Being a Brain Wise Therapist A Practical Guide to

Interpersonal Neurobiology (Norton Series on Interpersonal

Neurobiology)

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Schuster Adult Publishing Group, from AN ALCHEMY OF MIND
by Diane Ackerman. Copyright © 2004 by Diane Ackerman. All
rights reserved.
For my
daughter
Kate
The Brain—is wider than the Sky—
For—put them side by side—
The one the other will contain
With ease—and You—beside—
Emily Dickinson
“The Brain is Wider Than the Sky”1

Ultimately, I find consciousness a

fascinating predicament for matter
to get into.
Diane Ackerman
An Alchemy of Mind2
 Contents

Foreword: Daniel J. Siegel

Acknowledgments
Introduction

Part I: Theoretical Foundations

1. Preliminary Thoughts
2. The Brain’s Building Blocks
3. The Brain’s Flow
4. The Relationship between Brain and Mind
5. Attaching
6. Picturing the Inner Community
7. The Mutuality of the Therapeutic Relationship
8. An Application: Embracing Shame

Part II: Practical Matters

9. Preliminary Thoughts
10. Through the Lens of Diagnosis: Depression, Anxiety,
Dissociation, and Addiction
11. Grounding Therapy in the Right Brain
12. Listening to Family Histories
13. The Three Faces of Mindfulness
14. Getting Comfortable with the Brain
15. Patterning the Internal Work
16. The Integrating Power of Sandplay
17. Doing Art
Part III. Working with Couples, Teens, and Children
18. Preliminary Thoughts
19. Keeping Our Balance with Couples
20. Meeting Teens with Their Brains in Mind
21. Playing with Children, Supporting Their Parents

References
 Foreword

Being a Brain-Wise Therapist is filled with the wisdom of a

seasoned front-line therapist who writes like a poet and understands science
as if she were a full-time academician. What a rewarding combination!
Journeying through these pages offers us an opportunity to explore the
fundamental ideas of interpersonal neurobiology (IPNB), an
interdisciplinary view of the mind and human development built upon a
wide range of sciences and therapeutic arts. Through theory and practice,
the stories ahead enable us to see the direct applications of this approach in
various clinical situations.
An astute learner and deep thinker, Bonnie Badenoch has been a student
and colleague with whom I have been fortunate to dive deeply into this
exciting new field. When she first presented the idea of a workbook that
revealed the depth of her understanding and her passion for integrating
these ideas into clinical practice, the notion of this book was born. It is an
honor to write this foreword for what has blossomed into a wonderful guide
to this emerging field. IPNB is an approach that seeks the consilience across
distinct disciplines so that we can find the parallel principles that emerge
from different efforts to understand the world and ourselves. This
integrative approach reveals a larger picture, the “whole elephant” view of
human experience and mental health.
Applying scientific ideas to the field of psychotherapy is no easy task.
Without rigor, it is easy to slip into overly simplistic views of complex
conditions. This risk is always present when we draw on objective research
findings and attempt to create clear conclusions that then can be applied to
the subjective world of clinical interventions. In this book you will find an
artist’s hand that paints a clear and useful picture as it reaches a beautiful
balance between what we know from science and what may possibly be
occurring in the subjective inner and interpersonal worlds of our therapeutic
efforts.
 Beginning with theory and moving deeply into practical applications,
this wise author takes us on an enjoyable educational journey into the lives
of individuals and families. The pathways toward healing are illuminated by
her inviting narratives as she seamlessly weaves scientific theory with
humanistic interventions. These ventures into the clinical art of healing
continually weave the threads of interpersonal neurobiology into the
tapestry of a coherent framework of the mind, the brain, and human
relationships. This text serves as a powerful starting place for those new to
this interdisciplinary approach and as a deepening review for clinicians
already practicing with this view of the brain in mind.
For some, science has no place in the therapist’s mind. “Since science
doesn’t even know how the ‘brain creates the mind,’ why bother knowing
anything about science?” some cautious critics question. Yet with careful
analysis of the research findings, conservative attempts to illuminate a
larger and integrated picture of the whole can be both possible and quite
fruitful. When we stay close to the science, as Bonnie Badenoch does in her
writing, we then build a solid foundation for all that follows.
Interpersonal neurobiology embraces the perspective of a triangle of
well-being. The three points of this figure are made up of relationships, the
mind, and the brain. Though some scientists would cry out “dualism” if we
even see mind as more than the “mere activity of the brain,” modern
research actually suggests that the causal arrows of brain causing mind are
actually bidirectional. The mind can also be seen to use the brain to create
itself. The focus of our energy and information flow, one aspect of mind,
can actually change the activity and the structure of the brain itself. In the
IPNB model, we are being even more “politically incorrect” by stating that
there are not just two but actually three irreducible elements of human
experience. The mind in this perspective is the process that regulates the
flow of energy and information. Relationships are how we share energy and
information. The nervous system of our bodies embeds mechanisms by
which energy and information can flow. This sharing, regulation, and
mechanism cannot be reduced into each other. In this way, we examine
energy and information flow as being fundamental to human experience.
As the mind is both embodied and relational, we see a healthy mind
emerging from an integrated state: When elements of the system being
examined—an individual, couple, family, group, or perhaps society—are
integrated, that system is said to be the most flexible, adaptive, coherent,
energized, and stable. This FACES flow is a description of well-being. The
defining feature of this state of health is integration, which consists of the
linkage between differentiated elements of a system. Using FACES,
clinicians can approach evaluation from a new perspective: the assessment
of states of integration. The hallmark of a nonintegrated system are its
tendency to move toward chaos or rigidity or both. The quality of an
integrated system is that of coherence: connected, open, harmonious,
engaged, receptive, emergent, noetic, compassionate, and empathic. This
FACES flow—this harmonious, coherent state—is the characteristic of a
healthy condition in mind, brain, and relationships.
In the pages that follow, you will be given the opportunity to learn about
these basic principles of interpersonal neurobiology and see how they can
be applied in clinical work. As a part of our Norton Series, Being a Brain-
Wise Therapist adds an important educational opportunity for us all to see
the power of this approach to help others heal and develop toward well-
being. Enjoy!

