INTRODUCCIÓN

ESCUELA DE EXTENSIÓN
MATERNAL LE PETIT
 


“Lo mejor que

puedes hacer
por los demás
no es
enseñarles tus
riquezas sino
hacerle ver las
suyas”.
Goethe
 DOMINIOS DE INTEGRACIÓN

ALUMNAS: Anotar o dibujar una estrategia para

usar en el salón en cada dominio de integración.

Conciencia:

Horizontal

Vertical

Dorsal-Ventral (Frente y Atrás)

Memoria

Narrativa

Temporal (corteza Pre-frontal)

Estados mentales

Interpersonal

Transpiracional

Módulo 1 ¿Por qué ser una maestra neuro-biológicamente informada?
(Enfoque basado en la neuropsicología evolutiva)

“Si  la  pasión  maneja  que  la  razón  tome  las  riendas”.  
Benjamín  Franklin  

EL  DILEMA  DE  LA  SOBREVIVENCIA  VS.  FELICIDAD  

El  ser  humano  es  una  serie  de  oposiciones  que    son  vitales  para  nuestra  existencia  
pero   que   se   debaten   y   contraponen   constantemente.   Así   como   al   mover   un   brazo  
ciertos   músculos   se   extienden   mientras   otros   se   contraen,   dos   subsistemas   trabajan  
en  nuestro  cuerpo  oponiéndose  en  busca  de  el  equilibrio.  El  corazón  y  la  respiración  
son  regulados  por  el  sistema  nervioso  el  cual  está  compuesto  por  dos  sub-­‐sistemas.  
El   sistema   simpatético,   encargado   de   preparar   nuestro   cuerpo   para   huír   mientras  
que  el  parasimpatético,  quien  calma  al  cuerpo.  Los  dos  sistemas  están  activos  todo  el  
tiempo,   mientras   uno   de   ellos   nos   hace   acercarnos   a   los   demás,   o   a   hacer   ciertas  
cosas  generando  emociones  positivas,  el  sistema  simpatético  hace  que  nos  alejemos  
o   busquemos   prevenir   ciertas   cosas.   Ambos   sistemas   siempre   activos   que  
monitorean   el   medio   ambiente   y   producen   ambivalencia.   Por   un   lado,   sentimos  
curiosidad   de   acercarnos   a   una   escena   del   choque   o   de   un   accidente   en   carretera,  
por  otro  lado,  nos  sentimos  paralizados  al  encontrarnos  en  esa  escena  y  el  sistema  
de   alejamiento   se   activa   inmediatamente   imponiendo   su   poder   sobre   el  
generalmente  más  débil  sistema  parasimpático.    

Todos   los   impulsos   neuronales   de   los   ojos   y   de   los   oídos   van   primero   tálamo.   Del  
tálamo   son   mandados   a   la   corteza   frontal   en   donde   se   integran   con   los   procesos  
mentales  superiores.  Pero,  porque  esos  impulsos  neuronales  se  mueven  a  30  m/s  y  
eso  un  largo  camino  incluyendo  el  tiempo  de  decisión  (aproximadamente  uno  o  dos  
segundos),  existe  un  atajo  ventajoso  y  este  atajo  se  llama  la  amígdala.  La  amigdala,  
es   capaz   de   detonar   una   respuesta   más   rápida   ya   que   se   encuentr   debajo   de   el  
tálamo   y   al   tener   conexión   directa   con   el   tálamo,   logra   responder   de   manera  
inmediata  a  una  amenaza  (al  ver  una  serpiente,  echamos  a  correr).  
Aunque  la  amígdala  es  capaz  de  procesar  alguna  información  positiva  en  el  cerebro  
no   cuenta  con   un  sistema  de  alerta  instantáneo   para   notiQicar   placeres   de   forma  tan  
intensa  e  instantánea.  Es  importante  recordar  que  la  amígdala  tiene  canales  en  dos  
direcciones,   así   como   los   pensamientos   pueden   causar   emociones   (como  
recordamos  una  escena  vergonzosa),  las  emociones  también  
En  su  libro  The  Hapiness  Hypothesis,  Haidt  habla  de  las  cuatro  divisiones  básicas  en  
el   ser   humano,   y   cómo   éstas   áreas   se   contraponen   generando   de   intereses   con   las  
que  el  ser  humano  tiene  que  lidear  en  cada  momento.  Como  menciona  en  sus  libros  
y  ensayos  el  psicólogo  Tal  Ben-­‐Shahar,  a  la  evolución  nunca  le  ha  importado  nuestra  
felicidad.   Si   existe   dopamina   y   sistemas   de   gratiQicación,   estos   evolucionaron  
únicamente  con  el  Qin  de  hacer  prosperar  a  la  especie  humana.  

El  poeta  romano  Ovidio  capturó  la  situación  humana  en  su  escrito  Metamorfosis  en  
dónde  el  personaje  Medea  debe  elegir  entre  su  amor  por  un  jóven  o  el  deber  hacia  su  
padre  y  se  lamenta:  
   
“Me   siento   arrastrada   por   una   fuerza   muy   extraña.   El   deseo   y   la   razón   empujan   hacia  
direcciones   opuestas.   Por   un   lado   veo   y   reconozco   el   camino   correcto,   pero   sigo  
eligiendo  el  equivocado”.  

Como   se   mencionó   anteriormente,   Haidt   sostiene   que   existen   cuatro   divisiones  

primordiales  en  el  ser  humano:  

1.   Mente   y   cuerpo.   Así   como   el   Qilósofo   francés   Michel   de   Montaigne   sugirió   que  
cada   parte   del   cuerpo   contiene   su   sus   propias   emociones   y   su   propia   agenda,   Si  
ocurre   que   nuestro   cuepo   muestra   reQlejos   fuera   de   nuestro   control.   En   este   caso  
podemos   pensar   en   cuando     se   acelera   el   corazón   ante   una   posibilidad   de   peligro,   el  
sonrijarnos,   cuando   las   expresiones   faciales   traicionan   nuestros   pensamientos  
secretos   y   funciones   como   nuestro   intestino,   quien   opera   con   o   sin   nuestro  
consentimiento.  
2.   Hemisferios   derecho   e   izquierdo.     Esta   división   cerebral   descubierta   por  
accidente   en   1960   por   el   doctor   Joe   Bogen   quien   intentaba   ayudar   a   quienes  
padecían   de   episodios   epilépticos   graves.   El   doctor   Bogen   intervenía   en   el   cuerpo  
calloso,   dividiendo   la   estructura   entre   el   hemisferio   derecho   y   el   hemisferio  
izquierdo.  Aunque  su  intervención  si  funcionó  para  reducir  epilepsias,  se  detectó  la  
importancia   entre   la   cominucación   hemisférica   y   tambien   el   hecho   de   que   por   algún  
motivo  aún  desconocido,  el  hemisferio  derecho  maneja  la  parte  de  la  parte  izquierda  
del   cuerpo   y   vice-­‐versa.   Sabemos   ahora   que   el   hemisferio   izquierdo   se   es  
especialista  en  lenguaje  y  en  tareas  analíticas  así  como  esfuerzos  visuales  y  de  darse  
cuenta   de   detalles.   El   hemisferio   derecho   es   mejor   al   procesar   el   espacio,   las  
secuencias   y   sobretodo   la   cara   humana.   Aunque   las   personas   no   tenemos   el   cerebro  
dividido   a   lo   largo   del   cuerpo   calloso,   estos   estudios   son   importantes   porque   nos  
enseñan   acerca   de   nuestros   comportamientos   humanos   como   veremos   más  
adelante.  

3.  Estructuras  antiguas  y  estructuras  nuevas.  Así  como  una  casa  contemporánea  

está   planeada   desde   el   principio   con   sus   ampilos   espacios   y   cuartos   especíQicos,  
nuestro   cerebro   es   más   bien   como   una   casa   antigua   a   la   cual   se   le   fueron   agregando  
closets,  cuartos  y  recovecos  a  través  de  los  años.  Conforme  nuestros  cuerpos  fueron  
evolucionando,  el  cerebro  frontal  de  los  mamíferos  primitivos  desarrolló  una  nueva  
capa   que   incluye   el   hipotálamo,   el   cual   coordina   nuestras   motivaciones   y   deseos  
básicos,  el  hipocampo,  especializado  en  memoria  y  la  amígdala,  especializada  en  el  
aprendizaje  y  la  respuesta  emocional.  

