The Remarkable and Mysterious Brain
On a cold and wet winter morning, Bob overcomes his “excuses” and begins his daily run. As expected, the first few kilometres are gruelling and painful, but midway through the run, something magical is about to happen.
Astonishing electrical and chemical events are unfolding. Aroused by electricity, small molecules awaken and move across tiny gaps in his brain, exciting billions of others that send signals down familiar pathways creating an euphoric feeling that Bob experiences as a “runner’s high,” his reward for persevering.
A vicious dog interrupts the serenity of Bob’s run and begins the chase. Instantly, Bob’s brain assembles its stress and danger response team under the command of the hypothalamus. It signals other parts of the brain and body to release neurotransmitters and hormones, such as adrenaline, glutamate and cortisol to deal with the threatening dog. Responding to energizing signals from the brain, Bob’s heart beat increases to pump more blood to the limbs, his lungs dilate to allow extra oxygen intake, he runs faster, and he escapes to run another day.
Returning to the solitude of the run, in a way that remains a mystery, the greatest miracle of all occurs. Bob‘s mind energizes with self-awareness, freeing him to contemplate his existence, his place in the universe, his future, and his connection with God.
Throughout the run, outside of his conscious awareness, Bob’s brain functions as an active coach and trainer. It organizes and commands a vast team of neurons to make his run possible. It moves his legs, regulates his breathing, monitors his heartbeat, and processes visual signals to produce ultra-high definition 3D pictures with stereophonic sound in order to coordinate his movement, avoid hazards, maintain equilibrium, and return him safely home.
It’s clear that Bob’s brain, not his legs, deserves the credit for the run.
The brain is a complex, perpetual motion machine that controls everything we see, do, hear, and think twenty-four hours a day, nonstop for our entire lives. Usually, we associate the brain with thinking and making decisions. In reality, its role is far more reaching. It powers amazing electrical and chemical interactions involving hundreds of different organs and structures within the body and the brain itself. The human brain, with its vast network of alive, constantly changing neural connections is the ultimate multitasker, simultaneously managing everything from our heartbeat to our dreams, our immune system to our imagination. Although we associate the heart with our feelings, it is actually the brain that is in control of our emotions.
The brain is a ceaseless director, observer, participant, choreographer, and scriptwriter of our existence. It also relentlessly reinvents itself, literally altering its structure and chemistry in response to our experiences.
Most of the work of our brain is done without requiring our conscious attention. It works silently to make our hearts beat, forge memories, and orchestrate complex chemical and behavioural reactions to protect us from danger, even before we are consciously aware of any threat. Without our brain, survival is impossible.
A New Era. We’ve only just begun. With breathtaking speed over the last 20 years, neuroscientists have uncovered vast knowledge about the brain and its mechanics, but they are still at the early stages of unravelling the mysteries of the most complex and capable object in the universe. Until recent years it has remained mysterious and little has been known or understood about how the brain actually works. Now, in a new era, with amazing brain imaging techniques and extraordinary emphasis on research, the brain is slowly divulging its secrets.
Worldwide, brain research has become a priority with work proceeding at an unprecedented rate. For example, the government and The Brain Canada Foundation, a nonprofit public-private partnership formed to support brain research, have invested over 200 million dollars in the work of over 700 researchers. Such research is generating a constant stream of discoveries that informs innovative and effective interventions for brain disorders.
Serious interest in the brain is no longer confined to professionals. Books, television specials, and popular magazines like National Geographic, Scientific American, Time, and Discover are publishing content on the brain for all to read. Libraries and bookstores now regularly feature displays on the brain, including a growing body of material on the topic of brain health and vitality. Terms like “frontal lobe”, “serotonin”, “dopamine”, “neurotransmitter”, and “brain plasticity,” once the jargon of researchers, academics and doctors, are now part of everyday language. Empowerment comes with this knowledge. People have access to the knowledge that can make them informed consumers of mental health and counselling services. They can take charge of their brain health by learning strategies for dealing with disorders such as Alzheimer’s.
This article can provide only a brief survey of topics that are important for counsellors. Given the growing importance of neuroscience for counsellors, readers should take advantage of opportunities for further study available on the web, and in research reports, journals, and books.
