The Development of a Therapist with Lou Cozolino

Today on Explorations in Psychotherapy, we are welcoming Dr. Louis Cozolino. Dr. Cozolino has been a writer, professor, and practicing psychologist in Los Angeles since 1986. He is the Series Editor of the Norton Series on Interpersonal Neurobiology, and he has authored numerous books, including The Neuroscience of Human Relationships, The Neuroscience of Psychotherapy, The Pocket Guide to Neuroscience for Clinicians, Why Therapy Works and many more. Today we will be speaking with him about his latest book, The Development of a Therapist: Healing Others Healing Self, published in 2021.

Alexia Rothman: Louis, thank you so much for joining us today.

Louis Cozolino: My pleasure.

Anibal Henriques: Dr. Cozolino such an honor to sit with you. You have been an inspiration for many psychotherapists around the world, helping them to apply neuroscience in their clinical practices, even to become neuro fluent. You have been helping us to understand our social and executive brains, how they relate, and also how therapy can both positively affect the brain and be guided by brain functioning. Your dedication and attention to the training and career of psychotherapists is also admirable, showing so much care for both the profession and for the clients we care for.

Anibal Henriques: So again, thanks so much for all you have been doing an offering to the field of psychotherapy. Lou how do you differentiate your precious 2004 first book, The Making of a Therapist: A Practical Guide For The Inner Journey, and this new one, The Development of a Therapist: Healing Others, Healing Self ? Did you feel there was a need and good reasons for an update?

Louis Cozolino: Well, it's, let's see, it's not really an update. What it is, it's sort of a continuation of The Making of the Therapist, was a book that I wrote based on about 25 years of teaching on master's level and doctoral level students, the basics of psychotherapy. So that book really is what guided me in that in writing that book, was thinking about all the things I wish someone had told me when I was beginning to be a therapist. And also, I think that the core of that book is to give people permission to be confused and frightened and not know what they're doing because they don't know, none of us know what we're doing, when we start. We're sort of faking it until we make it, but also, it's a real, we really do feel, most of us anyway, we should feel a responsibility, first of all to do no harm. And second of all, to figure out some way we can help the people we're seeing, even if we aren't new and the feeling of being everyone has to start somewhere. And so that book really was sort of a, almost like a, I felt almost like I was, I wanted to sit behind the new therapist with my hand on their shoulder, trying to comfort them and soothe them and be there with them through that process. You know, a supervisor is very in their quality, their availability, their personalities, and many people aren't really lucky enough to get a good supervisor who, who cares for them as a person and also is very dedicated to their learning. So, my hope for that make for The Making of a Therapist was really to be supportive, to be getting therapist. And there were a lot of things in writing that book that I put sort of to the side, because I felt that they were deeper, more complex and not the types of issues that beginning therapist should occupy their minds with. And so, I thought, you know, after a year of practicing or so, after you feel confident and comfortable in the room, most of us after we get through that phase, realize again, that we don't know what we're doing. And so, then there's that question. Well, now what? Now we're working with people and were stuck with this one in one way and another client in another way. And so, what, what are the real, you know, what sorts of things can we remind ourselves over? Can we learn a new in order to make progress? When were, you know, when we're going forward? And so that's really what the impetus for the development of the therapist was as well as I wanted to inject a little bit of neuroscience that I think is really important. And I'm also the issue of, and it wasn't as much of an issue when I wrote the book about internet addiction. And now after the pandemic, we're all addicted to the internet. And so, the issue is that we're sort of exceptions in that articulated in this book are now sort of a rule for all of us because therapist and clients', everyone's addicted to, to where the internet and it's having an effect on all of our psyches on brains are, you know, social relationships. And so, I guess it was a very timely, although I wish I would have had a little bit more of a chance to write about the effects of the pandemic, but maybe that'll be another book.

Alexia Rothman: So, it seems that from what you're saying, and in reading the work as well the primary focus of this new book is on helping therapist to really deepen their understanding of how to use their minds, their brains, and their bodies to become more effective in their clinical work. And this brought to mind for me, the fact that unlike in some other professions where workers have physical tools or technologies to help them do their jobs for therapists, our own minds, our own brains, our own bodies truly are the instruments of our profession. So, your book seeks to help us make a deeper use of all that we are to be maximally effective with our clients. And I was wondering if you could speak to that a little bit?

