Tuesday, November 2, 2010

Empathy Series: Attunement, Attachment, Meditation and Psychotherapy

Primary Reference: Daniel Seigel. (2007). The Mindful Brain.

Key words: Attunement, Attachment, Meditation, Psychotherapy and Empathy

Two Problems
1. Affect Disregulation / Nueral Unintegration
2. Traumatic Narrative

Assumptions about Attachment
• Attachment is the relationship of the child to the caregiver over time – first three years are crucial
• Attachment style of the care giver conditions the style of the child
• Research has shown attachment shapes the developing mind/brain
• Attachment impacts self-regulatory circuits

Attachment Styles: Relationship Type

Relationship Type => Parenting Behavior

Secure => Responsive, Consistent
Avoidant => Rejecting, Distant
Ambivalent => Rejecting, Distant
Disorganized => Frightening, Confusing, Fearful

Characteristics of Secure Attachment: The Trusting Child
Securely attached children exhibit distress when separated from caregivers and are happy when their caregiver returns. Remember, these children feel secure and able to depend on their adult caregivers. When the adult leaves, the child may be upset but he or she feels assured that the parent or caregiver will return.
When frightened, securely attached children will seek comfort from caregivers. These children know their parent or caregiver will provide comfort and reassurance, so they are comfortable seeking them out in times of need.

Characteristics of Ambivalent Attachment: The Anxious Child
Ambivalently attached children usually become very distressed when a parent leaves. This attachment style is considered relatively uncommon, affecting an estimated 7-15% of U.S. children. Research suggests that ambivalent attachment is a result of poor maternal availability. These children cannot depend on their mother (or caregiver) to be there when the child is in need.

Characteristics of Avoidant Attachment: The Aloof Child
Children with an avoidant attachment tend to avoid parents or caregivers. When offered a choice, these children will show no preference between a caregiver and a complete stranger. Research has suggested that this attachment style might be a result of abusive or neglectful caregivers. Children who are punished for relying on a caregiver will learn to avoid seeking help in the future.

Characteristics of Disorganized Attachment: The Confused Child
The disorganized types seek attachment but experienced anxiety as a consequence of attachment. They also experience anxiety at the disappearance of the mother and are difficult to soothe upon reunion. Disorganized children are particularly ambivalent upon reunion with their attachment figure, both approaching and avoiding contact. Bowlby described these children as "arching away angrily while simultaneously seeking proximity" when re-introduced to their mothers.
Attachment Styles: Parents Narrative

Adult Narratives

Adult Narrative => Child Attachment

Secure => Secure
Dismissing => Avoidant
Entangled, Preoccupied => Anxious
Unresolved Trauma or Grief => Disorganized

Characteristic of Secure Narrative: The Balanced Adult
flexible, coherent, self-reflective, balanced perspective (positive with the negative)

Characteristic of Dismissing Narrative: The Adult in Denial
Incoherent-vague, inflexible-ridgid, minimize emotional significance, insist on lack of recall, based on denial

Characteristic of Entangled Narrative: The Preoccupied Adult
preoccupation with past, intrudes on present, intense idealization or fixation

Characteristic of Unresolved Narrative: The Traumatized Adult
disorganization, disorientation around issues of grief or trauma, unintegrated, spontaneously intrusive, disorienting

The Brain is a Social Organ

• The function of the brain is to engage with other people, other brains, in the shaping of its development over time and in shaping its activity in the present.

• Mirror Neurons and the capacity to develop empathy and insight = MINDSIGHT

• Our brains are extremely social. Areas involved in self-regulation overlap with those involved in interpersonal communication and plasticity

• How one brain interacts with another has important effects on how the brain functions: Social interactions are one of the most powerful forms of experience that help shape how the brain gives rise to the mind

• Mindsight enables us to meet life’s challenges with more flexibility and joy in our internal and interpersonal worlds

• We are ultimately connected to each other as part of a larger whole

Two Solutions:

1. Attunement via mindfulness (intrapsychically) and empathy (interpersonally via psychotherapy)
2. Coherent Narrative via psychotherapy

Secure Attachment and Empathy Fosters:

• Flexible self-regulation
• Prosocial behavior
• Empathy
• Positive sense of emotional well-being and self-esteem
• Coherent life-story
• Neural Integration

Brain Regions and Functions Integrated During Mindfulness and Psychotherapy:

I. Brainstem: Reptilian brain. Core functions. Heart. Respiration. Metabolism. Sleep-wake cycles. Fight-flight Response.

II. Limbic region: Mammalian brain. Social function. Connection with others. Memory processing into autobiographical context., Appraisal/meaning of sensations and emotions. Hormone regulation via the hypothalamus. Endocrine – autonomic and parasympathetic NS. Motivational drives and survival instincts.

