(Names and identifying information have been
changed to protect confidentiality.)
On a humid evening last September, Susan
and James burst into our office looking like two high schoolers in the
grip of a classroom giggle fit. Usually serious and reserved, James, 36,
explained between chuckles that he had been telling Susan a story about
his boss's gaffe at a meeting earlier that day. Still chortling as she
landed on our office sofa, 27-year-old Susan ran her fingers through her
cropped, blond hair and tried to compose herself, then eyed her gleeful
husband and began hooting all over again. I glanced at my wife and
cotherapist, Lisa, for a microsecond and gave her a raised-eyebrow
version of a high five: This had all the earmarks of an easy session.
After a bit more banter, we steered the conversation to the main order
of business-- the state of their six-year marriage. Susan began to
recount an incident that had occurred a few days before, when James had
volunteered Susan to drive his daughter to a birthday party so that his
ex-wife wouldn't be inconvenienced. "I felt used," Susan said
bluntly. So far, so good, I thought -- she is simply stating her
feelings. Then looking directly at her husband, she continued: "But
what upset me even more was your reaction when you saw that I was
unhappy. You started defending her!"
With these words, Susan's voice began to
shake and she ducked her head, starting at the flowered pattern of the
Kleenex in her fist. When she looked up her eyes were narrowed and her
face flushed a deep, mottled crimson. "You are so full of
crap!" she spit out. "You're too weak to stand up to her then
you look at me as if I'm the one with the problem. God, what a sucker I
am to stay with you!"
James rolled his eyes and sighed
elaborately, then turned toward us. "You see what I have to deal
with here?" he asked beseechingly. It was as though he had lit a
match to his wife's innards. "Oh, that's good James!" sneered
Susan. "Blame me again! This is classic. You're such a fucking
wimp!"
James didn't respond. In fact, I wasn't
even sure he had heard her. His whole body seemed to contract as he
turned toward the office picture window and stared unseeing through it,
his mouth a taut line. Though he sat very still, I could hear the ragged
sounds of his breathing. The relaxed, affable man who had entered our
office 10 minutes earlier had simply vanished.
Looking back, I realize it was pure
wishful thinking to equate this couple's initial good cheer with an easy
session. In fact, over the years I have often been struck by how swiftly
and dramatically the moods of intimate partners can change in the midst
of an interaction, as though some internal switch gets flipped that
compels each partner to react in a particular, almost predetermined way.
In a previous session, James had jokingly called Susan
"Sibyl," noting that whenever she became deeply upset, she
entered "the zone," a place from which she could only react
with white-hot wrath. At times, that rage turned physical: during one
particularly savage fight, she knocked James unconscious by pushing him
into a wall. Yet, in my observation, Susan was not the only partner
prone to meteoric mood shifts. James's predictable response to Susan's
rage–a lightning-fast retreat into his own zone of tuned-out,
protective distance–was every bit as sudden and intense as his wife's.
In the past, the goal of our therapy with
a couple like Susan and James would have been to teach them new habits
of thinking and behaving that they could call into play whenever
conflict arose. We would have coached them to listen to each other more
attentively, fight more fairly, and give each other more benefit of the
doubt. But over the years, we have noticed that the progress couples
made in these areas tended to be disturbingly short lived. Several years
ago, we informally followed up with a number of our couples and found
that within months of finishing therapy, many had reverted back to their
old, well-honed tango of attach and withdraw, storm and stonewall. For
some, it was as though they had never been in therapy at all.
Were we doing something wrong? My honest
response is yes–and we have loads of company. Controlled studies of
marital therapy outcome show that following a stint of treatment, only
50 percent of couples significantly improve. But even among those
couples who do make progress, a big chunk–30 to 40 percent–relapse
within two years. A close reading of this outcome research reveals a
still more dispiriting reality: many of the so-called
"successful" couples reported still feeling unhappy with their
marriages at a two-year follow-up. In the course of therapy, they had
merely progressed from "highly distressed:" to just plain
"distressed."
Why are we doing such a lousy job of
helping couples?
Numerous factors have been identified:
couples come in too late to be helped; reimbursed sessions are too few;
many clinicians are undertrained in marital therapy. But one possibility
that we haven't yet confronted is that many of our most respected and
widely used models for helping couples may be based on bad–or at least
badly outdated–information.
Most couples therapy today is geared
toward teaching partners to think and act differently toward each other,
on the assumption that cognitive and behavioral strategies such as
reframing, active listening, doing more of the works and so on can
short-circuit explosive emotions and promote renewed intimacy and trust.
But all of the foregoing assumes that our rational brains are in charge
of our emotions, that what distinguished Homo sapiens from so-called
"lower" animals is our capacity to reason before we react.
