The Next Big Step


What’s Ahead in Psychotherapy’s Fascination with Brain Science?

January/February 2014


The Decade of the Brain officially ended 14 years ago, but certainly not the explosive growth of neuroscience research, nor the popular interest in the three pounds of tofu-textured tissue between our ears. In fact, President Obama has just pledged $3 billion—a billion per brain pound!—toward what amounts to another brain decade, a 10-year project that would, as the Massachusetts Institute of Technology’s Technology Review modestly describes it, “reconstruct the activity of every single neuron as they fire simultaneously in different brain circuits, or perhaps even whole brains.” Only a few years ago, such an undertaking would’ve seemed like sci-fi fantasy; today, it’s just the latest, biggest, and priciest exploratory trip into Brainlandia.

Meanwhile, the tidal wave of popular and professional interest in the brain surges on. There’s hardly a psychotherapy professional conference in which the brain doesn’t figure prominently in a good chunk of the workshops: “the brain and emotion,” “the brain and addiction,” “the adolescent brain,” “the brain and couples,” “your brain on sex”—you get the idea. Plus, there are all of those pop-science books, articles on The Huffington Post site, TV shows, “brain games,” and do-it-yourself neurofeedback.

I fully understand this infatuation with neuroscience, having fallen hard for the little charmer myself. How could I not, given the sheer wonder of the extraordinary complexity of the brain? Just consider the numbers: the brain has 100 billion neurons amid another trillion support cells. A typical neuron connects with 5,000 other neurons, adding up to about 500 trillion synapses. The number of possible combinations of those 100 billion neurons is more than 10 to the millionth power—that’s a one followed by a million zeros. As a comparison, the number of particles in the universe is estimated to be a one followed by a paltry 80 zeros.

Just as exhilarating as these staggering numbers is the new knowledge about neurobiology that’s emerged over the last two decades. Through the remarkable power of brain imaging, we can watch different areas of a person’s brain activate as he or she thinks, perceives, feels, wants, or acts in different ways. Increasingly, new studies are showing how specific neural structures and processes underlie that very intimate experience of being “me.”

Even more thrilling, particularly for psychotherapists, are the implications of breakthrough understandings of the depth and breadth of neuroplasticity, the nervous system’s capacity to be changed by experiences. Of course, neuroplasticity itself isn’t breaking news. For more than a century, scientists have presumed that any sort of learning—a child learning to walk or an adult learning to navigate a tricky conversation with a partner—must involve some kind of change in neural structure and function. The breaking news is in the details of the mechanisms of neuroplasticity and their reach and power. Suppose, for example, someone regularly practices meditation with a focus on her breath. A part of the brain called the insula is routinely activated as she tunes into her body, which leads to a cascade of physical changes: new receptors get built at busy synapses, thus sensitizing them; new synapses grow in a matter of minutes; less used synapses wither away in a process sometimes called neural Darwinism (the survival of the busiest); and tiny strips of atoms, or genes, in the twisted-up molecules of DNA in neuronal nuclei get unpacked (“expressed,” in epigenetics) to do their work. In the insula, the cortex gets measurably thicker. Like repeatedly lifting weights to build a muscle, repeated patterns of mental activity build neural structure. In essence, the mind itself is the greatest sculptor of the brain.

In the famous saying inspired by the work of neuroscientist Donald Hebb, neurons that fire together wire together. Make an impression on somebody’s mind, reinforce it often enough, and bingo!—a new neural network forms. In other words, the mind has altered a little part of the brain. The possibilities radiate hope. Since the nervous system is enormously plastic, with enough effort, skill, and time (not to mention therapy) a person really can do a lot to overcome the effects of trauma, a lousy childhood, or major misfortune. This powerful fact has encouraged psychotherapists—some of us understandably troubled by the growing ascendancy of Big Pharma and psychoactive meds—because it indicates that our work in the consulting room can have a real impact on the concrete, physical brain, as much or more than do meds.

