The influence of neuroscience on the counseling profession is growing. So much so that the American Counseling Association has an interest network of members devoted to its exploration and discussion.
Neuroscience can be both a tool — one of many — in a counselor’s toolbox and a game-changing way to conceptualize clients, conduct assessments and select interventions, write Thomas A. Field, Laura K. Jones and Lori A. Russell-Chapin in their new book Neurocounseling: Brain-Based Clinical Approaches (published by the American Counseling Association).
“Neuroscience can help counselors understand how relationships are forged, leading to deeper and more meaningful working relationships with clients; recognize the persisting impact of systemic barriers such as oppression, marginalization and trauma on clients’ ability to achieve their goals; and take a wellness and strengths-based perspective that serves to empower clients and increase optimal performance,” they write in the book’s preface. “In other words, neurocounseling is commensurate with the orientation and identity of the counseling profession.”
Field is an associate professor in the master’s counseling program at the City University of Seattle; Jones is an assistant professor at the University of North Carolina at Asheville; and Russell-Chapin is professor of counselor education at Bradley University in Illinois. Counseling Today sent the trio some questions, via email, to learn more.
(Responses written individually as indicated; some responses have been edited, including for length)
Besides your book, what resources do you recommend for counselors who want to learn more about neurocounseling?
Lori Russell-Chapin: We are learning more about the fascinating brain every day through research and brain scanning. Counselors need to know as much as possible about the brain, especially as it relates to the skills of counseling. The very first thing helping professionals can do is refresh their knowledge base and skills. Take a course or workshop on neurocounseling. That material is out there. At Bradley University, there is an online course called “Neurocounseling: Bridging Brain and Behavior.” Perhaps readers might have a desire to even take an introductory course on human anatomy and physiology. Almost any university will offer this course. Even if you took a similar course years ago, take a new one. So much has changed in the last decade. Attend any ACA Conference and participate in the many workshops scheduled on neurocounseling. The number has tripled in the last 10 years.
Decide what aspect of neurocounseling interests you, [and] then ask colleagues for potential courses to take, from heart rate variability to biofeedback or neurofeedback. Many excellent for-profit corporations are offering these biofeedback and neurofeedback courses.
Of course, join any of the professional networks that have been created to connect with others who have similar interests: ACA Neurocounseling Interest Network; AMHCA (American Mental Health Counselors Association) Neuroscience Interest Network and ACES (Association for Counselor Education and Supervision) Neuroscience Interest Network. At the ACA conferences, these three groups join forces to connect and share information.
In the preface, you write that neurocounseling is “commensurate with the orientation and identity of the counseling profession.” Can you elaborate? How do you feel neuroscience is a good fit for professional counseling? How are counselors particularly suited to adopt its principles into their work?
Thom Field: Counseling has been defined as “a professional relationship that empowers diverse individuals, families, and groups to accomplish mental health, wellness, education and career goals.”
Neuroscience supports and strengthens the counseling profession’s values, as reflected in the above definition:
1) The relationship takes precedence.
2) Diversity is affirmed and actions are taken to modify the societal conditions and environments that cause dysfunction.
3) Wellness and mental health are as much a focus of intervention as remediating psychopathology.
4) A person’s strengths and challenges are conceptualized within the developmental context in which they occur.
First, neuroscience has and can provide information to us about what conditions are most important for a therapeutic relationship to be established. Information about client neurophysiological responses in the counseling room can help us understand what helping behaviors are facilitative, such as establishing safety and security. Chapter 5 of our book, written by Allen Ivey, Thomas Daniels, Carlos Zalaquett and Mary Bradford Ivey, is instructive in this regard. While theories of effective relational characteristics exist (e.g., interpersonal neurobiology, polyvagal theory), we believe more research is needed in this regard.
Second, epigenetics provides rich information about the neurophysiological impact of systematic marginality, oppression and trauma. Kathryn Douthit’s chapter on the biology of marginality (chapter 3) and Laura Jones’ chapter on traumatic stress (chapter 4) provide an excellent overview of this topic.