Louis Cozolino: No, I mean, I completely agree with you. I do think, having had, having spent some time with Carl Rogers many years ago, I was very impressed with, I mean, he really was the person who impressed upon me, how our own hearts and our spirits and our bodies, or the instrument of our work, what I've noticed over the decades, I think, as counseling and therapy have become a more and more deep professionalized, what you see is therapy, much of therapy, i would maybe even venture to guess the majority of therapy that I see is very formulaic and driven by workbooks and brief therapy models. And what I hear for my students, especially beginning students and even some very experienced ones is that they don't think of therapy as something you do with a client, they think of it as something you do to them. So, it’s sort of a reversion to the medical model and the hierarchical structure in a way from intersubjectivity and the interpersonal aspects of it. And so, in some of, you know, some days I feel like I'm, you know, sort of crying into the, into the darkness, with this where I am, but I've been very heartened to find the response really from all over the world of people holding on like they haven't in a sense been, I don't know, a capitalism hasn't sort of a completely absorbed their thinking about the conveyor belt notions of therapy. And so, I'm getting, I think a lot more interest now in Asia and in Europe, South America, just about everywhere in the world, I'm getting, you know, people contact me, and they're interested in, I just got a memo today of a person who translated Why Therapy Works, which is one of my books into Farsi. And so even in Iran, there is a, you know, there's an attempt to try to understand and work with these things and weave it into the culture. So, I feel more like a cultural warrior now and you know, sort of for, for the human connection than I am specifically for a psychotherapy.

Anibal Henriques: Beautiful. Lou in your clinical work, you say your primary methods as a therapist is one of connection, attunement and interaction. You working primarily from a psychodynamic model of treatment. And you also employ strategies and techniques from other forms of therapy you studied, including CBT, Family Systems and humanistic existential ones. How familiar are you with the IFS (Internal Family Systems) model or do you identify yourself or feel closer to any specific family of therapies or a particular model?

Louis Cozolino: Well, I mean, I guess if … it's really difficult because I really do feel like an alloy of all of these different works. I mean, I feel, I feel Rogerian in my body, in my connection, certainly sort of the, the theoretical richness of object relations therapy and intersubjectivity are also in front of mind and, you know, given my interest in neuroscience, in evolution, I'm thinking, I always think in terms of Family Systems, which are both external and internal, right? And I'm thinking about the multigenerational effects of, you know, shaping behavior and epigenetics, all of those things that a, you know, because for many clients their problems really can't be understood within themselves, within the organism, and they also can't even be understood within the generation that you're talking in that, that they're in. You have to think a, you know, go back to three, four, maybe more generations, because everyone needs to be placed into historical context. We have all been influenced by our culture and the struggles and the tragedies and triumphs of the people that we send from. And I think it's everywhere from the unit within us, from the molecular to the spiritual levels. And so, a lot of things go through my mind and I think that's how I stay so interested in doing therapy because my mind is a constant, it’s sort of a carnival of ideas and I'm always also trying to match the metaphors and the language of my clients because I think a narrative and storytelling are so important, it connects to the person's core, to their culture, to their fantasies and dreams. And so, yeah, you know, I think the thing that I, that I kind of sort of a push back against is anyone form of therapy that sold as a panacea.

Alexia Rothman: You had talked earlier about one of your aims for this new book was maybe to integrate a little bit of the neuroscience. And so, it seems like what we know is that for clients to be able to truly benefit from therapy, to really be able to learn and to experience change, it's important for therapists to be able to facilitate them reaching a less aroused, more regulated state in their nervous systems. And something I loved about your book was your discussion of the therapist role as an amygdala whisperer. So, I was wondering if you could help us understand what you mean by that concept and how therapist can learn to function well in that role.

Louis Cozolino: I guess it's all, it's all predicated on this, on the idea, and … it's all predicated on a sort of a neuroscientific apart conception, which is that we have at least three executive systems and the primitive executive system that’s centered in our amygdala actually has the ability to down-regulate and even inhibit our other executive systems or cortical, you know, problem solving, abstract reasoning system or in which, and also know that, which we use to navigate through space and also the system that's responsible for our sense of Self, our imagination and our ability to connect with other people. And so, for me, I think with the sort of rule one of therapy is to figure out how to calm someone's arousal. If the, in fact they are hyper aroused, so that the other executive systems in their brain can be active and engaged and they can be integrated. Okay. So, I think probably the reason why the psychotherapy outcome research over, I mean, I think over and over again, it shows that the key component is the relationship like with, with the therapist, a key component of change. And I have to believe that it has to do with the fact that a safe relationship is something that creates a state of mind and brain and the client that allows them to think, to reflect, to feel as fully as they can because their brain isn't being impaired with inhibition, you know, anxiety related inhibition.

Alexia Rothman: And I think what you're saying there, it brings to mind the way we work with protective parts and IFS Therapy. So, when we focus on those parts of the clients that can be associated with states of hyperarousal or hypoarousal, and we help those protectors be able to step back, the client then accesses that optimally aroused state we referred to that as Self. And then they can take full advantage of neuroplasticity for healing, for new learning in that state.

