Social Work Practice in the Time of Neuroscience
PROFESSOR EMERITUS
DR. ROB MACFADDEN,FACTOR
INWENTASH FACULTY OF
SOCIAL WORK, UNIVERSITY OF
TORONTO
Social Work Practice in the
Time of Neuroscience
Walter Lyons Memorial Social Work Clinic Day
Beyond Brain Health: A Colloborative Approach
Friday, September 19, 2014
Baycrest Health Sciences
www.robertmacfadden.com
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Social Work Practice in the Time of Neuroscience
BIO-PSYCHO-SOCIAL
“The Missing Link”
For decades social work has committed itself to a biopsychosocial
perspective with little evidence of the profession embracing the biological
side.
With the new knowledge emerging from neuroscience, social work is at a
crossroad in adoption of this new paradigm. Advances in imaging and
other technologies have opened a vista into the brain to reveal the
fundamental components and processes that underlie our thinking, feeling
and action.
Rosemary Farmer (2009), a social worker, has identified this focus on the
brain as the “missing link” for our profession.
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Social Work Practice in the Time of Neuroscience
We are a species that requires the most home assembly; brain continues to
mature right into the twenties. It changes throughout all of our lifetimes
Emotion powers our lives. It is a background and foreground influence.
Understanding fear,safety and love is critical to understanding people and for
intervention.
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Social Work Practice in the Time of Neuroscience
The brain has developed over millennia and this history influences who we are
today. The brain is an archeological record. (Triune Brain by Paul MacLean)
In general terms, the brain can be seen in terms of three evolutionary
components:
The reptilian brain was the first core to develop and is basic life sustaining,
controlling key functions such as respiration, circulation, the endocrine system,
reproduction, arousal & homeostasis. Much is reflexive and drive based- fear,
rage, eating, and mating which still retains a degree of control over our actions.
(Brainstem)
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Social Work Practice in the Time of Neuroscience
The paleomammalian brain was added on and brought with it learning,
memory and emotion. (Limbic system)
The neomammalian brain was a third addition and brought enhanced
cognition, enhanced social connection and sense of self and selfawareness. Problem-solving was enhanced and an increased emphasis
on social connection enabled us to organize into larger communities, to
increasingly plan ahead and to learn more from experience. (Cortex)
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Social Work Practice in the Time of Neuroscience
Louis Cozolino describes psychotherapy in “It’s a Jungle in There”
(Psychotherapy Networker 2008 September/October) is like working with
an anachronistic menagerie- a human, a horse and a crocodile within the
same body.
Our skull shares its space with ancient brain equipment and our
functioning requires integrating and coordinating these highly specialized
and complex systems. These areas of our brain can vie for dominance
and experience conflict with each other without us being conscious of
this.
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Social Work Practice in the Time of Neuroscience
http://www.youtube.com/watch?v=DDlfP1FBFk
“FLIPPING YOUR LID”
Dan Siegel’s Brain Hand Puppet from Siegel & Hartzell (2003),
Parenting from the inside out. P.173
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Social Work Practice in the Time of Neuroscience
Velcro for Negatives: Tilted towards Anxiety and Fear
Evolution favours an anxious gene (Aaron Beck).
We can be anxious/fearful about anything (e.g., our furniture)
Human condition is tilted towards anxiety or fear
Different Neuroplastic Properties
Hippocampus
Etch a sketch-repeatedly
Influenced by experience
Constantly remodeled
Amygdala
Keeps a constant dendritic profile-memory
Generalizes to as many situations as possible
Can make us rigid
Therapists are amygdala whisperers: work to build
networks of new learnings in hippocampus & prefrontal
cortex
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Empathy, warmth, positive regard creates the nourishing
Social Work Practice in the Time of Neuroscience
During fear and stress, Broca’s area (speech) inhibited. Yet we
need to put feelings into words & narratives to support emotional
regulation.
Involves integration cognitions and emotions. Broca’s area also
involved in prediction & anticipation. Impacts good choices &
victimization and dissociation.
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Social Work Practice in the Time of Mindfulness
and Neuroscience
Most Important Discovery in Neuroscience?
Neuroplasticity and Neurogenesis
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Social Work Practice in the Time of Mindfulness
and Neuroscience
Neural Circuitry: We’re all electricians.
Circuits are being formed, weakened, strengthened, and purged. Experience
is like a scalpel. Much happening unconsciously and may be consciously
driven.
Meditation is an act of circuit building- if you have an awareness of this, then
it’s a conscious act of circuit building.The ability to control and to direct your
attention is essential to well-being. It is the core of emotional regulation.
Secret to deliberate circuit building: paying attention. Intentional attention.
The ability to connect with, attune to, and help build new neural connections at
the heart of psychotherapy. We are all gardeners, helping each other manage
and grow our gardens.
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Social Work Practice in the Time of Mindfulness and
Neuroscience
Reacting to Challenges: the Autonomic Nervous System:
Stephen Porges & the Polyvagal Theory
Excerpted from stephenporges.com
Neuroception describes how neural circuits distinguish whether
Porgessituations
believes
our nervous
system is in a
constant quest for
safety.
