This is a very important question. In recent years we all were very optimistic about this. But many also saw the danger that a kind of neuroscientific "imperialism" might outrule other approaches and methodological autonomy of other sciences. Some authors several years ago responded sceptically to the early otimists, e.g.

Caspar, F. (2003). Psychotherapy Research and Neurobiology: Challenge, Chance or Enrichment? Psychotherapy Research, 13, 1–24.

In the long run it will be good to have an extended discussion a) about the value of neuroscientific results for psychotherapy practice and b) the autonomy of psychotherapy research

Best

Michael B. Buchholz

Intern. Psychoanalytic Univ., Berlin (Germany)

I agree with you about the independence of the two fields and I well know the risk of overestimating our knowledge in the neuroscientific field, but given that the same knowledge that we usually don't use in our psychotherapeutic approach is succesfully used in other fields (for example the knowledge on mirror neurons is daily used in neurological rehabilitation) why couldn't we try to use it in psychotherapy?

Of course, you are right with your view to use otherwise applicable knowledge in other fields also in psychotherapy. Some researchers, like Stein Braten, coming from experience as baby-researchers see how influential in subtle details mothering is - and it is meanwhile accepted that similar influences show up in psychotherapy interaction, e.g. rupture repair, initiating talk, gaze track etc. What we do not have, astonishingly, is a lot of studies concerning the voice of participants in psychotherapy. The voice is such an important "instrument", a medium of conversation and embodied, it's a little miracle that there is not more research about the phonetic dimension of talk-in-psth-interaction.

Best

Michael

I am skeptical that what you are describing is in fact related to the mirror neuron system. This system as far as I have understood it is diffuse and very integral and basic to early social development involving concrete imitation. I do not imagine that bulimic patients in the first months of life or thereafter would have had abnormal imitation of expressions or simple tasks like sticking out the tongue, rounding the lips, raising the eyebrows, implying a deficit or disruption of mirror neuron system development. Gergely and Watson identified differences in the preference for exact imitation versus varied, non-contingent responsiveness within the first year of life when comparing children who would go on to develop autistic spectrum disorder or disorganized attachment as compared to controls, but even that is different from the alexithymic dfficulty that you describe. What it seems to me that you are describing is the difficulty in labeling emotional states for self, more than for others. Mirror neurons are not to my knowledge involved in this process which links frontal cortical and limbic regions. Generally, it is hard to imagine that a deficit in labelling emotions in self would be exclusive, and not be linked to some deficit in labelling emotions in others. Have you tested bulimic patients' labelling of emotions in unfamiliar others versus attachment figures? We have studied mothers with violence-related PTSD and their children and have shown a pattern consistent with cortico-limbic dysregulation on fMRI (see our paper in SCAN) when compared to controls. We are currently replicating those findings and have submitted a paper on the relationship to the type of emotional dysregulation we see behaviorally among traumatized mothers with their toddlers and its relationship to identifying emotion in self and others as a dimension of alexithymia, We have not specifically studied bulimic patients. But regularly see such patients in my clinical work.

Would you do me the pleasure and send me a paper about your work? I feel a little bit misunderstood that my short remark provokes a statement to whom I could completely agree. I just wanted to underline that we have a continuity in conversation in general, may be due to mirror neurons, from early protoconversations to high-level symbolic talk. It is not long ago that we did not see this continuity. My clinical experience is, as far as I understood you, the same: that some patients do have difficulties in naming emotions - of self and others. This must not be caused by "early" deficits in mothering of what ever kind. Here something is overestimated.

Best

Michael

Dear professor Schecter, thank you for your answer, I would be very happy if you send me a copy of your paper, too.

I don't think that bulimic patients have an impaired mirror neuron system, (At least Anorexic patiens could have this problem, see Kate Tchanturia's works, we are researching on it but we have not still enough data) . In our opinion their MN works very well, so we try to help them to use this system in recognizin their OWN emotions through a video tecnique. We use this method with many alexithymic patients and it is very helpful, we are currently researching on its neurological background .

Just to be "clinic" , have you ever thought? when a patient doesn't recognize an emotion that is clearly painted on his face: "if he could see himself!?" Our technique allows him to look at himself.