Louis Cozolino: Okay. So, for you, if you are using Self on the term, sort of the, with a capital S like they do, you know, in Buddhism… the Self requires, all of these different brain systems that are involved in or, you know, cognitive and emotional capacities as human beings. I think it's what Freud talked about, you know, I think that's the Ego strength is related to, from a dynamic perspective on. Freud talked about, you know, when he defined trauma, he said that it's a surpassing of the stimulus barrier and there wasn't much neuroscience back then, but you know, what I think that the translation of that is, is that, that the amygdala becomes so activated or our autonomic nervous system becomes so activated that these other systems that regulate, filter, modulate our reaction to things in the environment become inhibited to the point where it just washes over us and we're victimized by it. So what it got to do is …holds us. And there's no way internally for us to be able to process it in a way that allows us to regulate what we're experiencing. So, I think that's also, I think the core of the definition of trauma as well.

Alexia Rothman: So, for optimal functioning, then these individual systems have to be integrated and functioning in a harmonious balance.

Louis Cozolino: Yeah, Dan Siegel uses the word complexity. I think that's a good word, although I don't tend to use it because I don't like to invoke complexity theory, because then what I think that does for most people is it lets their intellectual defenses takeover, and they start asking questions about quantum mechanics and all of these things. So, I tend to focus just basically on the fact that all of these systems have to develop and communicate with each other. And, when we feel we're really ourselves and when we were as smart as we can be and doing as well as we can navigating problems in navigating space and time that works, what we're experiencing really is a modulation and appropriate modulation of our autonomic nervous system and the participation of the parietal and frontal system, as well as the default mode network.

Anibal Henriques: Lou, in this new book, you suggest five survival tips for therapist starting their careers. And I love them all. And I'm going to name them if I may. One, think of a training as a lifelong process; Two, seek out colleagues and supervisors dedicated to expanding their knowledge and skills; Three, continue to learn from experts, but avoid becoming a devotee; Four, find the best therapist you can and stay with them; and Five, be aware of smoking your own banana. What do you like to comment on any tip in particular?

Louis Cozolino: Well, it's funny smoking your own banana has become, it is a term… It was a term that, that I remember from my high school days, because the backend in the sixties with a hippie culture, we were looking for anything we could to smoke to get us high. And there was someone who actually started a rumor that smoking banana peels would be, would actually get people high. And of course, the interesting thing is if you smoked banana peels, you will get high or you will get something it's not clear what you get, but the placebo effect is so strong that people would get high from smoking bananas. And so, you know, the term is still in use, now, in fact, I hadn't thought about it for years, but I work with some people like Google and other tech firms. And so, it started to come back as a term that's being used again. And that just means that you kind of, that you sort of, and I say, you make up some fantasy that, that you think is true, and then you believe, so, smoking your own banana is believing the lies that you tell yourself. I mean, Donald Trump will be a good example of someone who smokes his own banana.

Anibal Henriques: Thank you.

Alexia Rothman: So, you talk about the fact that therapists need to be able to move the focus of their awareness back and forth. So vertically between their own minds and bodies and also horizontally from their own systems to that of their client throughout session. So, I was wondering if you could describe this process that you referred to a shuttling and how it's beneficial in therapy.

Louis Cozolino: Yeah, I mean, I think that one of the things that are especially when we're, when are anxious, but I think most of us in the west think of our consciousness as an existing in our skulls, right? It's like somehow magically our brains admit this consciousness and it's only in our, in our, between our ears, but, you know, identity and consciousness really are imaginary processes. And so, what I found is very helpful, you know, from experiences and meditation and other, other sorts of self-help processes, different types of practices that I've been engaged and is that you really can move your consciousness from your, from your mind and think of it as moving down into your body, and as you do that, you are able to be more aware of your somatic state of often have your emotions are a variety of different things. And so, I encourage my students to, you know, to sort of relax enough, like we have a lot of my students do, and this might just be because they're students, is that they're so afraid of missing something. I think they want to pay attention to every word. So that's one thing. And the other thing is, they really feel like they've got to be smart. And so, while they're listening to every word, they have to somehow simultaneously come up with something very clever to say or make an interpretation. And so, they, in a sense, get stuck in their heads and therapy becomes a source of intellectual word game. Right? So, what I try to encourage them to do is to, to shuttle up and down. And in other words, to certainly be thinking and be speaking, with also taking a break from that and seeing how it feels and what kind of messages, you know. I often use the metaphor is I think of your body as a kind of a satellite dish and that there was this broad bandwidth of, of social information that's conscious and unconscious coming from your client, and you may not be aware that it even entered your body but go down and use what you are feeling as clues to something that you may be picking up from your client. You never know, you could have, you know, you might have indigestion and that might be you right, but so, you shuttle back and forth. And then you, you know, also to imagine, you know, what it would be like to be your client in sitting in the room and try to try to move your consciousness, of course, in imagination over to them and use whatever you feel or think, or impressions or associations use a mass potential hypothesis to, you know, to test with a client, to see whether you're picking up on anything that's about them and not you.

