Diana Fosha, Daniel J. Siegel, & Marion Solomon
HARDWIRED TO CONNECT with each other, we do so through emotions. Our brains, bodies, and minds are inseparable from the emotions that animate them. Emotions are at the nexus of thought and action, of self and other, of person and environment, of biology and culture. Emotion is a term that evokes many connotations, from the way we “feel” to the ways our lives are integrated across time. Specific emotions include love, joy, pain, fear, anger, gratitude, grief, care, closeness, awe, shame, excitement, agony, passion, and compassion. At one end of the continuum, we find extreme emotional states such as helplessness, terror, despair, and immobility; at the other, faith, enthusiasm, curiosity, tenderness, aesthetic wonder, ecstasy, wisdom, awe, vitality, and even transcendence.
We live in exciting times of shifting paradigms and emerging frontiers. The neuroscience revolution that has already changed our field has revealed the primacy of affect in the human condition. The Norton Series on Interpersonal Neurobiology, of which this book is a part, documents this revolution. This integrative, cross-disciplinary book at once reflects and expands that paradigm shift.
In parallel fashion, in the field of psychotherapy the locus of therapeutic action has begun to shift in emphasis from models favoring cognition—and, accordingly, top-down interventions—to models that assert the primacy of bodily rooted affect. Such experiential or “bottom-up” therapies consider insight to be the result, rather than the agent, of therapeutic change; they maintain that the deeper the bottom (in evolution, in the body, in the brain), the higher the top, and—not incidentally—the more effective and efficient the treatment. At one time marginalized, treatments that focus on emotion and the somatic manifestations of psychological processes are receiving fresh consideration. Moreover, increasing evidence about the plasticity of the brain throughout the lifespan is beginning to influence not only our techniques and effectiveness, but also to galvanize our therapeutic hopes and ambitions.
Just as emotionally traumatic events can tear apart the fabric of individual psyches and families, emotions can also act as powerful catalysts for healing. Like emotion, healing too is also gaining scientific respectability: We are starting to understand that healing is a process with its own characteristic phenomena and mechanisms, one that needs to be elucidated in its own right—and that emotions are at the core of it.
How do we regulate emotion in a healthy way? How do we foster environments conducive to its flourishing and reciprocity, the stuff of communication and resonance, of optimal health and effectiveness of action, of resilience, and of caring relationships? How do we do so without becoming flooded and overwhelmed? How can we use emotion to repair and heal, to grow and learn? How do we use emotion to mend ruptures caused by emotion? These questions, central to all clinical endeavors, are explored from a variety of perspectives in the chapters that follow.
This book provides the conceptual underpinnings for an experiential clinical therapeutics supported by neuroscience and developmental research. Although the contributors—neuroscientists, developmentalists, and clinicians—operate in different realms, all share certain assumptions about the primacy of emotion, the importance of engaged, empathic relatedness for the regulation and processing of emotion; and the value of experiential models of treatment that privilege bodily rooted experience. And while each author focuses on one part of the whole, we are all talking about the same elephant. Given the breathtaking variety of views on emotion, the resonant synchrony of the parts and the coherence of the whole is exhilarating. Just listen to physicist Richard Feynman:
Which end is nearer to God, if I may use religious metaphor, beauty and hope, or the fundamental laws? I think that the right way of course, is to say that what we have to look at is the whole structural interconnection of the thing; and that all the sciences, and not just the sciences but all the efforts of intellectual kinds, are an endeavor to see the connections of the hierarchies, to connect beauty to history, to connect man’s history to man’s psychology, man’s psychology to the working of the brain, the brain to the neural impulse, the neural impulse to the chemistry, and so forth, up and down, both ways. And today we cannot, and it is no use believing that we can, draw carefully a line all the way from one end of this thing to the other, because we have only just begun to see that there is this relative hierarchy. And I do not think either end is nearer to God. (1965, p. 125, emphases added)
Below is a narrative of the trajectory by which we seek to deal with “the whole structural interconnection of the thing” we call emotion, not only “up and down, both ways,” but also left and right, both ways. In the chapters of this book, down is deep into the brain (brainstem, limbic system) and body; the implicit middle is where life is lived—in development, in day-to-day life, in psychotherapy—and where emotions “do their thing,” for better (health) or for worse (psychopathology). Up refers to the realms for which we strive when we speak of healing, well-being, and the pursuits and qualities of being under the aegis of our best and most flexible natures. Because, after all, “Human emotion is not just about sexual pleasures or fear of snakes. It is also about the horror of witnessing suffering and the satisfaction of seeing justice served; about our delight at [a] sensuous smile…or the thick beauty of words and ideas in Shakespeare’s verse; about…any Mozart, any Schubert; and about the harmony that Einstein sought in the structure of an equation” (Damasio, 1999, pp. 35–36).
The first six chapters of this book provide the neuroscientific and developmental underpinnings for an emotion-based, bodily rooted experiential clinical approach. The next five are written by clinicians whose contributions to understanding emotion emerge from clinical work with individuals, couples, and families.
