By Sally Maslansky, LMFT, author of A Brilliant Adaptation: How Dissociative Identity Disorder and the Power of the Therapeutic Bond Saved Me
As a therapist, I often reflect on everything I learned about the field of interpersonal neurobiology (IPNB) first as a patient of Dr. Daniel J. Siegel, and later as one of his students. My formal education in a master’s program certainly taught me a great deal about historical and theoretical frameworks, but it is the lived experience of a long-term, intensive therapy grounded in trust, vulnerability, and personal commitment that is my greatest influence as a therapist today, shaping how I show up in therapy sessions with my clients.
While my memoir, A Brilliant Adaptation, chronicles my therapeutic journey through treatment for dissociative identity disorder (DID), what I wish to offer you here are some of the key IPNB concepts and clinical insights I gained from that process. These concepts are not just theoretical for me; they are lived. Just as they helped me make sense of my own inner world and life, I carry them with me as I work at helping my clients make sense of their lives.
IPNB is not a form of therapy; rather, it informs therapy. It offers an interdisciplinary approach integrating knowledge from many fields to understand human experience. It includes neuroscience, psychology, attachment theory, philosophy, mindfulness and many other ways of knowing, creating a consilient framework. For therapists, IPNB encourages openness, curiosity, and lifelong learning—challenging us to stay engaged with evolving research and to keep up with developments in our field while also continuing to turn inward, exploring our own integration and healing as we walk beside our clients on theirs.
1. Integration
In IPNB, integration is the goal of therapy. By definition, integration is the linkage of differentiated elements. The mind’s process of linking distinct modes of information processing into a functional whole is considered the fundamental mechanism of health. Without integration, we either fall into chaos or rigidity. Integration is both a process (a verb) and a structural dimension (a noun) and can be examined through functional and anatomical studies of the nervous system (Siegel 2012).
Integration, for me in therapy, ultimately meant that the memory barriers which had kept my dissociated self-states—each with its own way of navigating and processing the world—separate when I was a child, for my protection, gradually dissolved. These states began to maintain their distinctiveness while becoming linked through the healing process. As that integration unfolded, I was no longer living a life dictated by chaos (as represented by the rebellious state known as Jessica) or rigidity (as represented by the state that called itself “No Body”). I became able to hold the whole of my experience in full awareness—without pain, confusion, intrusiveness, or divisions. It simply became the coherent story of what my childhood was.
In my therapy with Dr. Siegel, one powerful moment of integration happened after I got very angry at my young son for not staying in bed—he’d wanted to go with his dad to drop off a friend, and I had said no. Things escalated. We were in a power struggle, and in the heat of the moment, without entirely meaning to, he struck me. Later in session, I was able to reflect on that moment and recognize that my reactions to the situation—my anger—were rooted in my own childhood experience. I had been acting from a rigid internal model that “no means no,” without room for my child to have his own feelings or desires. Through therapy, I came to see that it wasn’t his behavior that was the problem—it was mine. And I was able to go back to him and say that while it’s never okay to hit someone, I had been wrong to get so angry. That moment of awareness—seeing how my past was shaping my present in a way I didn’t want—was a moment of integration. I could now recognize that my son was allowed to want something different from me, and that I could have honored his feelings and worked through the moment together. It was a shift from reacting out of my past to responding in the present—with my connections to myself and my son still intact.
In very general terms, integration might be best thought of as helping a couple, a family, a group, or even an organization maintain their differences while fostering connection. At its core, integration is about honoring both our own and others’ differences while remaining connected. As Dr. Siegel often describes, we want to be “a fruit salad, not a smoothie.”
2. Making Sense
The idea of “making sense” was the guiding cornerstone of my healing. It wasn’t just about understanding what happened in my childhood—but how the events of my childhood shaped my nervous system, beliefs, and relationships.
IPNB defines making sense as the integrative process of creating a coherent narrative that links past, present, and future. It allows us to weave memory, imagination, and present-day experience into a story that makes us feel whole.
I entered therapy convinced something was wrong with my son. But as Dr. Siegel and I explored, it became clear that my fears had no basis in his behavior—they stemmed from the unresolved, nonintegrated trauma within me. That was a turning point early on in my therapy, and an awareness I keep in the forefront of my mind as a therapist today: that what a client presents with often isn’t what holds the most important and relevant therapeutic significance. Making sense is my ever-present guide.
3. The Adult Attachment Interview (AAI)
The AAI, developed by Mary Main and her colleagues, is a powerful tool that helps uncover how we have made sense (or not) of our early experiences. It was originally designed as a research instrument but now can be used clinically. (Trainings are available.)
In my own therapy, the AAI played a pivotal role. When Dr. Siegel asked me the AAI question about what kind of childhood I’d had, I replied, “I had a good childhood.” But when asked for specific memories, I had none. No childhood memories. That moment was a profound awakening—and a giant clue to my story—as it was the first time I recognized, as of course did Dr. Siegel, the gaps in my memory and the lack of any inner narrative. It didn’t make sense.