Alexia Rothman: That's beautiful, what you're suggesting, just getting out of our thinking lines in more in connection with our body, it allows us to really sense aspects of our client's unconscious processes. And then we're actually able to bring those up. Like I said, maybe it's about us, maybe it's about them, but we can explore that in a collaborative way.

Anibal Henriques: Lou you also say that the ability to be simultaneously thoughtful and emotional, to mix the poetry of human connection with a scientific mind is the essence of a youth psychotherapist. Can you say more on these?

Louis Cozolino: I mean, if I think of psychotherapy, psychotherapy is a relatively recent sort of professionalization of human connection, right? I think that what we're trying to do is we're striving for wisdom. And the difference between information and wisdom is information are facts and wisdom is information in a sense that is tailored to an individual to help them grow. So, you might call a good interpretation, might be wisdom, if it hits home and if it helps someone to expand their awareness. And this is something that's existed, I'm sure, you know, for tens of thousands of years in human communities and human tribal life. And I think that as we've become more professionalized, as we, you know. I see this in my students, worry, they're worried about the, there are the DSM diagnosis. They’re simultaneously worrying about ethics and morals and legal issues, and they don't want to get sued. And they're worried about, you know, a hundred other variables related to their what's going on with the client. And I think that many people lose, they… they no longer are a human being in the, in the relationship. They're kind of a human doing. They're doing things, they’re kind of like a clerk. And you see this now too with physicians, when my son's pediatrician, when we were going to him, he had his laptop out the whole time. And as you're talking to him, he's typing the entire time because he is, he has got to, he's got to record all this information, just because to cover his butt. The legal issues, right? And so, how does a child experience a doctor who was just typing, right? And if that's your experience with doctors, and I think, you know, most people before they ever come to a therapist, see lots of doctors. So, when they come in to see us very often, they want to just want to lay down and have us fix them to this sort of a passive model where you are, you’ve got the technical knowledge and you're just doing it to them. And so, you know, we're in a position then because of the lack of the appreciation of healing in Medicine, we're many of us are in the position of having to educate clients. So, this whole model of, you know, of collaborative of the journey of psychotherapy. And I think, you know, going back to the, to the basis of your question is that, you know, psychotherapy is not, is not a science. You know, we can, we can use science, but it's not really a science evidence-based treatment. The evidence, the evidence really is not good. People hold on to this notion of evidence as this as if the evidence matters, but having been, you know, at Harvard and UCLA for, you know, for 10 years and being inside of research groups all the time, I see that, you know, research groups find what they are looking for. And you can train clients in therapy to respond to certain measures that you keep giving them. And then of course they get better at taking your measures. And of course, if you don't look at response biases in all of those things, yeah, it looks like those are evidence-based treatments as opposed to treatments where no one's collecting that data. But I've got to say, I just, I just don't believe it. Right? And the problem is people get into the field who were more who really look like to me, they should be engineers. And they take that engineering that left hemisphere, doing it to the client and healing the client through words, or having them fill out forms and do exercises and homework. They take that much to seriously and they don't look at other evidence and they don't follow up very, very long after their treatment. And I think another thing is that they're looking, they're looking at someone's verbal responses to measures as opposed to their lived lives. And so, again, I guess as far as evidence-based treatment is concerned, I don't think I believe most of the evidence.

Alexia Rothman: I can't even tell you how deeply I appreciate everything that you just said. These are things that have been on my mind for literally decades now, in the way you just captured all of that speaks to so many concerns I've had. Thank you for laying that out that way. I also really appreciated in this newest book, you're a discussion of resistance. And part of what I appreciated is that I could really see from the way that you laid at the topic, that you have a deep appreciation for the fact that whatever seems like resistance now actually served survival at some point in the client's past and coming to understand what underlies the resistance is really essential to making progress in therapy. So, you said in the book, resistance isn't a hindrance to therapy, it is the heart of therapy. So, I was interested in hearing you talk a little bit about your views on resistance and how to understand it and work with it.

