Hug the Monkey

Did Hitler Have RAD?

How do human monsters get that way? Most of us can't imagine how anyone could create the evil and pain that Adolph Hitler did.

We like to think of Hitler and others like him as aberrations of nature, pure evil somehow come into human form. But monsters like Hitler are created by other humans; most often, they're made by their parents.

Alice Miller

In an article about Hitler reprinted on NaturalChild.org, she writes,

In order not to die, all mistreated children must totally repress the mistreatment, deprivation, and bewilderment they have undergone because otherwise the child's organism wouldn't be able to cope with the magnitude of the pain suffered. Only as adults do they have other possibilities for dealing with their feelings. If they don't make use of these possibilities, then what was once the life-saving function of repression can be transformed Into a dangerous destructive, and self-destructive force.

Hitler was beaten severely and regularly by his father; to protect himself, he learned to repress all feeling. But, Miller writes, his rage and pain remained. Her book, "For Your Own Good," explains how his childhood experiences caused him to become the man he was, as well as how German society created a generation with many people who were ready to follow him. The book is a polemic against the cruelty we inflict on children in the name of discipline and socialization.

Reactive attachment disorder, or RAD, is a diagnosis given to people -- most often children -- who are unable to bond with others. They show little or no empathy, they are often violent and destructive, and they can be very cruel. It's very likely that today, Adolf Hitler would be diagnosed with RAD.

Miller is very clear that Hitler is still responsible for his actions, as we all are. And she is NOT justifying what he did in any way. She says,

What point is there for us today in learning about Hitler and his history? For me, the main point is this: our knowledge will serve as a warning against our blindness and encourage us to give it up once and for all and to struggle against collective repression. This is what I do consistently in all my books in order to help people understand the psychodynamics of the mistreatment of children and its immeasurable danger for society, as demonstrated by Hitler's case. My explanations are by no means intended to suggest pity for a man as merciless as Hitler.

For other psychologically oriented analyses of Hitler, see posts in this forum:

http://www.behavior.net/bolforums/archive/index.php/t-372.html

RAD Becoming Recognized

The horrible stories about the abuse of children with reactive attachment disorder in the foster and adoption system just keep coming.

Therefore, I'm especially happy to read this story from the UK of a woman who's had success in mothering RAD kids.

Sue Clifford began adopting traumatized children in 1991. She intuitively developed parenting styles that help them, in advance of the new understanding neuroscience has provided in the last ten years.

Book Review: The Connected Child

Karyn Purvis, David Cross and Wendy Lyons Sunshine have written a handbook for parents of at-risk kids that's vitally needed. With the rise in international adoptions and adoptions of kids in foster care has come a mostly unacknowledged crisis. Unprepared and unsupported families are finding themselves unprepared for the task of parenting children with severe emotional problems.

The Connected Child helps parents put some of their therapeutic techniques into practice; more important, it helps them understand their kids in a new way.

Dr. Purvis is the director of Texas Christian University's Institute of Child Development; Dr. Cross is associate director of the institute and a TCU psychology professor. They treat kids with attachment and other behavioral disorders, and they run a summer camp for kids.

The book explains to parents how their assumptions of normal and acceptable behavior may be completely foreign to their children. Not being touched, not having enough to eat, not having toys or stimulation can create a worldview that's totally out of synch with the parents.

That's why setting rules for behavior or other cognitive approaches may not work with these kids. When parents understand that so-called bad behavior comes from fear or self-protection, they can find strategies that address the underlying fear and thereby change behavior.

For example, stealing or hoarding food is common among children from orphanages. They had no choices about when or what they could eat, and often didn't get enough to eat. Instead of demanding that the behavior stop, or that kids hew to mealtimes, the authors offer techniques to maintain a healthy, regular diet while increasing feelings of security about food.

For example, if a child asks for an energy bar a few minutes before mealtime, instead of saying, "No, we'll be eating in ten minutes," they advise giving her the bar and letting her choose whether to keep it in her pocket or by her plate to eat after dinner. Another option is letting the child keep a basket with healthy snacks in her room that she can eat whenever she wants.

