NEUROSCIENCE: A NEW DIRECTION FOR

SOLUTIONFOCUSEDTHINKERS?

Eve Lipchik, Mark Becker, Brett Brasher, James Derks, and Jane Volkmann

Eve Lipchik, MSW is in private practice at ICF Consultants, Inc. in Milwaukee, WIMark Becker, MS works as an outpatient therapist at North Central Health Care,

Wausau, WIBrett Brasher, MSW works as a therapist at the Mental Health Center of Dane County,

Madison, WIJames Derks, MS is a therapist affiliated with St. Joseph Regional Medical Center,

Milwaukee, WIJane Volkmann, MSW, works as a Social Worker and therapist with the Comprehensive

Center for Bleeding Disorders at the BloodCenter of Wisconsin, Milwaukee, WI

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ABSTRACT:

The development of highly sophisticated imaging techniques in the past twenty years has made it possible for neuroscientists to study the brain like never before. The resulting findings, particularly about emotions, are challenging psychotherapists of all orientations to reevaluate their theories and practices. These considerations are a particularly daunting task for therapists whose work reflects the post-modern denial of objective reality, like that of Solution-Focused therapists. In this article, the authors have juxtaposed solution-focused theory and practice with some key neuroscientific ideas in order to explore fit and incompatibility. Possible benefits for Solution-Focused practice are discussed.

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“The biological reality of self-preservation leads to virtue because in our inalienable need to maintain ourselves we must, of necessity, help preserve other selves.” (Damasio, 2003, p. 171)

Introduction

For the past decade, the authors of this article have been meeting to explore

aspects of Solution Focused Therapy (hereafter referred to as SFT). Some of us were part

of the group that developed it, others have been practicing it for many years. SFT has

gradually come to be defined differently by different practitioners. Some view it as a

model with strict guidelines, while others, like us, are guided by the underlying

philosophy more than the techniques. In particular, our group discussions have focused

on the role of emotions and the therapeutic relationship, areas that have been eschewed in

the solution-focused literature for the most part. The result of our discussions so far are

representative of the ideas described in Beyond Technique in Solution Focused Therapy

(Lipchik, 2002).

More recently, the wealth of information emanating from the field of

neuroscience has become increasingly central to our talks. This information seemed hard

to ignore, given our ongoing drive to grow, even though it comes from the domain of

neuroscience rather than that of philosophy. In developing their Theory of Cognition

Maturana and Varela (1987) faced the dilemma of seemingly inconsistent domains, as

well. They decided “…. to embrace a broader context” (p. 135) that does not consider

two possible descriptions of a system as a problem, but as necessary to complete the

understanding of the unity. “The problem begins when we unknowingly go from one

realm to the other and demand that the correspondences we establish between them

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(because we see these two realms simultaneously) be in fact a part of the operation of the

unity “ (p. 133-134).

We have also wondered whether a cross- fertilization of neuroscience and

postmodern therapies like SFT may represent a paradigm change , in keeping with

Kuhn’s theory that new scientific paradigms grow out of the limitations of existing ones

(l962). Be that as it may, our goal for our meetings has been none other than to enrich our

thinking. A typical example of a case that engages our curiosity and stimulates our

clinical conversations follows:

Diane, a 32 year old white female, and a single parent, sought help from a SF therapist for her twelve year old son who was suddenly becoming rebellious. Within a few sessions her son’s behavior improved, and she renegotiated the goals for therapy to deal with her own depression. Diane related a very difficult childhood, in a home with an abusive, alcoholic father who left the family when she was ten. After her parents’ divorce, Diane had to assume a lot of responsibility for her five-year-old brother because her mother had to go to work. In adolescence Diane acted out so severely that her mother terminated her parental rights and Diane was placed in foster care. She kept running away from foster homes and finally ended up on the street as a prostitute. A pregnancy at age 19 was a turning point in her life. She decided that she had to provide a decent life for her child. She gave up the street life, found a job in a restaurant, rented a studio apartment and reconciled with her mother, who was happy to become an involved grandparent. At the point in time when Diane came to therapy she had a good job in an insurance company. She had finished half the required courses for a Bachelors Degree and was providing a stable home for her son. One of Diane’s goals was to meet a decent man and get married some day. She was very disillusioned with the men she dated, most of whom she met in bars.

Diane revealed some anxieties (e.g. never going to the toilet when there was a man in the building) that suggested that she may have been sexually abused, but she claimed to have no memory of that. For the next six years Diane saw her SF therapist episodically. She gradually began to value herself and not experience feelings of depression and anxiety. The more she valued herself, the more she chose men who valued her. It was during her first really satisfying relationship that she returned to therapy in crisis. She reported having flashbacks during sex of the wallpaper on the ceiling of her grandmother’s bedroom. She had no idea what was happening and thought she was going crazy. The therapist reassured Diane, and explained the usual origin of flashbacks. She also allowed Diane to choose whether to talk further about it or not, and Diane chose not to. Nevertheless, Diane gradually remembered a man in bed with her at her grandparents’ farm during a summer she spent there when she was six years old. At first she could not identify the perpetrator and felt certain it had to be her father. She was shocked when she eventually recalled that it had been her uncle, 12 years older than she is, whom she had always considered the only man she ever loved and trusted. Months later, when Diane had integrated these memories from an adult perspective the therapist asked her why she thinks the memories of the abuse did not surface until recently. Without hesitation Diane answered, “Oh, I couldn’t have handled it earlier. I wasn’t strong enough.”