(27m 52s):
Louis Cozolino: All right. I think, you know, there are two pathways in my mind, to my perspective, the first was the, the rift between Sigmund Freud and Wilhelm Reich and Reich was, you know, for the listeners who aren't aware of him, he was one of the four disciples and he wrote a book called Character Analysis. And the first 100 pages, 120 pages of that book, is probably one of the most influential pieces that I've ever read in my lifetime. And what, you know, what Freud… Freud had an idea of discovering, you know, thinking of the talking cure and trying to get to those traumas and those crises that someone experienced and doing everything he could to get to those things as quickly as he could, but what he didn't really articulate well, I think, was the fact that, the defenses for the vast majority of people are actually the aftereffects of defenses that were necessary earlier in life in order to survive. And so, I think what… Reich took a step in the direction of saying, okay, these defenses are a part of the character armor, they’re part of a personality and they exist, not only in there in their physiology and their musculature, their posture, their gestures, it also exists in their manner and their bearing and their attitude towards the therapist. Right? So, he really, I think moved Freud's notion in the direction of not only because, you know, rolfing and somatic therapy is really they owe  their origins to Reich. What also this notion of that, the real focus on transfer is in the analysis of transfers and that the transference is the embodiment of this sort of what, what I think the psychodynamic folks would  and say, you know, this is, this is really a part of attachment schema that attachment researchers don't look at, right? Is for some people intimacy and connection is associated with terror or is associated with, with hatred or with, with distance or, you know, all of those things. And so, I think, you know, that's a big piece of it. And another big piece of it is that if you study brain both evolution and development, what you see is not the vast majority of, you know, a sensory motor system develop a very early in life, way before we develop episodic memory for our lives. And so, we come into conscious awareness when we're five, seven, nine, however old we are having already learned all of these different things about the world, about the, the safety and danger of relationships, on the environment, of sociality and really the foundation of our identity. And I think we really saw that, you know, he really saw that. And then I think if you, if you fast forward a little bit to Alice Miller's object relations work in the 1960s and 70s, you see sort of a manifestation of that therapy in her view as kind of like, as an archeologist, or more sort of an anthropologists of the history of that year. And it is a partnership with your clients where you try to help them get back into touch with their perspective on not of their childhood from an adult, but like what it was like to be a child as a child, you know, and she talked about double amnesia. You know, the fact that many of us have to forget who we are as children. And then we have to forget that we've forgotten. So, the process of psychotherapy really is first knowing that there's something there to find or having as an intuition or an inkling about that. And then going through the process of discovering that little girl, a little boy, that we have to leave behind an order to survive. So, it's those concepts from multiple perspectives that inform that belief, set of beliefs of mine.

Alexia Rothman: Yeah, absolutely. And you also talked about how, if we do manage to work effectively with what we might call resistance or an IFS protection, that sometimes bringing those methods up into the conscious awareness of the clients might make the methods may be less effective. And so, we have to be prepared to sort of deal what comes up when they get back in touch with what it felt like to be that child, for example. Yeah, it was wonderful to see how you had an appreciation for resistance as adaptive as a form of protection and as what can happen when we're able to help the clients become aware of it. And it does start to step back.

Anibal Henriques: Lou you have coined the terms, social synapse and sociostasis. Those concepts are psychotherapists to understand how their work can change and help power struggling brains. Could you say more on how these theories and concepts can guide or inspire our work as therapist?

Louis Cozolino: Well, I think if, from studying… from studying, even just briefly, how neurons develop and grow and survive and if you look at the fact that there were no individual neurons, they just die, if they’re isolated. I think that having this concept of, of the fact that evolution has conserved this strategy for taking simple structures and forming more complex structures, and in our case, it would be the simple structures it would be us. And the complex structures would be our families, our relationships, our families, or communities. And that, even though, we are… communication with each other now, as human beings is … is not so much, how can I say, it's much, it's much less chemical and electrical, and it's more symbolic, it's more gestures, and you know, we developed these brain systems to process all of these different ways we communicate with each other. I think that this notion of the social synapse and sociostasis, which by the way, is a word I learned from one of my professors, I didn't make that up, one of my teachers, Hans Miller used to use that term, and he was a physiologist as well as a clinician, by the way. So, it's interesting, he bridged those things as well, but there's just this notion that when I'm, you know, when I'm interacting with, with YouTube, for example, what's happening in my brain is being affected by what you're saying, the expressions on your faces, your emotions, the interests that you have. That's having an active and biochemical effect, you know, a neuronal effect on me and vice versa, right? And so, we come together and we're creating this organism, which we're calling this tree, you know, a threesome that we have this morning. And I think that in the therapy session, when you think of getting connected with your client in that way, it makes, it makes me more aware of the fact that my posture, my gestures, the things I’m saying and not saying, are all coming to bear, there are all having an effect. And, you know, and I'm thinking too, it's like, there's this other track in my mind, there's a simultaneous track of, you know, what sorts of things, what memories, what emotions are being conjured from my own life, by what my clients are saying? And so, there's another track of awareness, which is, well, how much of my reaction to my client is a function of my history and how much of it is a function of their experience and where I need to be now. So, I think what it does is, it keeps reminding me that I'm connected, but that the connection has so much information and I can never really be a hundred percent sure that what I'm thinking or feeling has to do with my client. And so, everything is a hypothesis. And when I do demonstrations in front of my students, they are always surprised as to how uncertain I appear, because they imagined that someone whose been doing therapy as long as I have, must know exactly what I'm doing, I must be able to read my client's minds. And so, I just said, you know, we don't know, it's just, that's not what's happening. I mean, I think I've gotten better, I probably have a higher hit rate than you will because I had been doing it for 30 or 40 years, or you're just starting. Right? But over time, you're hit where it will increase as long as you learn to keep quiet and listen. I mean, I certainly know, I certainly know therapist that are my age, who don't seem to be able to listen to anyone or understand anything going on around them. They might as well be politicians. And so, but that usually doesn't happen, but I'm just saying, you know, I can't remember who said this, but maybe was probably like Socrates or someone like that. They're there saying, you know, age and wisdom often come together. What sometimes age shows up all by itself.

