Neuroscience and Clinical Practice

Dr. Robert J. MacFadden

Neuroscience and Couple Therapy
Dr. Robert J. MacFadden

A neuroscience perspective involves looking at how our new knowledge of the brain and nervous system can change the way we understand problems that couples and individuals develop and how they might be reduced or eliminated.
Social Work has embraced a biopsychosocial perspective as its professional focus but the BIO component has been largely neglected compared to its emphasis on the psychological and social.

It is now being recognized that the biological aspects of our lives and particularly the brain are fundamental in what and how we perceive, feel, think and act. Everything comes through our senses to our brain and reality is constructed between the ears, within the brain.

However, even though we are fundamentally biological we are also highly social creatures. Our biology would not thrive if we had no social contact. As human beings, we have the longest period of dependency of any mammal on the planet and our brains are continually developing right into our third decade.
The brain needs much home assembly. That means that many of you in this class are still a work in progress. Actually we all are since our brains are constantly changing through the magic of neuroplasticity which the ability of the brain to change and grow throughout life.

Since we are social workers, let’s also look at the social side of this biological development. Our parents and caregivers are fundamental in shaping the structure and processes of our brains and they do this through the process of attachment.

Early Development
Infants and parents are set up to be exquisitely sensitive and mutually responsive to the communications of each other. Babies have an early ability to read faces and to pay attention to caregivers. They follow their eyes and actions and a very aware of the emotional communication, through verbal and non-verbal ways. Caregivers are similarly predisposed to pay attention to and respond to the baby’s verbal and non-verbal communication. This is the connection and bonding that is so critical to the baby’s development and the parent-child relationship.

The caregiver helps to settle the baby and respond to his or her needs. The baby also responds to the emotions, actions and presence of the caregiver. This mutual understanding and mutually responsiveness is the critical attunement process where a sense of oneself and the other is formed.

The parents are holding environments for the infant where they help the baby begin to regulate his or her emotions. When the baby is screaming, the parents may hold or rock the baby until emotional control is regained by the baby. Over time the baby learns to self-soothe and to control upsets. This is the beginning of self emotional regulation. It is believed that the baby internalizes the image and behaviour of the parents in this self-soothing process and doesn’t always require the parents to physically be there.

This is a process that alters the brain. In the early stages, the infant is essentially stimulus and response. There is no deliberation or cognition that would permit delay or control. Eventually, through the caregivers help and the developing maturity of the brain, the child is able to delay and to control emotions and actions. Through attunement and the attachment process, the child learns about the value of oneself and the other which leads to the attachment positions. These important beliefs about oneself and the other are formed by the age of two or three. For those fortunate enough to have secure attachments, the beliefs are that others are caring and will help when needed and they themselves are good persons who are loved. This secure base drives other beliefs such that the world is exciting, challenging and should be explored. Attachment involves the dyadic regulation of emotion. Arden and Linford (2009, p.17) state that, “Our brains are exquisitely adapted to changing in response to the attunement and compassionate interest of another human being”.

For an excellent and very detailed account of the early development of the child’s brain read the
Developing Mind by Daniel J. Siegel (2012, NY: Guilford Press). Siegel says that the capacity to regulate the appraisal and arousal processes of the mind is essential to self-organization and is at the core of the self and this emerges from these early dyadic relationships. Most mental problems are problems of emotional dysregulation.

The idea of adult attachments has flowed from our early attachment experiences. Couples can be viewed as developing an attachment bond with each other. Partners are engaged in attuning to each other’s needs and importantly helping to regulate each other’s emotions. An example of this is a husband who comes home after losing his job. The wife sees how distraught he is and they cry together, holding each other in their arms. Feelings of failure, outrage and anger at the employer and fear about the future emerge as the wife helps to soothe the husband. Gradually, the wife reminds the husband that there are ways they can financially restructure to gain some time for him to look for another job. This may be the time to pursue the retraining into another career that the husband has dreamed about in the past. The wife pledges her support and love and the husband begins to calm down and think about the idea of opportunities that she has suggested. Thus from the tragedy of being fired, the couple has used this situation to become closer to each other and to begin planning for their future.

