The Clinician as Neuroarchitect: The Importance of Mindfulness and Presence in Clinical Practice

Interpersonal neurobiology provides a framework from which to examine the incorporation of mindsight and mindfulness into clinical practice, employing the brain’s capacity for neuroplasticity to move oneself and one’s clients toward greater well-being. Through the lens of interpersonal neurobiology, this article will examine the benefits of mindfulness for clinicians, clients, and the therapeutic relationship. Lasting changes associated with mindfulness practices, including the hypothesized potential to alter one’s previously insecure attachment patterns, will also be discussed. An explanation of how to cultivate mindfulness by starting with presence and sustaining the practice with compassion will then be presented. Finally, practices that cultivate growth within the therapist–client relationship will be explained, along with clinical applications and recent research demonstrating the neural correlates of these practices and how they are effective at the level of the brain itself.     

A Place for Every Tool and Every Tool in Its Place: Cognitive Integrative Perspective for Coherence on the New Frontier of Mind and Body Practice

There is currently a growing research and clinical knowledge base regarding the application of Eastern traditions, especially mindfulness and other forms of meditation, to direct practice. As we incorporate new tools for intervention into our toolkit, it is important to expand our theoretical framework so that we can know when to utilize these tools, how their mechanism fits with the tools we already have, and what kinds of change or outcomes we should expect from utilizing them. These new tools are powerful across many experiences of distress, but clear guidelines are necessary to maximize their benefit. Berlin’s cognitive-integrative perspective provides a framework that allows for reflective understanding and application of mind/body/spirit that is consistent with social work values and what we currently know about the underlying science of mind. Using concrete examples from direct practice, this paper will lay out the framework that is consonant with Siegel’s interpersonal neurobiology, discussed in this volume, and also firmly rooted in the person-in-environment perspective that is characteristic of social work.     

Anxiety in Adolescence: The Integration of Attachment and Neurobiological Research into Clinical Practice

Attachment theory illuminates aspects of adolescent development and points to critical treatment directions for adolescents. Recent neurobiological research illustrates the importance of integrating physiological understanding into clinical work. The application of attachment theory and neurobiology to treatment is illustrated best through the case example of one adolescent with panic disorder treated in an outpatient setting.     

Maternal Neurobiological Processing of Negative Adolescent Stimuli: Relations With Positive Parenting and Relationship Quality

We examined associations between maternal affective neurobiology and positive parenting in a study of 20 mothers of adolescents. Mothers underwent functional magnetic resonance imaging during an emotion image task, rated parent‐adolescent relationship quality, and completed an adolescent interaction task in which positive parenting behaviors were observed. Maternal structure was associated with lower responsivity in emotional processing regions in the general negative image contrast and was related to greater dorsolateral prefrontal cortex activation to negative adolescent images. Parent‐adolescent relationship quality was associated with lower precuneus activation to negative adolescent images. Findings are among the first to connect functional brain processing with observed parenting behaviors for parents of adolescent children, and underscore the relative importance of affective processing in parenting older children.     

The Neurosequential Model of Therapeutics: An Interview with Bruce Perry

In this interview with Bruce Perry, MD, PhD, Senior Fellow of The Child Trauma Academy, Laurie MacKinnon discusses with Dr Perry developmental trauma and the Neurosequential Model of Therapeutics, an approach to clinical problem solving that utilises a developmental lens and incorporates advances in neurobiological development. Dr Perry gives his perspective on the causal connection between childhood abuse and later psychiatric diagnosis, the child's contact with a violent parent post‐separation, the importance of interventions that address the organisation and functioning of lower parts of the brain and his perspective on the use and limitations of psychotropic medications, cognitive behaviour therapy and family therapy.     

What clients of couple therapy model developers and their former students say about change, part I: model-dependent common factors across three models

Some researchers have hypothesized that factors common across therapy models are largely responsible for change. In this study we conducted semi-structured, open-ended qualitative interviews with three different MFT model developers (Dr. Susan M. Johnson, Emotionally Focused Therapy; Dr. Frank M. Dattilio, Cognitive-Behavioral Therapy; and Dr. Richard C. Schwartz, Internal Family Systems Therapy), Dr. Johnson and Dr. Schwartz's former students, and each of their former clients who had terminated therapy successfully. We examined possible common factors in our qualitative data analysis. Common factors fell into two main categories of model-dependent factors and model-independent factors. This article-the first of two-reviews the model-dependent common factors, common elements found across three distinct therapies. They include common conceptualizations, common interventions, and common outcomes, each with several subcategories. We discuss the clinical, training, and research implications of the results.     

