Fran Weiss, LCSW-R, BCD, DCSW, CGP, Psychotherapist
Just because it is hard to do, does not mean it is impossible to achieve
Fran Weiss — What Informs my Current Practice of Psychotherapy
My current practice of psychotherapy is informed by Contemporary Neuroscience, Interpersonal Neurobiology (IPNB), Modern Attachment Theory, and Sensorimotor Psychotherapy. This is sometimes referred to as brain wise psychotherapy.
Current Trends in Psychotherapy
The field of psychotherapy is going through a rapid shift in its thinking about the development of psychopathology. We are now immersed in what is known in the field as "The Decade of the Brain." The focus for psychotherapists has been on early attachments, their effect on the developing brain, and how this is manifested in adulthood. What is the emotional and neurological "footprint" of early attachments? The goal in psychotherapy is how to help people who have had less than optimal attachment experiences and "training" in infancy and childhood begin to develop a better sense of self, have better self-regulatory capacities, have more accurate cognition, and develop accurate readings of their internal experience of themselves and the world. Interpersonal problems often arise from errors in interpretation, such as misjudgments of the accuracy of how and what we convey of our internal experience to others, and misperceptions of others' intentions and states of mind. When self-regulation is compromised, anxiety and panic attacks present.
Lastly, theories of attachment informed by recent advances in neuroscience expand how we as psychotherapists can better intervene with our patients to promote healthy relationships and well-being.
Theory
We are born with our own unique temperament and genetic architecture. Relationships very early in life shape the structural development of the brain. The brain's development is an "experience-dependent" process. Psychotherapists' interest in this process is that different attachment experiences impact the developing infant/child's self-regulatory capacity, which is dependent upon how the brain and the automatic nervous system develop. We now know that the infant's experience of him/herself as a being encompasses the totality of his developing mind, which emerges from the substance and activity of the brain directly shaped by interpersonal experiences. The development of a psychological self occurs in the same way. These two are not a genetic given. We are all born with unique genes and DNA, but we are learning that the specifics of genetic expression may be experience- and environment- dependent, and intertwined. The notion of psychological self evolves from infancy through childhood and into adulthood. Its development critically depends upon the more mature mind and experiences with the attachment figure, the main caretaker, usually a parent. Mother takes a central role in this.
The hope is that this person is benign, reflective and sufficiently attuned to the emotional nuances — ups and downs — of the infant, toddler and child. When there is not sufficient and consistent attunement, or ability to "recalibrate" the misattunement for extended periods of time, problems can emerge. These problems are manifested in maladaptive behavior early on in childhood or in adulthood, in demonstrated inabilities in interpersonal relationships, problems within oneself, and problems in self-regulation. Can any of this be changed as an adult?
Potential Promise and Hope
Current advances in neuroscience research have allowed us to better quantify and measure the state of the brain through fMRI's (functional magnetic resonance imaging), studying where blood is flowing in the brain. (fMRI's have been used in brain research to determine which brain regions "light up," indicating changes made over time.) These images can also reveal structural changes in the brain. The emphasis of neuroscience has been on neuroplasticity and neurogenesis — the creation of new neurons and new neuronal pathways continuing throughout our life spans. This new research has documented that the brain continues to develop after adolescence and does not become rigid due to age as was once believed. The research implies that if certain structures did not develop in childhood, there is potential for development in adulthood under the right circumstances. With certain experiences one can gain flexibility and integration. Although this field is in its infancy, there is preliminary evidence that vast changes can take place as a result of significant life experiences and that, therefore, a positive, attuned therapeutic relationship in psychotherapy changes the brain and neurological systems for the better. The current neuropsychological goal is to take advantage of neural plasticity to stimulate neural activation and promote integrative fibers in the brain (Ed Tronick, Peter Fonagy, Allan N. Schore, Daniel J. Siegel, Louis Cozolino).
Much of this current data is coming out of the fields of infant attachment studies, neuroscience, behavioral sciences, traumatology and epigenetics. There is now an active movement to integrate these branches of the field to further understand how early relational trauma in infancy can effect gene expression and may give rise to a plethora of psychosomatic symptoms and regulatory problems.
