Reprinted from  “Systems-Centered News” Volume 15, #1, July 2007


PSYCHOTHERAPY FROM THE INSIDE-OUT: INTERPERSONAL NEUROBIOLOGYAND THE WORK OF DAN SIEGEL. M.D., A Primer for SCT Therapists 


Michael Robbins M.A., L.M.H.C. 

michaelrobbins@rcn.com  



In a recent course entitled “Psychotherapy from the Inside Out: The Brain of the Mindful Therapist,” Daniel Siegel puts forth an important understanding that is emerging from the field of Interpersonal Neurobiology: an integrated brain, a coherent mind, and empathic relationships are inextricably interdependent on each other (Siegel, 2005). We are beginning to discover how the objective world of neuroscience, the subjective world of the individual psyche, and the inter-subjective world of social relationships, each give us streams of information that can be checked and cross-checked against each other. By cross-fertilizing the research and theoretical understandings from each we can deepen our insight into all three.

The correlation among the objective, subjective and inter-subjective world is the seed from which a whole garden of theoretical reflections has begun to sprout. An interdisciplinary approach leads us to the conclusion that a therapist’s or consultant’s most powerful tool may be the integration of his or her own brain. Siegel defines neural integration as the “free flow of energy and information between the differentiated structures and the associated functions of the nervous system” (Siegel, 1999). He also makes the important hypothesis that therapy and consultation harnesses the reparative power of attuned interpersonal relationships to help people achieve a higher level of neural integration (Siegel, 2002). If neural integration translates psychologically into a coherence of mind, and interpersonally into a depth and power of presence and attunement, then by understanding the brain’s structures and the functions of those structures we may better understand how to achieve the goals of psychological and interpersonal healing and integration as well. If these three phenomena are actually the same thing viewed from a different perspective, each perspective can inform and flesh out the limitations of the others. 


Our Tripartite Brain - A Simplified Brain Anatomy


To begin with, it is important to have a basic understanding of the structure of the brain and the functions of those structures. In broad strokes, the brain’s anatomy has a tripartite structure. To illustrate this, Siegel uses the following model: fold your thumb under your fingers and make a fist, you have just created a simple three dimensional model of the tripartite brain.

The oldest level of the brain, the brain stem, corresponds to your wrist. The brain stem is the most primitive part of the brain and controls your basic survival mechanisms, such as breathing, coughing, grasping, sucking, your heart rate, and the regulation of your body’s temperature. If this part of the brain is injured, the physical body dies.

              The second layer of the brain, the limbic system, corresponds to your thumb, and is essential for your most basic emotional responses, your early attachment systems, memory, motivational, and learning systems. The limbic system “functions at the intersection of the internal and external world where the primitive needs of the organism (brain stem) negotiate with the requirements of the outside world.” (Cozolino, 2002). All mammals have a developed limbic system.   

There are two key structures in the limbic system that are important for therapists and consultants to know about.  The first is the amygdala, which along with the right hemisphere of the neo-cortex organizes implicit memory. Implicit memories are the memories that we have without words, which form the background feeling tone of our lives. The amygdala is also involved with the neural networks that organize early attachment, fear, trauma, and strong emotional experiences. The amygdala is present at birth and continues to function throughout our lives.  

The second structure is the hippocampus. The hippocampus only develops after 18-24 months of age. It organizes explicit memories in collaboration with the left hemisphere of the neo-cortex.  Memories cannot be explicitly coded in language prior to the development of the hippocampus. (In the 2006 spring issue of the Newsletter, I wrote an article called “The River of Well Being, Using the Implicit Memory System to Release Old Roles in the Body,” which explored the difference between the implicit and explicit memory systems and how we can work with them in therapy and consultation (Robbins, 2006).)   

The third and most evolved layer of the brain is the neocortex, which corresponds to your fingers. The neo-cortex is composed of a left and right hemisphere, as well as a structure called the corpus callosum, which connects the two hemispheres.  

The right hemisphere develops earlier then the left hemisphere. It is holistic in its perceptions of the world, responsible for facial recognition, the appraisal of affect, the immediate sense of safety or danger, and contains an internal map of the body. It is through the right hemisphere, in conjunction with the amygdala, that we grasp the emotional, nonverbal part of someone's communication. The right hemisphere is involved with the process of implicit memory.  

The left hemisphere does not become fully activated until 18 to 24 months of age. It is responsible for our capacity to think linearly, logically, and to use language. As information travels from the right hemisphere across the corpus callosum (the structure that unites the right and left hemisphere), the left hemisphere helps us to integrate nonverbal, intuitive information into words. The left hemisphere is involved with the process of explicit memory.  