Daniel J. Siegel, M.D.

Director, Mindsight Institute
Co-Director, UCLA Mindful Awareness Research Center
 Acknowledgments

In 2003 two of us from our small agency in Irvine, California,

attended the Annual Attachment Conference at UCLA where Dan Siegel,
Allan Schore, Ed Tronick, and others spoke about how science now
confirms that relationships shape our brains at the beginning of life, and that
certain relationships can continue to repair wounded minds throughout the
lifespan. We felt as though scientific ground had been placed beneath our
feet. For the 12 preceding years, building on the inner community paradigm
I had learned experientially in my own therapy with Dr. Timothy Maas, we
had had the experience of individuals healing profound psychological
wounds in the company of a compassionate therapist. We sensed the
importance of this person being a calm, comforting presence when these
courageous people needed to reenter the part of their inner world where the
roots of their pain lay. Now, with the discoveries of the last two decades,
synthesized by expansive, scientifically grounded minds, we had the
beginning of a blueprint about what was happening in the brain during this
process.
We began a project of pulling these two paradigms—interpersonal
neurobiology and inner community—into the pot together, stirring
vigorously, and seeing wonderful results for the families who came to our
clinic for care. Before sharing what we learned in that endeavor, I do want
to acknowledge the depth of inspiration and support I have received from
many sources. To begin, 20 years ago, Tim Maas guided my recovery from
a fragmenting childhood, instilling at the same time my felt awareness of
the diverse aspects of each person’s inner world. Because I had the
opportunity to learn about this inner community with both hemispheres of
my brain, it became the support for all the clinical work that has followed in
my 18 years as a therapist.
Foundational is the burgeoning research of neuroscientists across the
globe. Their work is the first generation, the ground in which new theories
of mental suffering and healing are able to flourish. Daily, my Mac is
flooded with discoveries that constantly challenge me to keep moving, to
take into account this new information as I sit with patients and colleagues.
We are at the beginning of this unfolding process, with no end in sight.
Now, the second generation is synthesizing these bits of new knowledge
into theories that support an expanding vision of how we can foster healing
from even the most severe wounds. In recent years, my primary guide in
this inner integration of science with the art of therapy has been Daniel J.
Siegel, in whose study groups, trainings, consultations, and talks my mind
has been reshaped to hold the broad vision of interpersonal neurobiology as
it illumines our healing work with ourselves and our patients. He has
challenged me to think carefully about language, so whatever precision is
found in these pages bears his imprint. In my experience, it is rare to find a
person with this kind of integrative imagination and original thought who is
also humble and accessible—and extremely funny. I think he has added at
least 10 years to my active life because my brain has not been lit up with
such a flow of ideas and experiences since I was in my 20s. As a result, the
feeling of gratitude is many-layered.
Dan’s study group is also a place where I have found new friends,
fellow travelers on the Inner-Galactic Express. I always walk away feeling
connected, even with those I have not yet gotten to know well, by some
magic of integrating minds. Two dear friends and colleagues from this
group, Donna Emmanuel and Carol Landsberg, have been kind enough to
carefully read the manuscript, contributing innumerable helpful suggestions
about content and style. Whatever clarity of expression you may find here
has been sharpened by them. My heartfelt thanks to both.
Out of our contact with Dan, a new group sprouted—GAINS (Global
Association for Interpersonal Neurobiology Studies). Our Board of
Directors—Lauren Culp, Carol Landsberg, Raven Lee, Judith Miller, Kirke
Olson, Joan Rosenberg, Debra Pearce-McCall, Sue Marriott, and Kathy
Scherer—continues to set my inner landscape alight with the feeling of
