Body, Brain, Love: A Therapist's Workbook for Affect Regulation and Somatic Attachment

By Karen Rachels

Karen Rachels' "Body, Brain, Love: A Therapist's Workbook for Affect Regulation and Somatic Attachment," is a first-of-its-kind contribution to the dynamic and unfolding world of body-brain integration. This workbook accessibly integrates three critical areas of therapeutic work brought to us by the Decade of the Brain: 1) brain-based attachment t

• Language: English
• Publisher: Karen Rachels, MFT
• Release date: Jan 1, 2015
• ISBN: 9780692641675

Book preview

Part I

Nervous System Regulation and Dysregulation

Chapter 1

Mindfulness

We begin our study of body-brain integration by learning about mindfulness. Observation and awareness of all facets of experience is the basis for developing the choice to change and to heal. Mindfulness is a concept and practice that comes from many traditions. It has only been in the last few decades that the psychotherapy community has seen the wisdom of its use.

In mindfulness meditation, a person notices the mind, lets go and detaches from intense emotion and unattainable desires. Mindfulness can help the person witness the emotion and the grasping that leads to suffering. In Hindu practice, this is sometimes called witnessing consciousness. Long-term mindful meditators often have a greater internal spiritual peace and a more secure psychological attachment.*

Many psychotherapies, including Dialectical Behavioral Therapy and spirituality-informed therapies, have adapted the concept of mindfulness to help the person observe and slow down the degree of control their emotions and irrational thoughts have on their lives. Such observation can help the person experience more distance from overwhelming emotions and thoughts and gradually learn to control them, resulting in more stability in their lives.

The kind of mindfulness you will learn in this workbook is utilized by many body-based therapies. Mindfulness becomes a practice for a person to observe their internal world. This observation facilitates the understanding of how they have organized their experiences. When talking is minimized and attention is put to other modes of experience such as physical sensations, feelings, urges, the qualities of breath, and muscle tension, the person’s more unconscious experiences can be accessed.

Mindful awareness is comprised of three elements:

1. Tuning into self.

2. Observing what is happening within you while experiencing at the same time.

3. Utilizing the following body-brain tools to become our own best friend:

Curiosity, Openness, Acceptance, Love (COAL – acronym and concept by Daniel Siegel in The Neurobiology of We – see bibliography).

Mindfulness Induction vs. Progressive Relaxation Induction

To work with clients somatically, we need to teach them how to access a mindful, observing state. In doing so, it is important to distinguish between progressive relaxation and mindfulness.

Progressive relaxation deliberately helps the person relax through suggestion as the therapist guides the person to relax each part of the body. In contrast, mindfulness aims to encourage and maintain observation and awareness of internal experience. It promotes the observation of all internal experiences including physical sensations, emotions, muscle tension, micromovements, quality of energy, urges, and shallowness or depth of breath. The goal is observation while experiencing rather than changing the experience, although the experience will change through the observation. We are not suggesting to the client that they experience anything in particular. The only exception is when the client is dysregulated, a topic I will discuss in depth later.

Below is a step-by-step guide for inducing mindfulness in the therapy room:

1. Ask the person if they want to explore what they are talking about.

2. If the person agrees, suggest a way to go inside which can include closing the eyes, having a soft gaze, keeping the eyes open but cast down, or keeping the eyes open and just listening.

3. Begin by changing the pace and tone of your voice, making it slightly more rhythmic and even rather than inflected.

4. When you speak, it is better to use language such as Let yourself…, Take a moment to…, As you get more still, notice…. Use you rather than we or us.

5. Gently direct the person to notice the physical experience they are having such as the support of the couch, feet on the ground, or changes in the cadence of your voice. Do this in a measured, rhythmic way.

6. After several suggestions like this, and as you yourself start noticing some things you hadn’t noticed, start incorporating your own observations by saying things like, You might notice the ticking of the clock, or the passing of traffic outside. Perhaps you feel a sensation of light filtering through your eyelids…

7. Lastly, begin to direct the person inside. Now, begin to bring your attention to what’s happening inside. Whatever you notice is completely okay. There is no right or wrong; there are only things to notice and experience. Notice if there are any feelings, physical sensations, images, thoughts, urges. Take a moment to notice whatever is there. And, when you are ready, let me know what you are noticing.