We begin with emotions as ancestral tools for living (Chapter 1), and then examine how, through bidirectional communication between brain and body, they are regulated by the autonomic nervous system. In Chapter 1, Jaak Panksepp describes the building blocks of the system, the seven emotional primes, as he calls them, the primary behavioral motivational systems that are at the core of what animates us: Seeking, Fear, Rage, Lust, Care, Panic (separation distress), and Play. Not learned, not secondary, “presyntactic,” in no way dependent on experience or cognition, they are the constituents of our fundamental experience and adaptation. In the vitality of the emotions, Panksepp finds a corrective for social ills and sees vigorous play as essential to the well-being of our children. Before he is done connecting “up and down, both ways,” he offers reflections on identity, the core self, and neuropsychiatric definitions of the soul.
From the subcortical regions of the central nervous system (CNS), where these vital biobehavioral systems that that we share with our fellow mammals originate, we move to the autonomic nervous system (ANS) and to the body: Evolutionarily speaking, we take both a step down (to reptiles) and a step up (to the specifically human) with Steven Porges’s Polyvagal Theory of Emotion (Chapter 2). We step down—to the brainstem, to the visceral organs—to contact the legacy of our reptilian ancestors in the activation of the dorsal vagal complex under conditions of life threat; and we step up to the evolutionarily newest aspects of the parasympathetic nervous system, the ventral vagal complex, and the entrainment of the Social Engagement System under conditions of safety. Porges’s work makes clear that how we engage with one another, how we are able to regulate emotion, even what emotional response (e.g., aggression or play) is evoked in us cannot be considered apart from differential neuroception, that is, the nervous system’s perception of the situation. This hardwired assessment of safety or threat determines which aspect of the ANS (old parasympathetic, sympathetic, or new parasympathetic) comes online to mediate emotional experience.
Next we see how these elements come into play in development and operate throughout the lifespan. Whereas Panksepp and Porges focus on primal emotional systems and their regulation in brain and body, the developmentalists Colwyn Trevarthen and Ed Tronick show us the neurobiological richness and complexity of babies and their relationships with caregivers and companions. The primacy of the affect revolution and the bottom-up orientation of experiential therapies find their evidence in development, for they go hand-in-hand with the revolution that rescued infants from assumptions of passivity and blankness: Developmental research shows infants to us as fundamentally active beings endowed with supreme intelligence, with talent and gusto for meaningful interactions, which their brains and bodies are wired to undertake from—literally—the first day of life.
In Chapter 3 Trevarthen outlines how emotions operate in all spheres of human endeavor and serve many functions. He shows them as forces for the healthy intersubjectivity that is at the core of healing not just our individual selves but also our relationships and even our culture. Reaching down into neurophysiology and evolutionary history and up toward community and culture, emotion for Trevarthen allows individuals to participate in the music and dance of interrelatedness toward establishing sympathetic companionship and transmitting the value of human community throughout the lifespan, the upper reaches of the human endeavor. Tronick (Chapter 4) regards meaning-making as fundamental and us as meaning-seeking creatures from birth throughout the lifespan. He defines meaning as coherence and organization at any level of “the structural interconnection of the thing” (neurophysiological, cognitive, relational, or emotional) on the part of the individual or the dyad, or presumably the group. He connects down and up via the relational psychophysiology of emotional communication in dyads, be they infant–caregiver or patient–therapist. Dyadically coordinated and complementary states of the ANS yield expanded states of consciousness that we reach as a result of these coordinated interactions transacted through emotional communication; when they go well, resonance is amplified, and each member of the dyad is transformed.
Back in the CNS, we then go lateral to explore the contributions of right and left hemispheres in emotion regulation. Allan Schore (Chapter 5) focuses on the crucial role of the right hemisphere, especially the right orbitofrontal cortex, in the regulation of subcortically generated emotion and of its ANS arousal. Given the primacy of the right hemisphere in emotion and attachment regulation, Schore addresses the importance of regulating the sympathetic arousal of the “vehement emotions,” Pierre Janet’s (1889) term that captures the intense urgency of dysregulated emotions. When not supported by an attachment matrix (due to either trauma or neglect), the sympathetic arousal that characterizes these emotions overwhelms the individual’s regulatory capacities and triggers the parasympathetic-mediated shutdown of dissociation as a survival mechanism. Schore discusses how recruiting attachment dynamics to the therapeutic situation to regulate emotion can gradually render dissociation vestigial and maximize the effectiveness of the individual’s emotion regulatory capacities.
We continue our neurobiological journey by focusing on the integrative structures, both subcortical and cortical, where the mechanisms that optimal development and therapeutic change seek to recruit are in the foreground.
Integration is at the center of how Daniel Siegel construes emotion. In Chapter 6 he considers the powerful role of the prefrontal cortex in the transformative integration that he deems emotion to be. Siegel’s discussion highlights how human relationships form and nurture the self-regulatory circuits that enable emotion to enrich, rather than enslave, our lives. The discussion takes us into the realm of mindfulness, a time-tested tool of experiential treatments for emotion regulation, and Siegel gives us a detailed description of the qualities of coherence (Connected, Open, Harmonious, Engaged, Receptive, Emergent, Noetic, Compassionate, and Empathic), complexity, and flow characteristic of optimal health and well-being—the very processes and qualities that experiential therapies aim to entrain and bring about.
