KN: It is an honor to be conducting this interview. I would like to provide a bit of history for our readers. I reviewed your book The Neuroscience of Psychotherapy for Voices in 2003 and we had a brief e-mail exchange about it. I was thrilled when I found out you were the keynote speaker for the upcoming Institute and Conference 10/2007 in San Diego. The theme for the conference is The Many Faces of Fear: Attachment, Trauma, and Neuroscience Perspectives. In preparation for this interview I read your newest book, The Neuroscience of Human Relationships. Congratulations on another excellent contribution to the field. In the introduction you state, “It is the power of being with others that shapes our brains.” No one in AAP would deny the power of community. It may be a leap for some to go from social relationships to the brain. We might use words like heart or soul to explain our connections. Can you provide some transitional concepts to explain how we influence long-term construction of each other’s brains?

LC: That’s a big question. A useful way to view this issue is to think about the brains of children. Parents influence their children’s ability to have effective social relationships through their interactions with them. These interactions stimulate the growth of neurotransmitters, hormones, capillaries of brain, neurons, and neural networks. I am, in effect, describing how love becomes flesh or “neural wetware” if you will. This transformation continues throughout adulthood in response to experience, but especially in response to social experiences.

KN: You have said that those who can better predict the intentions and action of others have an obvious advantage with respect to safety, competition, and mating. You conclude with saying that the next evolutionary advantage will be in the realm of self knowledge and ability to tolerate anxiety. I believe this section is the best advertisement for psychotherapy, for socio-political reasons as well as personal growth. that I’ve ever heard. Please summarize your main points for our readers.

LC: If you believe we are evolutionarily connected to animals, the current version of human beings is only a mere 100 years out of the agriculture age and only 1000 years from tribal life. We continue to develop and thrive by way of foresight and cooperation, concepts which are consistent with our religious values. This continued cooperation is necessary for future success as a civilization. We have evolved to the point of being able to automatically and unconsciously predict what others are thinking. On the other hand, self-awareness requires intention and effort. The willingness to tolerate the anxiety of the awareness of self, and getting beyond the ways our primitive brains project responsibilities for our suffering onto others, is the first step to global cooperation.

KN: There was some concern that the title of the conference would increase anxiety in some ways and, in fact, “scare” people away. It would seem, based on the popularity of your books, that your work has been well-received. What kind of controversy has it generated, if any? Are you viewed as pessimistic, reductionistic, or fatalistic?

LC: I haven’t been accused of being reductionistic. The concerns leveled at my books are more related to the belief that I am viewing human experience as a biochemical reaction. That is, is it too big of a leap to apply animal research and laboratory studies and/or neurological patients and lesion studies to the general population? What I am doing is creating a metaphor, another way to look at human development. It is important to remember that I am not marrying any of these concepts but rather casually dating them. Half of what I learned in graduate school, is wrong. For example, I was taught that critical periods were set in genetic stone, that we only use ten percent of our brains, and that we were born with all of the neurons we would ever have. All of these “facts” now appear to be incorrect. Likewise, half of what I’m saying now is probably wrong. I just don’t know which half.

KN: You write that “each of us needs others who seek us out, show interest in discovering who we are, and help us feel safe.” Can you speak to the role of conflict or danger? While I believe we get the most bang for our buck through rupture and repair, I also believe there is a fine line between optimal arousal and re-traumatization. What do you think about this distinction and are there obstacles to achieving a balance between the two?

LC: It is important to use intuition to determine a patient’s receptivity to working on the edge of their comfort zone. In other words, good clinical judgment guides the process that involves optimal pressure that is not overwhelming. This same concept applies to educators as well. Learning takes place when someone is challenged. The bottom line is that the brain experiences positive learning during brief periods of mild stress and positive excitement.

KN: Your corollary to Darwin’s survival of the fittest is startling. “Those who are nurtured best, survive best.” I think I take offense. I am reminded of a client who used e-harmony to find a mate. One of his requirements was that his prospective wife not be from a “broken home.” I wonder about preparation for the real world, the value of resilience, well-roundedness, ability to connect to different types of people, etc. Would you agree that those who are nurtured best may not make good therapists?

LC: Is this an editorial comment? You have some strong opinions, maybe I should be interviewing you. What doesn’t kill us does not make us stronger. It makes us weaker. Neglect or abandonment teaches a child that he is unfit to succeed in a dangerous world. Nurturance is necessary for people to be able to bond and attach and problem solve. Caregiver nurturance sets the stage for physical and psychological health. In another culture, being suspicious, for example, may be more valuable for adaptation and survival.

KN: Much of the book is devoted to the relationship between the infant and mother. Please comment on the role of fathers.

LC: Most of the research addresses the mother-child interaction. However, there is a growing literature that addresses the role of fathers in their children’s educational success and in their ability to have positive social relationships. Apparently, fathers interact differently with their children than do mothers. People learn how to be in intimate relationships from the primary caregiver, usually the mother. They learn how to be in the world from their fathers. And those people that have a good relationship with their fathers do better in society.

