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Brainspotting, a New Dual Attunement Model for Psychotherapy

Abstract: Brainspotting (BSP) is a new treatment approach that posits that the field of vision can be used to
locate eye positions that correlate with relevance to inner neural and emotional experience. Once located,
these eye positions, or Brainspots, can through maintaining eye fixation, lead to a resolution of issues held
deeply in the non-verbal, non-cognitive areas of the brain. BSP utilizes both focused activation and focused
mindfulness as its mechanisms of operation. It aims at a full, comprehensive discharge of activation held in
the brain and body. BSP is a model that incorporates systemic activation and resources applied based on
diagnostic and developmental considerations. The BSP model is developed as both relational as well as
technical with philosophical and physiological underpinnings. It is an open, inclusive model that invites
therapists to make use of their prior trainings and practice wisdom.

Brainspotting (BSP) was discovered by David Grand Ph.D., the author of this article, in 2003. This paper will
describe the discovery in detail as well as elaborate the ongoing development of BSP from a technical,
clinical, neurobiological and philosophical point of view (Grand, 2009). BSP is a psychotherapeutic approach
that uses the field of vision to locate “relevant eye positions” (or Brainspots) that are postulated to correlate to
neurological stimulation and internal experience. In order to determine these eye positions, the client is
guided to be in a state of “focused activation” which is usually in response to psychotrauma or emotional or
somatic symptoms. This is assessed the by the SUDs (Subjective Units of Disturbance Scale) level of 0 to 10
(lowest to highest) followed by determining the location of the highest body activation (except when using the
resource model) (Wolpe, 1969). At present there are six distinct methods (to be discussed in the body of this
paper) for locating the eye positions. Once determined, the client is guided to uncritically observe their
sequential internal process which includes affect, memory, cognition and especially body sensations. This
self-observation is called “focused mindfulness” as it is parallel to meditation but is performed in a state of
focused activation. At various junctures, determined by either the client or the therapist, a brief discussion
ensues reviewing the nature of processing. This is followed by the therapist reorienting the client to their body
experience as the unguided self-observation resumes. The process continues until the client arrives at a state
of resolution, determined by returning their original issue of activation with no SUDs activation present. This is
reinforced by having the client “squeeze the lemon” by attempting to internally reactivate the SUDs level
which is again processed down until it can no longer be reactivated. Based on the diagnosis, complexity of
the condition and client capacity for processing, resolution may occur in anywhere from one session to many
months or even years of treatment (Grand, 2009).

BSP was discovered by the author in 2003 while working with a 16 year old ice skater. She had been seen for
a year of weekly 90 minute sessions to treat significant performance issues that possessed a dissociative
quality. For example, in warm-ups before competition, she would either feel like she had forgotten her
program or reported that she couldn’t feel her legs. This resulted in performances far below par and an
inability to compete at a national level correlating to her level of talent. During the year of treatment the author
used his approach called “The Grand System” (Grand, 2001) which included aspects of EMDR (Eye
Movement Desensitization and Reprocessing) (Shapiro, 2001), SE (Somatic Experiencing) (Levine, 1997),
micromovements and relational insight-oriented therapy. The causative factors of the skater’s performance
problems were a variety of traumas including maternal rejection, parental discord leading to divorce when the
client was six, as well as a long history of sports injuries, failures and humiliations. The treatment had for the
most part been successful with a few exceptions, including the inability to complete a triple loop. This jump is
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not the most difficult for championship caliber skaters such as my client, and her inability to perform it made a
successful short and long program impossible. The client was guided to imagine doing the jump in slow
motion and freezing it at the precise moment she felt and saw herself “going off”. She then was guided to
follow the author’s fingers moving slowly back and forth across her visual field. Within a few passes, just
slightly off center, her eyes noticeably wobbled in a sustained microsaccade followed by locking into a frozen
position (Martinez-Conde & Macknik, 2007). Startled by this response, the author reflexively stopped moving
his fingers and immediately held them directly in front of the eye freeze, about three feet away from the client.
During the subsequent ten minutes a remarkable torrent of processing ensued. A series of new traumatic
memories emerged and rapidly processed through to resolution. But even more surprising was that a
significant number of “resolved” traumas reopened and processed through to a deeper level. At the end of the
ten minutes, the processing slowed and completed, and the eye lock released. This was an unusual event
indeed but it was reinforced the next morning when the young skater called after practice. She excitedly
reported repeatedly performing triple loops without a hitch. She never manifested a problem with the jump
again. This caught the attention of the author and he began to look for similar eye manifestations in other
clients while tracking slowly across their visual fields. When he observed them he repeated the procedure of
holding his finger dead center in front of where the anomaly occurred. He not only noticed an acceleration and
deepening of the processes, but he was again startled by client reports. Comments like, “this is really
different’, “this feels much deeper”, “I can feel it all the way in the back of my head”, and “I can really feel it in
my body”, emerged from a wide spectrum of clients. Of particular note were the pronouncements of clients
who were also therapists indicating that they observed a profoundly different experience and outcome from
this new approach. Additionally, with instructions from the author as far as how to perform the technique,
many of these therapists tried it out with their own clients and reported back similar experiences leading to
faster and deeper resolutions. So in the course of a month, the author with his own observations and the
feedback loop from his therapist clients, determined that he had stumbled onto a new method and perhaps a
new paradigm.