Yes! Indeed, we use a similar video feedback intervention "CAVES" to help traumatized mothers and toddlers such that mothers can see both their child's and their own affective communication. My response was only meant to challenge the connection between this very important clinical type of intervention that you are describing using mirrors (something that Paulina Kernberg also wrote about in her work with adolescents on their way to developing borderline personality disorder) and the mirror neuron system of the brain, which likely only plays a relatively small albeit meaningful role in terms of the subject's response during adolescence and adulthood. Will see which articles of ours we can send if not already uploaded. Thanks!

Great! We would be honoured to know your CAVES method and of having any comment from you on our technique. We also use self mirroring with patients with traumas, One of my first patient was a mother who had an 8 year old daughter suddenly died. Which is your opinion on theoretical basis of the efficacy of self mirroring in traumas?

I would caution any direct application of "mirror neuron" neurobiology to psychotherapy at the moment as well. In distinct ways, neither field has advanced sufficiently to do so. I would add that empathic processing (understanding emotions in others) has more complexity than mirror neurons, and increasing research demonstrates the existence of a parallel system in the brain for understanding emotions in others, which may depend or interact with the "mirror neuron" system. I reviewed the subject recently with Larry Siever and Howard Steele as co-authors, with respect to the neurobiology of empathy in borderline personality disorder. Eventually and theoretically, I agree that there may be important things that psychotherapy could learn from neurobiological research, and that there may be important directions for empirical neuroscience research to consider from psychoanalytic theory and metapsychology.

Article The Neurobiology of Empathy in Borderline Personality Disorder

Dear dr. Ripoll, I agree with you that it is very risky to apply to the clinic the theories of brain functioning! Sigmund Freud was the first to experiment this, he was neurologist and had in mind a theory of brain, but the neurological knowledge of that time was very poor and currently we don't know how "rich" is our knowledge! However in rehabilitation this approach works, patients with afasia have better results looking at their image in the screen while they try to speak, than while looking at the face of the therapist. With my question I would like to invite the researchers intersted to this topic to share their experiences (and failures) to improve this field of the psychotherapy. I think that it is very amazing that if Sigmund Freud would like to practice psychotherapy today it would be possible, while if he would work today as a neurologist it would not possible! It is strange that it is possible to work with the mind without knowing the brain.

Dr. Vinai, this sounds like promising work! I'm curious to hear more about the process, moderators of response, and outcome in these cases. I wonder what the specific benefit may be of using an image on the screen--whether use of the screen is more of a controlled, predictable stimulus than the therapist's face, whether it is a question of patient comfort, whether the effect is mediated by endogenous oxytocin or other types of signaling, or any other reason it may be more efficacious.

My hypothesis is that, in all patients, Freud's 'working through' the 'transference neurosis,' or perhaps Stern and Lyons-Ruth's process of 'implicit relational knowing,' may be changing the relative functional connectivity of the 'mirror neuron' and/or other empathic/self-relevant processing networks. Of course, at this point, this hypothesis remains highly speculative, but as we continue to define our clinically-based psychoanalytic concepts and aspects of the therapeutic process, and as we continue to explore the richness of neuroscience that you've mentioned, perhaps we could begin to test components of such a theory and investigate a neurobiological mechanism of psychotherapeutic action.

I think the gap between neuroscience discoveries and clinical practice is much more deeper than your approach suggests, even if we should aim at such an integration (see e.g. E. Kandel). Experimental basic research needs simplified variables and constructs, that you can not find (and manipulate) in real psychotherapeutic settings and interventions.

We don't aim to replicate in the clinical setting the experimental research,it is obviously impossible, but to transfer in the clinical setting a small part of the results of those researches. If we don't have in mind the practical use (even if sometimes in a very far future) of our the basic research, why we would perform it?

Sorry!! the above sentence is not correct !

"If we don't have in mind the practical use of our basic research (even if in a far future) why would we perform it?"

Practical use for mirror neurons??

First, Basic Research could exist just for adavancing knowledge. Alternatively, it would need a much longer and deeper work (both theoretical and lab based) for gaining in the future a clinical "utility".

What about use of knowledge on mirror neurons in treatment of afasia and stroke results?