Even sending a kid to her room for a time-out can hurt more than it helps, they write. If a child already feels cut off from the family, this isolation seems to reinforce that belief. Instead of dealing out consequences for misbehavior that may seem arbitrary and unrelated to the misdeed, Purvis, Cross and Sunshine illustrate how to help a child understand the real consequences of his behavior. For example, if a kid mistreats a dog, parents are advised to sit down with him and brainstorm the negative consequences of the behavior, such as, "If I hit the dog, it will run away from me." Next, they should make a list of positive consequences that might occur if the dog is treated kindly, such as, "It will like me."

They write,

"Adopted and foster children deserve deep compassion and respect for what they may have endured before they were welcomed into your home. Some of these little ones have survived ordeals that defy the imagination. … the difficult history of these children means that you, as a caretaker, have to work harder to understand and address their unique deficits and make a conscious effort to help them learn the skills they need at home with a caring family."

Parents need to respond to acting out, tantrums and other dysfunctional behavior with love and understanding. Over and over, the book helps parents understand the roots of misbehavior, so that they can respond with love instead of anger.

At-risk kids need to be told directly and simply what's expected of them, according to Purvis and Cross. Parents should identify specific behaviors or values they want to enable, and name them, for example, "asking with respect." If a child asks for something demandingly, the parent says, "Is that asking with respect? Can you ask me with respect?" Throughout, the book provides clear strategies and scripts for handling a wide variety of problems and behaviors.

Finally, The Connected Child includes a chapter called "Healing Yourself to Heal Your Child." Without judgment and with much compassion, the authors point out how much any child, and especially a traumatized child, needs to feel secure and loved by her parents. If a parent hasn't dealt with his or her own grief, anger or emotional dissociation, it will be difficult for that child to heal. If the child does begin to open up, it may actually make her parents uncomfortable.

They offer some advice for such parents, which tends to be on the cognitive side, such as reflecting on their own attachment styles and practicing identifying and articulating their own feelings. Of course, this isn't always so easy, and parents with attachment issues may benefit more from the same kinds of experiential therapy that kids get.

In fact, guiding a child with an attachment disorder toward healing could be exactly the kind of experience that could help a parent heal -- as long as it's done consciously and carefully. The Connected Child is a wonderful guide.

For background on the work of Dr. Purvis and Dr. Cross, see this article from the Texas Christian University magazine.

The Time is Right for "Holding Time"

It's time for another look at an 18-year-old book on repairing the attachment between mother and child.

When Martha G. Welch wrote Holding Time in 1989, the idea of attachment -- the bond between mother and baby -- was something intuitively understood, but not scientifically proven. Since then, studies of rodents, mammals and humans using functional MRI have begun to show how early nurturing shapes the brain, and how the lack of it harms brain development.

Welch treats attachment disorder using holding therapy at her treatment centers in New York City, Chautauqua and Greenwich, Conn. She's a psychiatrist at Columbia University's Department of Neuroscience, and she's studying both the role of oxytocin and secretin in autism and possible therapeutics using these two peptides. (Secretin is a gastric hormone that prompts the pancreas, stomach and liver to release digestive enzymes.)

Welch's method aims to repair the bond between mother and child. A baby's nervous system and brain aren't fully formed at birth, and development takes place in response to interactions with her mother.

Holding, nursing and nurturing develop the oxytocin response and they seem to determine the amount and sensitivity of oxytocin receptors in the brain, especially the parts of the brain that deal with social interaction. Oxytocin also is critical in moderating the fight-or-flight response.

If a baby experiences fear or abuse, she develops a strong and oversensitive stress response. If she is neglected, or doesn't get enough holding and attention, her brain won't learn to release oxytocin when she does have physical contact -- and contact, even soft nurturing, may seem intense and scary to her deprived body.

The diagnosis of reactive attachment disorder is a catchall similar to autism spectrum disorder. But, no matter the symptoms, its roots are trauma, neglect and the lack of a secure bond with a mother. (I'm using mother here to describe a role; anyone who is the primary caregiver and nurturer of a baby is acting as her mother.)

In Welch's method, the mother takes the child into her lap and attempts to make and keep eye contact. Welch's holding therapy typically goes through three stages: confrontation, rejection and reconciliation. In the first stage, holding often means restraining the child on her lap. In the second stage, the child may reject not only being held but also his mother, telling her he hates her, she smells, she's bad. The mother may express her own feelings, saying, "It makes me feel bad that you won't look at me," for example.

