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The Mindful Therapist

A Teleseminar Session with


Daniel Siegel, MD
and Ruth Buczynski, PhD

nicabm
The National Institute
for the Clinical Application
of Behavioral Medicine www.nicabm.com
The Mindful Therapist 2

The Mindful Therapist

Contents

The Scientific Evidence: Why Mindfulness Can Make


Health and Mental Health Practitioners More Effective . . . . . . . . . . . . . . . . . . . 4

How Quantum Theory Could Revolutionize Therapeutic Possibilities . . . . . . . . . 10

How the Development of Trust Leads to Brain Growth . . . . . . . . . . . . . . . . . . 18

How Mindfulness Can Facilitate Neural Integration . . . . . . . . . . . . . . . . . . . . . 20

A complete transcript of a Teleseminar Session


featuring Daniel Siegel, MD and conducted by Ruth Buczynski, PhD of NICABM
The National Institute for the Clinical Application of Behavioral Medicine
www.nicabm.com
The Mindful Therapist 3

The Mindful Therapist

with Daniel Siegel, MD


and Ruth Buczynski, PhD
Dr. Ruth Buczynski: Hello everyone. Let’s get started. I’m Dr. Ruth Buczynski, a licensed psychologist
and president of the National Institute for the Clinical Application of Behavioral Medicine.

We’re your hosts for this series on Mindfulness. Thanks so much for joining us tonight and for all the
nights that you’ve been with us as part of this series.

This is the sixth and last, open session of our worldwide series for practitioners on the Clinical Applications
of Mindfulness. Next week, we begin the first of two bonus calls for the Gold subscribers.

Throughout the five weeks so far, there have been 101 different countries represented. We’re so excited to
bring the world of practitioners together in this community. We did check with Google analytics to see if
we could come up with a number of exactly how many have listened so far and how many unique listeners
we’ve had. They’re reporting that number to be 18,000 or a little bit over. We think that might be just a
bit high…and I don’t want to guess because I could be wrong and I dont have a way to prove any number.

I do know that last week we had 3,232 listeners. Here are some of the countries that were participating
in the call. There were 6 people from Argentina, 1 practitioner from Bermuda, 1 from the Dominican
Republic, 1 from Greece, 28 from Israel, 19 from the Netherlands, 2 from Romania, 2 from Bulgaria, 1
from the Philippines, and 3 from South Africa.

In addition, we had several thousand people from the United States and let me just tell you a few of the
states: 81 from Pennsylvania, 67 from Oregon, 6 from Idaho, 57 from Georgia, 4 from Arkansas, and 1
from Alaska.

So, no matter where you’re calling from, state or country, we’re so glad that you’re part of our worldwide
community.

We also represent a wide range of practitioners. We’re physicians, nurses, psychologists, social workers,
dentists, chiropractors, body workers, dietitians, occupational therapists, physical therapists, and stress
management consultants. We represent a wide, wide range of practitioners and no matter what your
profession is, we’re glad that you’re part of this call.

I again want to encourage you to keep checking back on the comment board. That’s another part of our
worldwide community and an important one where you can see all the different ways people are applying
what they’re hearing each night.

My guest today is one of our favorite speakers – Dr. Daniel Siegel. He is a physician and Clinical Professor
of Psychiatry at the UCLA School of Medicine in Los Angeles. He is a prolific writer. Most recently, in
January, he published a book called Mindsight: The New Science of Personal Transformation, and even
more recently than that, a book called The Mindful Therapist.

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That’s what we’re going to focus on today: how the mindful therapist can really make a difference in our
work with patients. And I’d like to expand that: It’s not just going to be for therapists, because we have
doctors and nurses, who don’t work off a 50-minute hour, and we’ll be looking at your work as well.

Dan, welcome to the call and thanks for joining us today!

Dr. Daniel Siegel: Thanks, Ruth! It’s a pleasure to be back with you.

Ruth: Let’s jump right in and talk about why mindfulness can make health and mental healthcare
practitioners more effective. There’s more and more science coming out about that all the time. Can you
just give us some of the highlights?

The Scientific Evidence: Why Mindfulness Can Make


Health and Mental Health Practitioners More Effective
Dan: Well, there are a number of reasons why learning to be mindfully aware helps a practitioner of any
kind of clinical intervention be more effective.

On the basic level, the studies have now shown that if a primary “If a primary care
care physician learns to develop mindful awareness (which we’ll physician learns
define in a moment), that individual will be less likely to burn out.
to develop mindful
They’ll be more likely to maintain a state of empathy, which now awareness, that
studies are showing as one of the key ingredients for any kind of individual will be less
clinical encounter for a patient or a client to heal and to respond likely to burn out.”
positively to therapeutic intervention.

So, you keep a clinician feeling well themselves; you keep a clinician passionate about their work and you
allow them to actually have the very ingredient of interpersonal compassion (empathy) that is needed for
effective therapy in any kind of medical or psychotherapeutic encounter.

In all these ways science has now shown that teaching mindfulness to clinicians would be a very important
basic step in helping everyone involved in the clinical experience.

Ruth: Particularly for therapy, it seems like the science recently is saying it’s not so much the intervention
we use or the theoretical position we take, but the presence of the practitioner that seems to be the overall
healing ingredient across so many schools of thought. I know you meant that in your book about family
physicians as well.

Dan: Right. When we look at the broad notion of clinician, when we


“Teaching say a clinician is working as a nurse or as a physician with people with
mindfulness to medical conditions, even though clearly it matters which medications
clinicians is a very you prescribe, which surgeries you perform, how you bandage a wound
important basic – all those things really matter for medical encounter – but even with
step.” those important physical aspects of treatment, the interpersonal aspects
are vital.

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One research study showed that even if someone has a


common cold, they will actually get over their cold faster, “Even if someone has a
they’ll have improved immune function, if the clinician they common cold, they’ll have
see was actually empathic with them, was concerned not improved immune function,
just about the physical aspect of their medical condition, if the clinician they see
but what the inner mental experience was – the feelings, was actually empathic...
the thoughts that go along with it, the frustrations, the even in the medical world
expectations that were dashed. All the different ways in empathy and presence are
which a medical illness affects our minds are important for really important.”
an expert clinician to tune into.

