The neuroscience of psychotherapy: Q&A with Ana Lund

This conversation has been edited for length and clarity.

Alex Mendelsohn: Ana Lund, thank you very much for joining me.

Ana: Hello, Alex. Thank you for having me. I’m glad to be here.

Alex Mendelsohn: So I remember when I first started therapy. And I remember initially being quite shocked at just how quite demanding it can be. It’s really quite hard work a lot of the time. You have expressions of emotional pain, you have a lot of introspection, and after the hour was done, I would go away and I’d leave and then I’d wait a week come back do the whole thing again.

But I was always in awe that the therapist I was seeing often had the next person come straight in. They were spending the whole day in this quite intense profession. So I was wondering, what was it about this dedicated work that first attracted you to therapy?

Ana: What attracted me is that I spent most of my adult life in therapy. So before becoming a therapist, I was in therapy on and off from the age of 17, until now. I’m still in therapy. Therapy is something that I really feel I know inside out, I’m very comfortable with it. So that’s kind of one side of it.

The real kind of spark of an idea came to me in my previous work – which had nothing to do with therapy, I was working in science as you know. I worked there for 10 years. And there was obviously in 10 years in a workplace, you know, the same people you see day in, day out. There were conflicts, there were people who ended up not talking to each other. There are all sorts of problems, right? And I would always end up talking to all sides in the conflict, and being able to understand different points of view.

And so my boss at the time was like “you should be a therapist” jokingly, but I actually then started thinking maybe I should. So that’s how I started looking into it and decided to enroll in therapy training. That is kind of the origin story of it. It was basically my boss’s idea, without him knowing it.

Alex Mendelsohn: So I guess the question that comes to mind, was it an interest that rose up while your career as a scientist stayed level? Or did you lose interest in what you were doing as a scientist?

Ana: At that time in science, I was in a place where I knew that I wouldn’t stay in science anymore. But I stayed because I had a great boss. I always didn’t want to leave because I wanted still to work with him. But I knew that I didn’t really want to do science anymore because I was missing the human communication and contact. The science, as far as I’m concerned, did not fulfil those needs for me.

I always loved and keep the love for science and scientific methods, but I think the reality of science as a day-to-day profession, that was not something that was suitable for my personality, I think.

Alex Mendelsohn: You mentioned earlier that your boss sort of said you should be a therapist. I’m wondering did that, talking to people in your old job almost like a therapist, did that come from your early experiences in therapy? Did your experience as a client translate?

Ana: Well, a million-dollar question, I have no idea. Probably that could contribute. Because as I say, I was in therapy on and off through my whole life and undergoing different kinds of therapy. And so asking important questions and not feeling that that’s stupid or inappropriate, asking “how do you really feel” or things like that – that was always normal for me because I’ve been in therapy. It was part of my life.

And to your first question about the difficulty of therapy as a profession, I think… Yeah, there is certainly vicarious trauma in therapy. That’s why it’s important not to have too many clients. And I think when you don’t work for yourself, maybe you don’t have that much choice about that.

But I think therapists choose this profession, because I think it’s mostly a labour of love, you know, it’s a calling. These are people who genuinely really want to know what’s going on. And so, because it comes from a place of real interest for the other person, it’s almost kind of that mitigates somewhat the difficulty, I think.

Alex Mendelsohn: You’ve still carried the scientific mind over to therapy because you started the Substack Neuroscience and Psychotherapy. When I first came across it I found it quite rare to have someone from the therapy world involve so many aspects of neuroscience. Is that, I’m just curious, is it something you noticed when you first started therapy that this was needed? Is it an idea that built up, or is it something that came to you all of a sudden?

Ana: I wish it was as engineered as that, but no. No, I kind of started thinking about neuroscience psychotherapy prior to writing Substack and it was through really trying to understand some of the established neuroscience topics, or tropes rather I would say, that exist in psychotherapy that all turned out to actually be nonsense but initially I didn’t know: polyvagal theory, left brain, right brain, the triune brain theory. These are kind of the three pillars of neuroscience in psychotherapy.

You hear those tropes being thrown around as explanations for all sorts. It really kind of permeated the psychotherapy discourse. And I was very curious about those things. So I wanted to understand. And the more I was trying to understand, the more I was realising this actually has nothing, has no support whatsoever.