But what if the human brain isn't actually
wired that way? What if our neural circuitry programs us instead to rage
and cower and collapse in grief in a nanosecond, before we ever get a
chance to fashion an "I" statement or otherwise think things
through? With the help of ever more refined imaging techniques that
generate highly precise portraits of the brain in action, a new
generation of neurobiologists is in the process of documenting that our
cerebral topography actually favors flaming emotionality, not sweet
reason. Thinking still counts, but not nearly as much as we've always
assumed. So doctrine shattering is this mounting evidence for the
hegemony of the "emotion brain," or more formally, the limbic
brain, that Jaak Panksepp, a pioneering neurobiologist at Ohio's Bowling
Green State University, has called it a genuine "neuroscience
revolution."
But while the lay public appears fascinated by
this new look at our emotional brains, catapulting books such as Daniel
Goleman's Emotional Intelligence and Steven Pinker's How the
Mind Works onto the bestseller lists, thus far, clinicians have
seemed curiously unmoved. In our professional journals and conferences,
we have done little grappling with the implications for psychotherapy of
this major new strand of emotion research even though it strikes at the
very marrow of the work we do.
Perhaps our field has hesitated to
seriously confront the core tenets of the new, affective neuroscience
because if we did, we might find out that we are heading down a
hazardous road. For if our very brain circuits are primed to favor our
most volatile emotions over reason, we may need to call into question
our field's predominant tilt toward therapeutic models that rely on the
sovereignty of rational thought to engender change. As economic
pressures spur us to move increasingly toward ever briefer, more
cognitive-oriented models, we may unwittingly be investing enormous
energy in approaches that are, to a large extent, at odds with our
brain's most fundamental functions.
Let me say clearly that at this juncture,
almost nothing about the brain's role in emotion can be stated with
absolute authority. Behavioral neuroscience is still an infant field,
which means that many conclusions are still in the realm of correlation
and possibility. And high-tech tools notwithstanding, the task of
mapping the emotional brain is simply a staggeringly complex
undertaking. Each human brain houses up to 100 billion neurons, each of
which is capable of making, literally, thousands of connections with
other neurons. Attempting to relate this intricate, electrochemical mesh
to emotion, a concept that itself encompasses an enormously complex set
of phenomena, is a truly daunting task.
Nonetheless, as the "black box"
beneath our craniums is slowly and painstakingly being pried open, its
contents deserve our close inspection. For while the latest findings
about the primacy of emotion may be disquieting, they also hold the
promise of more potent and effective ways of doing therapy. This new
knowledge is already transforming my own work, spurring me to develop a
clinical approach that empowers emotion and thought to work in common
cause, rather than at cross-purposes, to help people manage their most
volatile feelings. And whatever a therapist's current orientation–be
it cognitive, behavioral, affective or some blend thereof–I believe
that the newly charted links between our neural circuitry and our most
primitive passions merit an open-minded and thoughtful response. For if
we discover that we are, in fact, traveling down the wrong road, we will
need to plot a powerful mid-course correction.
The conventional view of how the brain
processes emotion is highly appealing to us humans, who love to
fantasize that we're firmly in control. This comforting theory holds
that information about the world is transmitted via our eyes, ears and
other sensory organs to the thalamus, the brain's central relay station,
which, in turn, ships it directly to the neocortex or "thinking
brain." There, the incoming signals are efficiently recognized,
sorted and assigned meaning, then ferried downstream to the limbic
system or "emotional brain," which triggers the appropriate
visceral response. In this tidy, reassuring scenario, emotion is the
dutiful servant of the rational brain. Thought proposes, emotion
disposes.
And much of the time, this is indeed how
things work. But here's the catch: not always. Joseph LeDoux, a
neuroscientist at the Center for Neural Science at New York University,
recently discovered a second, parallel pathway that acts as a supersonic
express route to the brain's emotional centers. This neural back alley,
which appears to be reserved for emotional emergencies, bypasses the
neocortex entirely, routing information from the thalamus directly to
the amygdala, a tiny, almond-shaped structure in the limbic system that
has recently been identified as the brain's emotional alarm center. The
amygdala scans the information for potential danger: Is this bad? Could
it hurt me?
If the information registers as dangerous,
the amygdala broadcasts a distress signal to the entire brain, which in
turn, triggers a cascade of physiological responses–from a speeded-up
heart rate to jacked-up blood pressure to mobilized muscles to the
release of the "fight or flight" hormones, adrenaline and
noradrenaline. Within milliseconds, we explode with rage or freeze in
fear, well before our conscious mind can even grasp what is happening,
much less persuade us to take a few deep breaths and maintain our cool.
This cranial takeover can occur because
neuroanatomically speaking, our thinking brain is simply out-matched by
the competition. At the same time that emotion-laden signals are zooming
down our neurological express route–what LeDoux calls the "low
road"–the same data is being transported via the customary,
well-trodden "high road" from thalamus to neocortex to
amygdala. But because the shorter, subterranean pathway transmits
signals twice as fast as the more circuitous route involving the
neocortex, the thinking brain simply can't intervene in time. By the
time the neocortex gets into the act, the damage has been done–you
have already called your late-to-dinner partner an inconsiderate jerk,
shrieked at your smart-mouthed child, snapped at your critical colleague
or simply shut down, shaking inside, in the face of someone else's rage.