For those patients who were fortunate enough to have an empathic clinician, their immune system got
boosted and they got over their colds faster. So even though it was a viral illness, we can say that empathy
actually helps the immune system function better. So there you see that even in the medical world empathy
and presence are really important.

For the psychotherapy world it’s exactly like you’re saying. What
“The most important the studies show is that, in fact, we can try all sorts of therapeutic
impact is the ability strategies, which have an important impact to a certain degree,
but the most important impact is the presence of the therapist, the
of the therapist to be
ability of the therapist to be empathic to the internal world of the
empathic to the internal client or the patient, and for that therapist to actively seek feedback
world of the client.” on how therapy is going and be open to what that feedback is,
rather than being defensive.

John Norcross, one of the scientists who studied this, has shown in metta analysis of psychotherapy that,
in fact, these aspects of the therapeutic relationship are the most vital for positive therapeutic outcome.

Ruth: I haven’t read of any research being done on empathy and an effective empathic response for
physical therapists or occupational therapists. If anybody is listening and you know of something like that,
please put it on the comment board tonight after the call, so we can all see it. But I would bet that if we
are finding this with family physicians, and we are finding this with psychotherapists, then it would make
sense that it would matter for a patient who’s seeing a physical therapist or an occupational therapist as
well.

Dan: I think you’re absolutely right, Ruth. One thing just to keep
in mind is that as human beings we have a whole system of neurons “Built into the
(that we could talk about later on) that are detecting the intention of empathic interaction
another person. is the intention
Part of what happens with empathy is that not only is one person trying of one person to
to sense the inner world of another person and then really understand actually care for
that world (so sensing is one thing, understanding is another, but both and be concerned
of those are parts of empathy), but built into the empathic interaction about the other.”
is the intention of one person to actually care for and be concerned
about the other.

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So, if I’m the one receiving your empathy, Ruth, I’m going to not only have that sense of connection with
you, but I’m going to feel your intention to care about me.

That awareness of your intention inside of me is actually going to help me feel trusting of you, it’s going
to help me feel safe. It’s going to give me – in attachment terms – the sense of security.

Throughout our lives – not just for babies and young children
“For all clinical encounters
– our interactions with other people are always trying to assess
you want to feel that whether we can trust that person, whether we can feel safe.
the intention of that
professional is to care So an encounter with a clinician – a physical therapist, an
about your well-being occupational therapist, an educational therapist, we could go
and nurture your growth.” through the whole line-up of clinicians – has got to be enhanced,
we would imagine.

And studies show for some of these fields it’s actually been proven to be true. But we could imagine for all
clinical encounters, even with a teacher, you want to feel that the intention of that professional is to care
about your well-being and nurture your growth.

In these ways we could understand that if mindfulness teaches empathy,


which it does, and it teaches this capacity to really be present in an open “Mindfulness should
way, then those are the essential ingredients for the other person to sense really be seen as
that your intention is really to be open and caring about them. This is a basic science
why it’s a win-win situation. It helps the clinician’s own health, sense of every clinical
of purpose and well-being, and it also helps in the clinical encounter.
profession.”
In a way, you could make a pitch that mindfulness should really be seen
as a basic science of every clinical profession that we have. This really
brings up a wonderful opportunity to transform how we create resilience in our clinicians.

The world is a place filled with challenges and we need to support clinicians as they go out and try to
alleviate suffering and help people grow toward health. This would be a useful way to begin.

Ruth: Right. And as you’ve mentioned briefly, it does seem that mindfulness has been shown – at least in
one specific research study – to help primary care physicians be less burned out.

Dan: Yes, that’s what Krasner (Dr. Michael Krasner)


“If you can be open to what’s said, who really taught mindful awareness, this way of
going on inside of you as mindfully communicating.
it’s happening, then that’s a
gateway to being open and Mindfulness is a term that we want to define. People have
present to other people as tried to get at it with words in different ways. But ultimately
what many of these different writers in the scientific field
well...the more you are aware
have tried to articulate is the idea that if you can be open
of your own bodily sensations, to what’s going on inside of you as it’s happening, without
the more you could be aware being swept up by judgments or without being taken over
of other people’s internal by expectations, but rather being very present to your
emotional states.” own experience, then that’s a gateway to being open and

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present to other people as well. That’s where you see the link from an experiential point of view – this
openness, non-judgmental-ness of being receptive.

From a brain point of view, mindfulness really encourages people to be very attuned to their own inner
sensations. We could go through the circuitry in the brain that allows you to do that, but the take home
message is this: the more you are aware of your own bodily sensations, the more you could be aware of
other people’s internal emotional states. I think this is the real key that needs to be sent out as a message.

People often say, “Well, if I’m learning to do yoga, or tai chi, or meditation, or centering prayer, any of the
mindful awareness practices that are so helpful, that’s a private thing. Isn’t that selfish?”

The fact is that the circuits that you are strengthening with those reflective practices that develop mindful
awareness are the exact same circuits that we need to tune into the internal world of someone else.

Some studies at UCLA and at Harvard show that there are


structural changes in the very parts of the brain for people who “Studies show that
do practice, for example, mindfulness meditation. There are empathy is significantly
structural changes in the same circuit that we need to support increased in those who
our empathic communication with other people. That’s probably practice mindfulness.”
why you see these studies that show that empathy is significantly
increased in those who practice mindfulness.

Ruth: That’s great. You were talking about mirror neurons. We talked about that a lot when we had our
call in February when you were part of the new brain science. But there are many more people on this
call tonight. So let’s take just a minute to even define what we are talking about. I think for some of the
people this may be a new concept. So let’s just get into that a little bit and start with a description of what
we mean by mirror neurons.

Dan: Sure. If it’s OK, Ruth, let me just take a step before that and just say a couple of general things, so
as all of us are having this conversation together, we have the same perspective on this.

The first is to say that before we talk about mirror neurons, it’s helpful to say that for all people, we have
this amazing reality that we have our internal subjective life. Like right now, Ruth, you have your thoughts
and your feelings and your memories. And those subjective experiences, your feelings go together in time
with the firing or the activation of certain neural pathways in your brain.