Éstas  estructuras  son  en  ocasiones  conocidas  como  el  sistema  límbico  (derivada  de  
la  palabralimbus  en  latín,  o  límite)  ya  que  envuelven  al  resto  del  cerebro  formando  
una   frontera   o   márgen.   Conforme   los   mamíferos   crecieron   en   tamaño   y   se  
diversiQicaron,  el  remodelamiento  del  cerebro  continuó.  En  los  mamíferos  y  primates  
especialmente,   una   nueva   capa   de   tejido   neuronal   se   desarrolló   expandiéndose  
alrededor   del   antiguo   sistema   límbico,   esta   neocorteza   es   la   materia   gris  
característica   de   el   cerebro   humano.   La   parte   frontal   del   neo-­‐corteza   es  
particularmente  interesante  ya  que  sus  partes  no  parecen  estar  dedicadas  a  tareas  
especíQicas   como   el   movimiento   de   un   dedo   o   el   escuchar   un   sonido   en   particular.  
Más  bien,  esta  parte  del  cerebro  está  dispuesta  para  generar  nuevas  asociaciones  y  
trabajar  en  planeación,  pensamiento,  y  la  toma  de  decisiones,  procesos  mentales  que  
pueden   liberar   a   un   organismo   de   responder   solamente   instintivamente   a   una  
situación  inmediata.  
El   neurólogo   Damasio   estudió   o   personas   que   por   motivos   de   tumores,   golpes   o  
derrames   cerebrales   habían   perdido   parte   de   su   corteza   frontal   con   resultados  
sorprendentes.  En  1990,  Damasio  encontró  que  cuando  ciertas  partes  de  la  corteza  
orbito-­‐frontal   están   dañadas,   los   pacientes   pierden   emociones   y   gran   parte   de   su  
vida   emocional.   Cuando   nosotros   miramos   el   mundo,   instantáneamente   valoramos  
diferentes   posibilidades   y   por   lo   general   una   nos   parece   más   viable   que   otra.   Las  
personas  con  el  área  orbito-­‐frontal  dañada,  no  logran  tomar  una  decisión  (ni  acerca  
del  sabor  de  un  helado).  La  racionalidad  humana  depende  de  la  neo-­‐corteza  cerebral  
en   donde   la   razón   y   la   emoción   trabajan   juntos   para   crear   comportamientos  
inteligentes.  
4.   Procesos   controlados   y   procesos   automáticos.   Desde   1990   los   psicólogos   se  
dieron   cuenta   que   en   todo   momento   hay   dos   procesos   trabajando   en   la   mente:  
aquellos   controlados   y   aquellos   automáticos.   El   procesamiento   controlado   es  
limitado  ya  que  sólo  podemos  pensar  conscientemente  de  una  cosa  a  la  vez  
El  pionero  John  Bargh  diferencía  unos  de  los  otros  ya  que  los  procesos  controlados  
toman   un   gran   esfuerzo,   como   la   planeación   futura   o   un   cálculo   matemático  
mientras   que   los   procesos   automáticos   son   completamente   inconscientes   como   el  
Qlujo  del  pensamiento  continuo.  

La   relación   entre   los   procesos   controlados   y   automáticos   es   que   los   procesos  

controlados   trabajan   como   el   director   de   una   empresa   quien   hace   las   preguntas  
importantes  y  las  planeaciones,  mientras  que  todos  los  procesos  automáticos  de  la  
empresa,  siguen  las  órdenes  para  llevar  los  planes  y  metas  acabo.  

Cuando   las   primeras   neuronas   formaban   los   primeros   cerebros   hace   más   de   600  
millones   de   años,   seguramente   tenían   alguna   ventaja   evolutiva.   Hace   3000   años   se  
encontraba   en   el   planeta   tierra   animales   extraordinariamente   soQisticados   con  
sistemas   automáticos   sorprendentes,   como   pájaros   con   la   habilidad   de   navegar  
según  la  posición  de  las  estrellas  y  criaturas  con  sistemas  de  comunicación  aunque  
aún  no  se  había  desarrollado  el  lenguaje.    

El   procesamiento   controlado   requiere   lenguaje.   Aunque   se   puede   procesar  

información   a   través   de   imágenes,   resulta   diQícil   planear   algo   complejo   como  
analizar  las  causas  de  éxitos  pasados  o  el  Qlujo  de  efectivo  de  la  próxima  década  sin  el  
uso  de  palabras.  

Aunque  nadie  sabe  con  exactitud  cuando  el  ser  humano  desarrollo  del  lenguaje,  se  
estima   un   rango   desde   hace   2   millones   de   años   cuando   el   cerebro   se   expandió  
notablemente,  hasta  tan  reciente  como  40,000  años.  Los  procesos  automáticos  han  
existido  por  miles  de  años  y  han  pasado  por  muchos  ciclos  de  perfeccionamiento  a  
diferencia  de  la  madurez  con  la  que  cuentan  los  procesos  controlados.  

Cuando   el   lenguaje   evolucionó,   el   cerebro   no   había   sido   creado   para   obedecer  

órdenes  ejecutivas  por  parte  de  el  ser  consciente,  o  racional,  sin  embargo  es  ahora  
con  la  conciencia  con  lo  que  tratamos  de  controlar  estímulos  y  reacciones.  
Psicólogos   conductuales   como   BF   Skinner   pudieron   explicar   gran   parte   del  
comportamiento  de  los  animales  en  cuanto  a  conexiones  entre  estímulo  y  respuesta.  
Otras   conexiones   son   aprendidas   como   lo   demostró   Iván   Pavlov   con   sus   perros  
quienes  salivaban  al  sonido  de  una  campana  que  anunciaba  la  llegada  de  la  comida.  
Los   conductistas   vieron   que   los   animales   parecen   ser   esclavos   de   sus   ambientes   y  
tomaron   los   comportamientos   humanos   en   gran   parte   desde   el   punto   de   vista  
animal.  Aparentemente  los  conductistas  no  estaban  exactamente  en  lo  correcto.  Los  
humanos  contamos  con  este  sistema  controlado  que  nos  permite  metas  a  largo  plazo  
y   formas   de   escapar   la   tiranía   de   el   aquí   y   el   ahora.   Desafortunadamente,   los  
conductistas  tampoco  se  equivocaron  en  todo,  pues  aunque  el  sistema  controlado  no  
forma   parte   de   los   principios   conductistas,   los   sistemas   automáticos   han   existido  
por  tantos  años  ya,  que  han  monopolizado  el  botón  de  dopamina  a  nivel  cerebral.  Es  
por   esto   que   Haidt   recomienda   que   veamos   al   sistema   controlado   como   un   asesor  
quien   monta   en   el   elefante   intentando   que   éste   tome   las   mejores   desiciones.   El  
elefante   y   el   jinete   cada   uno   tiene   su   propia   inteligencia   y   cuando   trabajan   juntos   en  
equipo  generan  algo  único  y  brillante  en  el  ser  humano.    
Otro  factor,  a  parte  de  las  divisiones  mencionadas  anteriormente  que  puede  afectar  a  
las  personas  deteriorando  sus  estados  afectivos  es  el  elemento  de  la  negatividad.    

Negativity Bias:
Tiene más peso lo negativo que lo positivo.

