Chapter 2

Neuroscience The Newest Force in Counseling and Psychotherapy

CHAPTER GOALS

The chapter is designed to

1. extend your understanding of what neuroscience is and its relevance to the ongo- ing evolution of counseling and psychotherapy; 2. discuss the resistance that some mental health professionals have to the new neu- roscience force that is emerging in the field and specific factors that contribute to this resistance; 3. expand your knowledge of basic aspects of neuroscience, including your under- standing of neurotransmitters and different brain parts; 4. increase your awareness of the ways that neurotransmitters and different brain parts are linked to various cognitive, emotional, psychological, and behavioral reactions people manifest in their lives; 5. broaden your thinking about the different counseling/psychotherapy skills and interventions that complement the optimal functioning of various neurotransmit- ters and different brain systems; and 6. increase your understanding as to how helping strategies that are based on neu- roscientific research findings complement an integral approach to counseling and psychotherapy.

49 50—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

**VIGNETTE #2 impact on her standing in the company. In an effort to do something about these problems, Sachi is a 28-year-old, single female of Sachi has sought help by scheduling an Japanese descent. She moved to the United appointment with a counselor in the compa- States from Japan a year ago as a result of a ny’s Employee Assistance Program. job advancement that was offered by the large We will refer to Sachi’s case at different corporation where she is employed. Sachi’s points in this chapter to highlight various con- career move has resulted in advancements in cepts associated with neuroscience and its her income and professional status within the relevance to counseling and therapy theories company where she is employed. However, and practices. A description of the four quad- these career benefits have come at a cost: She rants that compose the integral theory is pre- is feeling increasingly depressed as a result of sented as a resource below. This resource is being isolated from family members and included at the beginning of the chapter to friends in Japan, and she is also experiencing help you acquire a deeper understanding of the elevated levels of generalized anxiety. The integral approach to counseling and psycho- increasing anxiety Sachi is experiencing in therapy that is discussed throughout this book. combination with more frequent depressed moods is leading to a circular problem, as it ** contributes to Sachi’s growing concern that AN INTEGRAL APPROACH her work performance may suffer as a result TO COUNSELING AND of these problems and possibly have a negative PSYCHOTHERAPY

The Individual Perceptions and Meaning The Behavioral/Physical/Neurological Quadrant Making Quadrant Clients’ behaviors and physical/biological/ Clients’ interior psychological processes neurological factors that are of relevance to (e.g., conscious, subconscious, unconscious) counseling and therapy practices and outcomes and subjective constructions of life experiences

The Cultural Community Quadrant The Societal/Professional Quadrant Cultural and community factors as they impact Societal and professional factors as they impact clients’ mental health and the process and clients’ mental health as well as counseling and outcomes of counseling and therapy therapy practices and outcomes

**INTRODUCTION work. Although there is growing awareness of this exciting new force in the mental health pro- Mental health practitioners are becoming fessions, many practitioners lack the training that increasingly aware of the neuroscientific revolu- would enable them to more fully understand the tion that is unfolding in the fields of counseling, relevance of neuroscience to counseling and education, psychiatry, psychology, and social psychotherapy theories and practices. Chapter 2 ◆ Neuroscience—51

Various issues related to neuroscience were The research focus and techniques used by presented in Chapter 1. This was done to neuroscientists have also expanded enor- mously, from biophysical and molecular stud- a. provide a general overview of what neu- ies of individual nerve cells to a broad range roscience is, of new imaging techniques that are used to b. acknowledge that this field is the newest study perceptual, motor, cognitive, and psy- force making a substantial impact on the chological reactions and brain functioning. work mental health practitioners do in The preceding chapter also generally the field, and describes a number of basic neuroscience concepts. These include discussing what neu- c. explain how this new force fits into the rons, neuroplasticity, and mirror neurons are Behavioral/Physical/Neurological Quadrant and how they impact human functioning. that complements the integral approach Those discussions remind us that the brain is to counseling and therapy discussed in essentially composed of billions of neurons this book. that transmit even more electronic-chemical To build on the information presented in signals in the brain that affect the way people Chapter 1, we discuss additional issues of rel- think, feel, and behave (Ndabahaliye, 2002). evance to neuroscience as a vital component The term neuroplasticity was also defined in an integral approach to counseling/therapy. in Chapter 1. In describing the meaning of Consequently, we begin this chapter by reiter- this important concept, it was pointed out that ating the definition of neuroscience. As defined in Chapter 1, Up until the late 1990s, professional and laypersons alike believed that people were Neuroscience is essentially the scientific born with a given number of neurons in the study of the nervous system. Traditionally, brain. It was generally accepted that, while neuroscience has been seen as a branch of neurons could “die” due to brain injury, biology. However, it is currently viewed disease, and exposure to toxic chemicals as an interdisciplinary science that incorpo- entering the brain; new neurons could not rates knowledge from many other disci- be reproduced. This widely held belief plines, such as psychology, computer sci- about brain chemistry has been found to be ence, mathematics, physics, philosophy, and irrefutably false as a result of research con- medicine. ducted by neuroscientists during the late 1990s and early 21st century. The brain’s As a result of the interdisciplinary nature ability to reproduce new neurons and reor- of this field, the scope of neuroscience has ganize itself by forming new neural con- broadened to include the study of the molecu- nections throughout life is referred to as lar, developmental, structural, functional, neuroplasticity (Begley, 2007). evolutionary, computational, medical, and psychological aspects of the nervous system There are different ways in which research- in general and brain functioning in particular. ers have noted neuroplasticity to occur. One 52—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY way involves the manner in which existing (Mirescu, Peters, Noiman, & Gould, 2006), neurons contribute to the production of new and physical exercise (van Praag, Shubert, neurons to compensate for injury, disease, and Zhao, & Gage, 2005). In short, the researchers exposure to toxic environmental conditions listed above provide evidence that explains (including environmental pollutants, poverty, how and why new learning activities, adequate violence, and other forms of oppression and sleep, and regular exercise contribute to the social injustice). generation of new neurons and/or the healthy maintenance of existing neural networks. Neuroplasticity also occurs as a result of Of particular relevance to this chapter is the intraneural chemical adjustments that neu- understanding of two additional basic points. rons make in response to new situations and First, from a neuroscientific perspective, it is experiences that characterize peoples’ lives. important to understand that the process of Recent research findings have verified that counseling and psychotherapy depends on neuroplasticity is enhanced when people clients’ natural biological propensity for are engaged in repetitive behaviors, such as neuroplasticity and neurogenesis. This is so routinely practicing a musical instrument; because positive counseling and therapy out- exposed to enriched environments, such as comes result in the generation of new neurons the enriched environments that are created in and neural networks that affect various changes many preschool programs; and exposed to in the brain that underlie clients’ sense of new, novel, supportive, and challenging psychological well-being or distress. activities, including counseling and psycho- Second, the types of changes clients hope therapy (Cozolino, 2002, 2010a, 2010b). to achieve in counseling and therapy are fos- tered by the neurological alterations that prac- The last statement in the definition of neuro- titioners stimulate by using various theoreti- plasticity underscores the basic biological fact cal principles, skills, and interventions that that counseling and therapy represent unique are increasingly known to stimulate the gen- experiences that can lead to the generation of eration and optimal release of various neu- new neurons and neural wiring that greatly rotransmitters that promote changes in cli- affect how people think, feel, and behave. The ents’ neural wiring and brain functioning. term neurogenesis is closely related to the con- Thus, to expand your knowledge of the rel- cept of neuroplasticity and refers to the genera- evance of neuroscience for counseling/therapy tion of new neurons in the brain. theories and practices, this chapter builds on While neurogenesis is most apparent in the short introduction in Chapter 1 that briefly infant and child development, researchers discusses the role of neurotransmitters. This have described conditions that foster or inhibit discussion is followed by a description of key neurogenesis in adult animals as well (Gould, neurotransmitters that are generated in the Reeves, Graziano, & Gross, 1999; Siegel, body and their role in healthy brain function- 2007). This includes studies that describe ing, all of which contributes to clients’ sense of positive neurogenetic reactions that are corre- psychological well-being or distress. lated with new learning activities (Becker, This chapter continues by presenting infor- 2005; Gould et al., 1999), adequate sleep mation that describes the role and function Chapter 2 ◆ Neuroscience—53 that different parts of the brain play in affect- and clinical practices. The following section ing the way people think, feel, and behave. discusses these issues in greater detail. We hope you find the discussion of how dif- ferent counseling skills and interventions con- ** tribute to the release of various neurotransmit- NEUROSCIENCE: ters and healthier brain functioning to be THE MISSING LINK especially helpful in increasing your under- IN COUNSELING AND standing of the relevance of neuroscience to THERAPY THEORIES the work practitioners do with their clients. AND PRACTICES Before continuing with these discussions, it is readily acknowledged that the study of neurosci- Despite acknowledging that neuroscience is ence and its relevance to counseling and therapy slowly being infused into professional train- theories and practices can be daunting for many ing programs as well as some counseling and persons in the mental health professions. This therapy practices, Farmer (2009) asserts that may, in part, be due to a person’s preconceived it continues to be the missing link in the men- notions about the complexity of neuroscience as tal health professions. In terms of the present well as one’s unfamiliarity and lack of training discussion, it is important to discuss how and in this area. We also recognize that many people why this missing link prevents mental health tend to avoid learning about subjects that they practitioners from operating at a higher level think are too complex for their liking. of efficacy and intentionality. With this in mind, we have made a special A basic assumption that underlies the fol- effort to describe neuroscience and its rele- lowing discussion is the belief that practition­ vance to counseling and psychotherapy in ways ers’ interest in neuroscience will be enhanced that we hope will both increase your under- by describing the relevance of neuroscientific standing of some of the basics of these interre- research findings as they relate to the specific lated topics and be professionally empowering. skills, interventions, and theories that counsel- By dedicating an entire chapter to extending ors and therapists use in the field. In addition the general discussion on neuroscience that is to increasing the efficacy of the work mental presented in Chapter 1, we hope you will be health professionals do, Farmer (2009) out- excited about the potential impact this new lines several other reasons why it is important force has to increase the efficacy of the mental to address this missing link in the mental health professions in the coming years. health professions: To more fully understand the relevance of neuroscience to counseling and psychotherapy 1. Although the neuroscientific revolution theories and practices, it is important to explore that is occurring in the mental health why this new force continues to be a vital professions may not provide answers to missing link in the mental health professions all the challenges practitioners face in (Farmer, 2009). It is also important to know their work, the important knowledge gen- what can be and is being done to address the erated from this revolution and its rele- general omission of neuroscientific knowl- vance to mental healthcare need to be edge in many professional training programs acknowledged and understood. 54—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

