Tag Archives: neurocounseling

Why neurocounseling?

Compiled by Bethany Bray March 12, 2018

Decades ago, you might have gotten some funny looks or raised eyebrows if you used the word “neurocounseling” in a professional setting. In recent years, however, counselors have become increasingly interested in using concepts from neuroscience to inform and support their work with clients.

What makes professional counseling compatible with neuroscience? How can it help counselors gain insights into human behavior and the challenges that clients bring into counseling sessions?

Counseling Today asked three practitioners for whom neurocounseling is an area of expertise, Thomas A. Field, Laura K. Jones and Lori A. Russell-Chapin, what draws them to this topic.

The trio are co-editors of the ACA-published book Neurocounseling: Brain-Based Clinical Approaches. 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.


Q+A: Why neurocounseling?


Laura Jones: Coming into the field with graduate degree in cognitive neuroscience, I have always playfully said that I do not know how to be a counselor without considering what is happening in the brains and bodies of my clients — both the physiological factors that have led to their struggles and resilience as well as the neurophysiological corollaries of their growth. As a counselor-in-training and later a student in counselor education, I could find very little work discussing this connection and became passionate about trying to bridge the two fields.

One of my foremost professional endeavors is to facilitate the intentional and informed integration of neuroscience into our field in a way that honors our professional identity (as I am also quite passionate about professional advocacy as well) and in doing so enrich and increase accessibility to training in this area. I am endlessly excited by the emerging science that can, has and will continue to influence the mental health field. For example, how can we ignore research that suggests that levels of certain gonadal hormones (steroids) have the potential to influence an individual’s susceptibility to suicidal ideation and attempts, drug relapse, responses to traumatic stress, etc., or the burgeoning research that implicates dysbiosis (imbalance) of our gut microorganisms (e.g., bacteria) in our mental health, or the fact that our body’s immune response has implications on mental and emotional wellbeing.

Although Descartes’ mind-body dualism has long been disproved, we (mental health and medical practitioners alike) often still function, largely implicitly, from this paradigm. Each and every day, researchers are substantiating just how complex this connection truly is, thereby underscoring how we can no longer work in health silos. This integrative perspective is the future of mental health.

Counselors have the opportunity to learn from other fields and use this information to strengthen our work with clients and our field as a whole. I firmly believe that counselors are well positioned to provide valuable and unique contributions to broader deliberations, research initiatives and policy efforts in the national mental health sector, and in doing so, secure our position as a leader among the mental health professions.

Another reason that I have become so passionate about this work stems directly from clinical experiences, much of which has centered around work with trauma survivors and individuals struggling with substance use disorders. I cannot express how powerful and empowering it has been for clients with whom I have worked to understand how processes in brain and body may be contributing to their struggles. The phrases, “So, you mean I’m not crazy?” “It makes so much sense!” and “Can you please explain that to my family?” have been used more than once. As counselors, we also are well aware of the pervasive and damaging stigma shrouding mental health challenges and those who are struggling. Most individuals with clinically diagnosable disorders never get the help they need, owing largely to this stigma.

Providing a physiological rationale for mental health challenges can significantly reduce mental health stigma; make mental health, often considered an enigmatic concept, more tangible; and alleviate the blame and shame that those who are struggling frequently experience.