Aparentemente  el  humano  se  preocupa  acerca  de  su  futuro,  de  su  salud,  incluso  de  
su   mortalidad,   cosa   real   y   segura   en   la   línea   de   su   vida.   Uno   de   los   principios   de  
nuestro   cerebro   según   Haidt,   es   que   lo   malo   predomina   sobre   lo   bueno   a   nivel  
cerebral.  Para  la  evolución  humana,  el  costo  de  perder  la  vida  al  ser  devorado  por  un  
depredador   pudiera   ser   catastróQico,   por   lo   tanto   nuestras   mentes,   moldeadas   por  
selección   natural,   fueron   diseñadas   para   responder   más   rápido   a   experiencias  
negativas.   A   este   se   le   denomina   el   principio   de   negatividad   “negativity   bias”  
principio   que   muestra   una   y   otra   vez   como   la   mente   está   preparada   para   reaccionar  
más  rápido  con  mayor  intensidad  y  persistencia  a  aquello  que  es  agresivo  o  negativo.  
Cómo   mencionó   Benjamín   Franklin,   no   somos   tan   sensibles   a   la   gran   salud   como   a   la  
menor  enfermedad.  
En   los   años   ochentas,   Davidson   estudió   la   relación   entre   las   asimetrías   en   la  
actividad   cerebral   de   las   personas:   algunas   de   ellas   presentando   mayor   actividad   en  
la   corteza   frontal   izquierda   y   otras   en   la   corteza   frontal   derecha.   Esta   actividad  
cerebral   mostró   una   relación   directa   con   el   típico   nivel   de   bienestar   personal   "estilo  
afectivo”.  
Davidson  descubrió  que  las  personas  con  mayor  actividad  cerebral  en  el  hemisferio  
izquierdo,   reportaron   menores   grados   de   ansiedad,   angustia,   temor,   depresión   y  
vergüenza   y   mayores   grados   de   satisfacción   y   optimismo   en   general.   (Citado   en  
Haidt  2006).  

En  un  estudio  de  bebés  de  10  meses  de  edad,  se  comprobó  que  aquellos  bebés  con  
mayor   actividad   cerebral   en   el   área   cortical   derecha,   lloraban   con   mayor   intensidad,  
duracion   y   frecuencia   al   ser   separados   de   sus   madres.   (Citado   por   Haidt   2006,  
estudio  de  Davidson  y  Fox,  1989).  
Según   Haidt,   el   tener   un   estilo   afectivo   que   logra   regular   las   emociones,   es   como  
ganarse   la   lotería   cortical.   Del   mismo   modo   a   tener   un   estilo   afectivo   que   no   logra  
regular   sino   que   más   bien   parece   reaccionar   activamente   ampliQicando   emociones  
negativas,  se  convierte  un  reto  enorme  a  lo  largo  de  la  vida  ce  esos  individuos.  John  
Milton   parafrasea   a   Marco   Aurelio   diciendo:   "la   mente   es   su   propio   lugar   que   puede  
hacer  un  paraíso  en  el  inQierno  un  inQierno  en  el  paraíso).  
Haidt  se  muestra  positivo  ante  la  posibilidad  de  modiQicar  el  estilo  afectivo  personal.  
Según   el   autor,   las   tres   mejores   formas   para   modiQicar   la   actividad   cerebral  
relacionada   con   las   emociones   son:   la   meditación,   la   terapia   cognitiva   y   aunque   a  
veces  controversial,  el  tratamiento  fármacologico  (como  el  Prozac).  
Marcel  Proust  escribió  que  el  único  verdadero  viaje  no  es  aquel  en  el  que  se  visitan  
Tierras   inexploradas   sino   aquel   que   se   recorre   con   nuevos   ojos.   (Grados,   1992  
página  290).  
Gracias   a   diversos   estudios   en   laboratorios   de   neurociencia   en   donde   se   aprecian  
neuro   imagenes,   se   ha   observado   que   el   cultivo   sistemático   de   la   mente   con  
actividades   de   atención,   concentración,   ejercicio   Qísico,   meditación   y   terapia  
cognitiva   entre   otros   puede   producir   cambios   importantes   en   la   estructura   y   Y  
actividad   cerebral   a   cualquier   edad   mejorando   notablemente   el   funcionamiento  
inmunológico  así  como  el  bienestar  de  las  personas.  
Módulo 2 ¿Cómo puedo fomentar el desarrollo de la auto-regulación emocional y
conductual de mis alumnos?
Conducta y Cognición: Las rutas cerebrales de éstos procesos.

An Interpersonal Neurobiology of Psychotherapy

© 2002 Daniel J. Siegel, M.D.-- Page 62

How many of us have seen that recent writings focus on the mind as essentially
equivalent to the brain? That is, if you put a person in a brain scanner and the
brain reveals this or that activity, then somehow we are visualizing the mind.

These recent advances in brain imaging have been profoundly important in

expanding our understanding of how the brain gives rise to the mind – but they
are not the same as visualizing the mind itself or reducing the mind to only brain
activity. That view reveals what can be called a “single skull psychology” which
does not provide a complete picture that can help us to fully understand mental
health or the power of relationships to hurt or to heal. The experience within
relationships can actually change how the mind develops. It seems likely, based
on indirect evidence in humans, direct evidence in animal studies, and
convergent findings from a number of independent disciplines, that this effect is
mediated through the impact of experience on the unfolding of brain structure.
For these reasons, in this chapter we are going to take a step outside of those
“single skull” views of the mind and brain to look at how relationships are likely to
change brain function and directly influence the developing mind.

Over 100 years ago, the father of modern psychology, William James (1890/1981),
said that such a practice of returning a wandering attention back to its target again
and again would be the “education par excellence.”

In other publications, I’ve proposed that integration is at the heart of well-being (Siegel,
1995, 1999, 2001) and I have highlighted nine specific domains of integration that can
be cultivated (Siegel, 2006, 2007a, 2010).
In many ways, integration forms the foundation for our explorations of interpersonal
neurobiology (also see Cozolino, 2002, 2010; Badenoch, 2008). Here we’ll be referring
to these various domains of integration as they fit into our larger framework of the
PART of therapy that works.These traits involve a set of nine middle prefrontal
functions that include

regulating our bodies,

attuning to others,

having emotional balance,

calming fear,

pausing before acting,

having insight and empathy,

being moral in our thinking and our actions, and having more access to intuition.
Integration can be defined as the functional coupling of distinct and
differentiated elements into a coherent process or “functional whole.” This
concept has been used by a wide range of researchers including those studying group
behavior (“inter-individual integration”), development across the lifespan (“individual
integration”), and brain functioning (“neural integration”). Within a coherently integrated
process, adaptive and flexible states are achieved as individual components remain
highly differentiated AND become functionally united. Such states may also be seen as
moving toward conditions that maximize complexity.

Coherent narratives and flexible self-regulation may reflect such an integrative process
within the individual mind. Interpersonal integration can be seen when the mind of one
person has the free and collaborative exchange of energy and information with another
mind. Such adaptive and flexible states flow between regularity and predictability on
the one hand, and novelty and spontaneity on the other, to yield a maximal degree of
complexity in their functional coupling. Such dyadic states may be seen within the
interactions of securely attached children and their parents. The “mind” – defined as
the flow of energy and information – can thus be conceptualized as an inherently
integrating system. This “system” may be viewed from a wide range of levels of
analysis, from groups of neurons to dyads, families, and even communities. Such a
view may allow us to synthesize our understanding of the neurobiology of the individual
brain with insights into the interpersonal functioning of people within dyads and larger
social groups.

These dynamic processes create a flow that moves toward complexity by balancing
the differentiation (specialization) of components with the integration (bringing together
as a functional whole) of components of the system. In emotional terms, complexity
flows between boredom and anxiety. Optimal flow runs right down the middle. When a
system does not move toward complexity, it can be seen as “stressed.” Such
deviations move the system to either side of complexity: rigidity on the one side, chaos
on the other. A stressed system does not function optimally. This is the hallmark of
posttraumatic sequalae. We can apply these ideas to the optimal learning experiences
a given individual may require. Learning environments that flood an individual with
information that cannot be processed effectively produce stress in that they overwhelm
the system and lead to chaos and uncertainty. Experiences which are under-
stimulating create stress in that they are filled with excessive sameness and
predictability and do not enable the system of the student’s mind to move toward
complexity.

The interweaving of findings from attachment research, complexity theory, and

neurobiology yield some intriguing possibilities. One idea is that the psychotherapy
helps the functioning of the system to develops the ability to self- organize utilizing the
modulation of both internal and external constraints. Internal mechanisms include
neuromodulatory processes that enable the mind to regulate its states of activation,
representational processes, and behavioral responses. Such a well-developed
capacity for neuromodulation would be mediated by circuits capable of integrating a
range of neural processes, from abstract representations to bodily states. As we’ve
discussed, these circuits may confer “value” to stimuli and are functionally connected
to the systems that mediate interpersonal communication.
“Integration” can be proposed to be a central self-organizing mechanism that
links these many disparate aspects of internal and interpersonal processes.

