Right Brain to Right Brain Therapy

brain therapy

THE CLINICAL APPLICATIONS OF ATTACHMENT THEORY

© Linda Graham, MFT

Right brain to right brain therapy is Allan Schore’s phrase.Applying what we know from the last 15 years of neuroscience research about how the brain actually works – and 90% of what we know about how the brain works we have learned in the last 15 years; learning how the right hemisphere of our brain processes and stores information and experience differently than the left hemisphere and from deeper structures of the brain, and the implications of that for therapy .

Applying what we know from 40 years of attachment research about WHAT is stored, implicitly, in the right hemisphere of the brain – pathways that are initiated that shape and influence future behavior – the 3 R’s of relationality, regulation of affect, and resilience that are the foundation of all exploration, learning and growth.

Applying what we know from 30 years of infant development research of how the neural patterns of those 3 R’s are created in the moment by moment interactions between infant and caregiver, forming internal working models of attachment-affect regulation-coping styles.

Knowing, from neuroscience and attachment research and infant development research that those patterns are processed and stored implicitly, outside of awareness, in the right hemisphere of the brain – the right pre-frontal cortex – by 18 months of age and, though we continue to learn from our relational-emotional experiences after 18 months of age, and can change our responses to our experiences lifelong, all the research that has followed infants up to 25 years of age, as well as research that from adult attachment styles can predict the attachment style that will develop in the infant before the infant is born, shows these early unconscious attachment patterns of the 3 R’s are remarkably robust and unchanging well into early adulthood.

That’s not a problem when the patterns are healthy and remain flexible and adaptive; we learn and change and grow from experience and emerge a self that is relationally-emotionally-mentally-socially health.It IS a problem if the patterns themselves are unhealthy, that can prevent learning and growth; strategies for dealing with feelings and relationships can become inflexible and maladptive; strategies become defenses that constrain change, can be a self selecting pathogenesis that over time can rigidify into what we as clinicians encounter as personality disorders, disorders of the self, which are basically strategies to cope with less than secure or disorganized attachment and affect dysregulation.

Right brain to right brain therapy is attachment based, emotion focused techniques to activate and re-wire these very early unconscious patterns processed and stored in the RH of the brain when they are unhealthy.There is neural plasticity in the brain lifelong; that’s a tremendously exciting, recent discovery of neuroscience.Every experience we have, every single moment of experience, causes neurons in our brain to fire, neurons all over our brain, not just the RH, and when we can create new experiences – of relationship and emotion – that causes the brain of the client to fire in a new way, new synaptic connections can happen, new neural pathways can develop, new neural circuits can grow; that’s all true, and clients can experience themselves, their emotions, themselves in relationships, in new more wholesome, healthy ways.The goal of any therapeutic process.

What those NEW experiences need to be, how to create them with clients, how to install them in the right and left hemispheres of the brain, how to access OLD, implicit patterns, activate them, re-wire them, and install them in the right and left hemispheres of the brain, is what we’ll learn here today.

This is in the lineage of Dan Siegel, who spoke at Marin CAMFT conference last spring, and Diana Fosha, who is speaking as the Marin CAMFT conference this spring; my integration of their pioneering work.And, because this is an accelerated model of therapeutic change that requires much challenging relational-emotional involvement on the part of the therapist, the case example I will present will be a short transcript of session with client two sessions ago working in this right brain to right brain attachment based, emotion focused way.

We know from infant development research that the early, moment-to-moment interactions between infant and caregiver are what cause the brain to grow new neurons and to grow so rapidly in the first years of life. Experience dependent maturation.Those early interactions are both verbal and non-verbal communications around bonding and regulating affects.Driven by the attachment system: the innate, biologically hardwired drive for the infant to “seek physical proximity to a caregiver in times of perceived threat or danger”.The attachment behavior of the infant (crying, reaching, crawling, cooing, gazing) triggers a response in the caregiver, always a behavior of caregiver in response, may be appropriate, may be inappropriate, may be nurturing, may be indifferent, may by inconsistent, may be murderous, always a response.The interactions, back and forth over time, lay down patterns of response in the child’s neural circuitry to its bids for connection and regulation.Every discipline has a different vocabulary for these neural patterns that initiate pathways in the brain that shape and influence future behavior – schemas, internal representations, internal working models, templates, object relations, scripts, rules, memory of the future – but what is stored are patterns of the 3 R’s: relationality, regulation of affect, and resilience.