Repeatedly applying this procedure during the following months, he noticed that by stopping the horizontal
eye tracking at eye level in front of any reflexive response he elicited a similar deepening and acceleration of
the process. These reflexes included blinking, quick in-breaths, coughing, hard swallowing, mouth
movements, eye widening or narrowing, head tilting and change of facial expression, among others. The
author found these new manifestations both curious and compelling as it made his already successful ability
to help clients process through issues to resolution even more powerful and complete. He searched for a
name for this process and arrived at Brainspotting with the recognition that these “spots” in the visual field
appeared to accessing locations and functions in the brain. During the course of the subsequent six months,
the author increasingly applied his new technique amassing evidence of its effectiveness with a wide variety
of clients carrying different diagnoses, histories and symptoms. It appeared that the containment provided by
the fixed eye gaze and the possible concomitant focused neurological activation were accomplishing a unique
approach to emotional healing.

The author recognized the need to have an organized yet simple way of accomplishing focused activation, in
the client, in order to initiate the optimal brain activity which is needed to accurately locate the relevant eye
positions. So he developed a simple “set-up” process to bring this about. He started by asking the client if
they were “activated” around the issue they wanted to work on. This was assessed by the SUDs (Subjective
Units of Disturbance) level discussed earlier in this paper (Wolpe, 1969). If the activation was not high
enough, the client was guided to “go inside and do whatever you need to do to push the activation level
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higher”. If it was high enough, it was simply rated with the SUDs of zero (lowest) to ten (highest). The next
step was to locate the area of activation in the body by observing “where you feel it the most”. After the
focused activation was accomplished, the set-up was completed by locating the Brainspot in the client’s visual
field. Following the set-up, the client was guided into the focused mindfulness process which ultimately leads
to the point of resolution of the issue of activation.

As the BSP process continued, the author closely observed and listened closely to client reactions and
feedback. Of note was that a number of clients who were being observed for their reflexive responses gave
feedback about eye positions that resonated with their internal felt sense. They guided the author to specific
spots where they felt the activation the most with comments like, “you just passed it”, or “move the pointer
over there”. This surprised him as he had not considered that Brainspots could be located by the client from
their inner experience. This, accordingly, gave him two options for locating the relevant eye positions
horizontally at eye level. He named the original locations determined by externally observing reflexes “Outside
Window Brainspots” and called the locations determined by the client self-observed intensification “Inside
Window Brainspots”. In order to locate these Inside Window eye positions, he asked clients whether they felt
the most activation looking to their left, center or right at a pointer he tracked across their visual field. Once
the general location was determined, he fine-tuned to find the most precise location of activation. But clients
kept directing him not only left and right but also above and below eye level. This development led him to first
search for Brainspots along the horizontal x axis followed by exploring up and down the y axis for the greatest
perceived activation. This allowed for BSP to move from a one dimensional process to two dimensions.

The author, prior to his discovery of BSP, had developed a modified version of EMDR which he had
designated as “Natural Flow EMDR” (Grand, 2001). He incorporated much of this approach in the further
development of BSP. The basic tenets of the Natural Flow approach included the “no assumptions model” or
phenomenology (“observe everything, assume nothing”), body resourcing (borrowed from Somatic
Experiencing) (Levine, 1997) and slower eye movements and gentler bilateral auditory stimulation (Grand,
2002). All of these methods were relevant to BSP and incorporated as such.

The phenomenology came from his decades of clinical experience noting how the unexpected always arises
in session, combined with the growing information about the infiniteness of the brain and accordingly how
unknowable it is by outside observation. This clinical/philosophical approach entailed tracking, or following the
client, uncritically and without expectation, wherever they went in their process. This was the recognition of
necessity of not leading the client, with the recognition that following the process reflects not only attending to
the associative processes, but also following the neural activity. The author noted how many subtle
assumptions were imbedded in most clinical models and how they became a part of the training and belief
systems developed by so many therapists. In his trainings he often challenged therapists presenting analyses
of client scenarios with, “how can you know this?”