There is one other structure in the neo-cortex that is particularly noteworthy. This is the pre-frontal cortex (which includes the orbito-frontal cortex). In our simplified model of the brain, this corresponds to the top of the middle and ring finger.  You may notice that anatomically, this area is placed in a very strategic position, which touches both the brain stem and the limbic system. Anatomically, it is optimally located for the nervous system to integrate many functions from different areas of the brain. It has been verified by research that the prefrontal cortex is involved with the following nine functions:  1) the balance and regulation of the body and the autonomic nervous system, 2) attuned communication, 3) emotional self regulation and balance, 4) response flexibility - the capacity to pause and center before acting,  5) empathy with others and insight into oneself,  6) auto-noesis, the capacity to know oneself over time and create a coherent narrative of one’s life, 7) fear extinction, 8) intuition, 9) moral judgment and a sense of conscience. All of these functions (except for fear extinction which has only been researched in animals) have been researched in humans. (Siegel, 2007). Wow!

 


Basic Principles of Interpersonal Neurobiology   


Let us start by reviewing Siegel’s definition of an “integrated brain.”  Siegel, defines neural integration as the “free flow of energy and information between the differentiated structures and the associated functions of the nervous system” (Siegel, 1999). He notes that the brain cannot be viewed apart from the nervous system as a whole, which reaches into every part of our body/mind. By understanding both the functions and the structures of the brain and nervous system, we can develop a more nuanced understanding of how an integrated brain, a coherent mind and empathic relationships are equivalent to each other.    

A fundamental principle underlying the emerging field of interpersonal neurobiology is the discovery that our genetic possibilities are constantly being sculpted by our interpersonal interactions so that our brain development is influenced and changed by interaction with the environment. In other words, nature needs nurture. This is particularly true when our brain is young and developing, which coincides with our early attachment experiences. However, the neuroplasticity of the brain and nervous system continues throughout our lifetimes. This leads to the important realization that it is never too late to change! (Siegel, 1999)     

The science behind the discovery of our brain’s interrelationship with our environment was pioneered by Eric Kandell, who won a Nobel Prize in 2001 for demonstrating the precise mechanisms by which experience activates genes that activate the growth of new neurons. The more impactful and repeated an experience is, the more deeply it is engraved on the brain and nervous system: “neurons that fire together wire together” (Hebbs axiom).  

Another principle posited by Siegel is a definition of mental health based on an understanding of Complexity theory. Complexity theory is a mathematical way of looking at open systems that are capable of unpredictable or chaotic behavior. Human beings as well as clouds and traffic patterns are prime examples of such systems. According to Complexity theory, systems move towards complexity by balancing two fundamental forces: differentiation and integration. When systems have a balance of these two forces they are flexible, adaptive, coherent, energized and stable. (Siegel is very fond of acronyms and uses the acronym “F.A.C.E.S.” to help his students to remember these qualities.) The development of complex systems is bordered on one side by rigidity (which would be too much integration or redundancy) and chaos on the other (which would be too much differentiation or ambiguity). If we apply this understanding to the field of mental health we have a definition of psychological well-being as the river of experience that occurs when we stay between these two banks. Siegel notes that all the categories of psychodiagnosis can be framed as either too much rigidity or chaos (Siegel, 2002). By remaining within the banks of this “river of well being,” human systems continue to “survive, develop and transform by discriminating and integrating differences” (Agazarian, 1997). A healthy human system is neither rigid nor chaotic and has this F.A.C.E.S. quality to its development. 

A final basic principle from interpersonal neurobiology is the following hypothesis: all healing relationships harness the reparative power of our interpersonal connections to create a higher level of neural integration in individuals and groups.       Now that we have reviewed some basic background information, let’s go to some of the clinical and theoretical implications of the field of Interpersonal Neurobiology. 


Dimensions of Integration in the Brain, Mind and Relationships


  Siegel addresses nine dimensions of integration in his thinking about how the brain, the mind and relationships interact with each other (Siegel, 2005).  These nine are:   1)  The integration of consciousness.  

2)  Vertical integration of the three levels of the brain and of  the brain with the body. The nervous system in the body is  understood as an extension of the brain and a vast resource  through which we process energy and information.  

3)  Bilateral integration of the two sides of the brain and their  associated functions.  

4)  Integration of the implicit and explicit memory systems.  

5)  Narrative integration, or the capacity to communicate both  to oneself and others a coherent story of one’s life with  insight, using the resources of both implicit and explicit  memory systems.  

6) Temporal integration, or the capacity to maintain a  coherent flow of energy and information across time and  thus freeing awareness from those frozen moments’ that  fixate our attention either actively or potentially.  

7)  Integration of the various “self states” that manage our  physical and psychological needs.  

8) Interpersonal integration and the capacity to maintain  empathic, attuned relationships.  9) “Transpirational integration” or our capacity to “breathe  across” all of these dimensions and to stay connected to  something larger than ourselves.  