Try experimenting with doing mindfulness with friends and family to gain some mastery. You can try it with clients to see how they respond, what they notice, and then fold that back into the work you are doing. Later, with other somatic skills, what comes from mindfulness will expand and feel even more useful.

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* See Daniel Siegel’s The Neurobiology of We for an in-depth discussion of the psychological and physical benefits of meditation.

Chapter 2

We are Braingrowers, Not Shrinks!

Evolution has prepared us beautifully as living beings to protect against hostile, dangerous environments. Our brains and bodies are geared to seek out and respond to danger. Reptiles and mammals, living beings before we evolved, instinctively respond to danger and return to normal as the danger resolves.

As humans, the highest and evolutionarily newest of living beings, we retain that capacity to sense and respond to danger, then return to normal. Critical brain structures (described in the next chapter, Normal Regulation) within human brains facilitate this response-recovery cycle.

As therapists, the work we do with our clients facilitates the maturation and integration of these brain structures. As part of that process, new fibers and nerve cells grow which increase the growth of synaptic connections and the size of these vital brain structures. Essential brain development that was thwarted has a chance to unfold thanks to the ongoing neuroplasticity of our brains. If we are doing therapy with care and respect in the best interests of our clients, we have a big role in this physiological unfolding. Understanding how this works will give you an opportunity to facilitate and enhance that development.

Fear without relief or recovery shrinks the brain. Therefore, if we were shrinks, we would be creating an environment of fear. In this scenario, the critical brain structures that help us feel safe do not have an opportunity to mature or integrate with each other. Fibers, nerve cells, and synaptic connections not used are and will continue to be pruned.

By contrast, what grows the brain is intrapersonal and interpersonal safety, and this is what we want and need to offer our clients. People who have a sense of well-being, self-actualization, and connections to others have brains that have, through their lives, integrated the communication and energy flow among their critical brain structures. Growing up in safe environments or being in a consistent, safe, and loving therapeutic environment naturally results in integrated brain structures. When continually reinforced and internalized, secure attachment is possible.

Chapter 3

Normal Regulation

Our human brain actually contains three brain structures developed through evolution which work together to respond to danger. These structures are presented here conceptually following the triune brain theory of Paul MacLean, explained in depth in his 1990 book, The Triune Brain in Evolution. Later research indicates these brains are not as discrete as originally conceptualized. For our work as therapists, however, studying them as discrete brains facilitates an easy, translatable use with clients.

Each brain reflects a further evolutionary change necessary for survival. The brains of reptiles were sufficient for the needs of instinct-driven living being. With the development of birds and mammals, where caring for, feeding, and protecting the young from predators became paramount, an additional layer of brain functioning was needed. This enlarged brain enabled the growth of attachment, social bonding, and emotional memory to ensure community survival. Humans, the most developed mammal, required a third layer of brain structure with the advent of language, abstraction, and thought. As we will see, communication and integration amongst all three brain structures is essential for overall healthy physical and emotional functioning.

The Evolving Triune Brain

Diagram used with permission from Buddha’s Brain, R. Hanson, New Harbinger Publications. (Terminology modified by K. Rachels)

1. Reptilian/brain stem (most archaic and interior brain): senses and reacts to danger instinctually, dating back 500 million years; involved with aggression, dominance, and territoriality; basal ganglia are the most critical brain structures.

2. Paleomammalian/limbic (second layer of brain): emotional brain which orchestrates a nervous system and electrochemical response to danger; responsible for motivation and emotion involved with feeding, reproduction, and parental behavior.

3. Neomammalian/neocortex (most recent, topmost brain layer): appraising and thinking brain which facilitates a return to homeostasis; involved in language, abstract thinking, planning, and perception.

Our human brain utilizes all three sub-brains in the entire cycle of response and recovery which is called regulation.

Here’s a fun, shorthand version of the communication between the brains during regulation:

Reptilian (to Mammalian): Oh, something’s up.

Mammalian: Okay, I’ll send in the troops.

Neocortex: Wait a second, this really is okay, not a real danger, calm down.

Mammalian: Okay, I’ll recall the troops and we can go back to normal.

Understanding regulation is the single most important concept you need to grow clients’ brains.

The healing power of therapy is amplified greatly by the therapist’s capacity to help the client on a moment-to-moment basis return to regulated homeostasis.