2. Neuroscientific insights can be of 6. Mental health professionals will increas- immediate and direct benefit in improving ingly be challenged to operate in ways our understanding of human develop- that reflect a greater integration of ment and behavior as well as the types knowledge from diverse fields and dis- of helping interventions that are likely ciplines in the future. (pp. 1–2) to be useful in promoting positive counseling and psychotherapeutic The integral model presented in this book outcomes among clients in diverse represents one way mental health professionals populations. can address the missing link described above. 3. The probability is that neuroscience will This can be done by increasing our profes- continue to yield significant insights sional efforts to develop and implement a more that are relevant to counseling and fully integrated and multidisciplinary approach therapy for the foreseeable future. to helping clients. Such an approach necessi- Consequently, practitioners must be tates increasing our knowledge of neuroscience ready—intellectually, emotionally, and and its relevance to counseling and therapy institutionally—to understand the devel- theories and practices (Behavioral/Physical/ opments that are unfolding in these areas Neurological Quadrant considerations). and be able to implement this new Clearly, the sort of comprehensive knowledge in their work or run the risk approach to counseling and psychotherapy of becoming increasing irrelevant and that is reflected in the integral theory pre- nonviable members of the mental health- sented in this book requires mental health care professions in the 21st century. professionals to move to a new level of con- sciousness as they are challenged to embrace 4. Neuroscience is enhancing our under- a more holistic view of counseling, psycho- standing of what it means to be human. therapy, and human development (Societal/ The utilization of knowledge generated Professional Quadrant factors). As noted in from neuroscientific research findings to this chapter, an important aspect of develop- increase the effectiveness of counseling ing an integral approach to counseling and and therapy will largely depend on psychotherapy necessarily includes acquiring whether practitioners’ conception of men- more knowledge about neuroscience in general tal healthcare is narrow (excluding neuro- and other factors that compose the Behavioral/ scientific knowledge and research findings) Physical/Neurological Quadrant. or broad (including neuroscientific knowl- History teaches us, however, that calls for edge and research findings). significant changes in any professional field 5. Neuroscience can help mental health are predictably met with resistance. Certainly, practitioners more effectively deal that has been and to some degree continues to with the multifaceted problems clients be the case in calling on mental health profes- present; clinical practice is becoming sionals to learn about the relevance of neuro- increasingly difficult as practitioners science for counseling and therapy theories encounter greater complexity of human and to incorporate this new knowledge into and societal problems and diagnoses. their professional practices. Chapter 2 ◆ Neuroscience—55

The following section discusses several In addition to this viewpoint, we point to a factors that underlie such resistance. It also philosophical perspective that represents a outlines new ways of thinking about neurosci- deeper and more pervasive variable underlying ence that can be helpful in minimizing the much of the resistance that is manifested manifestation of resistance to neuroscience toward neuroscience in the mental health pro- that contributes to the perpetuation of this fessions. The philosophical perspective we are missing link in the mental health professions. referring to is reflected in the remnants of dualism that continue to lead many practitio- ners to consciously or unconsciously dichoto- **ACKNOWLEDGING mize their thinking about the mind and matter THE RESISTANCE TO (e.g., the brain). This dichotomous thinking NEUROSCIENCE contributes to much of the resistance or apa- thetic reactions some mental health profession- The assertions put forth by Farmer (2009) als feel toward the rising neuroscientific force and other mental health professionals (Cozolino, in counseling, psychology, and social work. 2002, 2010a, 2010b; Ivey, Ivey, Zalaquett, & Quirk, 2009) constitute a compelling argument Dualistic Thinking About that supports the notion that neuroscience the Mind and the Brain promises to be a force that will continue to transform the practice of counseling and psy- The puzzle of the relationship between the chotherapy. Despite the potential of this mind and matter (the brain) is not only a science-based perspective to revolutionize the conundrum for the ages, but continues to be work practitioners do in the field, there is sub- manifested in different ways among mental stantial resistance to support this perspective health professionals. This historical mystery by numerous persons in the mental health pro- is reflected in a philosophical perspective fessions. Part of this resistance is grounded in referred to as dualism. the perceived complexity many mental health Dualism is reflected in a set of views about professionals hold about neuroscience and the relationship between mind and matter (i.e., their lack of formal training in this area, as the brain), which begins with the claim that noted above. mental phenomena are, in some respects, non- Louis Cozolino (2002), a well-respected physical. From this perspective, the mind refers to neuroscientist who has written extensively nonphysical properties that include thinking, about the relevance of neuroscience to psy- spirit, soul, or some such equivalent (Hiley, 2001). chotherapy, identified additional factors that Historically speaking, dualism is thought to contribute to this resistance. In Cozolino’s have originated at least as far back as Plato (2010b) words, “Many mental health practitio- and Aristotle. These philosophers speculated ners have a bias against neuroscience. They that the mind existed as an incorporeal soul describe it as confusing and irrelevant to their from which a person’s intelligence, reasoning, work. Although I agree it can be confusing, it is and wisdom are manifested. Plato and Aristotle extremely relevant to the process of counseling both maintained, for different reasons, that and psychotherapy” (p. xvi). people’s “intelligence” (a faculty of the mind 56—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY or soul) could not be identified with or explained that mind and brain were two dichotomous in terms of a person’s physical-biological entities, one being psychological and the body (Kalekin-Fishman, 2008). other physical. Toward the end of that cen- A generally well-known and alternative tury (i.e., the late 1880s), new knowledge version of dualism is attributed to René about the brain emerged, including the dis- Descartes. It is reported that around 1641, covery of neurons and synapses. Sigmund Descartes linked the mind with a person’s Freud, who by this time had been trained as consciousness and self-awareness and identi- a neurologist (i.e., one who treats diseases fied the brain as the seat of intelligence, serving of the brain and nervous system), also had as the purveyor of a person’s behavioral a great interest in the mind, and he wanted responses to his or her environment and to combine a psycho-biological view of the monitor of an individual’s biological mecha- person with the notion of the mind. To pur- nisms. Hence, Descartes was thought to be sue this interest, he went to Paris to study among the first to formulate the mind-body with Jean-Martin Charcot, who was using dichotomy argument that is perpetuated in hypnosis to treat patients with hysteria to similar ways among many mental health pro- demonstrate the interactions between the fessionals today (Praetorius, 2003). In doing body, the brain, and the mind. (p. 105) so, they tend to associate the mind with men- tal and psychological processes, whereas the Recently, Andreasen (2001) expressed a brain is linked to behavioral, physical, bio- more inclusive and integrated alternative to logical, and neurological processes and enti- dualism that is consistent with the thinking of ties. Farmer (2009) suggests that resistance to a growing number of mental health profes- the rising neuroscientific force in the mental sionals in the field today. According to health professions is largely due to those Andreasen, “the brain and mind are insepara- practitioners who continue to embrace the lat- ble and refer to the same thing or activity. The ter type of dualism. mind is the product of the activity occurring Speaking from a historical perspective, in the brain at the molecular, cellular, and Farmer (2009) notes that anatomical levels” (p. 27). Our own view of the mind and the brain Sigmund Freud is a symbol of the desir- puzzle extends Andreasen’s (2001) perspec- ability of rejecting the dichotomy of biology tive further by noting that the mind is the and psychology when it comes to mental product of the activity occurring in the brain healthcare. Freud’s own career is also at the molecular, cellular, and anatomical symbolic of how, because of the lack of levels, which are in turn impacted by a per- development in neuroscience in his time, son’s interpersonal relationships, cultural there has been the sort of historical acci- context, and societal experiences (Individual dent in the separation of psychotherapy Perceptions and Meaning Making Quadrant, from the biological. Behavioral/Physical/Neurological Quadrant, During Freud’s youth in the 19th cen- Cultural Community Quadrant, and Societal/ tury, a predominant view (that continues to Professional Quadrant considerations). be manifested by many persons today) was Andreasen’s and our own explanation of the Chapter 2 ◆ Neuroscience—57 mind and matter (i.e., the brain) puzzle on your own views of the meaning of the mind implicitly supports the importance of neuro- versus the brain as it relates to counseling and science and its relevance to counseling and therapy issues. By engaging in this reflective therapy theories and practices. process and following the additional steps Competency-Building Activity 2.1 will included in this competency-building activity, help you clarify your own thinking about your you are likely to gain insights into your ten- level of support for the neuroscience force that dency to support or not support the neurosci- is emerging in the mental health professions. ence revolution that is occurring in the mental It does so by encouraging you to first reflect health professions.

COMPETENCY-BUILDING ACTIVITY 2.1

Exploring Your Own Views of the Mind, the Brain, and Neuroscience Instructions In this section of Chapter 2, you have read about what the term dualism means as it relates to the way the mind/brain controversy has been and continues to be conceptu- alized by philosophers and mental health professionals. Several key points associated with dualism are summarized in the following instructions for this competency-building activity.

Step 1: Please take time to review the following summaries of dualism and reflect on your own thinking about the mind/brain debate as you do. A. Historically, philosophers such as Plato and Aristotle suggested that a person’s intelligence, reasoning, and wisdom emerge from nonphysical/nonbiological enti- ties such as the soul or other metaphysical processes. B. On the other hand, Descartes linked the mind with a person’s consciousness and self-awareness and identified the brain as the seat of people’s intelligence and behavioral reactions to life situations. In doing so, Descartes was among the first to formulate the mind-body dichotomy argument that is perpetuated in various ways among many mental health professionals today (Praetorius, 2003). This perspective primarily associates the mind with mental and psychological processes, whereas the brain is linked to behavioral, physical, biological, and neurological processes and entities. C. Sigmund Freud rejected the dichotomy of biology and psychology when it came to addressing mental disorders. Freud’s own training in neurology is likely to have influenced his thinking about the biological foundations of mental disorders. (Continued) 58—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

(Continued) D. More recently, Andreasen (2001) expressed a more inclusive and integrated view of dualism that is consistent with the thinking of a growing number of mental health professionals in the field today. As pointed out in this chapter, Andreasen asserted that “the brain and mind are inseparable and refer to the same thing or activity. The mind is the product of the activity occurring in the brain at the molec- ular, cellular, and anatomical levels” (p. 27). E. The authors of this book have extended Andreasen’s (2001) view further by sug- gesting that the mind is the product of the activity occurring in the brain at the molecular, cellular, and anatomical levels, which are in turn impacted by a person’s interpersonal relationships, cultural context, and societal experiences. This latter effort to resolve the mind/brain dichotomy integrates considerations associated with all four quadrants that compose the integral theory of counseling and therapy (Individual Perceptions and Meaning Making Quadrant, Behavioral/Physical/ Neurological Quadrant, Cultural Community Quadrant, and Societal/Professional Quadrant considerations). Farmer (2009) suggests that resistance to the rising neuroscientific force in the mental health professions is often noted among practitioners who embrace perspec- tives of dualism that are consistent with the ideas summarized in points A and B above. Step 2: After you have had a chance to reflect on the summary of the perspectives outlined above, write down your own views of the mind/brain debate. When complet- ing this part of the competency-building activity, please briefly indicate which, if any, of the above stated perspectives match your own thinking of this debate and which perspectives are most unlike your own views of this controversy.

