The Rise and Fall of PaxMedica - Page 9

By this time, Ilyana and I were looking directly into each other's eyes and leaning in toward each other—it felt to me as if we were on the same wavelength. She said, "I want to write this down. I'm not sure I'm going to remember it. It feels important."

I said, "I've been talking a lot today and I want to come back to you. How are you feeling right now?" Pausing, as if waking up, she said, "I feel better. I feel calmer. I see what you're saying; what my boyfriend said wasn't that big a deal. I'm feeling better now. I don't know how I'll feel when I'm alone again, but, right now, sitting here with you, I'm feeling better."

For me, that moment with Ilyana lies at the heart of the experience, incremental and uncertain as it often is, that therapy is all about. Somehow in the course of a session, a client finds a way to tolerate something that a few moments before seemed intolerable. Through the give and take between client and therapist, as in all relationships in which soothing and healing takes place, something shifts in the nervous system of both parties. The particular challenge of therapy then becomes how to take that immediate experience of calming or release or insight and turn it into an expanded capacity for self-regulation that goes beyond our consulting rooms. To be sure, brain-based therapy didn't invent the profound impact that a relationship can have on the brain, but it does provide a new language and a new map for guiding clients through both the intensely emotional encounter with their darkest demons and the more long-term process of rewiring their own nervous systems as they move toward greater well-being.

Since that first session with Ilyana, our growing bond with each other has enabled her to feel the immediate support of our relationship, while also understanding and absorbing the link between the fundamental principles of brain science and the changes she's experiencing—for instance, the fact that experience itself can generate new synaptic connections to create new neural networks. She's come to recognize in both the safety of our encounters and by taking that experience back into her life that, without altering the nature of her relationships with other people, it's likely that her habits, patterns of behavior, and moods will remain the same, as her neural networks continue to run in the same grooves—or ruts. But as she discovers new ways to think and behave when feeling troubled, she keeps finding within herself the basic truth of the neurobiological principle that "what fires together, wires together." She's also learning that becoming securely "herself" means allowing her brain to be nourished by her connection with others.

In addition, Ilyana is realizing that brain-based therapy is, in a sense, rooted in a kind of neurobiological athletics. As she understands her own brain better, she's training herself to use her brain more effectively. Like a tennis or golf pro, she's developing an informed sense of what moves she should make to best improve her "game" and the practice necessary to sustain them. And because she now feels she has more control over how her brain functions, she has a greater sense of agency in running her own life.

As Ilyana's mood has shifted, she's begun making better life choices—changes that are perhaps no different from what would have happened in many therapies not specifically informed by neuroscience. But a brain-based approach certainly has offered both of us a map through the sometimes bewildering twists and turns of the therapeutic process. When I've felt off track in my work with her, principles of neuroscience and attachment research have helped me focus on aligning my own internal state with hers, discovering how to renew my engagement with her in the moment to moment flow of a session in a way that's at once what any sensitive therapist might achieve and subtly different.

The brain-based model provides a framework to check in with oneself about what's being attended to and what might be neglected in a session. Are you spending too much time thinking about what's emerging from the client's left prefrontal cortex and temporal lobes—the speech centers that power the life narrative—and not paying enough attention to the client's posture, tone of voice, gestures, and other nonverbal cues? Or are you so caught up in the dance of mutual regulation that's going on between the language, the facial expression, the mirror neurons, and other biological facilitators of empathy that you neglect thinking about psychological theory or concrete behavioral interventions that might help the client begin rewiring his or her own brain? No doubt, there are many ways to help a client like Ilyana, but we'd wager that the work of any therapist would be enhanced by starting to think in a way that leaves the Pax Medica behind.

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