Now, it’s important to realize that subjective experience (like I have a feeling and you have a feeling) and
neural firing, while they correlate with each other, they’re not the same exact thing.

In a way, they are two sides of a coin. If you have a coin, one side is
“These mirror heads and one side is tails. You’ve got the coin in your hand, but there
neurons have this are two sides of this one coin.
amazing window In the same way we could talk about – as we are going to talk about –
into this blend feelings and intentions. Those are mental states that have a subjective
of the subjective quality to them. At the same time, there’s a neural firing pattern that
inner world and the seems to go along in time, or roughly around the same point in time, so
neural firing world.” we say they are correlated, or they correlate. They relate to each other
simultaneously.
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The important reason for saying that is that these mirror neurons that you are asking me about have this
amazing window that they give us into this blend of these two sides of the coin – the subjective inner
world and the neural firing world. We need to be very careful how we articulate it so we don’t make it too
reductionistic or too overly simplified.

So, I just wanted to start there, so we are really on safe ground when we start getting all excited about the
neurons and stuff. Is that fair to say?

Ruth: Sure, absolutely.

Dan: In the mid-90s in Italy several wonderful neuroscientists, including Gallese and Rizzolatti, were
studying the motor area of the monkey brain (In 2007, Vittorio Gallese with Giacom Rizzolatti and
Leonardo Fogassi received the Grawemeyer Award for Psychology for their discovery of mirror neurons.)

They found that when the monkey perceived an action that some other being was enacting – let’s say, a
human being was eating a peanut – the same motor neuron that fired when the monkey ate a peanut would
fire when the monkey perceived the researcher eating the peanut.

The many relevant aspects of that finding are these:

One, there was a link between the motor area of the brain and the perceptual area of the brain. That was
very exciting to find.

Secondly, this linkage of the same single neuron (these were electrodes in a single neuron, not just areas
of the brain, but one neuron), this one neuron having both perceptual abilities and motor abilities was an
exciting finding.

But it only acted when the action that was perceived had
“Mirror neurons embed
predictable sequences associated with them. Basically, that means
that the brain was calculating whether a sequence of movements
perceptual predictions
being perceived in another person could be predicted. If it was of motor actions in both
predicted, then it itself would mirror the action. the perceptual system
and the motor system.
The reason why I’m being very careful about how to say this To say it simply: they
is because people jump to all these statements about mirror let you imitate an
neurons – “they cook eggs” and “they plan your financial future” intentional action.”
and all these things.

Mirror neurons are very specific. They embed perceptual predictions of motor actions in both the perceptual
system and the motor system. To say it simply: they let you imitate an intentional action.

Now, once we say it that way, then you realize the exciting aspect of that when we’re really careful. We
believe that the collection of mirror neuron interactions with other areas of the brain – like there’s an area
called the superior temporal cortex, which is not a mirror neuron area, but it links very closely with it – we
believe that those work together to create a map. The brain is always making maps which are clusters of
neural firing that have symbolic meaning.

Here the map is of the intentional state of the other person. So, when the monkey sees the researcher
eating the peanut, we believe that mirror neurons working with this other area basically make a map of

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the intention of the researcher. Intention is a mental state. The absolutely revolutionary finding here is that
these researchers were able to illuminate the way neural firing maps create symbolic neural firing patterns
that are mapping out mental states. That’s huge! To say it simply: the brain makes a map of the mind of
another person.

Now, once you see that, then you go, “Oh my gosh…This is really,
“The brain makes a really exciting.” Then you can do what other researchers, like Marco
map of the mind of Iacoboni has done at UCLA, and it is to search for the ways that these
another person.” mirror neurons are not only involved in imitation of action, but the
simulation of internal states, which is the gateway to empathy.

Simulation, basically, means that if I were with you in person, Ruth, and you had tears in your eyes, I
would perceive your tears. My mirror neurons would pick up this intentional state in you, not so much a
motor action, but a behavior, a signal, a communication.

Inside of me, down through an area called the insula (the insular cortex), I would drive that information
of your tears down into my body. I would start having a change in my limbic area, my brain stem, even
in the way my heart was functioning, my lungs, my intestine. I would begin to resonate with you. This is
emotional resonance.

In that change in my bodily state, my subcortical areas – limbic, brain stem, and body are below the cortex,
so we call them sub (or below) cortical – so the subcortical resonance comes back up through this area of
the spinal cord called lamina (of the vertebral arch).

When it comes back up there, it joins with these brain stem and limbic changes up through my insula,
and now back into my cortex, where we believe awareness correlates, neural firing patterns correlate with
consciousness. Now I become aware of my internal state called interoception, and I feel my own bodily
feelings.

In the next stage, I have another area of my brain, right adjacent to that, in the middle part of the prefrontal
region just behind the middle of the forehead, and I then say, “Well, if I’m feeling choked up inside here
- my chest is heavy, my intestines are churning, tears are coming from my eyes - I wonder if Ruth is sad.”

So I simulate your state, and my awareness of my own bodily state


lets me know how you may be feeling. It’s empathic imagination. “My awareness of my
I can only take a guess. I can never know for sure. own bodily state lets
me know how you
The mirror neurons play a crucial role in that, because they let
may be feeling. It’s
us understand how we pick up your internal state, simulate it and
then become aware of our own state to take a guess at what’s
empathic imagination.”
going on in someone else.

If there’s any block in any of those steps, you and I could be interacting, you could be crying and I could
just be telling you what I had for dessert last night and ignore those tears, because they wouldn’t have had
any meaning if my system isn’t working properly.

Ruth: In a way, are we talking about the physiology of empathy?

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Dan: Totally. This is the physiology of empathy. It’s also the neurobiology of “we.” It’s how you and I
would get close with each other, because you would sense that you, your neuro-signals, are inside of me.
Certainly, you are separate from me, but not only can you be Ruth and I be Dan, but we could be a “we.”
That’s what you feel like when you are joining with someone, not just understanding somebody, but really
connecting and joining as a “we.”

Ruth: I’d like to move into quantum theory just a little bit. You were writing a bit about the plane of
possibilities as a model. Can we talk about that?