Finally, all the negative feelings having been expressed, the child and mother feel peaceful and can connect lovingly. According to Welch, this process is a more expressive version of the gentle cycling between arousal and calm that ideally happens when a mother interacts with her newborn. Being restrained on Mommy's lap gets the child's adrenaline going; that leads to the expression of rage, fear and sorrow, leading to release of those feelings and a new kind of arousal, that of pleasure in being close to Mommy.

Welch writes, "As the struggle continues, the child usually experiences a whole range of emotions but in the safety of his mother's arms. This time the state of arousal is associated with being held lovingly, resolutely, and closely."

It's important for the mother to also be able to release some of her frustration and anger, Welch believes. She writes, "Holding time allows both of you to discharge your pent-up aggression in a safe way."

Welch's method has much in common with Theraplay: The child being controlled and kept in therapist's or mother's lap; the therapist or mother taking charge of the interaction (designed to let the child know there is an adult in control); the goal of mutual gazing and intimacy; and the theory of consciously recreating the experiences that lead to healthy brain development in the infant.

While Theraplay uses activities to distract the child from her distress and engage her less directly with therapist or parent, the holding time method asks mother and child to stay with their feelings and work through them.

The book and Welch's treatment have come in for criticism because of the enforced holding, especially in light of the horrible cases where RAD kids have died during different types of holding therapy, when they were covered in blankets of grownups laid on top of them.

But her work makes sense in light of attachment theory. Children who aren't well attached to their mothers may be either anxious -- desperately craving attention -- or avoidant. Avoidant kids have learned that being close to Mommy means being hurt -- either being rejected or being yelled at. So, they've decided the safest course is to cut themselves off from anyone else.

I grew up avoidant. I still remember the moment when I consciously decided, "I'm not going to let them hurt me anymore." I still craved love and connection, but when it was offered to me, I froze. I desperately needed someone to break through the ice, take hold of me and love me. I kept waiting for someone to do that, but of course, since I couldn't reach out or ask for it, no one ever did.

From my own experience, I think holding therapy may be just what an avoidant kid needs.
Holding Time explains how to use this method; however, I'm not so sure parents should try it without training. The key to holding therapy is that the mother accept the child's rage, letting him know she loves him no matter what. This is easier said than done.

In the examples in the book, the mothers always respond by expressing their needs or feelings in non-judgmental ways. "I know you are angry at me, but I still love you." "I feel upset when you scream and fight. I am going to hold you until we both feel better."

This kind of response is tough for any of us to do; and, to be brutally honest, if this kind of interaction comes naturally to a mom, her kid is not likely to be in need of holding time. (In the book, Welch doesn't discuss the special needs of adopted children, who may have been traumatized or deprived before being adopted; this was before adoption became as widespread as it is today.)

A parent who hasn't been trained in how to respond could end up damaging the child more. As one Amazon.com reviewer, a self-described survivor of forced hugging, put it, "I found it punitive and abhorred it. Who wants to be yelled at and told to look at somebody while being subdued by force?! Who wants to be the recipient of false accusations with no recourse or defense?!"

If the mother hasn't learned how to give love, if she uses holding time to express herself in ways that frighten or hurt her kid, it will damage the bond even worse, by denying the child the one defense he has: withdrawal.

But if mother and child learn to do this with the support and guidance of a therapist, it could be that revelation that Welch promises: "a closer, more satisfying and truly wonderful relationship with your child."

Theraplay to Shape a Child's Brain

Interview: Dafna Lender, Theraplay Institute

Are We an Autistic Society?

Donna Williams, a self-described "mad, autistic artist" -- as well as a teacher, author and consultant -- wrote an article for American Chronicle that boldly questions whether our technology-oriented, individualistic society is creating more infants with reactive attachment disorder and autism.

She writes,

Is possible that we’re living in an age where some pregnant mothers being so busy with cerebral, passive interactions with technology and its related increase in time use that they don’t have the range of movements, emotional experience, that it’d be conceivable some don’t develop the same full prenatal bonding with their child that may have been more common before the 80s and 90s?

I'd answer yes to that. But I don't think that technology, and specifically our reliance on computers, is completely to blame. I think that the medicalization of childbirth, cutting mothers off from the biggest oxytocin rush a human will ever get and from the opportunity to bond immediately and bodily with their newborn babies, may be the biggest factor.

Add to that the necessity for most mothers to work, being away from their children for most of the day, and our reliance on television as a surrogate for human interaction, and you have a recipe for isolation and thwarted empathy.