To make matters worse, by this time,
amygdala-triggered emotional information has invaded the neocortex
itself, overwhelming its centers for logic and judgement. As a result,
your emotion-flooded thoughts about the situation are apt to feel
entirely accurate and justifiable. Whaddya mean, I'm overreacting?
So much for the doctrine that rationality
rules.
This telling new glimpse at the topography
of the brain helps to explain those moments in the consulting room when
you can see that couples are honestly struggling to think and behave
differently, but simply can't make the shift. You watch your client
trying to listen empathetically to his wife, but when she lets him know
that she is sick and tired of his shirking the housework, bam! Before
you can say "reframe that thought," the amygdala is sounding
its sirens and suddenly he's yelling that she's the slob, not him, in
fact, she's let herself go big-time and is goddam fat! And as he's
shouting all this, his face is turning the color of boiled lobster, his
heart is practically leaping out of his chest and he is sweating
gallons. Depending on your theoretical orientation, you might say this
man had just contacted his "wounded child," or that he had
been sabotaged by his "problem story" or that he was
reenacting a hurtful, family-of-origin script. But at the level of brain
wiring, his neocortex just got hijacked by his amygdala. And as we shall
see, understanding this neural takeover isn't just some kind of
intellectual exercise that explains our clients' reactivity: we can use
it to help clients arm themselves against future cranial abductions.
But first, we need to understand a bit
more about the tiny sliver of cerebral tissue that can so readily
commandeer the brain–the amygdala. While neuroscientists are only just
beginning to understand this complex little emotional sentry, they are
reasonable certain that it is a major player in producing fear and
anger, the particular kinds of emotions that frequently push people into
therapists' offices. In one set of studies, when researches implanted
electrodes in individuals' brains and stimulated a particular circuit
originating in the amygdala, subjects responded with heart-racing
terror. When a different, amygdala-driven neural circuit was stimulated,
individuals erupted in rage. In one study by Robert Heath of Tulane
University School of Medicine, a man whose amygdala-based rage circuit
had been stimulated furiously tore his hospital robe and lashed out at
the physician who was standing nearby, threatening to kill
him. So much for lab-induced passions. But
in our real lives, what makes our emotional brain kick into gear?
Neuroscientists believe that in most instances, the amygdala makes its
snap judgments based on the similarity of a current situation to past
events that once enraged or terrified us. In short, the amygdala seems
to be the repository of the very raw material of psychotherapy–emotional
memory.
Until very recently, it was widely
believed that the hippocampus, a sea-horse-shaped structure in the
limbic brain, was our emotional memory bank. But research by LeDoux and
other neuroscientists now suggests that the hippocampus is actually more
concerned with registering factual and contextual data, while the
amygdala is the repository of primitive feelings linked with those facts
and situations. So while the hippocampus will remember what your
ex-partner looks like–the jerk who dumped you for a new lover–the
amygdala is responsible for the surge of fury that floods your body when
you see someone who looks even vaguely like your former mate.
And "vaguely" is the operative
word here. For when the amygdala tries to judge whether a current
situation is hazardous, it compares that situation with its motley
collection of past emotionally charged events. If any key elements are
even crudely similar–the sound of a voice, the expression on a face–it
instantaneously unleashes its warning sirens and accompanying emotional
explosion. No doubt, this quick-and-dirty assessment method had
tremendous evolutionary utility. For our early ancestors, it was far
better to react to a false alarm than to miss an underfed saber-toothed
tiger lurking in the tall grasses.
But for modern-day relationships, the
amygdala's penchant for sloppy generalizations can exact a steep price.
To the amygdala, it may make no difference that it is your spouse who is
angry with you and not your father, who regularly took out his wrath on
your helpless body some 30 or 40 years age. The emotional state
triggered by the hyper vigilant amygdala–shuddering fear or unholy
rage–is apt to be exactly the same.
Back in our office, when Susan so suddenly
turned on James, the volcanic eruption of her fury suggested to us that
her amygdala had made some link between the triggering event–her
perception that James had been disloyal to her–and a painful situation
in her past. Years ago, we might have invested considerable energy
trying to help her become aware of these early events, so that she could
learn to disentangle them from her current interactions with her
husband. But recent brain investigations suggest that in some cases,
this kid of trolling for early trauma may simply be a well-meaning waste
of time.
For while the amygdala is fully mature at
birth, the hippocampus–our memory bank for factual data–doesn't
fully develop until a child is at least 2 years old. This means that
during early childhood, when relationships with care givers have such
profoundly life-shaping impact, the amygdala is busy making
emotion-charged associations about events that the embryonic hippocampus
never even records. An adult, then, can be plagued by chronic,
debilitating emotional out-bursts linked to a past event that he or she
neither remembers nor has any way of recovering, since one cannot
recover a memory that has never been recorded. Perhaps this is one
reason why many clients seem so unwilling to relinquish their
convictions that their explosive reactions to current spousal behavior–a
wife's propensity to flirt at parties, a husband who forgets to call
when he's going to be late–is entirely appropriate. There is no early
memory, even a repressed, deeply buried one, to trace it back to.
