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If we embrace the basic assumption that therapeutic talk changes the brain, an assumption that has received empirical support, the questions then become, Which aspects of the brain are changed? and What are the points of transduction between meaning-making and synaptic function? One strategy for addressing these daunting questions is to extend insights about development of sensory neural systems to the development and restructuring of the neural systems mediatiing attachment and social embeddedness.
In addition, a reciprocal strategy is required. Our current knowledge of neural dynamic systems is insufficient to answer these questions about mind-brain relationships. It is also necessary to use therapeutic insights and successes, such as this case presented by Susan Fisher, to pinpoint the functional aspects of neural system change and development. This strategy is akin to Sherrington's (1948) exquisite understanding of the functional and dynamic properties of behavior that demonstrated that neural conduction was an insufficient mechanism for explaining behavior, and enabled him to postulate the functional properties of the as-yet undiscovered synapse.
Fisher states modestly that there are three things of which she is certain; (1) the neural structure of her patient was changed; (2) she was a constant in the interaction; and (3) the process took time. Let us use her insights to structure what is currently known about neural development that can elucidate how therapeutic talk migh change the brain.
Neural development can be divided into six phases or stages: neurogenesis, migration, differentiation, synaptogenesis, cell death (apoptosis when most cells are lost), and synapse rearrangement (loss and development within specific brain