All of these nine dimensions have an objective neurobiological dimension, a subjective psychological dimension, and an inter-subjective sociological dimension.  

Let us now examine the first dimension, consciousness integration, and look at how it relates to all of the other levels of integration.   


Consciousness Integration and Mindfulness    


If we examine the basic architecture of consciousness, there are two fundamental levels that we notice: the observer, and that which is observed. This subject/object split is the fundamental polarity that creates the dynamic tension that results in all acts of creativity. It is also the root of our sense of separation, alienation and suffering. At the highest level of consciousness integration, duality is overcome in what Ken Wilber and many others have called a “non-dual” state of awareness (Wilber, 2003). Although dualistic thinking may have no ultimate reality, it is a “useful fiction” to think of the architecture of consciousness as a dialectic between the observer and the observed. (See Larry Ladden’s article “Mindfulness Meditation and Systems-Centered Practice” on page 8 for a more in depth treatment of this “dichotimizing faculty” of the mind.) 

To describe this duality, Siegel uses the metaphor of a bicycle wheel (Siegel, 2007). The inner observer sits at the hub of the wheel in a state of great receptivity. When we are centered and fully rested into the hub of awareness, the mind is discriminating and integrating information from the rim with freedom and creativity. This state can be discriminated from times when the mind is reactive and consciousness is fixated on something in the internal or external world. Whenever consciousness is fixated we are no longer integrating and discriminating information effectively. Our attention is narrowed and it can feel as if we are looking through a small window; the vastness of our possibility feels like it is just a small blue opening in a dark room.  In her article on “Role Theory,” published in the spring 2006, spring issue of the Newsletter, Agazarian used Siegel's metaphor of a bicycle wheel to theorize that a maladaptive role system is a fixation of someone's psychic energy in which attention is trapped in a redundant loop (Agazarian, 2006). Siegel does not explicitly talk about roles, but one can easily make the bridge between his map of the hub and the rim, and Agazarian’s theory of maladaptive role systems.  

In “The Mindful Brain” (Siegel, 2007), Siegel draws on a variety of spiritual traditions which practice forms of mindful awareness and on his own mindfulness practice to discern the qualities of the receptive hub of the mind. The acronym that he comes up with to crystallize these qualities is C.O.A.L., which stands for curious, open, accepting and loving. C.O.A.L. is the ember that burns in the center of our being. When attention is rested into these qualities, which arise naturally as we practice mindful awareness, we notice everything in our consciousness that needs to be discriminated and integrated without grasping or fixating. In C.O.A.L. we accomplish the function of discriminating and integrating information with flexibility, adaptiveness, coherence, energy, and stability (the F.A.C.E.S. pathway from Complexity theory).   

Following the metaphor of the bicycle wheel, Siegel observes that the hub of the wheel is connected to the rim by spokes. The “spokes” of the mind carry information and energy from the rim to the hub and vice versa. Siegel notes four distinct streams that connect the hub and the rim. The first is the five senses of hearing, seeing, touching, tasting and smelling. The second is the images that arise spontaneously, which carry intuitive information for us about our inner and/or outer world. The third is the feelings that arise in our bodies that carry information about our environment and our response to that environment. The fourth is the thoughts, which carry the different maps and models that we are inventing, moment to moment in response to inner and outer events. Siegel uses the acronym S.I.F.T. (sensations, images, feelings, thoughts) to help his students remember the streams that connect the hub and the rim. He encourages his students and clients to frequently stop, center, and S.I.F.T. through awareness to digest, (discriminate and integrate) energy and information. When we are centered, our attention is free to respond to everything with an unfettered flow of creativity and curiosity. When our attention is fixated, our flow is frozen and stuck. This “stuckness” may last a minute, a year or a lifetime.   

Siegel then inquires into the nature of the contents of consciousness and comes up with four categories: The categories are 1) our senses, including our internal sense of our bodies, 2) the inner observer, 3) the thoughts, concepts and images that arise in our minds, and 4) a non-conceptual, nonverbal knowing that one might call the basic ground of awareness. Siegel invented the acronym S.O.C.K. (sensations, observer, concepts, and knowing) to help his students remember these categories.  

In his investigation of mindfulness, Siegel notices that the primary goal of these practices is to free awareness from those automatic patterns that unnecessarily limit possibilities in life. To crystallize this idea, he invented the acronym Y.O.D.A. “you observe to decouple automaticity.” The more we dissolve the automatic patterns and tensions that exist in our bodies and minds, the deeper we are able to rest into the fundamental, impersonal, stream of consciousness itself.  

As we deepen our capacity for mindfulness, we begin to “observe the observer.” When we start to ask the question “Who is observing the observer?” we start to deconstruct the most basic fixations that are inherent in our conditioned sense of self and begin the journey towards non-dual awareness. In non-dual awareness we experience ourselves as one with the river of consciousness itself, seamlessly inclusive of subject and object and containing the existential paradoxes of life.  

