During this episode, I talk with Susan Dunaway (she/her), LCPC, BCN about Neurofeedback. It’s something we’ve all heard of, but don’t necessarily understand. I ask the questions we want to know!
Susan has been a therapist for over 20 years and is the co-owner of Amend Neurocounseling. Amend specializes in neurofeedback, a tool that helps the brain regulate attention, mood, and energy. They combine neurofeedback with talk therapy, parenting work and couples work.
Her clients deal with ADHD, anxiety, depression, trauma and post-concussion symptoms. A large part of her practice also addresses screen-based issues in children and teens.
Susan is also a sought-after speaker for educators, parents, and the general community on screen-related issues.
TOPICS IN THIS EPISODE:
OFFERS & HELPFUL LINKS:
· Susan’s website
· Jennifer Agee coaching page
· Counseling Community Facebook community
· Counseling Community Instagram
· Alaskan Cruise: Experiential Therapeutic Intervention Training for Therapists June 3-10, 2023
· Cabo, Mexico: Dreamer’s Retreat for Entrepreneurial Therapists October 6-8, 2022
Jennifer Agee: Hello Hello and welcome to Sh*t You Wish You Learned in Grad School. I’m your host Jennifer Agee, licensed clinical professional counselor, and here with me today is Susan Dunaway. Susan is a neurotherapist. She is also an LCPC, and she is the owner and founder of Amend Neurocounseling here in the greater Kansas City area. Also, Susan used to work for me back in our adoption agency days, so we’ve known each other for a really long time. Susan, thank you for coming on today.
Susan Dunaway: Oh it’s great to be here, thank you.
Jennifer: So what is something you wish you had learned in grad school?
Susan: Well since I’m now a neurotherapist, I would say it was amazing how much I did not learn about the brain.
Jennifer: Mm, you are right about that.
Susan: It is amazing. So we learned all the theories and different theories about counseling. But we didn’t learn about the brain. And so when I, after working for you, once I went into private practice, I found working with children. And I honestly found working with children because the other spots were kind of taken and I was trying to find, make a living, you know? And so I got into play therapy and I started doing some classes on play therapy and I got pretty far into it until I had to like, pick my track. Um, my theory and I got real, real stuck there. Because what I kept thinking was, seems like we keep blaming kiddos for their behaviors. And of course, some of it is behavioral, some of it is family, but what’s going on in their brains. Why can't we see what's going on in their brains? What if it's things that they actually can't control and we're blaming them for things that they can't control?
Susan: And so that's where I got stuck. So I didn't end up getting registered as a play therapist. I left that program, on this quest to figure out: how do I figure out what's going on in the brain? And at the same time, I'm at a clinic in Overland park, and another therapist had had a brain injury, from an accident. And she was having these seizure-like episodes and they couldn't really figure them out. She was going to KU, to work on that, and they sent her to integrative medicine. She started doing neurofeedback. Her seizures got much, much, much better. And she got her life back and I'm watching this process and I'm like, uh, Hey, what are you doing? And so they found out that she was a therapist, and the nurse feedback people at KU were like, we need more practitioners, you're a practitioner, you know how this works, why don't you get trained in it? And I just asked her if I could come along and we could get trained in it together. So that was, I think like nine years ago, maybe, time is weird now post COVID. I think it all gets squished up. But then, fast forward now she and I are the co-owners of Amend. And so when we found neurofeedback, it opened up everything for me, and how to treat clients at a whole different level. And now what I watch, oh, go ahead.
Jennifer: I was just gonna ask. So for neurofeedback, for people who are listening, therapists who are listening in and they've heard of it, but they don't really know what it is.
Jennifer: Can you just briefly share what it is? Like, what is a client experience when they come to see you and how do you do what you do?
Susan: Sure. The elevator pitch is that it's physical therapy for the brain.
Jennifer: Ooh, that's a good one.