How Quantum Theory Could Revolutionize Therapeutic Possibilities


Dan: Sure. The exciting thing is that we take the step of really trying
“We try to really to be very careful about how we articulate things like relationships,
be clear in our or brain, or mind. In the field that I work in, and this is called
teachings about interpersonal neurobiology, we try to base everything we do on
where the science science, but then show the applications of the exciting fields of science
points and where the to psychotherapy, clinical practice, medicine, conceptual foundations
in the field of health, teaching, etc.
practical applications
can extend those We try to really be clear in our teachings about where the science
scientific findings.” points and where the practical applications can extend those scientific
findings, but haven’t been proven yet.

When you are careful about it, then you can make statements like these. I’ve interviewed about 95,000
mental health practitioners in the various teachings I’ve done, and I’ve found that only 2-5% have ever
been given a lecture on the mind. That means 95% of us – and I’m one of those 95% – have never had even
a single lecture on the mind.

So, in our field, in interpersonal neurobiology, for almost two decades “95% of us have
now we’ve given a working definition of the mind that is basically a core never had even
aspect of our mental life (not all of what the mind is, but it’s a central a single lecture
feature), as this embodied and relational process that regulates the flow on the mind.”
of energy and information.

Once we are in the position to talk about the regulation of energy and information flow, you then can
look deeply not only at the body - and extend that to the nervous system and relationships, how we
communicate with each other – but you look at the monitoring and modifying aspects of regulation.

You have to ask the question, “What is energy?” If we are talking about energy flow, can you really
have a conversation with the physicist, for example, about what the energy is? Of course, when you
start talking to physicists, you realize they themselves don’t have
a firm definition of energy, except the capacity to do work or to do
“The mind is this something….
embodied and relational
process that regulates When you go deeply into energy, you realize that, as Einstein told
the flow of energy and us, mass – even something like holding a cup in your hand or a
information.” pen – is just very condensed energy. When energy is in very large

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form, it has certain aspects of certainty to it. So when you hold that
pen in your hand right now, you know it’s a pen. Three minutes later, “When energy is in
if you pick it from the desk where you put it down, it’s still a pen. very large form, it
has certain aspects
So very condensed energy that we call mass has properties that
of certainty to it.”
follow what is called Newtonian mechanics. You know that’s a pen.
I can look at the book on my shelf right here, and I know it’s a book.
I look again in five minutes, and it’s still a book. Newtonian rule says this is a kind of inertia…this is a
book, it’s going to stay a book, and it’s going to require a lot of energy to change that.

When you look at energy that’s not in highly condensed conglomerations that we call mass, but rather
is in the more fluid form we’re used to – like light or the electrical flow-down, ions going in and out of
membranes that we call action potential, or heat, or all these different forms of energy that in fact are not
accumulations of mass – then we start realizing that from the physics point of view, Newtonian rules don’t
apply. So that rather than absolute certainty or huge amounts of certainty (a book is still a book), we look
at the probability.

Quantum mechanics is a very old theory that’s been around for awhile. We know that there’s the theory in
science, it’s full of different arguments this way or that way.

But the essence of quantum theory is that when energy that’s smaller than the size of an atom, like an
electron or photon, is moving across time, its movement goes across the fields of probability rather than
certainty. You can’t know for certain where that electron or where that photon is going to go.

So the first thing about quantum mechanics is that it’s all about the probability fields. The next really
interesting thing about it is that you can’t predict; you can say that certain things influence probabilities.

Awareness is something that influences probabilities. When a scientist


“The first thing about actually decides to study where a photon’s going, the act of observing
quantum mechanics the pathway of the photon changes its pathway. This is the fascinating
is that it’s all about aspect of quantum theory that you cannot remove consciousness or
the probability fields.” observation from the understanding of the probability changes as
energy flows across time.

This, of course, is appealing to any therapist when you look at the process of therapy and realize that every
major form of psychotherapy that I’ve been able to find uses awareness as its essential feature in its toolkit.
Even though they may be at war with each other or seem contradictory, they all use awareness. You see
that quantum theory puts awareness right in front of itself to say
that awareness influences probability functions. “Awareness is
Then you are in this interesting position of saying that what we something that
do in psychotherapy with the mind, as this process that regulates influences probabilities.
the flow of energy and information (information is just swirls of Every major form of
energy that have symbolic value), is that we are playing with the psychotherapy uses
interactive experiences, including the therapeutic relationship awareness as its
that will alter the probability of certain patterns of energy flow, essential feature in its
which we call thought, or feeling, or memory. toolkit.”

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It’s important to realize that there are at least two sides of this one reality of energy and information flow
and that those two sides are the subjective side and the neural firing side….

I had just came from spending a week, about a year ago, with a bunch of physicists, talking about the
science of spirituality. After that meeting I was taking a train back to the airport, and I had three students
with me, two graduate students and one undergraduate. They said, “Gosh, we didn’t talk about how neural
firing relates to subjective experience.”

So, I took out my journal, and I started drawing for them this visual image of how to understand the
relationship between neural firing and subjective experience and the impact of quantum perspective on
probability shifts. That’s the origin of this notion of the plane of possibility.

Basically it goes like this. When we are totally open and probability is wide open for all sorts of things
to happen, then you can see that there is a large plane of possibilities where the probability of what’s
happening is zero. So you don’t know what’s going to happen from that plane.

When I say to you “Eiffel Tower,” you start thinking about France. When you and I are going to go to
lunch, you may say, “Let’s go get some crepes for lunch.” So just by my saying “Eiffel tower” I could have
raised you up in the flow across time to a plateau of French food. Then you say “crepes,” so you’d go up
to a peak of certainty. You want a crepe for lunch.

Then we drop down. We go to the French restaurant and it’s closed.


Now what do we do? Well, we’ve got to lower ourselves down from “The mind functions in
the peak of crepes for lunch and maybe find some other French health or un-health,
restaurant, or drop down to the open plane and say, “You know, in the freedom
let’s just go and have a picnic on the beach, and let’s get some by which people
salads from a local store.” move from peak of
certainty to plateau
We can move in and out of this. You can then understand all sorts
of probability to open
of ways that the mind functions in health or un-health, in the
plane of possibility.”
freedom by which people move from peak of certainty to plateau
of probability to open plane of possibility.