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Social Work Practice in the Time of Mindfulness and
Neuroscience
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Social Work Practice in the Time of Neuroscience
The face and voice are significant channels through which safety is
communicated to another. Face is the area particularly where presence is
communicated to the client (Geller and Greenberg). Faces are information
centres along with voice.
Over time, the therapist’s warm facial connection, receptive posture, open
heart and listening presence promotes safety and neural regulation of the
client’s physiology, strengthening emotional regulation.
Therapist’s preparation involves cultivating personal presence prior to
meeting. This is internal attunement which generates calm and safety within
the therapist. Therapeutic presence involves attuning to oneself and one’s
felt sense of the client. Feeling felt impacts the client’s physiology though
calming feelings of safety.
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Social Work Practice in the Time of Neuroscience
Much of this is also non-verbal. Therapy is not merely the talking cure, but
the communication cure.
The therapist’s whole being functions like a tuning fork, resonating,
attuning and feeling empathy. This is highly interactional between the
therapist and client. The therapist senses the client and is changed from
this feedback.
Emotions experienced by the client are being experienced by the therapist
and his/her feeling and body state changes. The client senses this
change and if there is attunement, the client “feels felt” which is the sweet
spot for change.
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Social Work Practice in the Time of Neuroscience
In mindfulness, Siegel believes the process of following your breath in
a certain way and with certain mental filters, leads to the meditator
developing a positive, supportive relationship with oneself.
This is similar to us being a secure parent to ourselves. We are
responsive, accessible and attuned to our behaviour, feelings and
perceptions.
Therapists talk about creating a supportive, holding environment with
clients. Mindfulness is a form of a supportive, holding relationship with
ourselves.
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Social Work Practice in the Time of Neuroscience
The “social” part of the term “social worker” underscores our
profession’s recognition of the essential nature of relationships to
our existence.
Neuroscience, similarly, has revealed how fundamental
relationships are to our brains, mind and bodies.
Human connections help to shape neural connections.
Relationships essentially sculpt our brains.
As a species we are, “Wired to Connect” (Fishbane, 2007).
Louis Cozolino (2010) asserts that there are no single brains and
that the brain, besides its genetic component, is a “social
organ” developed through interaction with others.
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Social Work Practice in the Time of Neuroscience
Mirror neurons are neural components designed to pay
attention to the behaviours, feelings, intentions of others and to
provide this information to our brains. This is a type of social
Wi-Fi.
When we watch others, the mirror neurons pick up these cues
and through the collaboration of other brain components such
as the insula, this information flows throughout our body and
brain. Aspects of our body resonate with this information and
change parts of our own physiology. These changes are sent
up the insula and into our prefrontal cortex which perceives
these changes as a “feeling”.
Thus, in watching others, we resonate and our bodies change
to attune and to reflect these states in others. We are able to
feel empathy for the other. The mirror neuron system in others
sense the change in our bodily states and resonates with
these changes and the other “feels felt” by us.
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Social Work Practice in the Time of Neuroscience
Therapeutic relationships are viewed as forms of attachment
relationships which create the conditions for optimal change.
Interpersonal relationships involve biochemical changes which
result in many things including new neural connections and
learning.
This new perspective views social workers as physical
change agents involved in stimulating new neural
connections.
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Social Work Practice in the Time of Neuroscience
Positive Emotions: Hanson and Happiness.
Inner strengths include character virtues such as generosity, modesty,
patience, and also secure attachment, executive self-regulation, distress
tolerance, resilience, plus mindfulness, compassion and loving-kindness
and positive emotions. These are related to happiness.
Have to activate inner states first, then install them. Fostering states until
they become traits is the secret.
Negative states can quickly become negative neural traits.
Most positive states are wasted because they are too short-term. Need
to transfer short term states from short-term memory buffers to long term
storage or no lasting value.
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Social Work Practice in the Time of Neuroscience
H-E-A-L PROCESS
Have- you have the positive experience – notice one or create one
Enrich. Increase duration, intensity, multimodality (bring into body,
sit up proudly), Novelty heightens learning and increase personal
relevance.
Absorb. Visualize it sinking in, sense it, build it.
Link. (optional). Hold positive feelings or thoughts or memories in
awareness and introduce some painful thoughts, feelings, etc. (natural
antidote).
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Social Work Practice in the Time of Neuroscience
The positive material will gradually associate with the negative
material, soothing, easing and eventually replacing it.
Have more episodes over the day, even 30 seconds at a time, half
dozen times a day. Dozen or so seconds each time. Will turn
activated states into traits eventually.
It is startling to realize how unwilling the mind is to give the gift to
oneself of a positive experience (Hanson).
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Social Work Practice in the Time of Neuroscience
Let us be grateful to people who make us
happy. They are the charming gardeners
who make our souls blossom.
Marcel Proust
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Social Work Practice in the Time of Neuroscience
SOME PRACTICE TAKEAWAYS
Need to understand how to explain the workings of the brain to clients and to appreciate
the importance of the normalizing effect that this knowledge can have for many clients. The
“handy” brain puppet is a useful tool for this purpose.