But this bewildering amputation of emotion
from its triggering event may take place at any point in our lives.
Studies by Bruce McEwen, a researcher on the biology of stress at New
York's Rockefeller University, indicate that even in a mature
hippocampus, severe stress can cause a shriveling of dendrites, the
stringy, branching ends of neurons that are largely responsible for the
initial phases of long-term memory formation. Recent studies have shown
that in trauma survivors, such as victims of chronic childhood abuse and
Vietnam veterans with Post-Traumatic Stress Disorder, the hippocampus is
measurably shrunken.
In stark contrast, stress seems to enhance
the functioning of the amygdala. As blood levels of stress hormones
shoot up, the amygdala seems to kick into overdrive, thereby
facilitating extremely potent learned fear. So if a person endures a
severely stressful situation, he or she may forget the distressing
incident itself, yet become emotionally hyperactive to future events
that are unconsciously reminiscent of the original, triggering situation
a client may have forgotten that she was raped repeatedly by her uncle,
yet become panicky and tearful whenever her husband approaches her for
sex. Or a man may verbally attack his wife whenever he perceives that
she is being "distant" from him, having altogether forgotten
that as a small child, his depressed mother regularly retreated to her
locked bedroom, leaving him utterly alone for hours at the time.
The idea that a person's current emotional
reactions can be embedded in past events is nothing new–Freud figured
that out long before the neurobiology techno-wizards on the scene. But
the gradually emerging portrait of our "emotional brain" gives
us an illuminating window on why many clients find it so horrendously
difficult to contain their reactivity in committed love relationships.
If the amygdala's original purpose was to act as our emergency alert
system, leaping into action in response to life-or-death threats facing
our ancestors, it is apt to activate with particular vigor in our
intimate partnerships, which are so thoroughly tangled in primal need.
Once, in our helpless infancy, our need to stave off abandonment truly
was a matter of survival. So when our partner says or does something
that telegraphs This person doesn't love me! This person is leaving
me! our amygdala scrambles blindly, frantically to the rescue.
The central role of this hair-trigger
brain mechanism in creating marital misery is persuasively suggested by
the now famous "love lab" research of University of Washington
psychologist John Gottman. By hooking up couples to a battery of
physiological sensors while they discussed sensitive subjects, Gottman
has documented that during highly toxic arguments, partners' bodies
become flooded by a virtual tidal wave of brain-mediated bodily changes,
including a quickened heart rate stepped-up sweat production, tensed-up
muscles and the release of a torrent of stress hormones. The
split-second nature of these changes–an angry spouse's heart rate can
accelerate 10 to 30 beats per minute in the space of a single heartbeat–strongly
indicates a cranial coup d-etat originating in the amygdala.
And like most coups, this one can wreak
ugly consequences. For Gottman further found that these classic bodily
signs of an emotional hijacking were highly correlated with specific
kinds of conflict behaviors–criticism, contempt, defensiveness, and
stone-walling–that, in turn, strongly predicted later divorce. In his
observation, the trajectory of divorce originates with frequent, nasty
arguments that eventually cause both partners to develop a kind of
bioemotional hypersensitivity to each other. In this state, observes
Gottman, "you react to your spouse like an animal conditioned to
fear a shock whenever it sees the color red."
In an ideal world, of course, couples
would show up at a therapist's door long before this kind of knee-jerk
hostility seeped into their marriage. Yet, research indicates that
couples typically battle each other for a good six years before they
finally find their way to a clinician's office. By this time, many
couples have become so sensitized to each other that each partner may be
only a spouse's caustic comment or a dismissive glance away from an
emotional mugging. In view of what we are learning about the hard-wired
basis of these eruptions, it may be time to forthrightly confront our
profession's gradual but unmistakable retreat from the whole arena of
emotion. Might there by a link between our field's growing inattention
to clients' internal emotional processes and our undeniably mediocre
track record in helping couples?
There is little doubt that in
psychotherapy today, the neocortex is where the action is. While a few
emotion-centered approaches are still holding their own, they hardly
represent the field's dominant direction. Instead, pressured by
increasingly meager third-party reimbursements, clinicians have been
scurrying to get trained in therapy models that promise the speediest
possible results. And by and large, the briefest models tend to be those
that zero in on retooling beliefs and behavior, based on the premise
that changing thoughts and actions will, domino-style, cause feelings to
change. In short, these models take for granted that the neocortex is
firmly in charge of the limbic system.
