Biofeedback for the Brain
by Siegfried Othmer | July 15th, 2008
I was delighted to be able to review this book prior to its recent publication. It is one of the few in recent times to introduce the public to neurofeedback / EEG biofeedback. Paul Swingle is a seasoned biofeedback practitioner, well-known within the field through conferences and workshops. Swingle was for many years the coordinator of psychophysiology services at Boston’s McLean Hospital, and lecturer in psychiatry at Harvard. He is currently active in private practice in Vancouver, Canada. This is the first time that his somewhat eclectic approach has been thoroughly described within one accessible resource.
The book will appeal to both mental health professionals and to the interested public. Health professionals will find it a useful introduction to how Swingle works with clients using both neurofeedback and complementary modalities. Its main appeal will be to parents and to other potential clients. Swingle proceeds with a focus on Attention Deficit Hyperactivity Disorder, even though he largely downplays the issue of diagnosis. ADHD has become a common label that is being applied to a heterogeneous spectrum of conditions. By now it is setting the terms of discourse for everyone. The book will nevertheless be sought out by parents with a variety of other behavioral, attentional, and learning issues with their children.
This volume is perhaps most similar to our own book, “ADD: The Twenty-Hour Solution,” being very much governed by a clinical and problem-solving perspective. This multi-dimensional tactical orientation may obscure the fact that both Paul Swingle and Mark Steinberg (co-author on our ADD book) proceed from a rigorous and well-constructed framework and professional orientation. When clients first encounter them, neither leaves much doubt as to who is the authority in the room.
Swingle accomplishes this with a strategy in which he proceeds first with a few key EEG measurements on the scalp, before he even gets into a long sit-down with the client. Then he tells the client what information he has been able to get from the EEG. All this transpires before the client has even had a chance to tell Swingle what his issues are. This strategy confers credibility not only on Swingle himself but also on the EEG as a source of relevant information.
Our world is moving away from such traditional authoritarian models, but this kind of an approach is clearly suitable to a situation in which many people are still coming to neurofeedback in a skeptical frame of mind. On the one hand, the neurofeedback clinician needs to persuade the client that he or she lies within the mainstream in the way they practice their craft. That is to say, in the spectrum of all their fellow professionals—horizontally—they are not out in the tails. On the other hand, they need to persuade the client of their outlier status with respect to their competence, i.e. vertically. The EEG-based strategy can accomplish that on the very first encounter.
The present book casts a wider net than our ADD book, and it will encounter an audience more aware of neurofeedback than was the case even a few short years ago. Additionally, this volume should be of even greater interest to the practicing professional than the earlier text, as it also covers a variety of techniques that Swingle employs in combination with neurofeedback. Some of these involve Swingle’s own research and development. Hence there is no alternative source for such information.
This book also takes its place alongside Stephen Larsen’s “The Healing Power of Neurofeedback.” The latter book largely focuses on the most exotic of the neurotherapy methods currently in use. Even though that technique is very effective, it will likely remain an outlier within the whole field. For most common conditions of disregulation encountered in clinical practice, the simpler strategies deployed by Swingle are perfectly adequate.
At the moment, of course, Swingle’s methodology is essentially unique to him. Whereas it has much more in common with traditional neurofeedback, it must still be considered an outlier. Swingle hopes to change that with this book. The strategy is easily adopted, as it involves only a few quantitative assessments that do not require a mapper. Since the target is fairly general disregulations, the corresponding EEG features are not going to be hard to detect.
The book also takes its place alongside Kirt Thornton’s “No Child Left Behind,” which is yet another outlier that is unlikely to be the main path of entry for people into neurofeedback. For initial acceptance, the technique has to be much more accessible, and Swingle’s strategy might well be striking a good balance in that it does justice to the EEG data while remaining largely tactical in its approach.
The question then is whether neurofeedback clinicians should have this book in their waiting rooms even if they don’t practice in the way that Swingle promotes. The strongest argument in favor is the book’s “voice.” Swingle talks to the reader very much in the manner that he might talk to his clients. It is a reassuring, competent voice, one that puts people at ease in digesting this material. On the downside, clinicians will certainly get questions from clients about their EEG that they may not be comfortable fielding. The hazard is that once the discussion gets firmly launched around the “objective” data of the EEG, it may be difficult for the client to move beyond that.
In our own work, we have managed to keep the discussion on the more clinically relevant issues, and the EEG almost never becomes the issue in protocol selection. Buy-in for us usually comes when the person experiences the first training session. Also, in our approach the center of gravity of the interchange lies between the client and the clinician rather than with the clinician. Both are involved in a joint project here, and one key obligation of the therapist in this venture is to bring the client along in that conversation, and in that capacity for self-appraisal.
It is, after all, of the essence in neurofeedback that the competence is to be conferred upon the client. The resources to be drawn upon reside entirely within the patient’s nervous system. Many practitioners therefore align their whole approach to the empowerment of the client. In such a strategy, the clinician plays at most a supportive role. The engagement of the client’s nervous system with the training instrument is the center of the drama, not the clinician.
The field of neurofeedback is still in its pioneer phase, one that is dominated by a modest number of people of strong opinions, and sometimes of irascible character as well. The field has not yet settled into maturity, so there are still various contending camps. Mostly the disagreements concern the underlying scientific models, which then drive the clinical approach. At the same time, the field has largely been advanced through clinical practice, shaped and honed by the realities of that world. It is high time, therefore, that the clinically-driven perspective be put forward crisply, compellingly, comprehensively, and matter-of-factly–that is to say, without apology or defensiveness. This is what Paul Swingle accomplishes with his manuscript. The debate about arcane scientific issues tends to obscure the reality that a robust therapeutic modality has already emerged.
“Biofeedback for the Brain” By Paul G. Swingle, Ph.D. available on Amazon.com