Williams asks,

what if society is improving upon detachment, passivity, being more cerebral than emotional and physical, and progressively then mistrusting and fearing unexercised real interaction with ’strangers out there’?

We are all, already, becoming more ‘autistic’ and the ‘geek syndrome’ generally associated with Asperger’s Syndrome is so widespread that mild cases are not even worth diagnosing lest we end up losing sight of any measuring stick of ‘normality’ (which is all relative anyway).

Williams raises the spectre of the "refrigerator mother," the idea in the 1940s that some women were intrinsically not motherly enough, thereby causing their kids' autism. The pendulum has swung away from blaming the parents -- which is a very good thing. But it may have swung too far.

Mothering matters more than anything else in our lives. Without mother love when we're babies, our brains don't develop the oxytocin response -- as well as many other systems and responses we need to successfully navigate the world.

Williams writes,

If so, if today’s generation benefit from, enjoy or are addicted to those causes, and if voracious consumer economy feeds, encourages and entrenches those addictions through increasingly consumed media, will we ever wake up? Will we be ‘allowed’ to? And in a dog-eat dog society of stone throwing tabloid press, witch hunts and bitching public forums, can we ever calmly look at even hints of the refrigerator mother yet empathically envision ourselves in their shoes?

A Traumatic Story

This brutally honest account shows how violence not only destroys a childhood but continues to cause harm throughout life. Meera Atkinson writes,

Even if survivors finally see the connection between their past and present symptoms, it doesn't guarantee others will extend compassion: if we ignore our past, no one knows; if we discuss it, we risk being seen as malingerers, as people who live in the past — which is, in a sense, exactly what we do, if not consciously.

For Atkinson, understanding how early trauma interferes with the brain's development was a first step to healing.

Interview: Dafna Lender, Theraplay Institute

Dafna Lender is training director and clinical coordinator for the Theraplay Institute, an organization that trains teachers, social workers and psychotherapists. Theraplay provides a structure for activities that help heal kids' attachment problems.

HUG: First, tell me how you got involved with Theraplay.

Lender: My involvement began when I was working in a foster care agency that had a residential component. Most kids had been adopted previously or been in a nuclear family, and their history of abuse, neglect, separation, loss and trauma had caused them to disrupt the place they had been in.

We found these kids were still unprepared after two years with us to go into a family. We were looking for some sort of method or therapy model that would help. I was sold from the beginning, and it was transformative for me, too. I felt I had hit on what I needed for the clients I was working with.

HUG: I've been hearing more in the news about reactive attachment disorder, and about failed adoptions. Is this problem increasing, or is there simply more awareness?

Lender: We have had a huge influx of parents who call us with these problems in the last ten or fifteen years, as societal problems get worse, and funding for social services diminishes -- and foreign adoptions become more common. There also is increased awareness of attachment issues. I definitely think it's a phenomenon that's increasing in size with not enough resources.

HUG: I've been distressed by some parents' accounts of adoptions that didn't work out. The parents seem not to understand how deeply messed up these kids are.

Lender: Parents do try very hard, and the lack of resources and support from the child welfare system or adopting agency can leave adoptive parents really depressed, resentful or despairing. They may feel like they're going crazy. An attachment therapist would help the parent put the child's behavior's into context so that the parent does not feel that they have gone crazy or are bad people. The attempt in the attachment community is to say it's not all the child's fault, but not the parents' fault either.

The child is projecting all this non-conscious trauma onto the parent. Most trauma that happens to kids is out of their awareness, because either it happened before they were verbal and therefore have no recollection of it, or they're defended against it, because it was such a horrible experience.

The only way for a parent or therapist to interact or give healing to these kids is to not to take it personally. That's a very difficult feat and requires a great deal of work on the parents' part and a great deal of support from a therapist. If parents sound callous, it could be because they have not received this help.

HUG: Do you buy the diagnosis of reactive attachment disorder, or RAD? There's no mention of this disorder on the Theraplay website.

Lender: There are a lot of problems with the diagnosis. There's a lot of overlap with other diagnoses, and no criteria that are discreet from others. Other people have talked clinically about attachment issues in terms of both severity and features that are more on a continuum, and that is more helpful clinically.

HUG: You work with both mother and father, if available. What about the idea that mother is primary regulator of brain and affect development in the first years?