And in some cases, they're right on
target. Brain-mapping studies suggest that in emotion-tinged situations
that aren't perceived as all-out emergencies, our thoughts do indeed
play a central role in influencing feelings. If you are confronting a
situation that is emotionally salient but not perceived by you as a
life-or-death matter–let's say, you've noticed a worrisome drop-off in
client hours–that information would travel first to the discerning
neocortex, which would mull over the situation and decide on the
appropriate emotional response.
If you were to apply a solution-focused
approach to this matter, your neocortex might be enlisted to make a
mental list of ways you've successfully beefed up your practice in the
past and secure a commitment to try those strategies. A narrative model,
meanwhile, might urge your thinking brain coolly consider how Fear is
trying to sabotage it. Within a traditional cognitive model, your
neocortex might be encouraged to battle any rumination about imminent
professional disaster with a tough-minded counter argument. Given the
right conditions, each of these interventions would likely spur your
rational brain to signal the amygdala to respond with, perhaps, mild
anxiety leavened with a strong, motivating shot of hope. In short, when
the neocortex has a chance to use its muscle, "think
therapies" can be powerful agents of change.
The trouble is, of course, that the
neocortex can be so swiftly hijacked. As we have seen, when we do deem a
situation an emotional emergency, the amygdala lights up the entire
brain and body with bioemotional fireworks before the neocortex ever
gets into the act. It is in precisely these kinds of volatile,
felt-crisis situations–which intimate partnerships, in particular,
seem so readily to create–that thinking-brain therapies are at a
serious disadvantage. Many clinicians, including myself, have spent
untold sessions trying to get fuming couples to engage in some kind of
well-established communications technique, such as "active
listening," only to watch the whole thing fly apart when one
partner says something seemingly reasonable–"I feel that the kids
don't get enough of your attention"–which feels, to the other,
like a poison arrow to the heart.
"Screw that!" the
"listener" shrieks, whereupon the partner flings back that
this is just so typical, isn't it, you're too narcissistic to even
listen to me, always have been, what's the damn use? And in those
moments, when your office vibrating with fury and you feel more like a
rookie referee at a mud-wrestling match than an authoritative,
multidegreed professional, your bulging bag of reframings, restoryings
and other sweet-reason techniques is worse than useless. Sweet reason
just got clobbered. The amygdala is king.
So where does the bad-news tale of limbic
mayhem leave therapists? If an element of our humanity as unalterable as
brain architecture favors blind emotion over rationality, why even
bother to try to help clients master their most volatile and disabling
reactions? In my experience, this work remains not only critical, but
eminently possible. For while the amygdala may run the neural show at
times it is by no means an entrenched, power-mad despot. Instead, I have
found it to behave more like an over-protective parent who, if
approached in the right way, can be persuaded to relax its nervous grip
on its child.
This neural "relaxation
response" is possible because it turns out that our brains are
wired not only for defense, but also for connection. In a related and
far more heartening realm of neuroscience researchers have begun to
chart paths for a number of discrete brain circuits that reliable
activate specific emotions, along with associated thought and behaviors.
While circuits for fear and rage have been most thoroughly mapped thus
far, the neurological terrain of intimacy-arousing emotions–most
notable sorrow and nurture–have very recently been identified.
Electrically stimulate an individuals'
sorrow circuit, researchers have found, and that person will report
feeling sad or lonely and express the need for comfort. Activate the
nurture pathway, and an individual will experience a surge of tender,
generous feelings and voice the urge to care for someone. When I first
encountered this realm of research, I felt a ripple of hope: Perhaps
there was some way to help clients move from a connection-breaking
circuit, such as fear of anger, to one that promoted emotional
vulnerability and intimacy. But how?
As I was trying to penetrate this puzzle,
I recalled perusing recent research by University of Wisconsin
psychologist Richard Davidson that suggested that the left prefrontal
lobes, the wedge of neocortex located just behind the forehead, played a
critical role in moderating emotional reactivity. While it appeared that
this sector of the brain could not keep the amygdala from spazzing out
in the first place, in some cases it seemed able to reduce the longevity
and intensity of neural hijackings and thereby to limit the fallout.
This made sense to me: It seemed all but
inevitable that we would need to use a slice of our orderly neocortex to
guide us out of the motional swamps. Yet, both my clinical experience
and my growing familiarity with the workings of the brain told me that
in the grip of a "survival" emotion, clients could rarely
simply think themselves into a more tranquil state. Then, suddenly, I
was struck by one of those unbidden, "aha" experiences.
It occurred to me that if the amygdala is,
indeed, a vestige of our primeval survival arsenal, perhaps it will not–simply
cannot–quiet its wailing sirens until it gets a clear signal that its
urgent, life-preserving clamor has been heard. This would explain why
new cognitions or behaviors are rarely sufficient to influence
"emergency" emotional situations, for those interventions seek
to override, rather than attend to, the amygdala's frantic distress
calls. But what might happen instead, I wondered, if we helped our
clients use their rational brains to fully acknowledge and soothe their
primordial limbic systems?