Neuroscience: An Emergent Force in Counselling
Over the past 100 years, five key forces (Figure 1) or approaches have influenced the direction and philosophy of counselling. Neuroscience is on track to become the sixth force. Each force offers counsellors important perspective, knowledge and guidance. Although some counsellors may strongly align themselves with a particular approach, most recognize the value of drawing on the insights offered by different theories and models. Wise counsellors make informed choices based on individual situations and client needs.
Six Key Forces in Counselling
- Psychoanalysis focuses on helping clients develop understanding and insight regarding the origins of their thoughts, feelings and behaviour. Heavy emphasis is placed on exploring the unconscious.
- Behaviourism looks at human behaviour as a product of learning and the environment. The emphasis is on behaviour shaped by reinforcement.
- Humanism, with Carl Rogers at the forefront, is based on the philosophy that people are innately driven towards growth and fulfillment. Core conditions (empathy, genuineness, and unconditional positive regard) are seen as “necessary and sufficient” qualities needed by counselors to help clients manage problems and emotions.
- Multiculturalism involves framing counselling interventions in the context of our clients’ cultural world views. In a multicultural society such as Canada, it a necessary perspective, regardless of the counselling approach adopted.
- Social justice recognizes the importance of counselling professionals working to help establish more equity regarding the distribution of wealth, resources, and opportunity. Social justice accepts that client problems may be the unfortunate outcome of oppression, poverty, and marginalization.
- Neuroscience is the study of the nervous system (see Figure 2), which includes the central nervous system (brain and spinal cord) and the peripheral nervous system (nerves outside of the brain and spinal cord). Neuroscience explores the electrical and chemical activity of the brain using a variety of experimental and brain imaging techniques.
Neuroscience explores how the brain controls thinking, behaviour, and emotions, and how the brain reacts to such things as physical or mental illness, trauma, and substance misuse. Neurocounselling, a term not yet in widespread use, is the integration of neuroscience into the practice of counselling. A neuropsychiatrist is a medical doctor who specializes in the treatment of neurological injury or disease. A neuropsychologist is a psychologist (usually with a Ph.D.) who deals with the psychological problems associated with brain injury or disease. In Canada, only those with a medical degree can prescribe medication, but in the United States (in some jurisdictions) specially trained psychologists can prescribe a limited number of medications.
Competent counsellors try to understand their clients by considering many variables, including genetics, developmental level, prior learning, relationship and family dynamics, impact of substance misuse, presence of mental disorders, overall health, the influence of culture and spiritual beliefs, as well as systemic issues such poverty, unemployment and oppression. Neuroscience, as an emergent force, will add yet another dimension for counsellors to consider. It represents no threat. It won’t negate the long-established and important cornerstones of effective counselling, such as relationship and the core conditions, especially empathy. In fact, as will be explored below, neuroscience has endorsed the validity of these cornerstones.
Why Neuroscience is Important for Counsellors
Neuroscience endorses counselling.
A growing body of neuroscience research is providing counsellors with scientific proof of the value of their work, as well as guidance on which counselling strategies are effective in given situations. McHenry, Sikorski, & McHenry (2014) call on counsellors to embrace neuroscience as an important additional tool regardless of their theoretical approach, noting that “all of the main theories of counselling can be supported through the use of brain imaging that provides evidence of brain changes in clients” (p. 12). Neuroscience will add credibility to the field, empowering counsellors with the confidence that comes knowing that their interventions are based on solid science. As Hill and Dahlitz (2014) note:
Confirmation by neuroscience of what were largely intuitive practices opens an unprecedented way forward for us as therapists to refine our technique, and ourselves, for even greater success, while leaving behind those practices revealed to be ineffectual or even detrimental (p.11)
In the future, neuroscience will no doubt continue to offer significant insight and precise guidance on what works and what doesn’t. Here are some examples of notable and relevant neuroscience research findings for counsellors:
- Neuroscience has confirmed the effectiveness of the mainstays of counselling, listening, empathy, and a focus on wellness (Ivey, Ivey, & Zalaquett, 2010).
