It's not always what you think, it's how you think of what you think about. Brief therapy creates fast and lasting change.
Kudos, Steve Andeas
The author of the post is an NLP practitioner and coauthor of many books dedicated to the practice of NLP. I always find it baffling to find someone bash the very science that might give ones own approach some legitimacy. Judging by the Wikipedia post on the subject, legitimacy and credibility is something that NLP sorely needs. I am not knocking NLP itself, it is probably more effective than many approaches proclaimed as legitimate, but I will never understand practitioners who argue for ignorance. Those may seem like harsh words, but they aren't meant to be. We are all ignorant of what we don't know and we are ignorant of how, what we don't know, might help us or inform or improve our work. When we say, I don't need to know neuroscience because neuroscience won't change what I do that is effective, one is arguing for standing still and no longer growing and learning as a practitioner. One is arguing that what I do cannot be improved upon by more knowledge and understanding, even though I don’t yet know what the knowledge or understanding might provide me. It is like a Lifeguard arguing that one doesn't need to be trained in the science of drowning. To the lay individual drowning looks like someone thrashing, screaming and flailing in the water, but to the well trained life guard, who is educated on the subtle and almost imperceptible and quiet signs of desperation, drowning looks very different. If you are going to be a good life guard, you better study up, because intuitive skill isn't enough. Your skill has to be informed by the science of drowning, otherwise you don't know what you are dealing with or what you need to be looking for.
Our clients are drowning all the time while clinicians that think they are just innately skilled at this work, let them struggle unaware of the subtle signs of their distress. Many of their clients end up in my office, ready to give up on life, because "nothing has worked". In my view, had more psychotherapists been versed in clinical applications of brain science, those clients might not have wasted so much time and money trying to get better unsuccessfully, only to feel as if the last resort is to "end it all".
We face an epidemic of suicides among military veterans who are not being served by existing therapies and methodologies, yet we are also being encouraged by this author that we don't need to know neuroscientific theories of PTSD to do good work with our traumatized clients. I cannot think of a more dangerous suggestion. We are failing our veterans and they are ending their lives in epidemic fashion! What we, as a field, are doing for our veterans is inadequate. I believe it is in the application and understanding neuroscientific principles where the answer lies in helping these veterans. Even just explaining how the involuntary survival mechanisms of the brain works, gives a great deal of relief to traumatized clients. A clinician who does not know this, cannot provide them with a neuroscientific explanation, and therefore cannot give them this relief, not to mention shift from a potentially overactivating "talk therapy" perspective to a more psychophysiological right brain processing approach.
This problem is not unique to our own field. Medical doctors prescribe drugs all the time based upon what their pharmaceutical representatives tell them about how the drugs work rather than a detailed and sophisticated understanding of the biochemistry of both body processes and the drugs. Maybe they argue they don't need to know biochemistry to help their clients. I knew a medical doctor who prescribed Neurofeedback for someone suffering from urinary frequency. Six months later the client died of bladder cancer. That doctor was one who argued for her ignorance and overplayed her intuitive skill. I fear she still hasn’t learned her lesson.
So lets stop arguing for our ignorance. Many clinicians I meet who say similar statements, are the same ones who practically dissociate whenever they are in a lecture that starts to talk about science. They get confused and shut down, probably just like they did in elementary school when they were introduced to math before their brains were ready. (Maybe their teachers needed an understanding of brain development). Or maybe it was caused by overbearing parents who put too much pressure on them. Or maybe it is just laziness? Or maybe they just don’t know what they don’t know and how a deep understanding of the principles might change their practice and enhance the wellbeing of their clients. Whatever the cause of their resistance lets stop arguing for our limitations and the status quo.
While clinicians can apply many techniques, without actually understanding the rationale that went into their approach, but that isn’t to say that these methodologies weren’t developed by someone who was versed in a complex understanding of the science of the day. While I believe that I could train a 4 year old to apply the basic protocol of EMDR as effectively as many adults, I would prefer an adult who was well versed in the psycho-neurobiology of trauma applying the technique. I wouldn’t let an EMDR therapist who does not understand the intricacies of the neurobiology of trauma work with me or any of my complex PTSD clients. EMDR can be quite a simple and effective technique to apply, but without a sophisticated understanding of neuroscience, I don’t think most therapists will understand when and why their approach is going wrong.