Susan: Thank you. What we're essentially doing is we are using biofeedback, which a lot of people are familiar with. So you can change all sorts of autonomic processes in the body if you have information on what it's doing. Your temperature, your heart rate, things like that. This is for brainwaves. And so the body only needs information about what it's doing in order to change what it's doing. We have a very simple system. We find that it works just as well as the super complicated ones. We put one or two sensors, electrodes on the head at different points, depending on the thing that we're working on, and it just reads the brainwave data. Like a stethoscope will listen to your heart. And it amplifies it through the machinery that we have, and it feeds it back to the client by way of a game that they're looking at. And so when the brainwave data changes in the way that we want, let's say they're anxious, they're gonna have a whole lot of what we call high beta. And so high beta activity will be too prominent, too in charge. And so we'll say, okay, when you're making less of this, the game will go better. And so it's a very passive type of work because they're not necessarily cognitively thinking: make the game go. ‘Cause you can't make your beta go down. So we just tell them, be relaxed, be present, and let your brain figure it out.
Jennifer: So are you talking about the game, ‘cause I've actually been to your office before I started referring clients to you, I wanted to see what the heck actually people would be doing if I sent them to you. And first of all, the cap, you know, that does the testing, it looks like the EEG cap, like what you think of, you know, when people put those little white caps on and they have the little stuff hooked back up to their brain, that's what it looked like to me. And then the game that you're talking about, it's really the one where you control it with your, with your brain, right. It's on a screen in front of you and it's some sort of game that you then use your mind, like, how sci-fi is this right? You use your mind to control what's happening. Is that right?
Susan: It is essentially, except that you can't really use your mind. So I tell people that it’s -especially for kids that use this visual- that there's your mind and there's your brain. And your mind might be thinking I'm really confused, or I'm really bored, or what am I gonna have for lunch? And your brain is sending all the signals that are keeping your heart rate, and keeping the amount of sweat that you need, and are you thirsty, and how's your heart going, and all of that. So we're trying to get underneath, to this firing pattern. And so you can't think your way through it. It's really kind of funny because when you try really hard, like in the example of the anxiety, you try really hard and you get frustrated, those patterns will actually increase ‘cause you're stressed. And so it really does actually teach a forced kind of: take a deep breath, sit back and relax, but that's about as much control as you have. And then I tell people it's like a bait and switch for your brain.
Susan: Brains like to solve problems, they like to solve puzzles. And so in the beginning, it's just kind of engaged in getting the points. So there's auditory and visual stimulation that you get. So like at a girl, at a girl, at a girl, you're on the right track, you're on the right track. But over time, the way the physical therapy idea works, is that over time, the brain starts realizing that it's actually a more efficient pattern. Having less high beta conserves energy, which is one of the greater goals of the brain overall. So once you show it a more efficient pattern, it starts taking it itself. And so neurofeedback is something that eventually retrains the brain to work in a different pattern.
Jennifer: Okay. So if I am sitting there, how do I actually control what's happening on the screen? ‘Cause you explained the mind and the brain, I thought that was a great explanation, but what am I actually doing and how am I making it happen?
Susan: You are not.
Jennifer: What? Okay.
Susan: And that's why it's so weird. You have the sensors on your head. You have a couple on your ears that help mathematically make the process happen, make it a cleaner signal. And then I'm setting the controls of how hard this is going to be. So you can't go from super high beta to very low levels. You know, you have to catch 'em where they are. And very slowly, it's a lot of learning theory, which I did learn in grad school. About 40% success rate actually keeps the brain focused and engaged, and not too frustrated.
Susan: And so I set it so that about 40% of the time they're gonna get a reward. And then we start gradually asking for more, asking for more.
Jennifer: Okay. So it's a reward system for the brain. Is it essentially rewiring the brain?
Susan: It essentially is, they think. If you get really into neural feedback, you'll get to the real experts who go: we don't know, we don't have a clue, really what we're doing. We think we know what we're doing, and then we find another thing that blows our minds about what's actually happening, and then that leads us to more questions. So the short answer is, it is showing new pathways and rewiring. So I tell people it's like going from a grassy field to an interstate and you just have to go over that over and over, And that things that fire together wire together, and we're just practicing over and over and over and over this different pattern.
Jennifer: What are the primary things that you've seen the most success with in using neurofeedback?
Susan: ADHD has the greatest success rate numbers-wise, it's at the same level that medication is, about 85%.