Like a lot of therapists, I was excited about neuroscience early on because I knew that the more we learned about what was going on inside the “black box” of the brain, the more effective we could become at intervening inside it. Much as the periodic table in chemistry provided an organizing structure for the elements, brain science has offered a way to place the great diversity of psychological theories, maladies, and treatments within a single, integrative framework. Neuroscience has given us a common tongue in the Babel-like world of psychotherapy. For instance, whether we describe our work with depression as helping clients grieve the lost part-object, dispute depressogenic thoughts, face existential fears of death, heal disruptions of empathic attunement in early childhood, or access their luminous core of being, it’s reasonable to turn to neuroscience to determine how each of these approaches affects the serotonin system in the brain, since it’s often a major factor in depression. Similarly, brain science offers common metrics for evaluating efficacy, such as the difference a treatment modality makes in serotonin metabolism.

It’s perfectly natural to be enthralled by this wonderful—and scientific!—new framework that’s starting to offer neurological evidence for the effectiveness of different therapeutic methods. Compared with the murky ambiguities of psychotherapy, the sheer visibility of the scanned brain—the ability to watch its neural structures and processes in action—is thrilling indeed. But if we get too infatuated with brain science, we’ll forget how young this field really is and how little we truly know. Neuroscience is a baby science, after all. I think it’s roughly comparable to where biology was a couple hundred years after the invention of the microscope: that is, around 1825.

There’s a natural rhythm of rise and fall in any profession when a new and exciting perspective comes along. In our own field, we’ve seen this happen with psychoanalysis, behaviorism, humanistic psychology, family systems theory, and positive psychology—and now it’s happening again with neuroscience. At first skepticism prevails, even resistance, as the Old Guard denounces or dismisses the new movement as ineffective, unprofessional, unsubstantiated, faddish, and even dangerous. Next comes the growing consensus that maybe the new thing isn’t so bad after all, that there might even be something worthwhile about it. As interest mounts, so does excitement: there really is gold in them thar hills! Then the rush is on, as everybody heads out to stake a claim and not be left out of the action. This bonanza mentality can be useful, as many thousands of prospectors explore the new paradigm, bringing in fresh ideas and new methods and enlarging our understanding of its overall worth and meaning. But eventually, once the hills are crawling with miners, the natural tendency is to step back and wonder if all that yellow stuff being dug up really is gold and not just cheap pyrite.

I think we’re at that point now in the history of the “brain rush” when we’re recognizing just how limited our knowledge is and how hard it is to make a meaningful correlation between our general ideas about the brain and the specific, real-life needs of our clients in day-to-day therapy. We’re also up against the temptation to go overboard with superficial and half-digested knowledge about what’s arguably the most complex and still barely explored object known to science.

In the throes of psychotherapy’s love affair with the brain, I know firsthand that it’s easy to make three specific kinds of blunders: oversimplifying the complexities of mental life into reassuringly mechanistic neural explanations, claiming the authority and prestige of hard science in a field that’s historically searched for respect, and underestimating the power of the mind itself.

The Siren Song of Oversimplification

Just about any significant mental function relies on the dynamic interworking of multiple neural assemblies and processes involving many different brain areas. Nonetheless, it’s easy to be seduced by the magic of brain terminology to play 21st-century phrenologist. Consider these common assertions about which pocket or bump in the brain controls which human function: emotion comes from the limbic system; the insula is the seat of self-awareness; fear is in the amygdala; the right hemisphere holds the sense of a personal self existing across time; empathy is about mirror neurons; and so on.

There’s a place for handy simplifications, but sometimes it’s too much of a good thing. Take empathy, for example. For all the attention given to mirror neurons, it’s still controversial whether they even exist in the human brain. Parts of our perceptual-motor networks do activate both when we perform an action and when we see someone else doing the same action, but this internal sense of the other person’s movements is just one aspect of tuning into him or her. The other major components of empathy are emotional resonance—supported by the insula—and “theory of mind,” involving the prefrontal cortex. Based on these neural systems, we “get” the actions, emotions, and thoughts of other people. Mirroring the actions of others is just one of three aspects of understanding them—and usually the least important in both everyday relationships and in psychotherapy. Yet the appealing metaphor of mirror neurons has dominated discussions of empathy for a decade.