Family Process and Child Development in Unlabeled (Normal) Families*

Preliminary data are reported from an ongoing project devoted to the study of normal families. The research emphasizes the effects of system-level variables and the micro patterns of conversational interaction on the development of children within the family. Our theoretical model focuses on the individuation process, and the way in which accuracy of interpersonal perception and mutual validation among family members contribute to and are affected by the personal development and functioning of individual family members. The data derive from two-hour interviews with 99 families in their homes, plus psychological, sociometric and achievement data on an adolescent girl in each family. We have found both structural factors and patterns of conversational interaction among parents that distinguish families of the adolescent girls who score high on the individual functioning measures from families of adolescent girls who score low on these same measures.     

Treatment of an acting-out adolescent girl: An interpersonal experience

The current emphasis on psychotherapy as an interpersonal or intersubjective experience is highly relevant to clinical work with adolescents. This paper presentes and discusses the treatment of an acting out adolescent girl from the perspective of the two-person relationship, emphasizing the interaction between the patient's dynamics and the therapist's responses.     

Putting Words to the Experience: An Italian Group Intervention for Children of Separated Parents

This article presents an Italian group intervention for children of separated parents and describes preliminary findings about its efficacy. After briefly discussing the state of art for interventions of children of separated parents, the core characteristics of the group intervention are explained and each meeting is described. Then, pre–post research is presented to provide empirical support for this approach. Results reported that participation in the group strengthens the social and interpersonal self-concept dimension in the majority of children. Results are discussed considering both empirical and clinical implications.     

The case for mindfulness‐based approaches in the cultivation of empathy: Does nonjudgmental,present‐moment awareness increase capacity for perspective‐taking and empathic concern?

Empathic responding, most notably perspective-taking and empathic concern, has important implications for interpersonal functioning. While empathy training approaches have received some support for a variety of populations, few extant interventions have targeted empathic responding in couples. Mindfulness- and acceptance-based behavioral approaches, for couples as a unit and/or for individual family members/partners, are proposed as an adjunct to empathy training interventions. Preliminary findings suggest that the viability of these interventions for increasing empathic responding should be further investigated, and specific suggestions for this line of research are offered.     

Dysfunctional Career Thoughts and Perceived Quality of Parental Relationships in Adolescents With Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is known to cause significant difficulties in interpersonal relationships. Empirical research in career development has demonstrated that close, supportive relationships are associated with positive vocational behaviors (Kenny et al., 2018). We examined dysfunctional career thoughts and perceived quality of parental relationships in high school students with ADHD. One hundred two adolescents (76 boys, 26 girls) with ADHD responded to measures of career thoughts and interpersonal relationship quality. Preliminary exploratory analysis, using multiple linear regression, showed that male participants' dysfunctional career thoughts were statistically significantly related to their relationships with their mothers. For female participants, relationships with fathers represented an area for further exploration. Results suggest that career professionals can enhance positive outcomes of decision-making and problem-solving issues in adolescence with additional focus on relational interventions. Future research should incorporate the influence of gender and race/ethnicity on crucial relationships and focus on paternal relationships using cognitive information processing–based interventions with this population.     

The Body Comes to Therapy Too

Current research reveals that trauma often cannot be resolved solely through interventions that utilize left-brain functions, such as those used in traditional talk therapy. Because trauma is actually something that happens deep in the core of the brain and the body, the most effective treatment approaches integrate traditional therapy modalities with those that focus on calming the nervous system such as yoga, mindfulness, imagery, expressive arts, and eye movement desensitization and reprocessing. This paper will focus on synthesizing current information on traumatic stress, the neurobiology of trauma, and evidence-based, body-integrative interventions provided within the framework of the Collaborative Change Model (CCM) (Barrett in The systemic treatment of incest. Taylor & Francis, Bristol, 1989; Treating complex trauma: a relational blueprint for collaboration and change. Rutledge, New York, 2014). Through the framework of the CCM, this paper will provide clinicians with an understanding of how and when to engage clients in body–mind approaches, how to help clients learn to recognize when they are in fight, flight, or freeze response patterns, and how to develop skills for managing emotional dysregulation. A detailed case study will be provided to illustrate this integrative approach in the treatment of trauma.     