- Counselling aids in the generation of new neurons, a process known as neurogenesis (Ivey et al., 2010). This is important because neurogenesis aids damaged brains to recover, and it can slow brain degeneration caused by dementia.
- Neuroscience is providing specific guidance on how to promote neurogenesis. It supports the efficacy (effectiveness) of counselling strategies that include exercise and diet (Arden, 2015), a strong argument for counsellors to encourage clients to add these lifestyle changes to their action and recovery plans. Similarly, stress management, having positive relationships (including the client/counsellor relationship), spirituality, and mental stimulation increase neurogenesis.
- Social interaction stimulates the brain’s reward circuitry and the release of dopamine and oxytocin, neurotransmitters that increase motivation, feelings of well-being (dopamine), and levels of attachment and trust (oxytocin) (Stanford, 2017). This finding reinforces the importance of the counsellor/client relationship, which is strongly linked to counsellor empathy.
- The counselling relationship, long recognized as the most important catalyst for client change, creates the fertile conditions for healing the damages created by stress and supporting the growth of new neural pathways fundamental to wellness and mental health.
- Mindfulness helps the brain to refocus, decrease worry, increase working memory, and decrease stress.
- Exercise helps to slow cognitive decline.
- Specific interventions such as exposure therapy can help to repair the damage caused by trauma to two important parts of the brain, the amygdala and the hippocampus (Trouche, Sasaki et al., 2013).
- Problem-solving work and selected computer games enhance cognitive functioning.
- Most counsellors are aware that confrontation is generally a poor strategy for effecting change (Miller & Rollnick, 2013). Neuroscience tell us why. Confrontation arouses the brain’s fight or flight response, as it mobilizes for what is experienced as an attack. As a result, valuable energy that might otherwise be harnessed for change is diverted to defence of the status quo. Empathy, on the other hand, offers no such threat and, in fact, acts to calm the brain and add to the development of the counsellor/client relationship, a major variable associated with favourable outcomes in counselling.
- Counsellors who use a strengths approach stimulate their client’s prefrontal cortex to shift to positive thinking and emotions which in turn helps to overcome unhelpful and negative thinking patterns (Ivey, Ivey, Zalaquett & Quirk, 2009).
- Dahlitz (2017) cited research showing that when clients are involved in decision making and have choices, there is increased activity in the caudate nucleus and other areas of the brain that are involved in motivation. The research suggests that clients with choices have a greater sense of control, increased motivation, and an overall more positive mood.
Addition of a Biological Perspective. Emergent research that reveals the biological basis of many mental disorders is helping to guide the development of preventive and interventive strategies. The research is also informing counsellors about how the brain is impacted by crisis, trauma, substance misuse, and social determinants such as poverty.
Since many counsellors have had little or no training in neuroscience, they will need to include this topic in their reading and professional development agenda. Counsellors do not need to become experts in neuroscience, but it is imperative that they have at least a basic understanding of the brain and the terminology. This will enable them to be active consumer of neuroscience information.
Neuroscience provides counsellors with another rationale for systemic change. Research endorsing the value of counselling interventions is providing compelling arguments for increased funding for counselling preventive and treatment programs. The Centre for Addiction and Mental Health (2017) estimated that the total cost of untreated mental illness in Canada is more than 51 billion dollars. Data such as this provide an empirical base for counsellors who are active in lobbying for political and systemic change to grossly underfunded mental health and addictions system.
Neuroscience can offer guidance on the use of technology for treatment. Counsellors who are well versed in neuroscience can inform and refer clients to take advantage of rapidly emerging technology. For example, Li, Montaño, Chen, & Gold (2011) described how virtual reality can be used to rewire the brain to deal with pain management. Techniques such as biofeedback can be utilized to supplement more traditional counselling approaches. Another promising technological advance is transcranial magnetic stimulation (TMS), which involves the use of magnetic pulses to stimulate the brain. An effective alternative to medication, this technique has proved very useful in treating depression, including for those who have not responded to medication.
