The use of adjunct treatment modalities is an important dimension in counseling. Clients may become stuck or otherwise limited when working only with individual talk-based counseling. Emotional and other struggles, in addition to ingrained behaviors, provide challenges to personal empowerment and change. This post considers an adjunctive therapy that can be considered when working with a population of offenders, such as sexual offenders.
Description – Adjunct Treatment Modality - Neurofeedback
Faiver, Eisenhart, and Colonna (2004) describe adjunct treatment modalities that are evidence-based, and which have particular theoretical underpinnings. In addition to “talk” based approaches, they describe group therapy, bibliotherapy and art therapy as active modalities. Therapeutic processes that actively involve the client can potentially access mental and emotional resources that may be nonverbal, self-empowering, and based on the mechanisms of activity and learning. These are important supplements to a strictly verbal cognitive, emotional, or solution-based therapy. Our clinical practice has an extensive program of group therapy, which is the primary modality for sexual offenders, with individual therapy provided on a selective, as-needed or as-requested basis. There is a need to identify further approaches that can adequately address the unique needs of this population. Sexual offenders struggle with issues including impulsivity, negative emotions and reactions, reasoning problems, and emotional problems stemming largely from guilt, loneliness, and pain.
Corey (2009) and Ivey, Ivey, and Zalaquett (2010) have emphasized the importance of a neuroscientific model when working with clients. This approach looks at the brain as the primary biological agent that gives rise to the client’s mental and emotional states and processes. When applied to cases involving sexual abuse and sexual offenders, it is possible to identify neuropsychological processes that are compromised or absent, such as the ability to control urges, or the ability to feel empathy for another person. Longo (2010) described the use of quantitative EEG (QEEG) to understand brain dysregulations in sexual offenders, and to relate it to their failure to adequately self-regulate. Baron-Cohen (2011) has further identified the specific brain locations and networks that are involved with the development and maintenance of empathy, as well as in the control of ethical behavior. These include the medial prefrontal cortex, the orbito-frontal cortex, the frontal operculum, inferior frontal gyrus, caudal anterior cingulate, anterior insula, temporoparietal junction, superior temporal sulcus, somatosensory cortex, inferior parietal lobule, inferior parietal sulcus, and the amygdala. With the exception of the amygdala, all of these regions produce measurable EEG potentials, and could be localized using low-resolution electromagnetic tomography such as LORETA or sLORETA. These would be amenable to training using neurofeedback, as a remediative and educational process. Neurofeedback in this situation would consist of having the client participate in a series of 20-minute training sessions, in which he or she would be viewing a computer screen while an EEG device monitors their brainwave activity. This enables clients to become aware of suboptimal and optimal brain states, and to learn to achieve more efficient and appropriate brain functioning.
Myers and Young (2012) cite research in which neurofeedback has been shown effective for disorders including ADHD, depression, and anxiety. The underlying mechanism of neurofeedback, which is brain plasticity, is a general process that can be adapted to specific client needs. Longo (2010) showed specific brainwave patterns found among the sexual offenders, and also described clinical improvement when neurofeedback was used to help client reregulate their internal states. Among the benefits reported using neurofeedback are reduction in impulsivity, reduced craving, and improved reasoning and planning skills. Therefore, the use of quantitative EEG (QEEG) and neurofeedback can be regarded as an evidence-based alternative treatment modality for mental health counseling, with specific value in a population of sexual offenders.
Baron-Cohen, S. (2011) The Science of Evil: On Empathy and the Origins of Cruelty. New York: Basic Books.
Corey, G. (2009). Theory and practice of counseling and psychotherapy (8th ed.). Belmont, CA Thomson Brooks/Cole.
Faiver, C., Eisengart, S., & Colonna, R. (2004).The counselor intern's handbook (3rd ed.). Belmont, CA: Thomson Brooks/Cole.
Ivey, A.E., Ivey, M.B., and Zalaquett, C.P. (2010) Intentional Interviewing and Counseling. Belmont, CA: Brooks/Cole.
Longo, R. E. (2010). The use of biofeedback, CES, brain mapping and neurofeedback with youth who have sexual behavior problems. International journal of behavioral consultation and therapy. 6(2). Pp.142-159.
Myers, J.E. & Young, J.S. (2012) Brain wave biofeedback: benefits of integrating neurofeedback in counseling. Journal of Counseling and Development. (90) 20-29.