A knowledge of the neural correlates of this scenario helps us to understand it in a different way. When the husband was informed of his firing, which is a significant threat, this would have stimulated the amygdala to signal the body to immediately commence the stress process of fight or flight. This is the automatic sympathetic nervous system that initiates in response to a threat. A cacophony of neurotransmitters would flood the brain and body and make it difficult to stand still, to think and to speak. The cognitive processes would be overwhelmed by the deep emotions of fear and anxiety. It would be hard to remember anything and to think well. Threat and fear and negativity would flood the husband. Processing in the right hemisphere would predominate and may lead to constant review and negative feelings such as reprocessing the trauma. Assuming the wife also has a secure attachment with the husband and is able to control her own feelings of threat and anxiety, her actions in offering emotional support and safety could reduce the impact of the amygdala and help her husband to slow the sympathetic nervous system reaction and to initiate the parasympathetic system which lowers blood pressure and helps the husband begin to relax and think. Speaking to her husband and beginning to explore some early possibilities would help to engage the husband’s left hemisphere in thinking and problem-solving and to initiate some positive emotions including beginning hope and optimism.

A focus on neuroscience underscores the importance of what Gottman referred to as “soothing” or the partners helping with the emotional regulation of emotion. Being a source of safety and support is critical when a partner is experiencing distressing emotions. It is an opportunity to help the other contain the negative emotions and begin the process of feeling hopeful through looking at problem-solving possibilities.

Therapists are involved in helping the clients to emotionally regulate. Most psychological problems involve emotional dysregulation. The Orbitofrontal Cortex (OFC) is the principal cortical area involved in emotional regulation. It is closely linked with the amygdala and emotional inhibition is a major role for it. The OFC is also involved in making plans, based on motivation and emotion. It is essential in fostering co-operation in social life and inhibiting aggressive impulses.

Two Mental Processing Systems: Explicit and Implicit
We have two mental processing systems which each involve the following functions:
Memory; Perceptions; Learning; Emotions; Action Control; Motivation; Emotional Regulation and Interpersonal Behaviour.

Explicit Processing System
This is the conscious processing system which is that part of us that we believe is who we are. Our conscious self. It involves us consciously perceiving things, remembering things like facts and events and being aware of how we feel and conscious of taking action. It provides the history for the development of our self-identity.
Working memory is a function of our brain that permits us to work with ideas, memories, and feelings, to make decisions and to store items throughout the brain. Many people are unaware of the prodigious nature of our unconscious thinking and we identify almost exclusively with our conscious thinking because of the awareness which accompanies this.

Working memory is contained in an area of our right prefrontal cortex that is the size of a postage stamp, above the right eye and one inch behind the forehead (Howard, 2006). It is believed to be the area where conscious processing or thinking occurs. Functionally it resembles a virtual scratchpad or desktop with limitations on what can be placed there and worked with at one time. Working memory is capable of holding small amounts of information for only a few seconds at a time (Ratey, 2001). It can hold 7 + or – 2 things at one time in consciousness, although this number may vary somewhat depending on what things (e.g., ideas, words, numbers) are being worked with at the time. Although these things can be “chunked” (e.g., three numbers can be dealt with as one item such as 1-2-3) to reflect more things and to increase capacity, working memory is still limited.

Although the limited capacity can be a disadvantage, there are also some advantages. We could easily get overwhelmed with too many past memories and current information when we need to decide on something so our working memory’s limited capacity creates a situation where we constantly have to re-evaluate and revise our ideas, like shuffling a deck of cards.
It is believed we can handle about 40 pieces of information per second consciously (Wilson, 2002). Thus there is enormous competition for our attention. Items that are novel, or which threaten our survival or present opportunities for survival or those which elicit emotions are marked for attention and memory.

Implicit Processing System

This is the most fundamental mental system and it occurs outside our conscious awareness. In relative terms
we are almost all about unconscious processes, yet we mostly view ourselves as conscious entities. Each of you right now is engaged in monitoring and controlling a wide range of your body processes such as temperature, heart beat, insulin levels and other systems. When you move, the position of your arms and legs will be constantly monitored and used to develop future moves.

