Does therapy actually work?

A woman with brown hair smiles and looks off-camera while sitting on a white couch in front of a white brick wall.

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Does therapy actually work? If you ask one of the millions of satisfied clients around the world, they’d say yes. If you ask author and psychology professor Louis Cozolino, Ph.D., he’d also say yes, and he’d tell you how it works, too.

Dr. Cozolino published “Why Therapy Works: Using Our Minds to Change Our Brains” back in 2016, but the neuroscientific research he employs to back up his claims is astounding. I read his book while getting my master’s in clinical mental health counseling and learned an incredible amount about how the brain works. I recommend it for all mental health professionals, as well as those clients who have an interest in what’s going on in their brain during their sessions.

Here are the three main lessons I learned from “Why Therapy Works” by Louis Cozolino.

Evolution has resulted in two types of thinking

Our brains have two tracks for processing information. The first is fast and involves senses, motor movements, and bodily processes. These are nonverbal and unconscious. The second evolved after the first and is not as fast. It involves conscious awareness, narratives, imagination, and abstract thought.

“The difference in processing speed between the fast and slow systems is approximately one half second. This vital half second is one of the primary reasons that we need psychotherapy.

It’s these two tracks that make our brains “extremely vulnerable to dysregulation, dissociation, and errors in thinking and judgment.” Evolution embedded a simple way of thinking into a very complex brain paired with a very complex social structure – “imagine a five-year-old operating a transit system.”

So, next time you make a regrettable decision in a moment of panic, blame evolution.

We’re wired for unhappiness

So much of our thoughts and behavior are dictated by our amygdala, which is our executive center for fear processing. Since humans have an innate desire for survival, the “primary job of the amygdala is to appraise the desirability or danger of things in our world and to motivate us to move toward or away depending on its decision.” This is great when we have actual danger ahead of us, but our brain errs on the side of caution whenever it’s unsure, which is why we feel anxious in traffic or when we get a bad grade on a test.

“The amygdala’s job is to keep us alive, and it has the neural authority to veto happiness and well-being for the sake of survival.”

Our amygdala doesn’t care that we’re no longer faced with the same dangers we had 500,000 years ago and that we just want to be happy and enjoy our life. It’s going to make sure nothing bad happens to us, no matter how crappy it makes us feel.

Our first years of life are vital for emotional regulation

That amygdala mentioned earlier? It matures while we’re still in our mother’s womb, but the systems that regulate it don’t develop until many years later.

“Thus, we enter the world totally vulnerable to overwhelming fear with no ability to protect ourselves.” No wonder babies cry so much!

That’s why a secure attachment with caregivers is so important at an early age. Because we can’t regulate our own fear, we rely on our parents and guardians to do it for us until we’re able to do it ourselves.

“The way our parents modulate our anxiety and protect us from fear becomes the template upon which our social and emotional neural circuitry becomes organized.”

How does therapy work?

Psychotherapy, therapy, counseling – whatever you call it and however you do it, we all have the same goal: “to expand conscious awareness and to increase the integration of the various neural networks dedicated to unconscious and conscious memory.”

Basically, we’re helping our clients become aware of the stuff they didn’t realize about themselves. Sounds simple, but anyone who has tried can tell you it’s not easy. Our clients are brave, vulnerable, motivated, and eager to work through their issues, but have evolution, trauma, and genetics getting in their way.

But there’s hope, as many, many clients of therapy can attest to. Little by little, hour by hour, clients are doing the work to break down the automatic processes of their brain with our guidance.


Brooke Leith

Brooke Leith, LPC-Associate, is a mental health counselor who works with adults, teens, couples, and families — in-person in San Antonio and virtually anywhere in Texas.

Supervised by Faith Ray, LPC-S (#10412), 210-386-3869

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