Understanding regulation will open up many therapeutic doors for you. Take your time to understand this basic outline of regulation. It will be well worth your while.

Following understanding regulation, we will look at dysregulation and why it is the essence of what our brings clients to therapy.

Normal Regulation

Normal regulation is characterized by an electrochemical cycle of response that moves through the three brains.

We begin with homeostasis. Neurobiologically, homeostasis is the normal activation of the PARASYMPATHETIC NERVOUS SYSTEM (PNS) which functions at different points in each of the three brains. The parasympathetic nervous system, a branch of our AUTONOMIC NERVOUS SYSTEM (ANS), governs our everyday activity. This activation of the PNS is responsible for the stimulation of rest and digest activities, social engagement, and attachment. When everything is fine, when we are experiencing connection, relaxation, and are in the present, this part of the PNS is activated. Another important part of the PNS will be discussed later.

The PNS, as part of its job, is sensitive to threats and danger and scans the environment to make sure everything is safe. If sensory information indicating possible danger comes in from the reptilian brain (brain stem) through the THALAMUS, a brain structure that sits atop the brain stem, the SYMPATHETIC NERVOUS SYSTEM (SNS, another branch of the ANS) becomes activated.

The thalamus, beginning to activate the SNS, reads the sensory input and immediately sends a watch out signal to three key structures in the limbic system (mammalian brain): HYPOTHALAMUS, AMYGDALA, HIPPOCAMPUS.

The HYPOTHALAMUS starts a release of neurochemicals including epinephrine and cortisol to mobilize the body for flight or fight.

At the same time, the AMYGDALA sounds the alarm to the SYMPATHETIC NERVOUS SYSTEM, which activates a neuroelectrical response to mobilize the body for fight or flight.

The hypothalamus and amygdala quickly facilitate bodily responses to danger — sending energy to the large muscles, shutting down cognitive, digestive and immune system responses, and increasing general energy for rapid, instinctive movement. On the other hand, the hippocampus slowly gets the message from the thalamus and the amygdala and sends the information to the NEOCORTEX (specifically the MIDDLE PREFRONTAL CORTEX or PFC) for appraisal, discrimination and determination of the presence of real danger.

Because the hippocampus process is much slower than the hypothalamus/amygdala process, the body is already in fight or flight mode before the message gets back to the amygdala that there really isn’t a danger. Once the amygdala receives this message from the hippocampus, it shuts the alarm off as it returns the body to the activated parasympathetic nervous system of rest and digest homeostasis and the social engagement system.

The everyday normal cycle over the course of many years leads to high-level amyg dala-hippocampus connectivity such that the fight-flight and recovery process is reduced to nanoseconds.

One of our key goals as brain-growing therapists is to increase the connectivity between the amygdala and the hippocampus. Such an increase enhances the communication between the limbic system and the neocortex and facilitates rapid relief from fear.

Thalamus (to self): I am sensing something bad that is Scaring me.

Thalmus (out loud): Hey, Amygdala, Hypothalamus and Hippocampus: Something bad is coming down.

Hypothalamus: Okay, I'll send in some epinephirine and cortisol to get us ready to fight or get our of here.

Amysdala: Watch out! Get ready to run, nothig else matters, we’ in trouble

Hippocampus: Huh?

Amygdala (panicked, fast voice): Yeah, my legs are charged to go, I’m not hanging around and I suggest you don’t either.

Hippocampus: What? All this stuff is happening, why?

Hypothalamus and Amygdala: What are you waiting for, don’t you know we’re in trouble? We can’t wait for you.

Hippocampus: Trouble? What do you mean trouble?

Hypothalamus/Amygdala (shouting): TROUBLE!!!!!!! What’s wrong with you? We can’t wait for you.

Hippocampus: Can you calm down, please, and let me know what’s going on?

Hypothalamus/Amygdala: NO!

Hippocampus: Okay, I have to send this up the chain because I’m not sure we need to do this. Hey, PFC, what do you think? Amygdala and Hippocampus are acting crazy.

PFC: No, I’m looking at this and I don’t see it. It’s just a car backfire. Tell them to calm down.

Hippocampus: Got it. No real danger here, right?

PFC: No danger.

Hippocampus: Amygdala and Hypothalamus, relax, there isn’t anything