Tuesday, May 14, 2013

Mindfulness, Attunement and Resonance: Chapters 2 and 3 in The Mindful Therapist

Back at the beginning of March I decided I would have a “mindfulness month” in which I would read five books about the topic of mindfulness and perhaps begin practicing. About a week later I realized that I was only about one chapter into the first book I wanted to read and that I should probably revise the project to a mindfulness year and give periodic updates. I’m pleased that I finished my first book today (two and a half months after starting, which puts me on track for finishing five books in a year, I think). I am starting on the second book and have begun experimenting with some simple mindfulness practices, mostly breath awareness and body scans. I am also working on teaching my toddler to use deep breathing when she is upset so that she can learn healthy ways to self soothe.

The book I just finished is “The Mindful Therapist” by Dr. Daniel Siegel. This was definitely a challenging book for me; I found myself taking extensive notes on each chapter as I went along because there was so much novel information. Over the next few weeks I plan to reflect on those notes and do some writing about what I learned in order to further consolidate my understanding. I have already talked about the first chapter in the book, which was about presence, a necessary quality for a therapist. The second chapter is devoted to attunement. Attunement is the process of focusing on another person and bringing their experience into our own inner world. Presence is required for attunement, but it is not the same thing. The idea of attunement in the second chapter then links to the idea of resonance in the third chapter. Resonance is the process of linking two people into a whole, so that a person recognizes that another person is attuned to him.

The most fascinating part of this chapter for me was Dr. Siegel’s description of the theory of how, biologically, attunement takes place. The reason the neurobiology is so fascinating for me is that it unites the two halves of psychiatry. When I was in training I found it very frustrating to have a lecture one hour on neurons and neurotransmitters and then the next hour on defense mechanisms and empathic listening. I couldn’t find a way to make those two worlds, the biological and the psychological, relate to each other. Yet they both seemed to have validity. Finally the work of Dr. Eric Kandel (a Nobel prize winning psychiatrist and neuroscientist) opened my eyes to how experiential learning can actually shape our physical brains. Since then I have been hooked whenever I find someone writing or talking about ways to base our psychology in our biology.

According to Dr. Siegel’s book, the biological process of attunement is likely to start in mirror neurons. These neurons have been shown to operate in preparing us to imitate the observed behavior of another person – for example, if I see you reach for an apple, the mirror neurons in my brain will fire as if I had reached for the apple myself. Mirror neurons also are likely to operate with emotional behavior as well, so that if I observe someone crying I myself will probably experience sadness. What I found even interesting is that mirror neurons relay to other neurons down into the body through the autonomic nervous system, so that I will literally “feel” what I observe in someone else, without my conscious awareness. Those internal bodily sensations are then carried back up through the spinal cord and finally relay back into the cortex of the brain in a particular area called the anterior insula, which is the point at which we develop conscious awareness of our internal feelings. This attunement can then be sensed by the other person, which creates resonance.

Interestingly, just the experience of attunement and resonance between two people can actually modify each person’s internal mental and emotional experience towards the direction of health. Hence the importance of the therapist maintaining his or her capacity to be present, to attune and to resonate when seeing a patient. One of the comments Dr. Siegel made in both of these chapter that I strongly agreed with is that attunement and resonance in the clinical encounter are hard, much harder than simply asking a patient questions designed to establish a diagnosis. You have to be humble and willing to let the patient lead, and you have to be willing to acknowledge that you don’t know. Being attuned and resonating also means keeping open your own “window of tolerance,” another metaphor Dr. Siegel introduced, for that emotional experience. You have to be able to tolerate feelings of fear, sadness, rage, etc… while remaining flexible and functional.

Dr. Siegel offers many exercises in these chapters designed to help therapists widen and stabilize their windows of tolerance. One exercise which I found very informative and also calming is a body scan exercise. In his book Dr. Siegel “talks” you through a slow scan of all of the different parts of the body. This exercise reminded me strongly of the Yoga Nidra exercise by Robin Carnes that a colleague recommended to me for sleep. It is very peaceful but it is also an exercise that builds your skill in attuning to yourself, so that you can have increased skill in attuning to others. Dr. Siegel also suggests ways to evaluate your own experiences with attunement and resonance (or the lack thereof) and how those experiences might be affecting your own capacities for presence, resonance and attunement today.

As I read these chapters I am struck by how well what he states matches my own experiences, not just as a therapist but as a spouse, parent and friend. When I am within my window of tolerance I am able to be present with others, open to my current experience and the information they are giving me so that I can attune and resonate. However when I am outside my own windows of tolerance: too uncomfortable, too stressed, too sad, etc… I can’t maintain that state. I shut down and try to shut the other person down too. I’m not listening, I’m not present, and I’m not mindful. I can see how the exercises Dr. Siegel suggests can be helpful in broadening the emotional and mental space in which I can be present and I can see how that is important for strong relationships in both professional and personal aspects of my life.