Loving with the Brain in Mind:
Neurobiology & Couple Therapy
Mona D. Fishbane, Ph.D.
Iowa AMFT Conference
April 21, 2017
www.monafishbane.com
[email protected]
Love
• Like many animals, we seek to form pairbonds
• Passionate Love, Companionate Love
• Relationship satisfaction tends to
deteriorate over time
• "Can love last?" (Mitchell)
The Life Cycle of Love (Helen Fisher)
• 3 Stages of Love:
– Lust, fired by Testosterone
– Romantic Love, fired by Dopamine and
Norepinephrine, Oxytocin
– Attachment, fired by Oxytocin and
Vasopressin
Love is a Drug
• Romantic Love is like an addictive drug,
triggering the same reward centers in the
brain as cocaine
• Romantic love lasts 12-18 months
Intimate Relationships
& Health
• Happy love relationships associated with
health and longevity
• Loneliness & unhappy relationships
associated with poor health and mortality
• Marriage, health & gender
Cultural beliefs
about love
• Happily ever after
• Entitlement to be loved
• “Falling in love,” “Falling out of love”: A
passive view of loving
• Values of individualism & competition:
Impact on love
Couples high in
satisfaction have:
– Equality
– Emotional skillfulness in partners (emotion
regulation, communication, empathy,
mindfulness, agreeableness)
– Secure attachment
Gottman’s Happy Couples
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Friendship, mutual admiration, respect
“We”-ness; partners turn toward each other
Nurture a culture of positivity; 5:1 ratio
Constructive Conflict
Don’t get physiologically overaroused in conflict
Trust: Built through repair after “mismeetings”
(Buber)
Becoming a Proactive Lover
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Active -vs- passive view of loving
Relational Empowerment
Self-responsibility, Relational responsibility
Nurturing the “We”
Thich Nhat Hanh: Water the seeds of love
Couples in Distress
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Mutual Activation Process
Hot Emotions
Reactivity, Defensiveness
Criticism, Contempt, Defensiveness,
Stonewalling (Gottman)
• Power Struggles
• Sense of defeat, don’t know how to get
through to each other
• The Blame Game
Cultural Influences
on the Blame Game
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Competition -vs- Collaboration
Debate -vs- Dialogue
Independence -vs- Interdependence
Individualism -vs- Relational Self
Rights-vs-Responsibilities
Naïve idealization of marriage/intimate
relationships
• Patriarchy, rigid gender roles
• Isolation of nuclear families
Neurobiology &
The Blame Game
• We are wired to protect ourselves when
we feel attacked or criticized
• Fight/Flight
• Attack/Defend; Attack/Counterattack;
Attack/Withdraw
• This happens automatically, beneath
awareness
“The Interpreter” (Gazzaniga)
• When we get upset, our brain seeks to explain
why
• “The Interpreter”: Left PFC (prefrontal cortex)
comes up with an explanation
– The explanation may have little to do with reality, may
be a confabulation
– The explanation is often self-justifying, and blaming of
our partner
• Both partners defend their “reality” in the Blame
Game
Automaticity-vs-Choice
• We live much of our life on automatic pilot
• This allows our limited cognitive resources to be
devoted to the important stuff
• The downside of automaticity: We are often
unaware of what is driving us, but we react
nonetheless
• “The unbearable automaticity of being” (Bargh &
Chartrand)
• Choice: A prefrontal process
– “The pause that refreshes” (Siegel)
Facilitating Choice in Couple Therapy
• Help clients:
– Become aware of automatic reactive patterns & their
origins
– Learn to pause before reacting, bringing prefrontal
thoughtfulness to emotional reactivity
– Set relationship goals that are in keeping with their
values
– Operationalize these values & goals
• “Neuroeducation” & Relationship education:
– Empowering couples for change
Erik & Lisa
• Current relationship crisis
• History of relationship
• Family of origin history of each partner
We are social animals
Our Brains are Wired through
Connection
• Early parent-child experiences wire the
young child’s brain
• In the first year most of this is right brainto-right brain connection
• This mutual shaping of brains in intimate
relationships continues throughout life
We are wired to connect
• Humans are social, need attachment with others
for survival--throughout life
• We need others for our mental and physical wellbeing
• We are affected by those around us.