Differentiation and Integration

As children grow, the neuronal circuits within their brains specialize in their functions by
the anatomical differentiation of their synaptic connections. Both genetics and
experience induce neurons to become linked in a complex web of interconnected
groups, circuits, and systems.
For example, the inherent asymmetric properties of the basic structures of the
brainstem that control bodily processes in the fetus before birth give rise to different
developmental pressures on the growing “higher” processing regions of the neocortex
during the early years of life. Studies have suggested that the right hemisphere, the
one that specializes in nonverbal signals and primary emotional states, is dominant in
its activity and growth during the first three years of life. As the child grows, there
appears to be a cycling of times when the right and then the left sides of the brain
become predominant in their growth spurts. The left hemisphere specializes in linear,
logical, linguistic based cognitive processes. As this side grows, the child begins to use
syllogistic reasoning to search for cause-effect relationships and analyze the world with
“yes-no”, “right- wrong” assessments that are based on digital representations. The
right hemisphere, in contrast, appears to process information in an analogic manner
utilizing a holistic, visual, sensory modality that “sees things as they are.” Hearing and
understanding this sentence uses primarily your left hemisphere,whereas observing a
painting depends primarily upon right hemisphere processes.

The brain appears to be naturally driven, by both genetic information and the
impact of experience, to differentiate its circuitry. Such a process enables the
brain to achieve an unfathomable variety of cognitive processes. Some have
estimated that the number of firing patterns within the human brain is an astonishing
ten times ten one million times (ten to the millionth power)! Of course these are human
brains that are making this estimation, so they are a bit biased... Nevertheless, even
the fact that we can reflect on our own mental processes is quite amazing. We now
believe that complex mental processes emerge from neuronal firing patterns that are
profoundly influenced by synaptic connections created by our inheritance and our
experiential history. One aspect of brain development is the specialization of function of
component parts that we have called differentiation. The other important aspect of
development is the bringing of these parts together into a functional whole in the
process called integration.

The complex web of interconnected neurons in the brain and the rest of the body
become functionally linked through neural integration. Integration enables the
differentiated circuits of the brain to become a part of an coherent information
processing system. Complex mental processes thus depend upon widely distributed
regions of the brain to be linked together into a functional whole. Memory is one such
process: the association of neuronal firing from distributed areas of the brain is the
essence of memory. We learn by how our neurons create functional linkages in the
moment of initial learning that then influence the likelihood of firing together in the
future. This view is called “Hebb’s Hypothesis” and is named after the psychologist
physician, Donald Hebb, who described the phenomenon over fifty years ago that
“neurons which fire together, wire together.” Memory is based on this process of
integration. Learning requires that we create linkages to alter the nature of our future
neuronal firing patterns.
 The mind is its own place, and in itself Can make a heaven of hell, A hell of heaven.—John Milton
“For a person to change, the mind must change.” Dan Siegel


The Mind:

A Definition – The mind can be defined as an embodied process that regulates the flow
of energy and information. Regulation is at the heart of mental life, and helping others
with this regulatory balance is central to understanding how the mind can change. The
brain has self- regulatory circuits that may directly contribute to enhancing how the
mind regulates the flow of its two elements, energy and information.


Mind Emergence – The mind emerges in the transaction of at least neurobiological and
interpersonal processes. Energy and information can flow within one brain, or between
brains. Naturally other features of our world, nature and our technological environment,
can also impact on how the mind emerges. Within psychotherapy, we can see that
relationships with another person profoundly shape the flow of energy and information
between two people, and within each person.

Mind Development – The mind develops across the lifespan as the genetically
programmed maturation of the nervous system is shaped by ongoing experience. We
now know that about one third of our genome directly shapes the connections within
our brains (4). Though genes are extremely important in development, we also know
that experience shapes our neural connections as well. When neurons become active
they have the potential to stimulate the growth of new connections among each other.
With one hundred billion neurons and an average of ten thousand synaptic
connections linking one neuron to others, we have trillions of connections within our
brains. These synaptic linkages are created by both genes and by experience. Nature
needs nurture. Experience shapes new connections among neurons by how genes are
activated, proteins produced, and interconnections established within our spider-web
like neural system.

Mental Well-Being – An interpersonal neurobiology view of well-being states that the

complex, non-linear system of the mind achieves states of self-organization by
balancing the two opposing processes of differentiation and linkage. When separated
areas of the brain are allowed to specialize in their function and then to become linked
together, the system is said to be integrated. Integration brings with it a special state of
functioning of the whole which has the acronym of FACES:
Flexible,
Adaptive,
Coherent,
Energized, and
Stable.
This coherent flow (5) is bounded on one side by chaos and on the other by rigidity (6).
In this manner we can envision a flow or river of well-being, with the two banks being
chaos on the one side, rigidity on the other. One way of viewing the symptoms of the
Diagnostic and Statistical Manual (7) for psychiatric diagnoses is as manifestations of
rigidity or of chaos. This flow of well being can be seen to reveal the correlations
among an empathic relationship, a coherent mind, and an integrated brain as three
points on a triangle depicting well-being.

Promoting Well-Being
What does an interpersonal neurobiology approach to psychotherapy offer as a
framework for considering how therapy works and how to work in therapy? Therapeutic
experiences that move an individual toward well-being promote integration. Deviations
from this integrated flow are revealed as rigidity and/or chaos and result in
symptomatic conditions that may be experienced as inflexible, maladaptive,
incoherent, deflated, and unstable. To achieve the goal of promoting integration it has
been helpful to delineate at least nine domains of integration that can remain in the
therapist’s mind within the process of psychotherapy. After briefly outlining these
domains, this article will then focus specifically on the nature of interpersonal
integration highlighting recent contributions from the studies of the mirror neuron
system and neural plasticity. A fuller description of the clinical implications of these
domains within psychotherapy can be found in other publications (8).
Domains of Integration

A. Integration of Consciousness
The mind flows as energy and information are channeled through the process of
attention. The nomenclature of science refers to the presence of three general
mechanisms of attention: exogenous, endogenous, and executive (9). Exogenous
attention is a form of attentional focus IPNB of Psychotherapy driven by the immediacy
of an often external stimulus, such as a loud sound. A more sustained, self-generated
form is called endogenous attention in which the individual chooses to focus attention
on a particular stimulus. With executive attention one can create a flexible response
not governed by the external world or by a singular focus of attention. The integration
of consciousness involves the development of executive forms of attention that are
associated with the larger capacities for self-regulation, such as the balancing of
emotion, improved stress response, and enhanced social skills. Self-awareness has its
roots within the central regulatory systems of the brain and thus may play an important
role in various forms of psychotherapy and in various psychiatric disorders (10). In
many ways, how we have developed the capacity to have a receptive, flexible form of
awareness enables us to have freedom to focus our attention in ways that are most
helpful to us and to those around us.

Enhancing this receptive awareness in the present moment is sometimes called

“mindful awareness.” Mindfulness is defined as paying attention, in the present
moment, on purpose, without grasping onto judgments. Mindful awareness has the
quality of receptivity to whatever arises within the mind’s eye, moment to moment.
Recent studies of mindful awareness practices reveal that it can result in profound
improvements in a range of physiological, mental, and interpersonal domains of our
lives. Cardiac, endocrine, and immune functions are improved with mindful practices
(11). Empathy, compassion, and interpersonal sensitivity seem to be improved. People
who come to develop the capacity to pay attention in the present moment without
grasping on to their inevitable judgments also develop a deeper sense of well-being
and what can be considered a form of mental coherence.