Step 3: Indicate how strongly you support or do not support the neuroscience force that is currently rising in the mental health professions as part of your reflective response to this written activity. Step 4: Keeping in mind your response to Step 3, briefly write down how you think your work as a mental health practitioner might be impacted by the support or lack of support for the neuroscience force that is rising in your profession. Step 5: After you have completed the four preceding steps, please note whether there is anything you might want to do to increase your effectiveness as a practitioner by developing a greater understanding of the relevance of the neuroscience revolution that is occurring in the mental health professions. When you have completed this competency-building activity, please file your responses in your personal-professional development portfolio. Chapter 2 ◆ Neuroscience—59

Ivey and his colleagues (2009) extend sev- precision where it now has immediate mean- eral points that have been made about the ing for counseling process and outcome. relevance of neuroscience to counseling and Neuroscience and neuroimaging have found therapy up to this point in the chapter. Their that measurable structural changes occur comments also illuminate additional barriers in clients’ brains as a result of cognitive and resistance to this new force in the mental and interpersonal therapy. Advances in health professions. positron-emission tomography scans and functional magnetic resonance imaging Counseling builds new brain networks. have made it possible to measure areas of Research in neuroscience and cognitive sci- the brain that “light up” or “fire” under ence is highly supportive of our emphasis on various stimulus conditions. And it is not listening, empathic understanding, and just the client who develops new neurons building strengths and wellness. Somewhat and neural nets in the process of counseling; surprisingly, neuroscience’s findings on the the counselor’s brain is changing as well. brain result in a more complete awareness of Getting our field to accept and learn how environment and culture shape the indi- about this new area will be challenging, vidual. The bridge between biological and however. We aren’t aware of any curricu- psychological processes is erasing the old lum that includes a serious discussion of distinction between mind and body, between how we can use neuroscience and cogni- mind and brain—the mind is the brain. tive science in counseling and therapy How and why are neuroscience and practice. Fortunately, our major accredit- cognitive science relevant to counseling ing association, the Council for Accredita- practice? First, neuroscience provides tion of Counseling and Related Educa- comforting research that suggests most of tional Programs, anticipated this future in counseling theory and practice is on target. its 2009 standards. In relation to one of But it also gives us a clearer understanding CACREP’s “eight common core curricular of why what we do actually works. More- areas,” we found the following statement over, it imparts ideas for improving our incorporating these new ideas: work with clients. We also learn that our Human Growth and Development— wellness and environmentally based orien- studies that provide an understanding tation is correct. Unless we have a mean- of the nature and needs of persons at all ingful and effective environment, we can- developmental levels and in multicultural not grow and change. In counseling, this contexts, including all the following: means that our key word relationship is all that more important and that we need to a. Theories of individual and family honor and respect what we have done and development and transitions across what we can do in the future. the life span You likely have noticed frequent stories b. Theories of learning and personal- on television and in the popular media on ity development, including current brain research and its implications for the understandings about neurobiological future. This research has reached a state of behavior 60—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

This CACREP Standards statement pro- the relationships they build with their clients vides a rationale and direction for our new (Goleman, 2007; Siegel, 1999, 2007) as well future. We are now at a point where neuro- as the different counseling and therapy the- science and its related areas can and will ories, skills, and interventions they use in provide a powerful impetus for adding new their work (Farmer, 2009) foster the release content to our counseling curriculum and of various neurotransmitters and stimulate practice. Unless we become aware of this related brain changes. The unintentional and new paradigm and change, we are in danger unconscious impact that these practitioners of falling behind in our daily practice, have in this regard largely occurs because teaching and research. John Cacioppo and many professional training programs and Jean Decety have written that “psychologi- theories textbooks have not made the connec- cal science in the 21st century can and tion between popular approaches to counsel- should become not only the science of overt ing and therapy and recent research findings behavior, not only the science of the mind, in neuroscience. but the science of brain function.” Not only We strongly support the inclusion of neuro- does neuroscience clearly indicate that we scientific knowledge when planning and imple- are on the right track, but it also demon- menting counseling and therapy services with strates the need for updating our field if we our clients (Behavioral/Physical/Neurological are to remain current and relevant. Quadrant and Societal/Professional Quadrant Many counseling professionals worry factors). We also recognize that this new about the “medical model” and a possible theoretical and evidence-based force will focus on pathology. However, you will increasingly impact the mental health profes- find that neuroscientists have a strong sions in many transformative ways in the years environmental orientation—client devel- to come. opment over the life span clearly impacts Despite our strong support for and recog- the brain. Evidence suggests that effective nition of the transformative potential of neu- counseling and therapy can change the roscience in the mental health professions, brain in positive ways. In truth, neurosci- we encourage students and colleagues to ence reinforces counseling’s wellness approach their learning about this new force model. (pp. 19–20) with cautious enthusiasm. By balancing one’s enthusiasm with a cautious eye, mental health Despite the resistance and apathy some professionals will avoid falling prey to publi- practitioners exhibit when encouraged to con- cations that overstate the positive aspects of sider the relevance of neuroscience to coun- neuroscience for counseling and therapy seling and psychotherapy, neuroscientific without basing these claims on credible research findings suggest that every counsel- research findings. This word of caution is ing and therapy session inadvertently stimu- consistent with the importance of operating lates a variety of neurological changes in both as scientist-practitioners and embracing clients and practitioners (Goleman, 2007). empirically supported theoretical perspec- Many practitioners who lack training in neu- tives in professional practices, as discussed roscience are not aware of the ways in which in Chapter 1. Chapter 2 ◆ Neuroscience—61

The following sections of this chapter Although many clients cannot control present information that is designed to many of the stressors that occur in their envi- increase your understanding of neurotrans- ronment, they can control the decisions they mitters and how they affect various cognitive, make that are related to their lifestyle. One of emotional, psychological, and behavioral the basic decisions clients make in this regard reactions people have to their life experi- relates to their dietary habits and intake. ences. Similar issues about specific parts of The expanded knowledge base related to the brain are discussed later in this chapter. the links between clients’ diets, the produc- All the information presented in the following tion of neurotransmitters, and various behav- sections is based on numerous empirical stud- iors that underlie mental health and psycho- ies in neuroscience. logical disturbance are leading many practi- tioners to direct attention to these aspects of the Behavioral/Physical/Neurological Quadrant **WHAT ARE when using an integral approach to counseling NEUROTRANSMITTERS? and therapy. This is especially true among prac- titioners whose theoretical orientation to coun- As noted in Chapter 1, the chemicals that are seling and psychotherapy is anchored in a holis- exchanged in synapses between neurons are tic view of mental healthcare (Melanson, 2007). called neurotransmitters. Neurotransmitters Given the growing relevance of these carry messages between neurons that stimu- aspects of the Behavioral/Physical/Neurologi- late biological reactions in different parts of cal Quadrant for counseling and psychotherapy, the brain. The impact of these neurotransmit- the following section is specifically designed to ters and the chemical reactions they stimulate extend your knowledge of how clients’ diets in localized parts of the brain contribute to the affect the production or suppression of various different cognitive, emotional, psychological, neurotransmitters that, in turn, affect clients’ and behavioral outcomes people manifest in moods, thoughts, feelings, and behaviors. their lives. Researchers have linked the production or We Are What We Eat lack of production of specific neurotransmit- ters to various environmental stressors and Nutrients in the foods we eat and liquids we people’s lifestyles (including a person’s drink generate certain amino acids in the body. dietary intake, coping strategies, and use of These amino acids affect our brain chemistry leisure time; Anderson & Summers, 2007). by increasing or decreasing the production of New research discoveries in these areas are various neurotransmitters. As noted above, greatly expanding our understanding of the nerve impulses that are transmitted by neu- ways that the problems clients report in rotransmitters across neural synapses contain counseling and psychotherapy are directly chemical information that impacts people’s tied to changes in their brain chemistry in thoughts, moods, attitudes, and behaviors. The general and the overproduction or underpro- findings of numerous neurological studies have duction of neurotransmitters in particular increased our understanding of the effect that (Farmer, 2009). different foods, vitamins, mineral supplements 62—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

(e.g., folic acid, choline, and selenium), as well particularly relevant to the work mental health as various drugs and alcohol have on the pro- practitioners do to foster clients’ well-being. duction of neurotransmitters in the brain and We are becoming more aware of the ways that related behavioral and psychological reactions the proper production of these neurotransmit- (Hubbs-Tait, Nation, Krebs, & Bellinger, 2005). ters (or lack thereof) impact people’s behav- Why this emphasis on nutrition as we start iors and psychological reactions. The specific a discussion on neurotransmitters? First, neurotransmitters that are of particular rele- effective nutrition and a healthy body are vance in this regard include acetylcholine, a essential for optimal brain functioning. neurotransmitter important for memory and Chudler (2010) examines the relationship of learning; serotonin, our natural mood stabi- diet to brain and nervous system functioning. lizer and sleep promoter; dopamine, our natu- For example, he states that lack of selenium ral energizer and mental focuser; and GABA can result in central nervous system damage, (gamma amino butyric acid), our natural Vitamin E is important for cell membranes, relaxer (Cozolino, 2002). and iron is necessary for basal ganglia func- Table 2.1 provides additional information tioning and preventing anemia. regarding the effects of deficiencies in the As part of the assessment process in coun- production of these neurotransmitters as well seling and therapy, it is important that you as specific foods that enhance or decrease consider health-related behavior. You may not their production in the brain. Understanding think of nutrition and diet counseling as part the relevance of the information presented of your work, but it is becoming increasingly in Table 2.1 to counseling and psychother- obvious that you need some knowledge in this apy is leading many practitioners to discuss area—at least enough for intelligent referral. these aspects of the Behavioral/Physical/ Of the more than 100 neurotransmitters Neurological Quadrant with their clients that have been identified by researchers, 4 are (Farmer, 2009).