Another thing that happened, this was all prior to Substack, is that I was really interested in attachment. I was interested in attachment when it comes to my own life. I was using attachment in my work, which was not part of my core training, but I learned about it, and then I realised that there is this emerging neuroscience of attachment, which was not Neurobollocks.

Neurobollocks, for your readers, is when neuroscience myths are used as facts in therapy.

And so I realised, okay, for attachment, there is this real neuroscience. And I started being interested in that. And then I started creating workshops around that that were successful.

And then that led to some invitations. And so one thing led to another.

By the time I started the Substack, I already had a blog and already had a readership and things like that. So really, there was no initial motivation other than to understand better neuroscience that already existed in psychotherapy.

Alex Mendelsohn: You’re describing the, you said the three pillars, what were they again, sorry?

Ana: The three pillars, I would say, are neuroscience tropes in psychotherapy that are thrown around.

Alex Mendelsohn: Sorry, is this Neurobollocks?

Ana: Neurobollocks, yeah. So the three ones are: polyvagal theory, the left brain, right brain… the lateralisation – I’m not saying that there is no lateralisation of the brain at all, but the right brain, left brain explaining everything that we can imagine – and the third one would be triune brain theory – essentially the lizard brain.

So yeah, these are the three main big ideas of neuroscience myths in therapy that are thriving, despite all my hard work, you see!

Alex Mendelsohn: We’ll get to your hard work in just a minute!

But the thing that came to mind, they’re all, they take something which is complicated, the brain, and make it, all three of them, come down to a very simple idea – you can do this very simple thing and your life will change significantly.

Perhaps this is an unfair question, but is that something which you think is unique to therapy and therapy culture? The attractiveness of these simple ideas. Is it something you think therapy culture is specifically susceptible to? Or do you think it’s something that’s widespread throughout everyone’s life?

Ana: I’m going to give a controversial answer here. I don’t think it’s specific to therapy at all.

Actually, I think I have good faith in therapy community. I think we’re very good in embracing complexity. That is our job.

And we’ve been mostly trained, whatever the modality, to embrace the complexity. And I think these new kind of neuroscience spin-offs that are not really neuroscience, Neurobollocks spin-offs, are kind of giving us the wrong message. It’s going against what therapy as a culture is.

I think as humans, we always want simplicity. I mean, if you think about it, science or scientific laws are a way to distil simplicity from the complex world. So all we ever do in science is trying to find simpler ways, trying to find order in the chaos, if you think about it, right?

I think… and this is only my intuition, I have no data on this… My intuition is that therapists feel: I don’t want to miss out, I don’t want to not provide the best possible information available out there to my client. And look, there’s this science! And so it must be true because the therapists don’t know it’s Neurobollocks. It took me a long time to realise that all those theories are just, you know, bollocks. And so, you can’t expect every therapist to spend as much time as myself researching that. And so therapists just kind of think, oh, well, it’s science. This training program says it’s science. Maybe it’s my duty of care to have this available knowledge to provide to my client.

I think therapists are maybe as susceptible to embracing simple rules, or maybe even a little bit less than the general population, because I think we do want to embrace the complexity of human nature. And we can hold black and white together. We can understand why somebody can be a good person yet do a bad thing.

Alex Mendelsohn: So if I’m if I’m understanding correctly, what you’re saying is that therapists, because of wanting to help their clients, are willing to go out and search for new theories. But if you haven’t been trained as a scientist – and training as a scientist I’ve known to be a very long, very difficult process – I remember how easy it is to look at something, and think “oh, that’s how things are”. And I remember how long it took me to get to the point where I would go “Maybe not.”

So, I think it’s very interesting that what you’re saying is not that, hey, look at these silly therapists in their Neurobollocks. You’re saying this is the process of how therapists learn and help their clients.

Ana: And I think that it’s only human to have this tendency to want simplified explanations, only so it happens that therapists work with people and then those myths are then used and perpetuated through working with people.

So I don’t think it’s specific to therapists as such. And yeah, you’re right. I think therapists don’t have the tools to understand whether it’s science or it’s not science. Having said that, many have good intuitions. I get emails and messages all the time of people saying “oh, I always knew there was something wrong. It just, it never felt right.” Many people felt that something was off and felt uncomfortable with the fact that they’re being taught that Neurobollocks is a hard science and those are the rules. And they just kind of thought, well, I’m not sure. So it’s not like everybody was falling for it.

