Linda Graham: Cultivating Response Flexibility: Neuroscience in Psychotherapy

Tami Simon: You’re listening to Insights at the Edge. Today my guest is Linda Graham. Linda has been an ardent practitioner and facilitator of personal growth and self-transformation for more than 20 years. She draws on her own experiences of healing and awakening, as well as more than two decades of integrated study, practice, and teaching of transformational psychotherapies, Vipassana meditation, and life coaching.

She’s the author of the book Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-Being, and with Sounds True, Linda will be teaching one of the four modules in a new series, the Leading Edge of Psychotherapy: A Yearlong Training in Neuroscience, Trauma, and Attachment, an online training series which features Linda Graham along with three other world-class trainers: Stan Tatkin, Bonnie Badenoch, and David Wallin.

In this episode of Insights at the Edge, Linda and I spoke about what she’s learned from neuroscience that can be particularly helpful to psychotherapists in their work with clients in terms of working with shame and anxiety, and creating a relationship with what she called a “true other” that creates a resonance circle and can become a resource for empowering change. We talked about increasing our capacity to be resilient and how Linda views resilience in terms of response, flexibility, and how the prefrontal cortex is “the CEO of resilience.” We talked about her journey with Vipassana meditation and dropping the self, along with her experience of strengthening the self through therapy and how she understands this paradox through the lens of neuroscience. Here’s my conversation with Linda Graham:

Linda, you’re a part of a new, yearlong training program from Sounds True that’s called the Leading Edge of Psychotherapy and you’re going to be teaching on Neuroscience for Psychotherapists. Right here at the beginning, what I’d love to know is what do you think [are] the most important items, the most important discoveries from neuroscience that psychotherapists need to know—the game-changing insights, if you will? I realize that’s a big question, but I think you’re the right person to answer it.

Linda Graham: Thank you for that vote of confidence. Where I would start is the greatest discovery of modern neuroscience is neuroplasticity—that the brain can create new neurons, create new connections among those neurons, create new circuitry and new pathways, new habits of behavior, and new skills of responding lifelong. We take that for granted now, because we know that now in the last 15 years, but for 150 years before that, neuroscience thought that once the brain fully developed, about 25 years of age, that you couldn’t teach an old dog new tricks, that the brain was fixed.

Now we know that it’s possible to change our patterns or responses to challenging life events lifelong. It’s very empowering for clinicians and for the clients themselves to know that we can learn to use tools and techniques, we can offer experiences that will shape the functioning of the brain in a wise and wholesome direction. It’s very empowering to know that we have ways of choosing the experiences that will shape the brain in ways that will accelerate the process of brain change so that clients can actually feel a sense of mastery, and competency, and efficacy in their own therapeutic work as they learn to and experience their own brain changing and rewiring.

TS: OK. So, this discovery of neuroplasticity, which you say many people now take for granted, but to dig into a little bit, what do you think the limits might be of how plastic our brains are? I mean, only to a point, or what about people who have really severe trauma from early in their life? Are our brains that malleable, really?

LG: There are limitations. There’s limitations simply as we get older and the brain changes less quickly and less plastically than when we were younger. I mean, the greatest growth in the brain is from zero to three years of age, so as we get older the pace will slow down. If there’s any kind of organic impairment—if there’s some kind of neurochemical imbalance or a structural malformation or if there’s been addictions for a long time—then it’s much harder for the brain to change, and the impact of trauma is significant, especially if it started young and especially if it’s been chronic.

Nonetheless, when we learn how to create conditions of safety, create conditions of openness and receptivity, when there is a relationship between the client and the therapist where there is mindfulness and awareness, where there’s compassion and acceptance, where there’s a sense of trust and safety, then the brain becomes more receptive to change. So we deliberately use the tools and techniques that will encourage or foster the plasticity of the brain.

It’s important to realize that probably the best thing to do is to repeat the experiences that we’re trying to install or create the changes in the brain again, and again, and again—that the brain learns from repetition. So we may learn to do a gratitude practice or we may learn to do a memory deconsolidation/reconsolidation practice, or we may learn to do a hand on the heart exercise to calm down the nervous system, but the most important thing is to be able to repeat those experiences so the brain has a chance to install it in long-term memory.

TS: You also mentioned that we now know things about how to accelerate brain change, so that’s interesting to me. What do we know about accelerating?

LG: Well, it’s very important to be able to pause and become present. This is where mindfulness practice can be very helpful, but we need to pull out of denial, distraction, dissociation. We need to show up and engage with our experience of the moment, and be able to actually experience it, reflect on it, and install it. So that’s one practice, simply pausing and becoming present. Another is to set intention, because when we set the intention of wanting to create a change, we’re actually activating the plasticity of the brain. We’re actually turning on the capacity of the brain to learn something new. Then the third thing that accelerates it is perseverance—doing a practice again, and again, and again so the brain has a chance to create that new neural circuitry.

