'Neuro-physiotherapy
with psychological consequences'
Internal Family Systems Therapy (IFS)
IFS has been described by some as 'Inner Attachment Work'. The basis of the IFS model is the assumption that our personality consists of many 'subpersonalities' or ‘parts’. These parts are akin to the concept of 'networks' in EMDR. These parts are formed in response to direct or indirect interactions with the environment and they store information about the situation in the form of unspent impulses (fight, flight, freeze), as well as thoughts, emotions, sensations and sometimes memories and images. However, the more pain the network contains, the more likely it is to become disconnected from the rest of the brain or become 'exiled' in the IFS language. This means the network's information never gets updated and remains unprocessed in the brain. Other networks are then formed, (known as 'protectors' in IFS) and these can take on extreme roles to stop us from becoming overwhelmed by the exile's pain and to prevent more pain in the future. An example of this might be a protector part that gets angry whenever people give you negative feedback. This protector gets triggered in order to protect the exiled part of you that feels 'not good enough' due to being criticised in the past. All psychological problems can be explained in this way, even with most extreme behaviours.
As neuroscience has proven, it is possible for networks of neurons to be accessed and modified through purposeful interactions with them. To do this, in IFS therapy, the therapist helps the client to access their core Self. The concept of Self is unique to IFS and is new to psychotherapy. Some describe it as a state of compassionate self-awareness. From a neurological point of view, when we are in the Self, we are outside of a network and therefore have no 'agenda' or urge towards completing an action. We feel open, curious, calm, safe, interested, compassionate, courageous etc. The Self cannot be physically damaged by trauma, however it can be obscured and therefore hidden by networks which formed from adverse experiences. The IFS therapist’s job is to help the client disentangle themselves from their parts and access their core Self. From this compassionate and curious place, the client can heal and help the 'burdened' networks that carry psychological pain. The aim is to connect the disconnected parts of the brain and help them feel safe again. This allows the parts to let go of their extreme or destructive roles and enter into a harmonious collaboration led by the Self. This process is not unlike EMDR or Brainspotting in its ability to reach, process and modify networks, however it is more gentle and leaves the client in complete conscious control of the process. The natural side-effect of this healing is a reduction in symptomatic behaviour and a deeper sense of Self. IFS therapy explicitly recognizes the spiritual nature of the Self, allowing the model to be helpful in spiritual development as well as psychological healing.
I am very passionate about IFS and for many years now it has been my main modality and leading life philosophy.
In 2015, the National Registry of Evidence-Based Practices and Programs (NREPP) recognized Internal Family Systems Therapy as an evidence-based psychotherapy model. In their independent, rigorous review NREPP found IFS to be an effective treatment for improving general functioning and well-being in regards to clients with chronic pain. It also found that IFS has promising outcomes for clients experiencing anxiety, depression, issues with self-concept, and physical health conditions.
Eye Movement Desensitization Reprocessing Therapy (EMDR)
Psychologists now believe that all psychological distress is caused by issues with 'poor communication' within different areas of the brain. EMDR assumes that the strong emotions experienced in trauma (and difficult experiences) interfere with how memories are stored, disconnecting them from existing, and more up-to-date memory 'networks'. EMDR has been designed specifically to help us process traumas by engaging our 'adaptive information processing system' to help restore homeostasis (balance) within the brain and the nervous system.
By focusing on trauma images, feelings, sensations and beliefs, and simultaneously engaging in bi-lateral movements or sounds, the therapist helps the clients to locate, hold in place, process/metabolise, and release information that is stuck in maladaptive survival modes or networks. Through this, the emotional charge around the memory is diminished and the network is reintegrated into the rest of the brain. If the client is not able to remember the past event, we are typically able to work with the presenting complaint directly and access the body memory via different channels. Changes are achieved on a neurological level, and whilst of course past memories cannot be erased, they can lose their emotional charge. One of the advantages of EMDR is that one does not need to discuss the events in detail. The process is quick and more comfortable than in standard talking therapies and the result is that the client quickly begins to feel less anxious, more confident and comfortable in their own skin.
EMDR is a powerful and transformational psychotherapy that is recommended by the National Institute of Clinical Excellence (NICE) and many other international bodies for the treatment of Post-Traumatic Stress Disorder (PTSD). It is widely practiced in the NHS. Alongside its proven effectiveness for PTSD and trauma, there are many published peer reviewed studies showing its effectiveness with phobias, anger, different anxiety disorders, grief, low self-esteem, complex trauma, chronic pain, addictions, anger etc.
EMDR can be practiced as a standalone therapy or in conjunction with other therapies including Cognitive Behavioural Therapy.
Brainspotting (BSP)
Brainspotting (BSP) therapy has evolved from EMDR and was developed by David Grant in 2003. Brainspotting is a beautiful and elegant way of dealing with emotional distress through engaging in deep brain processing. Like IFS and EMDR, it can be viewed as a neuro-physiological approach, with psychological consequences. However, many individuals find Brainspotting easier to engage with and more intuitive and report that processing is achieved to a deeper level than with other similar approaches.
Brainspotting originates from the observation that where we look whilst we are talking, or thinking is not random. In fact, when we are thinking of specific issues, because the eyes are an extension of the brain, our eyes naturally orientate towards specific eye positions that are neurologically linked (via the optic nerve) to the brain folders that contain the information we are accessing. This intriguing observation has led to the discovery of Brainspots. A ‘Brainspot’ is therefore the eye position which is related to the emotional activation of a an emotionally charged issue within the brain.
