Failure to thrive--emotionally and interpersonally--has roots in trauma, violence, poverty, and broken families. For some people, genetic vulnerabilities and gene expression may also contribute, but rarely independent from psychosocial factors. These psychosocial and genetic factors dysregulate healthy neuropsychological pathways of attachment and resilience.

Early indicators and neurobehavioral markers of failure to thrive include anxiety, depression, hostility, emotional withdrawal, hypertension, diminished vagal tone, disrupted HPA functions, and substance use.

Neuroscience research (e.g., the dynamics of polyvagal coping, dysregualtion of the hypothalamic-pituitary-adrenal (HPA) axis, and identification of regulatory brain structures) has clarified methods and options for psychotherapy. They options often include cognitive-behavioral methods (e.g., mindfulness, elicitation of the relaxation response, and attention training to manage intrusive emotions, as well as distress tolerance training, and titrated exposure to trauma).

Outcomes are further improved when treatment incorporates the mind-body neuroscience of trauma, attachment, and resilience.

CBT methods, however, have diminished efficacy when applied in an excessively technical manner divorced from a relational therapeutic alliance, and which excludes consideration of family systems issues, histories of personal and/or collective trauma, and the human need for existential meaning.

*

To address these issues, clinical supervision and professional training with Dr. Jared Kass introduces psychotherapists to Multimodal Person-Centered Psychotherapy.

Dr. Kass has taught principles of methods of multimodal person-centered psychotherapy for nearly five decades. His integrative mind-body approach tp psychotherapy has roots in two formative projects:

Dr. Kass worked with Dr. Carl Rogers, founder of Person-Centered Psychotherapy, from 1976-1981 as a staff member of the Person-Centered Approach Project. During this period, Kass refined skills as a person-centered therapist: somatically attuned reflective listening; the development of interpersonal therapeutic conditions (empathy, congruence, and unconditional positive regard) that research has demonstrated to be crucial to an effective therapeutic alliance; and helping patients discover their own capacities for an internal locus of evaluation and an internal locus of existential meaning-making.

Dr. Kass subsequently worked with Dr. Herbert Benson, a founding contributor to the field of Behavioral Medicine, from 1985-1991. This medical field introduced mind-body neuroscience into cognitive behavioral practices that have become figural in psychotherapy.

Dr. Kass continued to expand his incorporation of mind-body neuroscience into multimodal person-centered psychotherapy as trauma studies integrated psychodynamic developmental theory with the neuroscience of attachment, resilience, and trauma. This increasingly complex therapeutic model built upon research on the tri-partite model of brain structures and dysregulation of the HPA-Axis developed by the field of Behavioral Medicine to include the polyvagal model of stress coping, and somatic therapeutic approaches to trauma that monitored distress tolerance.

Dr. Kass additionally integrated mind-body neuroscience in his work through incorporation of the expressive arts therapies into somatically-oriented experiential therapeutic approaches that enable patients to develop awareness of their dysregulated behaviors in the immediacy of therapeutic sessions and to practice self-regulation skills in this in vivo context.

*

During professional training, Dr. Kass presents multimodal person-centered psychotherapy through four overlapping modules of practice:

Module 1: Developing an Effective Therapeutic Alliance:

Relational Methods that are Attuned, Trustworthy, and Culturally Credible.

Key Themes:

Reflective Listening and Empathic Attunement as essential clinical skills.

Responsivity to cultural differences.

Systems-oriented clinical assessment that affirms the impact of social identity.  

Module 2: Initiating the Work Phase of Counseling: Self-Regulation Skills

Collaborative Goal Setting / Cognitive-Behavioral & Mind-Body Self-Regulation Methods.

Key Themes:

Neuroscience of Stress, Vagal Brake, & Stress-Related Physical Illnesses.

Clinical symptoms: behavioral and cognitive expressions of the stress response.

Psychoeducation and self-monitoring to promote self-awareness.

Self-Regulation skills: Mindfulness and Eliciting the Relaxation Response.

Use of the Inventory of Positive Psychological Attitudes (IPPA)

Module 3: Deepening the Work Phase: Exploring Core Wounds and Trauma

Exploring Core Psychological Wounds, Trauma Histories, Attachment Templates, and Existential Crises that Dysregulate Healthy Growth.