Within psychotherapy the focus of attention on various domains of mental, somatic,

and interpersonal life can create the neural firing patterns in the brain that enables new
synaptic connections to be established. Neural plasticity, the change in neural
connectivity induced by experience, may be the fundamental way in which
psychotherapy alters the brain. Based on the modification and growth of synapses and
the potential differentiation of neural stem cells into fully integrated neurons, neural
plasticity reveals how the brain’s interconnectedness can change throughout the
lifespan. Consciousness may play a direct role in harnessing neural plasticity by
altering previously automatic modes of neural firing and enabling new patterns of
neural activation to occur.
The basic steps linking consciousness with neural plasticity are as follows: Where
attention goes, neural firing occurs. And where neurons fire, new connections can be
made. In this manner, learning a new way to pay attention within the integration of
consciousness enables an open receptive mind within therapy to catalyze the
integration of new combinations of previously isolated segments of our mental reality
B. Vertical Integration
Taking the perspective of the vertical plane of our somatic architecture, we can
envision the anatomically and functionally differentiated elements of our bodies to
extend from our head to our toes. Vertical integration directly links these elements
within awareness so that new connections can be established. We know that the mind
is embodied, built in part from its roots in somatic reality, but often seduced to live in
the land of the purely non-physical world we can isolate as “mental.” Linking the basic
somatic regulatory functions of the brainstem with the limbic circuits’ generation of
affective states, motivational drives, attachment, and appraisal of meaning and laying
down of memory is a first layer of vertical integration.

Above the limbic circuitry emerged the neocortex, or “outer bark” of our evolving
brains. The cortex, unlike the brainstem, is quite underdeveloped at birth and is shaped
by both genetics and especially by experiences out in the world. In general, the
posterior regions of the cortex are specialized for perception of the physical world (our
first five senses) and the body itself is registered in the more forward aspects of this
posterior region. In the frontal lobe of the cortex we have our motor and pre-motor
planning areas that enable us to carry out behaviors. The forward most part of this
frontal lobe is the prefrontal cortex. The side part of this area, known as the
dorsolateral prefrontal region, is considered an essential circuit for working memory
that enables us to pay attention to something in the here-and-now. Toward the middle
of the prefrontal cortex, just behind the forehead area, are several regions that are
sometimes thought to be the “higher part” of the limbic circuitry and a core aspect of
the social circuits of the brain: the orbital frontal area behind the eyes, the medial
prefrontal cortex behind the forehead, and the anterior cingulate just behind it. These
more midline structures, along with a region called the insular cortex, serve important
functions in linking body, affective state, and thought. For the purpose of this
discussion of the beneficial effects of psychotherapy, we’ll refer to these midline
structures as the “middle prefrontal cortex” as they generally work as a team with each
other.
A review of the anatomy of the middle prefrontal cortex reveals that it has a major
integrative function, linking body-proper, brainstem, limbic circuits, and cortex to each
other. In this manner these middle prefrontal circuits may carry out what we are
labeling as vertical integration. What does this term really mean? This idea means that
fibers literally physically connect the input of somatic and vertically distributed neural
structures with one another. A wide array of independent studies in basic brain
research reveals that these middle prefrontal areas are crucial for generating nine
aspects of life: 1. Body regulation: Balance of the sympathetic (accelerator) and
parasympathetic (brakes) branches of the autonomic nervous system. 2. Attuned
communication: Enables us to tune into others’ states and link minds. 3. Emotional
balance: Permits the lower limbic regions to become aroused enough so life has
meaning, but not too aroused that we become flooded. 4. Response flexibility: The
opposite of a “knee-jerk” reaction, this capacity enables us to pause before acting and
inhibit impulses giving us enough time to reflect on our various options for response. 5.
Empathy: Considering the mental perspective of another person. 6. Insight: Self-
knowing awareness, the gateway to our autobiographical narratives and self-
understanding. 7. Fear extinction: GABA (an inhibitory neurotransmitter) fibers project
down to the amygdala and enable fearful responses to be calmed. 8. Intuition: Being
aware of the input of our body, especially information from the neural networks
surrounding intestines (a “gut feeling”) and our heart (“heartfelt feelings”) enables us to
be open to the wisdom of our non-conceptual selves. 9. Morality. The capacity to think
of the larger good, and to act on these pro-social ideas, even when alone, appears to
depend on an intact middle prefrontal region.
By focusing awareness on the input from the body, our affective states, and our range
of thoughts and ideas, the first steps toward vertical integration can be encouraged by
the therapist. With a receptive mind, it may be that this vertical integration naturally
occurs. But for many individuals coming to therapy, having the intention to pay
attention to the body’s signals is a purposeful act that can transform a disconnected
way of living into a richer, more integrated way of living.

It is relevant to note that these nine middle prefrontal functions can be seen to emerge
not only with mindful awareness practices, but at least the first seven are also be
associated with the outcome of secure attachment between child and caregiver (13).
This finding may suggest that experiences of “mental attunement” – interpersonal in
the case of attachment or internal in the practice of mindful awareness – may be at the
heart of developing an integrated brain and well- being. Healthy self-regulation,
through relationships and self-reflective observation, may depend on the development
of the integrated circuits of these prefrontal regions (12, 14, 15).

Mental attunement may depend on a quality of openness to living in the moment that
may be essential for the therapist’s own stance and serve as a strategic goal for the
process of therapy itself (16, 17). Of note from the neuroscience literature are
preliminary studies suggest that mindful meditation practice, as one example of a
receptive mental state, may actually lead to enhanced growth of the middle prefrontal
regions as well as preserved neural tissue in these regions with aging (18).

C. Bilateral Integration
The nervous system of vertebrates is asymmetric with left being different from right in
animals from zebra fish to lizards, toads, chickens, pigeons, apes, and us (19). With
more complexity comes more adaptability. Cortical function and structure are driven by
the lower asymmetries of the limbic and brainstem areas and various forms of research
have revealed that the right and left cortex perceive and create reality in quite distinct
ways. In this brief overview these differences will be briefly highlighted to illustrate the
importance of bilateral integration.
The right hemisphere develops first after birth, its activity and synaptogenesis more
robust during the first two to three years of life (20). After that period, there are a series
of cyclical waves of left, then right, and then left sided dominance in growth and activity
(21). In general the right and left sides of the brain have the following characteristics
that have been supported by a range of scientific and clinical investigations.

The right mode of processing: A. Holistic – things are perceived in the whole of their
essence. B. Visuospatial – the right side works well with seeing a picture and is not
proficient at decoding the meaning of these words. C. Non-verbal – eye contact, facial
expression, tone of voice, posture, gestures, and timing and intensity of response are
the non-verbal components of communication that the right mode both sends and
perceives from others. D. A wide range of functions, including the stress response, an
integrated map of the whole body, raw, spontaneous emotion, autobiographical
memory, a dominance for the non-verbal aspects of empathy. The right mode has no
problem with ambiguity and is sometimes called “analogic” meaning it perceives a wide
spectrum of meaning, not just a digital restricted definition of something.

The left mode of processing: A. Linear – the left loves this sentence, one word
following the next. B. Logical – specifically syllogistic reasoning in which the left looks
for cause-effect relationships in the world. C. Linguistic – these words are the left’s
love. D. Literal – the left takes things seriously. In addition, the left is sometimes
considerer the “digital” side, with on-off, yes-no, right-wrong patterns of thinking.
One proposed manifestation of impaired left-right integration can be that the drive of
the left hemisphere to tell stories, to explain in a linear fashion using words, would be
compromised if the story were about the self. Given the repeated finding of
autobiographical memory being primarily mediated within the right hemisphere, what
would a life-story be like if the narrating left hemisphere could not easily access the
non-verbal autobiographical details of the right side of the brain? Before we turn to
such narrative incoherence, let’s first look at the integration of memory.
D. Integration of Memory
Memory can be defined as the way in which a past experience alters the probability of
how the mind functions in the future. Memory shapes how we experience the present
and how we anticipate the future, readying us in the present moment for what comes
next based on what we’ve experienced in the past. This broad view enables us to
examine the findings of two aspects of memory and explore how their integration can
promote well-being. Segregation of these memory functions, in contrast, may be seen
as one aspect the source of mental suffering.

Experience creates the activation or “firing” of neurons. This neuronal activation can in
turn lead to alterations in the connections among neurons, the basis of neural plasticity.
Throughout our lives we embed experience into memory via a first layer of processing
called “implicit” or “non-declarative” memory. Before one and a half years of age, this
early implicit layer of memory is the only form available to the growing infant (22). But
even beyond that early age, we continue to create implicit memories but they are then
often selectively integrated into the next layer of processing called “explicit” or
“declarative” forms of memory.

