Neuroscience and Clinical Practice

Dr. Robert J. MacFadden


1. Need to understand how to explain the workings of the brain to clients and to appreciate the importance of the normalizing effect that this knowledge can have for many clients. The “handy” brain puppet (Siegel, 2012, p.20) is a useful tool for this purpose.

2. Brain in an historical organ both personally and evolutionarily and was built to focus on threat and survival. This leads to vigilance and frequent “low road” processing, engaging the sympathetic nervous system which bathes us in neurochemicals. Since fighting and running is not an option for most of us, we end up “stewing in our juices” which can result in chronic arousal, psychological and physical problems.

3. Need to become experts in understanding and impacting the stress response. This involves understanding both the “brakes” (i.e., things that activate the parasympathetic system such as breathing, self-hypnosis, mindfulness) and the “accelerators” (e.g., sometimes a certain level of arousal is required).

4. The brain is Teflon for positives and Velcro for negatives. We are slanted towards overestimating risk and being cautious. In a crowd of people we will pay most attention to those with expressions of fear on their faces. Gottman has found that the appropriate balance of positive to negatives in relationships that last is 5:1 .

5. Clinicians need to be become “amygdala whisperers” and learn how to soothe the client’s fear and anxiety. Helping clients to learn how to self-soothe and helping partners and families to soothe each other is essential. Emotional regulation and co-regulation.

6. Positivity and positive emotions, the foundation of Positive Psychology, is extremely important. See the new book Flourish by Martin Seligman. We need to help clients find positives in their lives and learn how to recognize them, savour them, and marinate in them. Also related to Strengths-based work. Building social support networks is another example of positives.

7. After acknowledging and understanding the client’s problems, move towards identifying goals and tasks and experiencing positive emotions.

8. Both therapeutic change and learning have the same foundation: neural change. Emotion is central to feelings and thinking and to learning. Social workers need to help clients emotionally regulate. Social workers also need to know how to engage client’s emotions to involve them in therapy and learning (e.g., goals need to be highly relevant to the client).

9. Most mental activity is unconscious. Client decision-making is heavily influenced by pre-existing and frequently unconscious knowledge. Emotions help stamp experiences with positive (important to survival) and negative (unimportant) valences. Stereotypes and biases, for instance, are frequently implicitly held, strongly felt, unconscious and resistant to change.

10. We need to be sensitive to what we are communicating to client unconsciously (e.g., through non-verbal communication) and what implicit messages that agencies give off (e.g., messy and drab waiting room suggesting client low worth).

11. Powerful right brain to right brain communication is occurring implicitly and is seen as the most important form of communication in terms of impacting the client.

12. Use the mirror neuron system to “sense” the experience of the client but always check to see if your perceptions are accurate.

13. Work to improve vertical integration (cortex with the brain stem and internal organs and visceral system) by promoting body work so that the client is able to be aware of internal sensations and improve the vertical low essential in integration and mental health.

14. Work to improve horizontal integration (right brain to left brain communication) by exploring feelings, autobiographical self, experiences and how these connect with the left brain understanding through, for instance, the development of self-narratives. This enhances integration and mental health.

15. Understanding that evoking certain experiences, including intentional attention, activates neuroplasticity which helps to build new neural connections (i.e., learning) and the speed of the connections. Aerobic exercise, mindfulness practice, nutrition, therapeutic relationships can all promote neuroplasticity.

16. Mindfulness practice and secure attachments have been associated with eight factors that reflect mental health:

1. bodily control
2. attunement
3. insight
4. emotional regulation
5. fear modulation
6. flexible choices
7. morality
8. empathy

17. Conditions that promote therapeutic change:

1. positive therapeutic alliance with resonance, attunement, accurate empathy
2. naming feelings and integrating into self-narrative
3. feeling safe and feeling felt
4. working on highly relevant goals with tasks that make sense
5. incorporating self-soothing and co-soothing
6. repairing relationship ruptures
7. deliberately facilitating positives and positive emotions
8. monitoring the therapeutic relationship and outcomes

18. Goal is to promote mental health and well-being. Key is promoting flow (versus chaos and rigidity) and integration (i.e., everything working together individually, and in harmony). Triangle of well-being: Empathic relationships, healthy mind and integrated brain.

@ 2013 Robert J. MacFadden, All Rights Reserved