When there’s fluid movement back and forth, we would call that health. When people get stuck in a plateau,
we would call that un-health. They may get stuck in depression, or mania, or obsessive thoughts, or they
may have these recurring peaks that constantly bombard them with worries or posttraumatic memories
that are intrusive.

In many ways you can then use this to show how the neural firing
patterns are locked into certain high probability states that keep a
“When there’s fluid
person a prisoner. Then the therapeutic relationship can be understood
movement back and as bringing that person into a more fluid balance, integrated balance
forth, we would call among peak, plateau and plane.
that health. When
people get stuck in Basically, in The Mindful Therapist, we talk about that through the
a plateau, we would whole book, about this quantum view of psychotherapy that allows
call that un-health.” you – not in any kind of weird way, but actually in a very practical
way – to alter the probabilities of neural firing so that the subjective

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The Mindful Therapist 13

experience of a person can be freed up, and then how to use the
subjective focus of attention to actually change the structure of the “The therapeutic
brain, because that’s what we know that you can now do. Ultimately, relationship can
changing those structural connections in the brain alters the way be understood as
the brain makes for probabilities and certainties. bringing that person
Ruth: Now, that leads us into neuroplasticity, but before we get to into a more fluid
that, I think you said something really important and it came out so balance, integrated
fast that I just want to make sure that people got it. You said that we balance among peak,
are going from the peak of certainty to the plateau of probability plateau and plane.”
and then what was the last part?

Dan: To the plane of possibility…the best thing to do is to see it in the book or wherever you might get a
hold of this drawing, because you can see it in a flash. A picture’s worth a thousand words.

So yes, there are at least three dimensions. First, there’s the open plane of possibility where everything can
happen and you are open, receptive.

Then, you rise up to the plateau of probability which is necessary in life. You have to prime yourself to get
ready to play tennis, or pay your taxes, or whatever you are going to do. So that’s the plateau of probability.

Then there’s the peak of certainty, where you are definitely going to try to get crepes or definitely pay this
amount of money for your taxes.

And it’s not that we are sitting cross-legged in an open plane of possibility for our entire lives and that’s
it, or that it’s nirvana or something. We are saying that healthy living is the active freedom to move from
plane to plateau to peak, back and forth again, because we do have to stop at a red light!

You can’t just sit and say, “Well, that light could be red,” but it’s not
“Healthy living is the red, and then – bam – you crash. You’ve got to make commitments.
active freedom to You have to put your feet on the brakes and stop the car now.
move from plane to So this isn’t at all to put down a notion that certainty is like a bad
plateau to peak, back thing or anything like that. This is just the idea of fluidity, where
and forth again.” some people get stuck in one place or the other and they don’t have
this fluidity to move back and forth.

Ruth: It’s an interesting concept, especially if you take a big-picture look at the process of psychotherapy
or at the process of what we are trying to do with the patient.

Dan: Absolutely. When you apply this, it’s really exciting to see. Then you see the role of the therapist…
and in his/her own mind to also develop this healthy movement back and forth.

So, if I’m with a patient, and I’m convinced about what’s going on with her, but then I start getting some
information that doesn’t match the narrative in my head, I’ve got to be able to move back from that plateau
down to the plane to be more receptive to what’s truly going on inside of her.

I’ve given an example of that from when I was a pediatrician. You can have one idea or teachers can have
one idea, but sometimes you’ve got to really let go of those ideas, those judgments, or those expectations.

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Mindfulness in many ways is this capacity to move to the open plane of possibility, so you are truly
receptive and open to what’s going on, rather than laying on your judgments that filter what you see. This
model also applies to the whole field of mindfulness.

Ruth: Mindfulness, in a way, could be the skillful movement back and forth, as in all those possibilities.

Dan: Absolutely. I think that’s a beautiful way of saying it,


“Mindfulness is this Ruth, – the skillful movement back and forth from peak to
capacity to move to the plateau to plane. And this is the homework in an online course
open plane of possibility, that I teach that students apply this model to their daily life
so you are truly receptive experiences.
and open to what’s going
So they begin to be able to perceive their own internal state:
on, rather than laying on whether they are at a peak, at a plateau, or whether the plateau
your judgments that filter is high and they are limited in what may come up, or whether
what you see. ” the plateau is raised off the plane, or whether it is broader and
more flexible or even way down on the plane.

The neat thing is that you can actually do mindful awareness practices – there’s one we do called the wheel
of awareness – which opens you to understanding how consciousness itself can be experienced in a very
integrated way. So you become really very mindfully open to what’s going on rather than just being swept
up by things that happen – thoughts, feelings, memories, and things like that.

So, as you asked me to talk about, there are actually very practical applications that this plane of possibility
brings up. It’s basically a metaphor for what the science of the architecture of the mind is at the deep level
of energy flow patterns.

Once you get to that basic foundation, it becomes really fun, “The wheel of
because then you’ve laid this solid grounding, and then you can awareness opens you
build on it all sorts of really exciting predictions (science has
to understanding how
established some of those predictions). You are really on solid
consciousness itself
ground to keep on moving in this deep way to understand the
basic mechanisms of healing.
can be experienced in
a very integrated way.”
Ruth: Now, let’s go into neuroplasticity. In a way, when we were
discussing this movement, it almost seemed like it was a lead into
or another way of talking about neuroplasticity or what’s happening in a neuroplastic situation.

Dan: Yes, I agree. One thing just to start out with is the word neuroplasticity. It’s a wonderful word that
implies how the structural changes in the nervous system, especially the brain and the skull…how these
change in response to experience. So, neuroplasticity means how experience changes the structure of our
brain.

In the old days, people believed that after adolescence, the brain
“Neuroplasticity means was pretty fixed, and you were on the road to ruin as your brain
how experience would just deteriorate. We now know this is just not true. So that’s
changes the structure the great, great news.
of our brain.”

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If you ask what the most useful take-home message from the field of neuroplasticity is for clinicians and
teachers, here are some basic principles. If I can just outline them for you, I think they are really good for
everyone in the field of helping another person’s mind develop, whether you are a teacher or a clinician ….