Need to become experts in understanding and impacting the stress response. This
involves understanding both the “brakes” (i.e., things that activate the parasympathetic
system such as breathing, self-hypnosis, mindfulness) and the “accelerators” (e.g.,
sometimes a certain level of arousal is required).
Clinicians need to be become “amygdala whisperers” and learn how to soothe the
client’s fear and anxiety. Helping clients to learn how to self-soothe and helping
partners and families to soothe each other is essential. Emotional regulation and coregulation.
Positivity and positive emotions, the foundation of Positive Psychology, are extremely
important. We need to help clients find positives in their lives and learn how to
recognize them, savour them, and marinate in them. Also related to Strengths-based
work. Building social support networks is another example of using positives.
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Social Work Practice in the Time of Neuroscience
SOME PRACTICE TAKEAWAYS
We need to be sensitive to what we are communicating to client unconsciously (e.g.,
through non-verbal communication) and what implicit messages that agencies give off
(e.g., messy and drab waiting room suggesting client low worth).
Powerful right brain to right brain communication is occurring implicitly and is seen as
the most important form of communication in terms of impacting the client.
Use the mirror neuron system to “sense” the experience of the client but always check to
see if your perceptions are accurate.
Work to improve vertical integration (cortex with the brain stem and internal organs and
visceral system) by promoting body work so that the client is able to be aware of internal
sensations and improve the vertical low essential in integration and mental health.
Work to improve horizontal integration (right brain to left brain communication) by
exploring feelings, autobiographical self, experiences and how these connect with the left
brain understanding through, for instance, the development of self-narratives. This
enhances integration and mental health.
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Social Work Practice in the Time of Neuroscience
SOME PRACTICE TAKEAWAYS
Understanding that evoking certain experiences, including intentional
attention, activates neuroplasticity which helps to build new neural
connections (i.e., learning) and the speed of the connections. Aerobic
exercise, mindfulness practice, nutrition, therapeutic relationships can all
promote neuroplasticity.
Conditions that promote therapeutic change:
positive therapeutic alliance with resonance, attunement, accurate empathy
naming feelings and integrating into self-narrative
feeling safe and feeling felt
working on highly relevant goals with tasks that make sense
incorporating self-soothing and co-soothing
repairing relationship ruptures
deliberately facilitating positives and positive emotions
monitoring the therapeutic relationship and outcomes
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Social Work Practice in the Time of Neuroscience
SOME PRACTICE TAKEAWAYS
Goal is to promote mental health and well-being. Key is promoting flow
(versus chaos and rigidity) and integration (i.e., everything working together
individually, and in harmony). Triangle of well-being: Empathic relationships,
healthy mind and integrated brain.
Integrating brain, coherent mind, empathic relationships
Daniel J. Siegel
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Social Work Practice in the Time of Neuroscience
References
Applegate, J., & Shapiro, J. (2005). Neurobiology for clinical social work:
Theory and practice. NY: W.W. Norton & Company.
Cozolino, Louis (2010). The neuroscience of psychotherapy: Healing the
social brain. Second Edition. NY: W.W. Norton & Company.
Damasio, A. (2001). Interviewed in the video, produced by David Grubin,
Secret Life of the Brain. NY: Public Broadcasting System.
Farmer, Rosemary (2009). Neuroscience and social work practice. Thousand
Oaks, CA: Sage.
Hanson, R., Mendius, R. (2009). Buddha’s brain. Oakland, CA: New
HarbingerPublications.
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Social Work Practice in the Time of Neuroscience
Holzel, B., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D., Ott, U.(2011). How
does Mindfulness Meditation work? Proposing mechanisms of action from a
conceptual and neural perspective. Perspectives on Psychological Science 6 (6),
537-559.
MacFadden, R. (2011). Hypnosis and social work practice: Incorporating new
perspectives from Neuroscience. In Turner, Frank. Social Work
Treatment. Fifth Edition, Chapter 17, 271-278.
MacFadden, R., Schoech, D. (2010). Neuroscience and professional decisionmaking: Implications for ICT. Journal of Technology in Human Services, 28:4, 282294.
Saleebey, Dennis (1992). Biology's challenge to Social Work: Embodying the personin-environment. Social Work, 37(2), 112-118.
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Social Work Practice in the Time of Neuroscience
Schore, Allan (2012). The Science of the Art of Psychotherapy. NY: W.
W. Norton & Company.
Schore, Allan (2003). Affect regulation and the repair of the self. NY:
W. W. Norton & Company.
Seligman, Martin (2011). Flourish. NY: The Free Press.
Siegel, Daniel J. (2013). The developing mind: How relationships and
the brain interact to shape who we are. Second Edition. NY: Guilford
Press.
Siegel, Daniel J. (2010). The mindful therapist: A clinician’s guide to
mindsight and neural integration. NY: W. W. Norton & Company.
See also robertmacfadden.com for a range of related resources
from documents to webinars.
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Social Work Practice in the Time of Neuroscience