Along the way from body and brainstem to limbic system to prefrontal cortex, we also encounter other phenomena and processes salient to a comprehensive understanding of emotion. These include phenomena of resonance and mirror neurons (Chapters 3, 4, 6); phenomena reflecting the contributions of the insula, anterior cingulate; and of the temporal and parietal cortices to vital body–emotion–environment integrations (Chapters 1, 2, 5, 6). We explore some preliminary neurobiological ideas about the wired-in, affective basis of the core self, which Panksepp hypothesized to be “concentrated in central midbrain regions such as the periaqueductal gray and ramifying through the core of the higher brainstem to medial cingulate/frontal regions,” and possibly involved in the recognition processes by which emotional transformations are assimilated into the self (see Fosha below and Chapter 7).
At this point, our discussion takes us into the laboratory of the clinical situation, where the foregoing basic ideas about emotions, the brain, and the body in development and in relationship are applied in the service of healing. Detailed case presentations are an integral part of the clinical chapters that follow. Fosha’s accelerated experiential dynamic psychotherapy (AEDP), Ogden’s sensorimotor psychotherapy, Solomon’s attachment-and neurobiology-informed work with couples, Johnson’s emotion-focused therapy (EFT) with couples, and the attachment-focused family therapy of Daniel Hughes—all these therapies involve moment-to-moment tracking of somatically based and subjectively felt emotional experience in the context intersubjective and attachment-based relatedness, and all reflect the integration in action of the phenomena and processes elucidated by the neuroscientists and developmentalists.
Diana Fosha’s work focuses on emotion-based transformation and the energy and vitality that the experiential processing of the vehement emotions yields to the individual (Chapter 7). Noting that the process of emotion-based healing is marked, moment to moment, by invariably positive somatic/affective markers, and that transformation is not only a desired outcome but also an experience and a process, she outlines the phases of the transformational process: from dysregulation (her down), to processing first emotions and then transformational experience, to the calm of core state (her up). She elucidates a new phenomenology of transformational experience, constituted of vitality affects, receptive affective experiences, healing affects, and core state.
Also working with adults, Pat Ogden elegantly shows us how the body is a powerful resource for the regulation of emotion. Central to this regulation is the capacity to transform compromised strategies for the regulation of ANS arousal through working within and at the edges of the window of affect tolerance. She takes the action intrinsic in emotion and sensation and explores the importance of action and movement for motivation and vibrancy, a theme also sounded by Trevarthen. She systematically shows us how to work with trauma-related and attachment-related tendencies, distinguishing emotions and sensations and defining overlap in bottom-up processes. Ogden’s work illustrates the clinical uses of Porges’ polyvagal theory of emotion and shows how the capacity for zestful, flexible play specifically, and expanded affect tolerance more generally, are a culmination of therapeutic success.
In Chapter 9 Marion Solomon reflects on the neurobiology of attachment in partnerships and shows us relational psychophysiology in action by forging a physiological linkage, whether between the members of the couple coming for therapy or the therapist–couple pair. Solomon carefully tracks both the level of arousal in each member of the couple and her own somatic experiences, while also encouraging a mindful attitude toward the emotions. Further, she demonstrates how recent findings on neuroplasticity can contribute not only to regulating the nervous systems of traumatized individuals but also to healing relationships. Regulating and reregulating emotion can change the brain, and by extension, our old toxic patterns of behavior, and, when conditions of safety obtain, can transform “intimate enemies” back into “intimate partners” once again.
In Chapter 10 Susan Johnson discusses the extravagant transformational power of emotions, which can be harnessed to repair attachment injuries. No longer the exclusive province of poets and mystics, the emotion of love, in Johnson’s work, lands squarely in the science of attachment and emotion. Like Fosha, Johnson is interested in the phenomenology of emotions associated with the different phases of transformation. In working with couples, this involves the shift from the rigid secondary emotions that partners use to conduct their warfare (and protect themselves), to the excruciating primary emotions associated with loss or abandonment, to oxytocin-mediated “softenings” and the emergence of tenderness and empathy. These primary “soft” attachment emotions not only heal attachment wounds but further bond a couple and make life worth living.
Daniel Hughes’s attachment-based family therapy completes our trajectory (Chapter 11). Noting that working with emotion in family therapy is different from individual therapy—that is, the object of the emotion is present—he focuses on fostering the constructive communication of emotion (rather than its expression). Hughes illuminates the profound regulation that intersubjective qualities can bring to emotional communication between family members. And indeed, empathy, playfulness, acceptance, and curiosity—the elements of his therapeutic stance—go a long way toward repairing the disruptions and healing the traumas of and between children and their parents. They also bring about magical “moments of absorption,” moments of healing emotions in which new ways of being together are forged.