The counseling profession has been in existence in some fashion since the beginning of humankind. Reaching out to others for help with the varied complex issues of living, from using the village shaman to the local pastor to today’s licensed helping professionals, has been a core aspect of communal civilization.
As human beings have evolved, so too has this process of helping, including most recently the counseling profession as a whole. With advances in medical imaging and enhanced understandings of neuroscience, much more is known about the impact of counseling on behavior, feelings, thoughts and physiology. Neurocounseling represents another development in the counseling field and a new dimension of the counseling process. Neurocounseling simply states that behavioral and psychological symptoms have correlating physiological and neurological underpinnings. Integrating knowledge of the brain and related physiology into practice offers counselors and clients a more holistic approach to treatment.
By better understanding the interplay of the brain, its structures and functions, counselors are beginning to shatter many personality and behavioral myths surrounding mental health functioning and limits to clinical practice. For example, helping professionals believed counseling was effective because there was observable evidence that behaviors and thoughts often changed. However, through research involving functional magnetic resonance imaging (fMRI) and related advancements in brain imaging and recording, clear evidence denoting the effectiveness of counseling is now available. Counseling actually leads to discernible changes in brain structure and functioning, having been shown to build new neuronal and connective pathways through neuroplasticity and neurogenesis.
The goal of counseling has been to change behaviors and thoughts and help clients feel healthier. Today a major goal of counseling is to additionally help clients develop and enhance necessary skills for emotional and self-regulation. One concept highly relevant to self-regulation and neurocounseling involves allostasis, or the process of making changes to achieve balance or homeostasis. Robert Sapolisky’s work (2004) in allostasis, however, suggests that homeostasis can never truly be achieved and that each individual’s system is in a constant state of assessing and adjusting to reach a self-regulated state. The brain and the body must assess and decide what neurological, somatic, autonomic systems and internal and external stressors are needed to regain or maintain a sense of balance or regulation.
Having knowledge of the brain and related physiology can give counselors a richer understanding of a client and his or her presenting concerns, as well as allow counselors to be more intentional about the way they work with clients. For example, understanding that someone who has been traumatized may have a more reactive autonomic nervous system (ANS, the system that regulates our internal organs and is heavily involved in the fight-or-flight response) and perhaps greater emotional reactivity would suggest to a counselor that she or he would need to take longer to ensure that safety in the therapeutic relation has been developed and perhaps integrate techniques early on in the counseling process that would help to regulate the ANS and emotions. For example, teaching mindfulness, grounding skills, basic biofeedback skills of diaphragmatic breathing and heart rate variability can help in this regard. By regulating this system, traditional talk therapy will then be more effective. Regardless of clinical concern, from the moment a client enters a counselor’s office changes start occurring in the brain that can impact the work that is yet to occur. Counselors can enhance their effectiveness by paying attention to this vital information.
Educating clients about neurocounseling concepts and incorporating these into sessions helps clients view themselves through a very different lens and understand that they are more than their thoughts, behaviors and symptoms. Often it helps to destigmatize mental health and there is a relief in knowing physiology plays a role in the behaviors and emotions. Also, utilizing neurocounseling strategies can enhance a client’s self-confidence and intrinsic locus of control. This helps clients believe that their problems are not as insurmountable as they once seemed.
Integrating neurocounseling concepts into counseling sessions can take various forms, from formal neurofeedback (a form of biofeedback that utilizes brain waves) to simply using information about the brain to conceptualize and work with clients and client concerns. For example, neurocounseling might look and sound something like this: a new 14-year-old female client enters into counseling for the first time. Susie is greeted strategically and fills out the psychosocial history as usual, with the consent of caregivers. Once in the office, talk about confidentiality and the limits of counseling begins. Then the question, “What do you want to work on in counseling” is asked. Building rapport begins immediately by intentionally selecting the micro and macro skills to better understand the problem.
Neurocounseling utilizes all of the same intentional skills noted above, however, such approaches also consider the possible role that the brain may be playing in their presenting concerns and present condition. For example, being a 14-year-old female, Susie’s brain is developing rapidly, beginning to be enhanced between the prefrontal cortex and limbic regions. It is also experiencing a refinement of limbic functioning and a recent and rapid production of the sex hormone estrogen, which increases the production of dopamine in her system. This information may very well inform how the counselor works with Susie and the interventions that are incorporated into her session. Also, with the introductions, any hand shaking, any observed coldness and sweatiness in Susie’s palms are noticed. Entering the office, Susie’s breathing patterns are observed. Susie seems to be breathing shallowly and is a chest breather, not a diaphragm breather. Immediately additional information about the new client is gained regarding her current autonomic functioning, which may in turn inform autonomic regulation strategies that are introduced to Susie.
Furthermore, using a neurocounseling psychohistory model will also include questions about birth history, head trauma, concussions and any high fevers. This psychosocial history asks more about known brain dysregulation factors than the usual history. A Neurological Risk Assessment could even be given to the client. With these few additional assessment questions and observations—including information about diet, psychological trauma and prolonged interpersonal stressors—the counselor has acquired new information about Susie that may influence brain functioning.
Neurocounseling has the potential to enhance clients’ well being and treatment strategies above and beyond traditional counseling approaches. Understanding the workings of the brain and related physiology can benefit the counselor and client alike, and in turn enhance the work that is done together. The brain underlies every aspect of mental health and interpersonal dynamics, and comprehending the underpinnings allows counselors to better influence the neuroplasticity that occurs within counseling. Such knowledge also empowers clients to influence their own growth, regulation and development, both in and out of session. Once clients better understand their brain and how it functions, counselors can embrace even more the benefits of the therapeutic relationship with greater efficiency and efficacy.
About the Authors
Lori Russell-Chapin, a member of the American Counseling Association, is a counselor education Professor at Bradley University in Peoria, Ill. She can be reached at firstname.lastname@example.org.
Laura K. Jones, a member of the American Counseling Association, is an Assistant Professor at the University of Northern Colorado in Greeley, Colo. She can be reached at Laura.Jones@unco.edu.
Chapin, T. & Russell-Chapin, L. (2014). Neurotherapy and Neurofeedback: Brain-based Treatment for Psychological and Behavioral Problems. New York: Routledge.
Sapolsky, R. M. (2004). Why zebras don’t get ulcers. New York: Holt.