Brain is a “social organ of adaptation”
(Cozolino)
• Our survival depends on relationships with
others
• Brain is the “social organ of the body” (Siegel)
• We need others for “limbic regulation”
• We are helped--or hurt--by our relationships
• Social rejection triggers pain centers in the
brain
• “Tend & Befriend” (Taylor)
We seek safety
• Relationship as a safe haven-vs-living with the
enemy
• Our brain is constantly assessing for safety-vsdanger
• “Emotional contagion”: Intimate partners coregulate each other, for better or for worse
• Trust: Bedrock of a good relationship
Attachment
• Attachment and the young child
• Attachment needs throughout the life
cycle, “from the cradle to the grave”
(Bowlby)
• Adult love as attachment
– Need for safe haven
– Protest behavior with disconnection
Attachment Styles
• Secure
• Insecure
– Anxious
– Avoidant
– Disorganized
• Earned Secure Attachment
Couples and
Attachment
• Couples’ dances as attachment behaviors
(Sue Johnson)
• Partners pursue, criticize, defend, withdraw
when they feel threatened, not heard,
disconnected
• Emotional brain is often fueling the dance
Attunement
• “Feeling felt” (Siegel)
• “I see you” (Avatar)
• Necessary for healthy development of child & for
healthy intimate adult relationships
• “Contingent communication”: Explore-UnderstandJoin (Siegel)
• “Noncontingent communication”: InterrogateJudge-Fix (Siegel)
Neurobiology of Empathy
(Decety & Jackson)
• Resonance: subcortical, automatic feeling
in one’s body what the other feels
• Cognitive Empathy: consciously putting
oneself in the other’s shoes
• Boundary between self and other
• Self-Regulation in face of other’s pain
We are Emotional Animals
•“I think therefore I am” (Descartes)
•“I feel therefore I am”
(Cacioppo)
Emotions and the Brain
• Emotions: Body sensations
• Feelings: Awareness of emotion/body states
• William James: We don’t smile because we’re
happy, we’re happy because we smile
• Emotional Operating Systems (Panksepp)
• Much of our behavior is driven by emotion,
often beneath awareness. We then try to
explain or justify our emotion with a ‘rational’
explanation.
• Emotion & thought are intertwined
• Emotions are communications to others
Reading Our Own
Emotions
• Interoception: Tuning into our body states
– Insula
• Naming the emotion
• Integrating right and left hemispheres;
integrating limbic system with prefrontal
cortex
• Alexithymia: Inability to read & name one’s
own emotions
Reading Others’ Emotions
• We are wired to automatically read others’
emotions and intentions
• We do this quickly and beneath awareness
• We read (or misread) emotions through the
other’s eyes and face
• Misreading partner’s emotions can lead to
disconnections and fights in couple
relationship
Emotions and Couples
• Emotions drive couple relationships--for
good or for bad.
• Emotional aspects of memories are stored
in the amygdala. A current moment may
trigger an old memory, leading to reactivity.
• Therapy must address emotions, not just
behavior or cognition.
Brain: The Basics
Evolution
• We share 98% of our DNA with
chimpanzees. The biggest difference is in
the human neocortex.
• Nature reuses older brain circuits for newer
purposes.
• The older brain circuits can overwhelm our
higher functioning when we feel
threatened.