Alex Mendelsohn: I remember earlier you said you were particularly interested in attachment and that was something that has really interested you. What is it about attachment that, being punny, attached you to the idea of attachment?

Ana: Well, attachment is one of those things that even prior to writing about anything, it’s one of the things that when I learned about it, I just thought, wow.

Attachment simplifies the world, but it’s supported by empirical research. It does give you a map. That map is quite complex, but it does give you ways to understand things in a simplified way. That’s why it’s a successful theory.

When I heard about attachment, first, it was something that I could see my life through that lens and explained things in my life, and people around me. And then I realised how powerful it is in therapy. Because it explains patterns of how we relate. I will give a layman’s explanation of attachment theory because I’ve been thinking in terms of neuroscience of attachment for a long time. I now tend to see everything through that lens, but that didn’t used to be the case when I initially heard about attachment theory.

And so, do you know about attachment theory?

Alex Mendelsohn: A little bit, when I’ve sort of looked into it, for this interview.

Ana: But did you know prior to us talking about this?

Alex Mendelsohn: No, in terms of before I came on Substack, before I came across your work, I didn’t know anything about attachment at all.

Ana: So interesting. I live in such a limited world. I thought that everybody knew about attachment. Everybody should know! I’m joking. I’m joking. As I say, I also only found out about attachment theory when I was training really.

So attachment theory is a theory that is about human relating and it poses that we all have an innate set of instincts to seek the care of reliable others. Now, there is attachment theory that applies to children and development. And there is attachment theory that’s about relationships in adult life. But shall we just move to the relationships later in life? Because I think maybe that’s what people know more about, and also because I work on that.

Attachment theory is mostly known because of the three attachment styles, the secure, the anxious, the avoidant. There is a fourth attachment style, which is Fearful Avoidance, but I’m not going to talk about it right now. So these three attachment styles, they can explain some of the behaviours that people have in their relationships. And why certain people act in certain ways in relationships and why that is not something they do on purpose.

To kind of boil this down, secure attachment style is the attachment style where we are relaxed in the relationship. We’re not clingy, we’re not trying to push everybody away. We’re okay being intimate and close, sharing our emotions, asking for help, or we’re also okay being on our own and kind of leaving a little bit of room to the partner.

Then there is avoidance attachment style, which is usually considered as the villain of all attachment styles. And it’s the attachment style where people are really afraid or they really avoid becoming close emotionally. They will engage in all sorts of strategies to implement a defence, which is I can’t be close with somebody because I can’t really rely on other people. Therefore, what’s the point? And so in dating, let’s say, this will be typically people who, you know, oh, please don’t get attached to me or this is kind of going too fast. They’re never ready, they never want commitment. They’re not emotionally available for the other person. Whenever there is any kind of emotional drama, they just detach and they can’t deal with it.

The mirror image of the avoidant attachment style is the anxious attachment style, which would be kind of more clingy, lots of demonstration of love, affection, needing the presence of the other person all the time, becoming maybe jealous, becoming maybe overbearing, wanting contact all the time. And then in a very Greek tragedy kind of way, enact its worst nightmare, which is pushing the person away.

So anxious avoidance style is insecure, right? Once more, all the time, the demonstration of love because they don’t feel the person will stay with them or love them. But because they become so intense, they just, they basically make their worst nightmare happen because everybody in the end goes, oh, I can’t be dealing with this, you know?

Alex Mendelsohn: So my next question is, how does this relate to therapy, when you have attachment styles in therapy? Say I suppose a client is not getting what they want to in life and they are a certain attachment style. First of all, can you change an attachment style? Then is the aim in therapy to change the attachment style? And if it’s not, what is the aim in the therapeutic process?

Ana: So the aim absolutely can be to change attachment style. And if I work with attachment, my ultimate aim will be to change attachment style. Attachment styles do change. They are not permanent fixtures. They also don’t change easily, right? They are lasting patterns of feeling behaviour and even biology. So they make an imprint in the biological sense. They’re very, very powerful. I was giving the light, kind of maybe a bit of like a funny version when I talked about dating, but they are not conscious strategies. They really shape our biology in some ways you know. And certainly neurobiology. And so as a result, they are difficult to change, but they are amenable to change, which is a great news. And clients sometimes come already knowing that, because it’s quite popular now. Sometimes people come to me because they know I work with attachment and they’ll come for that specifically. But not always. Sometimes they know something is wrong in their life and they didn’t know about attachment but once they realise it’s like a revelation really you know.

