2013 Relationships and Neuroplasticity in Psychotherapy, UCLA : Siegel, conference note
Takeaway points on neuroplasticity from Dan Siegel, Day 3:
Dan Siegel’s home page: http://drdansiegel.com/

{compiled from notes taken by Andy Rose, mistakes and misinterpretations are his, not Dan’s}

Generation of new neurons and reconnecting existing neurons defines neuroplasticity. There are around 100,000,000,000 neurons and each has around 10,000 connections making 100,000 trillion connections. Additionally there are “glial” cells in even more numerous numbers that support neural activity.

Siegel credits Carla Shatz (Stanford) with the popular phrase “neurons that wire together fire together.” The mnemonic phrase is usually attributed to Carla Shatz at Stanford University, referenced for example in Doidge, Norman (2007). The Brain That Changes Itself. And our job in psychotherapy is to grown neurons and neuron connections. Associative learning has been discussed at least since 1949. See http://en.wikipedia.org/wiki/Hebbian_theory
Neurons that fire together also survive together, as there are periods (adolescence for one) where massive amounts of neurons and connections are pruned.

So we “SNAG” the mind. Stimulate neuronal activity and growth.

Not just neurons but the myelin sheaths that grow along the neuron axis are laid down by glial cells and support efficient operation, with a faster ‘action potential’ and shorter ‘resting period’. These changes yield up to 30,000 times faster communication. See http://www.ngidd.eu/public/myelinated.html (How nerve cells become myelinated).

Practice increases the myelination. “Memory is laid down by synapse connections, skill depends on myelin.”

Epigenetic change is possible. While genes are fixed, their expression is not. Regulatory molecules such as ‘histones’ and ‘methyl groups’ determine which genes activate (produce proteins). These situations are passed through the sperm cells and ova and create intergenerational “memory”. Abusive and neglectful experiences alter growth of regulatory circuits (HPA axis) and decrease amount of integrative fibers (long neurons).
http://www.cellplasticity.org/

Integrative fibers (Bruce Perry says they are 1% of 1% of 1% of the neurons) connect disparate parts of the mind that are mostly shorter, “local” neurons. For the brainstem and limbic areas to benefit from the prefrontal cortex’ ability to pause, reflect, consider long term consequences, etc, there must be effective physical links. Siegel says the task of developing the mind is “integration”, which he defines as “honor differences” and “promote linkages.” “Integration” applies at a cellular level all the way to the social level.

Due to the import Siegel places on relationship in his definition of the mind:

an embodied AND relational self-organizing process
that ‘emerges from’ AND ‘regulates’
energy and information flow within us AND between us

the “self is a plural verb.” This alludes to Siegel’s notion that “I” (my mind’s concept of self) extends beyond the skin and includes relationships.

Method: Monitor and Modify with Stability and Integration

[andy comment] So “the mind”, taught by the Buddha to be the source of our suffering, is “ours” only in part. The relational part is somewhat out of our consciousness and out of our control. We are influenced by the energy and information that our mind interacts with. At first glance this scares me in that my mind is essentially vulnerable.

Perhaps therapeutic strength is within that vulnerability. Can my mind allow for the energy/information from a person in pain, and interact with that (‘regulate information between us’) in a nourishing way rather than repeating the trauma of distancing, or abandoning the other?

[Siegel] The mind is in two places, within the skin and within the relationship. And the relationship tendencies are produced and reproduced by the mind.

So energy/information come from the environment (womb, world, mom, caregivers) and the body (sensations, feelings, images, thoughts) pattern (create) an ongoing process whose job it is to further regulate (do something with, tone down, tone up) energy/information.

This process can be modified by the mind or someone else’s mind. Information/energy can make a person’s mind change and act differently. New, novel experiences can change the process and since it’s iterative new patterns and processes are impacted by experiences.

Where this counts according to Siegel is interpersonal integration stimulates internal integration. Which means the therapist that consciously allows for the mixing of the minds, or “joins” with the mind of another in offering an integrative experience. Schore, elsewhere, has something to say about this process happening in the unconscious of two people regardless of what’s going on consciously.

So a non-defended “presence” supported by empathic responses and openness to feedback support healing through relationship. We as therapists need to develop presence through mindfulness practices. Mindfulness practice has been shown to prevent burn out and increase empathy.

Method: Wheel-Hub mindfulness practice
http://drdansiegel.com/resources/wheel_of_awareness/

The presence of a therapist willing to “join” with the client in the relationship undermines the client’s experience of the total, desperate loneliness of abuse and neglect. The client is no longer “alone” to cope with sensations, images, feelings, and thoughts (Siegel’s SIFT acronym) that are perceived as overwhelming.

“Integration” in the therapeutic relationship, where the differences between the therapist and client at honored and linkage is allowed and promoted, means we don’t lose “me”, “we gain ‘we’.” Siegel introduced the term “mwe” (“me-we”) as more accurate than “me” which he says does not reflect the real situation. Importantly, joining does not mean the loss of self. A centered mindful therapist can “be with” the feelings shared in the dyad while connected internally sufficiently so as not to dissociate or get too hyper.

[andy] So… the mind, which produces patterned, conditioned, historic behavior in response to stimula, can change and be changed… through the relationship (as well as the client’s internal mindfulness practice) IF the clinician is willing to be in the relational field with the client, experiencing upset, panic, fear, anger, etc while regulating (having a witness part of the mind that grounds the clinician).

Most of the left brain symbolic conscious activity of the therapist will be in the service of regulating the energy emerging in the mind, which may be brought on by right brain unconscious activity. The therapist needs to know that their “thinking” may actually be defending from the pain in the field and the analytic activity pulls them out of the relationship, further re-enacting the client’s abandonment.

Siegel offered the “Healthy Mind Platter” as options for tasks that improve the mind, including: sleep, attentional practice, doing nothing “chill time”, exercise, play time to enjoy and savor life, “time in” to reflect and SIFT the mind (pay attention to sensations, images, feelings, and thoughts), and “connection time”
http://drdansiegel.com/resources/healthy_mind_platter/