There have been a number of psychological theories that have influenced the Social Work and Counseling Professions.  However, I will only discuss some of the primary concepts of Interpersonal Neurobiology and Attachment Theory.  In addition, I will explain my “use of self” as the therapist in each theory, which relinquishes the social worker as an “expert” and replaces it with a more collaborative approach that involves using one’s self as a reparative object. Being able to be present therapeutically on behalf of another person requires a range of skills and abilities, including the intentional and disciplined use by the counselor of his or her experience, relational skills, and knowledge/wisdom in the benefit of the client. 

Interpersonal Neurobiology:

Interpersonal Neurobiology is an interdisciplinary field which brings together many disciplines in science including but not limited to anthropology, biology, linguistics, mathematics, physics and psychology to determine common findings about the human experience from different perspectives. Daniel J. Siegel, M.D. is a pioneer in the field called Interpersonal Neurobiology, which seeks the similar patterns that arise from separate approaches to knowledge.  Aside from Siegel, some of founding theorists are Stephan Porges, Edward Tronick and several more.

One of the primary concepts of interpersonal neurobiology approach is “Integration,” which ultimately promotes a flexible and adaptive way of being that is harmonious as opposed to chaotic. The brain is always in a process of working towards integration. According to Dr. Siegel, integration is viewed as the core mechanism in the cultivation of well-being and healing.  He writes:

In an individual’s mind, integration involves the linkage of separate aspects of mental processes to each other, such as thought with feeling, bodily sensation with logic. For the brain, integration means that separated areas with their unique functions, in the skull and throughout the body, become linked to each other through synaptic connections. These integrated linkages enable more intricate functions to emerge—such as insight, empathy, intuition, and morality. A result of integration is kindness, resilience, and health. Terms for these three forms of integration are a coherent mind, empathic relationships, and an integrated brain (Siegel’s website, 2014).

Another major concept in the emerging field of Interpersonal Neurobiology is the concept of “neuroplasticity,” which entails the rewiring of the brain through the use of mindfulness practices, or, what Dr. Dan Siegel refers to as “Mindsight.”   At its core, interpersonal neurobiology holds that we are ultimately who we are because of our relationships. We simply can’t grow and evolve without intimate relationships (Seigel’s website, 2014).  

Some of the assumptions of the nature of the problem are similar to attachment theory, such that the lack of early childhood attachment with a caregiver leads to an insecure attachment, which inevitably causes neural disintegration—a chaotic or fragmented sense of self and mind.  According to IPNB, the nature of the problem is both biological and social. An individual is born into the world with a genetic imprint (DNA); however, in the process of human development one can either experience secure attachments with very little trauma’s, or, insecure attachments with several stressors and trauma’s in early life and throughout one’s life span.  If the later occurs, an individual’s brain has a greater risk of becoming wired in a way that is unintegrated and may hold dissociated traumas, losses, and chemical loads that are toxic to the growing brain.

According to IPNB, our relationships have the potential to literally change the brain, particularly the most intimate ones, for example, with our primary care givers or romantic partners. While it was once thought that our early experiences defined who we are (social constructionism), interpersonal neurobiology holds that our brains are constantly being reshaped by new relationships.  This offers tremendous hope to all trauma survivors, psychotherapists, psychiatrists and their patients. Thus, positive relationships produce positive changes, which yields healing for those who have suffered from trauma (Badenoch, 2010).

Integration requires the implementation of a practice referred to as “mindsight,” another major concept of IPNB.  According to Dr. Siegel’s website, “Mindsight describes our human capacity to perceive the mind of the self and others. It is a powerful lens through which we can understand our inner lives with more clarity, integrate the brain, and enhance our relationships with others. Mindsight is a kind of focused attention that allows us to see the internal workings of our own minds” (Siegel, Website). What is particularly fascinating is that when an individual develops the skill of mindsight, they actually change the physical structure of the brain.  And we can grow these new connections throughout our lives, not just in childhood.

The emerging field of neurobiology is also changing the way in which therapist think about therapy, what they think happens during therapy, and how they think they should engage in the joint project together.  Bonnie Badenoch’s book Being a Brain-Wise Therapist, brings IPNB into the counseling room, weaving the concepts of neurobiology into the ever-changing flow of therapy.   She uses examples from her own therapeutic practice, which involves inculcating mindfulness practices into therapy.   Implementing the use of mindfulness practice aids in the building of neural intregration and mental health.