Table 2.1 Essential Neurotransmitters, Effects of Normal Functioning, Effects of Deficiency, Foods to Avoid, and Foods to Consume

Effects of Normal Effects of Foods to Neurotransmitter Functioning Deficiency Foods to Avoid Consume Acetylcholine Critical for memory, Deterioration of Sugar, Organic eggs, learning, optimal memory and deep-fried fish (especially cognitive imagination, fewer food, junk salmon, functioning, dreams, increased food, refined mackerel, emotional balance confusion, and processed sardines, and and control forgetfulness, food, cigarettes, fresh tuna) cognitive alcohol disorganization, lack of emotional control, increased aggression Chapter 2 ◆ Neuroscience—63

Effects of Normal Effects of Foods to Neurotransmitter Functioning Deficiency Foods to Avoid Consume Serotonin Directly effects the Low mood, Alcohol Fish, fruit, eggs, way a person feels, depression, avocado, wheat behaves, and thinks; difficulty sleeping, germ, low-fat sustains one’s feeling cheese, lean interest in and “disconnected,” poultry energy for emotional, lack of joy, anxiety cognitive, and behavioral processes; vital to sleep and anxiety control Dopamine Regulates movement, Lack in drive, Tea, coffee, Regular balanced emotional wellness, motivation, and/or caffeinated meals, fruits and motivation, enthusiasm; drinks vegetables high pleasurable feelings craving of in Vitamin C, stimulants wheat germ (e.g., caffeine) GABA Helps reduce anxiety Hard to relax and Sugar, alcohol, Dark green (Gamma amino and induces can’t switch off tea and coffee, vegetables, seeds butyric acid) relaxation and sleep anxiety caffeinated and nuts, drinks potatoes, bananas, eggs

**HELPING STRATEGIES THAT treatment strategies that can impact the neu- PROMOTE HEALTHY rotransmitters outlined in Table 2.1 in ways NEUROTRANSMITTERS that promote clients’ health and well-being. The following information is based on the Table 2.1 provides guidelines that counselors important work these and other researchers and therapists may find helpful when present- have done in this area. ing nutritional counseling information to pro- mote their clients’ healthy generation of the Counseling/Therapy Skills and four neurotransmitters described above. In Intervention Strategies That May addition to these helping strategies, research- Impact the Generation and Release ers have identified additional counseling and of Acetylcholine therapy skills and theoretical approaches that have a positive effect on the generation and Ivey et al. (2010) suggest numerous helping release of these important neurotransmitters. strategies that may enhance the production Ivey, Ivey, and Zalaquett (2010) provide a and release of acetylcholine. This includes detailed summary of some of the possible counseling strategies that help clients develop counseling skills and psychotherapeutic and implement an exercise action plan; learn 64—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY to use meditation on a regular basis; and relationships may simultaneously promote explore ways to develop new, positive social the sort of positive psychological disposition relationships. and sense of emotional well-being that is Referring back to Sachi, the 28-year-old linked to the generation of increased levels of Japanese client described in Vignette #2, acetylcholine in the brain. practitioners operating from a neuroscience Competency-Building Activity 2.2 helps perspective may consider how this client’s you assess your readiness to implement coun- overall psychological disposition may be pos- seling and therapy interventions that are itively impacted by recommending that she anchored in a neuroscience perspective that consider implementing some or all of the includes the helping strategies listed above. intervention strategies listed above. From a Upon completing this competency-building neuroscience perspective, it is possible that activity, you will be more aware of the types encouraging clients like Sachi to develop and of knowledge and skills you currently pos- implement a holistic plan that includes sess, as well as those that need to be devel- increasing their level of daily exercise and use oped in adopting a neuroscience-oriented of meditation and working to build new social approach to counseling clients like Sachi.

COMPETENCY-BUILDING ACTIVITY 2.2

Assessing Your Readiness for Implementing Neuroscience-Based Counseling and Therapy Interventions Instructions In this activity, you are encouraged to assess your interest and readiness in using a holis- tic counseling approach that is grounded in a neuroscientific perspective when working with clients like Sachi (the client in Vignette #2). As noted in this chapter, practitioners operating from a neuroscience perspective are likely to encourage clients like Sachi to develop and implement a holistic treatment plan in counseling and therapy. Such a plan might include offering assistance in developing a daily exercise action plan, encouraging the use of meditation, and exploring ways that they can build new social relationships. These strategies are, in part, aimed at promoting the sort of psychological well-being that is linked to increased levels of acetylcholine in the brain. Please write down your reactions to the following questions on a blank piece of paper to assess your interest and readiness to implement a holistic approach to counseling that is grounded in a neuroscience helping perspective.

Question 1: What is your initial reaction to the specific suggestions that were made for developing the sort of holistic approach with clients like Sachi that is described in this section of Chapter 2? Chapter 2 ◆ Neuroscience—65

Question 2: What other helping strategies do you think would be useful to implement with clients experiencing similar concerns as Sachi in counseling and therapy situations? Question 3: Write a statement that describes how comfortable and competent you feel at this stage of your professional development in offering assistance to clients like Sachi in developing a daily exercise action plan, using meditation, and exploring ways that they can build new social relationships. Question 4: Write a statement that describes how comfortable and competent you feel at this stage of your professional development in implementing the strategies you listed in your response to Question 2 with clients like Sachi. Question 5: Write a statement that describes how interested you are in developing additional knowledge and skills that are necessary to effectively implement a holistic approach to counseling clients like Sachi in the future (e.g., by offering assistance in developing a daily exercise action plan, encouraging the use of meditation, and explor- ing ways that clients like Sachi can build new social relationships, to name a few). Question 6: What specific actions can you take to develop the knowledge and skills needed to effectively implement the holistic interventions that are recommended for use with clients like Sachi (e.g., by offering assistance in developing a daily exercise action plan, encouraging the use of meditation, and exploring ways that these clients can build new social relationships)? Question 7: Write a statement that describes how interested you are in increasing your knowledge and competence in effectively implementing the strategies you listed in your response to Question 2 with clients like Sachi. Question 8: What specific actions can you take to develop the knowledge and skills needed to effectively implement the strategies you listed in your response to Question 2 with clients like Sachi?

Be sure to file your responses to this competency-building activity in the personal-professional development portfolio you are developing as you read this book and continue to complete the competency-building activities included in each chapter.

Counseling/Therapy Skills and Intervention Strategies That May patterns, maintenance of positive mood, con- trol of one’s anxiety, and feelings of self-esteem. Impact the Generation and Release On the other hand, serotonin deficiencies of Serotonin are related to increased depression, impul- Ivey et al. (2010) note that normal levels of sive behaviors, anger, and aggression. These serotonin are vital to ensure adequate sleep researchers further suggest that a variety of 66—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY counseling skills and therapeutic intervention lack of drive, motivation, and/or enthusiasm to strategies are likely to be useful in promoting complete routine tasks, as well as increased healthy levels of serotonin. This includes imple- craving for stimulants (e.g., caffeine). menting various strategies associated with Ivey et al. (2010) point out that encourag- positive psychology/wellness counseling the- ing clients to focus on positive stories about ories (see Chapter 13), cognitive-behavioral their lives can help increase their dopamine theories (see Chapters 7 and 8), and efforts to production. They also suggest that directing assist clients in developing clear visions and clients’ attention to their personal strengths meaning in their lives (strategies that charac- may stimulate the generation of dopamine. terize many existential-humanistic counseling This can be done by tailoring many of the interventions, discussed in Chapters 9 and 10). techniques and interventions that are associ- It is also reported that using the sort of ated with positive psychology/wellness coun- positive restorying associated with narrative seling and solution-focused/brief therapy counseling (see Chapter 4) and gaining a theories presented in Chapter 13. commitment from clients to implement new Recently, other researchers have noted that action strategies that are based on their resto- an increased production of numerous neu- rying is helpful in generating increased sero- rotransmitters occurs when clients receive tonin levels (Ussher, 2010). therapeutic massages. More specifically, Practitioners working from a neuroscien- patients with cancer and other medical disor- tific perspective may consider how fostering ders who receive massage therapy benefit Sachi’s (the client described in Vignette #2) from increased levels of dopamine, as well as serotonin levels may be helpful in addressing increased levels of serotonin, oxytocin, endor- her concerns about the increased anxiety and phins and increased production of natural depression she is experiencing as a result of killer cells (Goodfellow, 2003; Hernandez-Reif relocating for career reasons. Operating from et al., 2004). this perspective may lead practitioners to incorporate some or all of the counseling Counseling/Therapy skills and therapeutic interventions listed Skills and Intervention Strategies above to help Sachi deal with the problems That May Impact the Generation she is encountering in her life. and Release of GABA

Counseling/Therapy Normal levels of GABA are linked to an indi- Skills and Intervention Strategies vidual’s ability to effectively manage and That May Impact the Generation reduce anxiety as well as general feelings of and Release of Dopamine relaxation and adequate sleep patterns. Con- versely, GABA deficiency is associated with As noted in Table 2.1, dopamine production is a person’s inability to manage anxiety, inabil- linked to a person’s sense of emotional well- ity to remain relaxed for extended periods of ness, motivation, and pleasurable feelings. time, and sleep disorders (Adamec, 2000). Dopamine deficiency, on the other hand, has Ivey et al. (2010) offer a number of sug- been associated with clients reporting a general gestions that may have a positive impact on Chapter 2 ◆ Neuroscience—67 stimulating increased GABA production people’s mental health and contribute to among clients whose behaviors and concerns behavioral problems (Cozolino, 2010b). are consistent with the symptoms outlined in Before continuing this discussion, it is impor- Table 2.1. First, these counseling experts tant to emphasize that researchers have not point out that the basic listening skills that all reported a direct causal effect between spe- mental health practitioners are trained to use cific parts of the brain and specific moods, in their work are helpful when utilized thoughts, feelings, and behaviors clients among GABA-deficient clients. The power of manifest in their lives. The complexity of actively listening to clients in a composed and brain functioning and related cognitive, respectful manner not only serves to calm emotional, psychological, and behavioral individuals who are anxious and agitated but reactions suggests that these reactions result does so in a way that has a biological impact, from interfacing biological changes that occur resulting in increased production of GABA. in multiple brain parts. Second, Ivey et al. (2010) assert that various It is also important to point out, however, counseling interventions that require clients’ that neuroscientists are increasingly demon- active involvement in learning how to more strating how various brain parts contribute effectively cope with stresses that occur in their to the manifestation of different moods, lives represent other strategies that may con- thoughts, feelings, and behaviors. Thus, while tribute to increasing individual’s GABA levels. it is understood that specific brain parts may These interventions include but are not limited not have a definite causal effect on specific to stress management and relaxation train- psychological and behavioral outcomes, it is ing, mindfulness counseling (see Chapter 7), equally clear that there are strong correla- and the use of other cognitive-behavioral tional effects between the levels of neural therapy strategies to increase clients’ self- activation in different parts of the brain and regulation abilities (Lynch, Jarvis, DeBellis, & the manifestation of various moods, thoughts, Morin, 2007). feelings, and behaviors in people’s lives. Given the importance of understanding the **UNDERSTANDING THE impact that different brain parts have on cli- ents’ mental health, we describe various issues COMPLEXITY OF LINKING related to this topic below. PEOPLE’S THOUGHTS, Figure 2.1 represents a general profile of FEELINGS, AND the different parts of the human brain. Break- BEHAVIORS TO VARIOUS throughs in neuroscience are helping mental PARTS OF THE BRAIN health professionals better understand the ways that these brain parts contribute to the In addition to the information describing the behavioral and psychological responses we role and function of neurotransmitters in the experience during the course of our lives. preceding part of this chapter, this section A detailed discussion of the new knowl- reports on ways that other neuroscience edge that has emerged from recent neurosci- researchers help expand our understanding ence research on the functioning of different of how different parts of the brain impact brain parts is beyond the scope of this book. 68—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