Susan: OCD has really, really high success rates. Post-concussion has really good results when people still have headaches. Post-concussion or brain fog. We get really good results with the reduction of headaches and a reduction of that brain fog. We see memory increase with it. If it's concussion-based, or OCD based, then what really actually happens is because It's categorized as experimental, and so it doesn't get covered by insurance, what we end up seeing is the hardest people. So if you can go and see a clinician that can treat ADHD behaviorally, and you can get a script for Adderall, it's much more cost-effective.
Susan: But people who are like: but what we want is a brain that's changed over time, then it is more of an investment.
Susan: And we see really good success rates with that, but because of the cost we generally end up seeing really, really difficult clients, really difficult cases of people who just didn't have success with other places or with anything that was typical.
Jennifer: That is so freaking frustrating to me though, because if we can create a change where then people are not dependent on medication anymore, and like KU, big places are using it. This is not like some woo-woo science that nobody knows about. It's very well known and well researched. Why in the heck is it not being covered by insurance? That is so frustrating that that really reduces the level of access to care that some people can have.
Susan: Absolutely, tt does. The more frustrating thing is that it was completely covered up into the 1980s.
Jennifer: What happened?
Susan: Ritalin came on the market, and then there was a massive lobbyist group that changed it from effective to experimental. There's a whole book about it called “Symphony in the Brain”. It'll just make you even more mad.
Jennifer: That kind of stuff will fire me up for sure. Because we sit with people who are hurting, whose lives are real. They're struggling because their ADHD is affecting their relationships, their ability to focus at work or school, their confidence in thinking they're a bad kid, or I'm lazy, and to deny them access to something that works. Ooh, we could talk about that in, not a super nice way probably for a while, but, okay. So it's not covered by insurance. That's got to change.
Susan: Well, good luck.
Susan: We get some really good people, who've been working on it for a really long time, but there are some problems with our industry, for sure. With the neurofeedback industry, we are a niche. And inside that niche, there's a ton of different ways to do this, and it really depends on the equipment and your training. And so we're too fragmented, in my opinion, to have a great coalesced group that can go and, you know, fight against it.
Susan: So we don't help each other out in that respect, we're just kind of a bunch of analytic eggheads sitting in our own little offices, doing our thing and in just slightly different ways. Most all of them, super effective. It's just a different take on it and different equipment. And I think that's part of the problem with getting something changed, as big of a mountain as that is to climb.
Jennifer: Sure. And that makes sense. You know, most of us were in the muck and the mire of doing the work with clients every day. And so to think about taking on, you know, big pharma and all that kind of stuff, it's like, that is not on my radar screen, I have a full caseload, I gotta pay my bills, you know, so it doesn't necessarily philosophically…we want it, but it's hard to create the rallying cry to make that happen. I wanna circle back around though, to medication, ‘cause I do refer to you, we're in the same town for ADHD, a lot. Because I'm a firm believer, if you can heal something in a more natural way and not have to take medication, that's what almost everybody wants if given the choice.
Jennifer: Now are most people able to fully get off the medication? How long does it take? You know, gimme me a little bit of that kind of stuff so that if people are talking about this option with a client, they're a little more informed about how to speak on the subject.
Susan: Sure. What we say is that we're not going to promise that you're gonna get off your medication. So we can't have that as the primary goal, because then it becomes incredibly frustrating to people if that's not their story. And so what we tell people is our primary goal is a reduction of your symptoms, and improved quality of life. And so a lot of times that is a reduction, or a tapering off, or eventually not needing the medication. But sometimes I've had kids who need just a little bit, but their psychiatrists are like, we're not really sure this is so, subclinical as far as your dosage for your weight and age. But it's essentially like the nerve feedback is doing like 90% and then it just needs a little bit of an extra push. And so sometimes like the kid grows, but their need for medication does not increase. Sometimes they can taper off and be done with it. But we don't ever guarantee that because we don't want the wrong goal in mind.
Jennifer: Okay. So what's the average length of time somebody will need to have neurofeedback sessions? And how often do they happen? Like multiple times a week or once a week? Like more traditional therapy?
