INTRODUCTION 1 THE PSYCHOTHERAPIST’S ESSENTIAL GUIDE TO THE BRAIN The Psychotherapist’s Essential Guide to the Brain provides an overview of the essential parts and functions of the brain that every modern-day therapist should be familiar with. Written in accessible language and consolidating a large body of neuroscientific knowledge, this handy “beginner’s guide” forms a practical and accessible introduc- tion to brain science for psychotherapists. The current chapter lays the groundwork for a big-picture view of how the brain functions, providing essential reference points from which the reader may go on to develop an under- standing of what is happening in the brains of clients, as well as in his or her own. The contemporary psychotherapist has access to a more sophisticated model of mental health than ever before, yet key elements of that model entail an understanding of the neural functions that underpin behaviour, relation- ships, personality, and a sense of self and the surrounding world. This guide aims to bridge the gap between the of- ten esoteric realm of neuroscience research and the pragmatic realities of psychotherapy with clients. The therapist with a practical grasp of the concepts, regions and functions of the nervous system will be rewarded with improved outcomes that reflect a more holistic and integrated understanding of clients. Since Freud, the brain has been variously conceived in terms of an electrical system, a chemical system, and, more recently, a highly interconnected electrochemical network. In terms of convention, we are only now emerg- ing from an outdated medical model that conceptualized the brain primarily as a chemical system that could be “fixed” by means of drug intervention, and coming to the realization that the brain is a malleable communication network where the patterns of connections within and between brain regions are as important as the chemicals that serve the impulses travelling these routes. Understanding this communication network, which happens to be the most complex system we know, can enhance our practice of psychotherapy as we tune in to the intricacies of its various attributes. As a stand-out example, understanding the basic concept of a fast-reacting limbic system versus a slower prefrontal cortex can shed light on why cognitive therapies are often largely ineffective until more basic emotional issues have been addressed via a “bottom up” approach. Or, understanding that emotional memories can be “unhinged” from the hippocampal time/space marker for an event can furnish not only greater empathy for the PTSD sufferer but also ideas on how to reintegrate the traumatic memories from the past so that they stop intruding on the now. We can create better interventions when we know that memory is everything when it comes to brain function, and that memories can change, our neural networks can be altered, and even genetic expressions that support those neural networks can change. And so, with a debt to modern neuroscience, we embark on this modest overview of the brain, trusting it will serve you well in your conceptualizations of clients and arouse your curiosity for further learning. A connectogram of a healthy control subject. Connectograms are graphical representations of connectomics, the field of study dedicated to mapping and interpreting all of the white-matter fibre connections in the human brain. These circular graphs based on diffusion MRI data utilize graph theory to demonstrate the white-matter connections and cortical characteristics for single structures, single subjects, or populations. In this image: From outside to inside, the rings represent the cortical region, grey matter volume, surface area, cortical thickness, curvature, degree of connectivity, node strength, betweenness central- ity, eccentricity, nodal efficiency, and eigenvector centrality. Between degree of connectivity and node strength, a blank ring has been added as a place- holder. This connectogram includes five additional nodal measures not included in the standard con- nectogram. Image: Wikipedia. INTRODUCTION 2 THE DIVIDED BRAIN Iain McGilchrist, in his noteworthy book The Master and His Emissary: The Divided Brain and the Making of the Western World (2009), describes the asymmetry of the brain and the very different natures of the left and right hemispheres. This horizontal understanding of the mental system, as opposed to the vertical triune perspec- tive, gives us insight into the distinctly different yet complementary functions of the two hemispheres. In short, the right hemisphere handles broad attention (what we attend to comes first to us through the right hemisphere); is good at making connections so that we can appreciate the wholeness of dynamic structures and relationships that change over time; is attuned to emotion; and is empathic, intuitive, and moral. In con- trast, the left hemisphere has narrow atten- tion; is good at deconstructing things into parts; and has an appreciation for static, decontextualized, inanimate structures and abstractions. McGilchrist (2009) summarizes the “two worlds” of the hemispheres in this way: The brain has to attend to the world in two completely different ways, and in so doing to bring two dif- ferent worlds into being. In the one [that of the right hemisphere], we experience—the live, complex, em- bodied world of individual, always unique beings, forever in flux, a net of interdependencies, forming and re- forming wholes, a world with which we are deeply connected. In the other [that of the left hemisphere] we “experience” our experience in a special way: a “re-presented” version of it, containing now static, separa- ble, bounded, but essentially fragmented entities, grouped into classes, on which predictions can be based. This kind of attention isolates, fixes and makes each thing explicit by bringing it under the spotlight of attention. In doing so it renders things inert, mechanical, lifeless. But it also enables us for the first time to know, and consequently to learn and to make things. This gives us power. (p. 31) Allan Schore explains that the early-maturing right hemisphere is the locus of attachment formation and es- sentially the gateway to affect regulation later in life—so much so, indeed, that developing an expanded capacity for right-hemisphere processing (an emphasis on right-brained affective skills rather than a left–cognitive bias) is central to clinical expertise (Schore, 2012). In a similar vein, Badenoch (2008) warns therapists to be grounded in right-brain engagement with clients or run the risk of being disengaged from the regulating and integrating influence of right brain-to-right brain connection with clients. She further encourages therapists to widen their window of tolerance, be conscious of implicit vulnerabilities, and develop mindfulness to be present with both the client and self. There is a place for left-brain focus when thinking about specific interventions, but McGilchristas admonishes, the left should remain servant to the right hemisphere as master. 3 THE PSYCHOTHERAPIST’S ESSENTIAL GUIDE TO THE BRAIN Left Hemisphere Right Hemisphere • Less white matter—prioritizing local informa- • More white matter—facilitating faster transfer tion transfer within regions, reflected in an in- of information across regions, reflected in an in- creased ability to localize attention and enhanc- creased ability to hold global attention. ing its self-referring nature. • More sensitive to testosterone. • More reliant on dopamine. • More reliant on noradrenaline. • Superior in the expression of anger. • More intimately connected with the limbic sys- • Highly focused attention to detail; local, nar- tem—identifies emotions faster and more accu- rowly focused attention—sees “parts”. rately than the left and is more involved in emo- • Attends narrowly to the right field of view, the tional expression (except anger). right side of the body, the right side of objects • Open to broad awareness; on the lookout in a (demonstrated in what is known as “hemi-ne- broad and flexible way with vigilance and global glect” following a right-hemisphere stroke). sustained attention—sees the “whole”. • More engaged with the known, the learned, the • Processes information in a non-focal manner. expected; prefers what it knows—“grasps” what • Attends to the peripheral field of vision and the is in focus and has been prioritized. entire left–right visual field. • Efficient when routine is predictable. • Alert and attentive to the new and the nov- • Finds solutions perceived to fit best with current el—awareness begins in the right hemisphere, knowledge or schemas grounding and integrating the experience, before • Processes information in an increasingly focal being further processed in the left on a more de- way that suppresses information not immedi- tailed level. ately relevant. • More engaged in the learning of new informa- • Suppresses the right-hemisphere ability to make tion—explores. distant associations among words or objects • Outperforms the left when prediction is difficult; (and the broader scope of attention in general). more capable of shifting the frame of reference • Takes a local, short-term view. (important for problem solving). • Identifies things by labels rather than context; • Can associate words or objects that are not close- does not deduce from context like the right ly related; can understand unfamiliar (non-cli- hemisphere—in conversation takes things more chéd) metaphor. literally and has difficulty understanding -im