Three years ago I attended to a conference on neuro-rehabilitation and psychotherapy. At the end of my presentation on self mirroring therapy a colleague working with patients affected by stroke results asked me: " where is the novelty? We daily use this approach in neuro -rehablitation!" The problem is that psychotherapists usually meet only psychotherapists in their conferences, so they cannot share their knowledge with those of experts of other fields of neurosciences. . This approach could be very useful for both!

Neurological and Neuropsychological rehabilitation is a different matter compared to psychotherapeutic process.

Can aphasic and post-stroke patients be compared -for ex.- to narcissistic or dipendent clients?

N.B. My comment above was in response to your second to last question.

I think that neuroscience results cannot be easily shared with people coming from very different backgrounds. In other words, neuroscientists can not easily communicate their work to those with NO experimental background.

I know many researchers able to disseminate their knowledge, but it is true that not all researchers , as not all clinicians, are able in communicating, I think that this is a personal limit, not a postulate. Anyway I respect your opinion.

I think that sharing knowledge between clinicians a nd neuroscientists is important to both parties and of course could benefit patients. Communication is possible and was wondefruly shown at the" Brain, learning and development" conference in Vancouver last summer

I completely agree with you! I think that it is a sort of professional duty for young researchers and clinicians to learn how comunicate together better than we are able to do.

Please can you tell me any information on this conference?

Thank you very much!

We do not know but it is worth trying!

I hope your question prompts more people to do research and try it. Overall, I think yes, techniques and awareness can be developed. I also think that therapists and patients frequently mirror each other unconsciously, depending on their level of engagement . If we think of perception and action originating in the same neuron, can we really engage without using our mirror neuron system?

Dance Therapy uses mirroring as a basic tool. I used it with Tom (not his name), a 5 year-old patient of mine who had been diagnosed with autism. I am a physical therapist and I could not connect with Tom. One day I decided to imitate (mirror) everything he did as he was doing it. He was very interested, and connected with me for the first time. I used a standard movement technique which is to partner in movement with another person, taking turns leading and following. While he experimented with it, I watched him get the idea that he could mirror me. Eventually he began to imitate me for short periods of 15 seconds or so. We ended up in a short movement conversation mirroring each other, engaged, however briefly.

We had fun together. After that he was happy to see me. We had enough of a working relationship so we could begin to enter the real work of PT. I do not claim cure, or radical, instantaneous relationship. Right patient, right therapist, right moment, right technique. It can happen.

I had many experiences like this! Of course I also think that mirroring it is not a magic solution for every problem , but a very useful tool , that can be enhanced. It would be great to share our experiences and to create a group researching on this topic. If any of you is interested to take part in it I will be very happpy and honoured to collaborate .

I truly do believe a better understanding of mirror neuron functionality, and more importantly, barriers to mirror neuron communication in the therapeutic relationship can greatly affect methodologies in the psychotherapeutic process. It is very clear that mirror neurons play an important role in attachment, in intimacy, in diplomacy and in realizations of empathic process. Additionally, we believe the lack of mirror neuron communication contributes to poor relationship maintenance in "long-distant" relationships, which by the way, more relationships are becoming as a result of overutilization of electronic communication methods. The abandonment of true social face-to-face communication methodologies, or the reduction without enhancement by means of non-social communiques, has greatly interfered with the depth of building and retention potential for couples, families and within other systems. With that said, it has also expanded civilizations capacity to communicate in non-intimate ways immensely.

I would love to learn more of any research that addresses barriers to neuronal mirroring and it's effects on measures of intimacy, or empathy, if any such measures exist.

This is a great discussion and I totally agree that further research is very much needed in this area. I hope I can add something regarding how mirroring is well used within a well established model of psychotherapy. I work with a range of traumatised adult clients using intensive short term dynamic psychotherapy. This is a model which is very active, highly body focused and uses a lot of psychoeducation for the client early on in the work, especially mirroring to them their ways of managing unconscious and conscious emotions. Osimo (2003); Osimo & Stein (2013) and Ten Have De Lajibe & Neborsky (2013) have all written specifically in their manuals of this therapy about mirror neurons. Moreover, links between the therapeutic model and neuroscience in general have been key in the development of the model and understanding of what works and why. The model has developed as a result of Habib Davanloo videoing the psychoanalytic sessions he was having with clients and developing a model which used his learning about key moments of change for clients. We still use video taping of sessions in training and within clinical work – my clients often take weekly copies of their videos to watch and develop a great deal of insight and empathy for themselves, as they see their emotional responses and defences at play.