Third, neurocounseling supports the importance of adequate sleep, diet, exercise, social involvement and spiritual engagement in optimal functioning. Ted Chapin’s chapter on wellness and optimal performance (chapter 8) provides an extremely helpful clinical case study that emphasizes what a wellness-oriented neurocounseling approach might look like in practice.
Fourth, neurocounseling emphasizes the importance of understanding the development of the brain and body over the life span. Laura Jones’ first two chapters emphasize how to conceptualize client issues through the lens of neurophysiological development.
Lastly, we would be remiss if we did not mention that the text was organized around the Council for Accreditation of Counseling & Related Educational Programs’ 2016 standards. We believe that principles from neuroscience are relevant and applicable to the eight common core CACREP areas (human growth and development, social and cultural foundations, helping relationships, assessment, research, group counseling, ethical practice and even career development) as well as specialization areas (e.g., psychopharmacology, addiction, etc.).
In your opinion, how far has the profession come in understanding and incorporating neuroscience into counseling practice? Is it being readily adopted, or are there counselors who misunderstand it or don’t feel that it is useful?
Laura K. Jones: There is the question of how far has the profession come in incorporating neuroscience into counseling practice, and then there is the question of how far we have come in incorporating neuroscience into the profession as a whole, which are two related but distinct questions.
With regard to the profession, interest in neuroscience has expanded significantly in the past 10 years, since Allen Ivey and Mary Bradford Ivey gave one of the first talks on brain-based counseling at ACA’s 2008 Conference & Expo in Honolulu. One example is simply the number of conference sessions that integrate a discussion of neuroscience. At the 2008 conference, there were only around five that discussed the brain in some manner; at the 2017 conference [in San Francisco], there were not only three learning institutes but 17 educational sessions. This pattern of growth is visible across every sector of the counseling field, including both clinical training and practice areas. The 2016 CACREP standards delineate an increased focus on training in the neurological foundations of client development, well-being, presenting concerns and the counseling process, with over three times the number of references to the application of neurobiology and neuroscience than were cited in the 2009 standards.
AMHCA is also strengthening its focus on neuroscience, not only expanding its training and clinical practice standards in such areas, but also now allocating a section of its flagship journal, the Journal of Mental Health Counseling, to articles detailing the integration of neuroscience into counseling research or clinical practice. There are three national neuroscience interest networks, one representing each of the core organizations (namely ACA, AMHCA and ACES), as well as a new neuroscience virtual meetup group based out of Northwestern University, BRAINSTORM, which has monthly meetings to discuss neuroscience research and translate such research into clinical implications. Each of these groups now has hundreds of members — a significant change from the two pages of handwritten names I collected at the 2013 ACES conference in Denver, which were used to start the first neuroscience interest network within the field.
And this is a trend being mirrored across all mental health professions. As research surrounding the physiological underpinnings and outcomes of mental health struggles continues to expand (the roles of inflammation, the microbiome-gut-brain axis, the endocrine system, etc.), mental health providers are being called to reexamine our conceptualizations of mental health and mental health disorders, and neurophysiology is a significant construct within this new paradigm. Occasionally I will still hear individuals refer to this shift as a “fad,” but that perspective appears to quickly be fading.
One of the cautions, however, is that while there is certainly an ever-growing interest and acceptance within the field, as is often the case with an interest that grows quickly, there is also misinformation and to some degree a misrepresentation and overextension of the science that is also occurring. This is why, from my perspective, one of the especially exciting trends I am seeing in this area within our field is the rapidly growing number of master’s- and doctoral-level students who are eager to gain training in neuroscience. This interest, and subsequently the training of these future counselors and counselor educators, is the catalyst for continued growth and research [concerning how we as a profession can integrate neuroscience into our field in a manner that honors our unique professional identity.