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What is it about a case like this that interests us? Diane made gradual, positive

changes over years of episodic therapeutic contact with a SF therapist and then began to

have flashbacks. What does this say about how the brain functions or about SF therapy?

Does the brain have a way of determining a person’s readiness? Is Diane’s explanation

valid? After all, many people have flashbacks without feeling they are ready to deal with

them. Neuroscience has much to say about implicit and explicit memory. Cases like this

one offer an opportunity for speculations about whether neuroscientific knowledge might

be able to inform SFT in some positive way or not. Our hope in sharing our thoughts is

that they will stimulate readers to speculate along similar lines, thereby expanding

solution-focused thinking specifically, and the practice of psychotherapy, in general.

The Neuroscience/SFT Fit

The limitations on the length of this paper allow us to highlight only a few

major neuroscientific concepts that we have considered in relationship to our version of

SFT.

1. The Critical Role of Rmotions

Siegel describes emotions as “bodily responses triggered by brain circuitry”

(Wylie & Simon, 2002, p.33). Feelings, on the other hand, are thought of as conscious

awareness of emotions. It is important to think of emotions in dynamic terms, as a

constant flow of energy that is encoded in the entire nervous system, not just in the brain.

Since one cannot separate the rest of the body from the brain, or mind (consciousness)

from the body, emotions are involved in every aspect of human experience, even the most

complex levels of thinking.

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Until late in the 20th century, emotional reactions were thought to depend on

cognitive processing, that is, we have to think in order to feel. Increasingly sophisticated

imaging technology revealed emotions to be separate neural systems in the brain, much

like cognition (Damasio, 1994; LeDoux, 1998; Siegel, 1999). Moreover, emotional

systems are more extensive than cognitive systems even though they are interdependent.

That is why emotions can overwhelm rational thinking so quickly while rational thinking

does not regulate emotions as easily.

A central area in the brain that appraises and coordinates sensory input is an area

called the amygdala. The amygdala is one of the key components of affective memory,

not just in infancy but throughout life. The amygdala is considered a “hub in the wheel of

fear” (Le Doux, l998, p.170) because one of its more important functions is to alert us to

danger. Goleman (l995, p.17) describes how LeDoux’s research led to a breakthrough in

the understanding of emotions when he demonstrated that “sensory signals from eye or

ear travel first in the brain to the thalamus, and then – across a single synapse (space

between neurons, or brain cells) – to the amygdala. A second signal from the thalamus is

routed to the neocortex, the thinking brain. This branching allows the amygdala to begin

to respond before the neocortex, which mulls information through several levels of brain

circuits before it fully perceives, and finally initiates its more finely tailored response.”

When the signals bypass the neocortex, the amygdala can store emotional experiences

that are not in conscious awareness; when the amygdala and thinking brain have

processed signals together the encoded memory is more easily accessible.

The fact that some emotional experiences are not processed cognitively, and may

therefore not be consciously accessible, is illustrated by the case of Diane, above. Diane

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recovered and dealt with her memories of abuse after several years of SFT that

emphasized her strengths and resources. It is difficult to determine why this happened

when it did. LeDoux suggests that “learning [experience] that takes place in one situation

or state is generally remembered best when you are in the same situation or state” (1996,

p.211). Was the love Diane experienced for her current boyfriend a reminder of the love

she felt for her perpetrator? Or did she feel safe enough to deal with it? We can only

speculate about these occurrences in each unique situation.

2. The Brain is Plastic

The neuroscientist Daniel Siegel who coined the term “interpersonal

neurobiology” (Siegel, 1999, p. 21) describes the brain as a living system that is open and

dynamic. “The mind develops at the interface of neurophysiological processes and

interpersonal relationships. Connections in the brain shape the way you think, but the flip

side is true, too”(Wylie, 2004, p.37). “Plasticity refers to neuronal growth and

interconnection; the ability of neurons to change the way they behave and relate to one

another as the brain adapts to the environment through time”(Cozolino, 2002, p.296).

The brain consists of neurons (brain cells) that grow through the expansion and

branching of the dendrites they project to other neurons over spaces called synapses.

Information flows across synapses by means of electrochemical charges. Neurons

interconnect to form neural networks and neural networks in turn, integrate with one

another to perform increasingly complex tasks. Though they may make a greater

difference in the early years of development, synapses remain subtly changeable by

experience throughout life (LeDoux, 2002; Cozolino, 2002). Siegel (2002, p. 221)

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reminds us that “we are always in a perpetual state of being created and creating

ourselves. We will never be just the same as we are right at this moment.”

“Therapy is just another way of creating synaptic potentiation in brain pathways

that control the amygdala. The amygdala’s emotional memories…..are indelibly burned

into its circuits. The best we can hope to do is to regulate their expression. And the way

we do this is by getting the cortex to control the amygdala” (LeDoux, l996, p. 265).

The shaping of neural networks appears to be a gradual process but “for some people,

a small change in behavior or memory processing can yield subsequent changes in mental

set (or system state) that produce large changes in behavior and internal experience

(Siegel, 2002, p.221).

