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The Developing Mind: Toward a Neurobiology of Interpersonal Experience, by Daniel J. Siegel, Guilford Press, 394 pages. Attachment in Psychotherapy, by David J. Wallin, Guilford Press, 366 pages. My desire to know more about why we act and behave as we do seems to be never-ending. Neurobiology, while important especially in the treatment of certain disorders, has never been a practice priority. Referral to a psychiatrist for medication assistance supplanted my need to understand the brain and the bio-chemical aspect of treatment. I have had significant exposure to attachment theory during my education and training. Unlike neurobiology I have understood the practice implications and have benefited from this knowledge. Researchers like John Bowbly and Mary Ainsworth, sometimes referred to as the father and mother of attachment theory, are the acknowledged giants in this field. Their collaborative efforts identifying infant attachment classifications were simple but powerful ideas. This encouraged others to research and develop the reach of attachment theory. Eminent researchers like Mary Main moved the "focus of attachment research from infancy to adulthood and from nonverbal behavior to mental representation." Peter Fonagy helped to identify "intersubjective attachment relationships" important in the development for insight and empathy in humans. Daniel Siegel's book, The Developing Mind, integrates attachment theory and neurobiology. He does so by synthesizing neurobiology, research psychology, and cognitive science, skillfully guiding the reader through a detailed overview of attachment theory. He presents a clear understanding of brain structure as well as function and demonstrates how the different forms of attachment impact brain development. The availability of new brain imagery technology makes it possible to examine the structure of the brain. This in turn has made it possible to understand how "communicated emotions influence the regulation of brain circuit growth and the consolidation of cognitive systems." The final importance of this work is Dr Siegel's ability to translate research findings and point to direct implications for psychotherapy. It is this application to the practice of psychotherapy that has stimulated my interest. My past attempts at learning about brain physiology have always ended in frustration because of the lack of perceived relevance to my practice. Not the case anymore. Here is one example of many that the author presents about how individual personality is created. He points to the ongoing interaction of "genetically determined constitutional features and experiential exchanges with the environment, especially the social environment" as central to individual personality development. Notice the stress on interaction and the suggestion that dysfunction emerges "not from genes and experience in isolation from each other." Reading on, you see how human connections are necessary for the creation of neuronal connection. New neuronal connection, the "stuff" that memory and behavior are made of, in turn can be created(neurogenesis). The implications for treatment grow large for the practitioner. Because of the brain's "plasticity," further development beyond early childhood is possible. The author includes a discussion about attachment relationships and points to research and effective treatment studies: The most productive approach to creating lasting and meaningful results for treatment is via the medium of attachment relationships… Attachment research suggests how relationships can foster healthy brain function and growth. Here is what is very important to our practice: Growth happens through contingent, collaborative communication that involves sensitivity to signals, reflection on the importance of mental states and the nonverbal attunement of states of mind. Is this not what is central to the development of the clinical setting? Nothing new here! What is new is Dr. Siegel's connecting the prescription of how to affect change and how we practice to the development of the brain. This appears to be the connection of a heretofore "soft science"(psychotherapy) to a hard science (neurobiology). This is exciting indeed. Time and the need for brevity prohibit further exploration of this work. I encourage you to purchase this book and expect to spend many hours reading and digesting the information. This is not a fast read; I have had to go slow to enable the digestion of the knowledge presented. The second book, Attachment in Psychotherapy, by David Wallin, provides a perfect complement to David Siegel's work. Dr. Wallin describes the structure of the brain( the brain stem, the limbic system and the neocortex) and points out each structure's importance in clinical terms. I found his presentation of structure more easily understood because he addressed the clinical implications for treatment with each part of the brain. He discusses the brainstem: One clinical implication here is that treatment must take into account our patient's brainstem based pattern of over and under arousal…Therapy, especially with patients who have been traumatized hinges on our ability to accurately read and effectively modulate their levels of physiological arousal as well as their needs for relational engagement. Focus on the body and nonverbal experience within the therapeutic setting to facilitate this. He discusses the limbic system, the emotional brain where feelings are processed: The limbic system is where the internal and external worlds meet. It is here where, at an emotional level, we work out our relationship between ourselves and the exigent realities that exist outside our bodies… The limbic system is the neural substrate of the emotional self. The author spends time discussing the two key structures, the amygdala and the hippocampus. The amygdala is well-developed at birth and "is the sensory gateway to the limbic system. The hippocampus acts as a modulator of the amygdala's bias toward indiscriminate, uncontrolled, hair trigger reactions." We come to understand the balance of old and new information (memories) and how the secure relationships (parents or therapist) will allow the "child's developing hippocampus to balance the reactivity of the amygdala." Finally he says, "the patient in psychotherapy who revisits old trauma in the setting of a new attached relationship can forge fresh associations in the brain and the mind." Therapy, through the developed context of safety, can gradually transform recalled traumatic memories, fears and hurts (remembered past) . This can help "dampen long evoked automatic amygdala reactions." The author's discussion of the neocortex is far too complex to synthesize here. His continued use of the clinical implication of understanding the various sub-structures made it easy for me to understand and integrate. My focus on brain structure reflects the author's presentation priority. Understanding how and why the brain interacts with the body sets the stage to craft intervention strategies when working with our patients. Dr. Wallin addresses how the "self develops, the multiple dimensions of the self and how the varieties of attachment experiences shape the self." As you progress though this work, the words parent and therapist become synonymous. This reflects the role therapy can play in changing behavior as well as changing the hardwired neurological structure. The latter section of this book discusses attachment theory and clinical practice. I was particularly impressed by the need to understand "the language of the non-verbal." The author states, " we risk allowing the words we exchange in therapy to monopolize our attention." By doing so we lose sight of the fact that beneath the words "is a flow of critically important experience that provides the underlying context for the words." This unarticulated experience with its "fundamental emotional and relational quality is often where we find the greatest leverage for therapeutic change." The last two sections of this book develop, in more detail with specific clinical interventions discussed, how the body is the access point for much of the material needed to help clients heal. The concept of intersubjectivity is explored and we become aware of the third system in the room with the patient. The third focus is the subjective experience we each share as a result of our attached relationship with the client. The access of the non-verbal material that exists between the therapist and the client, our created subjective experience, has the potential to help the unconscious material to emerge. What I find challenging and very exciting is the active role we play though our own awareness of body/feeling sensations evoked within the therapy hour. What we have come to know as transference and countertransference takes on a new meaning when viewed through the lenses of the intersubjective experience. My attempt has been to share the important development in the field of neurobiology. The overlaying of the science of the brain with attachment theory and the concept of intersubjectivity provides us with more to think about. It may affirm some of what we know and how we practice. Hopefully the material contained within these two impressive works will challenge us to know more about ourselves, the other very important person (our subjective self) in the room with our clients. Fred Crimi is a licensed clinical social worker, providing psychotherapy for adult men, woman and couples. With 36 years of diverse professional experience working in the mental health field, he is able to assist individuals and couples to understand and change behavior. more>>>> |