So what does all of this have to do with the brain? Let us return to the nine dimensions of integration and see what neurobiology can tell us about the development of our capacity for mindful attention.    

Siegel correlates the receptive hub of awareness with the pre-frontal cortex. Remember the tips of your middle and ring fingers in our simplified model of the tripartite brain? This area of the brain is perfectly located at the hub of the brain’s structure and functions as a great clearing house for discriminating and integrating the energy and information of the entire brain and nervous system.  

The second dimension of integration is vertical integration, both within the brain and between the brain and the body. Siegel observes that the internal organs of the body, particularly the heart, the gut and the lungs, are surrounded by vast neural nets that are constantly processing energy and information. In other words, our internal organs function as a kind of secondary brain. From a neurobiological perspective, it makes literal sense to consult your gut feeling or your heart’s response to a situation. The old adage about “the wisdom of our bodies” has an objective, scientific dimension. Isomorphically, inside the brain itself, we also have the energy and information from the brain stem, the limbic system, and the neo-cortex to be integrated.  

The third dimension is bilateral. The information and perspectives of the left and right sides of the brain must be integrated if we are going to develop our mindful awareness. If we are imbalanced in either direction, either too linear and logical, or too holistic and intuitive, we will run into problems. We might say that our attention will become fixated on one side or another of our brain and that the corresponding functions as well as the energy and information of the unused side will stagnate.  

The fourth dimension, integrating implicit and explicit memory systems, builds on the third. The implicit memory system is connected with the right side of the brain and the explicit memory system with the left. Implicit memories exist without words as the background noise of our lives. Explicit memories are conscious memories that we have encoded in language.   

The fifth dimension, narrative integration, builds on the fourth. Our capacity to create a flexible, coherent, and energized narrative of our lives sustains a functional sense of identity across a life time. This narrative is woven from the threads of both implicit and explicit memories.  

The sixth dimension addresses our capacity to maintain a flow of information and energy across time without the fixations and distortions that can occur when we have not digested powerful, upsetting experiences. These upsetting experiences can be encoded by the amygdala and re-stimulated when a situation that resembles the past upset or trauma happens in the present.   

The seventh dimension involves our capacity to maintain the functional roles or “self states” that manage our different needs and interests, such as our desire for intellectual stimulation, professional success, sexual gratification, creative expression, food and rest. Each of these roles appear in the brain as a cluster of neural firing patterns that are organized around meeting the goal of each role. These different functions must be balanced within our “personality-as-a-whole” if we are to live a full life.   

The eighth dimension addresses our capacity for attuned, constructive interpersonal relationships.   

The ninth dimension addresses our need to maintain our connection with something larger then the limited personal perspective of our conditioned minds and bodies. This dimension of integration engages our capacity to “breath across” all of the previous dimensions of integration and beyond that into the mystery that holds everything together. Siegel calls this our capacity for “transpiration.” This dimension of human experience can never be fully understood as it holds all of the existential paradoxes of life, all of the dualities, together in a space which is neither subject nor object and is both subject and object all at once.    

Each of these levels offers a vast and important arena of exploration that is important for us to understand as therapists, consultants and human beings. As we develop our own capacity for integration across all of these nine levels, we deepen our mindful awareness and develop an integrated brain, a coherent mind and empathic, attuned relationships. It is an important hypothesis of the emerging field of Interpersonal Neurobiology that we can harness the reparative power of attuned interpersonal relationships to create higher levels of neural integration in the clients and groups that we serve. By developing our own integrated brain, coherent mind, and empathic attunement to others, we become an environment in which the individuals, groups and organizations with which we work can do the same.



Agazarian, Y.M. (1997). Systems-centered therapy for groups. New York: Guilford.  


Agazarian Y.M. (2006). Roles. Systems-Centered News, 14(1), p.5. 


Cozolino, L. (2002). The neuroscience of psychotherapy. New York, London: Norton & Company.  


Ladden, L. (2007).  Mindfulness meditation and systems-centered practice. Systems-centered news, 15(1) pp. # 8.


Robbins, M. (2006). The river of well being: using the implicit memory system to release old roles in the body. Systems-centered news, 14(1) pp.12. 


Siegel, D.J. (1999). The developing mind. New York: Guilford Press.  


Siegel, D.J. (2002). The clinical applications of interpersonal neurobiology. Course # T101 www.psychotherapynetworker.org    


Siegel, D.J. (2005). Psychotherapy from the inside out, the brain of the mindful therapist. Course # A -307, www.psychotherapynetworker.org   


Siegel, D.J. (2007). The mindful brain. New York, London: W. W. Norton & Co.  


Wilber, K. (2003). Kosmic consciousness, sounds true. www.soundstrue.com.