Areas of Study
For the past several years I have participated in a seminar led by Daniel J. Siegel, MD, in person and in a Skype webinar, studying his synthesis and interpretation of brain science and its application to psychotherapy. During this time I have also studied John Bowlby's classical attachment theory (internal working model) and the works of Peter Fonagy (mentalization and the interpersonal interpretive function). I have been in a variety of seminars studying theories of affect regulation with a central focus on the work of Allan N. Schore and his paradigm shift from classical attachment theory to his model, Modern Attachment Theory. This model looks at how regulation is the primary creator of an emerging sense of self: what he calls "right to right brain synthesis for implicit communication." His focus is on the right brain of the mother communicating implicitly with the right brain of the infant. Dr. Schore hypothesizes that a similar process emerges in psychotherapy between patient and psychotherapist. Central to this work is an understanding of the work of Bowlby's student, Mary Ainsworth, and her student, Mary Main. Mary Ainsworth developed the research tool, The Strange Situation. Mary Main developed the research application, Adult Attachment Interview (AAI). The work of these researchers and clinicians, along with the work of current neuroscientists and infancy researchers, laid the groundwork for Dr. Schore's paradigm shift. Daniel J. Siegel has taken this one step further, creating the model, Interpersonal Neurobiology (IPNB). Drs Siegel, Schore and Fonagy are considered "integrationists."
My immersion in the work of these theorists has involved the study of mind, brain and emotion; how each of these develops; how they affect each of us; and how the therapeutic experience can help transform and change people scarred by their family of origin.
Practical Techniques used in Treatment
Being a 'brain wise therapist' focusing on attunement and affect regulation, I have also studied various forms of relaxation techniques with Herbert Benson, MD, the cardiologist at Harvard's Deaconess Hospital; the visualization practices of Stephanie Simonton, Ph.D., who developed one of the original models of psychosomatic medicine; and Dr. Siegel's Mindfulness practices. Along with this I have been studying directly with Pat Ogden, Ph.D., the creator of Sensorimotor Psychotherapy. Sensorimotor Psychotherapy directly addresses the physiological elements that keep trauma alive in the body, allowing the therapist to affect somatically driven symptoms inaccessible in a purely talk therapy context. Part of this training involves understanding the body's somatic experience, and learning skills to intervene. The focus is on the application of simple body-oriented interventions, or techniques, for safely exploring trauma related physiological arousal and habitual tendencies, in order to transform overwhelming experiences into experiences of mastery. This is also applicable to helping people with a history of attachment issues (today called 'attachment trauma'). Some typical reactions of these phenomena are having extreme reactions to ordinary events, suffering from ongoing anxiety, having panic attacks, or becoming hyper-aroused under specific circumstances or by what people say. The techniques used give patients a capacity to gain greater self-control and mastery. Self-regulation is the ability to regulate or control one's emotional reactivity and habits. The central focus of this work is developing the facility to self-regulate so that one is less easily disturbed by emotional states.
Integration into Psychotherapy
As a traditionally trained psychotherapist in psychoanalytic and psychodynamic talk therapy, I have incorporated this new research and brain knowledge into my understanding of how people function interpersonally and how we affect each other dynamically. Central to this is the understanding of affect regulation and the application of new tools and techniques developed from current neuroscience to help patients gain mastery over mental states sometimes experienced as "out of control." I have added these techniques and somatic interventions, when applicable, to my practice. I have found that integrating these techniques into my work with individuals, groups, and couples who have regulatory problems makes all the difference in people's capacity to regulate themselves and to more quickly improve functioning. The techniques are not difficult for a patient to learn and practice on his own, and are of help to almost everyone. The cluster of somatic problems (regulatory issues) that can be addressed by these techniques include: eating disorders (aka disordered eating), weight regulatory problems, anxiety, anger, panic attacks, physical symptoms in peri-menopause and menopause, separation anxiety, issues of grief and loss, and boundary issues.
Photos above by permission of Getty Images — download, republication, retransmission, reproduction, or other use, of these images prohibited.