BSP is seen as “Dual Attunement Model” similar to the “Interpersonal Neurobiology Model” (Siegel, 2010).
This entails the simultaneous attunement of the relational model together with neurobiological attunement of
the technical aspect of locating and harnessing Brainspots. It should be noted that the author had been a
relationally based clinician for 27 years prior to the point of his discovery of BSP. His original training was in
psychoanalysis and psychodynamic psychotherapy which developed his skills of attuned listening to the
multileveled client communications. The analytic model was too structured for the author and he began to
interact in a more open, flexible, accessible manner with his clients. This expanded out the reach of his
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attunement from the observational to the interactive. The attunement skills of a psychotherapist are deepened
and widened over years and decades of practice and is considered by many both an art and a science. It is
accordingly of interest that BSP was discovered and developed by a clinician of over three decades of
experience. The determination of a Brainspot, described earlier as a relevant eye position, is very technical
from a neurobiological point of view. In essence there appears to be nothing psychological about it. It is more
a process of either where the therapist observes or the client experiences the activation the most. This can be
seen as akin to a medical examination. From this vantage point the technical aspect of BSP is an attunement
dramatically different from the relational attunement. BSP, in contrast to many other neurotechnical models, is
conceptualized and taught from a clinical point of view. The therapy relationship is not intended to serve the
BSP, the BSP is intended to serve and support the healing relationship. Yet there is neither a skew toward
either the attunement power of the technical or the relational. The attention to the synthesis of the two, the
dual attunement model, is the sine qua non of BSP and hence the source of its unique power.

BSP is also unique, in the author’s opinion, as it is designed as an integrative model. Oftentimes
clinical/technical approaches are taught discouraging anything less than a fidelity to the model. With other
approaches integration is tolerated with an “it’s ok if you do it” attitude. With BSP integration is not only
“allowed”, it is encouraged. This dovetails with how phenomenology is applied to BSP with the recognition that
the human system is too vast to be understood from the outside. Accordingly there can be no one model that
encompasses this system. It, in fact, explains why so many models of the human mind have arisen and have
efficacy. Any clinical approach can be used in concert with BSP or on a Brainspot. In fact, the complexity of
response to BSP necessitates that a therapist be well versed in a variety of modalities to both understand and
respond to the undefined or the unanticipated. The author has found that trainees of many different clinical
backgrounds find a commonality in BSP reflecting its synthetic nature.

The mechanisms that underlie the BSP approach are either yet to be understood or are known in fields
outside the purview of the author’s knowledge base. It is known that the eye is an extension of the brain. It
contains about 125 million light-sensitive nerve cells (photoreceptors) which generate electrical signals that
allow the brain to see. There are both conscious and unconscious visual systems and each process along
separate pathways in the brain. The unconscious system guides action and the conscious system recognizes
objects (Carter, 2009). It is posited that with BSP, “where you look affects how you feel” and that different fixed
eye positions correlate somehow to specific neural activity and internal experience. It also appears that by
maintaining this eye gaze while in a state of focused activation around an issue, that the neural activity is
more focused leading to a more economical processing and resolution of the internal neural and felt sense
experience. The author believes, as many others do, that we are wired for healing (Badenoch, 2008). He also
believes that this is driven by the survival instinct which is at the foundation of all animal and human
experience. The author also believes that nothing is held in any part of the human system that does not affect
all parts and the entirety of the system. This explains why BSP has been designed as a brain/body approach.
BSP is also relational, understanding that the original attachment to the mother/caretaker is the foundation of
the therapeutic relationship and underlies all psychophysiological development and healing.

The “Resource Model” is an essential aspect of BSP. It expands the application of BSP to the most wounded,
dissociative clients who tend to be too overwhelmed to utilize the so-called “power therapies”. Central to the
BSP Resource Model is the “body resource”. The use of the body resource in BSP is derived from the
author’s discussions with Peter Levine, developer of the Somatic Experiencing (SE) model (Levine, 1997).
Levine challenged EMDR as too activating, particularly in its focus on body activation. Levine taught the
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author, as is done in SE trainings, to guide the clients to where they felt calmer and more grounded in their
bodies. Levine’s “pendulation” model entails spending more time and attention in the body resource (“healing
vortex”) and much less time on the outer edges of the body activation (“trauma vortex”). In the Natural Flow
approach, the author, at the conclusion of the EMDR protocol, guided the therapist to move from the body
activation to the body resource and commence processing from there. This appeared to yield a less
abreactive and more tolerable processing for fragile, highly traumatized, dissociative clients. In BSP, the
author observed that the containment of the fixed gaze on the Brainspot was not always containing enough
for these same clients who were so easily overwhelmed. By incorporating this body resource while on a
Brainspot, he observed that many clients were able to better tolerate the emotional upheaval and body
activation and process more effectively. He also realized the Brainspots could be determined not only by
matching them to activation but located in concert to the body calm or groundedness which he called
“Resource Spots”. This was the beginning of the “Resource Model” of Brainspotting which has been vastly
and intricately developed by Lisa Schwarz (Schwarz, 2010).