Mild to moderate stress are considered favorable to the production of cells in the brain

according to Pham, Soderstrom, Henriksson & Mohammed (Cozolino, 2002, p.23-4),

whereas extreme stress can inhibit this process.

Another process that contributes to the plasticity of the brain is the repetitive firing of

a particular combination of neural cells. The repetitive firing strengthens the synaptic

connections in accordance with the Hebbian principle that “cells that fire together wire

together” (LeDoux, 2002, p.79; Siegel, l999, p.26).

3. Memory and Our Sense of Who We Are

Every person has a unique genetic signature, that together with social experience

shapes the body and mind. Cozolino (2002, p.21-22) suggests the best way to think about

this interaction is to use Kandel’s (l998) concept of genes as “serving both a template

and a transcription function.” Transcription depends on environmental triggers.

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Conscious awareness of one’s self is a gradual process that is related to the

development of areas in the brain that deal with memory. The present understanding of

memory is that there are two types: ”explicit memory” that “describes conscious learning

and memory,” and “implicit memory” that is “reflected in unconscious patterns of

learning stored in hidden layers of neural processing, largely inaccessible to conscious

awareness“(Cozolino, 2002, p.86-7; LeDoux, l998; Siegel, 2003). Implicit memory

networks are said to begin in utero and continue to develop as a child grows. During the

first few years of life, “Somatic, sensory, motor and emotional experience help sculpt

neural networks ….into a sense of physical self” (Cozolino, p.88). The capacity for

explicit memory usually does not develop until after the second year of life. It requires

the maturing of the cognitive systems that include the neo cortex and hippocampus.

Though explicit memory is dependent on both emotional and cognitive systems,

emotional and cognitive memories are stored in separate systems and have to be retrieved

from separate systems (LeDoux, l998; Siegel, l999). Moreover, memory is stored not

only in the brain but throughout the entire nervous system (Cozolino, 2002, p. 91).

How we perceive ourselves depends on implicit and explicit memory. Damasio

(l999, p.17) describes two kinds of consciousness of self, “a transient entity, ceaselessly

re-created for each and every object with which the brain interacts,” and a “nontransient

collection of unique facts and ways of being which characterize a person” and which he

calls “autobiographical self” (Damasio, l999, p.17). Siegel (2002, p.60) refers to this

nontransient state as “narrative” memory and describes it as the way we store and then

recall experienced events in story form. He points to the fact that narrative memory is co-

constructed on many levels from immediate family to culture. “Narratives creates

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shareable stories…determines patterns of behavior and may influence our internal

lives ...directly influences emotional modulation and self-organization” (p.62). However,

LeDoux (2002, p.210) cautions that memories “regardless of their emotional

implications, are not carbon copies of the experiences that created them. They are

reconstructions at the time of recall, and the state of the brain at the time of recall can

influence the way in which the withdrawn memory is remembered.”

Solution-Focused Therapy

How do these neuroscientific ideas relate to SFT?. A brief review of our version

of SFT is necessary to evaluate that further. By now, Solution-Focused Brief Therapy

(deShazer, l985; l988; l991, l994) and its off-shoot Solution-Oriented Therapy

(O’Hanlon, W.H., & Weiner-Davis, M., l989) are well-known for brief, focused

treatment. They are highly individualized approaches that help people who perceive

themselves as unable to resolve a problem, or who are sent to therapy because someone

else believes they have a problem. SFT evolved from Brief Family Therapy (deShazer,

l982), an ecosystemic approach that built on the work of Milton Erickson (Erickson, et

al., l976) Gregory Bateson (Bateson, et al., l956), and the Mental Research Institute

(Fisch, et al., l982). Its theoretical base shifted to constructivism when the developers

realized that solutions can occur independently of the problem, or when clients focus on

what works, rather than what does not work. More recently, de Shazer’s work has used

the philosophy of language (Wittgenstein, l974; Derrida, l982; deSaussure, l966) as a

foundation for SFT thinking (de Shazer, l994) while Lipchik (2002) has drawn on the

interpersonal theory of psychiatry of Harry Stack Sullivan (l953) and the biology of

cognition (Maturana & Varela, l987). Postmodern thinkers tend to shy away from the

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concept of a theory that guides their interaction with clients to avoid interfering with the

individualized construction of meaning (Anderson & Goolishian, l988; deShazer & Berg,

l992; Hoffman, l998). We, on the other hand, believe that a theoretical framework and

assumptions, can both respect the clients’ individuality and provide guidelines for

constructing and maintaining the context in which clients are most likely to find solutions

for themselves.

The Fit Between Our Theoretical Assumptions and Neuroscience

Dual track thinking (Lipchik, 2002) is a process whereby SF therapists monitor

their emotional state and thoughts to avoid getting caught in their clients’ emotional and

cognitive reactions. For example, a therapist may notice feeling discouraged when a

client reports no progress, or overwhelmed by the complexity of a client’s life. This is

undoubtedly how the clients are feeling, as well. However, since it is the SF therapist’s

responsibility to be helpful, he or she must have a mechanism for not getting stuck in the

client’s state of mind and feelings. The first step is to recognize that one is stuck; the

second is to refer to a theory and assumptions for how to proceed. When the discouraged

or overwhelmed therapists calls up “Nothing is all negative,” or “A small change can lead

to bigger changes” it remind her to keep exploring whether there was not a very small

change after all, or what small change might make even a bit of difference in the week to

come.