The capacity of our explicit systems are significantly limited. There is so much stimuli coming into our senses that it is estimated that our five senses are receiving more than 11 million pieces of information per second. We don’t have enough processing power and capacity to consciously manage all of this, so much is handled by the unconscious below our awareness. We don’t have to think about how to walk, how to drive, or when or how to eat and drink. These critical processes are being managed by that other part of ourselves, Our unconscious permits us to manage fundamental processes without engaging our consciousness. Life would be impossible without our unconscious processing.

Our implicit memories occur from birth on and contain emotional memories, learnings, and knowledge that have accumulated over a lifetime. It also contains our beliefs and attachment positions. There is an intelligence in this unconscious system. It appears to handle bivariate correlations between two variables then does conscious analysis. It can detect patterns with considerable acuity. And the knowledge that it develops is also marked with good, bad, approach and avoid valences. We remember things that help us achieve goals and things that do not or that threaten our survival.

How do emotions fit into this? Emotions are our earliest form of decision-making in a crude way. Something is bad, run or fight. Something is attractive, mate. Something is edible and smells good, eat it. There is no dichotomy between emotion and thinking or reasoning. They are part of the same processes. Emotions attract us to pay attention to things. We remember emotional things better. Emotions through neurotransmitters stamp our learning with good, bad, approach, avoid valences.

Most of our knowledge is implicit and emotionally stamped with good, bad, use or avoid. And most of our decisions are made beyond our awareness. Our implicit system has speedy ways of analyzing and making decisions. The valency or individual worth of knowledge speeds this decision-making up. We have these approach/avoid learnings that help us work through the morass of problem-solving we have to do each day.

But not all of this implicit knowledge is good or accurate. For instance it is normal and lifesaving to develop biases and prejudices to certain things. But some of this learning can be faulty and destructive. Racial biases and other forms of inappropriate prejudices can lead to injustice and problematic behaviours. And because these biases can work below our awareness we frequently are not conscious of these ideas. Yet we may act on these beliefs without knowing.

There are researchers who are exploring these implicit biases and developing ways to identify some of these beliefs. One website at explores these implicit biases and helps users to identify them in themselves. It uses various approaches to tap the unconscious beliefs and biases towards things such as race and body weight. Partners individually may have biases and beliefs that generate hostility towards the other partner. As an example, gender role expectations become implicit at an early age. Attempts are behaving differently may be felt deeply as profoundly wrong and disrespectful. Failure to live up to implicit gender expectations may be felt very strongly and negatively.

Brain and Learning Findings
Implications for Couple Therapy

Content needs to make sense to learners

Content has to be relevant

Emotions drive attention & memory

Action is important in learning

Multi-sensory experiences improve memory and utilization

Foster positive emotions, reduce threat and increase challenge

Work to develop learning at the conscious and unconscious levels

Encourage deep learning: memory & retrieval, analysis, critique, action, feedback and refinement

The therapist’s framework has to make sense in explaining the couple’s situation. This increases security and hope

The goals have to be the clients’ goals. They have to be owned and important. Working on a problem should always involve an important approach goal.

Therapist needs to work with emotions of clients to engage motivation and to explore underlying feelings and attachment. Fundamental issue is whether each person feels loved.

Very important to engage clients in several levels of change including affect, cognitions and behaviour. Feedback and experience is important in maintaining and enhancing change.

Engage couples in different ways through use of films, video recording, audio-recording to improve understanding and memory

While acknowledging problems move quickly to positive experiences. Strengths and solution talk, positive life/relationship review, relaxation training, positive imaging

Ways to impact implicit systems: paradox, metaphor, experiences without discussion, vigorously interrogating unconscious beliefs and substituting positive conscious beliefs

Need to process new learning. Explore it, try it out, refine it, continually use it. Have others support it. New stories that support the positive changes.

Emotion Regulation

Involves learning how to control the sympathetic nervous system through use, for instance, of the parasympathetic nervous system;

Integrating Left Brain and Right Brain to promote regulation;

Soothing the amygdala, reducing fear and anxiety: building trust and love with the couple;

Learning self-regulation first and then working with relationship to promote other regulation;

Using important others (partners, friends, families, therapists) to help us manage emotion. Attachment is fundamental and powerful.

Therapy always involves new learning and changes in the brain. The research on learning and neuroscience can inform couple therapy.

@ 2013 Robert J. MacFadden, ALL RIGHTS RESERVED