Neuroscience can reduce stigma. Moral and cultural judgments can inflict shame on those dealing with mental disorders, a reality that often leads people to forgo treatment and suffer in silence. Neuroscience research has made great strides proving that there are genetic and biological causes of mental disorders. These findings support the argument that mental disorders ought to be understood and treated in the same way that biological disease or injury is addressed. Stigma will be reduced when people learn and accept that mental illness is not a choice caused by moral weakness. Neuroscience knowledge will help to change thinking so that brain-based disorders are viewed no differently than any biological disease or injury. Counsellors can play a major role in communicating this notion to clients, their families, and the community.
Neuroscience provides explanations that can be used for psychoeducation. Psychoeducation, long a mainstay of counselling, involves helping clients and their families learn about the nature of their problems, including practical information on how they might address social, psychological, economic, and other issues. Neuroscience explanations can be used by counsellors to help clients understand how their brains are impacted by their life experiences, trauma, illness, and substance misuse. Most counsellors are not experts in neuroscience, so they have to be careful that they do not exceed the limits of their competence in this area. They need to refrain from giving medical advice or offering opinions on neurological issues in which they are not qualified.
The Internet has made information available to everyone. As a result, clients have opportunities to become better informed regarding their conditions. There is, however, a real risk that clients, or even professionals will be misled by false or misleading information. Sometimes, people will post to the Internet based on their beliefs or personal experience, but their statements may be malicious, fabricated or simply wrong. An informed client is empowered, but a misinformed client may delay or suspend treatment based on an unverified opinion expressed on the Internet. Counsellors can best support clients by encouraging them to consult with reputable sources such as government or national user sites. When counsellors have a basic working knowledge of neuroscience and the brain, they are in a much better position to help clients access and utilize factual and reliable information.
What counsellors can do is help clients acquire a basic understanding of how their problems might be influenced by the brain. To do so, counsellors need at least a rudimentary appreciation of how the brain works. For example, research has demonstrated that excessive anxiety might be due (in part) to an overactive amygdala (Arden, 2015). This knowledge can form the basis of a simple explanation that can help a client understand and deal with their anxiety. Here’s an example:
Counsellor: One of the interesting things they’ve discovered is that when people feel overly anxious, there’s a part of the brain that’s overactive. However, the good news is, it can be managed.
Counsellor: Some people are helped with medication, but that’s something for you and your doctor to discuss. You’ve told me that it helps to avoid situations where you get overwhelmed, and that’s one good coping strategy. It’s the everyday situations and moments that you can’t avoid where you need a solution. Right? (client nods). Generally, avoidance decreases anxiety, but increases fear, so the next time you face the situation, you will be even more anxious. If you want, we can work to develop a strategy that will help you take small steps to overcome both fear and anxiety. You’ll be in charge, and I won’t try to force you to do anything.
In the example above, the next step might involve the use of a best-practice counselling strategy such as systematic desensitization, a technique that combines relaxation with incremental exposure to anxiety provoking situation. (Caution: the use of systematic desensitization should be within the counsellor’s area of competence.) Clients such as the one in the example often report feeling relieved when they finally understand the reasons for their problems and empowered as they learn that their problems can be managed.
Neuroscience provides guidance on medication. Knowledge of how medications enhance, inhibit, or augment brain and bodily functioning is essential for assessment and goal setting with clients. For example, many psychotropic medications lead to weight gain, so counsellors can support clients with wellness initiatives (e.g., diet, exercise). As a result, medication compliance may be improved since clients will be less likely to abandon their medication because of the discouragement associated with weight gain.
Neuroscience offers hope. Because our brains are wired based on past experiences, there is strong pressure to act and think consistent with this wiring. Put simply, we are creatures of habit, even when our habits of thinking and behaving are problematic, the usual position that brings clients to counselling. However, the good news is that we can change our brains and change their future.
Neuroplasticity. Neuroplasticity, one of the most exciting and relevant discoveries in neuroscience, refers to the brain’s ability to change itself by forming new neural connections in response to learning, changes in the environment, or as compensation for injury or disease. Neuroscientists have found that not only can the brain change, it is constantly changing. (Neuroplasticity will be explored in more detail later in this article).