I remember that session vividly. It was the first crack in the wall that had kept my past hidden from me. It was also the moment I understood how much work I had to do.
Today, I use the AAI with clients—not always in full, but often drawing on key questions. For example: “When you were very young and upset, what would you do?”
This question can evoke deep reflection and be incredibly revealing for both client and therapist. I remember how, when asked this in therapy, I was immediately filled with terror. My reaction and awareness led to some of my most profound inner searching, and ultimately to important answers.
The actual information the AAI reveals is valuable, but just as important is how the information is presented. The AAI looks at coherence—do a person’s responses align with the questions? Do they jump between past and present? Does a question evoke a strong emotional response? These distinctions can provide valuable insights into a client’s attachment history and internal world—for both the client and therapist.
4. Implicit and Explicit Memory
Understanding the difference between explicit and implicit memory was a profound revelation for me—one that I now share with all of my clients. Explicit memory, when retrieved, comes with a tag that clearly identifies it as coming from the past. That is, you know you’re remembering something from the past.
Implicit memories don’t carry a tag or awareness of their coming from the past. Instead, they arrive in awareness as perceptions, bodily sensations, emotions, and behavioral patterns that we often mistake for present experience. We have a conscious awareness of the feelings—but that the feelings are from the past, not our present, is not in conscious awareness. Thus, implicit memories can shape our reactions and worldview in ways that have little to do with our present but are instead echoes of our past. I was once told by a client that this reminded them of something they learned in Al-Anon: “If I’m hysterical, it’s historical.” I find this a helpful mantra of sorts—if my response to any given situation doesn’t make sense to me, it’s an invitation for me to look inside for the answer.
As a patient, this realization was life changing. It helped me understand that the deep-seated fears I carried—the constant sense of being in trouble, the belief that something was inherently wrong with me—weren’t truths about my present but rather implicit memories from my childhood. Memories of feelings. Although I had little or no explicit recollections of my early years, these feelings, beliefs, and response patterns were the remnants of my past. And recognizing this allowed me to discern my past from my present and begin to see myself and my experiences through a new, truer and more compassionate lens. A big step in the making-sense process.
5. Neuroplasticity
Neuroplasticity is key to the therapeutic process. Simply put, it’s the brain’s ability to change its neural connections in response to experience. Many clients—and even some therapists—believe that change is no longer possible after a certain age, or after certain traumas. As I describe in A Brilliant Adaptation, a professor once told me my son, who began his life in an orphanage in Romania, would “never be okay” due to his early deprivation. Neuroplasticity tells us otherwise. Our brains remain capable of change throughout our lives.
As therapists, our role is to help clients harness this superpower, as it’s the direction of our attention that drives such change. There’s a saying from neuroscience that tells us that neurons that fire together wire together—or as Dr. Siegel explained to me: where attention goes, neural firing flows and neural connection grows.
Dr. Siegel’s belief in my capacity to heal and change was essential to the resolution of my trauma and healing. I’ve come to see that the therapist’s belief in a client’s ability to grow is itself a catalyst for neuroplasticity.
This brings us to…
6. Mindful Awareness Practices (MAPs)
Mindful awareness is a powerful way to engage neuroplasticity. The focus of our attention is what reshapes neural connections. Developing a mindful awareness practice, or MAP—like mindfulness-based stress reduction (MBSR) or the Wheel of Awareness—offers your clients a structured approach to training attention. These tools cultivate awareness of where we direct our attention, helping us create meaningful change.
As a patient in therapy myself, I carried a deeply ingrained belief system shaped by my past—including the development of DID—that prevented me from living fully in the present. My work in therapy taught me how to focus my attention on what was and wasn’t true—discerning my past from my present—which allowed me to free myself from the considerable constraints of my past. I often reflect on what my life would be like had my therapist not believed I could recover from my early trauma and DID but instead had me focusing on the fact that those things happened, which might’ve left me with the sense I could never fully recover.
I think particularly often of the Wheel of Awareness—a MAP created by Dr. Siegel that was transformative in helping me harness mindfulness in my recovery. He once asked me to think of a wheel, with the hub representing the knowing of awareness. The rim represented the “knowns”—the stimuli in my environment, transmitted to me by my five senses; the sensations coming to me from within my body; my mental activities, like thoughts, emotions, memories, or beliefs; and my relational awareness, my connections to others and the world. And then there were the spokes of the wheel, representing the focus of my attention—which I could direct. Dr. Siegel would then ask me to center myself in awareness. And we’d work to direct the spoke of my attention to each of the “knowns”: each segment of the wheel. If implicit memories arose, he would remind me that these memories were on the rim of the wheel. I could choose to keep them there—not to let them entry into the hub. That gave me the freedom of choice, the ability to choose what I paid attention to—an ability that was crucial to all the growth and change that came after. (If you’re interested in engaging with the Wheel, in particular, in more detail, I invite you to learn it as Dr. Siegel teaches it. It’s fully and freely available at his website,
http://www.drdansiegel.com
.)