Nature & Nurture
• Nature and nurture are intertwined
• “Experience shapes the brain throughout
life by altering connections among
neurons.” (Siegel)
• Experience affects the expression of
genes
Interconnected Neurons
• “Neurons that fire together wire together”
(Hebb)
• Our habits create and are created by
neurons that fire together
• Habits become ingrained as we become
stuck in our own ‘neural ruts’
Myelin
Tripartite Brain
•Brain Stem (Reptilian Brain)
•Limbic System
•Cortex/Prefrontal Cortex
A Tale of Two Roads
• Low Road: Amygdala
– Online at birth
• High Road: Prefrontal Cortex
– Not developed at birth; wiring not complete until
one’s mid-20’s
– Continues to change throughout lifespan
The Amygdala
• Emotional sentinel, always scanning the
environment for danger: “Fear central”
• “Quick and dirty”
• Works before we are even conscious of
perceiving something frightening
• Sets off fight-or-flight reaction
• Activates sympathetic nervous system & HPA
axis, which release stress hormones (e.g.,
cortisol)
• Stores emotional components of memories
• Couples’ “dance of amygdalas,” “Limbic Tango”
Middle Prefrontal
Cortex (PFC)
• Response flexibility
• Self-regulation, self-control, judgment,
thoughtfulness, self-awareness
• Self-soothing
• Social cognition, moral behavior
• Calms the amygdala
The Two
Hemispheres
• Left: Language, Linear, Logic,
Conscious
• Right: Emotions, Gestalt, Nonlinear,
Unconscious. Develops before Left.
• Corpus Callosum connects the two
hemispheres
The Brain is Embodied
• Constant flow between brain and rest of
body, back and forth
• Vagus Nerve between viscera and brain;
afferent fibers bring information from gut to
brain: ‘Gut feelings’
• Interoception: reading our body
– Insula
– Polyvagal Theory (Porges)
A Tale of Two Hormones
• Cortisol: stress hormone
– Toxicity of chronic or traumatic stress
• Oxytocin: “cuddle chemical”
– Released with orgasm, birth,
nursing, touch, empathy
– Reduces cortisol
– Found in both genders, more in women
– Associated with trust, generosity, attachment, nurturing,
empathy
….and Two More
• Vasopressin
– Found in monogamous male prairie voles, in
areas of brain associated with reward &
pleasure; not so in their promiscuous cousins
– Associated with territorial guarding & mate
protection
• Testosterone
– In both genders, responsible for sex drive
– Much more in males
– Associated with aggression & leadership
– Negatively correlated with empathy
Memory
• Implicit: Sensory, procedural, emotional,
unconscious
– Most memory is implicit
– Early memories are implicit, preverbal; they
drive our current reactivity, even though we
don’t consciously remember the original events
– Amygdala involved in emotional memory
• Explicit: Semantic, narrative, conscious.
– Hippocampus involved; develops after first year
Trauma and the Brain
• Abuse and neglect negatively affect the
growing brain
• Hippocampus is particularly affected by
abuse and neglect
• Trauma can leave implicit memories that
are not available as explicit memory, but
get retriggered in the present
Change, Habits, & the Brain
We are wired for habit
• Hebb’s Theorem: Neurons that fire together wire
together
• The more we hike on a path, the deeper the rut
becomes
• Habits become self-perpetuating
• You are what you do
We are wired for change
• The human brain is an “organ of adaptation”
• Neuroplasticity: Ability of the brain to change
– Neurogenesis
– Synaptogenesis
– Myelinogenesis
• Neuroplasticity continues throughout life
– Needs to be nurtured in adulthood
– What facilitates neuroplasticity: Exercise, learning new
things, paying attention
• Leaning changes the brain: Eric Kandel
• Fixed Mindset vs. Growth Mindset (Dweck)
COUPLE THERAPY:
Interventions Informed by
Neurobiology
Challenges of Change
• Couples come to therapy to change
--or to change each other
• Fears of change
• Stability/Change: a natural ambivalence
• ‘The Giant Exercise’
• Facilitating Neuroplasticity
& Relationship Plasticity
Goals of Couple Therapy
• Identify the couple’s dance or impasse, the
“dance of amygdalas”
• Look ‘behind the scenes’ at each partner’s
reactivity
• Identify behavioral, cognitive, emotional, and
neurobiological factors fueling the dance
• Give partners tools to manage their own
reactivity and make better, more thoughtful
choices
• Develop relational empowerment & resilience
• Facilitate empathy, generosity, & trust
Couples’ Dances
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Pursue/Withdraw
Criticize (Attack)/Withdraw
Attack/Defend
Attack/Counterattack
Withdraw/Withdraw
Escalations:
The Vulnerability Cycle
• Impasses
• Core Impasses
– Vulnerabilities
– Survival Strategies
Transforming the Vulnerability
Cycle
• Help couple “get meta” to their own vulnerability cycle
• Identify the circular, recursive nature of the cycle
– From a linear view to a circular view
– Both partners are victims of and (inadvertent) co-creators
of the vulnerability cycle
• Learn to notice when feel vulnerable and survival
strategy is getting activated
• Speak from vulnerability (which elicits empathy rather
than defensiveness from partner)
• “Grow up” own survival strategies
• Separate present from past
Rethinking Power in Couple
Relationships
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‘Power Over’
‘Power To’
‘Power With’
Relational Empowerment
‘Power Over’
• There are real power imbalances in couples’
relationships
• Physical size differences
--Potential for physical violence
• Financial resources differences
--How this affects who makes decisions
• Differences in class, race, education that affect
power & privilege
• Options each has to leave the relationship
• Power & Gender
Power Struggles
• Power and a sense of fairness in couple’s
relationship
• When we don’t know how to speak and be heard,
we either silence ourselves or try to dominate the
other.