Besides overlocalizing function, the tendency toward oversimplification also shows up in catchy yet exaggerated language that drastically distorts the way the brain really works. Take the popular meme that there’s an inherently female brain and male brain. Yes, some statistically significant differences have been found between the average adult female and male brains. But much, if not most, of these differences aren’t innate; rather, they’re acquired as a result of the different socialization of girls and boys, women and men. Further, the differences among female brains and among male brains are much greater than the differences between the average female and male brain. And in most of the fundamental functions of the brain—reasoning, memory, perception, motor planning, and consciousness itself—women and men are similar.

Perhaps the ultimate oversimplification is to reduce mind to matter alone. This little sleight-of-hand conveniently sidesteps the so-called—and unsolved—“hard problem” in brain science: how intangible experiences, such as a memory of childhood or a feeling of compassion, emerge out of tangible neural structures and processes. One time, a client of mine felt sad after not getting a promotion at work, and I said without thinking, “Oh, that’s a drop in dopamine.” Sounds good, right? But no one actually knows how slumping dopamine becomes the feeling of disappointment.

Even worse, neural reductionism puts our clients—and society as a whole—on a slippery slope of declining moral responsibility. I once worked with a middle-aged man and his aging mother, who started arguing about some money she’d given him. Things got heated, and he started swearing at her viciously while she froze in her chair. After I got him to slow down and stop yelling, I asked him about what had just happened, which left his mother reeling and me shaken. He shrugged unapologetically and said, “That was my lizard brain, it just took over.” Hmm. On the one hand, the notion of a lizard brain gave him language for his feeling of being overwhelmed by an internal force beyond his control, and that was helpful. But on the other hand, it gave him a convenient excuse for blowing up at his mother, along with the get-out-of-jail free card that he “couldn’t help it”—a powerful formula, since it came wrapped in the mantle of science. What’s the logical extension of reducing depression to low serotonin, addiction to insufficient dopamine receptors, and angry outbursts to the lizard brain within us all? Men who say that emotional conversation is beyond them due to their male brains? Teenagers who say they can’t do their homework because their brains don’t produce enough acetylcholine? (Of course, the teen who wants to blame this neurotransmitter will need to learn how to pronounce it.)

False Claims of Authority

You’ve probably heard this one already: (Q) How many therapists does it take to change a light bulb? (A) Only one. But the light bulb has to want to change.

The joke is silly and a little tired by now, but also insightful. Therapy-outcome studies show that a person’s motivation is a major factor in whether he or she gets better, and just talking about the brain can be a powerful motivator. Skeptics who’ve been court-, spouse-, or parent-ordered into therapy are more inclined to pay attention when you translate the immaterial mind into the material meat of the brain. In the past, when I touted the benefits of relaxation training for anxiety, I could almost see the thought balloon over the client’s head: “Yada, yada, long slow breaths, fluffy white clouds, whatever.” But these days, I tell a client how the sympathetic (fight or flight) and parasympathetic (rest and digest) wings of the autonomic nervous system interact with each other like the two ends of a seesaw: when one goes up, the other goes down. So raising parasympathetic activation through relaxation lowers alarm signals in the brain, thus reducing anxiety. When I explain it this way, I see the client’s eyes snap into focus; my “prescription” is now as concrete as a bottle of Xanax. Reframing psychological problems as neurophysiological conditions normalizes and destigmatizes them, making it easier for clients to deal with them squarely. It’s as if they believe that the brain is both more real and more respectable than the mind.