The Assessment Checklist for Adolescents — ACA: A scale for measuring the mental health of young people in foster,kinship, residential and adoptive care

The Assessment Checklist for Adolescents — ACA is a 105-item carer-report mental health rating scale, measuring behaviours, emotional states, traits, and manners of relating to others, as manifested by adolescents (ages 12 to 17) residing in various types of alternate care, as well as those adopted from care. The ACA was designed for population and clinical research with these young people, and for use as a clinical assessment measure. The ACA's content was largely derived from the Assessment Checklist for Children (ACC). Fifteen ACC items were modified to better reflect adolescent difficulties, and 25 additional items were derived using a combination of inductive and deductive strategies. Item and factor analyses were carried out on scores from a 136-item research instrument, obtained for 230 young people residing in long-term care (as part of the NSW Children in Care study). These data were supplemented by ACC scores obtained for 142 adolescents residing in treatment foster care in Ontario, Canada. A robust 7-factor model was identified among a core of 73 clinical item scores, accounting for 51% of score variance. Four of the factors replicate ACC clinical scales (non-reciprocal interpersonal behaviour; sexual behaviour problems; food maintenance behaviour; and suicide discourse), and three are unique to the ACA (social instability/behavioural dysregulation; emotional dysregulation/distorted social cognition; and dissociation/trauma symptoms). The ACA also contains two empirically-derived low self-esteem scales (low confidence; negative self-image) that are shared with the ACC. Initial data indicate that the ACA has good content, construct and criterion-related validity, as well as high internal reliability.     

Walking in the valley of death: The impact of brain tumors on children

Cancer is the largest cause of death by disease in children under 15, and tumors of the brain and central nervous system are the second most common type. Such tumors sometimes present initially with psychiatric features, and further diagnostic confusions can ensue with hospitalization and treatment. This monograph addresses the devastating impact of an intracranial neoplasm on the emotional life and adaptations of the child, with particular attention to interventions and possible diagnostic problems.The assistance of Dr. Edna F. Roth in the preparation of this article is gratefully acknowledged.     

International Adoption: Counseling and the Adoption Triad

Despite a 60-plus–year history of international adoption (IA) placements, the body of research exploring counseling and psychological interventions for those affected by IA is still in its infancy. This critical review of the state of the literature addresses research, theory, and practice relevant to the international adoption triad (adoptive parents, birth parents, and adoptees). We highlight the lack of empirical attention to the clinical needs of birth parents, the tendency to overlook the clinical needs of adoptive parents both pre- and post-adoption, early childhood vulnerability in international adoptees, and adolescent identity challenges and the attendant clinical issues.     

Adolescent Protective Factors Promoting Resilience in Young Adults at Risk for Depression

In a longitudinal, community-based study, adolescent protective factors for those at risk for depression were identified that were associated with resilient outcomes in young adulthood. For those with childhood risk factors for major depression, significant protective factors included family cohesion, positive self appraisals, and good interpersonal relations. Findings may help inform the development of prevention and treatment programs for adolescents vulnerable to depression. Implications for future research and clinical practice are discussed.     

The Effects of Parent‐Adolescent Relationships and Parental Separation on Adolescent Well‐Being

This article uses data from the National Longitudinal Study of Adolescent Health (Add Health) to investigate the short‐term effects of parental separation on adolescent delinquency and depression. Findings indicate that parent‐adolescent relationships prior to marital dissolution moderate the effects of parental separation on adolescent delinquency. The higher adolescents' satisfaction with their relationship with the same‐sex parent prior to residential separation the greater their increases in delinquent behavior when they are separated from this parent at Wave 2. These results highlight the importance of interpersonal relationships within the family prior to parental separation. Opposite‐sex parents constitute a significant influence on adolescents' depression regardless of family structure. These findings suggest that research on parental influences on children's well‐being needs to pay more attention to gender‐specific effects.     

Adolescent parenthood,economic issues,and social policies

Adolescent parenthood has highly publicized adverse social and economic consequences, but these same social and economic disadvantages can be viewed as root causes of adolescent pregnancy. Recent research and revisionist debates about these issues are reviewed and summarized. Diverse implications for social policy are considered. Prevention approaches are emphasized that build on both postponing adolescent sexual intercourse and helping sexually active teens avoid pregnancy.Appreciation is expressed to Christine Bachrach and Kristin Moore for their comments on a previous version of this paper.Dr. Miller's current research interests are the family antecedents of adolescent sexual behavior and the design and evaluation of prevention programs for adolescent problem behaviors. He received his Ph.D. in family sociology from the University of Minnesota in 1975.     

REVIEWS

Spring, J. A. (2004). How can I forgive you: The courage to forgive, the freedom not to .
Germer, C. K., Siegel, R., & Fulton, P. (Ed.). (2005). Mindfulness and psychotherapy .
Atkinson, B. J. (2005). Emotional intelligence in couples therapy: Advances from neurobiology and the science of intimate relationships .
Guterman, J. T. (2006). Mastering the art of solution-focused counseling .
Harris, S., Ivey, D., & Bean, R. (2005). A practice that works: Strategies to complement your stand alone therapy practice .