Thom Field: Neuroscience attracts me for several different reasons. First, I think neuroscience provides a scientific basis for understanding important foundational concepts about human development, the impacts of oppression and marginality and the centrality of the counseling relationship. It has already provided us with significant insights into why certain problems develop at different stages (e.g., why the emerging adulthood years make a person susceptible to develop bipolar disorder or schizophrenia; see Seth Grant’s genetic lifespan calendar). Second, certain clinical issues are better understood and addressed through the lens of neuroscience, such as traumatic brain injury, posttraumatic stress, substance use, autism, attention-deficit/hyperactivity and even depression. One of my close family members has a diagnosis of schizophrenia and another autism, so understanding how to prevent and treat these conditions is important to me personally. Third, neuroscience helps to explain why we respond to certain events, such as why our physiological systems become activated in response to threats in the environment, leading to quick and often automatic decision-making and action such as aggression. I am part of a team that has developed a therapy model around this concept (neuroscience-informed cognitive behavioral therapy (CBT); see the website http://www.n-cbt.com/ for more information). Fourth, many of my fellow counselors and students continue to underprioritize Maslow’s basic needs like sleep, and sometimes do not ask about this during the first meeting with a client/student. Fifth, and perhaps most important, neuroscience offers promise for the discovery of new information about the brain and body that can make us more effective professionals.

Most psychotherapy research is limited by self-reported data (which is largely unreliable) and has largely failed thus far to distinguish specific behaviors and interventions on the part of the counselor that lead to more effective client outcomes. For example, meta-analyses have found that most counseling theoretical approaches are equivalently effective, and component studies have found that specific components of a model (e.g., the trauma narrative in trauma-focused CBT) are relatively unimportant to overall effectiveness. Thus, while psychotherapy generally appears to be effective, we still have little clue as to what factors make counseling more/less effective.

I believe that the objectivity of brain imaging and measures of neurological activity may help us to better measure what makes counseling more/less effective in the future.



Lori Russell-Chapin: I have been teaching and practicing counseling for at least three decades. It seems that many clients are searching for methods to help them feel better. So many of my clients have been to several counselors who have been helpful, but the clients are needing, wanting and searching for “one more thing” to help with their psychological and physiological concerns. Neurocounseling, or bridging our brain to behaviors, is the missing piece or “thing” of the puzzle.

As I teach students, clients and other helping professionals about neurocounseling, an all-encompassing phenomenon seems to occur. Without exception when people begin to learn more about the brain and body connections, they often comment, “If I can control my breathing or heart rate or skin temperature, then perhaps I can control so much more in my life!” Offering people self-regulation skills teaches intrinsic locus of control and personal accountability. Neurocounseling strategies demonstrate on an individual basis quantitative measures to show counseling efficacy measures. An example of this is a client who enters the counseling office with a skin temperature of 75 degrees. With one skin temperature imagery exercise, the client may be able to raise the skin temperature 5 to 10 degrees. I have had clients literally skipping out my office because they have learned this simple but essential biofeedback tool. This is an outcome measure at every counseling session.

Another fun example of neurocounseling: I wear biofeedback/temperature control nail polish. I am constantly getting feedback about what is going on in my day. This is a constant reminder for me to diaphragmatically breathe, slow down and self-regulate!

Teaching others about neurocounseling doesn’t just help them with situational symptom reduction, but it teaches a unique approach to wellness, life and a method for adapting and regulating through life’s difficulties.





Related reading, from the Counseling Today archives:






Want to connect with other counselors who are interested in neuroscience? Join ACA’s Neurocounseling Interest Network. Contact Lori Russell-Chapin at lar@fsmail.bradley.edu or visit neurocounselinginterestnetwork.com.






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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.






Behind the book: Neurocounseling: Brain-Based Clinical Approaches

Compiled by Bethany Bray February 20, 2018

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.


Q+A: Neurocounseling

(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.




To join the ACA Neurocounseling Interest Network, contact Lori Russell-Chapin at lar@fsmail.bradley.edu. For more information, see neurocounselinginterestnetwork.com.





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 bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and Facebook at facebook.com/CounselingToday.




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.


The birth of the neuro-counselor?

Sebastian Montes November 25, 2013

Neuron-HeadLori Russell-Chapin was a quarter of the way through her scheduled 40 sessions of therapy with a 22-year-old college graduate with Asperger’s syndrome whose social shortcomings — understanding cues, relating with others — were hampering his relationship with his girlfriend and his parents.