III. Cortex: Neo- Mammalian brain. Cognitive function. Perception, planning, and attention. Resonance circuitr and mirror neurons. Imagination and empathy.

A. Left brain: language, linearity, logic, literal thinking. The narrarator.

B. Right brain: non-verbal, holistic, visiospacial, autobiographical memory, spontaneous emotion, stress modulation, empathic response, attention.

How Psychotherapy Cultivates Attunement, Self-regulation, and Neural integration:

Sharing coherence/integration
In the process of psychotherapy with a range of individuals with intact mirror neuron systems, shared states with the therapist may be an essential component of the therapeutic process. As two individuals share the closely resonant reverberating interactions that their mirror neuron systems makes possible, what before may have been unbearable states of affective and bodily activation within the patient may now become tolerable within conscious awareness. Being empathic with patients may be more than just something that helps them “feel better” – it may create a new state of neural activation with a coherence in the moment improves the capacity for self-regulation. What is at first a form of interpersonal integration in the sharing of affective and cognitive states now evolves into a form of internal integration in the patient. With the entry of previously warded-off states of being in conscious awareness, the patient can now learn to develop enhanced self-regulatory capacities that before were beyond their skill set. It may be that as interpersonal attunement initiates a new form of awareness that makes intrapersonal attunement possible, new self-regulatory capacities become available. - Seigel

Positive Attachment: Attunement and Narrative
Studies of attachment reveal that the parent’s openness to a child’s signals and the coherence of the parent’s own narrative are important predictors of a child’s development of security of attachment (13). Such factors seem to promote a form of resiliency in the child which self-regulation unfold as the child matures. Psychotherapy may naturally harness these developmental origins of well-being in creating a resonant state in which the therapist is sensitive to the patient’s signals and also has made sense of his or her own life. Being open to the many layers of our experience, often involving the non-verbal world of sensation and affect in addition to our verbal understanding is an important stance for the therapist to create toward the internal and interpersonal worlds. Within this framework, the state of brain activation in the therapist serves as a vital source of resonance that can profoundly alter the ways in which the patient’s brain is activated in the moment-to-moment experiences within therapy. Such interactive experiences allow the patient to “feel felt” and understood by the therapist, and they also may establish new neural net firing patterns that can lead to neural plastic changes. Ultimately lasting effects of psychotherapy must harness such experiences that promote the growth of new synaptic connections so that more adaptive capacities for self-regulation and well-being can be established. -Seigel

Adult Narrative made Coherent and Integrated During Psychotherapy:

A narrative is a story we tell ourselves that helps contextualizes our experience.
A narrative is just a construct, and needs to be flexible and adaptive.
In the case of traumatic experience, memories are decontextualized, fragmented, relegated to the unconscious and need to be reintegrated into a holistic, coherent and conscious narrative.
Implicit memories are procedural, non conscious, non verbal, non linear, unconscious, fragmented, emotional, somatic.
Explicit memories are conscious, autobiographical, verbal, holistic, cognitively contextualized.
We need to make positive meaning of our experiences in a coherent narrative.
This process of making meaning of traumatic experience is one of the hallmarks of good therapy.

Narrative: Making Sense of a Story

The hallmark of secure attachment being the ability to reflect on one's internal emotional experience, and make sense of it, and at the same time reflect on the mind of another. One can immediately see how these capacities are imbued in the infant through sensitive attunement of the caregiver. When a caregiver reads the verbal and non-verbal cues of the child and reflects them back, the child sees him or herself through the eyes of the attachment figure. It is through this attunement and contingent communication process that the seeds of the developing self are planted and realized. Insecurely attached individuals lack this reflective function either because their emotional responses are so repressed as in the case of the dismissing attachment status or exacerbated as in the case of the preoccupied attachment status that they are unable to either identify their own internal experience or reflect on that of the other. When either one of these extremes are the method of regulating the attachment behavioral system, the capacity for reflection (on oneself and others) is compromised. - Fonagy

Jeremy Holmes, likewise an analyst in England, has written the book The Search for the Secure Base: Attachment Theory and Psychotherapy (2001). Holmes talks at great length about the narratives of insecurely attached individuals. He refers to story-making, and story-breaking. In the case of dismissing attachment, where the story is so restricted as to reduce the possibility of dysphoric affect, the clinician is helping the patient create a story that is coherent, full of memory and manageable affect. In the case of preoccupied attachment, where anxiety over-runs the client's story in that it becomes convoluted and saturated with anger and disappointment, the therapist's role is to help break the negative cycle of the narrative, manage the affect more effectively and create a story that is balanced and coherent. - Dan Sonkin
See Sonkin's Article Attachment Theory and Psychotherapy

Nine Middle Prefrontal Functions
By Dan Seigel

Body Regulation:
Body Regulation is achieved by the Autonomic (automatic) Nervous System. This system generally works without conscious control and regulates functions like heart rate, breathing, digestion, vascular tone, inflammation and immune response etc.

