Relational exposure and semantic processes 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 understanding 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 neuroscience concerning the neural correlates of psychotherapy and emotion regulation. Consistent evidence accounts 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.