Clinical practice within the profession of psychology has been in the news of late as the debate on the efficacy of drug-based treatment vs. psychotherapy becomes more heated.
Recent reports on the problems with drug research, the lack of information given to clients on drug effects and the use of medication of children have projected psychotherapy into the spotlight as a safe and effective method of helping individuals in emotional distress.
This focus puts the spotlight on clinicians who are on the front lines in treating clients and reforming the mental health system.
The field of Epigenetic research connects genetics with environment in a molecular, lasting way and it makes what clinicians do on a daily more relevant, enduring and exciting.
Epigenetics applies to the domain of the genome as well as psychology and the practice of therapy.
The field of Epigenetic research is looking at external modifications to DNA that turn genes “on” or “off.”
These modifications do not change the DNA sequence but they alter the genetic expression.
On-going experiences can become embedded in our DNA and in our long term memory and will affect our thinking, feeling and behavior in current and future situations.
Clinicians need to be aware of the significance of these findings because what clinicians do with clients in practice may well become part of the client’s molecular genetic template. The emotional interaction with clients will have long lasting impact.
For clinicians and their clients, this news, which points to the embedding of strong negative and positive client experiences in DNA and long term memory is a call for more targeted assessments and treatment.
In addition, molecular changes in our DNA may be passed down through the years and through generations as well so that the children of clients may be influenced by the changes in the DNA imprint.
Impact of Long Term Memory
Memory is a complicated and multi-faceted concept and involves various brain systems that are engaged in working memory (known as short term memory), autobiographical memory episodic memory and long term memory.
When we speak of experiences that become part of our DNA and long term memory, we refer to strong positive and negative (traumatic) memories of abuse, of birthday parties, of divorces, births, deaths and transformative therapy interactions that have an emotional impact.
These powerful experiences are most likely to be processed into long term memory and genes and therefore have an impact upon our behavior, thinking and feeling.
What our clients have experienced in their past and present and what clinicians do during the therapeutic interaction leaves a lasting footprint.
In the case of early child abuse and other traumas, we now know why experiences and memories are never lost in memory and can be reconstructed and triggered by a variety of cues that may seem imperceptible to some.
This issue is a cautionary one because the repeated triggering reinforces the memory and becomes a disabling factor. Fear cues may appear within the therapeutic context as well and this knowledge may make the clinician more observant and a better listener.
PTSD and Threatening Cues
The cycle of repeated fear arousal is PTSD and many clinicians are learning and practicing methods of treating this painful disorder.
Traumatic memories can be brought up and reconsolidated in therapy, over-written with positive or neutral information but they are never completely lost.
Research shows that certain chemicals such as valprolic acid can strengthen reconsolidation of the original fear memory or enhance long-term memory for extinction such that it becomes independent of context.
These findings have important implications for the use of medications as adjuncts to behavior therapy in the treatment of phobia and related anxiety disorders.
Some individuals are more vulnerable to PTSD because of early abuse followed by what they perceive as threatening cues during their lifetimes.
Others, who have not been sensitized, are less vulnerable but with this information clinicians need to take certain steps in treatment with sensitized clients that will be noted below.
Beyond becoming a better listener and observer, there needs to be carefully targeted evaluation of the client’s early history. Their “lived experiences” need to be done as early as possible so that sensitive clients can be identified.
Within the therapeutic relationship and within the environment that the therapy takes place, there may be fear cues that are not readily apparent. These cues may involve the receptionist’s attitude towards the client, the number of people in the waiting room, the physical dimensions of the office and of the therapist themselves.
Context may provoke fear and the best strategy for bringing these cues to light is a detailed questioning about the context of early traumatic experiences. Clinicians are usually well trained in eliciting painful information by developing a relationship of trust and by observing the client’s reactions to what their senses are picking up.
For example, a client who remarks on the unsympathetic tone of voice of the receptionist or a disturbing painting on the wall may be telling us that he or she has been triggered.
Responsibility for Clinician
This situation places a responsibility upon the clinician to bring their awareness to a new and heightened level and to stay “in the moment” with the client. It goes beyond empathy into a more scientific screening and understanding of what the client is saying, doing, thinking and remembering.
Working with highly vulnerable, sensitized clients would involve more careful attention to the healing process that is recommended and a full scope of knowledge about available treatments.
The variety of treatment modalities is expanding daily. Cognitive behavioral therapy (CBT) is one type of counseling. Research shows it is the most effective type of counseling for PTSD.
Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy are among the forms.
There is a similar kind of therapy called Eye Movement Desensitization and Reprocessing (EMDR) that is used for PTSD. Also, medications have been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.
Clinicians may recommend alternative and supplemental therapies and activities; Yoga, mindfulness training, group therapy art and animal-support therapies etc., are examples.
There is good news on the horizon thanks to the brain’s plasticity and innovative, therapy-based advances.
Since the early life deleterious epigenetic programming can be reversed, at least partly, by favorable psycho-social conditions later in life, use of self-soothing techniques such as meditation may be another promising therapeutic approach.
Such a possibility is evident from recent studies where intensive practice of mindfulness meditation resulted in alterations of histones as well as in decreased expression of histone genes and pro-inflammatory genes.
If it is possible to correct disrupted epigenetic patterns via specific epigenome-targeted therapeutic interventions, then it will be possible to prevent a variety of chronic diseases to extend the human health.
The client who is sensitized and is aroused by many kinds of sensory cues is a challenge for any clinician who will be more aware of their own behavior, the environment in which the therapy takes place and the behavior of the client when he or she is aroused by certain stimuli.
The knowledge that what we do as clinicians becomes part of our client’s genetic record is truly an awesome responsibility.
Bernstein DP, Fink L. Childhood Trauma Questionnaire Manual. San Antoinio, TX: Psychological Corporation; 1998
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