TS: Now, help me understand how just my intention helps activate neuroplasticity or helps open that possibility, just my intention?

LG: Well, when we set an intention we’re focusing our attention, and when we focus our attention on our experience, then we’re activating the parts of the brain that want to process and learn about that experience. There’s a focused mode of attention, a processing in the brain, and there’s also what would then be called the “default network” of processing in the brain. Both can be used to create brain change, but when we’re focusing our attention and intention, we’re deliberately guiding or creating the changes in the brain that we want, so for instance, when we do a compassion practice or when we do a forgiveness practice.

When we let go of the guardianship of that attention and let the brain go into its mental play space of the default network, then the brain starts making its own links, its own associations, its own connecting the dots in new ways, and that’s where we get insight. It’s where we get our own intuitive wisdom. We can access that through daydreams and reverie, and very often some new understanding will come out of the blue, so to speak, and that is also part of our rewiring our brain in a good direction.

TS: Linda, I want to ask you what might be a slightly strange question if that’s OK.

LG: Sure.

TS: OK. Here you are, you’re teaching Neuroscience for Psychotherapists, and I’m imagining someone who says, “Look, I’ve been practicing psychotherapy for a long time. I was never really trained in neuroscience. What psychotherapy is at its core is a loving relationship, an unconditional space of listening and attending in openhearted way. We’ve been doing this for eons. I don’t need to know the last two decades of information about what’s been discovered through fMRIs, et cetera. I already know how to be a good psychotherapist. What’s all this hubbub?” What would you say in response to that?

LG: Well, I said in my book that we don’t need to understand how the carburetor in our car works or how a fuel injection system works in order to be able to drive our car, and that’s completely true, but it can be interesting to peek under the hood, peek inside the black box of the brain, and understand what’s happening with our clients as they mourn the loss of a pet, or as they struggle to make a decision when there’s an inner conflict about that, or when they’re having trouble managing their anger, or their anxiety, or their shame. It can be very illuminating. It can be informative about what’s happening inside of the brain so that we can guide it in a good direction.

To me, the neuroscience is simply validating—yes, everything you just said, that the mindful empathy that we bring to our clients in a therapeutic session creates the conditions for changes in the brain of our client. When—to me, when I know how the brain works, I have more conviction. I have more faith in the tools I’m about to offer my clients.

The other thing that I think neuroscience informs us is that everything we’re doing in therapy really is an experiment on the part of the client. They want to go in a different direction. We try this, try that, try something new, and see if it works, see if the mind and the sense of self stays open to a new possibility or whether it contracts and closes down again. The neuroscience can inform us what’s happening in the brain as we stay open or as we contract again.

As the science validates, there are many tools we use—we may use them intuitively out of our experience, to help clients shift out of the negativity bias of the brain, out of the contracted automatic survival responses in the brain, to more openness, receptivity, the larger picture, the bigger perspective. When we know in the moment how to help them make that shift, then we’re simply using the neuroplasticity of the brain to help them be more resilient and adaptive in their functioning. Of course, people have been doing good therapy for a long, long time.

So people have been doing good trauma therapy for a long, long time. But as we understand the conditions in the brain that help a client recover from stress and trauma, then we can accelerate that process.

TS: Let’s look under the hood a little bit, and you’ve given this example of a therapist introducing a new possibility to someone, and they’re open or they’re closed, closed, closed, closed, closed, closed. Let’s just give that as an example. What’s going on in the brain at that point, and how does your study of neuroscience inform what your options are as a therapist in that situation when you encounter that?

LG: All right, so probably what’s keeping a client closed [are] the two pathogenic effects of anxiety or shame. I want to know how to work with the anxiety or the shame that the client is experiencing that is keeping them closed or defensive from trying a new experience. So when I know how to help a client regulate their own nervous system to come out of anxiety or even to come out of depression back into what’s called the “window of tolerance,” where the body-brain is in this baseline physiological equilibrium; it’s where we can be calm and relaxed, but engaged and alert. It’s where the brain can learn the best. When I know the tools to help them come out of the anxiety or come out of a depression back into that window of tolerance, they’re much more able then to be open to learning a new experience. They feel safe in their own body-brain and they can do that.

When I’m working with shame, which is really the biggest derailer of our resilience altogether, if I can set up a relationship with a client where they feel safe, heard, understood, validated, accepted, clinicians may know how to do that very well on their own, but when I can pay attention to a client staying open with me in the relationship or closing down in the relationship with me, not necessarily closing down to the problems they’re facing, closing down in the relationship with me, and I make sure that there’s no shaming, blaming, criticizing going on, that the client can stay in an open, trusting space. Then it begins to unlock the rewiring of those shame-based memories at a deeper level in the brain, and that’s what I’m after.

TS: You mentioned this idea of the window of tolerance. Can you help me understand that more, this window of tolerance? What is that?