Key Themes:

Neuroscience of Trauma, Attachment, and Resilience; Polyvagal Theory of Coping..

Causes of Dysregulation: Socio-cultural, Psychodynamic, and Existential.

Psychodynamic Methods: Attachment Theory; Ego Psychology; Respect for Defense Mechanisms and Multiple Purpose(s) of the Repetition Compulsion.

Module 4: Amplifying the Work Phase of Counseling: Experiential/Somatic Methods

Mind-Body Integration through Experiential Psychotherapies:

Key Themes:

Neuroscience / Psychophysiology of the Mind-Body Emotional Self-Regulation System

Somatic Approaches to Defense Mechanisms and Body Armoring.

Role of Expressive Arts Therapies in Experiential, Somatic Approaches for treating trauma and helping patients develop an internal locus of evaluation and existential meaning-making.

These four modules overlap during psychotherapy. However, it is useful to intoduce them in this consecutive fashion for training in multimodal person-centered psychotherapy.

*

While developing this multimodal approach, Dr. Kass conducted research on these therapeutic methods. The research demonstrated that dysregulated behavior (failure to thrive emotionally and interpersonally) is reinforced synergystically across five dimensions of self. Dysregulation in each dimension of self strengthens dysregulation in others.

Consistent with recognition that mind-body neuroscience must inform therapeutic practice, this model begins with the bio-behavioral dimension: neural and physiological pathways through which individuals respond to stress.

It then delineates four psychological dimensions that interactively shape bio-behavioral reactivity. The salience of these five dimensions of self in psychological wellbeing (and failure to thrive) is evident in the preceding discussion of multimodal person-centered psychotherapy.

Thus, Kass' research and therapeutic approach highlight the role that neuroscience now plays in therapy.

The five dimensions of self that determine psychological wellbeing (and failure to thrive) are:

Bio-Behavioral: The neural and physiological pathways through which people respond to challenges, stress, and perceived threat:

Dysregulated responses produce hyper- or hypo-reactivity to internal or environmental stimuli. Flexible responses, which are associated with robust heart-rate variability (high vagal tone), contribute to resilient self-regulation, and relational co-regulation, as appropriate to specific situations.

Cognitive-Sociocultural: Cognitive schemas and social identity narratives that condition perceptions of self and others:

When these schemas become negative, individuals often experience a toxic Inner Critic. In the social dimension, toxic and distorting narratives strengthen group-based social dominance hierarchies that justify and legitimize their power and their privilege—while marginalizing and oppressing groups that they designate as the other.

Social-Emotional: The templates of attachment that shape the capacity for constructive interpersonal relationships, families, and community/organizational networks:

Secure attachment templates contribute to resilient self-regulation, emotional attunement to others, and relational co-regulation. Insecure attachment templates contribute to ambivalent, avoidant, and disorganized relational styles. Insecure attachment templates are amplified by histories of complex trauma and abuse.

Existential-Spiritual: The templates of attachment through which we experience and derive meaning from our relationship with the cosmos:

Secure existential attachment produces a coherent perspective on existence that enables resilient responses to life’s challenges, suffering, and inevitable mortality.  

Insecure existential attachment—often the result of traumatic life experiences—produces a chaotic perspective on existence that undermines resilient responses to life. Secure existential attachment can be cultivated through empathic self-inquiry that heals negative distortions in narratives about self, others, and life. Equally important, it can be cultivated through contemplative practices which enable individuals to experience a core, transpersonal dimension of self.

Integrative Worldview Formation: The synthesizing lens through which we perceive and respond to life events and people:

During maturational growth, this synthesizing lens produces Confidence in Life and Self, in which individuals develop sustainable levels of internal composure that enable them to respond to life’s challenges and stress with resilience. When this synthesizing lens produces low levels of Confidence in Life and Self, individuals become dysregulated in their attitudes and behaviors—both toward self and others.

Neuroscience research suggests that this synthesizing process occurs in the pre-frontal cortex, with input from the right & left cortical hemispheres, limbic system, and body (via the insula).