Alex Mendelsohn: So you mentioned there’s attachment in terms of the layman, but there’s also the neuroscience of attachment. What is the neuroscience of attachment?

Ana: The neuroscience of attachment in a nutshell, is neuroscience that studies the neural correlates of different attachment styles.

Alex Mendelsohn: What are neural correlates?

Ana: If you use a metaphor of a computer, or hardware. The Brain is a hardware of sorts… It’s what part of that hardware and what kind of relations, what kind of connections in that hardware make, which enacts that system of behaviour. Basically, if one person has an anxious attachment style and the other person has an avoidant attachment style, in which ways are the patterns of their brains and physiologies different, in order for their styles to be different? And, actually, is there a difference in neural patterns? Is there a difference in physiology? These are the neural correlates.

Alex Mendelsohn: Moving on a little bit, you’re also interested in the predictive brain. What is the predictive brain?

Ana: We think of our mind, what we perceive and see, and how we make conclusions in real time, as something that’s based on perceived reality. But the idea of the predictive brain is that the brain operates as a predictive machine or mechanism. When you think about it, the brain is not seeing. It is in the darkness of the skull, and has to reconstruct reality. The best way to do that, to construct reality, is based on what already we think we know.

One example from therapy and really linked to attachment is… Say I have an anxious client in therapy, if I ask them: How did the last session feel? How is this therapy working for you overall? They will see that as a bid for connection, and they will see that as me being attuned and caring about them. And they’ll like that, right?

If I’m sitting in therapy room with an avoidant client, they’ll go: “Why are you being so insecure? Why are you being so clingy? What do you want from me? Do you want me to validate you?“ This actually has happened to me in therapy. This was a breakthrough moment where a client with avoidant attachment, when I was asking how was the last session for you, they saw me as insecure, as wanting validation.

Do you see how both people see the same thing? But their brain doesn’t see the reality. Their brain sees what they are used to seeing. A person with an avoidant attachment sees the world as wanting too much from them and being too clingy. So even the therapist is insecure and clingy.

I’m just doing my job. I’m just asking how it was because the feedback helps me improve my work. And I don’t have a way of reading their mind. So I’m in kind of this very neutral position, but the observer, which is in one case avoidant, the other anxious, they see the same situation very differently based on what they expect from others and how others are. And so you see this is a prediction.

But predictions happen on so many levels. It’s not only about relationships. For example, I have motion sickness. I don’t know if you’ve experienced this ever, but for people who have and who are reading, they might be able to relate to this.

If I know I’m traveling, especially if I know I’m going to have to sit in the back of the car, I will, so Alex, I will an hour before start feeling sick and sometimes wanting to throw up… I’m not in the car. But I’m starting to get that interoceptive feeling. So, I mean, what is going on there?

You could have all sorts of weird explanations why that happens. But my brain knows I’m traveling in an hour so is already kind of putting the body in that state. Really, sometimes it’s so weird. I relish it because sometimes I’m like, wow, am I going to actually now kind of start feeling I want to throw up even if I’m not in the car yet?

Alex Mendelsohn: Predicting the prediction.

Ana: To me, it is about embracing the idea of the predictive brain without having to say that it explains everything. Sometimes people think when we do neuroscience in psychotherapy, we need to know the nitty-gritty of the brain. It’s not about that. It’s about adopting an idea from neuroscience that’s empirically supported and seeing how far we can go with that in changing how we work in therapy. That is for me how I think about it.

Alex Mendelsohn: So for your Therapyverse, a different reality upon which if something changed there would be some benefit to therapy, what would be your proposed alternate reality? If with a click of the fingers therapy is suddenly better through a change, what is that change?

Ana: For me if I could just click my fingers, I would really put the focus on finding out with the client, what is the predictive model they’re using? This would apply to other things as well, but let’s focus on attachment.

So, in the same way I earlier used that example of a client who reacts in certain ways to a question that’s very neutral, you can then…once you map out that model with the client… you can then work on more easily changing the model. Once the client realises they don’t perceive the “true” reality, that other people have their own models, they can think “how can I on purpose pull and stretch the model.”