During the hard work of therapy, with its ups and downs and pains and sometimes stagnant spells, clients are encouraged when they realize that their efforts are leaving lasting traces in the tissues of their brains. And it’s not just clients who get motivated by neuroscience. The new studies showing how mindfulness training, meditation, and psychotherapy can change the brain are heartening for therapists, too, who may sometimes feel that Freud was right when he characterized ours as an impossible profession. Further, as a practical matter, neural evidence for the benefits of psychotherapy could help motivate policymakers and insurance companies to give it more support.

Nevertheless, even a well-meaning use of neural terminology to help motivate clients can go too far, replacing psycho-babble with brain-babble. When talking about the brain, it’s tempting to mix in dollops of glib sciency-sounding explanations as a way to impress others and claim authority. (Mea culpa.) Given that psychotherapists and psychologists have historically had lower status than physicians and “hard scientists,” murmuring expertly about the brain is a powerful way to raise your prestige with clients, colleagues, the media, and (I admit it) your own parents. But in reaching for authority, we run the risk of actually losing it by resorting to neurological accounts that add little or no real value to therapy.

After I’ve said things like “Oh, that’s your amygdala firing off,” I’ve had clients reply, “So what?! How does knowing that help me?” Merely replacing familiar psychological language (“You felt anxious”) with fancy neural terminology (“Your amygdala was activated”) does little good by itself. Plus, it can implicitly communicate a kind of insecurity about your ability to analyze a client’s problems in mental terms and then offer mental solutions—and since this is the fundamental province of psychotherapy, too much brain talk can lead to doubt, in both our profession and the mind altogether.

Underestimating the Mind

It’s all too easy to lose sight of the power and potential of the mind in the midst of our fascination with the brain. Big psychological changes typically involve tiny neurological changes. For example, when someone has a revelatory insight into his or her childhood, or truly commits to stop using drugs, or finally works up the courage to say “I love you,” there’s certainly a shift in neural structure or function, but that shift is minuscule in the grand scheme of the brain. Further, much as a chalkboard can represent an infinite variety of pictures or words, the association cortices of the brain can represent an infinite variety of perceptions, thoughts, feelings, and desires. The flow of information across a chalkboard or through a brain is shaped by the unfolding logic and associations of the information itself more than by the properties of whatever physical substrate processes it. As psychiatrist and neuroscience researcher Daniel Siegel puts it, the mind uses the brain to make the mind. Since the normal brain can hold a vast range of thoughts, mental plasticity holds vastly greater opportunities for healing, well-being, and contributing to others than neural plasticity does. If the brain is an enchanted loom—in the famous metaphor from neuroscientist Charles Sherrington—it’s a loom that’s capable of weaving an infinite variety of tapestries whose patterns can never be reduced to the mechanics of the loom itself.

Over the past century, before much was known about the brain, therapists have helped millions of people feel better and lead more loving and productive lives. For example, I recently met with a mother trying to figure out whether to take a foster child into her home, given the potential impacts on her teenage son and an already strained marriage. We talked about the love that was leading her to consider this step, her worries about her son, and some practical actions she could take. What I know about the brain didn’t help me think more clearly about her issues or respond more skillfully, nor was it a relevant topic to bring up with her. This would be true for most of my sessions each week, and I suspect it would also be true for most therapists. In fact, brain science’s biggest effect has been establishing the neural basis of certain ideas and methods that have long existed in one school of psychotherapy or another. When an insight about the brain leads to a supposedly new approach with a catchy title, it’s usually old wine in new bottles. On this score, it’s ironic that our field, which so appreciates the effects of a person’s history, can be so casual about its own. Neuroscience has highlighted the importance, for example, of unconscious beliefs and motivations in influencing our experience and actions. Good stuff, but not news at 11, since Freud and others began writing about the dynamic unconscious more than a century ago.

Similarly, recognizing that the neural substrates of language processing—mainly in Broca’s and Wernicke’s areas—are a small fraction of the volume of the brain underscores the need to address nonverbal processes and ground psychotherapy in embodied experience, in sensation, emotion, and imagery. This is great to highlight, but already long emphasized in Jungian therapies, as well as in Reichian, bioenergetic, psychosynthetic, and somatic treatments.