Lender: That's definitely the case, but we don't work with kids during that period of time. Parents typically bring kids in toward the end of their second year, or before they start preschool. After the first year, the father is important typically -- although this is a stereotype -- in providing high levels of positive affect. This is important in being able to regulate high arousal, enjoyment, joy, interest and excitement. A child needs that just as much, so he doesn’t go berserk if he's waiting in line for the playground, for example. It also wards against depression and creates a great bond. So we love to focus on both parents.

HUG: There's an emphasis in Theraplay on certain special moments of connection that lead to change. Can you talk a little bit about this?

Lender: Those are called "now moments" or "moments of meeting" in the psychotherapy literature. It has to do with when two people are spontaneously sharing an idea, and they know that. It's an expansive moment, when we shared something that was meaningful. For example, when we're playing bubbles, and it pops right on the tip of the child's nose. There's a moment where he's startled, and then thinks it's funny, and I laugh too, and it's amplified. It's not something planned by me, it has to just happen.

HUG: Theraplay was developed for the Head Start program. Is there a change in the client base in the past few years?

Lender: In the last few years, there's been an increase in the severity of the abuse and neglect, the number of placements, and the rising awareness of the effects of drugs and alcohol in utero. On a parallel stream, there's also more and more focus on autism and early diagnosis, and we're known for that, as well.

Theraplay is a registered service mark of The Theraplay Institute, 3330 Old Glenview Rd, Wilmette, IL, www.theraplay.org

Theraplay to Shape a Child's Brain

One of the most exciting advances in neuroscience is the discovery of how psychological disorders are rooted in brain development. Thanks to functional brain scans, clinicians can see that depression, schizophrenia and many other ills correlate with over- or under-active parts of the brain.

It's clear that psychotherapy isn’t just for sissies, and that people can’t heal just by bucking up and not dwelling on the negative.

Our brains evolved to learn how to love from our mothers, and, later from our fathers and other family members, in an ever-widening social circle. But loving is the result of a series of neurochemical responses based on oxytocin, and it relies on brain structures and neural connections that develop slowly in the first three years of life.

Unfortunately, in those early years, it's possible to miss the experiences that form the oxytocin response. Some mothers were themselves abused, rejected or neglected as children; they may unconsciously transmit a tendency to shut down in the face of intimacy to their children.

Babies who spend time in orphanages, foster care or intensive care may miss the amount of touch, being looked at and spoken to that's necessary to spark the development of the social brain's attachment system and the oxytocin response.

Theraplay is a structured way of stimulating the brains who missed getting the right kind of interaction, for whatever reason. In a typical course of 12 to 15 weekly sessions, it provides experiences that trigger brain activity that will lead to its healthy growth and maturity. It's been used to treat children showing withdrawn or depressed behavior, overactive-aggressive behavior, temper tantrums, phobias, and difficulty socializing and making friends, as well as learning disabilities, developmental delays, and pervasive developmental disorders. Because it focuses on developing the attachment system, Theraplay is often used with foster and adoptive families.

The system was developed beginning in 1967 by Ann Jernberg when she was director of psychological services for Chicago Head Start -- long before science understood how the early environment shapes the brain. Because there weren't many resources for kids in the program who needed psychological services, Jernberg decided to develop a system that could be used by Head Start workers in the centers.

The evolution of Theraplay took a turn toward its current focus on repair of the attachment process following co-developer Phyllis Booth's year-long training at the Tavistock Centre in London. There, Booth studied the ideas of John Bowlby, who first developed attachment theory.

It's evolved since then to focus on repairing the attachment between the child and the mother or other primary caregiver.

The activities are organized around four dimensions that characterize a healthy relationship between mother and child: structure, engagement, nurture and challenge.

Kids who haven't been able to rely on a parent or other caregiver for emotional regulation need to learn to let the adult lead. The therapist strives to remain attuned with the child, as she selects and leads the activities. This reassures the child that someone is available to take charge.

Children from chaotic homes may find any change stressful, a response that will limit their later ability to fulfill their needs. Withdrawn or autistic kids may dislike engagement with another person.  The therapist focuses on the child in order to achieve and maintain a connection, moving at his own pace. The activities are designed to be engaging, showing the child that "surprises can be fun and new experiences enjoyable."

