Theoretical Underpinnings and Clinical Applications
Book Review by Jonathan Wills of Talk To Me Therapies Brisbane
Dr Pieter Rossouw (Editor) with eighteen other contributing clinicians from across Australia.
Published by Mediros, Brisbane, November 2014, 438 pages
A new therapeutic model based on neuroscience
Neuropsychotherapy is the skill of using neuroscience findings to inform counselling and psychotherapy – closely aligned with the work of Klaus Grawe expounded in his book Neuropsychotherapy: How the neurosciences inform effective psychotherapy (2007). Indeed Grawe’s work is often referred to, as is that of his preceding theorist Seymour Epstein’s and his cognitive-experiential self-theory. Both Grawe and Epstein’s contributions to Neuropsychotherapy as an emerging field are reviewed, analysed and critiqued by Rossouw in first three chapters of the book. The result is the creation of a new integrated model of Neuropsychotherapy, which recognises the need for safety, both in the therapeutic alliance and in client’s everyday lives as the sine qua non of effective therapeutic intervention. The new integrated model is the culmination of Dr Rossouw’s 25 years of work as clinician, teacher and theorist.
Rossouw also traces the history of neuroscience developments from the ancient world to the Nobel Prize winning work of Eric Kandel in unravelling the brain mechanisms involved in memory formation. Together with references to the more recent works of the ‘giants in the field’ like Michael Merzenich, Dan Siegel, Cozolino and others, a theme of hope emerges and is woven through both the theoretical underpinnings and in the clinical applications of Neuropsychotherapy. This hope, both for clinicians and clients, lays in the incredible phenomena that is brain plasticity. If we promote all that is required for the brain to demonstrate to it’s owner that they can ‘change their brain’, then a way forward to recovery from debilitating psychological incapacity can indeed be forged, and the development of new neural networks, not only for survival but also for thriving in life, can be built.
More than just theory
This is ground-breaking content, but as if a new theoretical model based on sound scientific evidence is not enough, the book also offers seventeen chapters of case studies presenting various pathologies within a range of client demographics, so that practicing clinicians can get a feel for how to use neuroscience in their own practice. Part B, Clinical Applications, explores the use of the integrated model by working with clients to better fulfil their needs for control and minimising their experiences of physical and psychological pain, and by increasing experiences of pleasure and improving clients’ sense of attachment and belonging, in all areas of their lives.
In chapter 4 a Neuropsychotherapy approach to adolescent social anxiety is explored by Dr Natalie Robinson wherein she brings her 15 year old client to the realisation that her anxiety can be controlled. And through behavioural change, her avoidance patterns of behaviour can be reduced, leading to greater participation and enjoyment in her life. In chapter 5 Kobie Allison combines neuropsychotherapy with a psychodynamic approach in guiding her client to adopt more effective ways to manage her fears of abandonment.
Lisa Stevens in chapter 6 introduces Neuropsychotherapy in an organisational setting. Working with coaches and players, Lisa’s work culminates in an exciting team victory on the field! It’s an outstanding narrative on psychoeducation and the application of theory put into practice. In chapter 7 Dr Sue Stefanovic offers a fascinating application of Neuropsychotherapy alongside a specialist hypnosis intervention for pain management. Her client reaches the point where he can better manage his pain and together with mindfulness and relaxation techniques now has a thorough understanding, and therefore greater control of his fear responses in any given situation.
In chapter 8 Jonathan Wills introduces Neuropsychotherapy in the non face-to-face setting of counselling via email for alcohol dependence. This case study introduces the recovery model and draws on the work of Jane Evans and Anne Stokes & Gill Jones, to highlight the specific skills required when counselling without proximal cues. Chapter 9 returns to the adolescent client demographic but this time Mark Andersen offers a mindful and Neuropsychotherapy approach to an abused athlete. In this moving case study, Andersen works with his client to gently educate him about amygdalic function and HPA responses and encourages him to use mindfulness to focus on the here and now, thereby improving sporting performance. In Chapter 10 David Williams returns to the blend of psychodynamics and Neuropsychotherapy applied in the case of a professional female cyclist who is lacking focus and confidence in her performance. By increasing the client’s feeling of safety and normalising anxious affect, the client realises improved self-confidence and significantly better performance.