More specifically with regard to mirror neurons and this model of therapy...

Ten Have De Lajibe and Neborsky (2013) discuss the potential role of mirron neurons with regard to introjection, identification and imitation, as well as the possible implications for attachment relationships - that though not evidenced, they probably have a role in enabling secure attachments to develop as well as in the creation of mirror neuron prisons - where the mirroring of punitive and abusive treatment enables vulnerable children to develop punishing and abusive ways of treating themselves which could continue, internally, indefinitely. In my experience, the impact of teaching my clients about these neurons and their possible role in the development of their psychological difficulties, has had a hugely de-shaming role. It has often enabled clients to take a more objective view on their ways of coping, and provides a clear justification for them to prioritise healthy relationships that will provide more healthy mirroring in their currently life to rewire their brain!

And as described by Osimo (2013)

“A first exciting step in the direction of identifying the nural circuits responsible for our mirroring ability is the discovery of mirror neurons. Indeed mirror neurons are thought to lie at the core of our ability to resonate with others’ internal states (Lacoboni, 2008; Rizzolatti & Craighero, 2004)”(pg 50).

“Most importantly, the experience of being present and resonating with each other, tuning in to this interpersonal current (Osimo 2001, 2002, 2003) can be enhanced by active mirroring by the therapist of all that they observe in the patient. By so doing we put the brain systems we are naturally endowed with to the service of conscious and unconscious therapeutic alliance, an equivalent of “making friends” in non therapeutic relationships. ... Mirroring interventions (MI) involve the therapist drawing the patient’s attention to aspects of the patient’s Self, especially those of which they are less aware. These are perceivable aspects, revealing emotions, fears and defensive attitudes. In particular, mirroring involves giving the patient constant and accurate feedback of what they are conveying verbally, physically or on any other level.” (Page 51)

Osimo, F. (2001). Parole, emozioni e Videotape: Manuale di psicoterapia Breve Dinamico-Esperienziale (PBDE). Milan: Franco Angeli.

Osimo, F. (2002). Brief psychodynamic therapy. In J Magnavita (Ed.), Psychodynamci and Object Relations Psychotherapies, Vol 1 in Comprehensive Handbook of Psychotherapy. New York: John Wiley and Sons.

Osimo, F. (2003). Experiential Short Term Dynamic Psychotherapy, a manual. Bloomington, IN: Authorhouse.

Osimo, F. & Stein, M. J. (2012). Theory and Practice of Experiential Dynamic Psychotherapy. London: Karnac Books.

ten Have-De Labije, J. & Neborsky, R. (2012). Mastering Intensive Short Term Dynamic Psychotherapy: Roadmap to the unconscious. London: Karnac Books.

Iacoboni, M. (2008). Mirroring people: the Science of EMpahty and Howe we connect with others. New York; Farrar, Straus and Giroux

Rizzolatti & Craighero, (2004). The mirror neuron system. Annual review of neuroscience, 27: 169-192

Dear Jessica a very interesting approach to the topic! Please can you explain me which is the practical method you use in your sessions?

I'll have a go at briefly describing the way I work and try to keep to what I have typically seen in the way that others work using this model. So we would focus on keeping a specific focus at the start of the session where the client is expressing a difficulty which they have a clear desire to work on (this itself is difficult with my client group but lets assume we have got that far). So, if they had told me they had recently had an experience where their partner treated them disrespectfully and they withdrew thinking 'whats the point'. I would first note whether they were showing signs of unconsicous anxiety that would prevent them connecting with their feelings with regard to this - if they start experiencing cognitive disruption or a headache for instance, their unconcious feeling about this experience is causing anxiety which they are channelling into pathways that will disrupt their ability to manage the underlying feelings. If they are showing this type of anxiety, I would mirror what they are showing me "Do you see how when you focus on this experience, your headache comes back? This is a sign of anxiety, your partner treating you disrespectfully causes feelings inside that make you anxious - do you see that?"