Attachment research has coded these patterns of response into 4 major categories.Listen with an ear to therapy. A responsive parenting style correlates with secure attachment in the child.When a parent is available, present, emotionally attuned, empathically resonant, contingently reflective of the baby’s inner reality, reciprocally communicating in tones, gestures, facial expressions as well as words, able to regulate the baby’s affects. soothe the baby’s distress and amplify the baby’s joy, providing relational-emotional experiences that are “good enough” enough of the time – research shows secure mother-infant dyads spend about 1/3 time relating, 1/3 time in rupture, and 1/3 time in repair, the most important phase being repair.So with good enough relating and repair, the baby feels safe and protected,“feels felt” in their own reality; feels regulated and soothed; develops trust of the caregiver as a safe haven, securely attaches to that caregiver; the trust of that secure attachment develops the internal working models of relationality, affect regulation and resilience known as the internal secure base; the child knows they exist in the heart and mind of the caregiver, they are effective and worthy of getting attention and soothing, they are able to flexibly focus attention between self and other and the world.

“Quoting John Bowlby, founder of attachment theory, an unthinking confidence in the unfailing accessibility and support of an attachment figure is the bedrock on which stable and self-reliant personalities are built”And quoting Allan Schore: “the security of the attachment bond is the primary defense against psychopathology.”

The secure base allows them to explore their world; research following securely attached children into adulthood find they grow up believing relationships are generally safe and people are generally helpful, that emotions are OK and are a way of communicating with self and others; they can be empathic with others and can comfortably depend on others; they find it easy to get close to others; they have the resiliency to explore their inner and outer worlds, to learn and grow.They tend to be confident, to tolerate frustration well, to believe they can succeed. especially as applies to relationships; they tend to be optimistic and positive about relationships lasting and being satisfying. (About 55% of children universally develop secure attachment; less than that in clinical population.)

A dismissive parenting style correlates with an insecure-avoidant attachment style. When a child experiences a parent too much of the time as dismissive, rejecting, neglectful, critical, judgmental, or absent, physically and emotionally unavailable and ineffective in helping them regulate affect; they will begin to withdraw from interactions, not seek comfort or soothing from the caregiver, begin to institute defenses against relating (since it’s too wounding or disappointing to want to connect and be met with so much disconnection) begin to institute defenses against feelings (since they won’t be attuned and responded to appropriately, empathically and feelings of anger or sadness or fear are too overwhelming and unbearable to be coped with all alone).Bowlby originally called this attachment style, which is based on defensive exclusion, compulsive self-reliance, for the child develops a precociously independent, pseudo autonomous style, Neural pathways of insecure-avoidant children can lead to pathology of growing up to be uncomfortable with closeness, devaluing of relationships and emotions themselves, defended against intimacy or vulnerability or dependency, can have difficulty trusting others, can be overly aggressive or hostile, overly focused on self or environment rather than other, dealing, but not feeling or relating. (About 20% of all children; higher in clinical population)

A pre-occupied parenting style correlates with an insecure-ambivalent attachment style in the child.The inconsistency of the parent’s responses, sometimes attentive and loving, sometimes off in their own world, pre-occupied, absent, cold, creates insecurity, self-blame and clinginess in the child, an ambivalence, sometimes desparately wanting the parent’s attention and soothing, other times angrily or defiantly rejecting it. Parents’ inconsistency in calming and soothing means child doesn’t learn to self-soothe and relax. Bowlby originally called this style compulsive caregiving, for the child can become overly focused on other rather than self, trying, trying, trying to take care of the parent or being overly emotional to maybe get a crumb of attention and connection.The insecure-ambivalent style leads to abandonment fears, chronic vigilance, emotional dysregulation and anxiety, passivity and lack of coping in adults, the victim stance; the adult can feel in over-emotional way and relate maladaptively but not deal. (About 20% of infants; higher in clinical population)

A disorganized parenting style, when the parent is disorganized, fragmented or dissociated themselves around by unresolved relationship trauma or loss creates a disorganized attachment style in the child. The parent they are turning to for comfort and protection isn’t “there” or may be abusive. This creates fright without solution for the child and they freeze, fragment or dissociate themselves.This is a clinical population that can’t feel or relate or deal.