Implicit memory involves the perceptual, emotional, and behavioral neural responses
activated during an experience. It is likely that our bodily sensations are also a form of
implicit memory, but these have not been formally studied in research paradigms.
Mental models, or generalizations of repeated experiences called “schema,” are also a
form of implicit memory. The brain also readies itself to respond in a fashion called
“priming” in which past experiences shape the way we prepare for the future.
Implicit memory encoding does not require focal, conscious attention. A second crucial
feature of implicit memory is that when we do retrieve an element of implicit memory
into awareness we do not have the internal sensation that something is being
accessed from a memory of the past. We just have the perceptual, emotional,
somatosensory, or behavioral response without knowing that these are activations
related to something we’ve experienced before.
The second layering of memory is called explicit and involves the two forms of factual
(or “semantic”) memory and episodic (or memory for an episode of an experience in
the past). Episodic memory has a sense of the self and of time. Both semantic and
episodic memory appear to require focal attention for their encoding and when they are
retrieved from storage into present awareness they do have the internal sensation that
something is being activated from the past. The hippocampus may serve an important
role in memory integration as it functions as an “implicit memory puzzle piece
assembler” that clusters the basic building blocks of the various elements of implicit
memory together into framed pictures of semantic and episodic memory. These framed
pictures of explicit memory can then be further integrated into autobiographical
memory, a function that may involve rapid eye movement sleep as our dreams
integrate our past experiences, our daytime events, and our emotional themes of our
lives.

One proposal about trauma’s effects on memory is that it may transiently block the
integrative function of the hippocampus in memory integration (23). With massive
stress hormone secretion or amygdala discharge in response to an overwhelming
event, the hippocampus may be temporarily shut-down (24). In addition to this direct
effect of trauma of hippocampal function, some people may attempt to adapt to trauma
by dividing their conscious attention, placing it only on non-traumatic elements of the
environment at that time. The resultant neural configuration of blocked hippocampal
processing, when reactivated, can present itself as free-floating, unassembled
elements of perception, bodily sensation, emotion, and behavioral response without
the internal sense that something is coming from the past. Beliefs and altered states of
mind may also enter consciousness as the implicit mental models and priming become
activated in response to environmental or internal triggers resembling components of
the original experience. This “implicit-only” form or memory can be one explanation for
the flashbacks and symptomatic profile of Post Traumatic Stress Disorder.
The key to memory integration is the neural reality that focal attention allows the puzzle
pieces of implicit memory to enter the spotlight of attention and then be assembled into
the framed pictures of semantic and self-memories. With such reflective focus, what
was once a memory configuration capable of intrusion on a person’s life can move into
a form of knowing that involves both deep thoughts and deep sensations of the reality
of the past.

Dos enfoques: Uno en el aquí y el ahora y

otro en las sensaciones y la crisis evocada
por la memoria detonada.
E. Narrative Integration
As we continue to grow throughout the first five years of life, explicit autobiographical
recollection becomes even further integrated into narrative memory which involves the
detection and creation of thematic elements of our lives. The brain appears to be able
to have a narrative function that can detect themes of our life story and to draw heavily
on prefrontal functions as they continue to integrate neural maps that form the
underlying architecture of our episodic and autobiographical memory systems. With
narrative reflection, one can choose, with consciousness, to detect and then possibly
change old maladaptive patterns.

In the attachment research world, it is coherent narratives, stories that deeply make
sense of our lives, which are the most robust predictor of how children will attach to us
(25). This finding suggests that parents who’ve made sense of their lives, as revealed
in their coherent life narratives, will be those that somehow offer their children patterns
of communication that promote well-being. In brief, we can summarize the exploration
of this finding by suggesting that it is the parents’ neural integration that helps them
create a coherent narrative, and helps them be receptive to their child’s own mind and
communicative signals (26). Such a pattern may reflect the central role of inter- and
intrapersonal mental attunement in the development of well-being.

4 HECHOS (Cosas que ocurrieron, y al final

una cosa buena)
Ej: Fuiste al dentista,
Tenías mucho miedo y lloraste al llegar,
te salió sangre de la boca, te dolió mucho,
pero te felicito, lo lograste, tuviste miedo y te
sentaste y abriste la boca y estoy orgullosa
de tí.

No hay
errores,
F. State Integration
As the brain becomes activated in the moment, it coalesces its firing patterns into
clusters of activation we can call a “state of mind.” These repeated and enduring states
of activation of the brain can help define what we see as our personality, our patterns
of perception and emotional and behavioral responses that help us denote who we are.
We can embrace the differentiated states of mind and their drive to satisfy different
needs for familiarity and comfort, novelty and challenge, connection and love, mastery
and exploration. State integration refers to the way we embrace and nurture these
different states and their defining needs across time. Late adolescence is thought to be
a time of resolution of these conflictual states, with mental well-being emerging when
such state integration is done well and mental turmoil present when resolution is not
achieved (27). Finding balance in the integration of states enables us to find our needs
satisfied and to create meaning in the pursuit of those various dimensions of our lives.
G. Temporal Integration
As we move from our earliest years and our prefrontal cortices begin to develop our
capacity for reflection on the nature of time begins to emerge. First available as a form
of mental time travel that enables an early form of self-knowing awareness, this
reflective capacity to link past, present, and future soon reveals itself in an awareness
of the finite nature of our time on this planet. We learn that people’s lives are often
limited to a century or so, and that the experience of death is an inevitable part of each
of our lives. Temporal integration directly confronts this organizational role of time, and
our transient lives, in helping us consider the deep questions of purpose in life.
H. Interpersonal Integration and the Mirror Neuron System
Our brain is the social organ of the body. The structure of our neural architecture
reveals how we need connections to other people in order to feel in balance and to
develop well (28). As we’ve seen in the function of the middle prefrontal regions, the
brain integrates input from other
people with the process of regulating the body, balancing emotional states, and the
creation of self-awareness. This visceral, social, and self integration suggests that our
minds are woven from the integration of aspects of reality that on the surface appear to
be quite disparate. How could bodily, interpersonal and mental go together? To explore
this dimension, let’s use the example of mirror neurons to highlight the integration of
these domains of reality (29).
Discovered in the mid-nineteen nineties, the mirror neuron system reveals how the
brain is capable of integrating perceptual learning with motor action to create internal
representations of intentional states in others. Initial studies in monkeys revealed that if
a monkey sees someone pick up an object, his own motor system will become primed
to imitate that same action. In humans, the mirror neuron system is much more
complex and emerging studies reveal that many ways in which our internal, one-to-
one, and larger social experiences may be shaped by the integrative nature of this
system.

For example, the mirror neuron system is thought to be an essential aspect of the
neural basis for empathy (29, 30). By perceiving the expressions of another individual,
the brain is able to create within its own body an internal state that is thought to
“resonate” with that of the other person. Resonance involves a change in physiologic,
affective, and intentional states within the observer that are determined by the
perception of the respective states of activation within the person being observed.
One-to-one attuned communication may find its sense of coherence within such
resonating internal states. In addition, the behavior of larger groups, such as families
and social gatherings may reveal this shared state of internal functioning.

The clinical implications of this work are profound (30, 12) and help therapists to
understand not only the inherently social nature of the brain but that their own bodily
shifts may serve as the gateway toward empathic insights into the state of another
person. Mediated via the insula, perceptions of another’s affective expressions may
alter our own somatic and limbic states and then be examined through a prefrontal
process of interoception, interpretation, and attribution to another’s states (31). Being
open to our own bodily states as therapists is a crucial step in
establishing the interpersonal attunement and understanding that is at the heart of
interpersonal integration. The term “countertransference” can be used to refer to this
important way in which our own non-verbal shifts in brain state may offer us a direct
glimpse into the internal world of our patients.
The mirror neuron system offers us a new vista into the neural basis of not only
imitation, social behavior and empathy, but also the interpersonal experiences that may
promote a state of well-being. Mirror neurons reveal the fundamental integration within
the brain of the perceptual and motor systems with limbic and somatic regulatory
functions. The mirror neuron system also illuminates the profoundly social nature of our
brains. This social basis of neural function may offer new pathways for us to
understand how psychotherapy leads to the process of change. When two minds feel
connected, when they become integrated, the state of firing of each individual can be
proposed to become more coherent. Literally this may mean that the corresponding
activations between the body-proper, limbic areas and even cortical representations of
intentional states between two individuals enter a state of “resonance” in which he
matches the profiles of the other. The impairment of such shared states has been
proposed to be a characteristic of forms of psychopathology, including schizophrenia
(29). Recent studies in individual with autism spectrum disorder (32) reveal impairment
in the capacity to perceive emotional expressions in others that is associated with
markedly diminished mirror neuron activation. With impaired mirror neuron system
functioning, the social brain is unable to share in the rapid social interactions that
depend on a shared set of neural profiles that create an embedded matrix of both
social behavior and non-verbal understanding of the meaning of social interactions.