From this core idea, I have developed a
clinical model that puts the thinking brain unreservedly at the service
of the emotional brain. The goal of this approach, which I call
Pragmatic-Experiential Therapy, is to help clients shift from the
defensive, isolating brain circuits that control rage and fear to the
connecting, healing circuits that mediate nurture and sorrow. Giving
immediate and thorough attention to clients' up-and-running, defensive
neural systems, we coach clients to sympathetically and respectfully
interact with those brain states until they feel safe enough to switch
to more vulnerable states.
In our experience, this internal sense of
safety is the linchpin of change for couples. For only when an
individual feels no longer threatened by his or her partner–threatened,
at bottom, by the terrifying, annihilating prospect of abandonment–will
the amygdala shut off it internal alarm system, freeing the individual
to authentically shift to an intimacy-promoting neural state. So, unlike
therapeutic models that zero in immediately on changing thinking or
behavior we don't ask clients to change how they think about, or behave
with, their partners until they feel safe enough to interact in a more
vulnerable way.
This is not suggest that cognitive and
behavioral strategies are unimportant to effective therapy. In our
clinical work, the rational brain–particularly the prefrontal cortex–is
an absolutely central player. The key difference between our approach
and explicitly cognitive models is that rather than using the thinking
brain to try to dominate the emotional brain, we put it to work helping
the ancient amygdala to gradually relax its defense. To do anything
less, we believe, is to paddle against our neural currents.
As Lisa and I sat with James and Susan in
our consulting room, we well knew that "helping the amygdala to
relax" was the last thing they had in mind. What was clear,
however, was that each partner was far too stuck in his or her
respective emotional circuit–Susan in rage, James in fear–to make
any immediate shift to a more intimacy-promoting state. Before that
could happen, each partner would need to get on much better terms with
the feelings that had so violently seized him or her. We responded,
therefore, as we customarily do when couples encounter extremely
"hot" emotional states–by calling a temporary time-out on
conjoint work to conduct some one-on-one emotional exploration.
Leaving Lisa and Susan to work together in
our office, I asked James to join me in a consulting room down the hall.
There, I suggested that if he was willing to explore his inner
experience a bit, he might be able to learn to respond to Susan in a way
that helped her to treat him well in return. He agreed to try, warning
me, however, that self-awareness wasn't his "thing." Like many
men I work with, James had done a good job of numbing his body to the
telltale, physiological signs of an emotional hijacking–the knotted
muscles, the racing heart, the queasy stomach–and consequently, during
his fights with Susan, he often had trouble knowing what he felt at all.
His lifelong stance, he admitted, was to keep a "stiff upper
lip" in the face of trouble–he saw no other options.
"None?" I inquired. "Who
taught you that?" After a few moments of silence, he began to talk
of his junior high football coach, whom he remembered as single-mindedly
intent on forcing him and his teammates to perform endless calisthenics
until their bodies screamed for relief. The coach would then stride up
to the player with the most tortured expression, get right in his face
and shout: "What do you feel?" On cue, the player would yell
back: "Nothing, sir!" to the loud cheers of his teammates. On
one broiling afternoon on the football field, James heard those rousing
cheers for himself, and he recalled no how curiously proud he felt of
his stoic denial of his own body. Shaking his head, he admitted: "I
guess I learned the lesson well."
I assured him that it would be possible–necessary,
in fact–to relearn to recognize his feelings. In an important way, I
explained, the body was the voice of the emotions, eloquently
communicating critical information about our current emotional state.
Tightened muscles and a sick sensation in the gut, for example,
typically accompany fear, while rage is characterized by an upsurge in
aggressive energy and increased body temperature. Learning to readily
identify an "emergency" brain state via its characteristic
physiological signals is the first, crucial step of our approach,
because brain studies suggest that the moment you become aware of your
internal state, you activate the prefrontal lobes, which in turn, can
begin to moderate your response. I suggested to James that the next time
he and Susan begin arguing, he simply try to notice any changes
happening in his body.
At the next session, Susan and James came–or
rather stalked–into our office, their signature brain states already
activated. Susan was furious at James for forgetting to buy her flowers
for their anniversary; James, already withdrawn, slumped sullenly into
his corner of the sofa. As soon as Lisa ad I got the gist of their
current conflict, James and I took off again for a private tete-a-tete.
Before I had even closed the door behind
us, James reported that he was feeling an uncomfortable tightness both
in his stomach and his lower jaw, sensations he had noticed several
times over the past week whenever Susan had become angry with him. At my
suggestion, he checked his current pulse rate and was stunned to find it
had soared to 85 beats per minute, in contrast to his usual, resting
rate of 68 bpm. In fact, the dramatic jump in heart rate closely mirrors
that of experimental animals in the "freeze" state after their
fear systems have been electrically stimulated. James, whose
clenched-jaw, stone-walling response to Susan's fury had a distinctly
frozen quality, was clearly in the midst of a full-fledged,
brain-mediated fear response.