As Russell-Chapin has done with hundreds of other clients the past four years, she put the young man into her neural feedback treatment program, which combines real-time brain-wave analysis with cognitive therapy. Ten sessions in, there was an astonishing breakthrough.

“I walked into the room one day,” Russell-Chapin says, “and he looked at me and said hello. And I said, ‘Hello!’ I know that doesn’t sound like much, but that’s big [for this client].”

Then, five sessions later, the client spontaneously asked Russell-Chapin how her daughter was handling her recent move, harkening back to a conversation the counselor and client had engaged in during an earlier session.

“I really almost fell off my chair,” says Russell-Chapin, a member of the American Counseling Association. “People start feeling more comfortable with who they are as a person if the central nervous system functions better. … It’s in behavioral checklists, it’s in empirical data. I can see it in my software — I can see their brain waves changing. People have the ability to regulate their brains.”

Four years — and hundreds of clients — after implementing neuroscientific technology into her counseling techniques, Russell-Chapin asserts that if counselors do not know what’s happening in their clients’ brains, they can’t possibly be effective.

“I’d been saying to graduate students for years, once we know more about the brain, it’s going to change how we do therapy,” says Russell-Chapin, a counselor educator at Bradley University and co-director of the Center for Collaborative Brain Research, a partnership between the school and a large medical center. “I really do think the brain is the final frontier, and we’re at this point where every day, we learn something new. If we as a profession want to go forward, we’ve got to go forward with the future, and this is where the future is. … The more I know [about the brain], the better counselor I’m going to be.”

Peering into the brain

The advances are staggering. Scientists and researchers are forging a seemingly endless stream of breakthroughs with the help of technologies that peer into the brain’s structure and function. And mental health practitioners are harnessing these discoveries through an array of new therapeutic models.

The torrent of technological innovation has already upended long-held notions of the brain’s slow but steady decay, furnishing empirical evidence that mental health professionals can bolster and even create new neural connections that may lead to targeted behavioral changes.

The development of functional MRI (fMRI) technology has opened a window into the brain’s neuronal network in real time, showing blood flow and activity in specific areas of the brain that are associated with specific functions. The discovery of neuroplasticity and neurogenesis — findings that the brain can change its neural structure and create entirely new neurons — has given rise to carefully engineered computer programs that claim to strengthen specific brain processes.

Although the study of the brain has long been the domain of psychiatrists and the more medically oriented end of the mental health spectrum, neuroscience has increasingly made its way into the counseling profession. With that has come the promise of heretofore unimaginable therapeutic possibilities that, for many counselors, have chipped away if not obliterated centuries-old beliefs about the distinction between the brain and the mind.

In growing numbers, adherents of the neuroscientific mindset are seizing upon an array of newer techniques to use in their clinics, including cognitive enhancement therapy and eye-movement desensitization and reprocessing. Many findings and techniques based in neuroscience are even being adapted into long-practiced counseling approaches such as cognitive behavior therapy.

A healthy portion of traditionalists and holdouts are uncomfortable with neuroscience’s growing influence in the practice of counseling, however, wary that it may steer the profession away from its humanistic roots.

Undaunted, neuroscience enthusiasts say that a generation of resistance is eroding as counselors begin to tap into the therapeutic power behind neuroscience findings and technologies. Their hope is that a new crop of counselors will emerge into the field already reared on curricula that place more emphasis on neuroscience.

The future is nigh

Around the turn of the millennium, Allen Ivey, a life member and fellow of ACA, started banging the neuroscience drum, calling on the counseling profession to embrace neuroscience under the mantra of “Therapeutic Lifestyle Changes” such as exercise, meditation and other brain-boosting behavior.

He and his wife, Mary Bradford Ivey, also an ACA fellow, continued that clarion call in a 2012 webinar hosted by ACA (see “Neuroscience: The Cutting Edge of Counseling’s Future” at counseling.org/continuing-education/webinars) and in their keynote at the ACA Conference in Cincinnati earlier this year.