Figure 2.1 An Overview of the Human Brain

Central Fissure

Motor Somatosensory cortex cortex Sensation and touch Body movement and coordination Body position Frontal lobe Parietal lobe Occipital lobe Hearing Vision

Temporal lobe Smell Lateral fissure

With these space limitations in mind, we divided into several lobes called frontal, pari- have nevertheless chosen to discuss six dif- etal, temporal, and occipital lobes. Along with ferent parts of the brain that are thought to be other brain components, the cerebral cortex particularly important components of the plays a major role in clients’ memory, atten- Behavioral/Physical/Neurological Quadrant tion, perceptual awareness, language, and and that have much relevance to the work consciousness. practitioners do in the field. Thus, we direct your attention to the location and impact of Prefrontal Cortex the following brain parts on clients’ behav- iors and psychological reactions to life: Figure 2.3 provides a visual representation (1) the cerebral cortex, (2) the prefrontal of the prefrontal cortex, which is located cortex, (3) the cingulate system, (4) the basal behind one’s forehead. The prefrontal cortex ganglia, (5) the temporal lobes, and (6) the constitutes about one-third of the entire limbic system. brain. As the most evolved part of the brain, it coordinates such executive functions as a person’s capacity for planning and organiz- Cerebral Cortex ing his or her life, controlling impulses, and The largest part of the brain is composed of an critical thinking. Given the importance of outer, grey-colored section called the cerebral such functions in leading an effective and cortex (see Figure 2.2). The cerebral cortex is satisfying life, it is important that counselors Chapter 2 ◆ Neuroscience—69

and psychotherapists learn about the kinds Figure 2.2 Cerebral Cortex of intervention strategies that can be used to Cerebral Cortex effectively stimulate the optimal function- ing of this part of the brain. A number of such strategies are described later in this chapter.

Cingulate System The cingulate system is located beneath the cerebral cortex and close to the center of the brain (see Figure 2.4). The cingulate system plays a major role in enabling people to effec- tively shift their attention from one idea to another in different situations. This part of the brain is also associated with the coordination of sensory input for emotions, emotional responses to pain, and the regulation of aggressive behavior.

Basal Ganglia The basal ganglia consist of a large number of neurons that are located close to the

Figure 2.3 Prefrontal Cortex Figure 2.4 Cingulate System 70—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY thalamus and amygdala (see Figure 2.5). This Temporal Lobes part of the brain is responsible for numerous The temporal lobes are located on the right functions, including motor control; learning; and left sides of a person’s head directly and the mediation of anxiety, fear, and moti- above one’s ears (see Figure 2.6). These vation. Currently, popular theories suggest brain parts are responsible for numerous that basal ganglia also play a primarily role in functions, including hearing, auditory per- the way people shift their actions in differ- ception, episodic and declarative memory, ent environmental situations. The “behavior and language. They also play a key role in a switching” that most people commonly exhibit person’s expression of emotion and learning in their lives is rooted in changes that occur abilities. within the basal ganglia. The biological changes that occur in this part of the brain, which lead individuals to change their behav- Limbic System iors in different environmental situations, are The limbic system is a complex set of also stimulated by signals that come from anatomical structures that includes the hypo- other parts of the brain, including the prefron- thalamus, hippocampus, and amygdala tal cortex and the cingulate system. (see Figure 2.7). This brain system has a

Figure 2.5 Basal Ganglia Figure 2.6 Temporal Lobes

The Location of the Basal Ganglia in the Human Brain

Temporal Lobe

Basal ganglia Thalamus Amygdala Chapter 2 ◆ Neuroscience—71

major impact on our emotional life, as Figure 2.7 Limbic System well as contributing to the formation of memories. Table 2.2 presents additional information describing how the different parts of the brain briefly discussed above impact a per- son’s behavior and psychological disposi- tion. Table 2.2 also outlines suggestions for corrective interventions that have been tested and found to be effective with many clients. More information related to these aspects hypothalamus of the Behavioral/Physical/Neurological hippocampus pituitary Quadrant of the integral approach to coun- amygdala seling and psychotherapy is discussed later in this book.

Table 2.2 Brain Parts, General Function, Results of Improper Functioning, and Potential Corrective Interventions

Part of the Results of Improper Potential Corrective Brain General Function Functioning Interventions

Cerebral Responsible for many Language problems, Increased dopamine production cortex “higher-order” difficulty understanding through cognitive-behavioral functions, such as incoming information counseling interventions; language and from one’s environment changes in diet and use of information processing supplements; food sources of dopamine-increasing tyrosine, including almonds, avocados, bananas, dairy products, lima beans, pumpkin seeds, and sesame seeds; Vitamin C, Vitamin E, and antioxidants

Prefrontal Increases a person’s Shortened attention span, Counseling that helps clients cortex attention span, distractibility, reduced focus on what they like more perseverance, problem impulse control, than what they don’t like, solving, forward hyperactivity, psychotherapy that promotes thinking, empathy procrastination, poor clients’ sense of meaning in judgment, trouble life (logotherapy), biofeedback, learning from experience medications (e.g., Ritalin, Norpramin)

(Continued) 72—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

Table 2.2 (Continued)

Part of the Results of Improper Potential Corrective Brain General Function Functioning Interventions

Limbic Sets a positive and Moodiness, negative Counseling and psychotherapy system calm emotional tone of thinking and perceptions interventions that work to mind, modulates of events, decreased reduce/extinguish automatic motivation, promotes motivation, social negative thinking, interpersonal positive interpersonal isolation therapy, body work and massage interactions and therapy, aromatherapy, increased relationships (bonding) physical exercise, supplements (e.g., L-Tryptophan, tyrosine, St. John’s Wort), antidepressant medications

Basal ganglia Integrate feeling and Anxiety, nervousness, Guided imagery, training for movement, smooth fine fear, panic attacks, meditation and deep breathing, motor movement, excessive efforts to avoid assertiveness/conflict moderate anxiety and conflict, headaches, very resolution training, nutritional fear, enhance low or excessively high changes (e.g., eliminate motivation motivation, physical alcohol and caffeine, increase sensations of anxiety Vitamin B complex), use of chamomile tea and lavender oil for aromatherapy, medication (e.g., antianxiety medication, Xanax, Ativan, Serax)

Cingulate Controls ability to shift Excessive anxiety, Rational emotive behavioral system attention effectively worrying, holding on to therapy, reality therapy, and move from one hurts from the past, paradoxical requests idea to another, getting stuck on (logotherapy), nutritional increases and maintains thoughts/ideas, changes to increase serotonin cognitive flexibility, oppositional behavior, production (e.g., eating more increases or maintains argumentativeness, chicken, turkey, salmon, peanut one’s ability to see uncooperative behavior, butter, eggs, green peas, options, maintains inflexibility, addictive potatoes, milk), increased one’s ability to “go behaviors exercise, medications (e.g., with the flow,” Zoloft, Paxil, Anafranil, enhances cooperative Luvox) behaviors

Temporal Determine Violent thoughts, Music therapy (using classical lobes understanding and aggression, anger music), learning to play a processing of language, expressed externally and/ musical instrument, increased long/intermediate-term or internally, sensitivity sleep, eliminating caffeine and memory, recall of to slights, reading nicotine, biofeedback complex memories, difficulties, emotional emotional stability instability Chapter 2 ◆ Neuroscience—73

**USING COUNSELING AND Before discussing these issues, however, PSYCHOTHERAPY THEORIES we present several points that serve as a TO PROMOTE POSITIVE backdrop for the information that follows. BRAIN CHANGES The first point relates to our resolution of the mind/brain debate. As noted earlier, it is The preceding sections of this chapter are our view that the mind is the product of the designed to increase your knowledge of basic activity occurring in the brain at the molecu- aspects of neuroscience as they relate to coun- lar, cellular, and anatomical levels, which seling and psychotherapy theories and prac- are all impacted by a person’s interpersonal tices. The specific issues that have been dis- relationships, cultural context, and societal cussed thus far include the presentation of experiences. information that is aimed at Second, the process of psychotherapy relies on the brain’s plasticity for its effective- a. increasing your awareness of the ways ness. The types of cognitive (problem-solving), that neurotransmitters are linked to emotional, psychological, and behavioral various cognitive, emotional, psycho- changes that practitioners strive to promote in logical, and behavioral reactions people counseling and psychotherapy are dependent manifest in their lives; on the production of new neurons and neural wiring that affect changes in different brain b. broadening your thinking about the dif- systems, which in turn contribute to positive ferent counseling/psychotherapy skills therapeutic outcomes. and interventions that can possibly pro- Third, “psychotherapy is a process through mote the optimal production and release which neural network integration and coordi- of various neurotransmitters in the nation can be created or restored. This is brain; and especially crucial for the networks that spe- c. fostering new knowledge of the ways cialize in emotions, cognitions, sensations, that different brain systems contribute and behavior” (Farmer, 2009, p. 109). to a wide range of cognitive, emotional, Fourth, while empirical research in these psychological, and behavioral reactions areas is still at the embryonic stage, there is a people manifest in their lives. growing body of research literature on the neurobiology of psychotherapy that describes The following section is aimed at increas- brain changes. These changes appear to be ing your knowledge of neuroscience further directly impacted by different psychothera- by describing how the implementation of dif- peutic processes. From these research find- ferent counseling and psychotherapy theo- ings, practitioners are beginning to “learn not ries, skills, and related interventions affect only about the effectiveness of different psy- different brain systems and human function- chotherapeutic theories and practices, but also ing. In doing so, we identify some of the cog- gaining insights concerning which clients, nitive, emotional, psychological, and behav- with which psychological disorders, can ben- ioral reactions that are linked to various parts efit from and should receive psychotherapy” of the brain. (Farmer, 2009, pp. 109–110). 74—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