Dual-track thinking may involve “mirror neurons” (Cozolino, 2001, pp.184-186;

Damasio, 2003, pp.115-186; Siegel & Hartzell, 2003) discovered by neuroscientists in

the past decade. Mirror neurons may be a key to understanding empathy in therapy, not

only in learning and communication. They “can represent in an individual’s brain, the

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movements that very brain sees in another individual, and produce signals toward

sensorimotor structures so that the corresponding movements are either ’previewed’ in

simulation mode, or actually executed (Damasio, 2003, p.115). Examples that come to

mind are when one person’s yawning causes another to feel tired or begin to yawn, or

when therapists find themselves assuming the body position of the client they are talking

with. “Because empathy is rooted in the body, the more mindful therapist’s are of their

own somatic responses the more skillfully they can choose to engage mirror neurons to

give valuable information about a client’s emotional state. Equally important, this can

slow down, or even halt, the brain’s rush to empathize when it might overwhelm the

client or the therapist.” (Wylie, 2004, p. 49).

The following theoretical statement represents the underpinning of the SFT

thinking in this article (Lipchik, 2002):

Human beings are unique in their genetic heritage and social development. Their capacity to change is determined by these factors and their interactions with others. Problems are present life situations experienced as emotional discomfort with self, and in relation to others. Change occurs through language when recognition of exceptions and existing and potential strengths create new actions.

We have juxtaposed the theoretical assumptions (Lipchik, 2002) with neuroscientific

ideas to highlight compatibility and incompatibility.

1.Every Client is Unique:

This assumption is a guideline for therapists to keep an open mind to clients’

stories and unique manner of functioning in the world, and not to allow themselves to

compare one client’s situation and responses to therapy with that of another.

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From the neuroscientific perspective, as well, every human is considered to be

unique from a genetic point of view and from how social experience shapes their mind

and body.

2. Clients Have the Strength and rRsources to Help Themselves:

With dual-track thinking this assumption guides therapists not to get caught into

the clients’ perceptions about their problem, but to talk about what has worked, or might

work. SF questions implement this assumption by asking clients to think of exceptions to

their problem; past experiences in problem solving; coping skills; fantasies about how

things will be different when the problem is solved; what to do if the problem persists;

what is positive about the negative aspects of the problem; and scaling questions that

measure the degrees of discomfort, as well as of change. The answers to these questions

have the potential of offering hope, which in turn can create motivation to risk doing

something different.

This assumption is compatible with the neuroscientific belief that as human

beings we have resources, such as: autonomic reactions to survive external threats (fight,

flee, freeze); an immune system that serves to combat internal threats; and a brain that

allows for learning, remembering, and experiencing life both emotionally and rationally.

SF questions regulate emotions. They may also facilitate recall of strengths and

resources by creating a mood state similar to one in which a client may have had positive

experiences. “……we are more likely to have unpleasant memories when we are sad, and

pleasant ones when happy. The so-called mood congruity of memory is amplified in

depressed persons, who seem at times to only be capable of maudlin

memories.”(LeDoux, 1996, p.212).

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These ideas cause one to speculate whether SFT gradually

reinforced Diane’s resources until she gained enough control over her

emotions to handle her disturbing memories.

3.Nothing is All Negative:

This assumption, like the previous ones, guides the SF therapist to

talk with clients about what works, rather than what does not work, so they

can focus on their resources rather than their problem.

From the neuroscientific point of view, consciousness is comparable to

our working memory. “Working memory allows us to know that the ‘here and now’ is

‘here’ and is happening ‘now” (LeDoux, 1996, p.278). Thus working memory engages

only an infinitesimal fraction of our implicit and explicit memory, and all encoded

memory can not be negative. The story of Diane is certainly a clear case in point.

However, neuroscientific concepts about memory, particularly implicit memory that may

be indelible, raises some questions about compatibility with this SF assumption. This

issue will be addressed further in the Clinical Implications.

4. There is No Such Thing as Resistance:

This assumption is intended to guide the SF therapists away from power struggles

with clients. Obviously, clients are often resistant to change even though they want it. We

have always been guided by Erickson’s concept of utilizing what clients bring to therapy

(Erickson & Rossi, l976; Erickson, l977), an idea that was translated into the solution-

focused concept of “cooperating with how clients cooperate” (deShazer, l982, pp.9-10).

This helps SF therapists to focus more on the clients’ point of view than on their own,

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and to avoid arguments about change. The most helpful question SF therapists can ask

themselves is “What is motivating this person?” not “Why is this person resistant?”

From a neuroscientific perspective, resistance can be thought of as an emotional

fear reaction that a person may or may not be consciously aware of. Since SF therapists

deliberately assume the clients’ position to avoid resistance, they obviously recognize

that is exists and is difficult to deal with. In that respect the two perspectives are

congruent.

5.You Cannot Change Clients: They Can Only Change Themselves:

This assumption is a guide to SF therapists not to try to influence clients but to

help them find solutions that fit them uniquely. This assumption fits neuroscientific

thinking that the unique genetic template and social development of a person resulting in

autobiographical /narrative memory makes it highly unpredictable when, how, and to

what extent a person can, or should change. The fact that some implicit memory may be

indelible must also be taken into consideration in this regard. Certainly Diane is a good

example of clients’ determining their course of change rather than therapists.