Here are the basic rules. There are four essential ways that the
brain changes in response to experience, and there are six ways
that you can really apply them in everyday life. So let me start “You can grow new
out with the concepts of how this is really happening. synapses, you can
strengthen synapses,
The first is (at the level of the) synapses. The connection among and you can make them
the neurons are at the level of neuron-to-neuron connection more efficient...memory
is called the synapse. You can grow new synapses, you can is how the synapses
strengthen synapses, and you can make them more efficient. change and respond to
There are all sorts of things you can do that you can just call experiences.”
synaptic change or synaptogenesis, which is the formal term.
That’s one basic way.

Basically, memory is how the synapses change and respond to experiences. Right now, if you are listening
to this and really paying attention to it, you can make synaptic changes pretty quickly, so that you will
remember things first in the short-term for short-term synaptic changes, but then the long-term changes will
establish (medium length memory, then long-term memory and then , in fact, permanent term memory).
There’s a whole series of changes that we could talk about, but the bottom line is memory, and memory is
based on synaptic changes.

The next kind of change you can make is neurons. We didn’t believe this, but now we know this is true
at least in the area called the hippocampus (but maybe in other areas as well). You can actually take
uncommitted neural stem cells – they divide every 24 hours or so – and with novelty and the close paying
of attention, you can get the daughter cell of this stem cell division. Instead of this daughter cell just
deteriorating and just dying, you can stimulate that daughter cell to develop into a fully differentiated
mature neuron over the course of 8-12 weeks.

You can actually see that this neuron will become fully integrated
“Throughout our into the whole system. That’s throughout our adulthood. So we have
adulthood we have synaptic genesis, we call this neural genesis, the stimulation of the
synaptic genesis, stem cells to differentiate and you continue the stem cell line with
neural genesis, and the daughter cell. Basically, you can grow new neurons. That’s very
the stimulation exciting.
of the stem cells Thirdly, with skill development, we believe you grow myelin.
to differentiate. Myelin is a fatty sheath; it’s what creates the white matter of the
Basically, you can brain…. When myelin is laid down over the axon, the long length of
grow new neurons.” the neuron, it connects two neurons to each other and it can create
among many neurons a more efficient circuit.

Why does myelin create more efficiency in the action potential or the electrical current equivalent going
down and letting the neurons communicate with each other? It does it for two reasons. One, the speed of
conduction of the electrical current, called the action potential down the axon, is sped up by 100 times.

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After neurons fire, they need to rest, and that’s called the refractory period. If you have myelin around you,
the refractory period is actually sped up by 30 times. So if you multiply 30 by 100, you got 3,000.

So, when you watch the Olympics and you see the amazing things athletes do…their athletics, you say,
“I can’t do that! It’s impossible.” You are absolutely right, because you haven’t spent 10,000 hours to lay
down the myelin that allows their circuits to be 3,000 times more effective than yours.

That’s why they can do something that looks impossible for you to
“Myelination is a third do, because it is impossible for you to do. But they’ve taken the time
way that experience and the discipline and worked on it to develop these myelin circuits.
can change the brain.” So myelination is a third way that experience can change the brain.
That skill development takes many, many hours.

A fourth way that we change the brain is really quite a startling finding that is just beginning to be elaborated
in ways that have profound implications for everything human. That is the area of epigenesis.

Genetics, of course, is the study of our genome, of the DNA and the sequences of nucleotides and nucleus
of every cell (except the red blood cell). These genes are like books in the library. The way a book
expresses itself in the world is that the librarian has to let the book out and people have to read it.

Epigenetics is basically a study of how experience changes


the regulation of gene expression. So we are just beginning to “Epigenetics is basically
learn that on the chromosome there are areas of this genetic
a study of how
material that are not the sequences of nucleotides that determine
protein production (as classically what the gene does), but these
experience changes
are regulatory areas on the chromosome that determine gene the regulation of gene
expression. So epigenetic change is experience induced change in expression.”
the regulation of those molecules within the nucleus that control
gene expression.

It’s like the librarian rather than the book. If you have a change in your librarian who doesn’t let out certain
books or encourages these other books to be read, you are going to change the impact in the world.

These epigenetic changes are like changing the librarian in the library. So you are changing the way genes
are expressed, the timing, the manner in which they are expressed.

One study by Michael Meaney showed that if kids…are exposed to very harsh, abusive conditions early in
life, there are changes in the regulatory molecules in their genome that determine how the genes that help
regulate stress response are going to be controlled. Meaney was able to show that these changes seem to
last for a lifetime, especially without therapeutic intervention.

So kids who were treated harshly early on, and as unfortunate as that is, at least we’ve been able to study
the integrative areas of their brains…that aren’t functioning well, and as a result, the kids can’t regulate
themselves.

Meaney has been able to show that it’s not only structural changes in the nervous system, but epigenetic
changes as well. So these kids have a much more difficult time responding to stress. Their hypothalamic-
pituitary-adrenal axis (the HPA axis) that allows you to respond to stress well, or not well, has been altered
based on these epigenetic changes.
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So, you have four ways (the brain changes): 1) epigenetic changes, experience changing the regulation
of gene expression; 2) myelination, laying down the sheath; 3) neurogenesis, the creation of new neurons
that can become fully functional neurons after a month or two; and 4) synaptic changes, which happen
pretty readily.

These are the four layers of change where you see neuroplastic effects in which experience alters how
the structure of the nervous system is and how the function, of course, follows the structure. So that’s the
background.

There are six ways I want to just describe to you, Ruth, but let me just pause for a moment. I know my
enthusiasm makes this flow out sometimes in a pretty rapid way. But it’s just very exciting to know all
this stuff.

Ruth: I think it is exciting, too. In a sense, it’s the science of things that we talked about way back even in
the 1960s and 1970s, nature and nurture, and which has the most impact…. Only then, we had no science
to talk about how experience affected the brain.

Dan: Exactly. It raises the complicated, but important finding that’s


just beginning to emerge, so we need to look for the science to know “Our children and our
that this is absolutely true. children’s children
can be impacted
There are now implications, initial implications, that what we by the stress we
experience as adults, in fact, can be passed through epigenetic experienced in our
changes through our sperm and egg. So our children and our own lives.”
children’s children can be impacted by the stress we experienced in
our own lives.

In the past we’ve always said it was the Lamarckian view, from a researcher named Lamarck, and we
didn’t agree with that view that the genes are changed by our experience and that view was disproved. But
he referred to genetic changes. These are epigenetic changes.