Pulling the infant development research together with the attachment research together with the neuroscience, we know that the experiences we have with early caregivers: whether our bids for connection were responded to or not; whether responses were contingent with what we needed or not; whether our distressing affects were soothed and our pleasant affects amplified or not; whether we got the message that our needs and our feelings and our reality were important, special, or even existed, or not: all these experiences, repeated over time, cause neurons to fire and neural pathways, circuits, networks to develop.These neural pathways, circuits, networks, etc, patterns of affect and attachment,make it more likely that with repeated, similar or even new experiences these same neurons will fire again in the same patterns again and strengthen the pathways, circuits, networks of the 3 R’s – relationality, regulation of affect, resilience.The brain stabilizes our experiences into patterns of neural firing that determine how we respond in the future to new experience; these memories determine our patterns of behavior, feelings, thoughts,that eventually congeal into our personalities – our strategies for coping, especially with relationships and emotions, andcohere into our sense of self.

We know that any experience, internal or external, causes a neuron to fire (or 10,000 neurons; we have 100 billion of them by the time we are an adult. 100 billion neurons in full grown brain, each neuron capable of 10,000 synaptic connections, more possibilities of variations of synaptic connections than there are atoms in the universe.) When a neuron fires, the electrical impulse sends a chemical message (neurotransmitter) across the synaptic gap to a neighboring neuron (one neuron can have up to 10,000 possible synaptic connections to other neurons); that firing creates a synaptic connection between the first and second neuron, or along many hundreds or thousands of neurons to create a neural pathway.Repeated experiences will cause the neurons to fire repeatedly; neurons that fire together wire together, strengthening the synaptic connections between them, making it more likely they will fire together again in response to new experience – memory of the future; these neurons connecting synaptically begin to build neural circuits that begin to stabilize and form patterns that begin to stabilize and lay down the foundation for a stabilizing self.These patterns set a trajectory, a course, that shapes influences, guides, predicts action in the future.These patterns are dynamic; they do change with experience lifelong.They must change, be updated with new experience, or becoming pathogenic, preventing learning and change. Neural plasticity – the growth of new neurons stimulated by new experiences – is what allows us to change these patterns and emerge a healthy, whole self.Brains do grow in interactive experiences with others, life long.This is how we learn and grow as human beings.It’s what makes change through therapy even possible.

The significance of the right hemisphere of the brain in all this.

1)The right hemisphere of the brain is dominant in the brain’s development, in volume and activity, from 3 months before birth until about 18 months of age when the left hemisphere “comes online” and begins to develop very rapidly until it takes over in dominance at about 3 years of age and remains dominant throughout life except during adolescence.This dominance of the right hemisphere of the brain is completely concurrent with the development of attachment and affect regulation patterns that are stable within toddlers by 12 to 18 months of age.In fact, we saw it is the interactions ofcaregiving and affect regulation of the attachment system that stimulate the right hemisphere of the brain to grow so rapidly in this early period.These patterns are processed and stored almost entirely in the right hemisphere of the brain, and become foundational for the emerging experience of the psyche and the self.