• When don’t know how to make partner an ally, we
make partner an enemy (turn against) or a
stranger (turn away); (Wile, Gottman)
• Couples fight over ‘reality’
Managing Conflict
Gottman:
• Conflict is normal even in happy relationships
• Find the dream/yearning/need in the conflict
• Manage conflict with respect & curiosity
• Don’t use 4 Horsemen
• Self-soothe in conflict, manage DPA (flooding)
• Move from gridlock to dialogue on perpetual issues
Challenge the Blame
Game
• Invite blame to leave
• Therapy office as a shame-free, blamefree zone
• Help partners shift from self-protective
positions to caring positions
• ‘I’ -vs- ‘You’ statements
‘Power To’
• Emotional & social intelligence
• Know how to speak respectfully and be
heard
• Power to be the kind of person one wants to
be: Self-regulation
• Relational empowerment
• “Tools for your relational toolbox”
“Making a Relational Claim”
• Convey one’s own feelings or needs while
making space for the other
• Stand up for self without putting the partner down
(Atkinson)
• Make partner an ally, not an enemy or a stranger
(Wile)
• State needs positively: “assertive claiming”, not
“ineffective blaming” (Lerner)
Self-Regulation
• Seneca: “Most powerful is the person
who has himself in his own power.”
• Self-mastery: The power to selfregulate, self-soothe, make thoughtful
choices
• Role of Middle PFC in Power To
Emotional Resilience
• Ability to recover from a stressful experience
& modulate own emotional response
• Neurobiology of emotional resilience
• “Affective chronometry” (Davidson):
– How fast you get upset
– How upset you get
– How quickly you can calm down
• Genetic & experiential influences:
Individual differences
Techniques for
Emotion Regulation
• Self-soothing: “parenting yourself from the inside out”
(Siegel)
• Identify own emotions; emotions as body states; read
own body cues
• Imagery work: dialogue between
PFC & Amygdala: Rewire brain circuits
• IFS Parts Work
• Mindfulness Meditation, Focused Breathing, Journaling
• Reappraisal
• Soothing each other
“Response Flexibility” (Siegel)
• Rigidity
• Chaos
• Flexibility
– Response flexibility is a prefrontal function
– It is enhanced by mindfulness meditation
– Allows us to choose how to respond
‘Power With’
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Proactive loving: Shared relational responsibility
Respect, equality, accepting differences
Nurturing the “We”: Working as a team
Empathy
Care, generosity
Repair, apology, forgiveness
Facilitating Attachment in Couple Therapy
• Sue Johnson: EFT with couples
• Couple as victims of and creators of their
cycles
• Trust & violations of trust
Facilitating Empathy
in Couple Therapy
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Empathy as a key relational skill
Empathy & Gender
Learning self-empathy
Learning empathy for the other
“Behind an angry partner is a hurt partner.”