6. Solution-focused Therapy Goes Slowly:

This assumption is intended to remind SF therapists to hold off on the use of

techniques until they truly understand clients’ needs and wants. The push to define a goal

too quickly has the potential of slowing down, rather than facilitating solution

construction. It is useful to think of defining a goal as a process that may require ongoing

clarification as clients become more aware of their actual needs and wants, and about

how they will know they have achieved them. The importance of goal clarification is

illustrated by the following case:

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Sylvia, a 35-year old physical therapist, came to see a SF therapist for help with her 7-year old daughter, Tammy, who was generally oppositional, but particularly around bedtime. When the therapist asked Sylvia how she will know that the problem is solved, she said that the child will respond obediently to her requests. The therapist asked about times when that happened already, and what was different at those times. Sylvia was able to describe a few exceptions but seemed unable to collaborate with the therapist any further. The therapist then asked Sylvia to describe in small steps how she hopes Tammy will obey in the future. This, and additional SF questions did not produce any movement toward a solution. Finally the therapist turned to Sylvia and said, “My questions do not seem to be helpful to you. Have we been talking about what you came here to talk about?” The client’s face lit up and she replied emphatically, “Actually, we aren’t talking about why I am here. I’m here because I think there is something wrong with me that I can’t make Tammy obey. I want to feel better about myself as a mother.” With that goal in mind the conversation became productive.

SF therapists’ on-going efforts to understand how clients perceive their situation

is the shortest route to solutions. One can imagine how emotionally upsetting it must be

for a client to come to an expert for help and to feel misunderstood! For Sylvia, the

frustration of not being heard, added to the stress caused by her sense of failure as a

mother, must have inhibited her ability to process cognitively even more. Had the

therapist clarified her reasons for coming more carefully before asking SF questions, a

different neuronal condition for change might have resulted .

As pointed out above (see Section 2, Plasticity of the Brain) it is really not possible to

predict the rate of change of an individual’s neuronal systems and behaviors. While it

may seem reasonable to assume that the changes are gradual, and based on repetition,

every therapist has experienced situations where sudden and lasting change occurs.

7. There is No Cause and Effect and

8. Solutions Do Not Necessarily Have Anything To Do With the Problem:

These two assumption are a warning to SF therapists to keep an open mind to change

in the future rather than on trying to understand why the problem exists. This suggests not

worrying about “why” a problem exists but focusing on “what to do about it.”

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According to neuroscientists, past experience affects development and present

functioning. Extreme stress and neglect has been shown to have a detrimental effect on

brain development in early childhood, and in processing later in life (Cozolino, 2002;

Livingston, l992, pp.172-3; Siegel, l999; Siegel & Hartzell, 2003). This information

implies that there are general causes for emotional distress, in the present, but it can not

be used to imply causality for specific symptoms. How could one verify that Diane’s

sexual abuse caused her rebellious adolescence and/or later depression? Furthermore,

while it is said that implicit memory encoded in the amygdala can not be erased (LeDoux,

1996, p. 251) it is said that new neuronal pathways leading to different responses are

possible and can be strengthened by repetition.

9. Emotions Are Part of Every Problem and Solution:

This assumption reminds SF therapists that feelings are another way to meet clients

where they are at the moment, and to engage on that level rather than to refocus attention

to behaviors. Postmodern thinking argues against treating emotions as distinct from

action [language being action] (Miller & deShazer, 2000 ) . On the other hand, Maturana

(1996) suggests that emotions as the basis for language, because emotions are the basis of

motivation, and motivation, rather than rational thinking, determine the decisions we

make.

Given that clients usually come to therapy lacking good emotional control the context

in which the therapeutic conversations take place must be calming. This context, which

we call the “emotional climate,” (Lipchik, 2002) serves as a medium for growing and

maintaining the therapeutic relationship. The SF therapist utilizes dual-track thinking to

counter clients’ usually negative, hopeless, either/or stance with acceptance, lack of

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judgement, and both/and thinking. The emotional climate can be seen as enhancing

clients’ ability to maintain optimal capacity to think under stress. This is congruent with

the neuroscientific finding that cognition is easily shut down by intense emotions because

connections from the cortical areas to the amygdala are weaker than the connections

from the amygdala to the cortex (LeDoux, 1996, p. 265). SF therapists’ accommodating

stance toward clients may also create a state of “neuromodularity,” a condition which

Siegel describes as one in which “neuron connectivity is more likely to happen and

[therefore] the brain is more plastic……. This happens through the release of

neurotransmitters like serotonin and norepinephrine.’ In lay terms, this means that the

more brain networks engaged [especially those involved in emotion], the more pliable the

circuitry” (Wylie & Simon, 2002, p.34).

10. Change is Constant and Inevitable: A Small Change Can Lead to Bigger Change:

This assumption helps SF therapists maintain a hopeful attitude in relation to

clients who may feel stuck or hopeless. The SF interview is geared toward helping clients

come up with small exceptions or ideas for the future that can be built on during the

session or between sessions. Traditionally, SFT has included a consultation break that

serves to reinforce this process. During this consultation break, the therapist either meets

with a team behind a one-way mirror or reviews the session alone. A message is

composed that is read to the clients when the therapist return to the room. Originally, this

message consisted of a compliment, a clue that offered a comment from the therapist

about the situation (e.g., a reframe, a normalization, some information) and a task clients

were asked to do for the next session. Lipchik (2002) has revised this to consist of a

recapitulation of what the therapist heard from clients during the session (“What I heard

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you say today……”) , followed by a statement of response (“My response to what I heard

is…………” The content of the response corresponds to the clue), and a suggestion for a

task, rather than a prescription. A prescription was seen as too directive in the context of

SFT. This latter process is believed to reflect the therapeutic process better than the

original one.