In the process of psychotherapy with a range of individuals with intact mirror neuron
systems, shared states with the therapist may be an essential component of the
therapeutic process. As two individuals share the closely resonant reverberating
interactions that their mirror neuron systems makes possible, what before may have
been unbearable states of affective and bodily activation within the patient may now
become tolerable within conscious awareness. Being empathic with patients may be
more than just something that helps them “feel better” – it may create a new state of
neural activation with a coherence in the moment improves the capacity for self-
regulation. What is at first a form of interpersonal integration in the sharing of affective
and cognitive states now evolves into a form of internal integration in the patient. With
the entry of previously warded-off states of being in conscious awareness, the patient
can now learn to develop enhanced self-regulatory capacities that before were beyond
their skill set. It may be that as interpersonal attunement initiates a new form of
awareness that makes intrapersonal attunement possible, new self-regulatory
capacities become available.

If the mirror neuron system were to be focused on one’s own states of mind, we can
propose that a form of internal attunement would allow for new and more adaptive
forms of self- regulation to develop. The practice of focusing attention in the present
moment on one’s own intentions and somatic states, such as the breath, have been a
mainstay of mindful awareness practices over thousands of years. The recent findings
that such practices are associated with enhanced physiological, psychological and
interpersonal functioning may fit into the larger framework that integrated states
correlate with well-being. A “Mirror Neuron-Mindfulness Hypothesis” can be offered (12)
that proposes that the focusing of one’s non-judgmental attention on the internal state
of intention, affect, thought and bodily function may be one way in which the brain
focuses inward to promote well-being. As the therapist attempts to achieve such an
open, receptive state of awareness toward both internal state changes and for
interpersonal signals sent by the patient, the patient’s own mind may be offered the
important social experiences to create a similar state. In this way the mirror neuron
system may serve a powerful role as the neural basis of mental attunement within and
between both patient and therapist.

Studies of attachment reveal that the parent’s openness to a child’s signals and the
coherence of the parent’s own narrative are important predictors of a child’s
development of security of attachment (13). Such factors seem to promote a form of
resiliency in the child which helps self-regulation unfold as the child matures.
Psychotherapy may naturally harness these developmental origins of well-being in
creating a resonant state in which the therapist is sensitive to the patient’s signals and
also has made sense of his or her own life. Being open to the many layers of our
experience, often involving the non-verbal world of sensation and affect in addition to
our verbal understanding is an important stance for the therapist to create toward the
internal and interpersonal worlds. Within this framework, the state of brain activation in
the therapist serves as a vital source of resonance that can profoundly alter the ways
in which the patient’s brain is activated in the moment-to-moment experiences within
therapy. Such interactive experiences allow the patient to “feel felt” and understood by
the therapist, and they also may establish new neural net firing patterns that can lead
to neural plastic changes. Ultimately lasting effects of psychotherapy must harness
such experiences that promote the growth of new synaptic connections so that more
adaptive capacities for self-regulation and well-being can be established.
H. Transpirational Integration
As individuals move forward in achieving new levels of integration across the eight
domains described above, clinical experience reveals a fascinating finding in which
people begin to feel a different sense of connection to both themselves and the world
beyond their previously skin-defined sense of self. The term “transpiration” denotes
how new states of being seem to emerge as a vital sense of life is breathed across
each of the domains of integration. One feeling that many patients have articulated is a
sense that they are connected to a larger whole, beyond their immediate lives, than the
previous sense of isolation they may have been feeling from others, and even from
themselves. It may be that our highly evolved mirror neuron systems reveal the
fundamental ways in which we are neurally constructed to feel connected to each
other. Because neural plasticity appears to enable the brain to change throughout the
lifespan, it may be that psychotherapy for individuals at any age can allow for
interpersonal experiences to open the door to change.

Research suggests that our presence as medical or mental health clinicians, the way
we bring ourselves fully into connection with those for whom we care, is one of the
most crucial factors supporting how people heal—how they respond positively to our
therapeutic efforts. Whatever the individual approach or clinical technique employed,
the therapeutic relationship is one of the most powerful determinants of positive
outcome in a range of studies of psychotherapy (see Norcross, Beutler, & Levant,
2005).

What these studies share in common is the notion that our presence—with others and
with ourselves—promotes empathy and self-compassion, which both cultivates well-
being in our mental lives and in our bodily health. And so this conversation will be
focusing upon two important dimensions of understanding: the scientific knowledge
derived from

various disciplines of research and the direct subjective insights attained by immersion
in personal experience through focused exercises, which we will be exploring
throughout this book.

The brain continues to develop throughout the life span, and with the proper focus of
our minds we can actually strategically change our brains in a helpful way. As you’ll
see, the conceptual framework, brain basics, and practical exercises contained within
each chapter offer a way for us to enhance our own lives as we develop resilience,
strengthen the focus of our attention, and create resourcefulness in our selves. These
are some of the many traits within our own way of being that support the presence,
empathy, and compassion essential in helping others.
 PART

PART stands for the following elements of the essential part we play in helping others
grow and develop:

Presence: The way in which we are grounded in ourselves, open to others, and
participate fully in the life of the mind are important aspects of our presence at the
heart of relationships that help others grow. This inside-out view helps us see what we
need to do inside ourselves as professionals to develop this essential receptive starting
place for all clinical endeavors. This first chapter will invite you to consider a new visual
metaphor for mindfulness, presence, and the intersection of subjective mental
experience with objective neural firing.

Attunement: As signals are sent from one person to another, we have the opportunity
to tune in to those incoming streams of information and attend fully to what is being
sent rather than becoming swayed by our own preconceived ideas or perceptual
biases. When we attune to others—even in the urgency of an emergency visit—we
offer a crucial open mind to listen deeply to what the patient needs to let us know.
Without attunement, vital information can be lost—sometimes with dire consequences.
This chapter explores how attunement enables the healing relationship to begin.

Resonance: In this chapter we’ll discuss how the physiological result of presence and
attunement is the alignment of two autonomous beings into an interdependent and
functional whole as each person influences the internal state of the other. With
resonance we come to “feel felt” by the other. This joining has profound transformative
effects on both people. Resonance is what our human nervous system is built to
require for a sense of connection to others early in life. This experience of connection
brings with it a feeling of security, of being seen, and of feeling safe. The need for such
intimate and vulnerable connection persists throughout our lives.

Trust: When we feel resonance with someone, we open the doorway to a sense of
feeling safe and seen, comforted and connected. The brain’s response to such attuned
connection is to create a state of openness and trust—the basic ingredients that can
promote brain stimulation and growth. In this chapter we’ll see how we actually have
neural pathways that govern this sense of openness and permit us to activate a social
engagement system.
T´S of Integration

1. TRUST Presence, attunement, and resonance are the way we clinically create the
essential condition of trust. As our patients feel this healing love without fear, as they
come to the neuroceptive evaluation of safety, trust is created within their subjective
experience.

And so trust emerges from the attunement we feel with ourselves so that we can
remain open to others. This presence-attunement-resonance sequence sets the stage
for all the “TRs” (our words beginning with tr) to come. The physical side of this trusting
state can help us see how trust creates the conditions for change.

We are all human, we all have social brains, and finding a way to acknowledge and
respect each other’s inner world of vulnerability with curiosity, openness, acceptance,
and love enables us to demonstrate our belief that trust is a basic neurological need.