Depending on the client and the level of anxiety, just showing to them how they respond, reduces the anxiety (and the headache) enough to ask about the feelings they have towards the partner. Sometimes, we have to do anxiety regulation to bring their anxiety down. When the anxiety is at a managable level...

Therapist: "So, can you tell me what you feel towards your partner for treating you disrespectfully in the clinic yesterday (not being general i.e. 'always' treating you badly - being very specific about the situation in which it occured)?"

Client: "Oh there's no point, he won't change" (client breaks eye contact and looks away)

Therapist: "Do you notice that you break eye contact with me as I ask you about this? What would you feel if you continued to look at me and inside yourself for the feeling you have towards him?"

Client: (Looks at therapist and starts scratching hand quite viciously)

Therapist: (Mimicking scratching hand to show client what she is doing, with concerned, warm look in eyes) "If you don't hurt yourself and you pause and pay attention to your feelings inside what do you notice about how you feel towards him?" (therapist tone with attitude of love and compassion).

Client: (Stops scratching, deep sigh). "Well, I think - how dare he swear at me?"

Therapist: "Right, "how dare he swear at me?" (using same tone or excentuating it a little to match the underlying emotion she is starting to express) it is what you think, sure. And as you say this and remember the way he swore at you, what do you notice about how you feel inside?"

Client: "I'm not sure"

Therapist: "Do you see that your hands tighten up into fists?"

Client: "Oh yeah (a little surprised). Well, I'm angry with him for doing that to me."

Therapist: "Yeah (pause - allowing client to feel validated and recognise this previously ignored feeling). And as you pay attention to this anger inside you - where do you feel it - in your torso, in your arms, your hands?"

Client:"Its in my hands and I've got energy all down my arms"

Therapist: "Is there also a feeling in your torso - you have sat up straighter in your chair"

Client: "Yeah its like energy inside me"

So really being with the client where they are and sharing with them what they are doing that they don't notice, both that blocks the therapuetic process as well as will facilitate it.

Sorry - another long response from me, its hard to summarise briefly and do justice to the detail of the work! Hope its a helpful example of the work in practice. references in previous response will have more detailed examples also.

Jess Bolton

Consultant clinical psychologist

Senior Academic Tutor, Doctorate in Clinical Psychology

Coventry University

Chair of Experiential Dynamic Therapy UK

Great!

Dieser Ansatz scheint mir nahe zu sein an eigenen Erfahrungen in der Arbeit mit dem "inneren Kind" (nach Reddemann), besonders bei frühgestörten Pat.: über eine Beschreibung der äußerlich sichtbaren Unterschiede zwischen dem/der Pat. selbst und anderen ist auf der Grundlage einer Arbeitsbeziehung zwischen Ther. und den gesunden Anteilen des Pat. (die zwar meist wenig Zugang zum emotionalen Erleben haben, aber durchaus zu konstruktiver Auseinandersetzung in der Lage sind) eine Rekonstruktion der frühen Biografie möglich, die ebenfalls auf die Unterschiede zwischen den eigenen (meist traumatisierenden) Beziehungserfahrungen und den vermuteten/wahrscheinlichen Erfahrungen eines imaginierten gesund aufgewachsenen Kindes abzielt. Das Kind, das Pat. früher war (schon von der vorgeburtlichen Situation in utero an, über Geburt und Säuglingszeit bis in das Alter, in dem bewusste Erinnerung einsetzt) ist dann die imaginierte Person, in deren Erleben sich Pat. nach meiner Erfahrung sehr gut einfühlen kann. Auf diesem Umweg wird ein Zugang zum emotionalen Erleben und eine Beschreibung möglich, die dann im nächsten Schritt in Verbindung gebracht werden kann mit dem Erleben und Verhalten des/der Pat. in aktuellen Situationen.

Dear Jessica very interesting approach! We do similar things using a video based approach, in which we show to the patient her/his face while he is recalling a significant event of his life.