Occasionally, learning more about the “black box” inside each person’s head does suggest genuinely new approaches. Neurofeedback is an example, as are emerging trauma protocols that use the “window of reconsolidation”—the relatively brief period during which negative material is rewoven into the networks of emotional memory—not merely to overwrite painful thoughts and feelings with more positive ones, but to erase the painful material altogether. Ultimately, as knowledge about the brain grows, so will the number of such novel and useful interventions.

The Real Story—Bigger than You Thought

Even granting the benefits of these new approaches, the impact of brain science on the everyday work of most therapists has been pretty limited. That’s because most of the new findings we get excited about—no matter how many bright blobs the MRI scans show—have little, if any, relationship to how we actually conduct therapy. Meanwhile, I think we’ve been missing the big picture. The real gift of modern neuroscience research, in conjunction with evolutionary biology and psychology, is to provide us with a much bigger, broader, and deeper general understanding of how the brain works as a whole: what its organizing principles are, how neural structures are built, and how they can change over time. We now have a much better grasp of the rules by which every human brain runs—rules set down through the processes of natural selection over eons of time since before the earliest hominid walked the earth. To borrow a metaphor from neuroscientist Jaak Panksepp, behind the eyes of every person today is a kind of living museum containing Cro-Magnon and Neanderthal cavemen and cavewomen, as well as ancient monkeys, mice, lizards, worms, and jellyfish.

Ironically, the lessons our ancestors needed to learn to survive under harsh and brutal conditions—lessons now woven into every nook and cranny of our brains—make it hard for our clients to learn to feel, think, and act in healthier and happier ways. Sure, every practitioner knows that learning new habits of mind and behavior is often hard; people resist change, even positive change they say they dearly want. But I don’t think our field as a whole has fully confronted how powerfully evolution has primed our brains to be really good at learning bad lessons from bad experiences, and relatively bad at learning good lessons from good experiences—what researchers call the brain’s negativity bias.

How powerful is the negativity bias? Very powerful. Much scholarship—including a literature review with the arresting title “Bad Is Stronger than Good” by research psychologist Roy Baumeister and colleagues—has shown that the brain continually looks for bad news, zeroes in on it while losing sight of the big picture, reacts intensely to anything negative, and quickly stores the whole stimulus-response package. While there’s a mild positivity bias for recollections—we tend to edit pain out of personal memories—there’s a marked negativity bias for implicit memory, the vast neural storehouse containing our expectations, assumptions, attitudes, motivations, models of relationships, effects of life experiences on mood and self-worth, and the overall inner atmosphere of the mind.

Consequently, negative states are fast-tracked into neural structure. We learn faster from pain than pleasure: once burned, twice shy. Something bad about a person is more memorable than something good, which is why attack ads dominate political campaigns. Negative interactions have more impact on a relationship than positive ones. It’s easy to develop “learned helplessness” from a handful of experiences of inescapable pain, and it takes many times as many counter-experiences of agency and efficacy to feel more like a hammer than a nail. The negativity bias pervades daily life, not just laboratory experiments. For example, a client of mine recently received a performance review with overwhelmingly positive feedback, but she couldn’t stop obsessing about the one suggestion for improvement. Another client has led a mainly decent and moral life, but is still haunted by the time he betrayed a lover as a young man.

During the 600 million years of its evolution, the nervous system’s negativity bias developed for a good reason: it helped our ancestors survive in harsh environments, live to see a new sunrise, and pass on their genes. In effect, they needed to get “carrots” (i.e., food and mating opportunities) and avoid “sticks” (i.e., predators and aggression within or between primate bands). Sticks usually have more urgency and effect on survival than carrots do. If you fail to get a carrot today, you’ll have another chance to get one tomorrow. But if you fail to avoid that stick today, then whack! No more carrots forever.