We are just beginning to get the preliminary evidence that shows that you can literally inherit epigenetic
changes that are acquired from birth, things that happened to your grandparents through the nucleus,
through the epigenetic regulatory molecules.

So it’s not just the experiences we have and our grandparents and our parents and stories they tell and the
way they treat us, but it could be what’s passed through the sperm and the egg. This has huge implications.

Ruth: Do you see this as similar to the concepts of


“It’s not just the morphogenetic fields?
experiences we have and
our grandparents and our Dan: In which fields, in physics or in biology?
parents and stories they
Ruth: When you think about how experience and that you’re
tell and the way they
laying it down in an epigenetic way…that it gets passed down
treat us, but it could be
from parent to child to grandchild, it almost seems like we are
what’s passed through making a field of experience that’s beyond just one person or
the sperm and the egg.” even one family.

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Dan: Yes, in that sense, I absolutely agree. There’s a beautiful work by


Christakis and Powers on the social networks and the invisible forces “The self, if we
that connect us. Their beautiful book called Connected would absolutely are going to
reinforce what you are saying, Ruth. We live within these fields of use this term, is
influence that we actually can’t see.
probably plural.”
When you take an image that our subjective mental lives are kind of
dancing along these neural firing patterns, sometimes those neural firing
patterns can sweep us up in these larger fields in which the body is just one node of a much larger network.
Yet we look at the body as some identity of self, but in fact the self, if we are going to use this term, is
probably plural. It involves these many nodes of which we are just one part of a much larger network.

It’ll be like a heart cell saying, “Well, I’m just a heart cell, I don’t have
anything to do with the bones, or the liver, or the nervous system. I’m
“We are simply just a heart cell. That’s my identity.”
nodes in a
larger network. And you say, “Hey, heart cell, you are a part of the system called
We are all the body.” In the same way, just like you’re saying, I think we are
interconnected and getting more and more evidence from all these fields of science that
interdependent.” we are simply nodes in a larger network. That doesn’t belittle us. That
just lets us embrace a larger reality. We are all interconnected and
interdependent.

It also lets us know – I think this is an important thing for all clinicians to consider – that the brain has a
tendency, especially with certain cultural influences, to identify the body as a separate self. “This is me,”
and “This is mine,” and all this kind of stuff. In a way, as Einstein said, “It’s an optical delusion that the
brain itself creates.”

So part of therapy, when you look at all the studies of “When people relax that
happiness and wisdom and kindness, you can show that rigid sense of bodily
when people relax that rigid sense of bodily defined defined identity and open
identity and open up to realizing we are all a part of the up to realizing we are all a
interconnected whole, it’s not that we lose the self, but we part of the interconnected
actually expand the self to include a much larger sense of
whole, we expand the self
interconnection. People are happier; they’re wiser; they’re
to include a much larger
healthier. Knowing that and appreciating that doesn’t have
to take away anything from us. It actually can enrich our
sense of interconnection.”
lives.

Ruth: I’d like to spend a little bit of time talking about how the development of trust can lead to brain
growth.

How the Development of Trust Leads to Brain Growth


Dan: There’s beautiful work from a researcher named Stephen Porges, which looks at this issues of how
you turn on what he calls the social engagement system. His views involve something he’s named as
Polyvagal Theory. It’s a wonderful conceptualization.

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But the take-home message here for our purposes is just that when you sense that another person is tuned
into you and caring and can be trusted, the state that’s created in your own nervous system is like… I don’t
know if we did this last time. Did we do the no/yes experiment? I don’t remember if we did it, but we’ll
do it now very, very briefly, because we have a few minutes….

If you just listen to these words, you’ll feel the difference between being reactive or being receptive. If I
go: “NO! NO! NO! NO! NO! Yes. Yes. Yes. Yes. Yes. Yes. Yes.” Did you notice the difference between
no and yes?

Ruth: Absolutely.
“Relationships of
trust help the Dan: How would you describe that, Ruth?
brain grow.” Ruth: The one felt harsh and shut down and I sort of separated myself. The
yes felt sweeter and safer and more approachable.

Dan: Beautiful. That sweeter, safer place would be what Porges would call a receptive state. You could
see what parts of the brain would be activated in this receptive state. This relates to those six things I
wanted to make sure to outline, which I can do very briefly.

Our relationships with each other can help the brain grow. In Louis Cozolino’s The Healthy Aging Brain,
you could show that when we have relationships in our life, we have longevity in our life. Relationships
are profoundly important. So relationships of trust help the brain grow. You can feel it in this yes/no
experiment.

The other things that help the brain grow – just to name them – are:

• Sleep and rest, which are very important. That’s when we consolidate memory.

• Good nutrition, including Omega-3s, so you can have the soil of the brain, allowing the seeds of
awareness to work as you’ll see in a moment. So we need good nutrition including the Omega-3s
that we can’t produce ourselves that are part of the membrane of the nervous system.

• Aerobic exercise. Not just exercise in the brain, of course, which we’ll do in a moment, but exercise
in the body. Getting the heart rate going, if you are medically able to do it, is really, really helpful
for brain health and brain growth.

• Novelty, bringing new things into our lives, new ways of doing things.
Not just doing crossword puzzles over and over, but trying out new “Novelty
musical instrument, learning a new foreign language, trying a new way to stimulates
walk around the block, and things like that. Novelty stimulates the brain the brain.”
in certain ways. One of the extensions of that is this sixth area, which is
the close paying of attention.

• The close paying of attention. I don’t mean multi-tasking and doing a million things all at once.
But the close paying of attention does two things. It allows you to specifically activate certain
neural pathways. If those are healthy ones, in interpersonal neurobiology we talk about neural
integration and you can actually learn to focus your attention to integrate the brain in these domains
of integration we talk about.

