John was a drug and alcohol counselor and a Vietnam vet. His worst experience during the war occurred in the marketplace in Pleiku while waiting to join his troops. When a teenage boy reached for the wallet in John’s hip pocket, he grabbed the boy’s arm. Suddenly, he heard someone shout, “Grenade!” and felt something push hard against his back. When he regained consciousness, he was leaning against a tree, still holding the boy’s arm. “But that’s all I was holding,” he said, “because the rest of him was gone.”

Good therapists have always known that to help people change the way they feel and behave, we have to help them change the way they use their brains every day, not tell them about their neural processes. By actively creating vivid, impactful therapeutic experiences, we can transform our clients’ perceptions of their own reality, shifting the way they think and feel about themselves and their capacity for change. Some of the most effective techniques for creating this shift, like the two described below, were in use long before neuroscience was even a distant speck on psychotherapy’s horizon.

Many of our clients’ problems are far simpler than most people realize, and the therapeutic interventions needed to resolve them are often equally simple. Current neuroscience is irrelevant to our understanding of both the problems and their solutions. After all, therapists were doing helpful, healing work long before neuroscience made its official debut at psychotherapy workshops and conferences and the field developed a collective case of “brain fever.”

The neuroscience information that’s currently in vogue seems primarily useful in convincing clients that we’re “experts”—that we have hard scientific knowledge about what’s actually happening inside their skulls. Telling them about the impact of brain function on their emotional lives can certainly help normalize their problems and convince them that they can take steps to change how their brains operate, though “brain talk” may also convince them that the solution is to take medications. Another danger inherent in this fascination with the brain is that therapists will use neuroscience to convince themselves that they know more than they really do, and thus must be practicing effective therapy.

Physicists found a while ago that the cosmos is made up of subatomic particles that interact in peculiar ways, and they went on to develop detailed and sometimes frighteningly effective recipes to put that information to practical use—think cell phones and hydrogen bombs. However, brain science has yet to translate its findings into effective or practical recipes for therapists. For instance, a lot of therapists are enthusiastic about the fact that they now know that a panic attack involves overactivation of the amygdala, but this knowledge doesn’t make them better therapists. Would they do their therapy any differently if they were told that a panic attack actually involved overactivation of the liver—or even the pineal gland, which Descartes believed to be the seat of the soul and the place where all thinking originated? I don’t think so.

In recent years, I’ve listened to many of the current experts in neuroscience talk about their interesting discoveries, and I’ve watched therapy demonstrations by the few who’ve tried to apply findings from the brain-imagery lab to actual therapy with a client, but so far, I haven’t seen any persuasive direct application of neuroscience to the practice of therapy.

Nothing reflects this fundamental truth more than the current infatuation with brain science. I think it’s wonderful that we now have at least some understanding of neural connectivity, synapses, brain chemistry, and mirror neurons—all of which help us understand our ability to change the way we think and act, and to experience empathy and compassion. I have great respect for the value of doing valid research in such an inherently complex field. However, what I’ve found in a close reading of original neuroscience studies is that many of the uncertainties and complexities in brain science research don’t appear in the popularized material written for the general public—and for therapists. Even if we set aside all the uncertainties and assume that current neuroscience studies are valid and won’t be revised substantially by further research, the key question remains: What can neuroscience tell us about what to do differently when we’re working with a client?

The newest edition of the Diagnostic and Statistical Manual has more than 900 pages describing the different kinds of disorders that people have, but not a single page telling us what to do to resolve them. As therapists, we’re useless to our clients if all we can do is describe what’s wrong with them. We need to create vivid, living experiences for them that’ll help them change. All the expert knowledge in the world about therapy or different psychiatric conditions isn’t worth a thing if we don’t know what to do with it.

Again, the room went quiet. My point in keeping up this line of questioning for almost 20 minutes was to make a clear distinction between what psychologist and communications theorist Paul Watzlawick called descriptive language—which tells you about something—and injunctive language—which tells you what to do. It’s the difference between describing a meal to someone and handing over a recipe.

“OK,” I said. “Let’s imagine that I’m hooked on drugs. Help me improve my self-concept. Help me out. What should I do?”

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“Well, you could use operant conditioning,” someone suggested.

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“Great!” I responded. “Condition me. Show me what you can do to help me improve my self-esteem.”

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The room got quiet again. “I’d start by helping you heal your past traumas,” another person eventually volunteered.

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“OK,” I said. “Let’s imagine that I was sexually abused as a child. Show me how to build up my self-concept in a way that’ll heal that.”