Relational Exposure as Mechanisms of Change in Psychodynamic Psychotherapy: Convergences between Psychotherapy Research and Affective Neuroscience

Although the efficacy of psychodynamic psychotherapy has been largely demonstrated, the under- standing of how therapeutic relationship produces a change in dynamic psychotherapy has been only partially achieved. In the present article, we discuss the hypothesis that the expression of previously avoided impulses inside a relational situation — relational exposure — and its cognitive correlates of change in the semantic representation of relationships may underpin therapeutic change. In discussing our hypothesis, we considered previous literature on: (a) common factors in psychotherapy; (b) relevance of exposure in relational situations in psychodynamic therapy; (c) recent advances in affective neurosci- ence concerning the neural correlates of psychotherapy and emotion regulation. Consistent evidence ac- counts for relational exposure as an important element of therapeutic change, especially (but not only) in the case of psychodynamic therapy. In line with this evidence, in-vivo relational dynamics as they emerge in the therapeutic relationship can be a powerful tool for psychotherapists.