In Chapter 11 Jacqui Louder brings anorexia nervosa under the Neuropsychotherapy lens. Working with a middle aged woman, Louder reveals an eclectic range of approaches, including exercises to increase the use of left and right prefrontal cortices to downregulate anxious affect and increase the clients’ sense of control, which have impacted this clients’ difficult to treat condition.
Chapters 12, 13 and 14 all describe a neuropsychotherapeutic approach to post-traumatic stress disorder. This complex pathology is becoming increasing recognised in many areas, including child physical and sexual abuse, returning Services veterans and those traumatised in natural and man made disasters. J David Haynes (chapter 12), Stephen Rendall (chapter 13) Daren Wilson (chapter 14) all provide compelling examples of how using a Neuropsychotherapy approach improves client outcomes and provides clients with an ongoing source of security in the knowledge they can indeed follow successful strategies to down regulate their HPA responses, so typical of this kind of pathology. Wilson also introduces his Structured Image Framework Theory, which incorporates neuroscience into an expressive practical therapy which facilitates client processing of traumatic experiences.
Chapter 15 takes a slightly different tack and examines light therapy and neuroscience. Adolf Deppe, who has previously published Therapy with light: A practitioners guide, considers light as therapeutic intervention and summarises four brief case studies after describing the evidence for light as a neurological stimulator.
In Chapter 16 and 17 our focus is on the issue of bullying, both from the victim and perpetrator perspectives. In another very moving account, Natalie Kyan describes her intervention with a 14 year old male dancer and how through understanding his anxious and avoidant behaviour in simple neuroscience terms, he has achieved enormous improvements in self-esteem and reduction in suicidal ideation. On the other hand Fiona Stevens looks at bullying from the perpetrator’s stance and discusses an organisational, Neuropsychotherapy and psychoeducation approach to breaking the bullying cycle.
Chapter 18 focuses on social anxiety and Dr Melissa Glenwright presents neuropsychotherapy commentary on a case of SAD in a 23 year old female. Here Dr Glenwright examines why graduated exposure therapy had not previously worked for her client, and bravely acknowledges a ‘mistake’ she makes in a solution-focussed approach. Yet in this realisation lies the key to her client’s progress – another moving account.
In Chapter 19 Peter Kyriakoulis applies a Neuropsychotherapy approach with a client suffering panic disorder and complex psychopathology. Kyriakoulis introduces the ‘diving response’ as a practical method to activate parasympathetic nervous system responses and a range of outcome and modern monitoring methods (mobile apps) used to provide real time biofeedback to clients.
Finally, but certainly by no means least, Shannyn Wilson examines Neuropsychotherapy principles working with children displaying symptoms of separation anxiety. There are some excellent practical examples of both child and parent psycho-educational work and practical exercises which bring Wilson’s child client to an enhanced experience of safety and self soothing, while away from her parents.
I thoroughly recommend the book
Pieter Rossouw and the valued contributing clinicians are committed to placing clients FIRST in the therapeutic relationship. It’s not about us as clinicians, it’s about how to provide our clients with the safety and trust they need and an enriched therapeutic environment in which they begin their recovery journey. Dr Rossouw has made a valuable contribution to extending and enhancing the integrated theoretical model of Neuropsychotherapy, and case studies which all apply this model are testament to the enormous benefits which clients can experience when they become just a little more familiar with their own brains!
I can wholeheartedly say that clinicians who become familiar with the integrated model and who effectively apply it in their work, will together with their clients, experience the beneficial results and improved client outcomes. I thoroughly recommend this book for any healthcare professional who wants a better understanding of how the brain works and how this knowledge can lead to healthier people and thriving communities.