being part of a community dedicated to fostering principles that might
actually contribute in a practical way to a more awake and compassionate
world. GAINS’s main endeavor so far is Connections & Reflections, a
quarterly publication about applying interpersonal neurobiology in various
fields. Our staff of writers and editors—Lorraine Granit, Bea Armstrong,
Jeff Anderson, Joan Rosenberg, Lauren Culp, Alex Onno, Lisa Firestone,
Kirke Olson, Raven Lee, Carol Landsberg, Debra Pearce-McCall, Ron
Levine, Jane Wheatley-Crosbie, Noah Hass-Cohen, Paul Cox, Donna
Emmanuel, Richard Hill, and Tina Bryson—together with our advisory
board contributors—Dan Siegel, Pat Ogden (with Janina Fisher), Tom
Burton, Carl Marci (with Helen Reiss), Diana Fosha, Marco Iacoboni,
Diane Ackerman, and the late John O’Donohue—contribute a wonderful
diversity of viewpoints from their emerging understanding of how to
embody these principles. Our mutual wrestlings with form and content have
pushed me to sharpen my awareness of neurobiology, and deepen my
appreciation for the fundamental humanity of this endeavor. At times, our
creative process feels as though it is emerging from one mind with many
hands.
Most of my other guides have come to me through the pages of their
books and articles, with the occasional seasoning of conference
appearances. Allan Schore’s understanding of regulation as the primary
creator of an emerging sense of self has shaped the way we therapists think
about our relationships with the patients who come to us. He has inspired us
to focus on the unfolding right-brain to right-brain interactions between us
and our patients, a dance that often proceeds below our conscious
awareness, providing an essential foundation for healing. Thinking about
therapy this way, we are led to the inevitable conclusion that our own
mental health is the cornerstone of our capacity to be agents of neural
integration. In addition, during the preparation of this manuscript, he was so
generous with his time, encouraging me to deepen my knowledge of
neurobiology.
Stephen Porges has taught us about fostering healing experiences by
creating environments that are dense with the feeling of safety. Ed Tronick
brought conscious awareness of the processes of rupture and repair into the
center of how we do therapy. Pat Ogden has encouraged us to integrate the
body into the way we understand the impact of trauma and developmental
injuries on the whole person. Marco Iacoboni has illuminated the wondrous
way mirror neurons connect us, body to body and heart to heart. Jeffrey
Schwartz pushed me to wrestle with the issue of free will, because without
that, what do we imagine we are doing? Building on John Bowlby’s seminal
work, Mary Ainsworth, Mary Main, and Eric Hesse have provided the
essential framework for understanding the crucial importance of our earliest
relationships. Although the list is longer, these people’s unique insights are
bedrock for our integrative endeavor.
Now, we come to the third generation—those of us in the trenches,
seeking ways to make these theories live in the midst of our work. The staff
of Center for Hope and Healing, where I have the privilege of mentoring
and supervising the next generation of therapists, is a constant source of
goodness for me. Our felt preference for empathic relationships has drawn
us together and continues to support each of us as we make our way
through the underbrush of our patients’ painful worlds. The staff also has
had a large share in shaping this book through the spirited interactions that
blossom in supervision. I particularly want to acknowledge Cindy Cook and
Emily Gombos for their depth of experience, which has enriched the
chapters on children, parents, and teens. As we have shared these materials
with other therapists in the community, the lively debate and conversation
we have about these concepts, along with the uniqueness of my colleagues’
thoughts, has further broadened my awareness of the power of these ideas.
In addition to this intellectual and empathic support, I am so grateful for
the community and corporate foundations who have long supported the
work of our small nonprofit. This writing project would not have been