As a result, most positive experiences flow through the brain like water through a sieve, while negative ones are routinely caught and turned into enduring neural structure. Our brains are, in effect, Velcro for the negative and Teflon for the positive. This hard-wired asymmetry in the conversion rate of mental states to neural traits—with negative states having the advantage—is the fundamental weakness in psychotherapy and other paths of healing and growth, such as mindfulness training, coaching, social-emotional education for children, addiction recovery, and human resources development. Unless people install, or internalize, useful experiences in brain structure, they have little or no lasting value. So, both in psychotherapy sessions and in daily life, we need to help our clients learn to turn positive mental states into positive neural traits.

How the Brain Learns

People come to a therapist because they want something to change: they want to feel or act differently, understand themselves or others better, or relate to things that won’t change in a more spacious and accepting way. These changes of mind, of course, require changes of brain. Psychotherapists are in the business of changing the brain for the better, which means building up the neural substrates of inner strengths, including character virtues, executive functions, perspectives, attitudes, positive emotions, and capabilities. These positive traits are the resources we draw upon to soothe ourselves, lower anxiety, feel loved and worthy, be appropriately assertive, contribute to others, and choose the higher road over the lower one. In many ways, the essence of therapy is developing inner strengths. But what does it take to grow strengths in a client’s brain?

It takes learning—the alteration of neural structure and function—which proceeds in two stages. First, there must be an activated mental state: a thought, perception, emotion, desire, sense of action (such as speaking assertively), or combination of these. Let’s say you’re talking with a client about her partner’s alcoholism. In her mind, the activated positive state could be a thought, such as It’s not my fault he drinks too much. Or there could be the sensation of relaxing, a feeling such as relief or self-compassion, the intention to go to an Alanon meeting, or practicing out loud what she could say to her partner. So far so good. Then the critical second stage begins, the installation of this passing mental state into a durable trait—a lasting neural structure. For example, fleeting thoughts, like It’s not my fault he drinks too much, need to become stable, bone-deep convictions, such as I’m not responsible for anyone’s alcoholism.

Positive traits—inner strengths—come from positive states. It’s easy to dismiss positive experiences as lightweight, New Age, pie-in-the-sky fluff, mere “positive thinking.” But these good moments are in fact the building blocks of self-regulation, secure attachment, self-esteem, and positive mood. We grow inner strengths by having experiences of them. If you want to be more mindful, have more experiences of mindfulness; if you want to be more confident, have more experiences of reaching goals (even simple ones, like finishing an email) or being appreciated by others.

But, again, merely having positive experiences isn’t enough: they must be installed in neural structures to have any lasting value. Otherwise, they’re momentarily pleasant—better than a stick in the eye—but with little or no enduring benefit. A positive experience must be held in short-term buffers long enough to start getting encoded in long-term storage. “Long enough” depends on the experience and the person, but it’s at least a few seconds (and usually longer) of staying with and really registering a beneficial thought, perception, emotion, desire, or action. Without this sustained immersion in a positive mental state, its conversion rate to positive neural trait will likely be low at best.

How often does this sustained immersion in the positive experience actually happen in therapy, or outside it? In general, not often enough. There could be a stream of positive experiences, interspersed with neutral ones, running through someone’s awareness, but each incoming experience—the next mental state—dislodges the current one in short-term buffers before it has much chance to sift down into long-term storage.

Some therapies do this installation explicitly, such as focusing, coherence therapy, and eye movement desensitization and reprocessing (EMDR). There are, of course, therapists intuitively gifted at installation. They encourage a sustained and richly felt engagement with key positive experiences so they really sink in. But on the whole, I think we waste a lot of positive experiences that could lead to lasting learning in our clients. (For a long time, I sure did.) During the past 30 years, many new ideas and approaches have entered the world of psychotherapy, but the average response to treatment—as measured by outcome studies—hasn’t improved significantly. I believe that’s because we’ve gotten much better at activating beneficial mental states, but no better at installing them in the brain.