Blocks to Empathy
• Anger, Blame, Defensiveness
• Anxiety
• Fear of losing self in empathy for the other:
Boundary issues
• Guilt
–“I feel bad for you” translates into “I am bad
because you’re unhappy”
• Rigidity, Imperiousness
• Gender Training
Boundaries
• Empathy and generosity are safe only if
we have good boundaries
• Differentiation; ability to be authentic and
stay in connection
• The ‘Fence Exercise’
Care & Repair
Nurture Friendship & Passion
• Turn toward each other, cultivate “a culture of
positivity” (Gottman)
• Importance of touch, sex, massage, empathy:
Oxytocin’s magic charms
• Protection & care: “Tend & Befriend” (Taylor)
• Love: “micro-moments of positivity
resonance”: (Fredrickson)
Rupture & Repair
• Connection-disconnection-repair
• These are normal oscillations in a couple’s
relationship
• 70% of well-attached mother/baby
interactions are misattuned or out of sync;
key is repair
Repair
• Happy couples give and receive repair
attempts (Gottman)
• The power of apology: Love means
having to say you’re sorry--a lot!
• Apology as self-responsibility and
sensitivity to the hurt other, rather than as
‘Finding the Bad Guy’
• Repair when calm
Guilt &
Forgiveness
• Guilt: Healthy, neurotic (Buber)
• Forgiveness as a dyadic, relational
process-vs-a unilateral one (AbrahmsSpring)
Acceptance
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Couple Serenity Prayer
‘Take the best and leave the rest’
Acceptance-vs-Resignation
Resignation: a sense of defeat or bitterness
Acceptance: Holding the good aspects of the
relationship while accepting partner’s
limitations
• Knowing one’s bottom line: When acceptance
is problematic or dangerous
Gratitude
• Appreciate the blessings in the
relationship; Gottman’s 5:1 ratio
• Research: gratitude facilitates
happiness, contentment, connection
• Scarcity -vs- abundance
• The Blessings Jar
Generosity
• Generosity & the Brain
– Generosity activates reward centers of brain
– Oxytocin increases generosity
• Generosity & Culture
– Dialogue-vs-debate
– Competition-vs-collaboration
– ‘Least Pathology Assumption’: Benefit of the
doubt
Healing Intergenerational
Wounds
• Family-of-origin issues and couple therapy
• Implicit memories from childhood affect current
couple relationship: Amygdala role
• Impact on couple relationship if partners are
stuck in anger and sense of victimization with
their parents, or cut off from parents
• Self as victim-vs-author of own life
• “Waking from the Spell of Childhood”
• The “Loving Update”
• Synergy between personal, intergenerational, &
couple transformation
Therapy as “Limbic
Revision”
• Therapy is not just about cognitive
reframes or behavioral renegotiations.
• It involves intense emotional work, and
rewiring of emotional circuits for
relationship success
• Safety first: therapy as shame-free and
blame-free zone
Position of the Therapist
• Therapist is not a judge; “multilateral partiality”
(Boszormenyi-Nagy)
• Witness, coach, facilitator
• Side with partner’s strengths & resources
• Transparency and collaboration with couple
• Facilitate change, don’t take responsibility for
change
Accepting &
Challenging
• Our deep need for confirmation
from others (Buber)
• Encourage partners to accept each other
while challenging counterproductive
behaviors
• Therapist accepts and holds
vulnerabilities, and challenges problematic
survival strategies
• Respect
Choosing Change
The Fork in the Road
• Growth mindset-vs-fixed mindset (Dweck)
• Monday morning quarterbacking:
“Retrospective reviewing” (Atkinson)
• Revisiting the script: What could I have done
differently?
• Making a different choice in the moment: The
Fork in the Road
• Celebrate these “sparkling moments” (White)
with the couple
Change: In the
Dance,
in the Self
• New Dances, New Pathways:
– As couple develop new dances, they are
developing new neural pathways.
• Setbacks when partners are stressed or tired; the
old pathways are still there.
• “Massed practice” (Doidge): With time, the new
pathways, the new behaviors and new dances
become automatic & natural.
• Maintaining change: Rituals & reminders;
nurturing the new pathways-vs-falling back into
the old ones