The therapy includes plenty of soothing, calming, quieting and caretaking activities to change the child's view of the world from scary to safe, predictable, warm and secure. This nurturing also fulfills the child's basic needs, reducing the level of stress chemicals, activating the parasympathetic nervous system and reminding his brain to release oxytocin.

Challenging activities mimic the way a good mother acts as a secure base from which her child can gradually explore and experiment with his environment and other people. These challenging activities are cooperative and fun, to help promote feelings of competence and confidence.

An article on the Theraplay Institute website offers a lovely glimpse into the small steps that lead to attunement between therapist and child, and then, mother and child.

A Theraplay-therapist is holding a panicky, disorganized child in her lap, checking out what a wonderful girl she is. The girl cries until, all of a sudden, the therapist beeps her nose. The child is startled and smiles. The next time, with another sound coming from the therapist’s nose, the child giggles.

Then, for three sessions she whines, cries, and turns away from all the therapist’s advances. One day, to the child’s amazement, a soap bubble pops before her finger even touches it. The therapist’s voice shows similar amazement: what happened? The child, who has forgotten to whine, pops the next bubble, and the therapist rejoices.

The next session, the child is suddenly still, absorbed by the eyes of the therapist, who attunes to every gesture and vocalization of the child, matching them to the nurture she is giving to the child’s feet; playing peek-a-boo with them, rhyming the child’s “mama” into a familiar song. Never before in her 3 years has the child been in prolonged eye contact. Now her eyes spell-bind the therapist, and her mother and me, looking from behind the mirror. Her whole countenance has changed from a frizzled rag doll look to an intense, oriented, girl of three.

Two sessions later as she is cuddled in her mother’s arms she reaches up to find the curly blond locks of her mother’s hair and starts to play with them, looking intently into her mother’s eyes. Her mother says her daughter was born to her at that moment.

Theraplay is a registered service mark of The Theraplay Institute, 3330 Old Glenview Rd, Wilmette, IL, www.theraplay.org

Schore: Freud Was (Mostly) Right

One subtext of Cal State Chico's Children in Trauma Conference was how much Freud got right about how our minds and emotions work.

In today's session focussing on the therapeutic alliance, and how and why therapy works, Allan Schore spoke at length about counter-transferance. He said the concept has moved from psychoanalysis to most flavors of psychotherapy.

Another thing Freud got right was the existence and importance of the unconscious, which Schore says is seated in the right hemisphere.

What he didn't get right, according to Schore, was the idea that releasing the negative emotions resulted in healing.

In fact, Schore said, it's countertransference that provides the healing in psychotherapy: As therapist and patient together create trust -- a safe place -- the patient begins to dare to re-experience small doses of trauma or the hurtful feelings that had not been experienced, remembered or expressed.

According to Schore, "In the moment, the context between therapist and patient must be safe enough for the patient to begin to drop defenses and experience in his body -- and tolerate -- affects that were too dangerous to experience, to feel, let alone communicate.

"What seems to create the healing is the pairing of the reactivated traumatic memory with the context of safety and comfort. That's what didn't happen in the first place when the parent was disengaged or hyperarousing."

Meth, RAD and Attachment Therapy

Kicking off the second day of Cal State Chico's Children in Trauma conference, Butte County District Attorney Mike Ramsey talked about the county's Drug Endangered Children Program.

Ramsey said that narcotics police would make drug busts, clear out the drugs, arrest the adults and push the crying kids into the arms of the first available adult -- who might themselves be drug addicts. There may be three generations of meth users in a family.

He said, "One issue is the disconnect of these children that have no parenting, children that are left alone and passed from caretaker to caretaker. Absolutely flat affect in children taken from these homes. Most of us coming from "normal" homes would expect that when heavily armed narcotics agents break down the door, the children would be very frightened about being taken from their parents. But all it takes is for a CPS worker to come in and say, "Hi kids, we're going to McDonalds," and those children leave the parents in a flat second because they haven't bonded with those parents."

In response, main presenter Allan Schore, author of "Affect Regulation and the Repair of the Self," reminded the audience, "We now know that even in the earliest events, infants are extremely aware of events and of their strongest attachments."

He said that while a child might have flat affect on the surface, there are likely rage and fear beneath the surface.

His presentation today focuses on how and why therapy works. He said, "Therapy is not a talking cure, it's a communication cure." That is, the therapist and patient must connect in the right hemisphere, the source of feeling.