Yes, psychotherapy stacks up pretty well against other interventions, including medications, for issues such as depression, trauma, stress, and interpersonal conflicts. But think about all the people who don’t get better during treatment and soon relapse when it’s over, or all the people who heal and grow much more slowly than they’d like. We’ve all had clients experience a hard-won breakthrough in a session and then be back to square one the next time we see them. It’s disheartening when this happens for clients and therapists alike. It certainly was for me—until I began regarding the installation phase of acquiring good traits as the crux of effective therapy (and other paths of healing and growth). That was when I began to see more deep-seated and long-lasting changes in my clients. Activating useful thoughts and feelings is certainly good, but installing them in neural structures is even better, and learning how to do this by overcoming the brain’s negativity bias has made me a better therapist.

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.

The Law of Little Things

The brain is the organ that learns, continually changing its structure for better or worse—with a bias toward changing for the worse. By tilting toward the positive—by activating and installing positive experiences—we simply compensate for this bias and level the playing field. Powerful forces are trying to change our brains each day from the outside in: authority figures, economic pressures, “if it bleeds it leads” media, political groups, advertising, and so forth. In the face of these pressures, we can teach our clients ways to change their brains from the inside out.

Much of the news about neuroplasticity has been about dramatic cases of recovering from terrible damage to the brain, but these stories aren’t relevant to most people. Most neuroplasticity is slow and incremental. It’s usually lots of little things that change a person’s mind (and thus brain) for the worse, and it’s going to be lots of little things that change this mind and brain for the better. One thing I’ve learned from my immersion in neuroscience is the extraordinary capacity of the brain to change for the better. Any single moment of taking in the good won’t change someone’s life. But a handful of times each day, day after day, month after month, year after year, will gradually—bit by bit, synapse by synapse—make a big difference.

Deciding to reshape one’s brain by intentionally taking in the good, one thought or experience at a time, begins with a conscious, willed decision of the mind. Regardless of what’s discovered about the brain, each person still has to decide how to live his or her life. The brain has a tremendous range of capacities that can be used for good or ill, and it has inclinations in both directions. Therefore, the crux of human behavior and experience is less the nature of the brain than the values of the mind. True, to be viable for human beings, our values need to be guided by our biology; values such as justice make sense for social animals like us but not for lizards or sharks. But on the broad canvas given us by evolution, each person’s mind paints in his or her ethics and aspirations as an existentially creative act. Under the pressure of our culture’s craving for a quick fix, and for simple and concrete explanations for complex psychological conditions, it’s important to keep faith with the deep wisdom in our field, and within each one of us, about the mysteries and the possibilities of the mind, no matter what we learn about the brain.

Twenty-five hundred years ago, long before the invention of EEGs and MRIs, the Buddha offered a teaching suggesting that he, too, along with Proust, was a kind of neuroscientist, who understood both the power of little things and our profound human capacities to heal and to grow: “Think not lightly of good, saying, ‘It will not come to me.’ Drop by drop is the water pot filled. Likewise, the wise one, gathering it little by little, fills oneself with good.”

Rick Hanson, PhD, is a neuropsychologist and New York Times best-selling author. His books include Hardwiring Happiness, Buddha’s Brain, Just One Thing, and Mother Nurture. Founder of the Wellspring Institute for Neuroscience and Contemplative Wisdom and a member of the Advisory Board of the Greater Good Science Center at the University of California Berkeley, he’s been an invited speaker at Oxford, Stanford, and Harvard. He’s taught in meditation centers worldwide. Contact: rick@rickhanson.net

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6 Comments

Tuesday, January 14, 2014 7:56:19 PM | posted by Sue Cirillo
loved the article

Saturday, January 25, 2014 4:04:07 PM | posted by Robert Hennelly
While the article makes some helpful points, it raises several problems it does not address. One is that that the adoption of the language of neuroscience by therapists, which the author advocates, will concede paradigmatic status to neuroscience because of the power of language. Neuroscience, still in its infancy, has not earned that status and may never do so. Another problem is the author fails to address the most critical issue: the relationship between consciousness and the brain. It is widely held in neuroscience that consciousness is dependent on the brain, i.e., no brain, no consciousness. This reductionist position, which is implicit in all the articles on neuroscience in the Networker’s current edition, is inimical to the many therapists who integrate the spiritual into their work, as well as to therapists who do not subscribe to the view that mind is an epiphenomenon of the brain. The therapy community deserves a more balanced treatment of the interface between neuroscience and therapy.

