Differentiation and Linkage in an IPNB Business Model and as a Multidisciplinary Approach to Complex Clinical Cases

This blog is a lead up to the Living Journal scheduled for 7/15/2020 at 1:00 PST. Register here: Center For Connection Round Table Living Journal

Intro by Tina Payne Bryson, LCSW, PhD, Founder/Executive Director of The Center for Connection:

When I speak to groups of therapists, I often get asked about my clinical practice, The Center for Connection. People often want to know to what extent our practice uses interpersonal neurobiology (IPNB) in our clinical approach. The answer is that IPNB guides everything we do, and not only in our clinical approach, but in our business model as well.

A fundamental framework for IPNB is integration, where differentiated parts are functionally linked, leading to states that are flexible, adaptive, coherent, energized and stable[1]. As a young clinician, this was an incredibly helpful way to understand dysregulated behaviors, emotions, and relationships. The more I learned about the embodied brain, nervous system, and integration, the more I wanted to peel the layers back to explore the source, or to “chase the why” to get to the heart of the impairment to integration. I learned quickly that to do that well, I needed to be linked to a team of experts who knew what I didn’t. I found that professionals from the fields of occupational therapy, educational therapy, speech and language/social communication therapy, neuropsychology, psychiatry, and others, could often help me ask better questions and find better answers.

As an LCSW, I worked from my mental health training, with kids who presented with mood and behavioral and/or relational challenges, and I saw that they could be helped by mental health intervention, but in many cases, I was helping clients with struggles that didn’t need to be coped with, but rather could be changed by harnessing neuroplasticity from specific, targeted, experiences with a different specialist.  For example, what looked like an anxiety disorder could instead be a sensory processing disorder that caused the child’s nervous system to become hyperaroused. So instead of managing the anxiety in mental health, we could treat the sensory integration in occupational therapy, changing the states of arousal.  And often, both were most helpful in combination, providing both top-down and bottom-up intervention together.

Just as IPNB is an umbrella framework to bring together many ways of understanding reality, I wanted a clinical practice that would allow me to approach problems from a diversity of perspectives and fields with a team of professionals. This drive to work in an interdisciplinary way, to have more facility with chasing and changing the why, and to focus on regulation and relationships, led me to start The Center for Connection (CFC), an IPNB-based interdisciplinary practice. The CFC turns five this summer. It started with a handful of various professionals who had been meeting monthly for a couple of years in a study group I’d been teaching on IPNB and has grown to be a clinical practice of 35 professionals based in Pasadena, CA.

From the beginning, the business model was built on the IPNB principle of integration, finding professionals who were differentiated in our training, expertise, personalities, clinical approaches, and diversity, and also functionally linked across fields, and in our own relationships with one another, working like a family. We cultivate a flow of energy and information among us as we work together to sharpen and teach one another, so we continue to ask better questions and utilize better approaches with our clients, and in how we collaborate, assess, plan, and create treatment roadmaps for the clients who entrust us with their care.

We knew that developmentally, in our early months and years as a business, we’d have some chaos and rigidity as we learned, but we, as a business, aim to be flexible, adaptive, coherent, energized, and stable as we honor differentiation and linkage. When we find our business in disintegrated states where we detect too much chaos and/or rigidity, we mindfully look to see if we need more differentiation, or more linkage. It’s this framework that allows us to do the incredible work we’re able to do with our clients, particularly when there are complex challenges and trauma, and when several members of the family need support while the client’s capacities are being built across multiple domains. It is a great honor to bring IPNB-based approaches not only to our clients, but to the other adults in a child’s life, as well as the schools, physicians, and others in our community.

With this background and context in mind, we’re looking forward to sharing what this approach to therapy looks like. Olivia Hauge, an Occupational Therapist, MFTI, and an incredible clinician, has written the following paragraphs to give you a sneak peak into the CFC case we’ll be sharing with you in the upcoming webinar, where IPNB interdisciplinary work made a huge difference for a kid and his family, who had tried so many other things and were grappling for hope.

Olivia Hauge, MFTI, OT:

This is a story about a family, their trauma, and the long road toward integration and healing. Charlie’s[2] parents chose to adopt rather than have children of their own because mental health issues run in their families and they feared passing this along to a biological child. Charlie was an infant when he was adopted from his orphanage in Ethiopia and brought to the United States by the loving couple. Their concern for Charlie began almost immediately, as their nearly one-year-old cried inconsolably for nearly all of the flight across the globe to his new home. The years that followed were filled with the couple trying to find answers, treat symptoms, synchronize care, and find hope. I was one of five members of our amazing CFC team working toward the goals of increasing his states of regulation through relationship, and to build his capacity by promoting integration.

Charlie’s services at The Center for Connection began with our occupational therapist. While she insightfully cared for Charlie and his sensory needs, she began to recognize that Charlie’s needs extended beyond her scope of practice. She referred Charlie’s parents to me for their additional support, while the OT continued to do sessions to improve his regulation through movement, specific, individualized sensory input, and other bottom-up strategies. When I began to work with Charlie’s parents, they were exhausted, sad, angry, and wanted answers – many, many, answers. In our work together I approached their grief, fear, and feelings of isolation with validation and connection.

When Charlie began having a series of scary and unsafe episodes and his behaviors were escalating, I referred him for a neuropsychological evaluation, and to a play therapist to begin addressing some of the underlying attachment trauma impacting his daily functioning. This coordinated effort to understand Charlie’s trauma and its impact on the development of his brain has been an empowering step for Charlie, his parents, and the team.

Charlie’s family has been a part of The Center for Connection family for the past three years. We have grown to know and deeply care for this family; we ache when we have setbacks and celebrate as a team when there are gains and new ways of understanding. Our team has helped this family using an IPNB framework to redesign expectations, forge meaning, build regulation and co-regulation, and provide a roadmap for treatment and hope.



[1] See Dan Siegel’s The Developing Mind

[2] Name and some details changed for confidentiality.