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And this is what you are doing: you are paying close
“We can then invite the client, attention and that gives you specific neural firing. The close
to participate in this journey, paying of attention seems to activate a part of the brain
where they themselves now called the nucleus basalis. You change the acetylcholine
can start using their mind that’s released throughout the brain and those neurons that
to change the way their have been firing not only get the benefit of acetylcholine,
brain is firing in the moment. which enhances the way genes get expressed, but also this
How you change brain firing firing of neurons can allow brain-derived neurotrophic
specifies how you change factor to be released locally.
brain wiring.” What those two things do – global acetylcholine and local
BDNF (brain-derived neurotrophic factor) – is they show
how you pay attention. The close paying of attention can increase gene expression and increase how
structural changes are established in the brain. In other words, your mind can change the structure of your
brain by activating genetic expression. We now know that for sure. We used to guess at this 10 years ago,
but now it’s been established in various research paradigms, and that’s the excitement.

When you think about these issues of trust, in therapeutic experience, then we want to create the yes state
which primes the brain for neuroplastic changes. We want to align ourselves through these profound ways
of therapeutic relationships to move toward presence, this open plane of possibility, and we can then invite
the client, the patient to participate in this journey, where they themselves now can start using their mind to
change the way their brain is firing in the moment. How you change brain firing specifies how you change
brain wiring.

When a therapist is informed about how to produce the kind of experiences in a relationship in therapy
that brings that brain toward integration, then the person is going to move the very structure of their brain
toward health.

You move away from the chaos and rigidity that come “You move away from the
from states of non-integration, and you allow the person chaos and rigidity that
to achieve these new and lasting states of integration, come from states of non-
which basically is the experience of harmony, flexibility, integration, and you allow
compassion and connection inside, and connection to a the person to achieve these
larger world. new and lasting states of
integration...the experience
Ruth: Dan, we don’t have a lot of time left, but I want to of harmony, flexibility,
tie all this back to mindfulness and where mindfulness fits compassion and connection.”
in with everything that we’ve been talking about.

How Mindfulness Can Facilitate Neural Integration


Dan: Mindfulness is, in many ways, a focus of attention. So in our research center at UCLA we use the
term mindful awareness practices. Mindful awareness is a form of awareness, which is open. It isn’t swept
up by judgments and it involves two things.

One, you’re paying attention to where your intention is. So if you are doing a practice of meditation where
you’re focusing on the breath, then that harnesses the ability to also be aware of your own awareness.

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Those processes are about seeing the mind. Your intention and your
“Your intention and awareness are aspects of the mind. So you’re developing this larger skill
your awareness that we talked about last time called mindsight.
are aspects of In all these ways, mindfulness contributes to a change in how the
the mind.” individual is actually having a relationship with themselves. They
become more attuned to themselves.

They’re strengthening the circuits of regulation that allow them to have more emotional flexibility, more
empathic connection, more capacity to plan, more ability to stay within what we call the hub of the wheel
of awareness and stay present to things.

As they do, the amazing thing is that with this mindful awareness “We need to bring to
practice, you can actually transform chaotic and rigid states in our own lives so we
lasting ways. This is why for any field of clinical intervention,
maintain the empathy
doing this first as a therapist is so important.
that then invites the
We need to bring the resilience to our own lives so we don’t get client, the patient
burnt out. We need to bring that resilience to our own lives too, so to actually develop
we maintain the empathy that then invites the client, the patient to the same integrative
actually develop the same integrative circuits in themselves. circuits in themselves.”
So, mindfulness is a practice. It’s also a way of being that really is
profoundly integrative. It’s not that mindfulness should be seen as separate from the larger picture of what
the mind is and how we develop a healthy mind. It’s one part of a larger process of integration as the root
of health.

Mindfulness is one of the most wonderful practices. It’s been around for thousands of years, studied in
recent times, but it’s a profoundly integrative practice. That’s where mindfulness fits in beautifully into
this larger framework of understanding the mind and how to bring health to our lives.

Ruth: I’m afraid we’re out of time, but I want to say to everyone a couple of things.

First of all, I’m going to send you an email, and in that email I will give
“Mindfulness is a you links to Dan’s two latest books. I will give you links to Amazon,
practice...a way of you can check it out. I’m not saying that you should buy it. If you want
being that really to go to your library and see if they have it, perhaps, you can print out
is profoundly the Amazon review and take it to your library. You may want it for your
integrative.” own library, in which case Amazon is probably the least expensive way
for you to get it. But I just want to provide that for you.

We’re also going to give you a link to the comment board. The comment board is our community board.
We’d like to hear from everyone on how you’re going to apply what you heard tonight. Tell us your
practice specialty. Give us your first and last name, your city and state or country, and your profession, and
tell us how you’re going to use in your work what you’ve heard tonight.

So no matter where you’re calling from, countries all over the world and cities and states throughout the
United States, thank you for being on this call.

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The Mindful Therapist 22

Dan, especially to you, I want to thank you for all of your work. You have done so much and you’re such
a wonderful teacher at making this cogent and clear. And, I would say, you’re a careful thinker as well. So
thank you for all of your work.

Dan: Thank you, Ruth! It’s a pleasure to be here with you.

Ruth: Good night everyone.

References:

Christakis, N.A., & Fowler, J.H. (2009). Connected: The Surprising Power of Our Social Networks and
How They Shape Our Lives. New York, NY: Little, Brown and Company.

Iacoboni, M. (2009). Mirroring People: The New Science of How We Connect with Others. New York,
NY: Farrar, Straus & Giroux.

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The Mindful Therapist 23

About The Speaker:

Dr. Siegel is currently a clinical professor of psychiatry at the UCLA


School of Medicine where he is also on the faculty of the Center for
Culture, Brain, and Development and the Co-Director of the Mindful
Awareness Research Center at UCLA. An award-winning educator,
he is a Distinguished Fellow of the American Psychiatric Association
and recipient of several other honorary fellowships.

Dr. Siegel is also the Executive Director of the Mindsight Institute,


an educational organization that focuses on how the development of
mindsight in individuals, families and communities can be enhanced
by examining the interface of human relationships and basic
biological processes. His psychotherapy practice includes children,
adolescents, adults, couples, and families.

Books by Featured Speaker: Daniel Siegel, MD

Mindsight: The Mindful Therapist: The Mindful Brain:


The New Science of A Clinician’s Guide to Mind- Reflection and Attunement in the
Transformation sight and Neural Integration Cultivation of Well-Being

Click HERE Click HERE Click HERE


to Purchase Now! to Purchase Now! to Purchase Now!

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