In the book she clarifies her “use of self” as a reparative secure attachment in the therapeutic process with clients.  According to Bonnie, one of the unfolding processes in therapy is the reactivation of the attachment system, often accompanied by anxiety and vigilance, since for most patients, the initial attachment process did not go well.  

In the therapeutic process, attachment seeking behaviors are activated.  As the longing for attachment dawns, therapist have the “precious opportunity to help their patients mend/rewire even the earliest relational fears, adding the new information of compassion, care, safety, stability, and warmth that is our contribution to the interpersonal system. ” (Badenoch, 2010: 54).   Supposedly, human’s neurologically regulate each other right brain to right brain. The Therapist acts as the central nervous system regulator, which allows for the healing to take place.

Bonnie further explains that “The very heart of secure attachment is contingent communication, which involves receiving people’s signals (nonverbal more than verbal) and responding in a way the lets them “feel felt” (Badenoch , 2010: 57). It is important to commit deeply to going into a patients world, no matter how painful. Being able to provide a sense of safety for patients is central to providing regulatory experiences.  Bonnie writes “When this wish to comfort is accompanied by streams of accurate empathy, the stage is set for profound healing. This kind of connection is at the heart of helping our patients develop balance through dyadic regulation (which leads to the capacity for self regulation” (Badenoch , 2010: 92).

Through repeated experience, the client will internalize a warm, caring presence that can comfort them when the therapist is not physically available.  This builds confidence and self-reliance in the client. According to Bonnie there is an increased neural integration as a result of the comfort, empathy and bonding in the therapeutic alliance. Overtime, the patient moves from insecurity to an earned secure attachment (Badenoch, 2010).

Attachment Theory:

Attachment Theory is focused on the relationships and bonds between people, particularly long-term relationships including those between a parent and child and between romantic partners. According to attachment theory, “the presence of a principal attachment figure as a source of emotional security significantly affects human development.  During infancy, the caregiver’s role is to provide a secure base from which the child can explore his/her surroundings. The caregiver’s response to this need will affect the child’s attachment behaviors” (Bettman & Jasperson, 2010: 98).   

The theory of attachment was originally developed by John Bowlby (1907 - 1990), a British psychoanalyst who was attempting to understand the intense distress experienced by infants who had been separated from their parents. Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life. He suggested attachment also serves to keep the infant close to the mother, thus improving the child's chances of survival.  (          )

The central theme of attachment theory is that humans grow and evolve through forming attachments at an early age. Infants need to develop a relationship with at least one primary caregiver for the child’s successful social and emotional development, and in particular for learning how to effectively regulate their feelings. Primary caregivers who are available and responsive to an infant's needs allow the child to develop a sense of security. The infant knows that the caregiver is dependable, which creates a secure base for the child to then explore the world. If the caregiver is unstable and unreliable, this creates an insecure attachment, which causes severe anxiety and depression. (    )

The assumptions of the origin of the problem are due to faulty socialization, insecure attachment and the development of an insecure working model (theory matrix). Attachment theory is not a developmental theory as there are no stages one must go through in order to achieve health. There is a critical attachment period that occurs between 0-3 years of age.  If bonding doesn’t occur from 0-3 a secure attachment becomes more difficult to attain (Theory Matrix).  Another assumption in attachment theory is that the same motivational system that gives rise to the close emotional bond between parents and their children is responsible for the bond that develops between adults in emotionally intimate relationships.  The later assumption was formulated by later researchers who further developed the theory, one of which is Mary Ainsworth.

Expanding greatly upon Bowlby’s work, a psychologist by the name of Mary Ainsworth performed a study titled "Strange Situation" (1970’s) that revealed the profound effects of attachment on behavior. Ainsworth found that children will have different patterns of attachment depending primarily on how they experienced their early caregiving environment. Early patterns of attachment, in turn, shape – but do not determine - the individual's expectations in later relationships.