Susan: Mhm, if you look up how to do neurofeedback, they'll tell you to do it two or three times a week. And because that's a great learning pattern for the brain. What we found is that, who can do that? Who can pay for three out-of-pocket sessions? Who can leave work or leave school three times a week? And so sometimes people can come in multiple times a week, but generally people are doing it once a week for their schedules, our schedules, their budget. And so the number depends on what they're coming in for. So a typical ADHD person is about 40 sessions.
Susan: And a typical OCD person might be more like 30. Anxiety stuff tends to regulate faster.
Jennifer: Okay, okay.
Susan: Concussions, it really varies on how bad it is, but it can take a while. And once we get to something called developmental trauma, you can have like a hundred because we're trying to rewire things that happened pre-verbal.
Jennifer: Okay. I'll tell you one of the areas -and I will bring an expert on at a later date- I wish we learned more about TBIs in grad school, because as you're sitting with clients and you're starting to hear stories, you find out, these behaviors weren't present prior to this car accident or different things like that.
Jennifer: Like you start to see the impact of that.
Jennifer: But we are not taught jack squat about it, and so that's one of the areas I think that would be helpful for us to know, but that's my little side point. What are you most passionate about when it comes to neurofeedback and running your business? Like, what do you feel the most passionate about?
Susan: What I feel the most passionate about are people that really need this to get better. I'm not into just the optimal, I'm a good athlete and I wanna be better, and pro athletes use neurofeedback in order to increase their reactivity, or their response time, all kinds of things. So there's Olympic athletes that will use it, and I'm not really interested in taking somebody from good to better, or from optimal to professional. I really want the kid that had the major head trauma, that we were able to help his brain regulate and he was able to graduate high school.
Susan: The stuff where they had labeled him lazy. They had labeled him all sorts of things that should not have been, and now he's a high school graduate, those types of things. The kid who could not figure out what to do with, had no problem-solving abilities and is now on the college scholarship. Those are the people I want, and the developmental trauma kids that couldn't make an attachment, and were reactive, and were running away, who are now sitting and having conversations, even though it's hard, and able to stay regulated. All of those types of things are what I'm the most passionate about.
Jennifer: Yeah. I could see that, and talking about that reactive attachment piece, that takes us back to our adoption days, and some of the kiddos, especially from overseas that would struggle with that, and I'm glad that there's this tool in the tool belt now that families have access to. I wish there was greater access of course, but that's a battle, you know, for another day. I know that you're a business owner as well, and because I know you personally, I know that you did not start out as like: I know how to run a business. I'm very passionate about helping people grow in their skill set, but also become confident as business owners, because when you're in grad school and you think: I might do private practice, you don't think: I'm going to own a business. You think I'm going into private practice or something.
Jennifer: Which is a minimalizing of the fact that you own a whole freaking business here. So what were some of the things that have been the greatest helpers or takeaways for you to establish yourself and feel confident as a business owner?
Susan: I do not feel confident as a business owner. And so here's what I did. One of the definitions of intelligence is that you compensate for your weaknesses, and you well know my ability to organize.
Susan: And so I have a business partner who's amazing at organization. And we hired an office manager who's amazing at scheduling, and organization, and all of the things. And we hired a great accountant that keeps us on track. And so I outsourced and partnered up with people who know all the things that I don't know.
Jennifer: That’s brilliant. I mean, I’ve done that all throughout my career, and especially even in private practice. I don’t have to be good at everything.
Jennifer: I have to know that I'm not good at everything. I have to be honest with myself about the areas that I need support in, and not apologize for the fact that I need support in them. Again, most of us as help are healers, we don't really love doing QuickBooks. We don't love, you know, doing some of the super tasky things because a lot of us are more relationship-driven. And so recognizing that and being honest about it is a win already.
Susan: Yeah, and with all of the things that we didn't learn in grad school, like when you mentioned head injuries, there's also viruses that attack the brain post COVID, it really has brought that to light, but there's a whole bunch of kids that are misunderstood that have basically a brain inflammation. And so when there are extra things to learn, that's the stuff I wanna learn, not myself really good at QuickBooks, ‘cause I can't outsource the work that I am doing. And so that's why I've chosen, like, if this is all already in your wheelhouse and you already kind of like this stuff, run with it, and I will pay you.