I encouraged him to notice how his state
of mind seemed to kick in all at once, as if a part of him just stepped
forward and took over. He replied that he had already noticed this
happening a few days earlier, when Susan was ragging at him about the
state of their finances. "I actually tried to respond to her, you
know, say something sympathetic about the bad day I knew she'd
had," he reported. "But somewhere inside, I'd just gone
cold." I suggested that he might think of that frozen, steely part
of himself as a little guy within him whose job it was to defend him
against Susan's attacks.
In our experience, personalizing emotional
states is a powerful way of helping people to accept their
survival-driven emotions, which prepares them to interact respectfully
with them. For this personalizing strategy, we are indebted to Dick
Schwartz's Internal Family systems model, which conceptualizes
conflicting behaviors as inner family members, each with its own
distinctive personality and function. In our work, we personalize
particular bodily responses, such as a constricted throat or a nauseated
stomach, that correspond to a client's emotional state. While I was
encouraging James to view his knotted stomach as a difficult but
fanatically loyal friend, Lisa, two doors down the hall, was similarly
helping Susan to understand her rage response–particularly a
characteristic throbbing sensation behind her temples–as a desperate,
love-hungry little kid inside her who was frantically trying to get her
husband's attention. The next step would be to help each of them consult
with these inner defenders about the possibility of letting down their
respective guards.
At this point, proponents of systems
therapy may well be raising their collective eyebrows, thinking: This is
couples work? My response is that while we do a lot of individual work
with intimate partners, we are very definitely doing couples therapy. In
our experience, the hair-trigger defense system of the emotional brain
is such that for many couples, learning to regulate brain states is all
but impossible in each other's presence; nobody can calm down long
enough to do the kind of quiet, deeply focused work that is necessary to
allow an emotional system to shift. Particularly early in therapy, each
partner is far more likely to chronically trigger the other's already
hyper aroused limbic system than help to soothe it, a pattern that may
lead many couples to prematurely quit therapy, convinced that theirs is
a "hopeless case."
Consequently, our customary modus operandi
is to do a lot of individual work during the first several sessions,
until each partner develops enough skill in shifting brain states to
rejoin his or her partner in the consulting room. At that point, couples
begin to practice making these shifts in "real time," in the
midst of authentic interactions. In this way, work on the internal
system of brain states powerfully supports work on the external system
of a relationship in action.
Over the next several sessions, Lisa and I
stepped up our roles as personal coaches, helping Susan and James learn
to shift their self-protective brain states to those mediating nurture
and sorrow. We knew that when the sorrow neural system is electrically
stimulated in animals, they emit distress vocalizations signaling a kind
of mammalian separation anxiety, which in turn, triggers a "moving
toward" response from nearby animals. This is, of course, the same
primal dance we endlessly try to choreograph in our therapy offices: if
he would only drop his Lone Ranger mask, we would bet the rent that she
would reach out to him. The catch, of course, is that nobody wants to go
first. By being more aware of the conditions that allow the brain to
relax sufficiently its defenses, we hope to more effectively support our
clients in making this leap out of fear and into connection.
To that end, I spent several sessions
coaching James through conversations with his stonewalling
"defender," in an effort to help it to feel safe enough to let
down its guard. Progress was gradual and halting. Then, toward the end
of one particularly slow-moving session, I brought up how James's
typical response to Susan–sullen stonewalling–had not managed to
blunt her fury so far. He nodded, admitting that, in fact, his icy
withdrawal seemed to aggravate his wife even more. I suggested that
James notice how his inner sentry reacted when I asked: "what have
you got to lose by trying something new–like reaching out to
Susan?" This was a delicate moment: I was asking James to engage
his prefrontal cortex to entertain a new thought, without asking him to
willfully redirect his current thinking. His hand on his stomach, James
closed his eyes and focused his attention within. Perhaps 15 seconds
passed before he opened his eyes and looked at me. "It's
okay," he softly said.
"You're sure it's okay with
him?" I asked, pointing in the direction of his stomach.
"Yeah, he's okay," nodded James. He looked relaxed and
younger, somehow–less defended. His inner watchdog, he told me, had
acknowledged that shutting down had only gotten him a redoubled dose of
Susan's rage, the terrifying experience of all out attack that had
activated his defense system in the first place. If there were a better
way to stave off these assaults, his defender told him, it would do its
best to stand aside. "I'm ready," James said quietly.
Susan was on her way to being ready, too.
While James and I had been doing our work, Lisa and Susan had been
making steady progress in helping Susan's inner defender feel safe
enough to expose the intense yearning for love that hid behind her fury.
As each partner's neural defense system gradually relaxed its hold, we
began spending less time on one-on-one coaching and more time in
conjoint sessions, helping them to practice real-world interactions
without flipping into their respective fury and fear states.
Then one evening, Susan and James walked
into our office in utter silence. They had had a violent argument two
days before and had barely spoken to each other since. The issue at hand
was James' relationship with his younger brother, Sam, and his
sister-in-law, Claire, who lived only a few streets away from them.