LG: OK. I’m going to answer that in two parts. The window of tolerance is a term that came from Dan Siegel originally; Pat Ogden promoted that in her sensorimotor psychotherapy, so it’s used in trauma therapy. The idea is there’s a window where we can operate naturally and fluidly. The nervous system will rev up, the sympathetic nervous system will rev up and mobilize us and activate us. When there’s no fear, then that’s how we move in the world to explore, and play, and create, and learn. When there’s fear, that sympathetic nervous system will rev us up into anxiety, or fight/flight/freeze. We want to be able to come down out of the anxiety, out of the anger, out of fear, back down into the window.

When the parasympathetic branch of the nervous system is activated—and this is all unconscious processing—we’ll calm down. We’ll relax. We might fall asleep after making love, or fall asleep, take a nap on the beach. It’s a very soothing, calming state. But when there’s fear, that part of the nervous system can over-activate and we actually numb out, collapse, dissociate, even faint. So we want to stay in that window where we’re not too revved up and we’re not too shut down. We can feel that in our bodies when we have this sense of calm and well-being.

Now, that idea of the window of tolerance has been sophisticated by Stephen Porges’ Polyvagal Theory where adding—he talks about the social engagement system that we use to assess whether the situation we’re in is safe or dangerous. So we check with people around us, and if we see calmness, or trust, or kindness in the people around us, then our own nervous system is regulated.

So that is very, very similar to the window of tolerance. We use that social engagement system and therapists use the social engagement system all the time to create a sense of safety, the “neuroception of safety.” It’s an unconscious resonance that we create with a client. We use that to create the safety in the therapy. If the client senses a sense of danger, their sympathetic nervous system might activate. If there’s a sense of life threat, they might go all the way to the deactivation of numbing out and collapsing. So those are sort of maps—they’re theoretical maps that give us a guideline to pay attention to the connection, the actual neural resonance between us and a client in a therapeutic session.

TS: Now, when you find you’re with a client and you sense that the person doesn’t feel safe, you can sense that, what do you do and what have you learned from your studies of neuroscience that will help that person feel safe and trusting?

LG: First, I want to ask the client to share with me their experience. I may be noticing something. I may be accurate, but I’m asking the client what they’re noticing about their own experience. One of my favorite interventions of all time is, “What are you noticing now? What are you noticing now?” I’m asking them to be present and be mindful, and if they can share their experience with me, or if I can pick something up in their facial expression or in their body language, then I’ll ask, “Can we explore what’s happening right now here in the room between you and me?” I just ask them if it would be safe enough to explore that. If it doesn’t feel safe, I would ask them if they’re willing to hear from me what I’m perceiving, and I want to check it out with them, whether it’s accurate. I open up the exploration, but I do see how they respond to that exploration as we go forward.

TS: In your book, Bouncing Back, you talk about this idea of the therapist being a “true other.” You introduce this phrase, a true other, and how important this is and you talk about the resonance circuit in the brain. I wonder if you can explain that for our listeners.

LG: OK. The phrase “true other to the true self” comes from my mentor, Diana Fosha, who developed Accelerated Experiential Dynamic Psychotherapy, and Diana says that the roots of resilience are to be found in the felt sense of being held in the mind and heart of an empathic, attuned, and self-possessed other. That connection, that relationship in the resonance circuit of the two people, is what begins to create the sense of existing, being important, being accepted, belonging that we need to feel calm in our nervous system.

But my understanding now—I’ve learned this since I wrote the book—Barbara Fredrickson in her book Love 2.0 talks about a kind of resonance that happens when two people—as in therapy—but two people are in physical proximity—so we’re not on our smartphones or our iPads—physical proximity, eye contact, where there’s a shared emotional experience, and there’s a mutual sense of care and concern, that would happen in therapy. Then what happens is that the neurochemistry of the two people begins to synchronize; the neural firings in the brain begin to synchronize. In traditional terms that would be called “entrainment,” the therapist entrains the client into an experience, into an emotional experience, but it’s happening neurochemically as well. When that happens, that sense of resonance is what creates the safety in the nervous system for the client to be able to be open and receptive to a new idea.

TS: This idea of someone being a true other—I found that tremendously inspiring, and I’m curious to know what do you think qualifies someone in the moment as a true other?

LG: Well, it can happen in a moment. It can happen in an ongoing relationship. What we understand from attachment theory and from inner subjectivity theory is that a developing child, and a growing person, and the client sitting in front of us, needs to feel connected, understood, accepted, validated, for them to know they are worthwhile, for the internal secure base to begin to develop psychologically, but also for the brain to begin to develop to learn the skills of regulating emotions and relating to other people, and being self-aware, and being empathic with other people. The earliest relationships we have, and the ongoing relationships we have, and the therapeutic relationships that we have, create that experience, that intersubjective experience of true other to the true self. It can happen in one interaction, but it can be installed more easily in the brain when it happens repeatedly over time.