During a Brainspotting session, whilst talking about an emotional issue, the therapist will guide the client towards their Brainspot. Keeping a fixed gaze on the Brainspot, appears to then open the brain’s ‘felt memory files’ and at this point the client is invited to ‘go inside’ and to begin observing her/his own internal process, with a mindful focus. What follows from here is a powerful form of accelerated yet effortless ‘focused mindfulness’. Clients describe this as a 'torrential stream of consciousness’ that pours out in the form of thoughts, emotions, sensations, memories, images and reflexes. The client becomes a passive witness whilst the brain is literally going over fragments of unprocessed information and metabolizing the emotionally charged material until all activation has cleared and the network has been re-integrated into the brain. This feels different from meditating or ruminating, in that it requires no effort on client's part and the experience is usually relatively mild and not overwhelming.
There are two active ingredients that are viewed as resources during Brainspotting. This includes the Brainspot itself. The second one is the ‘therapeutic relationship’. The therapist is in dual ‘attunement’ with the client, and is actively following the client’s system wherever it goes, thereby creating a safe space within which it is safe to feel every thought, emotion, memory, sensation etc. This is a very unique experience where we can truly feel 'seen' by and 'connected to' another human being. In fact, research shows that ‘deep attunement’ is highly stabilizing to brain's pathways and is akin to inner attachment work. In other words, in Brainspotting, the safety and compassionate presence of the therapist, combined with accessing the Brainspot, create the right conditions for new more adaptive neural networks to be built and for old redundant pathways to be cleared.
During Brainspotting, the brain is re-stabilizing, re-regulating, re-organising, resourcing, and rebooting itself and the processing often continues to occur after the session has ended. The process also gives the brain an opportunity to sort through old information by keeping anything that’s worth keeping and letting go of what is no longer useful. The result is that emotional distress is reduced, new insights are formed, and we have more access to feelings of safety within our own bodies and within the world itself. When this happens, the prior activation eases and the person feels and functions better.
In the last 20 years since Brainspotting has been developed, it has spread quickly through the world of therapy. There are now at least 25,000 Brainspotting therapists worldwide. I have personally managed to convince at least 10 of my colleagues to do the training! Even therapists who’d pioneered different trauma treatments are now singing Brainspotting’s praises. For example, Somatic Experiencing developer Peter Levine, was reportedly impressed by an early demonstration of Brainspotting administered during a chance meeting. Bessel van der Kolk (trauma expert and renowned author) listed Brainspotting among the methods he claimed had 'great success.' And trauma specialist Gabor Maté later remarked that after just one Brainspotting session, he was able 'to relax the grip of a burdensome perspective and its associated emotions, both of which I had carried for a long time.'
With it being a newish form of therapy, the empirical evidence supporting its effectiveness is still emerging. One study by Maréchal et al. (2018) examined the efficacy of Brainspotting in reducing symptoms of anxiety, depression, and PTSD in a sample of refugees, showing promising results. Also, a recent study published by the Mediterranean Journal of Clinical Psychology, compared the efficacy of BSP therapy with EMDR and concluded that BSP is a good alternative to EMDR in the treatment of trauma.
Brainspotting can be combined with most psychological therapies. I personally, really enjoy integrating Brainspotting with IFS and I am simply humbled by it's power and the positive change it can bring to everyone that tries it.
Cognitive Behavioural Therapy (CBT)
What I like about CBT is that it’s a very practical form of therapy that engages the logical hemisphere of the brain and from my experience even the most sceptical of clients come to like this approach. CBT is predominantly a here and now therapy. This means it’s rooted in the present and looks ahead to the future, whilst acknowledging the contribution of the past. The main premise behind CBT is that by changing our responses to our thoughts and behaviours, we can ultimately change the way we feel about life and get ‘unstuck’.
During the course of therapy, through a functional analysis of your experiences, both the client and the therapist become ‘psychological detectives’ and begin to discover the various psychological processes that are maintaining the problem. We explore your thoughts, emotions, behaviours and bodily sensations to understand how they are connected and how they impact on your life. We look into coping strategies and evaluate their effectiveness. We then work together to find alternative ways of regulating your emotions through learning techniques to help you create a distance between you and your internal experiences, thus creating more internal space and bringing more safety into your nervous system. Other techniques include learning problem-solving skills, learning to increase tolerance for positive and negative affect, assertiveness skill, behavioural experiments and identifying your core values. All of this is approached through the lens of mindfulness and compassion towards the different parts of yourself. These skills are not difficult to learn and get much easier with practice. We also spend some time looking at the most helpful neuroscience behind our responses, so that clients can develop a sound foundation of knowledge about how psychological difficulties develop.
CBT is not a static therapy and with new discoveries about the human mind, it has continued to evolve. In the last decade, there has been a shift of paradigm towards what is now called ‘the third wave’ of CBT. New approaches such as Compassion Focused Therapy (CFT), Acceptance and Commitment Therapy (ACT) and Mindfulness CBT (MBCT), which all come under the umbrella of CBT, are increasingly being used by therapists in the private sector and in the NHS. I find these approaches to be particularly well suited to individuals experiencing more complex, severe or longstanding psychological problems. These approaches are trans-diagnostic in nature, meaning they can be applied to most problems and presentations. I have come to call this integrative way of working as CBT+.
CBT has been researched extensively, and has demonstrated effectiveness with a variety of emotional, psychological and psychiatric difficulties and it is the treatment of choice recommended by the National Institute of Clinical Excellence (NICE).