2) How the right hemisphere of the brain processes information is through movements, sounds, visual images, touch, taste – non-verbal senses that come from our body; the right hemisphere of the brain is far more connected neuronally with the body and the lower structures of the brain than is the left and it’s where our procedural body-based knowing how to do something, like ride a bike, resides; and the RH processs through our emotions, our affects, that come from the limbic system of the brain; the right hemisphere of the brain is far more connected neuronally with the limbic system than is the left, though both are required, in different ways, to help regulate affect. The right brain is where we read the non-verbal social and emotional cues of an other – the visceral, sensory, energetic and holistic perceptions of body sensations and movements, facial expressions, gestures, tone of voice,that allow us to empathize, connect, relate to other beings. The right brain processes all this body-based emotional-relational information holistically, big picture, everything all at once, like taking in a painting all at once, or recognizing someone’s face all at once.The right hemisphere then, throughout life, is the mediator between our higher brain, the cortex, including itself, and the body, between our cortex, including itself, and our emotions from the limbic system, and our sense of self in relation to others, our relational-social gestalt.It is also the locus of the auto-noesis, self-knowing, knowing our self as self.

3)Our brains process and store information and experience implicitly (outside of awareness) from the moment we are born, from before we are born, throughout our lives.Always.Any experience, if it’s emotionally significant enough to register, is encoded in our implicit memory, conscious processing is not needed.Explicit memory comes on line about 2 ½ to 3 years of age, with the development of the hippocampus that turns implicit memory into explicit memory and the rapid development of the left hemisphere of the brain that processes information so differently than the right:linguistically through words; linearly, one data bit at a time, logically, looking for cause and effect, episodically, not holistically, specifically and factually.The development of the left hemisphere gives us an explosion of language; explicit memory gives us awareness, consciousness.Language and consciousness expand our world exponentially and give rise to complex capacities of thought and analysis.Absolutely essential for the growth into complexity we associate with being human.And

4) because patterns of attachment and affect regulation are developed in the right hemisphere of the brain by 18 months of age, and because there is only implicit memory storage of these patterns well past 18 months of age, all of these patterns are stored implicitly (outside of awareness) in the form of body sensations, movements, images, emotions, but not words.We have lots of words later, from the left hemisphere of the brain, and they are explicit.The right hemisphere can process and store information explicitly, too, once the hippocampus has developed, though because right hemisphere processing is often procedural, it becomes implicit (like how to ride a bike) and we don’t have to think about it anymore.But these early, early 3 R’s that operate robustly well into adulthood, are entirely implicit.Entirely outside of awareness.We become aware of them as we are able to process our experience explicitly, and they may change with new experiences and new processing, but unless we can access the old implicit patterns, using our right brains to activate the right brain processing of our clients, these earliest patterns will remain unchanged and unchangeable. Not a problem if they are secure; we procedurally know how to regulate our affect and relate to others in satisfying ways, we just roll along, like riding

a bike.More of a problem if they are insecure or disorganized; we procedurally, unconsciously, regulate our affect and relate to others in very problematic ways, not knowing why we do this or how to change it.And, because of how brains work, the defenses related to either style of insecure or disorganized attachment actually keep new experiences of self or relationship out.The defenses we learn and solidify early on make it difficult for any new perceptions or experiences to get in; our brains fire in the same old neural patterns; we relate to rejection or disappointment in the same old way; we don’t learn anything new, and the patterns become less and less changeable.

So now we see why people, clients, ourselves, can continue to do destructive things, manage our feelings or relationships poorly, reactively, even though we know better, because we do know better in the part of our brain that can know consciously, and these earlier patterns of self-other-emotion just continue along as a deep, untouchable RH undercurrent.

In order to change the relational-emotional patterning embedded implicitly and non-verbally in the right hemisphere of the brain, we need to be able to access it and create new experiences that will re-wire it, as well as creating new experiences that can become embedded in both right and left hemispheres to guide responses to future experiences.

Right brain to right brain therapy is an attachment based, emotion focused approach that, realistically, has to use the left brain as well, we are all engaged in talk therapy, and we need the integration of the entire higher cortex – right and left -the 80% of brain volume that makes us fully human – to emerge the mature, complex, fully alive, fully whole human beings we can be.We’re emphasizing right brain to right brain here because it’s an essential counter-balance to the dominance of the left brain in most of our dealings with clients, and because, for healing early attachment and affect regulation patterns, since those patterns are 100% implicit (outside of awareness)it’s the only thing that works.