That sense of being accepted, validated, OK in one’s sense of self, creates a sense of safety and trust. Probably what’s happening, part of that neurochemical resonance, is that the oxytocin—which is the brain’s hormone of safety and trust, it’s the brain’s hormone of bonding and belonging, of calm and connect. It’s the basis of building a secure attachment. When the oxytocin is flowing in the therapist, in the client, then that creates the safety and trust of the resonance circuit that makes therapeutic change possible.

TS: You’ve used a couple of times this interesting phrase when such and such is “installed” in the brain—this phrase “installed,” as in some new experience like, “I feel safe with this true other,” this gets installed. What do you mean by that, and how does something get installed in my brain? It makes me think a little bit of like, some kind of software going into my computer. Does the brain really work that way?

LG: [Laughs.] Oh, the brain is so much more than a computer. Part of that is because a computer operates on electrical signals and the brain operates on electrical and chemical signals, so what I was just talking about, the oxytocin, the neurochemistry, is part of how a brain works; it’s not just electrical learning. So an installation is simply transferring an experience from the moment, to short-term working memory, to long-term memory storage in our implicit memory bank. We value our conscious explicit processing, but we operate most of the time on our implicit, unconscious if you will, memory storage.

So say there’s a positive experience between the client and the therapist. It feels good in the moment, they reflect and talk about it in the session, it’s real, it gets reflected and repeated so that the client can install it in their memory. If the client spends a few times in the next days or weeks remembering that interaction and remembering what that interaction felt like in the body—remember in Diana’s quote, it was a felt sense of being held in the mind and heart. When the client practices re-evoking that felt sense of feeling safe, and loved, and cherished in that moment with the therapist, that begins to install it in our long-term conscious memory but also in our long-term implicit memory.

Then a couple weeks later, there’s a moment of startle, or upset, or disappointment, or difficulty, or whatever’s going on with the client, and the client can re-evoke that memory, that felt sense of that memory of that moment with the therapist, and they’re resourced. That’s a resource that they can use in that moment to meet that difficulty, so it’s now available to them in their long-term memory and they can call it forward.

TS: Linda, you focus in your work, among other things, on resilience and helping people cultivate and become more resilient. When you were talking about this relationship with a true other and when that becomes a resource for us how then we become more resilient, can you help me understand the connection there? First of all, how you define resilience, and then how this resource when I need it is going to make me more resilient?

LG: OK, so resilience—the capacity to cope with adversity, to cope with challenge and crisis, to be able to respond flexibly, adaptively, skillfully to the ups and downs of our lives—has been studied traditionally in terms of a temperamental quality of grit or determination, just the capacity to endure and plow through. But more recently it’s studied as the capacity to build coping strategies, and then it’s really being studied in terms of response flexibility, and the more able we are to respond to new difficult, stressful, potentially traumatizing situations with response flexibility, the more resilient we’re going to be.

There was a beautiful article in the February 11th, I believe, 2016 issue of the New Yorker about how people learn to become resilient, and it’s based on a lot of research. What they’re finding is that the more people can believe they have a choice about how they respond, the more they can respond to a challenging event as an opportunity to grow rather than something that’s going to overwhelm them. The more people feel like they have a sense of choice in how they’re going to meet any difficult situation, the more resilient they’re going to be.

So the thinking in the field now is shifting from focusing on the external stressors, the external problems—whether that’s a natural disaster, or the death of a loved one, or a divorce, or a loss of a job—to how we respond to those situations internally. Do we respond with stress and anxiety? Do we respond in fear and collapse? Do we respond with flexibility and making some choices?

One of my colleagues, Frankie Perez, says how you respond to the issue is the issue. So I’m trying to teach clients to pay attention to their responses. This is where—and I do teach in my own therapy tools of mindful self-compassion, because mindfulness allows us to be aware of our experience and our reactions to our experience, and then the self-compassion allows us to be accepting and allowing of our experience and our reactions to our experience. When a client can get ahold of their reaction to an experience, and can we just slow down a minute here to look at that reaction and whether it’s really working or not, and are there other responses available that might meet the difficult situation more skillfully or more flexibly, then that is shifting the client from being reactive to being responsive and being resilient. The resilience I really focus on as response flexibility—as one of my friends, Janet Freedman says, “Catch the moment. Make a choice.”

TS: This relationship in the heart and being loved by a true other, how does that play into the feeling that I have, “Oh, I have a choice?”

LG: One of the things I said earlier was that shame is probably the biggest derailer we have of our resilience—the sense of being unlovable, or not good enough, or a failure, or I can’t do this. When that can be healed in the therapeutic relationship, and it’s healed by the therapist accepting the client exactly as they are, and exactly as they’re responding and behaving. “Oh, given what you’ve experienced, given what’s happened to you, it’s perfectly understandable that you would feel and behave the way you do.”