To continue to accurately, ethically and successfully incorporate neuroscience into the profession, we need to enhance our efforts at training counselors and counselor educators in the basic principles of neuroscience and how this information can be applied to our work with clients, supervisees and students. As such, we cannot sustain this interest within the field and our reputation in the larger mental health world without having a body of counselor educators who are accurately trained in neuroscience and able to teach future generations of practitioners and educators.
This is one of my primary interests in this movement and was a significant impetus for me in working on this book. This gets back to the original distinction I made between a growing emphasis in the field versus in clinical practice. Where we see the preponderance of the integration of neuroscience into counseling practice now is in client conceptualizations, psychoeducation, wellness practices, social justice and, to some degree, assessment. Research has also substantiated that psychotherapy has the ability to enhance brain functioning in the alleviation of client symptoms. However, additional outcome-based research is needed within the counseling field in particular to further our understanding of how we can use neuroscience to further substantiate our theories and techniques, as well as build new, more efficacious interventions.
We have made significant progress in the last 10 years, and yet we still have plenty of room to grow, as do the other mental health professions in this area. I am excited to see the continued expansion of neuroscience within our field and counselors become even more established as leaders in neurophysiologically informed research, practice and mental health policy in the future.
What misconceptions might counselors have about neurocounseling?
Laura K. Jones: There are a number of common misconceptions that individuals have when it comes to the integration of neuroscience into clinical training and practice. One of the primary misconceptions is that neurocounseling is a new branch of counseling, often likening it to a new theoretical orientation of sorts. In reality, the integration of neuroscience into clinical practice can best be conceptualized more as a metatheory of the clinical process that can be applied to every theoretical orientation.
This distinction has led some individuals to suggest that the term “neurocounseling” is to some degree misleading. Understanding the neurophysiological correlates of clients’ developmental levels, struggles, strengths and progress can all be used to inform and enhance all aspects of the clinical process, from case conceptualization and assessment to interventions and advocacy. It is a layer of information that we as mental health providers can use to enrich our understanding and work with clients. This knowledge of the brain and body can also be used to develop new theoretical approaches, such as neuroscience-informed cognitive behavior therapy (CBT), but it is not in and of itself a separate form of clinical practice.
Another misconception is that integrating neuroscience into our field and practice is just another way of medicalizing the profession. Relatedly, some have voiced fears that it takes too much of a reductionist view of clients and client struggles. Understanding the neurophysiological pathways of addiction, for example, does not negate or diminish the importance of the therapeutic relationship, but it can help us to decrease the internalized stigma some of our clients may have of being weak and, similarly, empower our clients in their own recovery. As another example, take some of the developing theories around depression. Researchers are working to further substantiate the divergent pathophysiology between possible subtypes or phenotypes of depression. This information can be used to help us develop more effective therapeutic approaches for our clients. Neuroscience is not a threat to our professional orientation; if anything, it can be used to strengthen what we uniquely do as counselors.
An additional misconception is that in order to integrate neuroscience into your practice, you need specialized and expensive equipment. Although biofeedback and neurofeedback are growing in popularity, efficacy and accessibility, and can certainly be used as part of informing and enhancing your work with clients, this is not the only way of integrating neuroscience. This is something that I like to really emphasize when discussing the role of neuroscience within the field. You do not need any fancy toys to benefit from all that neuroscience has to offer.
Just having the information related to how the brain and body respond to trauma completely changes the way that counselors conceptualize trauma survivors who are struggling with symptoms of posttraumatic stress. Similarly, knowing how the brain is developing during adolescence not only demystifies the struggles children and parents may face during this seemingly tumultuous time, but also changes how we approach working with individuals during this developmental period. The knowledge in and of itself can simply make us more intentional in our work.