7. Window of Tolerance
We all have “windows of tolerance” for what we think, feel, and remember and how we relate. When our window of tolerance for any given facet of our experience is narrow, we can become rigid in our thinking and responses. Shut down. And when we get overwhelmed, we can be catapulted out of our window into chaos. As I learned in therapy and teach my clients now, the more we are able to sit with difficult awarenesses of all types, the wider our window of tolerance grows. In a way, it is like a mini-mindful practice—just sitting with the difficulty, for even a few seconds at a time, can help widen our window.
My experience of practicing this for many years now is that I have awareness, almost like an early warning signal, that I’m getting close to the edge of my tolerance for something—and often, I can simply breathe into the feeling, thus avoiding becoming stuck in rigidity or exploding out into chaos.
If you open the DSM to any page, you might notice that the symptoms of every disorder listed there are either symptoms of chaos or rigidity—or both. Helping clients learn to be aware of and manage their windows of tolerance is a powerful tool towards healing. It can also be of great value to therapists working with clients struggling with emotion regulation.
8. Secure and Earned or Learned Security of Attachment
Secure attachment is the optimal measure of attachment in childhood. IPNB defines secure attachmentas embodying certain essential elements, known as the Four S’s:
· Feeling Safe: When a child is protected from harm and not being threatened by their caregiver
· Being Seen: When a child has a caregiver who attunes to their inner experience, not just their outward behavior; when what the child feels, thinks and needs is valued
· Being Soothed: When the child’s caregiver is able to help calm the child when they’re dysregulated, this process of coregulation teaches a child how to manage distress, which over time builds resilience
· Security: When these first three S’s are met, the child then is able to develop security—a core sense of trust and security within themselves and the world. And this is what Secure Attachment is.
It was once believed that if you were not offered security of attachment in childhood, you couldn’t develop it later in life. Now we know, since the discovery of neuroplasticity, that you can develop secure attachment later in life. This can happen within a trusted relationship with a therapist, mentor, pastor, or partner. It has also been shown to be the outcome of a mindful awareness practice! With this new knowledge, some years ago, Mary Main and her colleagues researching adult attachment added a new category to the Adult Attachment Scale: Earned or Learned Secure Attachment.
I also know about the power of earned or learned secure attachment from my own experience. I started out life with disorganized attachment, as diagnosed by Dr. Siegel. But through the work I did in therapy—and within the powerful therapeutic bond he and I developed—I was able to develop learned secure attachment. In A Brilliant Adaptation, I describe a moment, much later in my therapy, where I attended a clinical workshop at Dr. Siegel’s invitation. During his presentation, Dr. Siegel answered a participant’s question in a way that felt to me like he was defending me. It created a feeling within me I had never felt before. It was exhilarating, and I believe now that was the feeling of secure attachment—the security of attachment I had learned as a result of the work I had done in therapy with him.
In closing, I want to introduce two acronyms from IPNB that, in addition to all the above concepts, guide me personally and professionally.
9. FACES
This acronym describes the qualities of an integrated mind. An integrated mind is one that is
· Flexible
· Adaptive
· Coherent
· Energized
· Stable
And an integrated system flows with these FACES qualities—and is thus capable of living life with resilience and responsiveness.
10. COAL
This acronym captures a particular state of mind or stance that is optimal for both therapist’s and client to maintain.
· Curious
· Open
· Accepting
· Loving
I reflect on COAL often, in life and work. It helps me to work with my window of tolerance—to create a sense of safety in moments of life’s everyday overwhelm.
In Conclusion
As I said at the beginning of this offering, IPNB is not a form of therapy; it informs therapy. It’s not a method or a model; it’s a way of seeing, feeling, and knowing. A way of being. These few essential concepts I have included here can be used singularly in any single therapy session. But when they’re woven together over the course of therapy, with intention and presence, they can serve to create the conditions for integration—the linkage of differentiated elements, and the ways we process distinct modes of information—that is the essence of emotional well-being. The process of making sense.
If you’re interested in learning more about IPNB, I recommend consulting Dan Siegel’s Pocket Guide to Interpersonal Neurobiology(2012) as a place to start. If you’re interested in reading more about my story and my therapeutic journey as a person diagnosed with DID, you might read my book A Brilliant Adaptation. Ultimately, I hope this resource has offered you some food for thought and guidance on your continued journey to provide clients the care they seek.
References
Siegel, D. 2012. Pocket Guide to Interpersonal Neurobiology: An Integrative Handbook of the Mind. New York: Norton.