The National Institute of Mental Health is increasingly turning to neuroscience as an alternative for moving away from the Diagnostic and Statistical Manual of Mental Disorders, Allen Ivey says. He predicts that action will eventually yield a totally new diagnostic approach.

“The brain-based paradigm is coming. … We’re going to have a very different way of handling mental health,” Ivey said in the 2012 ACA webinar. “

Ivey points to the understanding that negative stress leads to neuronal damage, which in turn impairs a person’s faculties for memory and emotional regulation, while traumatic experiences can negatively affect the individual even at the genetic level. He also points to evidence that positive empathic interventions — such as those provided by counselors — generate neural pathways, and he posits that a neuro-friendly mindset helps underpin multicultural awareness. These conclusions, among others drawn from neuroscience, have led Ivey to be boundlessly optimistic that counselors can — and should — tilt the balance of the nature-nurture dichotomy in their favor.

“There’s absolutely no excuse to give up on any client. … Our counseling can overcome genetics,” he says in the webinar, which stands as one of the most popular ever produced by ACA.

But others sound a note of caution on behalf of the humanist-oriented side of the counseling profession.

Matthew Lemberger-Truelove, president of the Association for Humanistic Counseling, a division of ACA, readily concedes that he marvels at some of the neurobiological work he sees his colleagues doing at the MIND (Mental Illness and Neuroscience Discovery) Institute at the University of New Mexico (UNM). But as those breakthroughs filter out, he says, counselors must be wary not to let them run roughshod over the profession’s humanistic principles.

“We’re way more sophisticated than what’s going on in one or two places inside of our body,” he says. “Instead, we’re a total unit that’s operating in a reflexive way with the world around us. You can’t just separate those. So, on the one hand, I agree with folks like Allen Ivey that neurology is incredibly important. But my problem is reducing it to the single problem, or even to a primary operation of what therapists need to do.”

Lemberger-Truelove, an ACA member and assistant professor of counselor education at UNM, worries that counselors are closing their critical eye in the hopes of finding a panacea with neuroscience.

“We are eager to find out things that will help our clients,” he says. “I think in so doing, we are going to — with good intentions — grab onto things that might be a straw man. An overreliance upon neurology without looking at the total human experience … is potentially naive. And, yes, I do see more counselors going that way, for the same reason we go to simple diagnostic algorithms, for the same reason we refer a client for psychotropic medications for the quick fix: because we as human beings want linear causation. There is a link between sensation and perception. But there’s also a difference between sensation and perception. In counseling, what we primarily deal with is a client’s perceptions. In some way, the thing that individuals sense certainly leads to their perception, but it’s not a perfect linear relationship. If counselors prioritize our profession as a profession about sensation, then we will change as a profession.”

Becoming neuro-minded 

Bill McHenry, associate professor of counseling at Texas A&M University-Texarkana, is a relative newcomer to neuroscience. He broke into the field a little more than a year ago after a long career focused largely on drug addiction. Looking back on his education, training and supervision, McHenry says it hinged on the belief that the brain people were born with was the brain they died with. It never broached the brain’s capacity to change or the brain-based aspects of the counseling process, he says.

Throughout his early career, McHenry felt limited by how little he understood of what was going on inside his clients’ brains. So, he started immersing himself in the emerging research and literature. That curiosity eventually led him to strike up a dialogue with one of his university colleagues, Angela Sikorski, a neuroscientist and assistant professor of psychology. To his surprise, he found that he could understand her explanations of the brain’s structural, chemical and neural processes, which he had assumed would be overly complex.