In the study, researchers observed children between the ages of 12 and 18 months as they responded to a situation in which they were briefly left alone and then reunited with their mothers. Based upon the responses the researchers observed, Ainsworth described three major styles of attachment: secure attachment, ambivalent-insecure attachment, and avoidant-insecure attachment. Later, researchers Main and Solomon (1986) added a fourth attachment style called disorganized-insecure attachment based upon their own research.

Attachment styles also have an impact on behaviors later in life.  For example, Children diagnosed with oppositional-defiant disorder (ODD),conduct disorder (CD) or post-traumatic stress disorder (PTSD) frequently display attachment problems, possibly due to early abuse, neglect or trauma. Clinicians suggest that children adopted after the age of six months have a higher risk of attachment problems. (      ).  On the other hand, those who are securely attached in childhood tend to have good self-esteem, strong romantic relationships and the ability to self-disclose to others. As adults, they tend to have healthy, happy and lasting relationships.

The therapists “use of self” is an integral part of helping the client to move towards more health and integration.  For attachment theory, the “use of self” is similar to Interpersonal Neurobiology.  The therapist acts as a reparative secure attachment figure and provides a safe container that allows the client to regress to the ruptured attachment. The therapist responds with attunement and repairs attachment ruptures.  Through the practice of empathetic listening, facial expression, eye contact, tone of voice, tempo, breathing, the therapist creates a kind of wordless but dense and charged felt presence, which permeates the being of both therapist and client.   At some point in the therapeutic process, the client internalizes and “earned secure attachment” and will hopefully generalize it to other relationships.

This paper identified some major concepts and assumptions in Attachment Theory and Interpersonal Neurobiology.  It also clarified several ways in which the therapist uses themselves as a reparative object for healing trauma’s and insecure attachments.  Both theoretical perspective draw from similar roots, but are different in their approach.   What is fascinating to me is how they are completely transforming the way in which therapy is done and what is occurring in the brain of both the therapist and client during the therapeutic process.  Interpersonal Neurobiology is taking Psychotherapy to a whole new level by scientifically proving things that have always been doubted by pragmatic Behaviorists.  For example, Wylie and Turner’s article The Attuned Therapist, explains the “seemingly immense divide between psychological and biological sciences and how Interpersonal Neurobiology has been a new “integrative bridge” which includes the whole human system—mind, brain, body and relationship. 

According to Wyle and Turner, “Psychology was dominated by a behavioral model during the ‘60’s and ‘70s, then by cognitive models in the ‘80s and ‘90s, and now affect and psychobiological processes are taking center stage” (2011, 48).  

For many years there was little knowledge about the biology of emotion and feeling—what they were, where they were in the brain, what caused them, how they influenced behavior.  However, according to Wyle and Turner, for the past 15 years, neuropsychological scientist and therapists claim that we are in the throes of an “emotional revolution,” that is more integrative and validating of the power of the emotions and interpersonal relations to change the physical structuring of the brain (2011).   

After decades of cognitive and behavioral therapists purposely seeking to put emotions out of sight and out of mind, they’re being forced to relearn the ancient emotional systems have a power that is quite independent of neocortical processes.  She writes, “In our increasingly technological world, therapy seems to be directing our attention to the very core of our primeval being, the ancient emotional systems that are the source of love, hatred, rage, desire, compassion, of our unquenchable need for connection with others of our own species.” (      49).   I am particularly fascinated by the cutting edge work of Nancy Chodorow who wrote book called The Power of Feelings.  Not only is this work challenging dominant paradigms in Sociology and Psychology, but it is changing and improving the way in which we do therapy.

 References:

Badenoch, Bonnie. (2008). Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology. W.W Norton & Company, New York, NY.

Bettmann, Joanna and Jasperson, Rachael. (2010). Anxiety in Adolescence: The Integration of Attachment and Neurobiological Research into Clinical Practice. Clinical Social Work Journal, 38:98-106.

Wylie, Mary Sykes & Turner, Lynn. (2011). The Attuned Therapist. Psychotherapy Networker, March/April.

Dan Siegel’s Website. (2014). Retrieved from: http://www.drdansiegel.com/about/interpersonal_neurobiology/website

 

 

La Clinica Website. (2013). Retrieved from http://www.laclinicahealth.org/

Personal Interview with Valerie Barnum. (2013). Client at La Clinica School Based Health Center, Phoenix Elementary School.