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This month we put the spotlight on licensed clinical social worker and adult psychoanalyst, Hilary Jacobs Hendel. She has a Master of Social Work with Clinical Concentration from Fordham University and has completed the 4-year certification program in Psychoanalysis at the Institute for Contemporary Psychotherapy in New York City. She is a certified psychotherapist and supervisor in accelerated experiential dynamic psychotherapy (AEDP) and a Level 3 certified practitioner in eye movement desensitization and reprogramming (EMDR). She has a full-time private practice in psychotherapy on the Upper West Side of New York City. Aside from her extensive clinical experience, Hilary was the mental health consultant for six seasons of the AMC television series Mad Men. Hilary has published articles in The New York Times and professional journals. Her blog, The Change Triangle, is read worldwide. Hilary’s new book, It’s Not Always Depression will be published in February 2018 by Random House USA, Penguin UK, and by publishers in Mainland China, Taiwan, and South Korea.
NPT: In your experience, how has an understanding of neurobiology helped you in your practice/research?
HJH: Neuroscience and neurobiology affect the way I think about everything that’s happening in psychotherapy. When I am with a patient, I often imagine their neural networks. I see networks that need uncoupling and others that need associating. Because neuroscience tells us that neurons that wire together, fire together, we have a real way to change the brain and help people. We can willfully foster connections between brain cell networks that increase well-being. Equally, we can undo brain cell associations that are maladaptive for wellness, like beating ourselves up when we make mistakes.
For example, “Elizabeth” told herself she was bad any time she felt angry, yet we know that treating ourselves harshly when we have naturally occurring emotions only exacerbates psychological distress. Furthermore, berating ourselves doesn’t stop us from having emotions because emotions are not under conscious control. Elizabeth, like all of us, would feel better and deal better with her anger if she could accept it, listen to it, and respond compassionately to her struggle. I helped Elizabeth uncouple the networks that made her habitually beat herself up and to associate networks that made self-compassion her new default.
Stephen Porges’s polyvagal theory is another neurobiological application to psychotherapy that I find very useful. The theory teaches us that the vagus nerve has three branches—whether our patient is in a fight, flight, or freeze mode, or in a calm state, will depend on which branch is stimulated. When our body is regulated and feels calm, we feel safe in the world. It is only when we feel safe that we can engage socially and become curious in the world.
My training has taught me to notice the nonverbal signs and symptoms of each state (fight, flight, freeze, and calm) and how to actively work to help our mind and body relax in the here and now of the session. Working with emotions is one of the most effective ways to regulate our nervous system. One way I do this is by reacquainting people with their core emotions. First, by educating my patients on the brain, I help them understand and then accept that their emotions just are—we cannot stop emotions from happening. Then I teach my patients to name and validate their core emotions as they are having them. We can learn to listen to what our emotions are telling us and then learn how to channel them adaptively; we can work with emotions in very specific ways to process them. When we do that, our mind and body calms down. When we are connected to our emotions, we are connected to our authentic self. Connecting to our emotions and listening to what they are telling us helps us in our relationships because we can effectively communicate our wants and needs to the people we love.
NPT: You write about something called the Change Triangle. Can you explain more about the Change Triangle and how it relates to neuroscience?
Sure! The Change Triangle is a map and a tool to help us connect with our core emotions so we feel more vital and authentic. Most of us block access to our core emotions with a variety of creative defenses originally erected to protect us from emotional pain and discomfort. While offering us emotional protection, defenses block access to our core emotions, which leads to chronic states of anxiety, depression, and other psychological problems. As adults, we need to relearn to experience our core emotions safely. By doing so, anxiety and depression are reduced and we feel much better.
For example, “Joe” was effectively taught by his father, due to being repeatedly ridiculed, not to show sadness and definitely not to cry. His brain learned to thwart sadness using shame, an inhibitory emotion. But we need to experience all our core emotions to feel vital and authentic and to recover from life’s losses. People who cannot experience sadness get “stuck” and develop psychological symptoms, which are in fact cues that something within us needs attention and care. The Change Triangle guides us to uncouple shame from sadness. By working to undo the connections between sadness and shame in his brain, Joe learned to experience sadness once again and felt better in a whole host of ways. Moving through our emotions regulates the brain and nervous system. That is why, when we connect to our core emotions and move through them, we feel more confident, calm, and clear.
NPT: Can you tell us a little about the theories and philosophies that have most impacted your work?
HJH: I am interested in theories of how people transform quickly. I originally came from a psychoanalytic perspective, then by chance I attended a conference on emotions and attachment, and my life and work totally changed. I learned about the difference between top-down and bottom-up processing. Top-down processing means we work with thoughts and insights to achieve change at the level of how we feel. Bottom-up processing, on the other hand, brings about change by working with emotions and physical sensations. It is the faster way to achieve physiological regulation because of how the brain and body are anatomically organized and how the brain is wired.
I grew up thinking I was supposed to control my emotions. So when I learned that emotions happened outside of conscious control, and that we all have core emotions (anger, sadness, fear, disgust, joy, excitement, sexual excitement) and inhibitory emotions (anxiety, shame, guilt), I felt validated and transformed by that information. When I learned that emotions were actually physical sensations, it was an “aha!” moment for me. It felt true and right. I stopped working in an analytic model and instead adopted an emotion-centered model based in neuroscience that was also formed by attachment theory. That model was accelerated experiential dynamic psychotherapy (AEDP).
NPT: What are you working on currently?
HJH: There is a gap between what trauma and emotion-centered psychotherapists know, and what information trickles down to the public. My passion, besides helping people in my private practice, is educating the public on emotions through my writing. Emotions are physical forces that have the power to cause psychological symptoms when they are thwarted, or healing when they are safely and fully experienced. I think psychiatry and insight-oriented models of psychotherapy are based on paradigms that need updating with the current science of emotions and attachment.
NPT: If there was one thing you would like to impart to a new psychotherapist what would it be?
HJH: Learn about the brain and how the brain changes through emotion processing. Study trauma-informed therapies such as AEDP, internal family systems (IFS), eye movement desensitization and reprocessing (EMDR), and somatic experience (SE), all of which are grounded in the most current science on how the brain changes. Learn how to establish safety—this is paramount to doing good psychotherapy. Attachment theory and polyvagal theory also provide a great scientific foundation. And lastly, learn everything you can about the effect of shame, which is ever-present in our lives and in the psychotherapy room. Shame is, unconsciously and insidiously, adversely affecting the connection to our self and connections with others. Shame needs to be addressed by the therapist from the get-go as patients will not bring it up themselves; they don’t know it exists and it is too painful. AEDP training teaches the techniques and therapeutic stance for putting all this science into action for the benefit of people who entrust us with their care.
HJH: I am so excited about the release of my book, It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self (Random House, USA/Penguin, UK; due February 2018). In the book, I show how to work the Change Triangle based on stories from my patients’ lives and my personal life. I also include exercises so people can start to put these concepts into practice. My education in neuroscience, emotions, trauma, and attachment theory has changed my life and the lives of so many others. By writing this book, I hoped to reach and help many more people than I could ever do, working one-on-one in my practice.