While social workers have long espoused the importance of relationships and their impact on our psychological functioning, truly understanding those relationships requires understanding the brain as a social organ.
As Louis Cozolino, one of the nation’s leading authorities on neuroscience, says, “Each generation of mental health practitioners needs to be taught that although we look like separate beings, we are connected in deep and profound ways we are still coming to understand.”
In their latest edition of Neurobiology for Clinical Social Work: Theory and Practice, Janet R. Shapiro and Jeffrey S. Applegate dive into this new world to offer a foundational understanding of how neuroscience can inform not just a more sensitive and empathic practice, but one that is highly attuned to the physiological implications of trauma.
Human development is both complex and dynamic, intertwined with environmental factors, and changing in ways that are often not linear.
Shapiro and Applegate write, “As applied to the study of brain development, a nonlinear dynamic systems approach considers brain and nervous system development as a fluid process,” that is equally affected by innate individual factors and the relational and external environment.
Because of the complex interplay of environmental and person-specific factors, neurobiology has become an important part of understanding many psychological and behavioral phenomena, especially trauma.
We now know there are sensitive developmental periods when the brain is particularly effected by experience. Experiences during these periods determine brain plasticity and support the development of a “stability landscape.”
One example is the development of the orbitofrontal cortex, which develops between 6 months and 1 year of age.
Shapiro and Applegate write, “In order for the wiring of this area of the cortex to proceed normally, the infant must be engaged in exciting, intensely pleasurable, face-to-face interactions with a caregiver.”
Neuroscience has also opened the door to better understanding how gene expression may be influenced by environmental factors — what is known as epigenetics.
“From a social work perspective, the field of epigenetics provides an important framework for understanding the biological mechanisms by which environmental influences, both positive and negative, have an impact on a host of health and mental health conditions, including autoimmune disorders, heart disease, and cancer,” write the authors.
Understanding how emotions move between people further informs the relationship that develops between the social worker and the client. Memories, both conscious and unconscious, are stored in neural networks which activate physiological patterns.
As these neuronal firing patterns are activated more frequently, they become strengthened, increasing the probability that the network “remembers”.
In the case of traumatic experience, the person may only be aware of the physiological and emotional sensations and not necessarily the explicit memory of the experience.
However, trauma can overwhelm a person’s emotional capacity, leading to disruptions in cognition, learning, memory and relationships.
Shapiro and Applegate write, “For children who experience affective dysregulation in the context of caregiving experiences, what may be learned is a strategy of withdrawal to the self that, in turn, limits ongoing opportunities for learning in the context of dyadic interaction.”
Withdrawing may be one form of an “emotional command system” that offers a categorical understanding of affect driven responses. The authors point to the work of Panskeep, who described four emotional command systems: seeking and reward; rage; fear; and panic or separation-distress.
As experience generates associations between environmental experiences and internal states, what is often left behind are somatic markers that become part of our embodied knowledge about how we feel.
In interacting dyads, like that of the mother and child or the therapist and client, each partner affects the other’s self-regulation and together, they each achieve greater coherence and complexity.
However, in cases of severe emotional child abuse and neglect, these experiences can have physiological effects, such as reduced volume in the orbitofrontal cortex.
At-risk parents and children can often be characterized by atypical patterns of interaction, which, the authors write, “precipitate change in the early wiring of the brain in neurobiological and neurochemical processes that have import for the experience and regulation of affect.”
One dysfunctional pattern Shapiro and Applegate describe is that of scapegoating, where one family member is induced into either internalizing or externalizing anxiety, depression, or other distressing affects in order to reduce them in other family members — a process which jeopardizes all of the family members’ capacities for affect regulation.
“This dysfunctional pattern, over time, becomes encoded into the neural architecture of all family members, who sustain it in order to experience a sense of safety,” write the authors.
Disabling dysfunctional patterns and their neural residue begin with helping family members to become aware of how these warded-off affects shape family dynamics. Through psychoeducation and an exploration of family histories, high levels of distress can be diminished and the family can learn more cooperative, empathically-based communication that fosters neural and psychosocial integration.
Translating complex research into useful practice, Neurobiology for Clinical Social Work: Theory and Practice offers a foundational understanding of how attachment, memory, trauma, and relationships can influence client physiology, affect, and functioning, and offers clinicians powerful strategies to help clients shift from neuroadversity to neuroprotection.
Neurobiology for Clinical Social Work: Theory and Practice, 2nd Edition
W.W. Norton & Company, August 2018
Hardcover, 245 pages