Marion Solomon and Daniel J. Siegel
WELCOME TO THE world of how we help the mind grow. We are psychotherapists, the editors and contributors of this book, who have found a range of practices and approaches that help guide the growth of individuals, couples, and families toward well-being. As with any edited text, you will find in these pages differing styles of writing and clinical practice that reflect each author’s life experience as well as unique understanding and articulation of the process of change that underlies therapeutic work. One of the benefits of reading a multiauthored text such as this is the compact offering of diverse presentations that illuminate a wide range of distinct strategies to support the growth of others toward health and resilience. In this brief introduction, we (Marion and Dan) offer you a synthetic overview of what you have in store. It is our hope that within the wide range of explorations, you’ll find something that touches you in a deep way, establishes an orientation across a range of approaches, and perhaps inspires you to pursue the writings of some of these authors in more depth in the future.
Psychotherapy is both an art and a science. Your experience as a therapist will be shaped by a myriad of factors, from your own temperament and upbringing to your style of learning and belief systems regarding the nature of reality. It’s no wonder there are so many unique approaches in the field of mental health! Even more, each person is unique, and not every approach to therapy works for everyone. For these reasons, we are excited to offer these introductory essays that sample a range of approaches and give you the chance to feel for yourself, in your own reading experience, how they relate to you and how they might work for different people with whom you work.
In our first chapter, Phillip M. Bromberg explores the important role that the experience of the therapist plays in joining with the inner life of the person in therapy. This chapter powerfully illuminates the notion of “self-states” and the ways in which each of us—therapist and client/patient alike—are created moment by moment in our interactions with others, and by the fantasies and memories that shape how our minds unfold in the present. This emerging process is central to the experience of both connection and transformation. Bromberg invites us to consider the deep ways in which this joining between two people shapes the process of change, and how we as therapists can participate fully to help facilitate this growth.
In the second chapter, Louis Cozolino and Vanessa Davis build on Bromberg’s notion of the central role of our own inner experience in reflecting on the role of evolution in how our social brains have transformed across the generations. Exploring a range of emotions and their role in our inner and interpersonal lives, Cozolino and Davis illuminate the nature of shame and how this powerful state of self-dejection can influence not only our clients’ life experiences, but even our own as therapists. In this way, these authors suggest that we view our relationships, both to others and to ourselves, as central to the healing process.
In Chapter 3, Margaret Wilkinson offers a broad view of the process of change, taking us deeply into the layers and circuitry in the brain to address how our relational connections may shape the way the brain changes in response to experience. We are offered a sophisticated review of how the field of neuroplasticity can reveal how therapeutic experiences may alter not only the synaptic connections linking neurons in a range of crucial circuits, but how myelin formation and the epigenetic regulation of gene expression can be molded by what we go through in life. Such neuroplastic responses can shape how traumatic experience may affect us; and the same neuroplasticity can hold hope—at any age—for how therapy may facilitate the process of long-lasting change.
In the fourth chapter, Pat Ogden invites us to explore the ways in which the focus of attention on the body’s sensations and movements can be a primary component of the process of change. This powerful illumination of the ways in which going beneath and beyond words to push the boundaries of our windows of tolerance enables us to see how therapy is not simply a matter of being with clients/patients, but of helping them experience uncomfortable edges of their capacities and then move beyond those edges for deep change. Because focusing attention in this particular way streams energy patterns into awareness, therapists can greatly advance their work by utilizing this important source of our mental lives to further help clients/patients constructively change understandable but unwanted past adaptations.
Peter Levine then takes us on a journey into the question of what is emotion in Chapter 5, clarifying the differences and overlapping connections among bodily sensations, subjective feelings, and expressed emotion. By exploring the role of the body—its physiological responses, motor movements, and neural processes—in our emotional lives, Levine offers us helpful insights that widen our view of how therapy may help those with emotional dysregulation to achieve more harmonious states. This chapter further highlights Ogden’s emphasis on how our usual focus on words needs to be deeply expanded to allow the non-worded world of the body and our states of mind to become a central focus in the process of change.
