Still Face and Mirror Neurons -The Neuroscience of Psychotherapy

Overview:

The development of human beings’ intersubjective nature starts immediately after birth and probably represents the foundational principle of our meaning-making ability. Since the very beginning of our life, relationality plays a key role in our existence: infants’ ability to imitate facial expressions not only guarantees their survival but also allows them to interact with their mothers in an attuned way, thus creating increasingly complex relational exchanges, which are fundamental to their psychobiological development. The discovery of mirror neurons has provided a neurophysiological basis for the Still Face paradigm and made a substantial contribution to scientific research in this field. How can Psychotherapy build on this valuable knowledge in order to promote individual wellbeing?

This on-demand video course from the congress “Still Face and Mirror Neurons – the Neuroscience of Psychotherapy” will give some of the most eminent experts in this field the opportunity to answer this question. A number of internationally well-known speakers will illustrate the most recent studies on the role of emotional/relational attunement and the individual’s relationship with the Self, by exploring both the research implications and the therapeutic applications in this field. They will emphasise how intersubjectivity is not strictly related to the relationship with the Other, but also involves the relationship with the Self, which is one of the main goals of the psychotherapeutic change process. In addition, different therapeutic approaches and a series of hypotheses on mind functioning – that Neuroscience can support and validate – will also be discussed. Besides this, speakers will focus on the role of self-recognition in the mirror, as well as on the shame and self-loathing that traumatised individuals typically experience, in order to deeply explore the relational dimension of the Self within the most advanced therapeutic frameworks.

Part 1: Epistemic trust and free energy: an integrative model for psychological therapy by Peter Fonagy

Perhaps the most influential neuroscientific model of the last decade derives from Friston’s recent free energy model. This computational neuroscience model has enabled psychotherapists and psychopathologists to extend their understanding of the brain-mind and integrate it with phenomenological and dynamic models of mental disorder and its treatment. This presentation represents a contribution to this field linking the therapeutic model based on epistemic trust, to Friston’s understanding of neuro-functioning based on the concept of free energy. The presentation will review Friston’s model as well as the model of epistemic trust, and advance a set of integrative ideas to inspire a new generation of research in this area.

Part 2: The still-face and the dynamic process of human meaning making by Ed Tronick

The fundamental significance of humans’ meaning-making about themselves in relation to: the world of people; the inanimate world and to their own self is instantiated by the Still-Face paradigm. Findings on this paradigm show that making of meaning is a dynamic process, made at multiple brain areas and systems – psychobiological or neurosomatic. While meanings are often made endogenously, they are more typically co-created with each other in an active exchange of information. That exchange is messy. It is characterised by mismatches and matches of meanings and their repair. Successful meaning-making results in an expansion of consciousness and generates attachment and relationships, resilience and trust. Failure to make meaning shrinks and constricts consciousness, and generates distrust and fragility. Research from Tronick’s laboratory on human genetics, physiology, emotions, epigenetics and caretaker-child and adult interactions will be presented to illustrate this conceptualisation. There will be videotapes of the Still-Face in infants, children, and adults to elaborate on his research.

Part 3: Mirrors to the soul: self-face representation and social mirroring by Harry Farmer

The ability to accurately recognise one’s own face has long been held to be one of the key markers of higher-level consciousness. Recent research has increased our understanding of the contribution that the integration of information from several different sensory channels (including vision, touch and our internal senses of proprioception and interoception) makes to the representation of self-face. In addition work in social neuroscience shows the key role that the mapping of other people’s actions, facial expressions, touch and pain experiences onto one’s own sensory systems (mirroring) plays in the development of empathic responses and perspective taking . In this talk, Farmer will draw on research from the cognitive neurosciences to illustrate how self-face perception both influences and is influenced by social interactions with others. First, he will present evidence that tactile and motor mirroring of others can lead to increased perceived facial similarity and with it, an increased sense of affiliation and trust. He will then outline research demonstrating that this relationship also works in reverse with trustworthy behavior and increased social affiliation, modulating the response of both the tactile and motor mirror systems. Finally, he will present recent work examining how disruptions to the sense of self, presenting as depersonalisation, lead to disrupted mirroring in both the tactile and motor domains.

