Psychodynamic Formulation in the Age of Neuroscience: A Dynamical Systems Model

AbstractThe dichotomy between biological and psychosocial psychiatry has stood as a deep divide in psychiatric treatment and training since the advent of psychoanalysis. It is now complicated by the proliferation of diverse theoretical perspectives, both psychotherapeutic and neurochemical. Our deepening understanding of neural network dynamics can provide empirical constraints in validating psychotherapeutic approaches, while the appreciation of the patient–therapist intersubjective matrix can inform biological treatment. The Cartesian mind–body fallacy can now be analyzed as a unified complex dynamical system in the same light as Einstein's integration of the seemingly divergent concepts of space and time into a unified fabric of spacetime.Dynamical systems approach to neural network functioning offers the most comprehensive foundation for psychotherapy available to us today. Recurrent patterns of thinking, feeling, and relating can be analyzed by modeling the dynamical landscape of cortical and subcortical network processes. Dynamical Systems Therapy (DST) stands as a trans-theoretical model with the explanatory power to integrate systems of synaptic networks with systems of meaning. It powerfully argues for shifting the clinical emphasis from our patient's symptomatic presentation as the focus of clinical attention to conceptualizing psychopathology as fixed patterns of adaptive attractors in response to the dysfunctional developmental environment. Patients come to be seen as active agents who create the meaning of their experiences based on their unique implicit templates. In this view, DST-informed psychodynamic formulation helps us chart the patient's dysfunctional attractor basins, and therapeutic relationship becomes our tool in reshaping the dynamical landscape topology to reestablish self-organizing process. Additional informationNotes on contributorsYakov ShapiroYakov Shapiro, M.D., is an Associate Clinical Professor of psychiatry and psychotherapy supervisor at the University of Alberta, Edmonton, Canada; and co-director, Psychiatric Group Outpatient Program, Grey Nuns Hospital, Edmonton.