Alexia Rothman: I saw that quote in your book, I loved it. I've used it like 20 times since reading it…

Louis Cozolino: Its yours. If you bought the book you own the quote now.

Alexia Rothman: Yes, it's on page 17 or something, but, and you know what you were just saying, brought in to mind another idea that you talked about in your book, which is it's estimated that 90% of the brain is involved with processing information. That's already contained within the brain such that, you know, only about 10% of our experience involves what's coming from the outside. So, you were just speaking to all of that right now. And it made me curious about how specifically you work with the idea transference and countertransference with your supervisees.

Louis Cozolino: Well, I find that I can't go very far with it because the training, the training is not that good. In other words, they… students are no longer required to be in their own therapy. And so, you know, again, you've get, you probably get three-quarters of the student's in a class and maybe more who haven't been in their own therapy. So even the, even teaching the concept of transference and countertransference, it's easier for them to understand countertransference because it's something that the patient is doing, but the fact that they're, who they are and their being and their awareness distorts, what they're hearing from the world, it's kind of like trying to teach people like, it's like the, one of the problems in the black lives matter movement is like trying to teach white people that they're privileged because they don't feel privileged. Right? And they don't experience the contrast between how they live their lives in how people who are targeted all the time for being black lived their lives. And so, it's similar, I think in some way, to try and to teach students about countertransference, it's almost like an assault or an affront to them that they're misunderstanding something or not getting it. And also, I think another piece of it is that too, the degree to which we're distorting, what we're hearing to, the more severe distortions are tied to our own pain in our own survival, right? Like for me, when I started doing therapy, I was fortunate to have really good supervision and sort of hour-to-hour supervision. Every hour I was seeing the client, I had someone watching me or listening to a tape and  can't imagine that happens much anywhere anymore, you know, but … the initial feedback back I got was you're, why are you joking so much with your clients? It seems like when they get, when they are going towards some negative feeling, you know, you're joking, you're trying to distract them from it. And that was very hard. That felt like a criticism to me. I know that I'm a good therapist, even though I didn't know what I was doing, right? And the problem was, is in order for me to see the fact that I was trying to cheer them up, what was the fact that I had a lot of trauma related to my mother's depression and I spent my childhood trying to cheer her up. And so, it wasn't just learning sort of a fact. It really was a part of me having to face something that was very painful for me. And I think that's one of the reasons why it's a, it’s so difficult to work with students who haven't had any experience as clients, because you really can't do that work in a group in a classroom, you know, and expect, expect to make progress. You know, it's a lot easier to work with senior therapist who have already gone through that who have had 20 years of trial and error and failure, to where are they going to be? Oh, that's right. I am, I am a jerk. That's right. And now I know, and I can accept it. So, when you're having the conversation about the fact that we're all jerks, they're not defensive they are more curious. I missed that way, that I was a jerk tell how, you know, tell me.

Anibal Henriques: Lou, in your book, The Neuroscience of Psychotherapy, you synthesize the field of psychotherapy with findings, from Neurology, Neuroscience and Neurochemistry to provide a model for the underlying mechanisms of action in the therapeutic process. You describe four key principles for enhancing neuroplasticity in the human brain and mind the complex secure relationships allow to a moderate level of physiological arousal, a balance of emotional and cognitive processing and the construction of coherent narratives about the self-relationships in the world. This is a beautiful map and metatheory for any kind of psychotherapy journey, I would say. Can you elaborate on the last one, the construction of coherent narratives about the Self, why this one is also so important?

