Las propuestas de acuerdo deberán ser turnadas a las comisiones, y una vez estudiadas,

When Siegel talks about alignment, attunement, and mental state reso- nance, many clinicians may feel on familiar ground. Attunement is close to what Carl Rogers, writing 40-plus years ago in On Becoming a Person, called empathy. Rogers believed that being in this process (to him, empa- thy was a process, not a state) with a client was the most crucial aspect of the therapeutic relationship. To have empathy with another human being, he wrote, means

entering the private perceptual world of the other; becoming sensi- tive, moment to moment, to the changing felt meanings which flow through this other person. It means temporarily living in the other’s life, without making judgments, and sensing the meanings which the client may only be dimly aware of. (Rogers, 1980, p. 142) Rogers also defied the powers that be in the psychoanalytic community by shifting the stance of the clinician from analytic neutrality to what he called “unconditional positive regard.” Let me tell a story about Rogers’ method; this comes from the pen of psycho-oncologist Rachel Naomi Remen, as told in her book Kitchen Table Wisdom:

While I was still part of the Stanford faculty, I was one of a small group of traditional physicians and psychologists invited to a day-long master’s class with Carl Rogers, a pioneering humanistic psychotherapist. I was young and proud of being an expert, sought after for my opinions and judgments. Rogers’s approach to therapy, called Unconditional Positive Regard, seemed to me a deplorable

lowering of standards. Yet it was rumored that his therapeutic out- comes were little short of magical. I was curious and so I went.

Rogers was a deeply intuitive man, and as he spoke to us about how he worked with his patients, he paused often to put into words what he did instinctively and naturally. Very different from the articulate and authoritative style of presentation I was used to at the medical center. Could someone so seemingly hesitant have any expertise at all? I doubted it. …

Finally, Rogers offered us a demonstration of his approach. One of the doctors in the class volunteered to act as his client and they rearranged their chairs to sit opposite one another. As Rogers turned toward him and was about to begin … he stopped and looked thoughtfully at his little band of experts, myself among them. In the brief silence, I shifted impatiently in my chair. Then Rogers began to speak. “Before every session, I take a moment to remember my humanity,” he told us. “There is no experience that this man has that I cannot share with him, no fear that I cannot understand, no suffering that I cannot care about, because I too am human. No matter how deep his wound, he does not need to be ashamed in front of me. I too am vulnerable.” (1996, p. 215–217) Rogers then did his demonstration with the doctor volunteer, the result of which Remen describes this way:

In the safe climate of Rogers’s total acceptance, he began to shed his masks, hesitantly at first and then more and more easily. As each mask fell, Rogers welcomed the one behind it unconditionally, until finally we glimpsed the beauty of the doctor’s naked face. I doubt that even he himself had ever seen it before. (1996, pp. 215–217)

Empathy, as it is traditionally defined, is taking the felt experience of the other person into oneself and resonating with what that person is saying, literally feeling what the person is feeling. This is distinct from sympathy, in which one feels for someone who is in a painful situation. When I am sympathetic toward someone I may feel sad or sorry for the person. But when I resonate deeply with the other’s pain (that is, when I feel the person’s feelings, not just feel for the person), that is empathy, or empathic attunement. Forty years after Rogers’ work, Siegel eloquently demon- strated the neurological substrates of what Rogers was teaching.

One of the outcomes of empathic attunement is that the traumatized client feels deeply understood by the clinician. This enables the client to

The Therapeutic Relationship and Its Underlying Neurobiology • 25

feel safe enough to do active trauma work. As Judith Herman writes in her seminal work, Trauma and Recovery, “Traumatic events, once again shatter the sense of connection individual and community.” Trauma victims feel like outcasts from society, both perforce and voluntarily. Whom can they trust, after all? Van der Kolk notes that “despite the human capacity to sur- vive and adapt, traumatic experiences can alter people’s psychological, biological and social equilibrium” (van der Kolk et al., 1996, p. 4).

Empathic attunement can safely recreate the client’s feeling of belong- ing and bring him or her back into the communal fold through the dyad of client and clinician. When the clinician consciously chooses to be attuned, resonating, and in alignment with the client, the clinician holds the client with his or her eyes or in his or her soul. Thus the clinician is creating something greater than safety: the attachment necessary to opti- mize EMDR treatment. Making the choice to do this is a left-brain analyt- ical process, yet empathic attunement itself is a right-brain affect-to-affect process, or, as Schore has shown, a right orbitofrontal connection of the clinician to the right orbitofrontal part of the client’s brain, amplifying the attuned attachment.

Dr. Uri Bergmann, an EMDRIA-Approved Trainer and Consultant, and one of the most oft quoted clinicians on the neurobiology of EMDR, adds to the depth of understanding the neurobiological substrates of empathy and the intersubjective (Personal communication, Feb. 16, 2005). He states

At the interface of the neurobiological and psychoanalytic literature it becomes apparent that the interactive transfer of affect between the right orbitofrontal cortices of both the other–infant and thera- peutic dyads are extremely similar, and can, in both, be described as intersubjective relational fields. It is the clinician’s right amygdala and right orbitofrontal cortex considered by LeDoux (1996, 2002) and Schore (1994, 2003a, 2003b) to be the predomi- nant neural substrates of the unconscious cortex that is responsive to fluctuations in the emotional and unconscious communications of the client’s amygdaloid and orbitifrontal cortices, facilitating his or her “oscillating attentiveness” to nonverbal behavioral and affec- tive shifts in both himself and the patient. This generates the empa- thy that is imperative for the clinician’s attunement and for the patient’s unconscious knowledge that he or she had been under- stood. It also facilitates, as Schore (2003b) has described, a treat- ment focus on the identification and integration not of conscious mental states but of nonconscious psychobiological states of mind/ body that underlie state-dependent affective, bodily, behavioral,

and cognitive–memorial functions. At a neurobiological level, given the right orbitofrontal cortex’s direct connection to the ven- tral vagal complex (the main affect regulation engine of the brain-stem), these regulated emotional exchanges may very well trigger synchronized energy shifts in the client, just as they do in the infant, facilitating a more adaptive regulation of the emotion-processing orbitofrontal cortex and true trait-change. (Personal communication, March 15, 2005)

Even when I am empathically attuned to my client, however, I remain grounded in my own state of mind. This lessens the likelihood that I will become vicariously traumatized by the client’s story. This is why it is criti- cal that clinicians maintain who they are in the situation, even as they are taking the other’s feelings into themselves. In saying this, I am disagreeing with Rogers. He states that being empathic means “laying aside not only your own views and values, but also in some sense laying aside yourself ” (Rogers, 1980). I do not believe a human being can do this (as I wrote in the Journal of Psychotherapy Integration in 2003). Humans take ourselves with us wherever we go. Believing that we can lay aside both our conscious and unconscious selves is, to me, a fiction.

Empathic abilities are developed over time, and they can entail a mea- sure of risk. Caution must be taken, even by the most mature, well-trained clinician. (I live outside New York City, and after the 9/11 crisis, there came a time when I could not tolerate hearing any more client narratives of seeing people holding hands and jumping to their deaths instead of being burned alive in the World Trade Center.) Because of the nature of the intersubjective — which is defined as two people having reciprocal influence on each other — trying to maintain an empathically attuned stance with a traumatized client is like walking through a minefield. When clinicians enter the world of someone like this, we are walking collabora- tively into the minefield with them. The potential for our being triggered increases dramatically. This is why knowledge of transference and counter- transference, as I define it in EMDR terms, is crucial to doing EMDR suc- cessfully. I will examine this topic in Chapter 8.

27

CHAPTER

3

Using EMDR Relationally in