Collaborative Therapy and Neurobiology

Evolving Practices in Action

Marie-Nathalie Beaudoin, Jim Duvall, Marie-Nathalie Beaudoin, Jim Duvall

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317223146
• Edition: 1
• Topic: Psychology
• Subtopic: Neuropsychology
• Index: Psychology

Collaborative Therapy and Neurobiology is the book many clinicians have been waiting for: an integration of twenty years of scientific and therapeutic cutting-edge ideas into concrete clinical practices. Interpersonal neurobiology and the development of exciting new technologies that allow us to better understand the brain have provided us with an enriched perspective on human experience. Yet, many clinicians wonder how to use this knowledge, and how these discoveries can actually benefit their clients. In particular, what are the concrete practices that each field uses to help clients overcome the issues in their lives, and how can these fields build on each other's ideas? Could minimally developed concepts in each field be combined into innovative and powerful practices to foster client wellbeing? This book offers a collection of writings which provide theoretical food for thought, research evidence, and most importantly hands-on, concrete clinical ideas to enrich therapists' work with a variety of clients. Illustrated with numerous transcripts of conversations and clinical stories, the ideas in this book will stimulate the work of people interested in renewing their practice with new ideas.

Section I
Energizing Clinical Practices with Intriguing and Cutting-Edge Ideas

1
Pivotal Moments, Therapeutic Conversations, and Neurobiology

Landscapes of Resonance, Possibility, and Purpose

Jim Duvall and Robert Maclennan

Introduction

Pivotal moments, “aha” experiences, are natural phenomena that occur in the present moments of everyday life and in therapeutic conversations. As Daniel Stern stated, “[t]he only time of raw subjective reality, of phenomenal experience, is the present moment” (2004, p. 3). Michael White described these moments as epiphanies that “are in harmony with what is precious to people, that’s beautiful, that they want to rush toward…. What makes them stick is how they are responded to in the outside world” (Duvall & Young, 2009). Pivotal moments make it possible for people to experience an enriched sense of connection with their hopes, and a renewed sense of intimacy with themselves and others (Duvall & Béres, 2011). Pivotal moments are powerful entryways to alternative personal storylines, which open up space for creativity, choice, and connection.

In this chapter we explore the intersection of pivotal moments and brain activity in narrative therapy. This collaborative therapy is situated in postmodern theory, which acknowledges the multiplicity of identities and realities available to people. We offer the analogy of a three-act play, which conceptualizes a therapy session as a story. Focusing on the dominant dispositions of the cerebral hemispheres, we review salient functions of the “social brain” in an attempt to identify and understand factors that may contribute to the occurrence and sustainability of “aha” experiences. Neuroscience has both validated and contributed to our exploration of pivotal moments, giving us a fuller understanding of the relationship between the left and the right hemispheres. This understanding has influenced our use of language, the types of questions we ask, our use of subjective time (Arstilla & Lloyd, 2014), novelty, imagery, and our overall in-the-moment reflexive therapeutic posture.

A story serves as a temporal map, providing space over time to alleviate the problematic effects of life’s distressful transitions on people’s experience of identity and agency (Duvall & Béres, 2011). People’s difficulties are viewed as their attempts to adjust to these transitions. The interpretation of transitional life-stories as “rites of passage” has been handed down through many cultures and generations (Turner, 1977; van Gennep, 1960; White & Epston, 1990). In contrast to a deductive “problem-solving” approach, an inductive “storied” approach introduces reflective practice and critical thinking into the therapeutic process. Herein lies a significant paradigm shift. A deficit-focused problem-solving approach attempts to categorize people and measure them against a predetermined normative standard. An inductive storied approach invites people to step back and view themselves within their social context and, together with others, recall or acquire the knowledge and skills necessary to manage their transition. Thus, they are not the problem. The problem is contextual and they are in relationship with it.