Creating that acceptance, seeing the true self of the client, the capacities that are there, even if they’re overwhelmed or buried temporarily, begins to help the client accept themselves. When they can stop “shoulding” on themselves, or criticizing themselves, or judging themselves, or berating themselves, or putting themselves down—when they can just accept, “Oh, I’m a human being. This is happening. This is a pretty normal response to an abnormal event”; when they can accept themselves, then they can begin to perceive possibilities, options, different choices that they might have, because they’re not so busy and caught up defending themselves or running away from themselves. They can just accept and then try something new.

The relationship of acceptance—Carl Rogers said a long time ago, “The curious paradox is when I accept myself exactly as I am, then I can change.” The therapist offers that acceptance. The client experiences that acceptance from the therapist from themselves, and then they can begin to change.

TS: Now, interestingly, in terms of talking about resilience—and I’m wanting to make a link here to your work with Neuroscience for Psychotherapists—you talk about the prefrontal cortex as being the brain’s “CEO of resilience.” I’m wondering if you can talk some about that. Why do you focus here on the prefrontal cortex? If it’s my CEO of resilience, I’d like to get yet a better upgraded CEO, so can you help me in terms of my prefrontal cortex?

LG: [Laughs.] Right. That’s a big question, actually. The prefrontal cortex is considered the center of executive functioning in the brain. We know that as the center that allows us to analyze a situation, discern options, make a decision, make a judgment, put together a plan. That’s what traditionally is called the center of executive functioning.

Now, the prefrontal cortex does much more than that, and it integrates many deeper layers of the brain. When I’m looking at what Dan Siegel offers as the functions of the prefrontal cortex, that it allows us to regulate the body and the nervous system; it allows us to manage a broad range of our emotions, positive and negative; it allows us to quell the fear response of the amygdala. So those qualities right there, we’re not just making an analytical decision about our response; we’re actually using our own somatic resources, our body-based resources, to become more resilient.

The prefrontal cortex is what allows us to attune to our own experience and to attune to someone else’s experience, and receive the attunement of someone else to our experience. It allows us to empathize, to get a felt sense and make sense of our experience, and somebody else’s experience, and to receive their empathy. It’s what supports and fosters our self-awareness, our sense of who we are, and a continuity of ourself as we move through time.

Dan identifies the prefrontal cortex as the structure that supports response flexibility in the brain. The prefrontal cortex integrates input from the lower brain and the higher brain, from the left and the right hemisphere. It integrates a sense of past, present, and future, and so it is the structure that we rely on for response flexibility.

How do we strengthen the functioning of the prefrontal cortex? Because the prefrontal cortex develops and matures, it’s kindled in our earliest attachment relationships. When we—when the child, or later when the client experiences being attuned to and regulated by the parent or by the therapist, the brain is learning how to do that on its own. The mindful empathy that we offer in the therapeutic relationship entrains the prefrontal cortex of the client and begins to redevelop, remature, kindle the full maturation of it, and that shows up when the client is then better able to regulate their own emotions, to attune to themselves and other people, to have more self-awareness, to have more response flexibility.

TS: Hmm, you’re right. It was a big answer to my question about the prefrontal cortex. It also sounds like if I want to strengthen the prefrontal cortex that’s something I have to do in relationship, yes?

LG: Well, I wrote the book Bouncing Back: Rewiring the Brain for Resilience and Well-Being for the individual reader. I am a therapist. I do this all the time in my own clinical sessions with my clients, but the book is written for an individual reader to do 80 different exercises that will strengthen the functioning of their prefrontal cortex and then apply that in situations when they’re relating to other people. I try to help the reader recover the somatic intelligence, the emotional intelligence, the relational intelligence of their prefrontal cortex, and the exercises are designed to do that.

TS: Now, you’ve been using this interesting phrase “mindful empathy.” Is that a phrase that you came up with and what do you mean by that?

LG: Well, I came up with it, though I’m sure thousands of other people have also come up with it. The idea is to both pay attention to experience in an aware way, a mindful way, reflect on it, but also to have empathy, to have compassion, to care about the experience, not judge it or push it away. Both are necessary to mature the prefrontal cortex. Both are necessary to create the sense of safety and trust where the brain can do that. They draw on tools from both paradigms, from mindfulness and from relational psychology, and integrating tools from those paradigms to be used together, to be used at once to create—well, to accelerate the changes that happen in the brain.

TS: OK. You mentioned, Linda, that you wrote the book Bouncing Back for people to work, if you will, on their own—not necessarily for professionals, just for the layperson who wants to strengthen their prefrontal cortex. It has 80-some-odd exercises. Can you give us a sense, one or two exercises, that we could actually begin to get a feeling for this strengthening of this part of our brain?

LG: I can offer two right off the bat that are fairly easy to understand. One is the hand on the heart, and that’s an exercise that’s drawn from many different modalities. [It’s] simply placing the hand on the heart center and feeling the warm, safe touch of the hand on the heart, and then breathing more slowly, more gently into the heart center, and then even breathing a sense of ease or goodness into the heart center, and then taking a moment to remember a moment of feeling safe, and loved, and cherished by another human being. That could be a spouse or a partner. It could be a parent or a child, but it could also be a therapist or a friend. It could be a spiritual figure. It could be a pet, and for many clients, pets are actually really terrific.

