Working without an Assessment–the Recipe Approach

Recipes are used because they do work a reasonable percentage of the time. But there is certainly likely to be a big difference between what you get when you eat something made by my mom from a recipe of hers-and what you get if I make the recipe. The people who create the recipe (in this case) have years of experience with thousands of cases and probably have a great intuitive feel for what is happening as they follow it–and the ability to adjust. Some trainers are unlikely to have brought any of that to the process. Conditions affect the results (making a cake at 5000 feet above sea level is different from making one in Miami) and ingredients affect the outcome. So the “following” the recipe is not always the same. Just often enough that people can do it and get good results much of the time. As for the practitioners, they got paid for their sessions whether you got the results or not.

When you only know one recipe, and you follow that recipe blindly and end up with unexpected results, you have a serious problem: You have no idea what else to do, since you have no idea why you did what you’ve already done. The first step is to tell you, “don’t worry, it’s temporary; it’s actually good for you, no matter how bad it feels.” When that doesn’t pan out the next step is…blame the client! Finally, send him to someone else.

If you’re seeking training, ask a prospective trainer how they go about deciding what to train. If you don’t hear something about looking at the brain before deciding how to intervene in its operations, thank them and leave. Ask them what systems they’ve trained in and how much experience they have. This may be just a personal prejudice, but I’m always a little nervous around folks who have one source for their knowledge. There are a number of systems focusing on professional training that have sought to create a cocoon for those who enter their doors. You buy their equipment, take their trainings, go to their workshops, participate on their lists, etc. It’s nice for the trainer–no pesky questions entering your mind to make you think outside that particular box. But it makes them one-dimensional and overly averse to any form of uncertainty.

The terrible truth is that there are MANY systems for doing neurofeedback, and all of them have some kernel of the truth. I’ve never taken a workshop that I didn’t learn something! I’ve learned enough to know that almost NOTHING will turn out the way I expected it to, so I have to really pay attention and be ready to respond. But if I’m religious in any of my beliefs about brain training it would be (big surprise): only an egotist or a fool starts mucking around with another person’s brain without knowing what it’s already doing!

It’s really hard for many who are trained in the area of mental health care to get this concept: it’s the BRAIN that is changing. You aren’t changing it; it’s changing itself. If you’ll just let it look at itself in a series of mirrors (feedback) until it finds one it likes, it will change in positive directions–even better if YOU stay out of the way. Remember the poor kid trying to learn to ride a bike with a helpful uncle/father/brother telling him how to do it. It takes five times as long as if you just help him up when he falls (feedback) and brush him off and let him try again.

I long ago stopped trying to understand:

1. WHY a brain is the way it is; that’s psychology and, if you give the brain information about what it’s doing, it’s not necessary. Certainly psychology can be very helpful in guiding the client/family/support system to break through the homeostasis and letting the person move into a new space, but “processing” the history doesn’t usually require any help;

2. WHAT the brain will respond to among the various options; just test and notice (you know, the “scientific method”) and do what the brain says it likes and follow instead of trying to lead. If it’s critical to the TRAINER that a proper name be given to the constellation of symptoms–even knowing that this won’t in any way help determine how to CHANGE them using NF–then swell. Go for it. But the most efficient and respectful way of brain training I have found is to look at the symptoms that are problems for the client, identify possible brain patterns that relate to those symptoms, see which ones the brain responds to changing and give the client the credit.

Of course there are expected activation relationships in the brain. Many of these come from the QEEG data that has been developed over the years. The TQ is not creating a new standard; it is an attempt to give you largely the same information you would get from a Q in a more efficient and more focused way. It does not compare brain sites against normative databases (not, by the way, US databases but simply “normal” subjects selected from various sources depending on who puts it together) in terms of absolute and relative amplitude, phase, coherence, multiple ratios, etc. It is a very detailed look at brain activation compared against what someone has determined to be normal, and it produces pages of what are called “Z” scores–numbers representing the number of standard deviations the individual brain is from the mean of the normal brains in each of the many different measures. The result is rather like trying to figure out what an animal is by looking at a microscope slide of some of its cells. However, the Q has helped to identify a number of overall relationships in brain activation and related them to various performance, function or mood problems. The TQ simply allows you to gather this data in a short period of time, using readily available equipment, and it focuses your attention–when you look at the data through the window of the client’s desired changes–on the most likely relationships.

As I’ve said in most of my trainings, I avoid this entire discussion, because I rarely share the assessment with potential clients. I focus on the training plan with them and on their role in helping to select the correct training approach. That not only avoids my having to explain all that data and where it comes from and what’s important in it–it avoids the problem down the road of having the parent/client come back and say, “yeah, we’re seeing changes, but golly: look at the parietal beta!” Nobody ever comes in with a goal of creating changes in the assessment file relationships, but if you aren’t careful you can train them to start thinking THAT is what is important instead of the client.