The consultation break was said to result in a “yes set” (deShazer, l982; Erickson

& Rossi, l979; Erickson et al., l976) for clients, a state of mind that induces relaxation

after increased tension, and is manifested by approving head nods. The tension clients

experience during the break while waiting for the therapist to come back with a message

is relieved by the recapitulation because it indicates that they have been heard and

understood. In this more relaxed state of mind clients are believed to be more receptive to

new information, and more likely to profit from it between sessions. This process

translates easily to neuroscientific thinking about favorable conditions for synaptic

growth.

11. One Cannot Change the Past so One Should Concentrate on the Future:

This assumption reminds SF therapists to work on what to change in the future

rather than on reasons for the problematic past or present.

Neuroscientists tell us that implicit and explicit memory can not be erased under

normal circumstances, but can only be contained by change that occurs through the

strengthening of synaptic connections between neurons. These seemingly divergent views

also have a degree of compatibility when we consider that problems experienced as

occurring in the present are processed through memory that is an encoding of past

experience. However, memory is not all negative. It includes positive experiences of

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loving, coping and learning, as well as of pain. A change in the perception of the past

may lead to more self-regulatory behaviors in the present and future. The neuroscientific

caveat that remains, however, given the indelibility of some traumatic experiences

(LeDoux, l996) is the potential for the traumatic memories to dominate again at times of

increased stress.

In therapy, Diane began to understand and accept her mixed feelings of love for

her uncle and anger at his behavior. This understanding helped her overcome her guilt for

having participated and remembering that she enjoyed aspects of it. It is obviously

impossible to predict whether these memories could, or will create stress for her again

under certain circumstances in the future.

Clinical Implications

The clinical implications that follow reflect the uncertainties of work in progress.

It is a summary of our attempts to integrate what we are learning from neuroscience,

with SFT, in a manner that fits constructivist thinking as much as possible.

1. The Citical Role of Emotions

Systemic or post-modern therapies focus on behavioral and linguistic patterns

rather than emotions as a locus of change. In SFT conversation about behavior is favored

because it is easier to track and to measure. However, we believe that excluding talk

about feelings may limit possibilities for change (Lipchik, 2002) because the mechanisms

through which cognitive and emotional memory are stored, and retrieved are different

(LeDoux, l996, p.69). We also do not divert clients from talking about feelings to talking

about behaviors because it has become clear to us that the SF sequences of questions

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eventually lead to talk about behaviors anyway (Kiser, Piercy, & Lipchik, l993). We

prefer to avoid the risk that clients may feel that they are not being heard .

Most clients use feeling language to describe their reasons for coming to therapy,

such as “I feel so hopeless,” “I feel so angry at myself (or another),” I feel so unable to

concentrate since my mother died.” After empathic reflections and clarification of how

clients will know they do not have to come anymore, the SF therapist usually asks

whether there are times when the feelings expressed are just a little better or more

tolerable. The answer may include a description of a behavior, such as “when I’m busy,”

“when I’m at work,” “when I’m talking on the phone.” The behaviors described may

represent steps to possible solutions yet the client may not follow up on them. The

reason for this is either that the goal has not been clarified enough, or that the client lacks

the necessary motivation. Motivation is emotionally based. The best way to rekindle

motivation is accept what the client is offering, the ambivalence, and to express

understanding for that position. The suggestion to keep doing what they are doing until

they feel ready to do something different relieves the emotional stress of the ambivalence

at the same time that it makes room for new ideas.

On the other hand, there are clients who are noticeably unaware of their feelings

in spite of the fact that their situation calls for them. The ability to recognize and tolerate

emotions, rather than to deny them, provides the control clients are seeking. Anger or

anxiety can be seen as a resource when recognized early and handled in a productive

manner. A trusting therapeutic relationship resulting from a safe emotional climate can

build gradual tolerance of formerly avoided feelings. Our feeling is that the best way to

help clients retrieve as many resources as they can, given the different channels through

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which they are stored and retrieved, is to address both their feelings and their thoughts

and behaviors.

A totally new consideration for SFT is the understanding that emotions are a

whole body experience. This demands development of new ideas and techniques.

Following is an example of how we are beginning to think about this:

A depressed woman, who is afraid to be assertive with her husband, is asked, “What do you feel in the body when you feel intimidated by your husband? Where do you feel it?” “How is that different when you feel relaxed in your husband’s presence?” “What do you want to tell him when you are intimidated?” “Imagine yourself relaxed in his presence now…..feel that in your body…..imagine telling him how he makes you feel when you are in a relaxed state?” “What do you notice that is different?” The relaxed state can then be reinforced with suggestions that clients evoke the feeling five to ten times a day between sessions.