Jennifer: I like that point. We have to free ourselves to have the energy and the space to continue to grow in the ways that we still want to serve. If there's time and energy, that's limited, ‘cause we all have limited time and energy. Where do we wanna invest that to make the greatest impact for the people that we serve in for our [INAUDIBLE]?
Susan: Yeah. And I have some energy when we walk back in, for the two teenage boys in my house.
Jennifer: Yes, it requires a lot of energy. Those days were very busy days, I remember them well. So you mentioned the viruses, can you pick that up when you're doing the neurofeedback testing? Like how do you know that?
Susan: We cannot pick it up in the way that would give a definitive answer, no.
Susan: It's almost like seeing a fever and then not exactly knowing what causes the fever. So what we can pick up on is generally a very slow activity in the brain, which is like brain fog, and cognitive inefficiencies, the brain is just slugging along. And so we use that plus their history, plus blood work that we’ll have them do, or they'll bring in, so it's pooling a whole lot of things together. And then with things like pans that will happen right after either like a strep infection, or an illness, or sometimes a vaccine, or a tick bite, all kinds of different things that sometimes parents can point to. But they'll all say the same words, like my kid suddenly became crazy, my kid was normal, then this happened and then my kid became crazy, and so they’re all kinda saying the same words. And so you get to pick up those patterns and assume that that may be there.
Jennifer: Okay, interesting. I'm thinking about what I learned about the brain in grad school, and all the ways we did not acknowledge at the time, the brain-body connection. There was this woo-woo part that acknowledged the brain-body connection, you know, where do you feel that in your body and all that stuff, and I literally do say that, so I'm not judging anyone else who does, ‘cause I say that to clients all the time, but you know, there's this kind of existential acknowledgment that it's connected, but in terms of really looking at someone as the whole person and seeing the way truly our mental health is affected by things that are unseen, that are happening in the brain, viruses that are floating around and are leaving lingering effects, our beta waves like things like that. I don't remember anyone ever talking to me about that.
Susan: I had none of that. I really didn't understand the gut-brain connection, and so now we talk a lot about poop. I ask a lot of poop questions, cause I wanna know, how is that system working? ‘Cause there's more serotonin in the gut than in the brain. And I had no clue about that.
Jennifer: I learned about some neurotransmitters, but I didn't know that there was far more serotonin in the gut. And if your gut is off, how can it get up to your brain? That type of stuff is amazing. We didn't even know that there was an actual immune system in the brain until like maybe 20 years ago.
Susan: It's amazing, the things that might just not have existed in the late nineties when I was going to grad school that they just didn't know about.
Jennifer: Yeah. I think that's a good thing to keep in mind that one of the things I actually love about this field is you will continue to evolve and grow and learn, I mean, CEUs are required, but also what’s demanded of you is the fact that you genuinely care about your clients, which makes you become a researcher like none other.
Jennifer: You care about people. Someone is stuck, I know that I wanna help them, and so you'll go to trainings, you'll watch YouTube videos, listen to podcasts and things in that effort, and so you’ll always be a lifelong learner. The best therapist you will ever have is one who knows that they don't know everything, and is committed to lifelong learning and being on the journey with you.
Susan: Absolutely. Totally agree.
Jennifer: All right, Susan, thank you for coming on today. How can people get into contact with you?
Susan: Our business is called Amend Neurocounseling, and our website is amendnc.com, ‘cause nobody wants to spell neurocounseling.
Jennifer: Yes, that’s right.
Susan: My email is email@example.com. So look us up, we have a very awful web presence, ‘cause I just never paid much attention to it, but you can still find us if you look.
Jennifer: Well, I think that's one of the things that when you hit a certain level, like it is important to keep your web presence up and all of those things, but it falls to the back burner when you start getting a lot of referrals organically.
Jennifer: You need a landing page, but yeah, I've been in that zone myself a few times. So thank you for coming on, if people wanna connect more with me or with Counseling Community, the podcast, counselingcommunity.com, you can also find us on Facebook, Instagram, and Twitter, all the links will be below. Thank you so much for listening and get out there and live your best dang life.