Remembering a moment—not the whole relationship, but remembering a moment of feeling safe, and loved, and cherished, and letting the warm glow of that feeling wash through the body, and staying there for about 30 seconds and feeling the sense of calm that comes to the body in doing that. What’s happening very quickly with the neuroscience of that, any time we have warm, safe touch anywhere on the body, we can begin to activate the release of oxytocin, the brain’s hormone of safety and trust. Oxytocin is the brain’s direct and immediate antidote to the stress hormone cortisol, so as soon as we start activating the oxytocin, we begin to calm down. The breathing more deeply into the heart center activates the parasympathetic nervous system in a safe way, and so we move into more calm and ease. Breathing in a sense of safety or ease can put the brakes on our automatic survival responses.

When we remember a moment of feeling safe, and loved, and cherished, we activate the release of oxytocin. It can be powerful enough—I teach my clients to do this as they go throughout the day. It can even be powerful enough to preempt the stress response in the first place, but a technique like hand on the heart is powerful enough to calm down a panic attack in less than a minute. I teach it to all of my clients. It’s bringing them back into that window of tolerance.

Another technique that I use I learned from Natalie Rogers, who is an expressive arts therapist. She was Carl Rogers’ daughter. It’s using the juxtaposition of positive and negative to actually rewire a pattern of response in the brain. The idea—in a way that’s small, and safe, and slow—is to inhabit in the body a difficult emotion that you want to work with. It could be anger, or fear, or shame, or jealousy—anything—and work with it in a way that’s small, not to retrigger or retraumatize, but enough that you can feel that in your body. You hold that position of your body for 30 seconds.

Then without thinking, without going to your head at all, you just let your body move to an opposite posture, and you inhabit the opposite posture, and you get a sense of what that feels like in your body, and then you hold that for 30 seconds. You come back to the original posture; I’m actually even doing it myself right now as I sit in the living room talking to you. You go back to the original posture for 20 seconds. You go back to the second more positive posture in the next 20 seconds, and then you come to something in the middle for 30 seconds. You do an integrated posture.

When I first did this with a client, he was exploring depression and he thought the opposite of depression would be happiness, but what he found was it was reverence. We’re just tapping into our body-brain’s own intuitive wisdom. This technique is now quite famous. It’s called “power posing,” and it’s taught by Amy Cuddy at Harvard Business School, and her TED Talk on power posing is the second most watched TED Talk in TED history. The idea is to stand in a position of strength or empowerment. It might be like mountain pose in yoga, but to stand tall and strong and to feel the energy of that in your body before you go into a job interview, before you go into a courtroom, before you go onstage somewhere. We’re using this somatic wisdom of the body to shift our physiological state. When we do that enough it actually can rewire the brain’s patterns of responding to a new or difficult situation.

TS: Linda, I’m going to ask you a question that may show my ignorance here, but that’s OK. In those two examples that you just gave us, which I appreciated, I could feel how the sense of somatic intelligence was increasing and how I was receiving new information, and increasing my mindful empathy, if you will, from my own experience. But I don’t understand how that connects yet to strengthening the prefrontal cortex, what the connection is there to that part of the brain.

LG: How I would make that connection is when I teach these techniques, what I’m really teaching, like the Trojan horse, is that the clients can not only learn a technique, but they can learn a technique that will shift the functioning of the brain. They can learn a technique that will harness the brain’s neuroplasticity. They can learn a technique that will create brain change. When the client learns that about themselves—”Oh, I can use and master techniques that allow my brain to function in a different and better way”—that strengthens the functioning of the prefrontal cortex. That strengthens their center of executive functioning, because they’re learning how to make choices. They’re assessing, and judging, and learning how to make choices that will lead to better responses to whatever situation they’re dealing with. That is strengthening the functioning of the prefrontal cortex.

TS: Now, Linda, I’m curious to know a little bit more about you personally. Here you are, you’re a psychotherapist. You became interested and devoted, if you will, to Vipassana meditation to the point where you teach Vipassana or insight meditation now. How did then your interest in neuroscience emerge in your life?

LG: As I began learning through conferences, many mentors—and many teachers that are also featured on the series, the webinar series, et cetera, from Sounds True—but as I began to learn about the neuroscience of attachment, the neuroscience of human relationships, the neuroscience of how we communicate with each other and become intimate with each other, the neuroscience of relationship is what got me interested in neuroscience altogether. We can use it for more than relationships, but how to create more health, more resilience, more skill, more capacity in the human relationships, whether that was my own personal relationships or my professional relationships with my clients.

That’s what got me interested, the empowerment, the sense of mastery and skill that can come in relationship. That’s what the neuroscience opened up for me. That’s how I became passionate about it.