In Chapter 6, Russell Meares widens this view by exploring the importance of our connections with each other early in life to establish an integrated sense of self. Exploring the work of William James and Hughlings Jackson from the 19th century, Meares then offers insights from his own work on neural functioning in those with borderline personality. A take-home message from this chapter is that who we become is derived from how we’ve been a part of a relational connection, initially derived from what Colwyn Trevarthen has called “proto-conversations.” The importance of this chapter to our foundational theoretical stance is to identify in principle how therapy may utilize such connections to help facilitate the growth of a more integrated self.
Daniel Hughes, in Chapter 7, offers insightful clinical vignettes involving work with children that enable us to dive deeply into the central role of a therapist’s sense of wonder and empathy in creating the fabric of the therapeutic relationship at the heart of healing. Within these dialogues of exploration, children’s narratives of who they are in the world and how they relate to others and to themselves are brought into a coherent state within the supportive explorations of therapists’ caring curiosity. This relational connection is the pathway for helping children develop a sense of security and resilience in life.
In Chapter 8, psychoanalyst Martha Starks delves into the mathematical model of complex adaptive systems and explores the need, as Pat Ogden noted, of moving systems toward edges of functionality in order to promote growth. This chapter highlights the author’s model of internal change, through classic psychoanalytic notions of id, ego, and superego, as well as pointing out the overlap of these insights with interpersonal subjective experience as well as relational interactions that cultivate change. From Bromberg to Stark, we are offered a wide range of ways of viewing the importance of the inner world and its interface with our connections with others. Ultimately, letting go of unhelpful patterns and adapting new strategies of growth are how these internal, experiential, and relational processes are again proposed to facilitate the change process.
In Chapter 9, Stan Tatkin clarifies this overlap further with his psychobiological approach to couple work, emphasizing the ways in which a therapist can place pressure on the system of a couple to both reveal and transform places that are stuck in their functioning. By exploring the nature of attachment, neural functioning, and relational regulation of affect, this approach further demonstrates the message of this book of how a therapist can utilize many levels of understanding from science to inform clinical strategies for change. Harnessing the power of long-term neural change, new levels of co-regulation, sufficiently repeated, can become embedded not only in behavioral change within the couple, but also in likely neural changes in the individuals themselves. Inter and inner become part of one unfolding process within psychotherapy.
In Marion Solomon’s Chapter 10, we delve further into couple work, looking deeply at three cases to examine how defenses against attachment challenges from childhood can form the basis for the troubles of a couple in their present experiences and how to help each individual within the couple move toward a more flexible way of relating. In this chapter, we again see how understanding various neuroplastic responses of brain systems can help a therapist see how to move beyond engrained memory representations into new and more health-promoting ways of interacting. Here, too, inner and inter become the focus of therapeutic work.
In Bonnie Goldstein and Dan Siegel’s final chapter, group therapy is explored with an aim to reveal how the process of communication within groups reflects the various ways individuals may have come to live a restricted life of isolation. The group setting can help facilitate ways of joining, of “feeling felt” by other members of the group, so that this unhealthful isolation can give rise to a more integrated way of being a linked yet differentiated person. The process of integration itself—the linkage of differentiated parts—can be seen as the fundamental mechanism of health and resilience. Here, this process of integration is illuminated and enhanced in the group setting.
There you have it: nearly a dozen ways to explore the process of change in psychotherapy. One link connecting each of these chapters, as we’ve seen, is the blending of the inner and the inter focus of the therapeutic work. In many ways, this balance of the inner and the interacting is itself a form of linking differentiated elements of our human reality, of cultivating more integration in the lives of those for whom we care in our professional work. There are many ways to catalyze integration, and these chapters may reveal the wide swath of strategies that help create the optimal internal and interactive regulation at the heart of change and the creation of well-being. We hope that this wide selection of authors and approaches will find a resonance with your own experiences and offer a jumping-off point from which you can dive more deeply into these varied and insightful approaches to healing and growth. Enjoy!