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Ruth Cohn
   
Daniel Siegel's Reflections on Reflection:
The Mindful Brain

…The flow of perceptual stimulation must be chunked into meaningful units best sized to make us adaptive, rapidly and efficiently.  Chunking aids the work of the present moment.  It is the basic building block of psychologically meaningful experiences that extend in time.
– Daniel Stern1

… neural firing patterns of large assemblies of neurons are influenced by past learning and by inherent developmental features, such as one’s constitutional temperament.  Reaching toward a deeper essence of one’s self would directly move against these top-down influences as mindfulness moves us closer  to the bare awareness of experience…On a practical level, if our past top-down influences create an internal set of “shoulds,” then becoming enslaved by these beliefs without meta-awareness would make us prey to being quite judgmental about ourselves and others.  The receptivity, self observation, and reflexivity of reflection each help dissolve top-down influences.
– Daniel Siegel (p. 137)
2

As a lifelong recovering schizoid, I have been ever embroiled in conflict about the belief “I can do it all myself.” Not surprisingly I was magnetically compelled by attachment theory and ultimately became a relationship therapist. As all core beliefs, residing deeply in the old brain, this one dies hard; and readily rears up and challenges me. 

Along my developmental path, many of my friends, greatest teachers and helpers have been attachment figures who never, or barely knew me. In effect I could be both alone and in relationship. These were people to whom I related through the books they authored or presentations they gave in conferences and trainings. I have a short list of such “primary” relationships. When the advanced notices arrive about an upcoming book by one of them, I am so enthused that when the book is finally released I somehow find myself with three or four copies. Such is the case with Daniel Siegel, attachment researcher, neuroscientist, teacher and clinician extraordinaire. He gave us the groundbreaking Developing Mind in 1999 and was a tremendous influence (not only upon me!) in helping to bridge the gulf between mind and brain; consulting room and research lab; and the art and science of psychotherapy.

I anticipated Siegel’s newest book, The Mindful Brain with excitement, eager to learn what he would come up with next. From a long history with somatic and experiential therapy approaches, I was no stranger to some definition of the concept of mindfulness. I was curious. When I finally got to read the new book, I encountered a strange dismay. It was from Siegel himself, and his buddy and close colleague Allan Schore that I had learned so much of what I know about how the brain develops in relationship. An expert in the neuroscience of attachment, Siegel’s work has been all about how the brain of the infant resonates with the brain of the caregiver, and how a secure or anxious attachment shapes mental, emotional and physical health. Securely attached infants grow up with calmer nervous systems, confidence to explore and experience the world, the ability to self regulate, greater ease in relationship and healthier auto immune function. In this new book Siegel was proposing some radical new ideas.

In the last several years of studying mindfulness and meditation, including participation in some lengthy silent retreats, Siegel has developed the notion that these practices replicate the physiological experience of a secure attachment. In effect, the resonance with the self in meditation parallels the attuned resonance between infant and caregiver, and facilitates similar benefits. Siegel is hypothesizing that mindfulness based meditation practice may in effect be “as good as mother’s milk” as foundational for mental health. With very mixed feelings, I found myself exclaiming, “so now you’re telling me I can do it all myself?!” Admittedly, I found myself even angry. I thought, Daniel Siegel is on some spiritual trip and he is taking us all along! After the first few chapters I wanted to just shut the book and actually dump all 4 copies in the trash.  It was all I could do to force myself to keep reading, but because it was Siegel, I just could not dismiss the ideas. I had to at least hear him out.

Being a true scientist, and also an invaluable resource in making neuroscience accessible to clinicians, Siegel painstakingly elucidates the physiology of his ideas. He exquisitely balances neurobiological detail with simplicity, so the science is both complex and interesting. He uses the definition of mindfulness proposed by Jon Kabat-Zinn, a western Buddhist practitioner in the vanguard of introducing mindfulness practice and meditation to the larger non-Buddhist world. Kabat-Zinn’s definition is the following:

Paying focused attention
On purpose
Without judgment
To the experience of the present moment
As if your life depended on it.  