Fifth, counseling and therapy often involve therapy, and other related activities have assisting clients in shifting attention from a been implemented. particular negative issue or situation (e.g., the problems that are causing distress) to an ** alternative perspective (e.g., therapeutic goals NEUROSCIENCE and positive outcomes). Neurologically RESEARCH FINDINGS speaking, helping clients shift their attention AND PSYCHODYNAMIC from negative thoughts and feelings to posi- THERAPY THEORIES tive cognitions, emotions, and behaviors results in specific neurological changes that An emerging dialogue is occurring between take only milliseconds to occur in different practitioners who support and use psychody- parts of the brain. namic therapy theories in their clinical prac- Mental health practitioners intentionally or tices and other professionals who understand unintentionally facilitate changes in different the relevance of neuroscience to the work parts of the brain when providing counsel- psychodynamic practitioners do in the field ing and therapeutic services to their clients. (Beutel, Stern, & Silbersweig, 2003). One of Clients’ ability to regulate and direct their the central tenets of psychodynamic theories is attention in specific directions enables them that clients’ past life experiences result in the to control their distress, learn from new formation of mental schemata that are stored in experiences, and reflect on the therapeutic their minds (see Chapter 5). While most people discussions they have with their therapists. are generally conscious of different aspects of Neuroscience tells us that these changes result these schemata, psychodynamic theory empha- from both psychological and complementary sizes the significant role that the unconscious biological changes that occur as a result of plays in maintaining negative memories that counseling and therapy. underlie negative reactions (e.g., anger, sad- The final point that serves as a backdrop ness, fear, depression) many people routinely for the information presented below is that experience in their lives (Individual Percep- research in these areas has been made tions and Meaning Making Quadrant factors). possible because of significant improve- Drawing again from our description of the ments that have occurred in neuroimaging mind and the brain, we are reminded that the techniques over the past two decades. Neu- mind is the product of the activity occurring in roimaging procedures are based on the the brain at the molecular, cellular, and ana- understanding that mental activity is largely tomical levels, which are all impacted by a reflected in biological changes that occur in person’s interpersonal relationships, cultural different parts of the brain. This includes an context, and societal experiences. Thus, all the increase or decrease in the volume and flow conscious and unconscious memories that are of blood, oxygen, and glucose in the brain. stored in people’s minds are grounded in spe- These technological advancements allow cific neurological changes that occur in differ- researchers to examine specific biological ent parts of the brain. Neuroscientists refer to changes that occur in different parts of the the unconscious memories that contribute to brain before, during, and after counseling, many people’s problems as implicit memories. Chapter 2 ◆ Neuroscience—75

These scientists discuss three specific kinds of Begley (2007) discusses the affect of sub- implicit (unconscious) memories: emotional liminal priming in an investigation that was memories, behavioral memories, and percep- conducted to reduce negative and unconscious tual memories. stereotypes that Israeli college students held Siegel (1999) discusses these memories toward persons of Arab descent. This experi- and their relationship to different brain sys- ment is detailed in Chapter 5, when psycho­ tems in the following way: dynamic theories (including attachment theory) are discussed in greater detail. Implicit memory relies on brain structures Interpersonal therapy (IPT) is a short-term that are intact at birth and remain available psychodynamically based theoretical approach to us throughout life. These structures to counseling and therapy. IPT focuses on the include the amygdala and limbic regions ways that unconscious processes adversely for emotional memory, the basal ganglia affect a person’s interpersonal interactions and and motor cortex for behavioral memory, result in various forms of psychological dis- and the perceptual cortices and prefrontal tress and disorder (see Chapter 6). cortex for perceptual memory. (p. 29) IPT was initially developed to treat adult depression. It has since been effectively applied The mental schemata and unconscious to other psychological problems, including the memories that are formulated early in peo- treatment of depression in adolescents, the ple’s lives and biologically housed in differ- elderly, and people with human immunodefi- ent brain systems result in distinct neurologi- ciency virus (HIV) infection (Cuijpers, van cal wiring. Psychodynamic theorists assert Straten, & Andersson, 2008). that changing the neural circuitry that under- In studying the neurological and psycho- lies implicitly stored memories is likely to logical impact of IPT, Brody and his col- involve a considerable amount of time and leagues (2001) studied the effect that this effort in therapy. However, recent neurologi- treatment modality had among clients suffer- cal studies have demonstrated how a process ing from major depression. Three groups were called subliminal priming can at least tempo- included in this investigation: (1) a group of rarily disrupt the brain circuitry that underlies clients whose only form of treatment for their unconscious (implicit) memories in a very depression was a medication called parox- short space of time (Begley, 2007). etine, (2) a group of clients engaged in 12 Subliminal priming consists of tuning weekly IPT sessions, and (3) a control group certain neural pathways to certain events. that received no treatment. All the research This involves introducing a sensory stimulus participants underwent brain imaging proce- (e.g., visual, verbal, olfactory, or auditory dures before and after participating in the cue) to alter a person’s unconscious pro- study. cesses (e.g., implicit memory) at the neuro- Positive psychological changes in depres- logical level. The brain changes that occur sion levels were noted when comparing pre- during subliminal priming largely take place and post-test self-reports from the clients in in the prefrontal cortex, amygdala, and hip- the medication group, as well as in the IPT pocampus (Li et al., 2010). group. However, no changes in depression 76—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY levels were reported among the persons com- In detailing the results of this investiga- posing the control group. tion, the researchers highlighted two partic- The researchers also reported notable neu- ular outcomes: First, the persons assigned to rological changes occurring among the clients both experimental groups reported signifi- in the medication group and the IPT group but cant anxiety reduction in public-speaking not among the persons in the control group. situations. Like the clients in the medication group, the Second, like the individuals in the medica- persons participating in 12 weekly IPT ses- tion group, persons receiving cognitive- sions demonstrated decreased neural activa- behavioral therapy manifested noticeable tion in their prefrontal cortex and cingulate changes in specific brain systems as reflected systems (Brody et al., 2001). in the pre- and post-test brain-scanning proce- dures. These neurological changes specifically ** resulted in decreased neural activity and NEUROSCIENCE RESEARCH blood flow to the amygdala and hippocampus FINDINGS AND (Furmark et al., 2002). COGNITIVE-BEHAVIORAL Both of these brain structures (the amyg- THERAPY THEORIES dala and hippocampus) are located in the lim- bic system. As noted in Table 2.2, normal Although still low in actual numbers, there has functioning of the limbic system is linked to a been more neuroscientific research done to positive and calm emotional tone of mind, determine the biological impact of cognitive- while overactivation of the limbic system is behavioral theoretical models than for any associated with excitability and anxiety. It is other counseling and therapy theory. One of understandable, then, that persons receiving these studies involved the work of Furmark and the sort of counseling that proved to promote his colleagues (2002), who studied the psycho- optimal functioning of the limbic system logical and neurological impact of cognitive- would likely report reduced public-speaking behavioral therapy among clients experiencing anxiety as a result of participating in that anxiety attacks when involved in public- therapeutic modality. speaking situations. The researchers used self- Biofeedback training is a popular offshoot report instruments to measure clients’ subjec- of cognitive-behavioral therapy that is used tive experience of their anxiety levels, as well for a broad range of client problems. This as having all the research participants undergo includes but is not limited to using biofeed- brain imaging before and after the study began. back training with clients experiencing The results of this investigation indicated migraine and tension-type headaches, sleep that, while persons making up a control group disorders, anxiety attacks, phobias, and neu- did not demonstrate changes in their anxiety romuscular disorders, to name a few. Although reactions to public speaking, research sub- much research has been conducted to assess jects in both the cognitive-behavioral therapy the efficacy of biofeedback over the past 30 group and a medication (citalopram) group years, investigations focusing on the impact exhibited significant and positive psychologi- of biofeedback on different brain systems is a cal and neurological changes. relatively new research area. Chapter 2 ◆ Neuroscience—77