HOW to do that: right brain to right brain therapy.

1)Attachment based, emotion focused means we want to help clients learn to regulate their own feelings or feel safe to experience them at all, and learn to empathize with other people’s feelings and know whose feelings are whose, and be able to manage and shift their inner emotional states from afflictive to wholesome and be able to respond to other people in appropriate connecting ways rather than pushing them away or swallowing them whole, we want to help clients be more comfortable with feelings and intimacy and closeness and connection, and help them deal with all feelings and all relationships in an open undefended way.

We do all that by: 1)becoming new, more adaptive attachment figures to the client.This almost goes without saying in psychodynamic therapy these days.Because the RH programming – the damage or de-railing of the 3 R’s occurred in relationships in the first place, the re-programming, creating new patterns of relationality, regulation of affect and resilience, will occur in relationship as well.Being reliable, available, attuned, empathic, helpful in the therapeutic alliance will create new experiences of the client’s self in relation to an other.We need to do this with the client over and over and over; adult brains grow new circuits more slowly than infant brains.But with enough repeated experiences over time, processed implicitly RH, explicitly LH, the client’s brain will grow new neural patterns, will internalize a secure base, perhaps for the first time ever in their lives, with all the possibilities for integration, flexibility, cohesion that implies.

2) In the therapeutic attachment relationship, if we can relate to our clients in the way that research has shown contributes to the development of the secure base in the infant, the implicit transmission of safety and trust through effective affect regulation, we can have some hope of contributing homologously to the earned internal secure base of the client.I.e. being present, attentive, being affectively and energetically attuned to the client’s affects and vitality affects underneath the story. (vitality affects are the background hum of energy and presence when “nothing” else is going on.) being resonantly empathic and unconditionally accepting of their inner reality, the gestalt of it, helping them experience and regulate feelings they have warded off as too dangerous or shaming to experience on their own, and that can include positive affects as well that the client can’t allow themselves to feel,help them regulate or bypass pathogenic affects of anxiety or shame to directly experience core affects or directly experience relating that anxiety or shame may be prohibiting.Right brain to right brain tracking facial expressions, tone of voice, gestures, body language, underneath the story.This sounds like what we all do all the time, but to work right brain to right brain, it really is all the time. Shifting the emphasis from any content to the inter-active process of the moment. Moment-to-moment tracking.That shifts in attunement and empathy happen in the briefest of moments, seconds, not over 5 minutes or 20 minutes or a whole session.Staying very experience near to the client, experience of their own inner states in the room with you.

3) This means privileging the relational-emotional experiences in the room over relational-experiences outside the room, and over any other kind of experience/story outside the room, and making that focus explicit.Because what heals a client around early attachment wounds, deficits in affect regulation, maladaptive defenses rather than resilience, isn’t so much technique or theory; it’s us.The warmth, genuineness of our caring about our clients and relating to them in explicit ways that show them we care.Softening, bypassing, confronting any defenses that would block the direct experience of feeling and the direct experience of connection.Acknowledging and honoring their usefulness at one time; de-pathologizing them, reframing as necessary strategies at one time but now getting in the way.

We know from neuroscience that whatever we turn our focal attention to will cause a neuron to fire.Focal attention creates brain change. If you and the client focus on the relational emotional experience of this moment, between the two of you, as a more adaptive experience in relationship; in fact, if you are deliberately evoking relational-emotional experiences between the two of you, you will help the client’s brain to install new implicit and explicit memory patterns it will make of this experience.

This is RH emotion and connection in the laboratory of the therapist-client relationship.In the intersubjective field, techniques of attaching and of affect regulation, techniques of: what are you feeling right now? (And deep empathy for that).Where are you feeling that in your body?What’s it like to feel that with me? I’m feeling touched as I hear you say that. What happened just now as you were remembering your brother turning away.You’re not alone; I’m with you. What are you experiencing right now, here with me as we sit together; what’s it like to be experiencing this here now with meWhat do you see in my eyes as we experience this here together.What do you see in my eyes as I feel what you feel?I’m so moved that you would share this with me. And, of course, attempting to repair any rupture, any empathic failure, any impasse immediately.Responding to client’s attempts to repair.This is intimate connection to emotional-relational experience and it’s deliberate.