The final misconception is one that is still somewhat debated even among those of us working in this area. I often get the question, “Do I actually need to learn the anatomy or physiology?” My answer to this is always a resounding “yes,” but I certainly do not speak for everyone working in this area. I am not suggesting that counselors need to be experts in neuroscience, but knowing the basic physiology and nomenclature allows counselors to understand the basis behind why a particular approach may be more beneficial for a particular client and be more intentional in that decision. It also allows counselors to continue reading the research that is coming out on a near-continuous basis. What we believe we know about the brain today may very well change tomorrow.
Also, fields that translate “hard” neuroscience research into applied contexts (education, peak performance, counseling, etc.) can at times fall victim to overextending and misrepresenting the original research as they attempt to retranslate other translations of the science. This may sound a bit convoluted, but what I mean is that one practitioner who is well-versed in neuroscience will translate the possible implications of some neuroscientific finding into practical and applied information for their particular field. Then another practitioner in an allied area may take that information and try to reapply the initial implications in a new way to the new field. This is the root cause of a number of the “neuromyths” that are currently circulating and why there are so many “brain training” games available today. In essence, we become too far removed from the actual science.
Our field needs to be able to do some of that translation firsthand and, ideally, build interdisciplinary research teams to collaborate in conducting the research rather than rely on translations from other fields.
One final rationale for training in basic anatomy and physiology is that we are seeing a growing number of integrated care practices and interdisciplinary treatment teams. Having a basic knowledge of the physiology allows counselors to collaborate more effectively with the other specialties and advocate for the best care of their clients.
What made you collaborate on a book about neurocounseling? Why do you feel it’s relevant and needed?
Lori Russell-Chapin: There are many neurocounseling experts throughout the United States. By joining forces, we can share this knowledge with so many other professionals who are interested. Integrating the concepts of neurocounseling from our book into my counseling has made me a more efficacious practicing counselor, counselor educator and counseling supervisor. The following short examples are offered to demonstrate why neurocounseling is relevant and needed in our counseling field.
Neurocounseling interventions strengthen the intentionality of counseling. Understanding the brain and its functions make skill selection and strategies even easier. Teaching self-regulation skills such as diaphragmatic breathing or physiological and emotion regulation requires many brain connections to connect together from the prefrontal cortex, the insula and the anterior cingulate cortex. The next time you teach any self-regulation skill, think about all the brain centers you are activating.
Understanding that rapport building and therapeutic alliance is essential to counseling and change is central to the tenets of neurocounseling and counseling. Both rapport and therapeutic alliance create emotional and physiological safety using the vagus system and interoception, helping the body be more aware of its senses. There is nothing more important to clients’ change than rapport and emotional safety.
Even as my clients are introducing themselves to me for the first time, I begin to experience them in a more holistic manner. With that first handshake, I can feel if their hand is cool, warm, sweaty or limp. Each of these symptoms is a clue to a person’s sympathetic and parasympathetic nervous system. If the client’s hand is very cold, then it might be that he or she is anxious, [thus] activating the sympathetic nervous system. I could easily teach diaphragmatic breathing, heart rate variability and skin temperature control to help initiate the parasympathetic nervous system where we are supposed to be most of the time.
Still another neurocounseling example is essential for building healthier neuroplasticity. Because of negative bias and the system’s evolutionary nature to survive, counselors must use our positive reflections lasting at least 10-20 seconds to deepen this change and build positive neuroplasticity. We remember a negative experience almost instantly. To remember a positive experience takes much longer.
Lastly, counselors must better understand that skills such as summarizations assist the client and the counselor to activate the default mode network. This network helps us see the world of self and others in a more comprehensive manner. Identifying the neuroanatomy aspect of our counseling skills allows for more intentionality and strategy in counseling. This is neurocounseling at its best. Then collaborating with others gives greater access to all this knowledge. Working together again offers the best method to expand the depth and breadth of neurocounseling.
Neurocounseling: Brain-Based Clinical Approaches is available both in print and as an e-book from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-347-6647 x222
Bethany Bray is a staff writer for Counseling Today. Contact her at email@example.com
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.