“That was certainly a watershed moment for me in my career. I still have all of my [counseling] techniques, all of my awareness and clinical intuition, but now I can be even more purposeful in what I’m doing,” McHenry says. “If you had asked me five years ago, eight years ago, 10 years ago, ‘Are you going to be this closely connected to the field of neuroscience as a counselor, and do you think that’s going to be important?’ I believe I would have said no. Because that’s not what we do in counseling. What we do in counseling is more artistic than regimented. As I’ve grown as a counselor, the better my skill set is, the more effective and efficient I am as a counselor. I would hope people would trust that this is a good thing for us. To know more about the brain is a good thing for counselors.”

As the first step in what can be an admittedly steep learning curve, McHenry suggests counselors immerse themselves in the neuroscience literature. This does not mean they necessarily need to stay up to date on every single breakthrough and innovation. Rather, he says, with a basic understanding of neuroscience principles and a few training sessions, counselors should soon be able to communicate those fundamentals to their clients.

“I’ve gone through cases that I worked years ago, and I thought, ‘Man, if I would have know that, I really could have educated my clients better,’” he says. “That’s the first piece to being more neuro-friendly for counselors is to be able to educate clients on potentially structural, chemical, biological and developmental issues within their particular brain. That information can be therapeutic in and of itself.”

The second step centers on the therapeutic process. McHenry now understands the value of counselors being able to focus their attention on what lobe of the client’s brain they’re working in and where there might be a neurological disconnect. “If I can discover those things, then I can go back and try to reignite or retrigger other parts of the brain,” he says.

The dialogue between McHenry and Sikorski led the duo to co-author A Counselor’s Introduction to Neuroscience, which was published in August. Their partnership is one that embodies the deepening ties between neuroscience and counseling.

Sikorski admits that neuroscience has its shortcomings, but she says the steady march of new findings is continually proving how much common ground counseling and neuroscience share. One of the most encouraging dimensions of the neurobiological breakthroughs, she says, is that researchers have unearthed surprising discoveries into the brain’s sensitivity to environmental factors, giving credence to the positive impacts of empathic listening and the counselor-client relationship.

“Do we know everything we need to know about how the brain works? The answer is no, absolutely not,” she says. “But the technology changes so much, and we learn so much more year by year, and one of the things it shows is that counseling and neuroscience are related, and they’re related in a really, really good way. The more we know about each, the more we contribute to our own specific discipline.”

A possible bridge

The past several years have seen the emergence of interpersonal neurobiology (IPNB) to the forefront of the mental health field, says Raissa Miller, a doctoral student at the University of North Texas. Many counselors see IPNB as a model that represents the possible middle ground between hard science and the art of counseling.

Pioneered by Dan Siegel, a clinical professor of psychiatry at the UCLA School of Medicine and executive director of the Mindsight Institute in California, IPNB seeks to foster an interdisciplinary view that encompasses the mind, body and brain as well as a person’s relationships with others. Under the catchphrase of “inspire each other to rewire,” IPNB draws from such disparate approaches as psychology, cognitive science, linguistics, chaos theory and anthropology to highlight how focus and personal relationships can change brain structure. It also gets at an understanding of the link between, for example, thoughts and feelings, or bodily sensation and logical processes.

IPNB, along with the writings of Bonnie Badenoch, particularly her landmark book Being a Brain-Wise Therapist, convinced Miller of the need to adopt a neuroscientific mindset as a counselor. An ACA member, Miller still has the audio recording of the first time she showed one of her clients a model of the brain to help the individual better understand stress level reactions. “It was shaky and probably sounded kind of funny, but I remember the client really lighting up and having an aha moment and releasing some of their self-blame,” says Miller, who was seeing clients in her private practice at the time.

Miller took Siegel’s 90-hour online course and participated in several IPNB workshops. She also trained with Badenoch in Dallas. Her next frontier is to study what happens not to clients within the IPNB framework, but to counselors themselves. Her dissertation is a qualitative phenomenological analysis of counseling students’ experience learning IPNB, and she presented a hypothetical IPNB-based curriculum at the Association for Counselor Education and Supervision Conference in October.