Wednesday, February 5, 2014 4:16:50 PM | posted by Sally Bailey
Involving the client's body as well as his/her brain makes the HEAL method work even better (as the body is connected to the brain and, in fact, the body is sometimes talked about as being part of the brain because of the connectivity) Creative Arts Therapies, especially Drama Therapy, does this all the time and, as a result, enhances the effect. Clients Have a positive experience, which is Enriched and Absorbed, and after the experience the client(s) talk about it and Link it to their lives.

Tuesday, February 18, 2014 4:52:44 AM | posted by Vivian Baruch
Thanks Rick for stressing the need to incorporate the multisensory "installation" aspect of desired behaviours used in Focusing, EMDR & Coherence Therapy. And for linking these to your "taking in the good" practice which needs frequent(daily)holding in awareness for a minimum of 12 seconds. Your metaphor of the mind being like teflon for positive events has helped me help clients develop a fully embodied experience in session of the changes they desire, using visual, auditory & kinesthetic cues which we hold in awareness for about one minute. The use of this is encouraged outside the room, immediately after they've been triggered, within the window of consolidation period. It's all about "practice, practice, practice" to rewire the neurons.

Sunday, March 9, 2014 11:44:11 PM | posted by Steve Andreas
Hanson’s HEAL process is a fine outline; using it well requires a LOT more specific detail. For instance, the first step, “Have a positive experience,” doesn’t give any guidance about what kind of positive experience to have. Assuming that you know something about what troubles someone, a specific counterexample experience will usually be most useful. For instance, if someone is easily upset by criticism from an authority figure, a counterexample would be praise from a respected authority figure. If a client regrets a decision that turned out badly, a counterexample would be a decision that turned out exceptionally well. An appropriate counterexample will be far more impactful than simply remembering lying in a sunny meadow, or feeling good after an exquisite meal.
The second step, “Enrich” advises, “Let the experience be as rich as possible.” While that is a nice general hypnotic instruction, some specific direction about exactly how to do that can make it far more impactful.
One of the first things to check is whether the client is experiencing the memory by being inside it, with easy access to all the positive feelings, or experiencing it as an outside observer objectively looking at a still picture or a distant movie. Objectivity is a great resource when remembering a horrible experience, because the feelings are omitted, but it will also prevent the positive feelings that make a good experience such a powerful resource.
If a client is looking at a still image, you can ask them to turn it into a movie; if they are watching a small movie of themselves, you can ask them to “Close your eyes, and first make the movie life-size, and then step into that movie, pull it around you as if you were putting on an overcoat, and feel it happening again,” so that they have full access to their positive emotions.
Then you can check to be sure that their experience is in full color, includes sound, and that it moves and changes over time, just as a real event would. Making the experience a bit brighter, and/or adding a judicious amount of sparkle (like early morning sunlight on dew or frost) to highlight elements will also enhance it, and strengthen its impact.
These are only a few examples of how you can give specific directions in order to rapidly change your own or your client’s experience and felt response in useful ways.
Steve Andreas SteveAndreas.com

Saturday, March 19, 2016 3:06:54 PM | posted by phebef@yahoo.com
There will be a problem in talking about neuroscience for psychotherapists because the research is helping us enter through the nervous system, what up to now has seemed to be exclusively the domain of the body. It does seem to be more accurately said to be the domain of the mind, rather than exclusively the body with which we are making contact. With this new 'land bridge', we are offered a two-way relationship where before there was only the 'top down' approach. I recommend articles from articulate people grounded in the 'bottom up' perspective, such as Aline LaPierre has been writing.

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