The Brain on the Couch

Daniel Siegel is using his brain a lot more these days. But it’s
not the one in his skull that’s got him so excited; it’s the
plastic one in his office.

The associate professor of psychiatry at UCLA and author of
The Developing Mind (Guilford Press, 1999) is one of a new
wave of psychotherapists who are discovering the power of
neuro-biology in their everyday counseling work. ‘I not only have a
model of the brain that I . . . take out maybe three or four times
a week with different patients, but I also have a chalkboard I
constantly use to draw brain diagrams to help people see their
problems in a different light,’ Siegel tells Mary Sykes Wylie and
Richard Simon in Psychotherapy Networker
(March/April 2004).

The results, he says, have been eye-opening. ‘Patients keep
telling me things like, ‘You know last week when you drew that
picture of the brain? I finally understood my amygdala. It’s
changed my whole view of what’s been going on with me all these

Siegel and others are looking at new ways to read brain activity
and apply that information to psychotherapy. Their recent embrace
of neuroscience, argue Wylie and Simon, represents a fundamental
shift in a profession that historically has been at odds with
neuroscience and its tendency to see an individual’s temperament
and psychological health as ruled by genetics and seldom subject to
change. But as scientists have learned more about the brain’s
innate ‘plasticity,’ psychotherapists have become more willing to
use that knowledge to help their clients.

Contrary to earlier thinking, researchers now know that the
brain produces new cells throughout a person’s life and that its
development is influenced by experience as well as genetics. Each
stimulus we experience causes millions of neurons to fire together
in the brain, creating neural maps or networks that add up to what
Wylie and Simon call ‘the architecture of all our experiences.’
This new knowledge of the brain, combined with advances in
technology to measure and interpret brain activity, have allowed
therapists and their clients to consider how an individual’s brain
functions in a way that goes well beyond the word-bound techniques
of traditional ‘talking cure’ therapy.

‘Magnetic resonance imaging (MRI), positron emission tomography
(PET), and CAT scans can now photo-graph the brain at work and play
and even after therapy,’ Wylie and Simon note. ‘With electron
microscopes, the nuclear tagging of living human molecules, and
other biochemical investigative techniques, scientists can now see
what happens in different parts of the brain when an alcoholic
looks at a martini, or a schizophrenic has a hallucination, or a
meditator experiences spiritual transcendence.’

This allows the therapist and the client to look at problems in
a more focused, less emotional way. As psychologist Marcia Stern,
author of Child-Friendly Therapy (Norton, 2002), puts it,
clients experience the workings of their brain in a much more
personal way than they experience even their own behavior patterns.
Showing them how their brain processes information, for instance,
gives them ‘an incredibly compelling way of grasping the most
intimate details of their moment-to-moment functioning,’ she says.
It helps them ‘understand their own behavior and the behavior of
other people in their families in a new way — for example, how
easily our thinking brains can become hijacked by our feeling
brains — while dramatically diminishing the amount of shame and
blame that gets passed around.’

One of Stern’s clients always described herself as picky and
obsessive, to such a degree that at seminars she would have to beat
everyone else into the room so she could get a seat in the front
row. Her colleagues called her neurotic, but by looking at how the
woman’s brain worked, Stern helped her realize that she was simply
compensating for the difficulty she had filtering out sensory
information. ‘Once she was able to do that, she went from a
negative explanation of her behavior — ‘I am neurotically
obsessive’ — to a compassionate view of how this behavior was a
way of taking care of herself,’ Stern says.

This approach allows therapist and client to move from digging
into the past to the more manageable task of simply learning to
live with one’s brain, Wylie and Simon explain. It can be
liberating for both parties as the focus shifts from figuring out
why to deciding what’s next.

To get there, however, will require that therapists ask
different questions than they ask now, says Harvard associate
psychiatry professor John Ratey, author of A User’s Guide to
the Brain
(Pantheon, 2001). ‘Instead of reflexively asking
‘How do you feel?’ therapists will increasingly try to find out
about how clients perceive the world,’ he explains. Therapists will
‘tune in to clients’ movement habits and other aspects of their
behavior that show how their brains work and how to communicate
with them.’

And while this marriage of neuroscience and traditional therapy
is not without its critics — many of whom worry that it could
erode a century of therapeutic practice — Stern, for one, is
convinced that it’s a positive development. ‘Every clinician at one
time or another realizes that words are not enough,’ she says. ‘So
often the results you see in your office don’t carry over when
people go home. The challenge of therapy is always to get clients
from intention to action. Helping people understand their own
brains and the unique way they process information can help bridge
that gap and make change stick.’

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