TS: What was it about the neuroscience of relationships that first captured your imagination so much, your interest?

LG: I think being able to experience the shift—myself and in my clients—from any kind of insecure avoidant or insecure anxious attachment, let alone disorganized attachment, to that more secure attachment where the sense of self, how the brain is functioning, is more stable and is more flexible. It’s both. Coming into that sense of more stability, more flexibility at the same time, for me, but also for my clients, that’s what I wanted to learn how to do better. So that’s when I began studying and implementing more neuroscience-informed psychotherapy.

TS: I’d be curious to know in your own life journey how the information you received from neuroscience helped you through that process, if you will, of becoming more flexible and stable as you mentioned, in terms of just your relational capacity, and who you are as a person. A little bit about how that process unfolded for you.

LG: OK. Well, I have an example of how that unfolded for me in a kind of iconic moment. I tell this story in the book. I used to have my office in San Francisco, so I would park my car in Golden Gate Park every day and walk to my office, and I could do that on automatic pilot. I didn’t have to think about it. So one day I was walking to my office and I was worried about something. I had to make a decision and I wasn’t quite sure what to do. So I wasn’t paying attention to where I was going, and I blithely walked into a sidewalk of freshly-laid wet cement up to my ankles. The whole cascade of shaming, blaming thoughts started. “You stupid klutz. Look what you’ve done. You’ve ruined your shoes. You’re going to have to be late for clients. You’ll cancel clients. You’re probably going to lose your business.” I mean, the whole catastrophic dive down the rabbit hole happened.

By then, I’d had enough mindfulness and self-compassion practice, and probably also enough study of the neuroscience to realize, “Oh, hey. I need to shift my attitude here. I need to respond to this whole thing differently.” And I began to realize, “So I made a mistake today. It’s probably not the only mistake I’m going to make today. I’m not the only person on the planet who made a mistake today because they weren’t paying attention. I think I can respond to this differently.” I pulled my feet out of my shoes and my shoes out of the sidewalk, and there happened to be a apartment building nearby with an outdoor water faucet, so I began washing off my shoes. I realized, “Yes, I can change my attitude right now in this moment. I can cope with this differently. I can cope with it better, and if I can shift my attitude in this moment, I can shift my attitude in any moment.”

As one of the construction workers came over with some paper towels to help me wipe off my shoes—and I, to this day, I’m grateful that he was empathic. He was kind. He was not shaming in any way. I realized, “Yes, shit happens, but shift happens too.” To me, that kind of summarizes what we’re learning how to do when we learn how to harness the neuroplasticity of the brain and change our responses, change our patterns. We can become more flexible. We can become more resilient, and that was the moment that sort of crystallized for me, “Yes, this works. This is the heart of it,” and so that’s what I still try to teach today.

TS: Now, Linda, one final area I’d love to briefly touch on with you is, as somebody who teaches meditation and you write about it as a practice, part of the practice is that we learn to let go of the self when we’re meditating. Snd at the same here you are, a psychotherapist, and in that role you’re strengthening the self, if you will, in the people that you’re working with [in] a sense—a positive sense of who they are and their capacities to make choices. How [do] you hold that paradox, if you will, of both helping people to strengthen their self and teaching people meditation practices where they’re dropping all sense of self altogether with?

LG: It was actually the neuroscience that helped me resolve that paradox for myself, or reconcile the paradox. Because as I learn how the brain functions to help us strengthen that sense of self, and we can use our focused mode of processing in the brain to guide and deliberately create change, but the neuroscience also illuminates how the brain works in its default network where we’re not guiding change. We’re not managing or controlling the change. We’re letting the brain play. We’re letting the brain make its own associations and connect the dots in a new way. That default network opens us up to a more spacious way of experiencing ourself, and I teach exercises where in fact the sense of self can disappear because it’s not needed, where we’re in a sense of awareness and flow and the sense of self is not needed.

We learn it is the prefrontal cortex that helps us toggle back and forth between those two modes of processing in the brain. The focused attention, where we can create new conditioning or reconditioning of brain patterns; or the default network, the defocused mode where we can use deconditioning to create new insights and new revelations. The neuroscience validates both ways the brain has to operate, and it even teaches us the prefrontal cortex can integrate those ways of processing information in the brain. So it helped me reconcile the two paradigms, and I came to see that both are necessary. Neither one really is sufficient. Both of them are necessary, so that’s where I can teach something like mindful empathy or mindful self-compassion, because it’s an integration of those forms of processing in the brain.

TS: Yes, that’s interesting to me. So these two different ways of processing in the brain: one [the] no-self—and you’re calling that the default network. For people who are unfamiliar with that, can you explain how that’s a no-self state of being in the brain?