At its essence it is the confluence of intention, attention and present time experience.  And it includes the awareness of awareness. Many of us therapists are quite familiar with the concept. It is one of the basic principles of the philosophy upon which Sensorimotor Psychotherapy is based. There it is defined in terms of a dual attention: being both in present time experience and also an observer of present time experience, simultaneously. EMDR also capitalizes on this duality: both experiencing and observing. Siegel clearly details both the anatomy and function of the pertinent brain areas, as he lays out a framework for understanding what he describes as “top down” versus “bottom up” processing.

An example of top down influence might be the mental, emotional and/or somatic intrusion of my age old belief “I have to do it all myself,” when faced with a situation where real or imagined, I cannot count on another person. The cognition, informed by archaic and probably obsolete experience overwhelms and overshadows the realities of the present. I might become angry, feel sorry for myself, maybe feel depressed or lonely, lethargic and weighed down. The intrusions of these old mental constructions, what Siegel is calling “top down” processes involve specific brain structures and functions.

“Bottom up” processes, the direct emotional, somatic even cognitive experience of the organism in the present moment, involve different neurobiological structures and functions and have different psychological impact.
 
We experience top-down influences each moment of our lives.  With the process of mindfulness, we can awaken from automaticity  to not be “enslaved” by the large-scale dynamics set up by earlier experience and embedded in beliefs in the form of mental models of right and wrong and judgments of good and bad. Top down influences also come in less abstract forms, such as intense emotional reactions or bodily responses derived from prior learning. (p.135)               
    
In describing the sequence of physiological mechanisms that constitute top down processing, Siegel hypothesizes that the practice of mindfulness, interrupts that neurological sequence, replacing it with a “bottom up” sequence.

At the simplest level of experience, “bottom-up” processing likely entails a linkage of the neural activity of [these eight] senses with our dorsolateral (side) cortex as we become aware of the core of our being… Living in this core gives us a grounded sense of being fully present and open to the moment-to-moment arising of whatever offers itself from the rim of the wheel of awareness. Here the hub of our mind is spacious and receptive. (p.137)

Admittedly I was compelled by the science, (which is beyond the scope of this brief article).  I also tremendously respect Siegel’s gutsy willingness to stick his neck out with truly alternative ideas, in the largely traditional, western medicine-oriented and male dominated world of neuroscience research. So I read on. He hypothesizes that mindfulness meditation practice can alter the neural routes of thinking and reactivity, creating new circuits that locate a person in the present rather than in past. This is certainly a challenge and a goal in psychotherapy, and definitely in my world, which is psychotherapy in the treatment of trauma.       

That meditation practice affects the brain is not news. For over a decade, the Dalai Lama has been meeting annually with a collection of psychologists, neuroscientists, philosophers and researchers, essentially putting their heads together to integrate the progress in their various disciplines; see where the interfaces and possible commonalities might be, and learn from one another. The meetings have spawned a remarkable series of books to disseminate their shared knowledge with the larger world. One of them, Destructive Emotions3 recounts research in which an advanced meditation practitioner engaged in a specific practice was placed in a brain scanner where his brain activity was imaged.  In his brain, the left prefrontal area, locus of positive emotions (and a part of the brain useful in regulating the right limbic “fight/flight” brain center;) fired profusely. This research raised the question as to whether such practice might be an effective antidote to depression and trauma. Siegel is raising many more questions of how the practice of mindfulness meditation might complement, supplement, augment, even supplant our work. By now I was very stirred up. When I finished the book, I did something I had never done before: I went straight back to the beginning and read it from cover to cover, again.

As a decidedly non-Buddhist endurance athlete, I have never been drawn to practices that involve a lot of sitting still. Yet I found that Siegel’s ideas, if in some ways disturbing, captivated me. Not only was my thinking extremely stirred up, but suddenly I seemed to find these ideas everywhere I happened to look.  It seemed as if Siegel was the key note at all the conferences I was attending, whether they were on couple’s therapy, attachment or more general psychotherapy. Jon Kabat-Zinn’s eight-session protocol of mindfulness training, Mindfulness Based Stress Reduction (MBSR) is offered in all the major local hospitals. My husband even showed me an article about it in the latest Fortune Magazine, mindfulness meditation as an asset for overly stressed CEO’s. I did sign up for a Mindfulness Meditation for Psychotherapists training with Siegel and the renowned Zen master Thich Nat Hanh.4

Not too long ago, another attachment research pioneer, Daniel Stern, released his book The Present Moment: in Psychotherapy and Everyday Life. Stern too, is compelled by present time experience, seeing in that capsule the essence of where contact and change occur. It is an interesting read, much more impressionistic- like poetry or music, than Siegel’s. In studying tiny slices of narrative where subjects recount moments in time, he locates “a world in a grain of sand.” 