I do want to say that while putting a full focus on it would be new, attachment theory has had the intuition to see that we operate within, it’s called, internal working models of attachment. It’s part of attachment theory because very early on they have realised that it’s almost like we are operating from a model and not from reality. And so that idea is not new. It’s not like me introducing the idea of models into attachment.

Alex Mendelsohn: So if I understand correctly, it’s not so much about introducing something completely new, it’s about introducing a framework, making the predictive models a central framework.

Ana: Yes. That’s what I’m trying to do when it comes to attachment, really kind of finding ways how to really put that in the centre of the conversation.

Alex Mendelsohn: So how is the predictive brain not in the centre at the minute with attachment? Is it in terms of just simply not thinking about attachment that much in a predictive model type way, or is it something else?

Ana: Yeah, I think in therapy, mostly when it comes to attachment, typically people will focus on feelings and why we feel this way and how that reminds us of our childhood and things like that. But I think it’s not seen as really an object, as a model. Let’s kind of stretch the model, let’s change it, let’s really work with that. I think it’s currently a side thing in attachment work in therapy. Sometimes it would be accommodating the world to our attachment style rather than changing our attachment style, changing the model.

Alex Mendelsohn: The word that came to my mind when imagining what changing the model would look like was “roleplay”. But I don’t think that is exactly what you mean! In the therapy room, what would the process look like instead?

Ana: It wouldn’t be in a therapy room. So I think attachment therapy currently is very much focused on the work in the room. But I think attachment style has to be changed through work outside it. So it would be more in life rather than with a therapist. A therapist is the guide, as in we will then talk about things that have happened and plan how to put in place new experiences.

Let’s imagine somebody who is the avoidance attachment style. And so that person typically will think that whoever they meet, they will want straight away to be an exclusive relationship. They will want to move in with me. They will want something from me and they will already be checking out before they even start seriously dating somebody, let’s say. Because they are pre-emptively trying to kind of distance themselves. And we might work on the fact that they give an opportunity to this new person to show who they are without that kind of avoidance and see whether they might not be the person they think they are. That they are more capable to be on their own than what they think, you know? And so through that, rather than their usual reaction, just give the benefit of the doubt to the person to show who they are and therefore adjust the model, right?

Because acting in their usual way, it’s almost a self-fulfilling prophecy. If you don’t let anybody come near ever, well, you’ll never be able to update your prediction about others because nobody’s close enough to show who they are.

Alex Mendelsohn: I think that’s a good place to end. My final question, which is going to be a regular final question for this interview series. Do you have three Substacks or publications or individual articles that you’d recommend to readers?

Ana: I was trying to reduce it to three, but can I give you five?

Alex Mendelsohn: Yes, of course you can have five.

Ana: Are you sure?

Alex Mendelsohn: Yeah, Let’s go for it.

Ana: The first one is the Substack of Michael Halassa. Mike is a neuroscientist who is very open-minded and very down to earth and doesn’t feel that as a scientist, a neuroscientist, he’s above everybody else. And, you know, I can ask him any question and he won’t think it’s stupid or anything like that. So I learned a lot from him. He writes amazingly well on very complicated things in neuroscience and he has a really good overview of the frontier of neuroscience today. And so for me, it’s very, very interesting.

And another person is Molly Dickens, PhD, she writes The Maternal Stress Project and she is a stress physiologist. It’s really interesting for me on many levels and so I follow her Substack on neuroscience and physiology of stress.

The third one is Diana Fox Tilson, LICSW who writes Other Interests on Substack and she writes many things, but she has done some amazingly brave debunking of some of the guru figures in psychotherapy and trauma world, such as Bessel van der Kolk or Gabo Mate and Peter Levine. So she’s really my go-to to find what’s what and some really in-depth debunking about these important topics.

And then I want to also mention Helen Gifford. She writes Therapy for a New Generation and she is a therapist that is thoughtfully writing about working with young people. I don’t work with young people, so I don’t know much about it. She’s my go-to if I want to find out a little bit about that. She also writes interesting things about how to improve the standards of training for therapists.

Last but not least, Will Dobud PhD. He writes Unscripted. And again, he’s somebody who writes with lots of knowledge about evidence support in psychotherapy. At the same time, he’s somebody who is very down to earth and very accepting of difference.

Alex Mendelsohn: Ana Lund, thank you very much for helping me create a Therapyverse.

Ana: Thank you so much for having me.

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