it that way. I don’t really like to see the same problem over and over again. I always think of psychotherapy as kind of like a collaborative research project. People come in and we work together to figure out what’s going on—how did it arise? Is there any hope of making it better? I really like having problems I haven’t dealt with before.
SR: What do you wish you’d known as a beginning clinician?
LC: When I started, I was looking for an answer and I wanted to know who had the answer. So
I tried to become a disciple of one person or another person. It took me quite a while to realize nobody has the answer. Everybody has a little piece of it.
I tried to become a disciple of one person or another person. It took me quite a while to realize nobody has the answer. Everybody has a little piece of it. And what I’ve got to do is just learn the best I can and then sacrifice and move on. This is a very ancient Rig Veda philosophy—every day you wake up, you sacrifice the day before, you move on, you create a new reality.

Had I understood this, I would have spent a lot less time worrying about finding the truth and being acceptable to whatever godhead I happened to run into at the moment. I think idolatry is the problem. Idolatry and objectification.
SR: It’s hard to avoid being exposed to that as a student. At least in my experience, in every new class you’re exposed to something people think is the answer, the best way to look at things.
LC:
In my experience, the degree to which someone is enthusiastic and adamant about having “the answer” usually reflects the degree of insecurity they have and their lack of ability to tolerate their own ignorance.
In my experience, the degree to which someone is enthusiastic and adamant about having “the answer” usually reflects the degree of insecurity they have and their lack of ability to tolerate their own ignorance. If we’ve learned anything, especially when it comes to diversity, it’s that we have to embrace our ignorance and be curious as opposed to leading with certainty.

Jacob Bronowski was a physicist who died about 20 years ago, but he did this wonderful documentary about visiting Auschwitz, where his whole family was slaughtered. He waded into the mud behind the crematory and grabbed a handful of mud, realizing that his ancestors were part of this soil, and said, “This is what happens when we’re certain.”

Certainty leads to ideological beliefs that supersede humanity. At a less dramatic level, we get so enamored with our philosophies and our therapeutic beliefs that we miss our clients because we’re so convinced that we’ve got to convince them we’re right about the things we believe should be true.
SR: So last question here; where do you think the field as a whole is going?
LC: Well, I don’t think mental distress is going anywhere. I think that more and more people are going to be having psychological problems as society and civilization become increasingly crazy. No matter how many therapists the schools pump out, the world is creating plenty of suffering, so there will always be a need for therapy.

And though there will always be therapists trying to create revolutionary new therapies with great acronyms, I think that the tried and true methods will remain strong and stay strong because they’re tapping into fundamental constructs in human experience—the need to connect with other people, to be able to leverage our thinking to modify our brains, to ask questions about ultimate meaning and existence.

Where the field is going to have to upgrade its sophistication and quality is in the areas of like pharmacology, epigenetics, psychoneuroimmunology, diet. All of the actual mechanisms that create and sustain our brains will have to become part of the dialogue about how we help people sustain and maintain health. This might just be my Eastern philosophy bias, but we’ll probably be moving in the direction of more holistic, integrated thinking and treatment—not just combining East and West, but integrating scientific discoveries into our case conceptualizations and treatments.

Finally, I hope that psychology becomes more integrated with education. I have a book series that I’m editing for W.W. Norton which is on the social neuroscience of education, and we’re pushing to have psychologists, neurologists, neuroscientists and educators communicate more so that the things we’re learning can be integrated into each field.
SR: Well that seems like a great place to end. Thank you so much for taking the time to share a bit about your work and your life with the readers of psychotherapy.net.
LC: It was a pleasure, thank you.

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Louis CozolinoLouis Cozolino, PhD, is a professor of psychology at Pepperdine University and a private practitioner. He is the author of The Healthy Aging Brain: Sustaining Attachment, Attaining Wisdom (2008), The Neuroscience of Human Relationships: Attachment and the Developing Social Brain (2014), The Neuroscience of Psychotherapy: Healing the Social Brain (2010), and Why Therapy Works: Using Our Minds to Change Our Brains (2015). He lives in Los Angeles, California.
Sudhanva Rajagopal is a doctoral student in clinical psychology at the Wright Institute in Berkeley, CA. His clinical and research interests include trauma, political psychology, and the development of culturally responsive assessment and treatment protocols. Sudhanva is also a freelance writer, musician, and filmmaker. As a flamenco musician, he has performed throughout Europe, Asia, and the US, including a 2015 appearance with the Los Angeles Philharmonic. He also has a masters degree in film producing from the University of Southern California. His 2006 documentary film, Panihari: The Water Women of India detailed social issues faced by women of the Thar Desert in northern India. The film was an official selection of the 2006 UN International Film Festival in Rome, Italy.
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CE credits: 1
Learning objectives:

  • Understand the current focus in neuroscience research as it pertains to the field of psychotherapy.
  • Illustrate how the field has changed over the course of the last 50 years.
  • Describe the future of neuroscience and psychotherapy integration, as predicted by Cozolino.
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