Miller believes IPNB can yield useful insights into the counseling experience, for example, by applying scientific terminology and understanding to counseling elements such as countertransference and the dynamic of empathy.

By taking that approach, she says, “it’s not just theoretical concepts anymore. It’s actual things going on in the brain. Anecdotally, what I hear is that it helps them [counseling students] understand themselves a lot better, which in counseling training is so important. Anything that helps counselors be more aware of their own internal world and understand the reactions they’re having with clients in the moment can also help them understand what’s going on with their clients and what really needs to be targeted for intervention. We are so grounded in the [client-counselor] relationship having a substantial impact on the mind, change and the whole counseling process. This helps us understand from a neuroscientific perspective why that information is critical.”

Immediate results

The neurological answer to a client’s problems can start as simply as learning to breathe.

Russell-Chapin still uses much of the same cognitive therapy she has used with clients throughout her career. The difference today is that she incorporates neurofeedback into the therapy to show clients how to control their skin temperature, breathe, exercise and sleep.

“People who come to me for neurofeedback have been to five or six therapists and they have had good therapy, but there’s still something missing. This is the piece that’s missing,” she says. “I’ve always believed counseling works, and we’ve known it works from the beginning of time. Behaviors change, so we can see people changing. Now we know what works, and we can see it with fMRIs. You can truly see pre- and posttest how we’ve built new neuronal pathways from doing therapy. So I’m still doing cognitive therapy, but now when my client comes to me and says, ‘Boy, am I feeling anxious’ or ‘Boy, I have this huge headache’ or ‘I am so depressed,’ I know exactly what part of the brain is activating.”

“I love doing this as a counselor,” she says. “Through the principles of operant and classical conditioning, I can help get their brain waves regulated again. It’s remarkable. The brain is so malleable that we can condition it just like we can condition any other muscle in our body.”

Ryan Melton, an ACA member and clinical training director of the Regional Research Institute at Portland State University, had his doubts. He didn’t think the array of computer games associated with cognitive enhancement therapy would work. He judged them to be too mundane and not engaging enough for clients to find worthwhile or useful.

But in the studies in which he has been involved, cognitive enhancement therapy has time and time again proved to be useful for clients with severe mental disorders who were consistently showing signs of neurocognitive deficits. Melton describes those neurocognitive deficits to his counseling students as “the invisible symptoms within invisible illnesses.”

Melton says cognitive enhancement therapy was developed and originally implemented more by psychologists. But the therapy has been making its way more and more into the counseling profession during the past few years. And he couldn’t be more excited.

“Because of some of our traditions [in the counseling profession], I think what happens … is that when we feel like the talking cure doesn’t work, then we’re kind of stuck,” Melton says. “There’s more that we can do, and when we focus on these neurocognitive deficits and the skills, the accommodations that can be done can be very simple.”

With dozens of clients, Melton has seen cognitive enhancement therapy’s video-game-based model leverage neuroplasticity to repair specific psychosocial and neurobiological deficits, including processing speed, executive function, working memory, social cognition and the like. The video games require clients to employ those specific faculties at certain times.

Melton reviews the results with each client. He talks through what cues the clients responded to, what they did well and what they struggled with, and how those cognitive decisions — be they failings or successes — translate into the clients’ day-to-day performance at work and in their personal lives.

By performing better on the games, the clients get instant feedback and find a sense of greater self-efficacy, Melton says. In addition, he says, clients show up more regularly for appointments and feel more invested in the process.

“It’s more immediately engaging. They see immediate benefits,” Melton says. “They feel — and probably there is — more science behind it than, say, cognitive behavioral therapy, even though CBT might be doing the same thing. The clients are really buying in [with cognitive enhancement therapy].”

Melton has weaved neuroscientific principles into every course he has taught in three years as a counselor educator at Portland State. “Once you get through that initial barrier of what [counseling students] think the profession can and can’t do, there’s absolutely an appetite for this kind of information,” he says.

