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The Neuropsychology of the Unconscious: Integrating Brain and Mind Into Psychotherapy. Efrat Ginot, PhD (2015) New York W. W. Norton & Company. 336 pp.

Hernandez-Cardenache, Rene PsyD; Raffo, Arlene PsyD

The Journal of Nervous and Mental Disease: April 2016 - Volume 204 - Issue 4 - p 327
doi: 10.1097/NMD.0000000000000494
Book Reviews

Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Miami, FL

The Neuropsychology of the Unconscious by Dr Efrat Ginot provides a sophisticated explanation of how complex neurobiological mechanisms interface with unconscious processes, involved in emotional self-states such as bonding, fear, anxiety, and trauma. The book is introduced with an elegant foreword by Dr Allan Schore, whose work has been largely dedicated to examining the role of the brain’s right hemisphere in shaping implicit processes and the unconscious mind. This is a useful book for mental-health clinicians who are interested in learning about the interplay between neurocognition and unconscious mechanisms.

Utilizing a neuroscientific lens, the early influence of the infant and mother relationship is brought into focus in this book. This provides the reader with interesting insights into fascinating processes such as affective attunement, the mirror neuron system, and the intergenerational transmission of trauma in the formation of unconscious self-systems. Dr Ginot describes how the development of subcortical pathways and the limbic system is linked to form inflexible, deeply embedded, and maladaptive patterns of behavior. More broadly, the author posits that through the integration of neuroscience into psychotherapy, clinicians can use therapeutic modalities that promote conscious “reflective and reflexive” metacognition in their patients’ everyday life in order to alter rigid self-systems over time.

To this aim, Dr Ginot’s overriding premise is that psychotherapy is successful to the extent that it produces adaptive changes in neural pathways over time and increases the likelihood of cultivating enduring change in a patient’s everyday functioning. In an era of evidence-based practice, it has become increasingly important to understand brain/behavior relationships in order to guide therapeutic progress. Therefore, the author highlights that neuropsychological research is altering the way in which psychotherapy is being conducted. If therapeutic changes can result in changes to important neural networks, then clinicians can guide their patients toward rebuilding unconscious maladaptive schemas into flexible, adaptive, and conscious systems of functioning. Dr Ginot argues that while the brain is unconsciously built throughout the lifespan, it can also be restructured through the process of psychotherapy. At a practical level, this book provides some neurocognitive findings that will assist clinicians in designing individualized treatment plans for their patients who have been notably resistant to change. The author presents a clear outline of neuroanatomical substrates and their functional role and most importantly illustrates how clinical and neuropsychological data can be applied to psychotherapeutic work through numerous case vignettes.

As clinicians concerned with understanding how the brain and its abilities are affected by neuropsychiatric illness, we read this book with an open mind hoping to gain a deeper appreciation of how the unconscious mind is explained through neuropsychological research. Although the field of neuropsychology is still far away from adequately comprehending the underlying mechanisms of the unconscious mind, we feel that Dr Ginot’s work further bridges the fields of neuroscience and psychotherapy. From the perspective of applied clinical neuropsychology involving primarily rigorous assessment approaches, we had a difficult time dissecting all of the information and applying it to everyday practice. Nonetheless, we recommend this book to graduate students and mental health professionals who are interested in advancing their knowledge about how neuropsychology and psychodynamic theory intersect and can be applied to their psychotherapeutic work.

Rene Hernandez-Cardenache, PsyD

Arlene Raffo, PsyD

Department of Psychiatry and Behavioral Sciences

Leonard Miller School of Medicine

University of Miami, Leonard Miller

Miami, FL

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The authors declare no conflict of interest.

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