This form of questioning has the potential for expanding possibilities for

solutions that are similar to the Miracle Question. Talking about the problem may also

lead to resources given that “the matchbetween thecurrent emotional state and the

emotional state stores [as part of a memory] facilitates the activation of the explicit

memory” (LeDoux, l998, p.212). In situations where talk about present and future

solutions has not proven to be productive, exploring the problem situation in greater detail

may uncover useful coping skills and resources. Naturally, this requires monitoring

clients’ comfort and safety carefully.

Alternatives to talk therapy are obviously not new. One need only think of

Virginia Satir and her experiential techniques like family sculpting (Satir, Stachowiak, &

Taschman, l975). Modalities like psychodrama (Blatner & Blatner, l988) and

neurolinguistic programming (Grinder & Bandler, l976) have similarly explored routes for

going beyond the verbal route to change. More recently, EMDR (Shapiro, 2001) describes

protocols for reprocessing disturbing experiences stored in the nervous system that have

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not been cognitively processed. Levine and Frederick (1997) and Ogden & Minton (2000)

aim to achieve similar goals with methods that focus primarily on sensorimotor systems.

SF therapists have always tended to think their work entails asking the right

questions. Those who choose to broaden that belief will have to become more aware of

their clients’ non-verbal cues (repetitive gestures, body positions, breathing, skin tones)

as well as their own. They will have to broaden their questions to include the body and

non-verbal expression. Techniques that utilize drawing, imaging, and music can be useful

adjuncts, as well, depending on a particular client’s unique interests or characteristics.

2. The Brain is Plastic

We have always believed that SFT is a highly effective and client friendly

therapeutic modality and juxtaposing it with neuroscientific information reaffirms that

belief. Clients usually come to therapy with some fear about how they will be judged and

what the experience will be like. It is probable that their amygdala is communicating with

their orbitofrontal cortex to assess whether the therapist and the situation are safe. Clients

may be experiencing feelings of helplessness, hopelessness, anxiety, defensiveness and

anger at themselves or at others. They are focused on negatives, including their

perception of the problem, its causes, and their mistakes. Problems and solutions are

experiences as either/or and as distances apart. Feeling stuck and out of control stimulates

the autonomous fear reactions that are registered all over the body. In response, the SF

therapists “cooperate with how clients cooperate” by being nonjudgmental and non-

confrontive, by eliciting memories of what has, or might work for them, and by

encouraging a both/and, rather than an either/or perspective. The resulting relationship

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that unfolds in the safety of the emotional climate produces the conditions that

neuroscientists describe as optimal for change.

In contrast to the above, we are also told that mild to moderate stress stimulates

neuronal growth. How does one gauge the degree of comfort or stress necesssary for

neuronal growth? Since every person is unique, clinical judgement will have to

be the determining factor. Our current thinking is that regardless of how safe clients feel

in a therapy session, the concentrated focus on their problem and the possible options

results in the necessary degree of stress to counteract the effects of total relaxation.

. The Hebbian principle that “cells that fire together wire together” (1949) raises

the point that it may be useful for SF therapists to consider prescribing repetition of

thoughts or behaviors that represent possible steps to solutions. Since most SF therapists

are accustomed to giving homework assignment, or making suggestions at the end of the

session, this fits with the existing protocol. For example, one might suggest “Every time

you have a negative thought about yourself follow it with one of the positive ones we

discussed in this session” to clients who are self-depreciating, or “Practice placing your

hand on your abdomen and taking three deep breaths slowly at least three times a day.

Notice how your body feels afterwards. Then, as soon as you feel any anxiety place your

hand on your abdomen and take three deep breaths slowly.”

3. The Concept of Time

SFT traditionally cautions the therapist to talk about the future rather than the

past. However, since the past, much as an imagined future, have to be constructed in the

present, and involve emotional and cognitive memory, talking about the past may be

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useful, as well. When clients come to therapy feeling incompetent because of a past

situation, unloved in a present relationship, or anxious about a future event, the difference

that will make the difference for a solution has to occur in present time.

It may also be useful for SF therapists to explain to clients that present memory

may be somewhat different than past memories of the same event, and that everyone’s

reality is valid in the present, particularly when working with couples and families that

keep bringing up the past. Narratives change over the span of a lifetime, and what is

believed to be true at one time may no longer be true at another. This variability is also

true of behavior, since memory at any one time determines reactions, and experience in

response to reactions are encoded and in turn affect future reactions.

4. Neuroscientific Information Can Benefit Clients

A valuable aspect of neuroscientific information is the function it can serve as a

therapeutic tool (Atkinson, 1999, 2001). The heavy emphasis of the media on the

various treatments for emotional problems does not seem to have made clients feel less

badly about having to seek help from a therapist. This is not the case when people have to

see a physician about a physical ailment. Consequently, a neuroscientific explanation of

why we are unable to gain control over a symptom can serve as a valuable cognitive

reframe that relieves emotional pressure. This is very similar to externalizing the

symptom (White, 1988/9). Emotional relief clears the way for hope and consideration of

options.

A recent example that comes to mind is a woman who came to therapy to deal with uncontrolled rage. She spent the first two sessions responding in a “yes but” manner to everything the therapist asked or said. The therapist decided to explain that it is unlikely that she is going to learn to control this anger because of the way the cognitive systems in the brain shuts down when the emotional systems are over- stimulated. This seemed to relieve the client and she wanted to know what to do to reduce the emotional stimulation. The therapist suggested various way of reducing stress and increasing relaxation (including some the client had said “yes but” to before). At the next session the client reported that she has incorporated

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exercise and relaxation into her daily routine and that she was experiencing more self control.

