The HEAL Process
With clients, I summarize the process of turning passing experiences into lasting inner strengths by using the acronym HEAL: Have a positive experience, Enrich it, Absorb it, and (optional) Link the positive experience to negative material so as to soothe and even replace it. Informally, I call this “taking in the good”—the deliberate internalization of positive experiences in implicit memory.
The first step—Have—initiates the activation phase of learning by either noticing or creating a positive mental state. For example, in a session, I could help a client become more mindful of the sense, already hovering in the background of awareness, of feeling cared about by his or her friends. Then between sessions, the client could try to notice this feeling more when it’s present in daily life. The client could also deliberately create the feeling of being cared about by bringing to mind times when he or she felt included, appreciated, liked, or loved.
The second step—Enrich—begins the installation phase by drawing on one or more of five well-known factors in the neuropsychology of learning:
- Duration. Sustain the experience for 5 to 10 seconds or more; protect it in the mind.
- Intensity. Let the experience be as intense as possible; even subtle experiences such as gratitude can be powerful if they fill awareness.
- Multimodality. Help the experience be as rich as possible by including emotions, body sensations, and behavioral expression (e.g., sitting up a little straighter to strengthen a sense of determination).
- Novelty. Look for what’s fresh or unexpected in an experience, such as some new subtle sensation in relaxing.
- Personal relevance. Let the experience matter; consider how it could be helpful (e.g., why it’s good to really register the benefits of an experience of staying sober).
With a client who’s sharing an experience of feeling cared about, I could gently slow him down as he talks about it and bring him back if he gets distracted, thus helping the experience last (duration). I might ask if he can let the feelings of being seen and appreciated become more powerful (intensity) and more felt in his body, perhaps by placing a hand on his heart (multimodality). In mirroring back what the client’s saying, I might emphasize an aspect of feeling cared about that he’s never spoken of before to highlight fresh nuances in familiar experiences (novelty). And I could ask how this experience has mattered to him (personal relevance).
The third step—Absorb—heightens installation by priming and sensitizing memory systems. For example, when we’re determined to take in the sight of a gorgeous sunset, we intend to let this experience really sink in. In the same way, I might ask my client if he can give himself over to feeling cared about and let this experience become a part of himself, perhaps by imagining that it’s soaking into him like a warm soothing balm. With children, I’ve described the process as putting a jewel in the treasure chest of the heart that they can now take with them wherever they go.
To use the metaphor of a fire, the first step of HEAL ignites it, the second adds fuel to it, and the third lets us feel its warmth sinking in. Then, if appropriate, we could take the optional fourth step—Link—by being aware of both the positive material in the foreground of awareness and the negative material in the background. The positive material will tend to associate with the negative material and—if what’s positive is both more intense than the negative and a natural resource for it—the positive will gradually soothe, reduce, and potentially replace the negative material. In a recent session with a man who was abused as a child and has a hard time feeling lovable, I suggested he stay aware of the feelings he was describing of being cared for by his adult daughter while also being aware of old feelings of being abandoned and unwanted. I encouraged him to keep making the positive experience more intense than the negative one, and he said after a minute or so that he felt something ease inside.
Clients can apply these skills to positive experiences in everyday life, using a dozen seconds or more to take in a feeling of relaxation, a sense of accomplishment in finishing a task, or the warmth in a friend’s smile. They can also apply them to “key resource experiences” in a framework I use based on how the nervous system evolved. As the brain developed in its reptile, mammal, and primate/human stages, so did its capacities to meet the three fundamental needs of any animal: safety, satisfaction, and connection.
Today, three overarching regulatory and motivational systems use the brain as a whole to meet these needs by avoiding harms, approaching rewards, and attaching to others. An unmet need for safety—indicated by anxiety, anger, or helplessness—is best addressed by inner resources that help us avoid harms, such as a sense of strength and protection. Similarly, an unmet need for satisfaction—with related feelings of frustration, disappointment, loss, failure, or dreariness of life—could be addressed through activating and installing rewarding experiences of goal attainment, accomplishment, gladness, gratitude, pleasure, and success. And an unmet need for connection—with feelings of abandonment, loneliness, envy, inadequacy, or shame—could be gradually helped through internalizing experiences of being included, understood, valued, liked, and loved by others. Clients can look for opportunities to have those key resource experiences that will make the most difference for them in daily life, and they can take in the good at specific occasions, such as meals, at the end of a meditation or workout, during a therapy session, or just before bed.
Like other therapeutic methods, there are four ways to use the HEAL process with clients:
- Do it implicitly in the flow of a session. For instance, listening to a client describe a compliment she received from her boss, you could ask her to say more about how this felt (activation) while slowing things down to keep the experience alive in her mind for a dozen seconds or more (installation).
- Teach it explicitly, and leave it up to the client to try it or not.
- Explicitly take the client through the first three and perhaps the fourth HEAL steps.
- Encourage the client to take in the good between sessions.
Of course, I didn’t invent taking in the good. We all know how to do it, from savoring a fine meal with friends to letting a therapist’s wise comment sink deep and plant roots. The essence is simple: have it, enjoy it—especially the latter, which is what installs the experience in the brain. Or even more simply, mo bettah: more episodes each day of taking in the good and more depth of engagement in each episode. The more neurons that fire together—and the more often and the more intensely they fire—the more they’ll wire together. This means that if we take in the good a handful of times a day, usually for 30 seconds or less at a time, we can gradually use the mind to change the brain to change the mind for the better.
Repeatedly taking in the good offers three kinds of benefits. First, it grows specific inner strengths, such as determination, calm, stress hardiness, compassion, happiness, and self-worth. Second, it develops qualities that are built into taking in the good, including mindfulness and kindness toward oneself. Third, much as negative experiences can increasingly sensitize the brain negatively so it reacts more intensely to negative experiences, routinely internalizing positive experiences can gradually sensitize the brain so that it converts these experiences more rapidly and efficiently into neural structures.