What I see in the office whether it be in the intensely somatic sensation-focused sensorimotor trauma work, or deeply emotional couple’s work, the transformation occurs in those moments of present time experience. I observe what Siegel describes as the top down tendency is interrupted and subverted by the alternate route into bottom up. Something fresh and new occurs as clients locate themselves in the here and now in a new way. I talk to my clients a lot about creating new circuitry, and we all seem to watch it happen.

Stern defines the present moment as being approximately  three seconds- between three and ten. He describes many functions in nature and culture that occupy such intervals of time: an exchange of communication between infant and caregiver, a cycle of breath inhaled and exhaled, a musical phrase, a conversational “turn.” Perhaps the moment of now is an essential ingredient in the operating system of our design. It is certainly looking that way to me as I continue to ponder the questions Siegel has raised.

Meanwhile, I have practiced some with Jon Kabat-Zinn on recording. It is not new to me that depression is largely about the past and anxiety about the future. But I have taken more often to reminding clients, that right here, right now, in this very moment, everything is OK.

I have referred several couples and individuals to local MBSR classes. In one of the couples, one partner had disabling anxiety when the other went out of town for her work; causing complicated dynamics to constellate between them. He felt terribly abandoned and unloved by her leaving him to suffer so. She felt imprisoned and imposed on by his disability. Although no substitute for the important couple’s work, the MBSR training and practices greatly supported his process of becoming able to tolerate her absence; and greatly enhanced her calm in allowing herself to travel and have good experiences. The classes are relatively inexpensive. They are an activity that partners can share. And they are empowering (partly in that they don’t involve me).

I have incorporated mindfulness techniques into sexual sensate focus assignments.  Fluency and intention at attending to the present moment in the body and emotion (in both self and partner) are a boon to sexual relating. Clients come back calmer and appreciative. 

Admittedly, in some subtle ways I find myself calmer since I have been studying these ideas. For example, with a recent athletic injury, rather than infuse it with distress based on past injuries, I was able to stay with the experience of the moment, and keep from dramatizing it and making it more than it needed to be. I am certain that the enhanced intention, peacefulness and acceptance supported the healing process. And I certainly felt better! Clearly the practices are valuable.  

Siegel himself is fully aware that much more research is needed. He is posing questions for further study. My unscientific and gut feeling is that I cannot do it all myself, that solitary mindfulness work is decidedly not a substitute or equally potent to relationship. As Harville Hendrix has said, the essential unit in nature is the dyad, cells dividing in two. I still believe that as I await definitive research. 

Perhaps what is most valuable in Siegel’s work is that he is giving us the neuroscience of why those profound moments in psychotherapy have such impact, what happens at the brain level when we truly and intentionally inhabit and experience the moment of now as if our lives depended upon it. That does in fact make a lot of sense to me. So as I said to a client recently, I’m not sure I agree with Siegel, but he sure has messed with my thinking, and I actually love that! I strongly recommend the book. Unfortunately I’ve already given away all my extra copies.

References

1. Stern, Daniel  The Present Moment : In Psychotherapy and Everyday Life. W.W. Norton & Company, Inc. New York. 2004. P. 43

2. Siegel, Daniel  The Mindful Brain: Reflection and Attunement in the Cultivation of Well-Being.
W.W. Norton Company, Inc. New York. 2007.  P. 137.

3. Goleman, Daniel (ed.)  Destructive Emotions: A Scientific Dialogue with the Dalai Lama. Bantam Dell. New York. 2003.

4. Mindfulness and Psychotherapy: Cultivating Well-Being in the Present Moment–Two Day Conference. UCLA Extension. www.uclaextension.edu.

Ruth Cohn, MFT is in private practice in Rockridge. AASECT Certified Sex Therapist, also certified in EMDR and Sensorimotor Psychotherapy. She specializes in relationship work with adults overcoming histories of childhood trauma and neglect, their intimate partners and families. She can be reached at cohnruth@aol.com or www.cominghometopassion.com.

© 2007