Research Updates in Psychiatry

Your Brain and the Therapeutic Relationship

The premise of psychotherapy for trauma – that talking can make it better – is not intuitive. After all, we cannot erase the past. In fact, therapy does not attempt to undo the past. Instead, the therapist works to create a secure relationship from which the therapeutic process can take place, gradually enabling your brain to better manage challenges.

How Therapy Facilitates Recovery From Early Relational Trauma

A common factor that brings many adults to therapy is early relational trauma. Relational trauma is so damaging because it is through our early relationships with caregivers that we develop the ability to manage strong emotions such as fear, anger, and despair. Early relational trauma prevents the development of mature emotion regulation.

During infancy and childhood, our nervous systems are biologically immature. As a result, we need our caregivers to “manage or regulate” intense emotions. When we feel intensely upset, the fight or flight system is activated. Cortisol and adrenaline are released into the bloodstream, preparing our bodies for action.

This intense state is not meant to be endured for long and we need to bring ourselves back to a feeling of calm and safety. During these episodes, children need to rely on caregivers to provide appropriate levels of comfort and care. Ideally, the caregiver manages (or helps manage) the child’s emotions for them during a vulnerable period of development.

Consistent, reliable, and appropriate care is essential for providing the building blocks for the child to learn to manage strong emotions on their own (1). The child learns that upset and other intense emotions can be managed and that relational disturbance is followed by repair. For example, anger is followed by forgiveness, fear is followed by feeling safe again, and sadness can be overcome.

Through these interactions we come to understand that negative emotions are transient, they do not need to linger for long periods,  and they are something from which you can recover.

Adults who were exposed to inconsistent, abusive, or neglectful parenting did not have a secure relationship in which to develop the ability to manage stress and emotions. Emotion regulation is not simply about feelings. Building emotion regulation is a relational, cognitive and neurobiological process that can occur through the relationship with the therapist and the safe, secure environment of a therapy session.

The results of therapy facilitate the development of increased self-awareness, coping skills, and build a sense of self-control. The effects of trauma, especially early relational trauma, often rob us of our chance to control our emotional reactions and responses to stress.

The therapeutic process is multifaceted, helping us first to manage and understand ourselves and then learn how to connect with others. This happens within the context of a trusted relationship and a supportive therapeutic alliance (2).

The Neurobiology of the Therapeutic Relationship

Adults who experienced trauma often have on-going physical experiences of fear. When our bodies become afraid, corresponding sensations such as a hyper-alertness can rob us of the ability to feel safe and relaxed. Adults who experience on-going effects of trauma can also feel overwhelming physical sensations in the chest and stomach, depression, and anxiety (3).

Through the process of connection and learning how to manage emotions and reduce stress levels in therapy, the enduring effects of trauma can be mitigated or removed. An important role of the trauma-focused therapist is to help us stabilize our emotions.

What researchers understand from neuroscience is that in terms of self-regulation, our biology is an open-looped system. What this means is that when we are afraid, angry, or sad, we need others to help us calm our feelings and feel safe again.

When we are left to do this on our own, especially as young children, we tend to experience spirals of fear and sadness. When this repeats over time, we are not given the opportunity to learn how to manage our own emotions (4).

Feelings of fear and safety cannot co-exist. When we are given the opportunity to connect with another person that we trust, we can feel relief. If the trusted relationship continues over time, we are given the chance to rewire the brain.

The therapeutic relationship provides the first step to rewiring our brain from a trauma-focused system to a brain that feels in control. Through the process of relating, sharing, and learning to rely on a supportive person, the nervous system begins to learn how to manage emotions and return to calm after an upsetting thought, experience, or memory (5).

How Do I Know if my Therapist is Helping?

A good therapist will help you to feel safe and comfortable. It is also important that you have a sense that the therapist is in tune with you and interested in you as a person. If your therapist seems stern, cold, or judgmental, it is unlikely you will feel safe or calm in his or her presence.

The feeling of safety in a relationship is how we are able to influence the unconscious and implicit bodily understanding of ourselves. Through an on-going and supportive relationship, the nervous system begins to develop bodily knowledge that it is safe in this world. In other words, the body can learn what it feels like when we have another person available to help us feel safe and manage how we feel (6). This is why therapy can have a substantial impact on healing. The therapeutic relationship is able to influence the inner workings of your nervous system.

Successful therapy will provide you with the skills you need to bring your emotions and stress response under control so you can build healthy relationships in the future and develop a lasting support system outside the therapist’s office.


Schore, A. N. (2009). Right-brain affect regulation-An essential mechanism of development, trauma, dissociation, and psychotherapy. Fosha D, Siega l DJ, Solomon MF, editors. The healing power of emotion: Affective neuroscience, development & clinical practice. New York/London: W W Norton & Company.

Van der Kolk, B. (2014). Healing from trauma: owning yourself. In B. van der Kolk. The body keeps the score: Mind, brain and body in the transformation of trauma. Penguin UK.
Van der Kolk, B. (2014).

Schore, A. N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51(3), 388
Nan, J. K. M., & Ho, R. T. H. (2014). Affect regulation and treatment for depression and anxiety through art: Theoretical ground and clinical issues. Annals of Depression and Anxiety.
Van der Kolk, B. (2014).

Your Brain and the Therapeutic Relationship

Fabiana Franco, Ph.D, LLC

Dr. Fabiana Franco has been a clinical professor of psychology at George Washington University. She is credentialed by the National Register of Health Service Professionals, certified as a clinical trauma professional and has Level II C-PTSD certification by the International Society of Trauma Professionals. She sees clients in her New York office.


APA Reference
Franco, F. (2020). Your Brain and the Therapeutic Relationship. Psych Central. Retrieved on September 19, 2020, from


Scientifically Reviewed
Last updated: 20 Feb 2020
Last reviewed: By John M. Grohol, Psy.D. on 20 Feb 2020
Published on All rights reserved.