KN: In a recent article in AARP magazine, Daniel Goleman was referenced as wondering about the effects of “inexorable technocreep.” What do you anticipate will be the evolutionary consequences of internet communication? Will nature select for ubergeeks?

LC: I really have no idea how the internet will impact social relationships. Maybe we will adopt a group mind. The thought makes me uneasy, though. I’m sentimental and prefer face-to-face interaction. People spend more time online than they do face to face and it is a very different kind of social process than those that involve eye gaze and touch.

KN: Much of your work has focused on how therapy changes the brain of the patient. How does therapy change the brain of the therapist?

LC: I believe therapists are more sensitive to all aspects of social processing by virtue of self-selection or training. I also believe that a profession whose main tool is the relationship can’t help but expand the brain.

KN: Would you care to comment on the neural substrate of that expansion?

LC: Therapists hone many skills including language, emotional awareness, and awareness of body…I guess it is in the integration of brain regions dedicated to the functions that participate in human resonance that experience the most brain growth. Therapists most likely have more elaborate social brain networks.

KN: The real artistry of your books is your ability to use clinical examples that put the otherwise tedious neurochemistry in a fascinating light. What kind of practice do you have?

LC: I see mostly adults and adolescents and a handful of children. I also work with mothers/newborns to work on attunement skills. About one-half of my clients have Axis II disorders. I use a hodge podge approach based primarily on object relations although I have experience with Gestalt and Jungian approaches as well. I have been seeing a greater percentage of attorneys, CEOs, and men as I have become better able to explain therapeutic concepts in more technical terms.

KN: Your chapter quotes are stunning. I am curious about the selection process.

LC: Totally random.

KN: You chose to include more about the insula in your second book. Is that based on available research, interest…? Please discuss its role in linking hearts and minds.

LC: I believe the importance of the insula and the cingulate has been overlooked. Because they appear to be involved with both internal awareness and empathy, they are far more relevant to psychotherapists than neurologists who are looking for connections among brain activity and observable behaviors. Between my first and third books I spent time in a dissection lab. It is interesting to me that the insula begins on the surface of the brain but that eventually frontal and temporal lobe expansion relegate it to a hidden position. This is the part of the brain that links primitive body states with emotional/behavioral reactions. It serves an interface between the experience of self and self-control. The insula is one of two regions, the other being the cingulate, that becomes activated while watching others experience pain. It appears to be a neural substrate of resonance.

KN: You wrote “Prolonged shame states early in life can result in permanently dysregulated autonomic functioning and a heightened sense of vulnerability to others.” The issue I want to address is permanence. I find this concept to be quite misunderstood and controversial. Aren’t we in the business of change?

LC: We are in the business of change but no one said it would be easy. When stress is early and prolonged, neural structures and the functions they serve are compromised. Once compromised, the functions become selfperpetuating and self-fulfilling…unless we do the work of psychotherapy. However, some things may not ever change. We just don’t know.

KN: You have stated that science seems resistant to acknowledge the truth of our interconnectivity. What are the ramifications of this stance?

LC: The ramifications are primarily financial and secondarily scientific. Access to funding is contingent upon the study of individuals. The result is we are looking at bite size chunks when need to look at systems. The same problem applies to medicine. The western approach to the human body has resulted in a variety of specialists and specialist research that does little to explain the whole body and the integration of mind-body.

KN: “If we recognize the centrality of a caring relationship to positive change, and the psychotherapeutic context proves to be too threatening or artificial for some clients, new situations for contact should be explored.” Please describe some alternative situations.

LC: I am thinking of the community psychology movement in the 1960s. Bar tenders and hair stylists were trained in crisis intervention. This approach puts the emphasis back on supportive relationships regardless of the setting. Coaches are another good example. A good coach-athlete relationship involves good parenting/reparenting.

KN: Let’s go back to the issue of permanence. You state that attachment schema can change for the better and that certain things reshape the circuits. Please explain the concept of “earned autonomy.”

LC: Healthy relationships, life challenges, loss, and personal growth all contribute to the resculpting of the social brain. Children do not necessarily have to have safe and secure relationships with their parents to become safe secure adults. Those who are successful may have accomplished earned autonomy. That is, they have found surrogate parents that help regulate their emotional world. It is this process that interrupts the transmission of negative attachment patterns from one generation to the next. This is a major goal of psychotherapy.

KN: What is your next challenge?

LC: My next book will address aging, midlife, the evolution of culture, and wisdom. I also want to update my first book.

KN: Is there anything else you would like to add?

LC: I am thinking about the theme of the conference. I want to go back to Freud’s concept of love and work. From my perspective, absence or minimization of fear is necessary for optimal functioning…to be healthy. We have the neuroscientific confirmation that there is an absence of fear when people are in love. When we live without the constraints of fear and anxiety…we can freely forage/explore and imagine/ create. Anxiety disturbs the natural process of growth and must be treated as a navigation device rather than a danger signal. By approaching rather than avoiding the feared feeling or situation, with the proper support, a better outcome is possible. Redemption lies in repetition of this type of happy ending.