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Book Review: Why Therapy Works

According to psychologist Louis Cozolino, we experience our lives in a state of perpetual catch-up: it takes a half second for our brain activity to register in our conscious awareness. “During this vital half second,” Cozolino writes, “our brains work like search engines, unconsciously scanning our memories, bodies, and emotions for relevant information.” Conscious processing requires more neurons and systems than does the actual brain activity itself, and that creates a time lapse. In this sense, the mind, or consciousness, is different from — or, at best, a step behind — the physical brain.

The title of Cozolino’s new book, Why Therapy Works: Using Our Minds to Change Our Brains, suggests a duality between mind and brain, even a whiff of conflict. But must we be at war inside ourselves? According to Cozolino, the battle between mind and brain is inevitable, but there is hope for helping the two become allies. In order to do this, however, some sleight of hand mind is involved.

Unlike other animals who are born with an almost immediate ability to fight for survival, human infants are dependent upon their caregivers for years. Relationships, therefore, are an incredibly influential component of the modern human brain and lay the groundwork for our interaction with, and perception of, the different environments we encounter. Freud’s superego construct is partially composed of how children internalize parental attitudes toward them; specifically, whether the parent felt the child should live or die, or was wanted or unwanted.

While we may not have an explicit memory of internalizing these primal parental relationships, the experiences themselves are imprinted within us and influence how we think about ourselves. “Our own value and lovability,” Cozolino writes, “are among the lessons that we don’t remember learning, but never forget.”

Through intensive therapy, Cozolino posits, we can uncover the “core shame” that results from implicit negative internationalizations. Techniques such as “reality testing, experimenting with visibility, and creative visual imagery” can guide clients toward improved well-being. Although we cannot verify whether shame-promoting emotions are eliminated from the client’s worldview, Cozolino writes, we can do our best to help ease them.

This is where some conflict is likely between mind and brain. The thalamus-amygdala pathway allows for fast processing of danger signals and, as a result, fear conditioning. Research shows that the amygdala is linked with a type of primitive emotional memory, an elaborate programming from evolution deeply engrained within our neural circuitry. Regardless of how much someone desires intimacy from a partner, those implicit abandonment experiences from childhood that first triggered our autonomic arousal are still very much at work. Helping clients reframe and then manage feelings of shame and abandonment may lead them toward healing, but it is not a panacea.

To overcome this and enable secure attachment, Cozolino writes, the association must be weakened by inhibiting reflexes and learned fear responses stored in those brain areas. This is where mind over matter comes in, quite literally, and where therapists who assist clients in overcoming their fear of intimacy participate in creating those new pathways.

Cozolino’s book is not intended to be a philosophical treatise on the duality of mind and brain. Instead, it is a work that compiles relevant findings from years of published research in the fields of psychology and neuroscience. Cozolino synthesizes central theories into a compendium that demonstrates the efficacy of therapy on the modern mind and primitive brain.

I would like to have seen a comprehensive reference list included at the end of the book; as written, it lacks an appendix that identifies the source research publications in the fields Cozolino covers. For this reason, I caution against students and educators using the book as a definitive neuroscience resource.

Still, this is a valuable source for showing how academic concepts can be applied in therapeutic treatment. Cozolino’s distinguished career as both a professor and mental health clinician qualify him as an expert in bridging the gap between theory and practice. In terms of accessibility, the book is a quick read that covers a lot of ground in a short space. With its helpful (and often humorous) overviews of key theories, plus its innovative fusion of biology, behavior, and human evolution, it will no doubt prove beneficial to both lay readers and mental health practitioners.

Why Therapy Works: Using Our Minds to Change Our Brains

W. W. Norton & Company, November 2015

Hardcover, 288 pages


Book Review: Why Therapy Works

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K.M. McCann, PhD

APA Reference
McCann, K. (2016). Book Review: Why Therapy Works. Psych Central. Retrieved on September 27, 2020, from
Scientifically Reviewed
Last updated: 12 Feb 2016
Last reviewed: By a member of our scientific advisory board on 12 Feb 2016
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