Framework for Psychological Evaluations

Here is the framework I use when making recommendations. I hope it will be helpful to you in making use of the recommendations I provide, and help you to come up with ideas of your own.

What is well-being?

The latest neuroscientific and psychological research defines “well-being” as a state of integration in which the different parts of our brain and nervous system are all working together harmoniously.   Since our brain has a natural inclination toward integration, the best treatments are those that either support this natural process, or remove what may be interfering with it.

Ok, that may sound a bit complicated. So what does it feel like when our brain and nervous system are working together in harmony?  If you’ve ever experienced even a brief moment of “being in the flow” or “being in the zone” – moments in which  everything feels connected, effortless and joyful - that’s  what harmonious brain functioning feels like.  It can happen anywhere, anytime – tending a garden, throwing a ball, playing music, watching a beautiful sunset, or in a special moment of connection with someone you care about.

The Rings of Awareness – A Metaphor For Brain Integration

 Imagine two rings, one inside the other.  In the outer ringis everything we see, hear and touch - all the people, places and things in the “outer world” that we’re aware of.  In the inner ringare the thoughts, feelings, hopes and desires that make up what we call our “mind.”  The inner and outer rings together contain everything we’re aware OF. 

At the very center of the rings is the quiet, calm experience of simply being aware– an experience sometimes referred to as getting back to that “still quiet place” within.  No matter what stuff is going on in the world around you – in the outer ring– and no matter how dramatic or stressful the stuff going on inside your mind – in the inner ring – the center of awareness is always calm. The experience of the center is characterized by a sense of spaciousness, tranquility, and connection to ourselves and others. 

Our attention is almost always captured by the “stuff” of the inner and outer rings, causing us to lose our connection with the still quiet place within.  Ultimately, everything that contributes to our experience of happiness and well-being works, in some way or other, to free our attention so we can get back to that still quiet place at the center of it all. The more we are connected to that, the more the brain’s natural tendency toward greater integration can take effect. 

The brain has a natural tendency to coordinate and harmonize our thoughts, feelings and actions, as long as we let it do its job. And the best way to do this? Remember, over and over, to shift our attention from what we’re aware OF to that center of quiet, calm awareness.  Making this shift has been shown to lead to reductions in virtually all symptoms, from depression, anxiety and PTSD to bipolar disorder and even schizophrenia.  It improves relationships, school achievement, and success at work, and leads to feelings of deep contentment and happiness in every area of our lives. 

The PFC  - 

The Key To Integration of our Instinctive, Emotional and Mental Brain Programming

Human beings, among all living creatures, have a unique part of their brain, the pre-frontal cortex (or “PFC” for short) which enables us to make this shift.  The PFC is kind of like the captain of our mind-body ship, the coach of the mind-body team, the CEO.  The main activity of the PFC – what psychologists call “executive functions”  - involves decision-making, planning, and focusing attention, all contributing to the job of guiding our thoughts, speech and actions.  

Perhaps the main reason the practice of mindfulness has become a basic practice in almost all of contemporary therapy is that training attention (which is basically what mindfulness is) is among the most powerful ways to train the PFC.

But why is it so hard to make use of the PFC? Over a billion years of evolution has created brain programming which is very complex and very good at overriding the best intentions of the PFC. Here’s some simple terms I’ve made up to help you understand your brain programming:   

·      The instinctive programming is the most ancient, dealing with our basic needs for survival, utilizing pleasure and pain mainly as a means of identifying what helps or hinders survival, and our capacity to master our environment.

o  When our survival needs are not met, we are far more prone to anxiety and anger, we desperately seek out for possessions and/or people who can make us feel safe and secure.  We may become obsessed with satisfying our desires and avoiding pain, and we either seek domination (rather than healthy mastery of the environment) or passively accept being dominated by others.  It becomes extremely difficult to control our attention, and we are far more subject to being overwhelmed by even minor everyday stress.  As a result, we may also develop all kinds of unhealthy habits related to food and various addictions.

·      The emotional programmingemerged most powerfully with mammals, and represents a shift from competition as the main means of survival to cooperation and collaboration.  Its strongest characteristic is the capacity to form strong emotional bonds with others.  

o  When our needs for emotional bonding are not met, we become depressed; we may avoid interactions altogether, or become overly dependent on others.  This can have a negative impact on virtually every area of our lives.