possible without the tangible gifts of The California Endowment, The
Fieldstone Foundation, The PIMCO Foundation, the Irvine Health
Foundation, the Boeing Employees Community Fund, and an anonymous
donor whom I hope will recognize herself here. All of these organizations
and people do enormous good in our community.
It goes without saying that profound inspiration comes from the people
we serve, as they willingly take us into the dark night of their pain, in order
to become better human beings for themselves and their families. When
events in the wider world give me cause to question the courage and
intrinsic goodness of human beings, these determined people restore my
faith. They continually expand my awareness of the heart’s willingness to
face monsters, and the mind’s capacity for restoration. My admiration and
respect know no bounds. I want to particularly thank those who have been
willing to share their stories for this book, all of them in the hope that their
suffering and recovery might become stones cast in the pond of healing,
with ripples radiating to touch and inspire others.
From the first day this project reached Norton, Deborah Malmud guided
it through the maze toward publication with wisdom and focus. She also
drew me into the sort of collaborative partnership I like best—a potent
mixture of kindness and honesty. Kristen Holt-Browning, Sue Carlson,
Margaret Ryan, and Vani Kannan answered my numerous questions,
humored me in my ignorance of the process, gently helped mold the
manuscript, and, with Deborah, gave me room to feel at home with many
beneficial changes, while honoring my sense of the flow of the overall
project. Closer to home, artist Ron Estrine worked with me to create brain
images that are clear and beautiful.
A number of people whose ideas don’t directly appear in these pages
formed my own inner first generation. They have shaped my vision of the
human capacity for transformation and the expression of truth, beauty, and
compassion. Graham Ledgerwood (Ramakrishnanandaji) set my feet on the
spiritual path, and remains my constant inner guide. Dave Brokaw gently
directed my fledgling steps as a therapist and left such a mark by
embodying profound respect for all people. Tom Burton, life-friend and
provocateur of my becoming a writer, has been the kind of encouraging
support everyone deserves. My sister, Patti Lampman, asks a lot of deep
questions, and out of those discussions arise greater awareness and more
love.
I have felt such strong support for my inner life from three people I met
only once, but whose own well-cultivated lives have permeated mine to a
remarkable extent. Diane Ackerman and the late John O’Donohue offered
words and visions that draw my inner spaces into deeper contact with the
world of grasshoppers and communion—at the same time. Their attention
to detail, accompanied by a profound sense of the sacred, fills me. Spending
2 days at a conference in the presence of Jack Kornfield’s compassionate
heart and wise mind transformed something I can’t quite grasp in words,
adding significantly to my lifelong spiritual journey.
At the core of it all, my dear family—Tom, Andy, Kate, Jocelyn, and
Cindy—provides the epitome of inner and outer support. They have been
kind and patient as my energies have been quite internal during this work of
remaking my own mind to hold all this healing goodness. When I need to
apply the principles to every daily event, they tease and laugh and tolerate
my obsessive ways. Most of all, they have cradled this endeavor with the
gentleness and humor that are typical of them. On the practical side, they
have made sure I have food, sleep, laughter—and the occasional movie
night. I am so grateful for how all these lives are woven with mine, creating
the ground and foundation for everything else I do.
In an entirely different vein, I thank flowing water—rain, streams,
oceans, showers—as a sweet and reliable source for birthing the integration
of emerging ideas. I can count on words to bubble up, mesh, and find a
happy arrangement just by being in the presence of water. We never really
know where or when we may find such precious companions. Or perhaps
they choose us.
And, of course, any interesting mistakes are entirely of my own
crafting.