Historical Development: Practice-Based Evidence

My (JD) first time witnessing a pivotal moment was unintentional. It occurred in October 1995 while a colleague and I were routinely viewing a session behind a one-way mirror. A student therapist, Alan, was interviewing a single woman, Sarah. The session was being recorded for supervision purposes. Alan began with a discussion about Sarah’s relationship with the problem. He asked a question that invited her to reflect on her abilities:

Alan: Sarah, I’d like to talk with you away from the problem for a while. That will help me to get to know more about the skills and abilities that you have to bring to bear against this problem. Would you tell me about a time in your life when you felt particularly confident about your abilities to handle life’s challenges?

Sarah: (Her face relaxed. She looked up to her left.)

Sarah’s eye movement up and to her left suggests that she is accessing visual memory via the right cerebral hemisphere (Bourne, 2006).

Alan: (Waiting for a response.) I’m wondering, Sarah, what are your hopes for this session today?

Sarah: (Shook her head, refocused.) I would like you to tell me what to do to loose these feelings of sadness.

Post-Session Debriefing

Following the session, we played the video recording, frame-by-frame for Sarah and then for Alan, so that they could see her responses to his questions.

Sarah: (Watched the playback tearfully.) He asked me to tell him about a time in my life that I felt confident about myself. Suddenly, I remembered when I was 18 years old, standing in my bedroom. I could see the detail of the dark green and yellow flowered wall-paper. I was more confident then than I ever was in my whole life. That’s what I want! I want to regain that confidence that I had then and get my life back.

Jim: What was it like when the therapist asked you the second question, which was, “What are your hopes for the session today?”

Sarah: It felt disjointed and pulled me out of my thoughts. I wanted to stay grounded with my memory. I felt connected to myself for the first time in a long time.

We then played the same videotape segment for the therapist.

Alan: Whoa! I didn’t notice Sarah having that experience. I thought she couldn’t answer the question, and I was trying to ask her a more useful question.

Jim: Now that you do notice her experience, what would you do differently?

Alan: I would slow down and leave space for her to stay with her thoughts. Then, I might say, “It looks like something may have just happened with you. Would it be useful to talk about it, or is it something that’s private and you would prefer to keep it to yourself?” I would pay more attention to her responses and manage my responses to her. (Alan voices his intention to develop more “reflexivity,” more awareness of his effect on Sarah.)

At that time, we assumed that the pivotal moment experienced by Sarah was an anomaly. Nevertheless, her experience captured our curiosity about the potential contribution of such experiences to person-generated change. We studied the phenomena of pivotal moments further. Our team spent countless hours combing through videotapes and watching numerous live sessions. We discovered that, given the right conditions, pivotal moments were actually commonplace and had been hidden in full view (Stern, 2004)! We wanted to authenticate these transformative thoughts and memories in the moment, to give them “stickability” (Duvall & Béres, 2011, p. 126; Duvall & Young, 2009, p. 18) in the external world. We co-created therapeutic environments that were favorable to the occurrence of pivotal moments, and we trained ourselves to recognize and respond to them as they were occurring.

Neuroscience Makes an Entrance

My (RM) curiosity about pivotal moments developed into a quest to link such epiphanies in therapy with recent discoveries in neuroscience (Maclennan, 2015). Ian McGilchrist (2009) speaks directly to this topic. He attributes the emergence of “aha” experiences primarily to the activity of the brain’s right hemisphere, noting that “this process is not a gradual putting together of bits of information, but an ‘aha!’ phenomenon—it comes all at once” (p. 47). The right hemisphere, in addition to realizing things suddenly in a flash, also “sees things whole, and in their context” (p. 27); mediates “insight… the sort of problem solving that happens when we are… not concentrating on it” (p. 65); can “hold several ambiguous possibilities in suspension together without premature closure on the outcome” (p. 72); “with its greater integrative power, is constantly searching for patterns in things” (p. 46); and enables “the appreciation of time, in the sense of something lived through, with a past, present and future” (76). Conceivably, Sarah’s experience of transport to her 18-year-old confident self emerged from her intuitive right hemisphere. Realizing this, I became excited by the possibility that neurobiology might help to explain, and even predict, the occurrence and sustainability of “aha” experiences in collaborative therapy.