Louis Cozolino: It's based again on a neuroscientific and evolutionary belief in that is that our, brains, our social brains, that contemporary human brain co-evolved with narratives and the, and that narratives actually serve a neurological function, which is to integrate physicality. Well, I should say integrate space-time, the experience of space-time, our emotions, and our abstract reasoning. So, as we, just to put a little more meat on that bone, as our brain became more and more complex, and you had a user of all elaborately complex systems related to all of these different specialty areas. The role of keeping them integrated became a bigger and a bigger challenge. Right? And so, I think one of the, one of the mechanisms that evolution was able to, to leverage was sociality and storytelling. Because if you look at a story, right, it was a narrative is a, it's a, it combines, it combines space with time. It has a beginning, middle and end ramp. It combines thinking with feeling, and it has some social relevance, like other people can relate to what we're saying. And so, with that, those things, it's not really a narrative. It's usually liked some boring story our uncles telling us that it has no point, right? What the narratives reflect, I think the primary needs of our brains to have a, an intersection between all of these different structures or the structures that are necessary to create a coherent narrative. We have to have, we have to use our parietal and frontal areas in order to create a sequencing in time and space. So, we paint a picture of them will tell him the story. Stories without emotions don't really matter to people. And so, we have it, it forces us to integrate and to communicate with our left and right hemispheres to mix, you know, these are concepts along with our feelings. It activates our bodies, when we're talking, especially Italians, we can't talk if we can't move our hands. And so, we have gestures as part of that. So, my suspicion is that the existence of narratives is one of the things that's allowed our brains to develop the way they have. And if you take this people's stories away, you strip them of their culture. And in a sense, they, and in that sense of identity and the sense that are lost, and there've been many, many authors and philosophers, and the people who have talked about this related to, you know, cultural appropriation or, or imperialism, where you go in and you take us a culture story away, and a very easy to tame them because they have no organization or direction. Right? And so, that's really why I think the narratives are so important. Now, having said that there are situations like with children who are, who are pre-verbal, or maybe not particularly verbal, the narratives don't necessarily have to be in words. They can also be symbolically played out in stories and sand trays and the drawings and all sorts of other things, but human beings really have evolved to use words for the most part. And so again, I think the reason why our brains are, are so complex is because we have stories. And I think the reason why we're so vulnerable to dissociation whenever we're, we, we have a higher sustained level of stress, is that we lose integration between these different networks, our experience becomes fragmented along with our narratives, and we don't have the narrative then to serve as a, sort of a, an integrating process and also kind of a map to go forward. And, and I think, you know, Mary Main in her work with a, you know, what the adult attachment interview, really just beautifully when she looked in and she didn't analyze the content, she analyzed the coherence of the narrative and creating a coherent narrative reflects on brain functioning on the executive functioning and on executive functioning integration. So, her work is just brilliant.

Alexia Rothman: Speaking of executive functioning and executive functioning integration. I really enjoyed what we were talking about earlier today about that. And in your book to how you talk about, despite the fact that there's this bias in western psychology towards understanding executive functioning, as a purely cognitive top-down function, it is actually a very intertwined with emotion with self-awareness and empathy. So emotional functioning really plays just as large a role in executive functioning as cognitive abilities do. And I know you mentioned earlier that you included a small section, hopefully, maybe another book soon, but a small section in this book on how the development and functioning of the three executive systems that you talked about earlier could be negatively impacted by internet over use or addiction. I didn't know if you wanted to say, this is a little bit about that here.

Louis Cozolino: Yeah. I think the, you know, the development and integration of the three executive systems depends, I mean, our brains are social, that's how they've evolved. And the… in developing the narratives, you have to have the right, the emotional regulatory functions going, and it's much more difficult, I think, especially for younger people to gain that kind of socio static regulation on the internet. And I think what I've learned, I mean, sort of like this last year of being forced to be on the internet for teaching, for therapy, for all sorts of things, I’ve realized how important it is for me to be able to really connect and focus and almost like dive into the eyes on the face of the person that I'm with, I'm interacting with to get that sense of an intimate connection. What I'm seeing from my… I first, sort of like, was alerted to this with a client of mine who was a, I think he was a 15 year old high school student. And, and he came in, he said, you know, I think I've got, I, I either have attention deficit disorder or I'm psychotic, or I have some brain damage. And I said, well, what makes you think of that? And he said, well, my teacher gives me an assignment that she says is an hour assignment, but it takes me eight or nine hours to do it. And so, I asked him, well, you know, show me, you know, bring your computer next time and bring your assignment and let me just sit next to you, right doing it and what would he, and I should do it exactly the way you do it at home. And what he showed me was that he has about five or six windows open while he's doing his homework, he's returning text, he's watching the video, he is playing a video game, scanning for information, and I looked at him, I said, well, I don't think I have brain damage and it will take me nine hours to do that assignment as well. And so, I think that along with the internet, the Internet's a tool. The problem is that the, you know, the social engineers that construct them, drive the internet, don't want it to be a tool. They want it to be our whole lives because every time we click or a swipe or do something, the cash register rings, you know, from one of these companies and they compete with each other, right? For our attention, and they compete with sleep for our attention, and they compete with face-to-face relationships for our attention. And they're very clever in, there are lots of psychologist, there are lots of social engineers, they call themselves in Silicon Valley that, that focus on these things. And so, in a sense, we've been kind of taken over, you know, even the people that haven't been taken over by QAnon have been taken over by Google and Facebook and TikTok and everything else. And so, I think, you know, it's… we're not going to get rid of these things, these things are here to stay, but I think we're kind of, we're not yet aware of how powerfully they're impacting us. We're noticing now that the uptick in anxiety and depression and suicidality in younger and younger people, we know, if you have a maybe someday, if there is a mass shooting every day of the year, people will think, maybe there's something wrong with us, as opposed to just habituating to it. There are lots of, you know… I don't know how long it takes for people to wake up to it, but hopefully that'll happen soon.