LG: When neuroscientists first began putting people in their scanners to see what would happen in the brain when they were playing music or watching the news or whatever, they assumed that when they weren’t asking the brain to do anything that the brain would be quiet. They discovered the brain wasn’t quiet at all; it was active all over the brain. So that came to be called the default network. It’s what the brain does automatically on its own when we’re not asking it to do something. That default network many people can experience when they start to meditate and they’re not focusing on anything in particular. They’re just opening up to experience, and the brain starts going into worry, and rumination, and has all kinds of thoughts flying around. That is what the brain can do on its own.

But that default network is also how we open up to what Dan Siegel calls “the plane of open possibilities.” It’s a mental play space, and we begin to see that all of our experience, all of our thoughts, all of our sensations come and go. They flow right through. There’s an analogy, not so much from neuroscience but from modern physics, that when we penetrate matter and go down through the molecular, anatomic, and subatomic, and particle, and quark level, we find that there’s actually more space than stuff in physical matter.

When we begin to explore and drop down through the layers of the self, we find the self-experience changes. It flows. And we begin to see in a way—we begin to experience that there’s more space in the sense of self than there is stuff, and the sense of self can just sort of dissolve into open spacious awareness or into the sacred. It’s a subjective feeling of ease and well-being that the self just simply doesn’t even have to be there, and it’s not a problem. There are ways that we can lead ourselves into those kind of experiences, and we can come back out into a more focused mode of attention and figure out how we want to continue those experiences in our ongoing daily life.

TS: I’m with you in terms of having this open plane of possibility and exploring that as well as having a more focused mode of being, and feeling a sense of self in that focused mode. The question I have is the integration of those two, and how your understanding of neuroscience has helped you understand these two existing at the same time, how they’re integrated.

LG: Well, I guess it’s more of a foreground, background kind of thing in that the neuroscience helps me know that the prefrontal cortex allows me to choose which mode of processing I want to have in the foreground and which one is operating in the background. I know that I can toggle or dance back and forth between the two. The neuroscience essentially lets me know of that capacity of my brain to do that.

It is very interesting, the neuroscientists all agree, they have no idea how the physical substrate of the brain creates consciousness, or creates the mind. They don’t know how that happens yet. It may be many generations before we can develop the computers that are powerful enough to begin to understand that, but we can understand how the brain itself works and shifts between what we experience as different states of consciousness or different states of being.

TS: First of all, before our final question, Linda, I just want to thank you. Thank you for answering all of my questions so patiently and generously. Thank you.

LG: Thank you for asking.

TS: Now, just a final question, which is, this interview show is called Insights at the Edge. One of the things I’m always curious to know is what somebody’s current edge is in their own life, in a personal kind of way—what the edge is that you’re exploring or working with in your life.

LG: OK. I’ll still tie that back to what we’ve been talking about. The one thing I am getting very, very interested in both personally and professionally is the impact of digital technology on the brain—the impact of digital technology on our relationships, and on our capacities and willingness to show up for in-person conversations rather than using our phones or our email, and how the technology affects the functioning of the brain because we know that it does. We can get addicted to the dopamine hit that we get when the email pings.

The other thing I’m interested in is trauma and the brain. I’m interested in that partly because I had a rear-ended car accident last November and got a concussion, and apparently have fully recovered, according to my doctor, my neurologist, and my own sense of how I’m functioning. But I’m very, very interested in what we’re learning about the impact of trauma on the brain and how we can help people recover both from physical trauma but also psychological trauma. What are the research findings about post-traumatic growth that would be relevant to how we do our therapy?

TS: I’m curious in terms of that exploration about trauma, there’s a lot being written and taught about trauma these days in the field of psychotherapy. I’m curious, Linda, what aspect of it is this curious edge for you?

LG: That I think as we understand how the brain processes trauma, how trauma memories are held in implicit body-based memory, how we need to have some body-based somatic tools for working with trauma so that traumatic memories that are compartmentalized away outside of awareness can be safely brought to consciousness and brought to awareness again to be rewired. I mean, the work of Bruce Ecker and his Unlocking the Emotional Brain and how we learn to use memory deconsolidation/reconsolidation to actually rewire trauma memories—not to override them, but to rewire them.

That’s the most interesting to me, how the neuroscience is helping us understand how we rewire even the most difficult, problematic memories that we carry in our body-based memory so that we can be free of the trauma and actually be able to be more resilient then, again, no matter what the traumatizing event was in the first place.

TS: I’ve been speaking with Linda Graham and she is a featured presenter in a new yearlong training from Sounds True, the Leading Edge of Psychotherapy, and Linda will be teaching a module on Neuroscience for Psychotherapists: A Practical Training [on How to Strengthen Your Client’s Neural Platform of Resilience and Well-Being.] She’ll be joined in this yearlong training by Bonnie Badenoch, Stan Tatkin, and David Wallin, other leaders in the field. Leading Edge of Psychotherapy. Linda Graham, thank you so much. I’ve learned so much from this conversation with you. I’m very grateful. Thank you.

LG: Thank you.

TS: SoundsTrue.com: many voices, one journey. Thanks for listening.

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