2.Truth: As we open ourselves to others and to ourselves, the true nature of our
internal world of memory, perception, longing, and desire emerges into awareness. It is
this grounding in things-as- they-truly-are that permits deep and lasting change to
begin. We’ll dive deeply into these important issues in this chapter and see how
knowing the ways our own narratives may be imprisoning us is a first step toward
awakening the mind and stirring us from the slumber of automatic pilot. Facing realities
openly rather than automatically attempting to move them in our desired but impossible
direction is how truth becomes the friend of clinician and patient alike.

3.Tripod: This chapter illustrates the way we stabilize our mind’s lens to see the
internal world. Sometimes the emergence of neural representations of things as they
are into our awareness can be jumpy and confusing as we experience them as fleeting
images or intense sensations that flood our mind’s eye. The tripod is a visual metaphor
for a three- legged support of the lens of the mental camera we use to view the mind
itself—the important capacity called mindsight. Our mindsight lens is supported by the
tripod of openness, objectivity, and observation and enables us to see the mind with
more clarity and depth, and to move our lives toward well-being and health. Each of
these three legs of the tripod can be strengthened with specific mental practices we’ll
explore.

4.Triception: Ultimately the ability to use mindsight to see the internal world with more
clarity and to transform the mind with more power relies upon our capacity to perceive
a triangle of well-being. This perceptual ability is calledtriception and enables us to
sense the flow of energy and information within three interdependent aspects of human
life: relationships, mind, and brain. Relationships are how we share energy and
information flow; mind can be defined in part as how we regulate that flow; and brain is
a term we can use to refer to the mechanism of energy and information flow in the
extended nervous system distributed throughout the entire body. In this chapter we’ll
see how a clinician’s

5.Tracking: Within the therapeutic relationship we establish with our patients and with
our clients (I’ll be using these two clinical terms interchangeably as they each have
benefits and drawbacks in our various therapeutic fields), the natural drive of the
nervous system to move toward health can be released through a process of tracking
energy and information flow within and between people. Ultimately this tracking is a
way of placing into awareness the energy and information flow of the triangle of well-
being that can then release an innate push toward something called neural integration.
This chapter will illuminate how integration entails the linkage of differentiated parts of
a system. When we are integrated, we live in harmony. Out of integration, we move
toward rigidity, chaos, or both. As we’ll see, integration can be viewed as the underlying
mechanism of well-being and overall mental health.

6.Traits: Psychotherapy can offer tremendous opportunities for growth. Yet we are
born with enduring and genetically influenced traits seen in our earliest months of life
as temperament. In this chapter, we’ll explore a synthetic view of adult personality that
proposes a mechanism whereby childhood temperament goes from an externally
observable set of characteristics to an internally organizing pattern of structuring
tendencies of attention and meaning.

7.Trauma: Overwhelming events can be seen to flood an individual’s capacity to adapt

flexibly to an experience. When we remain with unresolved trauma of large and small t
sorts—of life-threatening events or significant but non-life-threatening betrayals —we
can see how the layers of memory have remained in a nonintegrated form. In this
chapter we’ll explore trauma from the inside out and sense how the layers of implicit
memory with their representations of perception, emotion, bodily sensation, and
behavior may remain jumbled and dominate our internal mind-scape. The pathway
toward resolving trauma can be seen to involve the integration of these disconnected
elements of implicit memory.

8.Transition: When people first come for therapy, they often are mired in life patterns
filled with chaos or rigidity. When neural integration is freely occurring, we live with the
ease of well-being. When regions do not become differentiated, or if they are blocked
from becoming linked, integration will be impaired. The outcome of such blocked
integration is chaos or rigidity. As clinicians we can take the “pulse of integration” by
sensing these movements of life’s flow and feel the internal sense of these transitions
toward chaotic intrusions or rigid depletions.
9.Training: The mind is like a muscle. We need to tone our musculoskeletal system
regularly or it will not function optimally as we age. Naturally there is no actual muscle
tissue in our mental life —but the need to offer specific ways to harness our regulatory
capacities is real. We keep our mental acuity, our brain’s synaptic webs, and our
interconnections within relationships well honed by mental training. In this chapter we’ll
see how ultimately this training supports the way we develop mindsight skills, likely
harnessing the power of deep forms of practice to stimulate the growth of myelin
sheaths that make our neural networks more efficient.

10.Transformation: As clinicians we can feel the pulse of integration and when chaos
or rigidity are present we can then strategically place a spotlight of attention on the
various domains that are blocking the linkage of differentiated aspects of a person’s
life. Neuroplasticity—the process of change in the structural connections in the brain in
response to experience—is promoted with such focused awareness and serves to
activate specific neural groups simultaneously. This chapter reviews the nine domains
of integration and how these can be seen as the transformative integrative process that
shapes the overall functioning of our mind, brain, and relationships.

11.Tranquility: Neural integration promotes a coherence of our minds and we f e e

lconnected,op e n ,harmonious, engaged,receptive,emergent (things feeling fresh and
alive),noetic (having a sense of deep nonconceptual knowing), compassionate, and
empathic. The systems view of integration reveals that this flexible and adaptive state
has a sense of emotional equanimity and meaning embedded in it —what some would
call a state of tranquility. This chapter will explore how developing this form of what the
ancient Greeks termed eudaimonia—of living a life of meaning, compassion,
equanimity, and connection —offers us a path to helping others develop tranquility from
the inside out.

12.Transpiration: The human brain is constructed in such a way that it gives us

tendencies not only to emphasize the negative, but also to feel isolated and apart from
one another. Transpiration is a term that signifies “breathing across” and is intended to
signify the ways in which breathing across all the various domains of integration we’ll
be exploring in ourselves and others actually can dissolve the top- down influences
that make us believe we are isolated beings. This chapter will offer a way of seeing
how transpiration is a state of awareness that inspires us to rewire our brains toward
the reality that we are all a part of a living whole. Integration reminds us that this whole
is more than the sum of its parts: We retain our individual identities while fully joining as
a “we.” In the healing arts we focus on healing and health and holistic, each derived
from the word whole. Coming to the full realization that we are in fact part of an
interdependent whole, an interconnected web of the flow of living beings across time,
enables us to see the powerful role we can play in helping others as we strive to heal
the planet, beginning with ourselves and working one relationship at a time to make
this a kinder and more compassionate world.
RESUMEN DE IDEAS:

EL DILEMA DE LA SOBREVIVENCIA VS. FELICIDAD

- Mente y Cuerpo

- Hemisfo derecho y hemisferio izquierdo

- Procesos Automáticos y procesos controlados

- Estructuras antiguas y estructuras nuevas

- caos y rigidez - triangulo del bien estar

- regulation via monitoring and modifying,

Notas de dominios de integración:

Integration is the linkage of differentiated parts.

·      Consciousness integration is the ability to differentiate or distinguish between awareness and that which
a person is aware of. Getting lost in object of awareness is not integration.

·      Bilateral or horizontal integration is the right/left brain material discussed by McGilchrist in The Master
and his Emissary (and summarized in the brief video here).

·      Vertical integration refers to the “upstairs” and “downstairs” brain distinction in simple terms. For our
purposes it refers to the (a) cortical, (b) limbic and (c) brainstem and neural nets surrounding internal organs of
torso. Someone living “in his head” or unable to cortically control limbic/physical reactivity is not vertically
integrated.

·      Memory integration refers to implicit and explicit memory. Implicit includes perceptual, emotional,
behavioral and body memory, as well as mental model and priming. Explicit refers to autobiographical and
factual memory. Unresolved implicit memory (e.g. traumatic event) that has not yet been processed into
explicit autobiographical and factual memory is not memory integration.

·      Narrative integration is being the author of one’s life story. It is part of consciousness but not all of it.
Sensory awareness is important as well.

·      State integration refers to having cohesive states (intrastate) and that these differentiated states can
collaborate or cooperate (interstate).

·      Interpersonal integration means the ability to remain a differentiated self as well as the ability to link with
another as a “we.”

·      Temporal integration refers to awareness  across time. Its integration involves balancing a desire for
certainty (prediction) along with the knowledge of uncertainty (transience).

·      Transpirational integration is a person’s recognition of being a differentiated self as well as a part of
something larger.