So how does neuroscience help us in a clinical setting? Is it just theory, as the author above suggests, that bolsters our own ego and makes us look like “experts” to our clients, or is there actually a real substantive contribution that science has to how we practice? Most psychotherapists, if asked, will not be able to come up with a working definition of what an “emotion” actually is. Since that is our field of expertise, the fact that most clinicians don’t have a much more sophisticated definition than a 4 year old armed with a feeling or mood chart is disturbing. However, if we understand that according to neuroscience, emotion is a pre-organized sequence of adaptive strategies that prepare the body for adaptive survival that consists of changes is the both the body and the brain then we might abandon left brain “talk therapy” and insight oriented approaches for body based procedural memory, right brain approaches like Somatic Experiencing, Sensorimotor Psychotherapy, or Focusing. If we understand that the visceral physiological responses that represent an emotion (nausea, tightness, quickening heart, flushed skin, etc) send information back to the brain changing the brains state and thought process, we might apply or recommend visceral bodywork to soothe the anxiety of a client, rather than ask them to tell us the details of the story of what happened. If we understand that when a client tells the story of a traumatic event that Broca’s area shuts down and the right brain and lower brain sensorimotor areas light up, then we might change our approach to actually regulating physiology and assisting the body in completing incomplete survival oriented “pre-ordered sequences” that weren’t able to be completed at the time of the trauma. If we understand that 80% of the nerves going between the viscera and the brain are actually afferent (i.e. Sensory) then we might realize that visceral bodywork might be more effective than talk at addressing someones anxiety or to stabilize them physiologically when they are in an intensely dysregulated suicidal crisis. If we understand neuroscience we might save our breath trying to convince someone with a body image issue that they have a distorted perception and get them on a balance board doing activities that can reorganize and correct the insula’s faulty body map when that is the actual cause. If we understand the way animals in the wild discharge these pre ordered survival patterns through a sequence of behavior that resembles psychogenic seizures (seizures are considered trauma related) we might be able to help these clients come through this process gently and without fear that perpetuates and compounds their trauma and dysregulation. As Bessel van der Kolk states the “dorsolateral
prefrontal cortex (dlPFC), which is involved with insight, understanding, and
planning for the future, has virtually no connecting pathways to the brain centers that generate and elaborate emotions” and therefore it has limited efficacy in helping people “inhibit the automatic physical actions that emotions provoke”. Knowing this points out interventions towards biological and regulatory processes that are primarily mediated by the right brain. Neuroscience has shown us that mindfully tracking body sensation without
If we understand that the insula, medial prefrontal cortex, and anterior cingulate play a role in extinguishing fear arousal, that individuals with OCD and PTSD have deficiencies in these areas, and that mindfully tracking sensations without judgment causes increased growth in these areas, and that individuals who show resolution of OCD and PTSD symptoms have improved function in these areas, then we might engage our clients in mindfully tracking sensations instead of engaging them in the “talking cure”. I could go on and on about how knowledge of neuroscience helps us effectively understand and apply refined interventions to help our clients who have been otherwise failed by antiquated models and theories. The more I understand about neuroscience, the more refined my interventions and the more effective I find I am with my clients. Neuroscience has changed the way I practice and has so fundamentally transformed the way I work with clients that nothing that I do now remotely resembles what I was taught in school. I will continue to strive to be the best and most informed therapist I can be. I hope you won’t adopt the view of the author above. Don’t let you patience drown.
Brian J. Whelan, LCSW, CST, SEP
Very helpful. This is what I do but I always wondered if maybe I was "discounting" my clients' problems even though they were getting "better."
I feel comfortable to quote the author "...it’s a simple matter of finding out exactly what the structure of someone’s personal experience of a problem is—rather than the content within that structure—and then experimenting with useful ways to change it."
I couldn't disagree more with the author that there is no application for the current neuroscience within the realm of therapy. I will use my own experience in working with soldiers as to the efficacy of using brain knowledge in helping them overcome significant barriers to successful treatment. For example, telling someone about the possible structural changes to the hippocampus, can help them to normalize their feelings of having issues with memory. Informing them of how activated the amygdala can get when it is subjected to certain triggers, gives them a sense that if they can identify triggers (either from childhood or adult experiences), they can then take steps to extinguish the reaction from the cues.
I have literally used the current knowledge of neuroscience as a starting point, to break down barriers to treatment, and to enter into the deeper work that needs to be done. In conclusion, I must say that by using neuroscience, it has given me an empathic connection to engage in successful therapy.