Focal attention to activate and fire neurons works in both hemispheres of the brain, left and right.That’s how positive affirmations work.That’s how practices to cultivate compassion or gratitude work.That’s how creating new, more wholesome attachment and affect regulation patterns in therapy can work.We create new relational-emotional experiences with our clients, have the experience that is being registered implicitly through body language and emotions encode explicitly as well through our words, by talking about the experience as it is happening, and those experiences, repeated enough, begin to create new neural pathways, circuits, networks in the client’s right and left hemispheres.These experiences are processed and stored non-verbally in the RH as body sensations, emotions, images.Why this has to be done face to face, eye to eye, not on the couch or on the phone.Client has visual image of the light in your eyes looking at them with appreciation and respect and love, how they exist for you in your mind and heart. These new relational emotional experiences are real.They are not just an idea or concept or a hope.They are real and the feel real and then the client can begin to use them as a resource as a point of reference when things get weird, and as a point of comparison to other relationship experiences with other attachment objects past and present, and begin to choose. Accessible explicitly, operating implicitly, procedurally, new unconscious patterns of feeling, and dealing, while relating.

This very experience near, moment to moment work, to explicitly create new implicit relational-emotional patterns, goes beyond working in the transference, though we do that, too. We’re not just exploring the client’s projecting their old patterns onto us, so we can see what they are; we’re creating new experiences and installing them as patterns, as reference points, for comparison to the old or even current transference patterns of other self-other-emotion configurations.This work goes beyond re-enactments, though we do that, too, and consciously explore the dynamics and defenses against affect or against vulnerability or against intimacy that led to the re-enactment.We’re creating new experiences that can stand as alternatives and choices.This work goes beyond being a participant-observer and sharing with clients our comments on their experience; it is deliberately creating new experiences in the intersubjective field that we both participate in and both can observe and comment on.This requires self disclosing on part of therapist that is new territory for most of us, making our inner emotional experience of the client’s experience and their relating it to us explicit, out loud, visible, and vulnerable. This work goes beyond the client taking us in as a good object; it is internalizing themselves as a good subject.This work goes beyond mirroring, beyond seeing the client’s inner reality and reflecting it back to them, though we’re doing that, too; it’s letting them know their inner reality exists in our minds and hearts, we are tracking them, their reality exists and is important to us.“The roots of resilience are to be found in the experience of knowing we exist in the mind and heart of an empathic attuned self possessed other.” This is therapist being True Other to client’s True Self.This is emotionally intense work for the therapist; we are using the capacities of our right brain processing to create new experience of self, emotions and relationship to be processed and stored by the RH of the client.It’s how we create new experiences of self that gets to live in the mind and heart of the clients; it’s also how we get the leverage to budge the intractable old patterns that were laid down a long time ago and still exist in the mind and heart of the client today, if unconsciously.

We budge OLD patterns, re-wire them, really, by lighting up the neural networks of the old patterns, embedded implicitly, and begin to process them even without conscious awareness. This is jargon from the imaging technology that can measure areas of brain activation when we are concentrating on one particular mental activity or another.So what does it mean to light up the network? Turning our focal attention to a relational-emotional target. This could be an old memory. like we use in EMDR, which usually means an explicit memory after the age of 3, and when we ask about feelings and body sensations that go with that memory we can access still deeper patterns, but sometimes the target is a body memory that is before the age of 3 and has no words, but is real and is part of the memory network.We can attend to client’s dreams. which often have deep relational-emotional content and meaning to them coming from primary (RH) processing.We can use Gestalt techniques of empty chair work that can access early implicit memory along with later explicit memory.We can use guided imagery to light up the right hemisphere.If I ask each of you right now to imagine the EiffelTower, what experience do you have?[visual image? Memory? Any feelings or body sensations along with the memory?]We can use Eugene Gendlin’s Focusing techniques to help a client get to their visceral felt sense of what’s happening inside.Somatic experiences, movement, body work, brings information right from our body to the RH, the mind body connection is so strong.So we use these techniques to light up the network. And everyone has their favorites or ones they feel most comfortable with.We don’t have to use all of them.All the while staying very close to the client’s actual emotional-relational experiences in the room with you.