Maybe interesting literature:

Dorrmann W (2008): People in suicidal crisis. in: Hermer M, Röhrle B (Hrsg.), Handbuch der therapeutischen Beziehung, Band 2, Spezieller Teil (S. 1448-1476). Tübingen: DGVT Verlag

Dear Colleague, you write: "..we help these patients to recognize their own emotions using their mirror neurons, showing them the emotions depicted on their face through a video technique. Do you think that this method could be useful in improving the efficacy of the psychotherapy?"

In order to answer your last question, it would be necessary to understand how this method is implemented: how their mirror neurons are "used" and why only those neurons? how the emotions are shown? and, in particular, which components of the emotions? cognitive, somatic, motor or else? and what is this video technique?

I can only guess that, if the method is really effective in "recognizing the emotions", then yes, it could be useful, but only provided that 1) the patient has some deficit with this skill (recognizing emotions), and 2) emotions are correctly identified by the system you set up. The n.2 seems to me particularly problematic.

Meanwhile, I well remember I used a video-feedback of a stammerer, who - given the opportunity to look at himself in a monitor while speaking - completely stopped stammering. He was recorded with a camera at about 3/4 of his front plane, and the video was fed back to him in real time. But the benefit was short-lived as the stammering restarted soon after.

Dar Doctor Sibilia, thank you for your interest in our work, you can find a more detailed explanation of our method in the book of Ruggiero and Sassaroli Tecnica del colloquio cognitivo: the last chapter is focused on it . Our method differs from classical video feed back because we do not only show to the patient his emotion in action, but also the effect on himself of wieving these emotions from a "meta" position.

I will be happy to share with you any detail of the method.

A couple of points. (1) The discovery of mirror neurones by Rizzolatti et al was a welcome addition to neuroanatomy, but told us nothing new about function. It has been known for at least 60 years that there is a translation mechanism in the brain for converting input from seeing a conspecific do something into output whereby the individual does that same thing. This translation is necessary for imitation and underlies our ability to be intersubjective. Nothing new there. The translation mechanism is present from birth. Even less new is the ability of psychotherapists, and before them, good vicars/priests/shaman/wise men and women/ordinary people to be empathetic, to read minds and even to know what someone is thinking and feeling better than the person themselves.

(2) there is an unfortunate fashion for alluding to neurological / physiological features in order to give scientific respectability to some psychological idea. Some have called it "neuro-babble" referring to the epidemic of neuro-X where people scramble to give their subject (X) the appearance of solid science by attaching neuro- in front of it (anyone for neuro-astrology, neuro-phrenonology?) Appealing to the mirror neurones is in the same league.

Instead of neurologising, how about saying - does it help to be empathetic with patients? (yes) Does it help the help patients see how others see them? (maybe) Does it help patients to point out to them how they are behaving and what they might be feeling (maybe). Does it help to help patients be more empathetic? (maybe).

There is no need for neuro-babble, to ask useful questions in psychotherapy. In fact it is category mistake, bringing in brain anatomy to inform a problem in the Mind. To confuse the two and introduce neuroanatomy and neural functioning into this arena risks alienation, which does not help the patient.

I suggest you read "Mindsight" by Dr. Siegal of UCLA. It may change your mind (and your brain)!

Dear professor Richer I appreciate a lot the scientific debate when it is based on scientific considerations, so I will honored to discuss with you about any theoretical, technical and methodological aspect of our method . I will be very happy to send you the paper we have written on this topic as soon as it will be fully accepted, (it has been already revised and we are making the corrections requested by the reviewers). Among the authors there are also researchers working in the same department in which the mirror neurons have been discovered.

I also don't appreciate the neuro babbles, but I think that to split the mind from the brain and the psychology from the neurology was one of the bigger methodological mistakes of the 20th century. This fact opened the doors to a lot of neuro babbles! Another effect was that the field vacated by psycologi was completely occupied by the neuro-pharmacologist who continued to treat the mind dealing only with the brain!

To be provocative: If it is not useful to have in mind the neuro anathomy to be a therapist, why we study it so many years? And why empathic combers cannot work as therapists ?

I agree with you that "neuro-words" are used as mirrors for birds to hide theoretical and clinical weaknesses, but it is not our case. Our aim is to try to link neurosciences and psychology (surely doing a lot of mistakes, that will be corrected by future knowledges in the field of neuro sciences), we think that this is the scientific method.