Neuroplasticity concepts can be used by counsellors to convey hope to our clients. They can help clients understand that they are not permanently doomed to their current thinking, behaviour or emotions. These concepts can provide guidance regarding how clients can change or “rewire their brains” in ways that reduce or eliminate their current problems. Neuroplasticity concepts can show how tools such as cognitive behavioural counselling, mindfulness, risk taking, meditation, exercise and diet can be the roots of positive change in our lives. For both counsellors and clients, neuroscience provides the science that supports the use of techniques, such as cognitive behavioural therapy, that harness the brain’s amazing neuroplasticity to form new neural pathways to replace and extinguish unhelpful and harmful thinking and behavioural patterns. Peckham (2017) offers this perspective:
The very definition of neuroplasticity shows us that acceptance of circumstance does not have to be the end of the story. If experiences have shaped us in ways that currently cause distress (both to ourselves and to others in our lives), what experiences could change us to have better lives? What experiences might we need? (p.15)
Neuroplasticity research confirms that new learning is not only possible throughout the lifespan, it is also inevitable. Old dogs can, in fact, learn new tricks.
Here’s how a counsellor might explain it to a client:
Counsellor: In the last 30 years brain researchers have discovered that our brains are constantly changing.
Client: So, what’s the big deal. It’s not something I can control.
Counsellor: That’s what everyone believed until recently. Now, they’ve learned that there is actually a lot we can do to help our brains grow and heal. Since your brain is going to change anyway, you might as well be helping it change for the better. And the good news is that we now know how to do it.
Neuroimaging. Modern advances in neuroimaging have provided facts and information with enormous implications for counsellors. Research is increasingly guiding and informing counsellors how their clients’ brain structure and chemistry might respond to different intervention strategies. We are well on our way to understanding how specific counselling strategies change the brain to promote positive growth, including neurogenesis, the growth of new neurons, something that a short time ago was considered impossible. Clients can change their brains. Counselling can support, enhance, and accelerate this outcome.
A look ahead. In the coming decades, neuroscience will continue to have a major impact on our understanding of mental and physical disorders. Counsellors, social workers, psychologists, child care workers, and other social service providers will need to have at least a basic understanding of the brain and the implications of neuroscience research for their fields of practice.
Academics and researchers in the counselling field will no doubt begin to generate their own research and commentary from a neuroscience perspective. Educators will be challenged to integrate neuroscience into professional training programs. Research reports in any discipline are often difficult for the average person to understand and absorb. Frequently, this results in a disconnect between the empirical results of science and their application to field practice. Counselling-specific literature utilizing neuroscience has the potential to bridge this gap.
In the same way that multiculturalism has become a continuing theme in virtually all counsellor education programs, neuroscience will confirm its place as a new force. There is still much to learn, but there is abundant room for optimism that neuroscience discoveries will continue to provide hope for clients, and guidance to counsellors on how to help people repair damaged brains and slow age-related decline. Neuroscience research will develop greater precision regarding how chemical, electrical, and structural abnormalities in the brain lead to brain disorders like Alzheimer’s and mental disorders, such as depression and schizophrenia. Along with this will come new psychotropic medications, custom designed to restore equilibrium and function to wounded brains. The future holds fantastic possibilities!
Integrating Knowledge Into Practice
with Matthew Dahlitz
We All Need Integration
We all know about the pressures of our profession, we tell our colleagues to be mindful of workload, we wonder why friends and colleagues took so long to get some help.
It’s a simple fact that the mental health professions are at a high risk for burnout, vicarious trauma, and other stressors about clients, systems, and money.
I Can Help
After a decade of producing and developing The Neuropsychotherapist and The Science of Psychotherapy I have engaged with, published and brought into our Academy expert contributors from around the world. This has given me a wide ranging, interdisciplinary knowledge that can be of great value to you. The real key is to know how to integrate that knowledge into your professional practice. Together we can “join the dots” in your practice and life in areas like:
- the science of your practice
- integrative practice and approach
- burn out | vicarious trauma
- imposter syndrome
I’m making myself available to anyone in our Science of Psychotherapy community, wherever you are in the world, for online counseling and consultation. I won’t replace your supervisor, but I can be a valuable human resource for you.
How: Online video conferencing using Zoom
We all need support. I look forward to connecting with you online whenever you need.