Then, we use techniques to re-write the pattern that has been lit up, even if it’s not completely explicit.Re-writing, by feeling emotions and imagining visual images, is as real to our brains as an actual experience.Research is showing that, too.Imagining a banana fires the same neurons in my visual cortex as seeing a banana.And with neural plasticity, the capacity of our brains to create new synaptic connections from new experience, even imagined experience, re-writing is re-wiring.This is not re-writing history, not re-writing what happened.But it is re-writing what could have happened. Andwhen that inner experience of what could have happenedis about emotions and relationships, by re-writing – re-wiring what could have happened emotionally-relationally, we are re-wiring the patterns that are the foundation of the inner experience of the self. (Remember that auto noesis, sense of self as self, is stored in RH.)

When a client is stuck in anger or fear or grief about a relationship, current or past or long ago past, lighting up the networks of that memory – the visual image, the emotions, the body sensations of that memory – (remembering that those networks can reach back to early, early implicit memory, even though we have no conscious awareness of that) allows us to process that memory – that pattern of neural firing – differently.Through portrayal. The client imagining the scene and then imagining very different actions, very different behaviors on their part (completion of motor response is very key here) can shift the emotions and the sense of self dramatically.A guided visualization. once those networks are lit up, can lead the client to a new experience very different than the old and in fact, re-wire the old, at least lay down a very viable alternative with a new groove to get there. [new protocol from Barbara]Expressive arts. music therapy or sand tray. if focal attention is used to light up network first.Inner child work. whether done as portrayal or guided visualization or empty chair, can totally alter a person’s sense of self from way back.Bringing in resources in the form of imagined wise guide or best friend or larger self can re-wire one’s experience of one’s self and one’s emotions.Movement therapy. even body-based practices like yoga or tai chi can begin to process this relational-emotional material; can always tell when a client has begun a yoga practice; they are in their bodies and in their experience of self differently.

Using the reflective capacity of our left brains to make all of this re-wiring explicit and talk-about-able helps integrate the experience into both right and left hemispheres of the brain and make it accessible to explicit memory and processing later, forever.Using our left brains to help integrate this right brain work, while we are in right brain mode at the same time, is also helpful because the right brain does process information holistically rather than linearly, bit by bit.It tends to integrate in new information quickly by making it fit old information/patterns it already had.We gradually need to change the whole picture, the whole pattern, not just pieces of it, bit by bit. But talking about the changes as they happen, bit by bit, is part of changing the whole.That can then become the new implicit procedural knowing.

To do this work, we do need to be able to be engaged with a client in an open authentic intersubjective field; we need to be able to receive, hold, contain, metabolize a lot of affect, our own and clients, especially negative affect; we need to be able to repair empathic failure and rupture; we need to be able to regulate clients affective experience until they internalize capacities to regulate for themselves; we need to be resilient in the face of stress, to self cohere, to cope; we need to be able to observe and reflect on the process when client goes into disorganized attachment, dissociation or collapsed state.We need to be able to process at the meta level at any time, maintain the big picture, the balanced perspective; we need to have our own external differentiation, internal integration and capacities to tolerate and thrive in complexity.So, as wounded healers, just in case we don’t have our own internal secure base yet, this work will require us to get there.

Linda Graham, MFT, is in full-time private practice in San Francisco and Corte Madera, CA, specializing in relationship counseling for individuals and couples. She offers consultation and trainings nationwide on the integration of relational psychology, mindfulness, and neuroscience. She publishes a monthly e- newsletter on Healing and Awakening into Aliveness and Wholeness, archived on www.lindagraham-mft.com, and is writing a book: Growing Up and Waking Up: The Dance of the Whole Self. Contact Linda through this website

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