Sebern Fisher, MA, BCIAC

Consensus is building that all successful therapy relies on affect regulation and that most, if not all, serious disorders are, indeed, disorders of affect regulation. The core affect giving rise to all other painful, disorganizing affects, is fear. Although effective for the organization of brain function in many realms, neurofeedback is perhaps most singularly effective in quieting fear.

In this workshop, I will discuss the connections between fear and psychopathology.

I will review the emerging literature on attachment, brain development and affect regulation. This research is extremely important for neurofeedback providers because it offers a guide for assessment and protocol development and because, presently, neurofeedback offers the most significant hope for the ‘untreatable populations’: personality disorders, conduct disorder, severe mood disorders, attachment disorder and sociopathy.

Fear, of course, underwrites less severe conditions as well. We will look at all psychological disorders in the light of affect regulation. In neurofeedback terminology, affect regulation is usually broken down into overarousal, underarousal and instability of arousal. We will consider the usefulness of DSM diagnosis in neurofeedback compared to symptoms of arousal.

Neurofeedback provides new clinical opportunities for the therapist and it also makes new clinical demands. When someone has lived in a state of fear and then fear recedes, there is inevitably a crisis in identity. We will discuss how to predict and mange this crisis to make it a time of possibility rather than a time of more fear.

The neurofeedback practitioner must be prepared for very rapid shifts in state and must be able to discern the meaning of these state shifts and also be able to teach the patient to do so. We will spend time on the reality and meaning of state dependence, on the consequences of state shift, and on the confusion we experience between our state and “ourselves”. We will discuss the transference implications of neurofeedback, particularly the impact on negative transference, and we will reflect on the reconfiguration of the therapeutic relationship that now includes the powerful “third”, the neurofeedback training.

Neurofeedback presents us with a fundamental paradigm shift away from psyche or learned behavior toward the infra structure of both, the brain. Once we begin neurofeedback, neurofeedback has to become our operating paradigm. We can no longer fall back on concepts such resistance or secondary gain. Once under way with training, the first rule-out for subsequent effects is always neurofeedback. This paradigm shift has profound implications for the way we view psychopathology and the way we approach its treatment. I will rely heavily on case material to illustrate all of these concepts.

We will also discuss the pragmatics: when to talk and when to train; when to introduce alpha-theta; the issue of ‘touch’; the presence of the therapist; the length of sessions; the set-up of the system for optimal interpersonal connection; and other concerns as they arise. We will also look at the necessity and the limitations of the therapist training him or herself.

Neurofeedback enhances psychotherapy but psychotherapy also enhances neurofeedback. They are most beautiful together. Those in psychotherapy tend to stay in neurofeedback and those doing neurofeedback tend to do much better in their therapy. The alliance with the therapist contains and sustains the patient through any periods of destabilization or lack of progress with training. With help from the therapist, neurofeedback teaches one of life’s most important lessons – we are not our states. It allows a forum for the naming and practice of new emotional and behavioral capacities such as empathy and trust. It allows for the integration of rapid changes in state and identity, as well as the possibility for exploration of all that was lost in their inability to regulate affect. Finally, it allows for the consolidation of the new self that is born of affect regulation within an attuned relationship. This possibility brings us full circle in the attachment paradigm that was set out at the beginning of the workshop.

The first day and second morning, I will talk about these topics, primarily calling on my case experience as we develop a discourse on integration. During the second day, I will ask participants who wish to, to present their cases and their dilemmas in the integration of psychotherapy and neurofeedback.

The integration of neurofeedback and psychotherapy is one of the richest experiences any therapist could hope to have. We have the exceptional privilege of being at the intersection where brain becomes mind.

This workshop is for psychotherapists who are working with adolescents and adults. If you are working primarily with children and feel from this description that the workshop will be helpful to you, please join us. Although my orientation is psychodynamic, I am also quite familiar with cognitive-behavioral approaches. Neurofeedback proves that both approaches are right and neither is sufficient.

Learning Objectives

1. Participants will explore the interface between affect regulation, mental health and neurofeedback
2. Participants will learn to move between paradigms of psychotherapy (dynamic, analytic and behavioral) and that of neurofeedback
3. Participants will learn approaches to the theoretical and practical integration of neurofeedback and psychotherapy.

Sebern Fisher has practiced psychodynamic psychotherapy for nearly thirty years; she was the first person to implement Dialectical Behavior Therapy in a milieu setting and for the past seventeen years has been using neurofeedback as an essential component of her treatment approach. She has trained nationally and internationally on neurofeedback, on fear and psychopathology, and on attachment theory and neurofeedback and authored the new book from Norton, Neurofeedback in the Treatment of Developmental Trauma: Calming the Fear-driven Brain.