·      The mental programmingextends way back in evolution, and can be seen in its initial forms even in one-celled organisms. However, as the capacity to form highly complex ‘stories” about other organisms, and most important, to direct one’s own behavior and to choose to refrain from mechanically following the instinctive and emotional programming, it emerges most powerfully in human beings.

o  Almost everyone, to some degree, has distortions in the “stories” they have about themselves, others and the world in general.  Research on cognitive behavioral therapy (and really, all therapies to some extent) has shown that the simple act of becoming aware of and developing more accurate “stories” is enough, in many cases, to dramatically improve and even cure a wide range of psychological issues (and even some physical ones as well, including insomnia, Type 2 diabetes and many kinds of physical pain).

In addition to the various programmings that come together to make up our unique personality, there’s something extra - what I call “the little me” – this little thing that nags and harasses us every moment of our waking lives, always trying to get its needs met, in whatever way it can.

To deal with this, we can learn to use our PFC to help us step back from both the inner and outer rings, let go of our preoccupation with the “little me,” and rest in the center of awareness.  From there, we can help to organize the various activities of thought, emotion, etc on the inner and outer rings.  As our outer personality becomes less chaotic and presents less of an obstacle, we will get more and more glimpses of that calm, quiet, joyful awareness at the center.  

Ideally, therapy, medication, supportive family and friends– even our homes, neighborhoods, towns and cities – can be set up in a way to assist this process of harmonizing our brain programming, and reminding us again and again to return to that innermost center of calm, quiet, joyful awareness.   

Treatments:

“Natural” Treatment Interventions

What then is the most effective way to help connect to the quiet place within that is our natural, innate source of greater happiness and well-being?   

Though they have an important role to play, it turns out that therapy and medications are not the most effective methods.  Over 20 years of research in “positive psychology,” tells us that the greatest factors for increasing happiness and well-being are having an environment where people care about and support each other, and having work or interests that inspire us.  

Some of the most powerful interventions we can make as therapists - and parents – are based on a recognition of the interests a patient already has interests that take them out of themselves and give them a sense of connection to something or someone beyond their own needs, problems, and desires. That sense of connection to purpose and people outside ourselves, is a natural and effective way to connect to the quiet place within.  Finding ways to support and encourage those interests can make a powerful difference in the person’s life. 

“Active” Treatment Interventions – Where do therapy and medication fit in this picture?

Medication

Ultimately, what interferes with the brain’s natural capacity for integration, is the fact that our attention gets caught up in the stuff we’re aware of – whether it’s the “inner” stuff of thoughts and emotions or the “outer” stuff of people, places, things, and events.  

In cases where the person’s brain is in so much conflict – that is, when their attention is so trapped in the ”stuff” of the outer circle that they lose access to the center, medication can be a useful tool.  It can help to calm the intensity of the moods and thoughts that keep our attention fixated on the outer circles – and make it easier to get a taste of the quiet integrating power at the center.   

Therapy

Although there are more than 100 different forms of therapy, recent research suggests that – to the extent they are successful – they’re all really doing one thing.  They are helping to train our attention to let go of its tight grip on the stuff of the outer circles and shift it to the still quiet place within.  In brain language, attention training is a way of strengthening our prefrontal cortex (“PFC for short).  The pre-frontal cortex is what gives us the ability to reflect on our thoughts, feelings, and behaviors, evaluate their usefulness to our well-being, make new choices that will have a more constructive result – and ultimately, redirect attention back to that innermost place of quiet, calm awareness, the experience of “simply being.”

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Putting It All Together

So when I am working on the main section of the report andwhen I’m putting together recommendations, I’m keeping the following in mind:

·       What is the best way to foster a supportive environment for this patient, one which will give him or her a strong sense of connection to others and a sense of being part of something greater than him or herself?

·       What are the patient’s interests that are most likely to develop the ability to self-regulate, to be empathic and caring toward others, to make wise decisions, to be strong and calm in the face of adversity?

·       What specific therapeutic interventions might be most helpful?

o   I may recommend specific, well-known, “evidence-based” therapies. However, I may also advocate specific interventions that, based on test results and diagnoses, are likely to help them “shift” their attention from “the stuff” of the “inner and outer circles’ to the “still, quiet place within” (which, after all, is the fundamental core of all therapy and counseling; in fact, of all psychological development).

·       How much medication will the patient need if they are not able to make use of the above ways for developing greater well-being?

Perhaps most important of all – once we have had a glimpse of that state of calm, peaceful awareness that comes from shifting to the still, quiet place within – we can train our brains to remember, over and over, to pause, let go of our concerns about the future and past, momentarily set aside our agendas and plans and todo lists (and phones!), and return to that innermost center of awareness.  As we remember to do this more and more frequently, this can

give rise todeep feelings of love, peace, kindness, and connection and a feeling of being at home in the universe – perhaps for the first time.