Attuned Communication:
Attuned Communication is defined as the coordination of input from another mind with the activity of one’s own, a resonance process involving these middle prefrontal areas. This is distinct from other resonant functions such as those achieved by the mirror neurons in the motor cortex that automatically interpret the motor actions of another as one’s own.

Emotional Balance:
Emotional Balance in this context is defined as being able to balance between rigidity and chaos. In other words, being able to keep from being overwhelmed or becoming inflexible in one’s emotional response.

Response Flexibility:
Response Flexibility is the capacity to pause before action. Such a process requires the assessment of ongoing stimuli, the delay of reaction, selection from a variety of possible options, and the initiation of action.

Empathy (Mindsight):
Empathy is defined as conscious awareness and sensitivity to the mind of someone else. It is the putting of oneself in someone else’s shoes.

Insight, or self-knowing awareness:
Insight links the past, present and future. The middle prefrontal cortex has input and output fibers to many areas. Insight means integrating cortical representation of autobiographical memory stores and limbic firing that gives emotional texture to the emerging themes of our present awareness, life story, and image of the future.

Fear modulation:
Fear can be modulated from the middle PFC via neurons that enervate the amygdala, a limbic structure that registers threat and opportunity. These neurons can release calming neurotransmitters (GABA) and can be consciously reprogrammed.

Intuition in this context means registering the input from neurons from the heart and gut. In other words, respecting one’s gut feeling.

Morality in this context means the ability to think of the larger social good and enact those behaviors, even when alone.

Nine Forms of Neural Integration
Adapted from Dan's Seigel's Mindsight: The New Science of Personal Transformation (2010)

1. Integration of consciousness - Awareness of the body, mental/emotional, relational, and outside world. Openness to things as they are.

2. Bilateral integration - Left and right hemispheres working in synchrony. Left hemisphere is logical and linear, very literal. Right side is more creative, metaphoric, and symbolic.

3. Vertical integration - Body up, including lamina-1, from the brainstem through the midbrain (hippocampus) and into the cerebral cortex. [ME: Also look at the role of the vagus nerve in vertical integration.]

Gut, heart, and lungs all have neural networks that seek to communicate with the brain. Too many people are disconnected from the awareness from our bodies.

4. Memory integration - Implicit and explicit memory integration. When traumas become implicit memory, a schema, we are stuck in the past. To integrate memory, we make implicit memories explicit.

5. Narrative integration - Biographical memory, needs to be included. Run into the trauma, not from it. When a dog tries to bite you, stick your fist down it's throat - it'll gag and release. We get wounded, but not as bad as if we pull away and the dog's teeth tear the flesh from our hands.

6. State integration - we are multiple selves sharing a body. Three parts: We need to learn to honor our states (intrastate), interstate, honor that we have different needs at the same time and we need to pay attention to that, and interpersonal states, maintaining my own states while in relation with others.

Other states - such as gross, subtle, causal, nondual?

7. Interpersonal integration - Honoring and supporting the differences in each other promotes neural integration in the brain. Mind is energy and information flow. Talking about thoughts and feelings gets you nowhere. It's about nurturing energy.

Communication of feelings, not about feelings, can be integrative for the brain - promotes integrative fibers in the brain. Parent-child interactions that create healthy attachment work in this way.

8. Temporal integration - Making maps of time. Connected to narrative - we seek certainty, but change is the only constant. We also become aware of our eventual death.

Differentiation and linkage, chaos and integration. We need to differentiate before we can link, and we need to recognize the chaos before we can integrate.

9. Transpirational integration - The identity of a bodily self expands beyond the boundary of the skin - we sense our interconnection time, place, and people. Integration of integration. We Space consciousness.

1 comment:

  1. Thanks for this post Miles,
    I am working on a piece about using the IFS (Internal Family systems) model for working with PTSD and this was very helpful.
    If you're interested I will be posting it to my blog http://www.yourtherapist.org/www/ifs-blog/
    when it's done.
    Take Care,