Although this chapter focuses mainly on the reciprocal functioning of the left and right hemispheres in the co-creation of pivotal moments, the hemispheres represent only the most recent neuronal evolution. All regions of the “triune brain”—the neocortex, the limbic system, and the brainstem—function optimally as an integrated whole. The right hemisphere is more densely interconnected with the bodily nervous system and oriented toward emotion and sensory experience, or “inwardly engaged” life. The left hemisphere is more densely interconnected within itself and oriented toward language and social interaction, or “outwardly engaged” life (Cozolino, 2014; Schore, 2012; Siegel, 2012). Mental functioning involves extensive neocortical and subcortical interaction, including the entire brain and nervous system, with implications considerably beyond the laterality of the hemispheres (Panksepp & Biven, 2012). Together, we recognize that neuroscientific theories can be challenged by new discoveries. Although the consilience of psychotherapy and neurobiology offer much hope and possibility, our proposals are speculative and embedded in an evolving social and scientific context.

Storied Therapy as a Three-Act Play

Act 1: Separating from Known and Familiar Understandings: Setting the Stage for Pivotal Moments

When people arrive at their first therapy session, it’s reasonable to assume that they may not be at their best and may even be at their worst. They are likely making “thin” conclusions about themselves or others, thinking, “I’m the problem, or he or she is the problem. My son is ADHD, or my husband is depressed, or I have an anxiety disorder.” Immediately, the therapist asks questions that begin to deconstruct and externalize problem-saturated stories. She introduces novelty, ignites curiosity, invites interest, and increases relational engagement. There is an increased appreciation for the complexity of experience and the significance of people’s local knowledge. In Act 1, the therapist acts as a conversational manager, assuming a welcoming and participatory posture. She works with people through a partnership, using “co” prefixes (e.g., co-author, co-develop, and co-construct). She invites people to choose what’s most important to talk about as they move the story forward.

This inductive conversation, grounded in invitational questions, is competency focused rather than pathology focused. Instead of merely gathering information, the conversation remains information and generates experience through a dialogic toing-and-froing between the therapist and the people who consult her. What the therapist hears and perceives is a result of how she participates with others in the conversation. Distance is created from taken-for-granted understandings as they disembark from familiar territory and “perhaps from some status, aspect of identity, or role that is considered to be no longer viable for the person concerned” (White & Epston, 1990, p. 7).

Getting the Act Together

When people are living under the influence of a problem, their cerebral hemispheres may be functioning at a diminished level of integration. Problem-saturated stories may be tenaciously linked, occluding or excluding other possibility-rich stories. A collaborative therapeutic conversation can help to make visible the subordinated aspects of the larger life-context, linking them together to form alternative storylines. In this creative process of differentiation and association, the participants can embark on a journey toward greater neural, personal, and interpersonal integration (Siegel, 2012).

Briefly above, we outlined the right hemisphere’s disposition toward contextual experience and intuitive problem-solving. By contrast, the conceptual, analyzing left hemisphere “sees things abstracted from context, and broken into parts” (McGilchrist, 2009, p. 27); “takes the single solution that seems best to fit what it already knows” (p. 41); “makes up a story, and, lacking insight, appears completely convinced by it” (81); has a “stickiness,” a “tendency to recur to what it is familiar with” (p. 86); and “is more concerned with categories and types” (52). When the left hemisphere is “stuck” in a fabricated problem story, it then “re-presents” that story to the right hemisphere, which may “totalize” it, generating problematical moods. In response, the therapist can enlist the instrumental tendency of the left hemisphere, which “is always engaged in a purpose” (McGilchrist, 2009, p. 174, italics in original), to construct an interpersonal environment favorable to the experience of pivotal moments (Giorgi, 2011).

A calm, welcoming, regulated, and resonant approach, what Michael White termed a “cool engagement” (White, 2007), can help to activate the body’s “social engagement system” to stabilize a person’s emotional state. The ventral vagal nerve, a myelinated branch of the parasympathetic nervo...