Though he’d still like to see neuroscience more widespread across counseling curricula, he hopes its growing presence is creating a profession in which hostility toward neuroscience principles is a thing of the past. “I hope so. I think we need to grow as a profession,” Melton says. “Others might disagree with that, but I hope so.”

A leap of faith

Critics of neuroscience blast some of the techniques as lacking scientific justification and data to prove their effectiveness. Even counselors who are enthusiastic supporters of neuroscience generally remain guarded about its more dramatic claims.

Miller is encouraged by the developments she has witnessed within the IPNB framework, though she acknowledges that much of the research upon which IPNB is based lies largely outside her expertise.

The science “is emerging, and I think we have to be cautious. For any of the neuroscientists, it is easy to get ahead of themselves,” she says. “I feel like I am having to trust some of these neuroscientists and psychiatrists who are writing these books. I’m having to trust their interpretations. I’m having to trust that some of the implications and what they’re saying is true, which I guess is a little shaky, but I’ve not hesitated.”

Melton takes issue with how directly some practitioners draw conclusions from the neural activity they witness during sessions. He concedes there is a lot of room for the science to grow and become more precise.

“We do sometimes make too much of the fMRIs,” he says. “If we could diagnose using fMRIs or blood tests, we would do that. But we don’t, and we can’t. Even the [American Psychiatric Association] says we’re still 10 years away from that. Of course, I remember them saying that 10 years ago. It’s not just about what’s lighting up in our brain. Even when I talk to physicians, they say, ‘Oh, well they’re getting less blood flow to the dorsolateral prefrontal cortex’ or wherever, and I say, ‘What does that mean for the kind of day-to-day work [the client] faces?’ And they can only say, ‘Well, they’re getting less blood flow.’”

Still, neuroscience continues to entrench itself into what insurance providers and mental health organizations deem as best practices, Miller says. This leaves some counselors worried that other mental health professions are making big advances as a result of embracing neuroscience. They fear that if counseling doesn’t do the same, there will be dire consequences, especially if counselors aren’t at least conversant in neuroscience principles or able to express how those principles are relevant to — and supportive of — the counseling process.

“I kind of see us falling behind or maybe not being seen as legitimate, which I think is already sometimes a struggle — to not be seen as on the same playing field as other mental health professions,” Miller says. “This seems to be the emerging common language, so if we want to stay on the same footing as other mental health professionals, we would do well to integrate it. … The counseling profession has struggled to produce significant outcome studies showing that what we do is effective. If we can start using this language and show how what we do is effective and publish it more, I think it’s just going to strengthen the field.”

But faced with that argument, Lemberger-Truelove urges the counseling profession to stand its ground.

“For how long do we as counselors have to feel feelings of inferiority with our big brothers, the psychologists and psychiatrists?” he asks. “Let’s just do what we do well. I encourage other professions to chase that straw man because, in the end, that’s just not the philosophy of counseling. Counseling is really about appreciating the individual, their unique differences and how an individual can best manifest whatever unique difference they have. If we remain steadfast in the idea that we interact with clients’ perceptions of themselves and their world and the social systems under which they operate, then I think there will still be a place for us, and we won’t be competing with the different [mental health] professions. We’ll really be stalwarts. We’ll be the experts of how clients can exist in a very pragmatic, useful way.”

In that sense, the humanistic aspect that counseling brings to mental health is a crucial counterweight to the excitement of neuroscience, Melton says.

“We still know that we get our best outcomes when we establish a strong therapeutic alliance with our clients,” he says. “That’s one thing we know that’s almost necessary in treatment, regardless of our profession. It’s true in psychiatry and psychology and social work and counseling. So we still need that piece, even if our follow-up treatment is going to be a pill, cognitive behavioral therapy or cognitive enhancement therapy. That still needs to be there. Let’s not go one way or the other. Let’s stay in the middle with this, because that’s what we know.”

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