Part 4: Undoing aloneness, feeling seen and the experiential processing of deep relational experience: energy for life & the emergence of the core self by Diana Fosha

Attachment and intersubjectivity are not just processes humming in the background, silently working their potent magic; they are also important relational experiences, which, if worked with explicitly and experientially, can be transformative. This workshop will explore the power of undoing aloneness and the explicit and experiential processing of deep relational experiences, both traumatic and reparative. AEDP has developed powerful relational processing techniques for working experientially with deep relational experience, and powerful metatherapeutic processing techniques for working experientially with the emergent transformational corrective relational experiences. Diana Fosha will delve into the vital role of positive relational emotions in the process of change, that emerge as an integral aspect of therapeutic work with the painful and overwhelming emotional experiences associated with attachment trauma. AEDP has identified and described a phenomenology of positive affective experiences, including the healing affects, the “we” relational affects, and core state, which signal the operation of healing transformational relational processes. Fosha will discuss how (i) through the moment-to-moment tracking of bodily rooted experience and dyadic affect regulation (ii) in the context of a relationship in which the individual feels safe and known, (iii) undoing aloneness and (iv) the experiential processing of deep relational experiences associated with both attachment trauma and corrective reparative relational experiences (v) repairs relational trauma, (vi) frees the patient’s fully functioning core self, and (vii) naturally culminates in energy rich flourishing, i.e., deeply positive experiences of aliveness, vitality, connection, hope, faith, clarity, agency, simplicity, compassion, joy, and truth. Key to this is the focus on and experiential processing of the experience of healing transformation in the context of a healing dyad.

Part 5: Healing attachment insecurity with the help of imagined ideal parent figures in psychotherapy by David S. Elliott

Effective treatments for attachment insecurity includes the recognition of the vital role of the felt sense of being empathically attuned to by important others. As psychotherapists, we try our best to be attuned and responsive, and to express and mirror qualities of being that help our patients to feel protected and cared for, seen and known, valued and valuable, appreciated and loved. Though we can be very helpful in these ways, there is a practical limitation to this mode of treatment: our insecure patients carry internal working models of themselves as children being in some form of a problematic relationship with their parents. A new and positive adult relationship with a psychotherapist is certainly beneficial, but it is unlikely to replace or most efficiently change the original problematic internal working model. As a complement to the ‘therapist as good attachment figure’ approach, “ideal parent figures” can be part of the therapeutic process toward attachment security. When an adult patient, in the context of a safe and attuned therapeutic relationship, imagines being and feeling as a young child and interacting with imagined parents who embody all the qualities of being and behaviour that feel just right to the patient-as-child, the original problematic internal working model becomes replaced by a new, positive, secure attachment relationship model. This approach is consistent with and complementary to the principles and implications of polyvagal theory, memory reconsolidation, and relational and body-oriented psychotherapies.

Part 6: Still face and mirror neurons in psychotherapy: how to work at an implicit level using the mindful interbeing mirror therapy – theory and methodologies by Alessandro Carmelita and Marina Cirio

The Still Face Paradigm and the mechanism of mirror neurons are two foundational principles of Mindful Interbeing Mirror Therapy (MIMT): as a matter of fact, both of them have emphasized – in a scientific way – the innate relational dimension that characterizes the processes of Self-construction and existential meaning-making of every human being. By using the mirror, therapists can explore the client’s relationship with their own Self since the very beginning, while the concept of “Self” is objectified as an “Other” with whom the client interacts. Consequently, the intersubjective dimension of humanity is experienced in a new way, which contributes to making change faster. Based on a conscious, targeted activation of the specific neurobiological circuits that regulate face recognition, and the identification of emotions related to facial expressions, MIMT is an effective form of psychotherapy, conceived as a process of reconstruction of the Self. The therapeutic goal is helping the client recreating a deep sense of connection with and belonging to their own image, reflected by the mirror; in addition, MIMT aims to overcome the shame and self-loathing that typically characterise traumatised clients, by helping them experience a new self-compassion.