Anibal Henriques: Lou in your book Why Therapy Works?, you propose the theory of social status schema that relates to shame, so present in our lives and clinical work. Could you please tell us how this theory can help us psychotherapists?

Louis Cozolino: Well, I think the, you know, the… the thumbnail version of it is that, before we had language and organized thinking about how we interacted with each other, evolutions challenge with, with all the critters, but especially social animals, like, you know, elephants, dolphins, human beings, how do you… how do you get when you bring individual organisms together to form groups, then you have another layer of evolutionary selection. There is a just individual selection, there's a group selection, right? And so, the question is which group is going to survive? And probably over time would happen, this is my evolutionary fantasy, you know, this is… evolution is like a roar shock. So, we have to kind of come up with theories that make sense and see, and, and test them if we can. But I think what happened in evolution is that one of the ways in which mammals were organized were through social status hierarchies, right? And so, in elephants, you have the oldest female being the alpha and her existence and her interactions serve socio status purposes with the biochemistry of all the members in the group, and it's the same thing I think with the, with primates, if you look at all primate groups, they have different manifestations of this. But all primate groups have alphas, betas, omegas, is just the way things are organized. So, I think what we have is this… into our deep history, is this hierarchical organization based on social status as a way to organize groups. And there's plenty of plenty of evidence that this is still going on in humans, right? The problem though, with, with so many of these things that have been conserved in evolution is that with the development of a very large mind, or a very large brain and self-identity and imagination, these things get manifested in ways that were never intended to happen early on. You know, when we were, when we were chimps and primates and bonobos. And so now not only do we have a physical hierarchy, but now we have an, like a, a Self… a self-identity hierarchy. So, most of us spend time worrying whether we are thin enough, whether we look good enough, whether we fit in, on whether we've got the right clothes, you know, all like comparing ourselves with the neighbors, especially acutely in high school and with young kids. And so, shame is kind of a manifestation, and I'm not talking about shame, appropriate social shame for doing something bad to someone, I’m talking about shame about who and what we are. And this is a kind of a holdover from our evolution. It's like our tailbone, it's a vestigial organ. So, I think one of the ways that… one of the ways I think is helpful and the way I've used it is educating my client's and the people that I work with and all different walks of life to say that shame about yourself really is not about you. It's a historical artifact based on how we use to organize society. And so, you've got to begin in a sense, exercising and, and, you know, like freeing yourself of those particular concepts. They're not going to go away because we are hardwired to believe those things, but you have to realize they're not true. So, it's like any, it's like a, it's like a delusion. You have to figure out how to say, okay, this solution keeps popping up. I have to figure out ways to counterbalance it, but not worry, you know, not worry about the 10,000 things that the Kardashians may want us to worry about so that we look more like them.

Anibal Henriques: Thank you.

Alexia Rothman: Lou, I noticed that you and I actually attended the same doctoral program in clinical psychology at UCLA, and just reading your work, I was reflecting that while I was there seeing my first clients, I was completely convinced that all I had to offer was curiosity and compassion in my own humanity and that what would actually make me a truly effective clinician was learning more tools and techniques and theories, and it's funny that, you know, 23 years now, after starting that program, I'm back to where I started, and that I've learned that when I'm actually at my most effective, I'm deeply attuned to my own system, to my client's system. And I just felt your work really spoke to this in so many different ways, including in giving us the neuroscientific perspective on it. There are commonalities across modalities that various techniques and theories can absolutely be helpful, but that at core, we're going to be attuned, integrated and connected both internally with our systems and externally with our clients’ systems is really what helps us be maximally effective. So, I just want to thank you for all your brilliant work really. That has helped me so much over so many years and others as well.

Louis Cozolino: You’re very welcome and thank you for saying that. I had to survive UCLA more than enjoy it. And so, I had G.I. symptoms whenever I would drive up Westwood boulevard towards the campus for about five years after I would start getting my stomach would start rumbling and I have to make sure I had some tums close by.

Alexia Rothman: It's a super, super intense program. I was lucky, my sister was there with me. We were probably the only siblings that ever attended that program. She's a neuropsychologist. She was at the NPI.

Anibal Henriques: What's coming for you Lou for the coming months and times? What are your future projects?

Louis Cozolino: Let's see… no future projects right now, I’m gonna read novels for a while and spend time at the beach. I'm going to see, and maybe that will evolve into retirement. I don't know. I was going to write a book on trauma and I did the proposal and it got accepted, and then I started thinking about it, I'm not sure I'm going to do that. I think I like just to relax for a while. We'll see what happens.

Anibal Henriques: Thank you so much for your time and for having us and for such a lovely and inspiring conversation, wishing you all the best for the coming times.

Louis Cozolino: Well, thanks so much for having me guys. This was fun. I hope it was helpful to your listeners.

Alexia Rothman: Thank you so much.

Louis Cozolino: Thanks so much. Good to meet both of you.