5. The Therapist's Use of Self

Traditionally self-reflection has also not been part of SFT even though

“cooperating with how clients cooperate” and maintaining the emotional climate, require

the SF therapist to consciously assume a stance in relation to clients. The interaction of

the therapist’s positive attitude with the client’s negative one is thought to contribute to a

shift toward the positive for the client.

The emphasis of neuroscience on the importance of interpersonal relationship for

brain development and change makes it seem more important than ever that we use

ourselves as much as possible for our clients’ benefit. Our understanding of ourselves

should now extend beyond the intellect to emotional and physical sensations. We can

explore other therapeutic methods and techniques to see whether they can be adapted to

fit SF assumptions. For example, when a SF therapist notices that a client blushes and

smiles while talking about her anger at her spouse, he would not attempt to interpret that

inconsistency, as a psychodynamic therapist would, but ask the client what this behavior

means to her, what she think the consequences of the behavior are, whether or not she

wants to continue this action, and if not, what she would like to do instead.

Further research on “mirror neurons” will undoubtedly have much to offer us in

terms of how to use ourselves in relation to clients. We may find out that the balance a

therapist maintains between emotion and cognition by means of dual track thinking is

transmitted to clients through “mirror neurons.” We all know that clients are reactive to a

therapist’s anxiety or uncertainty. Why not to the therapist’s emotional balance?

Conclusion

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Neuroscientists work in a domain in which the human body is a material reality.

SF therapists work in a domain in which reality is a subjective experience constructed

through language. It is difficult in this moment in time to imagine a theoretical

integration of these very different domains. We have experienced similar dichotomies

before. Family therapy theory focused on patterns between people as the locus of change

This theory was gradually challenged as discriminating against women and minorities

(Hare-Mustin, l987; Goodrich et al., l988; McGoldrick, Anderson & Walsh,1989; Sue &

Sue, l990). The attempts to consider both social context and systemic patterns resulted in

a paradigm shift that focused on individual constructs of reality. Those individual

constructs depend on interactions with other systems on many levels.

SF therapists considers problems as subjective realities and believe that people

have inherent resources to find solutions to these perceived problems. In this paper, we

have explored some neuroscientific findings that suggest that the most evolved living

systems (human beings) have mechanisms that allow for subjective realities and

continuing change. When SF therapists say that change occurs through language they

mean verbal and nonverbal language. Verbal language is cognitively based; nonverbal

language is usually out of awareness and expressed through the body. Problems are

subjective realities that are experienced cognitively and physically. Therefore,

psychotherapy can be conceived of as helping clients both cognitively and physically.

SFT has used cognitive/behavioral techniques to collaborate with clients for change.

Purists have always maintained that the SF therapist must not offer any suggestions since

solutions must draw wholly on the clients’ own resources for solutions. At the same time,

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those very therapists have prescribed tasks or homework assignments after a consultation

break or at the end of a session.

A more moderate view of therapeutic collaboration would allow SF therapists to

contribute “news of difference” (Bateson, 1979) toward solution that is not limited to

any specific technique. It could be as broad as providing any information the client may

need but lacks. The source of “news of difference” would be derived from therapists’

professional knowledge about theory, technique, human development, social and cultural

attitudes, and clinical experience. It could even include neuroscientific information!

How would utilizing relaxation exercises to help clients regulate their emotions, drawing

to access implicit memory, or the use of EMDR at times interfere with the belief that

clients have a subjective reality that we must respect as uniquely theirs, and not impose

on, except for ethical transgressions prescribed by our profession? Does the knowledge

that implicit memory may be affecting our clients’ present behavior without their

awareness have to interfere with our clinical decisions?

This brings us back to Diane, whose story we presented at the beginning of this

article. What can we learn from this case other than to be awed by the protective qualities

of the mind? Could there have been a safe way to access the sexual abuse earlier without

retraumatizing Diane? If so, would that have been useful for Diane, and how? Or is it

best to “cooperates with how clients cooperate?” The more we learn the more we want to

know!

The project we are engaged in continues to raise more questions than to provide

answers. The most obvious question is what is to be gained by even thinking about this

integration? Is it more than an exercise of translating the language of different domains?

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What about the boundaries of SF therapy? If neuroscientific findings were to be

integrated into SFT, would it still be SFT? How would this affect therapists’ training?

How can therapists reconcile more concrete concepts with subjective ones? Will

neuroscientific information represent a step in the evolution of psychotherapy in general,

or simply confirm existing ones, particularly pychodynamic therapy? Time and

continuing research in neuroscience and psychotherapy will undoubtedly answer some of

these questions at the same time that they may raise new ones. Some questions may

never be answered, or just continue to confirm that the therapeutic relationship, rather

than any methodology, makes the biggest difference (Lambert,1992). Be that as it may,

we shall continue our project rather than accept that what we are presently doing is the

best we can do for our clients.

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Eve Lipchik

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ICF Consultants, Inc.

1524 N. Farwell Avenue

Milwaukee, WI 53202

Fax: (414) 273-2223; Telephone: (414) 273-2220)

e-mail: icfeve@sbcglobal.net

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