Part 7: The neuroscience of resilience by Linda Graham

Resilience – the capacity to cope skillfully with adversity and bounce back quickly from disappointment, difficulty, and even disaster – is innate in human beings because it is innate in the human brain. The conditioning of early attachment experiences develops the capacities of the prefrontal cortex to regulate the body-nervous system-emotional responses to stress, danger and life threat; to relate to one’s self and others from a sense of safety, protection, trust and intra-personal/inter-personal resonance; to recognise and reflect on implicitly encoded patterns of response to life’s challenges and crises that would foster resilience. Experiences of complex developmental trauma lead further to experiences of seemingly intractable shame and self-loathing that invariably derail resilience. Complex developmental trauma even derails the development of the brain’s structures and functioning needed to recover one’s innate capacities of resilience and develop flexible, adaptive coping strategies for the future. Modern neuroscience illuminates which body-based tools of mindful empathy and resonant connection (re-parenting) psychotherapists can use to foster clients’ self-awareness, self-compassion, and self-acceptance that can heal the shame and re-integrate split-off inner parts so that they no longer derail the inner secure base of resilience. Modern neuroscience also illuminates which underlying processes of brain change like memory consolidation/reconsolidation can be used safely, efficiently, effectively to get the maturation of the brain back on track, shifting the functioning of the brain out of contraction, negativity, reactivity into more receptivity, openness to learning and growth. Clients can bounce forward into new meanings and a deeper sense of purpose.

Part 8: The traumatised self in the mirror: overcoming shame, self-loathing, and dissociation by Ruth Lanius

Self-statements such as ‘When I look in the mirror, I see a monster’, or ‘when I look in the mirror, I do not recognise myself’ represent the reality of many individuals who have endured chronic developmental trauma. Not only does trauma often have devastating effects on an individual’s sense of self, but its impact is also felt the relationship with others, leaving the traumatised person feeling ashamed of their existence and estranged from the world. These feelings of shame can have profound effects on the ability to experience positive emotions, which may lead the traumatised individual to feel non-deserving of experiencing pride, joy, and love and may fuel feelings of self-loathing. Moreover, these experiences can trigger severe hyper- and hypo-arousal states that often have the effect of pushing the traumatised self outside the boundaries of the window of tolerance, rendering the individual dissociated from his/her own body and the world around them. Self-mutilation is also common, an action that is often driven by feelings of disgust and shame about the self. This lecture will address specific strategies of how to deal with shame and related self-dysfunction, including self-loathing and self-mutilation. In addition, targeted interventions that can help to increase self-compassion will be illustrated, with the goal of reaching the restoration of the self. Implications of trauma-related self-disturbance for mindful interbeing mirror therapy will also be described. Finally, neurobiological mechanisms underlying self-dysfunction, positive emotion intolerance, and self-mutilation will be described. At the conclusion of the lecture, participants will have the ability to: i) describe the effects of long-term traumatisation on the self; ii) identify the cognitive and affective sequelae of disturbances in the sense of self; iii) identify interventions strategies aimed at restoring the sense of self and reducing symptom states; and iv) describe the neurobiological underpinnings of self-dysfunction, shame, and self-mutilation.

Part 9: Intentional attunement: from mirror neurons to intersubjectivity by Vittorio Gallese

The discovery of mirror neurons unveiled the neural mechanisms mediating between the multi-level experiential knowledge we hold of our body, and the implicit certainties we simultaneously hold about others. Such personal body-related experiential knowledge enables our intentional attunement with others. This we-centric space allows us to understand the actions performed by others, and to decode the emotions and sensations they experience. A direct form of “experiential understanding” is achieved by modeling the behaviors of others as intentional experiences on the basis of the equivalence between what the others do and feel and what we do and feel. This modeling mechanism is embodied simulation. By means of embodied simulation, we do not just “see” an action, an emotion, or a sensation. Side by side with the sensory description of the observed social stimuli, internal representations of the body states associated with actions, emotions, and sensations are evoked in the observer as if he/she would be doing a similar action or experiencing a similar emotion or sensation. Mirror neurons are likely the neural correlate of this mechanism. The sharp distinction, classically drawn between the first – and third – person experience of actions, emotions, and sensations, appears to be much more blurred at the level of the neural mechanisms mapping it. The gap between the two perspectives is bridged by the way the intentional relation is functionally mapped at the neural level by mirror mechanism. By means of a shared neural state realized in two different bodies that nevertheless obey the same functional rules, the “objectual other” becomes “another self”.