For this reason we put together experts of the two fields, if you want join us we are honored to collaborate with you.

Of course in the setting we usually don't speak with patients neither of mirror neurons nor of neuro-anything,!!

Thank you for you interest to our work and for the time you spent in answering our question. I'm looking forward to hear any clinical and theoretical comment from you on our method.

@Dr. Vinai,

Respectfully, I would suggest that discussing with many patients about mirror neurons and brain anatomy would be useful to the patient. It gives the patient some context within which to understand the "what" and the "how" of their treatment or counseling. The modern patient can, often, be well-informed and wants to be proactive in their health.

Of course! I just wanted to say that we do not use psychotherapeutic sessions to emphasize the effectiveness of our method.

@Dr. Lucero,

whenever there is an opportunity, I tell my patients, that mirror neurons exist and why they are so important - only some little portions of information here and there - and the effect is just what you suggest: patients can use this description for better understanding of themselves and their relationships.

Maybe "Gegenübertragungs-Analyse" is the way, Therapists use their mirror neurons most effectively.

Dear Dr Vinai. Thank you for your helpful response to my comments. I should be most interested to receive a copy of the paper you mentioned once you know it will be published and to hear about your network. Thank you for that kind offer.

It is certainly true that neurological or other physiological knowledge can be used in therapy. Sometimes it illuminates for patients / parents why they (or their child) are feeling something, for instance helping someone to make a connection between what is eaten when there is a putative intolerance of a foodstuff, and discussing the various sensations experienced or behaviour seen can be very useful. Identifying visual migraines or pointing to the hypersensitive hearing of some children with autistic behaviour can improve understanding and treatment. And so on. All this is common in everyday clinical practice.

Sometimes neurological ideas can be helpful as metaphors in psychotherapy, and here mirror neurons can be invoked to emphasise the centrality of our ability to be intersubjective, but they are not necessary to that understanding and may not help many patients fully to understand. The danger to be avoided is for the clinician / therapist to try and claim scientific underpinning for their views when in reality the neurologising is just tacked on and the therapeutic efficacy is derived from elsewhere. I seem to see a lot of this in publications from, but not only from, the USA. Having said that, if any therapist finds that using the mirror neuron idea is helpful in their therapy, that's fine, we all find approaches which suit us, as long as the pitfalls I have described are avoided.

Underlying my thoughts on this is the idea that far too much psychology and psychiatry hopelessly confuses physical and mental concepts. Of course, the language of mental concepts is created by functioning brains, or, to be more precise, by the interaction of individuals whose behaviour is, of course, controlled by their brains. That does not mean to say that mental concepts can be mapped onto to brain anatomy, they are a different sort of logical entity. And when we communicate WITH each other, the concepts which we use are, at least partly, mentalistic. It is only when, for instance, you and I communicate ABOUT another person, that we can can use only non mentalistic terms (though we may also use mentalistic ones). But if that third person hears us talking about him in this way, he may feel that we are treating him as an object and not as an individual with a subjective life who is to be respected and treated as a moral agent. There are important implications to this confusion.

Yours sincerely Dr John Richer (not Prof!)

Dear John,

Just as with elementary particles that have a mass and an energy phenomenon that can be associated with them, people's brains can have a duality: one of form, the other of function. The form is, of course, the brain anatomy; the function can have a variety of manifestations: standing waves, neural network excitement patterns, and the emergent property of the mind. So we shouldn't think only in terms of mapping mental phenomena to an anatomical part of the brain; there are many other kinds of conceptual mappings that can be done.

In general models are used because they are useful, not because they capture all the nuances of the world we experience.

Thank you, Antonio, for this comment. Both form and function can be concepts within the "scientific" / observer logic. As you rightly say either can be applied in physics (although sometimes not at the same time if Werner Heisenberg's Uncertainty Principle applies). The distinction between physical and mentalistic terms is not the form-function one. It is closer to the old Body and Mind issue, and an essential difference is that mentalistic concepts can be applied by the user to themselves. They embrace the first person singular. So the distinction is between form and function on the one hand and concepts like intention, feeling etc. on the other.