Of particular interest for the present dis- Such efforts will bode well for the mental cussion, several researchers have recently health professions, as the cultural-racial reported how biofeedback training fosters the transformation of our society is leading many optimal functioning of several specific brain persons to question the relevance and viabil- systems that are linked to clients’ mental ity of traditionally trained practitioners. These health and sense of personal well-being. This questions are particularly aimed at those prac- includes studies that examined the types of titioners who continue to use traditional coun- neurological changes that ensue from using seling and therapy theories in ways that are biofeedback training with clients experienc- not responsive to or respectful of culturally ing panic disorders (Goodwin & Montgom- different clients’ worldviews, values, and help- ery, 2006) and individuals suffering from ing preferences (D’Andrea & Daniels, 2001a, stress-related headaches (Cathcart, Winefield, 2001b). Efforts to develop and implement Lushington, & Rolan, 2001). new holistic and integral mental healthcare Both of these studies confirmed that bio- services will, indeed, need to be more cultur- feedback training contributed to the optimal ally responsive, effective, widely accessible, functioning of clients’ prefrontal cortex and and cost efficient than the fragmented mental limbic system. Several other neuroscience healthcare services that are currently avail- researchers have also noted how the use of able to promote healthy human development biofeedback training can promote the optimal in our culturally diverse society. functioning of clients’ temporal lobes, which is Many practitioners are striving to imple- identified as another area that is important in ment more holistic and integral interventions engendering and maintaining mental health that are aimed at supplementing and extend- and well-being (Amen, 1998; Critchley, 2001). ing the traditional therapeutic theories dis- Neuroscience research findings such as cussed in this book. For those practitioners those discussed above enhance practitioners’ who are not competent to provide specific understanding of some of the ways that tradi- holistic services that may be of benefit to their tional counseling and therapy theories and clients, many are developing relationships related interventions can affect clients’ brain with other healthcare providers so that they systems when used in clinical practice. This can make informed decisions when referring understanding will expand over the coming clients to these allied professionals. This decades as additional investigations are made includes developing referral connections with into these and other areas that focus on differ- individuals who can effectively provide ent aspects of holistic and integral approaches nutritional counseling, massage therapy and to counseling and therapy. The collective find- body work, qi gong, various forms of music ings of all the work that neuroscience research- therapy, yoga training, indigenous healthcare, ers have done and will do in the future will not sexual counseling, guided imagery and visu- only help practitioners use the counseling and alization, aromatherapy, meditation training, therapy theories that currently exist in the community advocacy interventions, and field today in more intentional and efficacious physical exercise planning services. ways but will also give birth to new approaches Practitioners are encouraged to keep two in mental healthcare. overarching considerations in mind when 78—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY making such referrals. First, it is important to Behavioral/Physical/Neurological Quadrant, consider the level of cultural competence (see and Cultural Community Quadrant factors). Chapter 3) that other professionals exhibit Cultural neuroscience is the interdisciplin- when providing the types of services listed ary field that studies the relationship of cul- above to clients from diverse groups and ture, biology, brain functioning, psychology, backgrounds. This consideration reflects the and other social sciences. It is an area just referring practitioner’s commitment to ethical beginning to unfold in the social sciences but professional practices that is emphasized in already has profound implications for our Chapter 1. professional practices, particularly as they The second consideration focuses on the relate to the development and implementation degree to which the services clients are of preventive and social justice advocacy encouraged to receive from other healthcare interventions to promote healthy human providers are empirically supported by development. research findings (see Chapter 1). This con- Among the relevance of these interdisci- sideration directs particular attention to the plinary connections is information generated degree to which neuroscientific research find- by cultural neuroscientists in the American ings affirm the efficacy of such services when Association for the Advancement of Science implemented among culturally diverse client who discuss the adverse impact of the culture populations. of poverty on millions of persons in our society, The latter point requires a basic understand- especially the youngest members of society. ing of the relevance of the newly emerging As cited by Krugman (2008), field of cultural neuroscience to the work mental health professional do in a culturally Poverty in early childhood poisons the diverse, 21st-century society. This topic is dis- brain. . . . Many children growing up in cussed in the following section of this book. very poor families with low social status experience unhealthy levels of stress hor- mones, which impair their neural develop- **CULTURAL NEUROSCIENCE ment. (p. 28)

The brain exists only in relationship to what Additional cultural neuroscience research goes on around it. Input from the environment findings of relevance to practitioners who in terms of visual impressions, sounds, sensa- work with persons in the culture of poverty tions, tastes, and aromas is organized into come from a compilation of studies that was meaningful and lasting brain patterns in the completed by Evans (2004). These research child’s brain. In effect, what goes into what we findings highlight the adverse impact that poor call the mind is as important as the biological children experience as a resulted of being rou- processes described in the previous sections of tinely exposed to increased levels of family this chapter. And of course, thoughts, behav- turmoil, violence, separation, and lack of social iors, emotions, and meanings are learned support. Evans further noted that children liv- within particular cultural contexts (Individual ing in poverty tend to have poorer nutrition, Perceptions and Meaning Making Quadrant, live in polluted environments, and attend Chapter 2 ◆ Neuroscience—79 schools that are less effective. All these factors and plastic, ever-changing through its rela- contribute to the development of unhealthy tionship with the environment. Neuroscience stress hormones, particularly cortisol, which in general and cultural neuroscience in par- can be permanently damaging to the brain. ticular underscore the vital role that the What are the implications of these findings client-counselor relationship plays in promot- for counseling and therapy, helping practices ing the sort of psychological and neurosci- that have primarily been developed to address ence changes that are necessary to realize new the needs of verbally talented persons from and untapped dimensions of human develop- middle- and upper-class backgrounds? Given ment and well-being (Cozolino, 2002, 2010b). the failure of the mental health professions to From the perspective of cultural neurosci- substantially address the unique strengths and ence, it is important that mental health practitio- needs of poor persons, the data suggest that ners direct time and energy to acquire and we need to reconsider and expand our profes- implement the multicultural counseling compe- sional roles and mission to facilitate the tencies that have been developed and formally healthy development of persons living in pov- endorsed by numerous professional organiza- erty in general and poor children in particular. tions (American Psychological Association, Despite the failure of the mental health 2003; Daniels & D’Andrea, 2003; Sue, professions to effectively address the strengths Arredondo, & McDavis, 1992). These compe- and needs of people living in the culture of tencies serve as blueprints that practitioners can poverty, traditional individual, family, and use in effectively building the kinds of thera- group counseling and therapy theories that are peutic relationships that foster mental health grounded in culturally biased helping per- and optimal neurological functioning among spectives remain the mainstay of helping for clients from culturally diverse groups and many practitioners. The summary of research backgrounds. Chapters 3 and 12 detail addi- findings presented above suggests that the tional issues that describe why it is vital for counseling and therapy services many practi- practition e­rs to develop these competencies tioners provide poor clients are simply not when providing services to culturally different relevant to the challenges many people living clients (Cultural/Community Quadrant and in poverty routinely face. Societal/Professional Quadrant considerations). As a mental health practitioner, you can Blanding (2010) summarizes additional play an important role in fostering the devel- research findings that are relevant to a broader opment of new neurons and neural networks discussion of cultural neuroscience. These among the clients you work with. As noted findings are presented below. throughout this chapter, providing counseling and psychotherapeutic services that help gen- • One of the generally accepted assump- erate new neurons and neural networks are tions about neuroscience is the view that key in helping clients from diverse cultural biological processes that occur in the brain are groups learn to lead more satisfying, produc- similar to the brain activities that all people tive, and empowering lives. experience, regardless of a person’s cultural In achieving these counseling outcomes, it background. However, Blanding (2010) is useful to think of the brain as being flexible disputes this generally held view by reporting 80—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY on the results of brain imaging procedures • Significantly more East Asians were (fMRIs) that have been done among American found to possess a genetic trait (a short allele and Indian students who listened to classical in their serotonin transporter gene) that makes music. The brain imaging results of these per- them susceptible to depression in comparison sons indicated different patterns of neural with research subjects in the United States. activation had occurred in different parts of the However, Blanding (2010) points out that the brains of the American students versus their support many East Asians commonly experi- Indian counterparts. This finding substantiates ence as a result of being a part of collectivistic one of the ways that culture appears to have a cultural groups helps prevent the manifesta- differential impact on the activation of differ- tion of clinical depression during many Eastern ent brain systems when presented with similar Asian persons’ lives. environmental conditions. • When viewing photographs of human • When analyzing the results of brain faces that express fear, research participants imaging procedures (fMRIs) among research more accurately identified the intended emo- subjects from Japan and the United States, it tion portrayed in the photographs if the faces was noted that greater levels of neural activa- presented appeared to be persons from their tion were recorded in the parts of brain that own cultural-racial group. When conducting are associated with emotional reactivity when this study among culturally different persons, presented with pictures of human faces. While the fMRI results of the research participants the fMRI results of persons from the United indicated that the brain system associated States reflected significantly higher activation with emotional reactivity (the part of the in analytical regions of the brain (in the pre- temporal lobes called the superior temporal frontal cortex), the Japanese research partici- sulcus) reflected higher levels of neural acti- pants recorded lower neural activation in this vation when the research participants were part of the brain when presented with the presented with pictures of people from their same pictures. own cultural-racial group experiencing fear as compared with the neurological reactions • People (typically persons from the that individuals from other cultural-racial United States) who exhibited an individualis- groups exhibited when viewing the same tic cultural orientation to life manifested dif- photographs. ferent neural activation levels in different parts of their brains (as measured by fMRIs) Our daily cultural interactions lead to cer- when compared with brain imaging results of tain patterns of neurological responsivity that persons from East Asia who operated from a can be captured in brain imaging procedures. collectivist worldview (Blanding, 2010). This Kitayama and Park (2010) cite research show- latter research finding is supported by the ing that westerners tend to activate the frontal work of Park and Huang (2010), who provide cortex when involved in mathematical calcu- convincing neurological evidence that points lations, while Chinese and Japanese people to the differential impact of individualistic exhibit higher activation levels in the parietal versus collectivistic cultural worldviews on a regions of the brain when they are engaged in person’s brain functioning. the same cognitive activity. The parietal lobe Chapter 2 ◆ Neuroscience—81 is a part of the brain positioned above the environment conditions when providing occipital lobe and behind the frontal lobe. counseling and therapy services among The information related to cultural neuro- clients from diverse cultural-racial science presented above has several important populations? implications for the work mental health prac- titioners do in multicultural counseling and For practitioners interested in implement- therapy situations. First, although limited in ing professional services that are informed by number and scope, the existing research find- neuroscience, it is important to realize that ings that report on the similarities and differ- cultural views of the self and others are ences in the neurological functioning of per- reflected in similar and different levels of sons from different groups and backgrounds neural activation and in different brain sys- validates much of what the multicultural field tems depending on a person’s cultural-racial has already known: that persons reared in one background, conditioning, and lived experi- cultural-racial group experience and process ences with others. Cultural neuroscientists life experiences differently from persons in have been particularly consistent in describ- other cultural-racial groups. Despite this ing these neurological differences as mea- understanding of cultural differences, many sured among persons in diverse cultural practitioners are surprised to learn that people groups who adhere to individualistic and col- in different cultural-racial groups have differ- lectivist worldviews. ent neurological reactions when viewing pic- Neurological differences manifested in tures of persons who physically resemble these areas are not based on multicultural themselves in comparison with those brain myths but on scientific evidence. With this reactions that occur when viewing photo- evidence in mind, we assert the need for graphs of persons in other cultural-racial practitioners to remain flexible and open to groups. learning new approaches to promoting Needless to say, these differential neuro- healthy human development based on the logical reactions make the understanding of growing empirical knowledge base in cul- multicultural issues more complex than previ- tural neuroscience. ously thought. Among the relevant questions Chapter 3 is designed to expand your think- to be posed to practitioners regarding this ing of additional cultural issues by emphasizing matter are the following: the importance of recognizing, understanding, and responding to the multidimensionality of 1. Are you able to transcend your own multicultural counseling. The multidimen- cultural biases and conditioning when it sional view of multicultural counseling comes to understanding why people in presented in the next chapter leads practitio- diverse cultural-racial groups have dif- ners to understand how the interface of clients’ ferent biological reactions to the same multiple cultural identities and life experi- environmental situations and stimuli? ences impacts their psychological develop- 2. What are the implications of under- ment and neurological functioning. standing the cultural basis of these dif- The RESPECTFUL Counseling and Ther- ferent neurological reactions to the same apy model presented in the following chapter 82—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY describes 10 factors that underlie the multidi- different clients who are traumatized by vari- mensionality of multicultural counseling, a ous forms of injustice, oppression, and dis- concept that is included in the integral theory crimination that characterize their lives. The described in this book. The RESPECTFUL following section is designed to expand your Counseling and Therapy model provides understanding of these issues so that you will practitioners with a road map that extends be better prepared to effectively address the practitioners’ thinking about multicultural needs of traumatized clients in culturally com- counseling in ways that include and extend petent and responsible ways. our current understanding of the important psychological and neurological differences ** that are commonly exhibited by persons in TRAUMA AND OTHER diverse racial-ethnic groups. THREATS TO ONE’S This increased understanding is grounded WELL-BEING: in a more expansive knowledge base related MULTICULTURAL to persons in different religious/spiritual, eco- AND NEUROLOGICAL nomic, gender, sexual, and age groups. Many CONSIDERATIONS persons in these groups share a common set of life experiences that ensue from various Trauma and related threats to individuals’ forms of social injustice, oppression, discrimi- well-being put many people at risk for psycho- nation, marginalization, and devaluation in logical and neurological harm. Such harm our contemporary society. All these societal typically occurs when the life stressors indi- dynamics result in different stressors that viduals experience exceed their ability to cope adversely impact the mental health, psycho- in constructive and effective ways. An indi- logical well-being, and neurological function- vidual’s personal resources (coping skills, ing of millions of people in marginalized and self-esteem, and social support) may be over- devalued groups included in the RESPECTFUL taxed when a person is subjected to ongoing Counseling and Therapy framework. Some of environmental stressors over extended periods these stressors have a traumatic effect on of time or forced to face a traumatic event that many culturally different clients. occurs in a short space of time. Persons who The stressors associated with traumatic life experience stressors for extended periods of events have a particularly profound effect on time or are confronted with immediate trau- the psychological and neurological functioning matic events are vulnerable or at risk for future of persons in culturally diverse groups. Practi- mental, physical, and/or neurological problems tioners are increasingly called on to work with (Lewis, Lewis, Daniels, & D’Andrea, 2011). clients who suffer from different traumatic Counselors and therapists frequently work experiences that often go unaddressed in coun- with persons in these vulnerable, at-risk groups. seling and therapy. Unfortunately, many prac- This includes providing services to poor, titioners are not knowledgeable about the psy- homeless, and unemployed people; adults and chological or neurological factors that are children in families undergoing divorce; preg- associated with traumatic stress. This is fre- nant teenagers; sexually and physically abused quently the case when working with culturally persons; individuals with HIV or AIDS; Chapter 2 ◆ Neuroscience—83 persons with cancer; war veterans; and people descent, sexually abused women and children, who are victimized by various forms of age- gay/lesbian/bisexual/transgender persons sub- ism, racism, sexism, and other forms of cultural jected to personal attacks and collective dis- oppression, to name a few. crimination, and other persons exposed to Heightened, prolonged, and historically based various forms of abuse and violence in their stressors fall within the Societal/Professional lives (Lewis, Lewis, et al., 2011). and Cultural Community Quadrants of the Neuroscientists have expanded our under- integral theory presented in this textbook. standing of trauma from a Behavioral/Physical/ However, these stressors simultaneously Neurological Quadrant perspective. One of the impact factors listed in the Individual Percep- most comprehensive descriptions of the neuro- tions and Meaning Making Quadrant as well logical changes that occur when people experi- as the Behavioral/Physical/Neurological Quad- ence trauma comes from the work of Jonsson rant included in this comprehensive theory. (2009). Commenting on the neurological pro- To be effective in their work with these cesses that are linked to traumatic experiences, persons, practitioners need to accurately Jonsson points out that assess the different ways that environmental and historic stressors contribute to the trauma When a person experiences a traumatic situ- many people experience. This includes being ation or ongoing forms of trauma, the amyg- knowledgeable about the ways that inter- dala and hypothalamus activate fight, flight, generational trauma may contribute to the or freeze responses to such events. When psychological, behavioral, and neurological this occurs, these brain parts overcome the problems many persons from various cultural/ normal functioning of the frontal lobe. racial groups experience. The frontal lobe is the part of the brain Duran (2006) writes extensively about the where our consciousness lives and rational adverse psychological impact of this cultural thinking occurs as well as the location that phenomenon. In doing so, he refers to inter- enables us to link new and old experiences generational trauma as a soul wound. The and exhibit the capacity to react to situa- integral-minded practitioner who under- tions calmly and with forethought. When a stands the complex nature of the soul wound person is traumatized, the level of activation and the significant ways that it contributes to in her or his amygdala and hypothalamus is the psychological and spiritual problems high enough to interfere with the normal many Native American Indians experience functioning of the frontal lobe. This set of today is cognizant of how it affects several neurological events results in heightened factors associated with all four of the quad- fight, flight, or freeze responses that are rants that compose the integral theory dis- accompanied by extreme emotional reac- cussed in this book. tions (e.g., heightened fear, anger, depres- A soul wound adversely impacts the lives sion, apathy, etc.), which the traumatized of many other people who are members of person is not fully conscious of as he or she cultural groups that are subjected to various exhibits an increase of irrational thinking forms of violence, injustice, and oppression. and a lack of ability to respond calmly and This includes many persons of African intentionally to various life events. (p. 450) 84—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY

Among the treatment strategies Jonsson areas will not only result in increased efficacy (2009) found useful in reducing the activation in treating persons suffering from a broad of the amygdala and hypothalamus while range of trauma-based disorders but will also simultaneously increasing the activity of the increase the use of new empirically supported frontal lobe to facilitate traumatic healing is interventions among persons in diverse cul- the use of cognitive-behavioral techniques tural groups that are suffering from stress- and eye movement desensitization and repro- induced problems (Individual Perceptions cessing (EMDR) therapy. and Meaning Making Quadrant, Behavioral/ EMDR is a neurologically based therapy Physical/Neurological Quadrant, Cultural Com- approach that was developed to resolve symp- munity Quadrant, and Societal/Professional toms resulting from traumatic events and Quadrant considerations). other disturbing and unresolved life experi- It is suggested that prevention services in ences. Practitioners who utilize EMDR with general and social justice advocacy interven- traumatized clients implement a structured tion strategies in particular are likely to be format to address past, present, and future among the specific interventions that will be aspects of the client’s disturbing and trau- supported by future multicultural and neuro- matic memories. This therapeutic model was scientific research findings (D’Andrea & developed by Francine Shapiro (1995, 2001) Foster Heckman, 2008). Among the social to resolve trauma-related disorders resulting justice counseling and advocacy areas that from a person’s exposure to extremely dis- researchers are encouraged to study from a tressing events, such as rape or negative expe- neurological perspective are future investi- riences in military combat. gations that study why it is important that Clinical trials have been conducted to our children assess EMDR’s efficacy in the treatment of posttraumatic stress disorder. Research find- •• have enough nutritious food to eat, ings revealed consistent positive outcomes •• have access to good schools in which to when practitioners used EMDR in clinical set- learn, tings. The accumulation of these positive •• receive consistent love and guidance research findings has resulted in this theoreti- from their parents, cal model being listed as an evidence-supported •• are able to live and play in safe com- therapy (Societal/Professional Quadrant inter- munities, and vention strategies; American Psychiatric Asso- •• are the direct beneficiaries of public ciation, 2004; U.S. Department of Veteran policies that support holistic and inte- Affairs and Department of Defense, 2004). gral approaches to healthy human devel- Neuroscientists will predictably uncover opment from a neurological perspective. additional biological factors that underlie the onset of psychological trauma as well as new Stressors that are linked to the various counseling and therapy interventions that are forms of racism, sexism, heterosexism, ageism, effective in addressing this complex psycho- ableism, and other social injustices that con- logical health problem. Advances in these tinue to be perpetuated in our society represent Chapter 2 ◆ Neuroscience—85 additional areas that beg for the attention of assessing your current level of interest, support, neuroscientists and practitioners alike. In this and/or resistance to the neuroscience force regard, it is noted that many practitioners have in the mental health professions. Another become more knowledgeable of the damaging competency-building activity helps you assess effects of cortisol (the stress-related steroid your ability to implement services that reflect hormone that suppresses the immune system) a holistic, integral, and neurologically and the implications of this neuroscientific grounded approach to counseling and psycho- finding for counseling and therapy. therapy. This latter competency-building Given the relevance and utility of the new activity also encourages you to consider ways knowledge that has been generated from neu- that you can develop new knowledge and rological research findings, it is predicted that skills to more effectively implement such ser- research in the areas described above will vices in the future. indeed expand in the future (D’Andrea & The mental health professions will greatly Foster Heckman, 2008). The new knowledge benefit as the neuroscience revolution contin- that will be generated from such endeavors ues to expand to new and uncharted areas. will undoubtedly help increase the efficacy of Future research findings generated in the the work practitioners do in the field. It will subfield of cultural neuroscience will be par- also be helpful in building a more just and ticularly helpful in advancing practitioners’ healthier society in the process. understanding of the relevance of brain sci- ence for the work they do in a culturally diverse society. **SUMMARY The next chapter will expand your under- standing of the multidimensionality of multi- This chapter invites you to explore numerous cultural counseling and therapy. Specific issues related to the neuroscience revolution multicultural competencies and interventions that is unfolding in the mental health profes- are described in Chapter 3. Learning about sions. To increase your understanding of this these competencies and interventions will important force, we present information that lead you to think in new ways about the is aimed at expanding your knowledge of the important roles practitioners can play in mak- roles that neurotransmitters and different ing a more positive impact on the psychologi- brain systems play in human development. To cal and neurological well-being of larger further expand your knowledge base in these numbers of persons from diverse and margin- areas, we describe the types of counseling and alized groups than has been accomplished in therapy skills, interventions, and theories that the past. researchers have described as being effective in stimulating the optimal production and Learning From the DVD That release of neurotransmitters in various brain Accompanies This Textbook systems. One of the competency-building activi- The Chapter 2 video clip that is included on ties included in this chapter assists you in the DVD that accompanies this textbook 86—PART I ◆ AN INTEGRAL APPROACH TO COUNSELING AND PSYCHOTHERAPY provides an overview of some of the key the video and podcast represent additional points related to the neuroscience revolution resources that are designed to assist you in that is emerging in the mental health profes- synthesizing the new knowledge you have sions. You can also access a podcast that sum- acquired as a result of reading Chapter 2 and marizes information presented in Chapter 2 completing the competency-building activi- by going to www.sagepub.com/ivey7e. Both ties included in this chapter.