Susan had long felt resentful toward Sam, whom she felt took advantage
of James's helpful nature, but even more hostile toward Claire, a
stunningly beautiful local fashion model. James denied feeling attracted
to Claire, but Susan had not believed him since the night she had seen
James flipping through the pages of her modeling portfolio, which
included some nude pictures.
Susan was furious now because, on the
first day of a recent, heavy snow-storm, James had called to say he was
stopping on his way home from work to help Sam and Claire dig out their
driveway before coming home to help Susan shovel out so she could attend
an evening yoga class. An hour later, when Susan walked the half-mile to
her in-laws' house to drag her husband home, she was incensed to find
James and Claire working in the driveway and laughing companionably
together, with Sam nowhere in sight. That evening Susan never made it to
her yoga class; instead, she raged hard and long at James, accusing him
of caring more about his brother's long legged, exotic-looking wife than
about her.
As our session began, Susan warned that
this was a horribly painful issue for her. As she began to recount the
incident, within seconds she was breathing so hard and fast that I
thought she might start hyperventilating. "James," she managed
between jagged breaths, "do you have any clue what you're like when
you get within sniffing distance of Claire?"
I quickly looked at James, who had turned
his gaze downward and was sitting stock-still. I feared he was shifting
into a full-scale shutdown. But after a long moment he looked up again
at his wife. "Susan," he began softly, "I don't give a
damn about Claire." When Susan hooted bitterly at this, James shook
his head in frustration. But he didn't fold. "When Sam called me to
help out, I just didn't think," he went on. "I should
have."
When Susan turned away in disgust, James
looked suddenly desperate. "Look, Susan," he said pleadingly,
"when you get mad at me like this, it's awful." She looked
back at him, clearly surprised. "It makes me feel sick
inside," he admitted to her. "I feel kind of lost." As
Susan continued gazing at him, he touched her arm. "But whatever I
did, I'm sorry I hurt you."
At this, Susan's face began to crumple.
"You did hurt me, James," she cried out. Tears spilling down
her cheeks, she jumped up and fled the room. For a moment, James looked
stunned and disoriented: A tearful Susan was not what he had expected.
Then he, too, abruptly rushed out into the hallway, where his wife was
weeping. "God, Susan, I really didn't know what a big deal this was
to you," we could hear him say. "Will you help me
understand?" As she continued to sob, we stepped out into the hall
in time to witness James enveloping his wife in a bear hug and
whispering into her hair: "It's you I want."
It was a moment of great tenderness, on of
those exchanges of naked need and open-hearted nurture that remind a
couples therapist why he or she has chosen this work. Yet ultimately,
the melting moment of bonding that we had just witnessed was not what
made us feel optimistic about James and Susan's futures. For we knew
that such jolting shots of connectedness, however real and deep, would
inevitable fade; stinging disappointments and misunderstandings would
arise again. What encouraged us most was that in the midst of this
highly charged interaction, James had demonstrated the ability to shift
from a reaction of fearful withdrawal to a warmly empathetic state that,
in turn, allowed Susan to shift from her own state of fury to one of
sorrowful hurt. We knew that if they were to construct an intimate bond
that could truly sustain them–and not remain on a neural roller
coaster of endless highs and lows–they would need to continue the
difficult and delicate work they had begun. Little by little, they were
teaching their brains to trust.
To imagine ourselves this way–as beings
whose deepest passions are rooted in the pushing and pulling of neurons
along the electrochemical tracks of our brains–is, at best, a
disturbing experience. To therapists, especially, all this talk of
neural circuitry and amygdalian imperatives may seem distastefully cold
and mechanistic for a phenomenon as warm-blooded and mysterious, even
sacred, as emotion. Yet, what may be finally most disquieting about this
exploration of the emotional brain is not that it separates us from the
pulsing core of our feeling selves, but rather that it brings us so
uncomfortably close. Any serious examination of the ancient, neural
bases of emotion forces us to confront our essential kinship with other
mammals–those instinctual beasts who seem all bared tooth and bloody
claw, so fundamentally different from our proudly cerebral human selves.
We get ourselves into far more trouble
than it's worth, suggests neurobiologist Jaak Panksepp in his
ground-breaking book Affective Neuroscience, through "our
strangely human need to aspire to be more than we are–to feel closer
to the angels than to other animals." So deeply uneasy are we with
the quivering, feral forces that can, in an eye-blink, burst through our
surfaces that we risk encasing ourselves in a kid of protective
cognitive supremacy, identifying much too thoroughly with our
city-building, book-writing, resolutely right-minded selves. Of course,
our rational brains are potent, indispensable human equipment. But the
paradox is that these impressive cerebral capacities can only guide us
to safety if we acknowledge and honor, too, the primeval responses that
still lurk in the lattices of our neural wiring. Far from dehumanizing
us, they are the elements of our humanity that we most urgently need to
welcome.