Another aspect the author incorporated from Natural Flow into the BSP was the use of bilateral sound,
delivered by his BioLateral Sound CDs. These CDs were engineered to move healing nature sounds and
music slowly and gently from ear to ear. These CDs, used continuously, had been the primary mode of
bilateral stimulation utilized by the author in his version of EMDR. He had discontinued use of them with the
advent of BSP, feeling it to be unnecessary due to the power of his new paradigm. However, a number of
clients requested to additionally listen to the sound while receiving BSP. To his surprise, the author discovered
that with most clients the CDs enhanced and provided an “auditory resource” that deepened and supported
the process. In response he guided the rest of his clients to listen to the sound during the BSP treatment. The
sole exceptions were the hyperstimulated clients who found even the Resource Model (2010) to be
challenging their capacity to remain grounded. It should be noted that doing BSP with the CDs is
simultaneously accessing and activating the neuro-visual and neuro-auditory systems. The observed power of
this dual sensory activation and its effect deserve further inquiry and study.

As guided and developed by the author, BSP was and still is, an open, integrative, ever-evolving model. One
of the first of these integrations was the use of “One Eye” Brainspotting. This borrowed from the work of
Fredric Schiffer who determined that each hemisphere of the brain was like a separate personality (Schiffer,
1999). The access to the two sides of the brain through the visual system is cross-hemispheric. Accordingly
he developed goggles that restricted the vision in either eye so that light was only coming in from the extreme
left or extreme right activating the opposite hemisphere of the brain. By switching periodically between the two
goggles, Schiffer observed an integrative response leading to issue resolution. Prior to BSP the author had
used the Schiffer model with interesting results together with bilateral eye movements and sound. He
hypothesized that doing BSP on the more active eye would further focus the power of his method when
needed. But he needed to develop modified goggles as the Schiffer version covered most of the visual field
making Brainspotting impossible. In contrast, the BSP goggles were designed to obscure 50% of the visual
field, either one eye or the other. To determine which eye held the higher level of activation he asked his
clients to alternately cover each eye to assess the SUDs level for the open eye. The eye with the higher level
SUDs was called the “activation eye” with the lower SUDs eye called “the resource eye”. Once the activation
eye was determined, the appropriate goggles were put on with the activation eye exposed. Inside Window
BSP was used to find the point of greatest activation on the activation eye. The One Eye approach was used
when either the client manifested slow processing, or for vague emotional conditions like generalized anxiety
disorder or chronic depression or for physical conditions like chronic fatigue syndrome or fibromyalgia. The
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author originally assumed that when the SUDs level was processed down to a zero that the process was
completed. But he realized he might be missing something and began checking the resource eye after the
zero SUDs was attained on the activation eye. He observed that in most cases additional activation was
present and that a new Brainspot needed to be determined on this secondary eye. At times the SUDs level
flared up one this “resource eye” to a 7, 8 or 9 and took considerable time to process down to a zero.

Another observation made by the author was that a zero SUDs level was not a true zero. He developed a
procedure he called “squeezing the lemon” where the client was guided, after a zero was attained, to “go
inside and do whatever you need to” in order to reactivate the SUDs level. This was followed up by continuing
to process, on the original Brainspot, back down to zero. This was repeated until no activation could be
generated. This squeezing the lemon process revealed that more unprocessed material remained despite the
attainment of the original zero. This deepening squeezing the lemon technique also appeared to reduce the
occasions where the effect of the process wore off for the client days after the session leading to the return of
the activation.

The author has thus far articulated three ways of locating Brainspots including Outside Window, Inside
Window and through One-Eye BSP. The remaining three that will be discussed are Rolling BSP, Z axis BSP
and Gazespotting. They will be discussed in the order they were discovered and developed.

Rolling BSP is a versatile way of utilizing Outside Window Brainspots. It is performed in a similar manner to
how Outside Window Brainspots are initially located and mapped. This constitutes slowly tracking horizontally
across the client’s visual field, stopping at each location where a reflex expresses itself. In Outside Window
this procedure is used to determine one spot where the eyes will remain fixated through the entire process
until all activation is discharged. In Rolling BSP the movement from Brainspot to Brainspot continues for the
entire process until discharge has been accomplished. The amount of time paused on each reflex spot can
vary between a few minutes to a momentary pause. This is determined by client response and intent of
purpose in using this technique. It is posited that by using Rolling BSP the flow of movement from Brainspot to
Brainspot will be more active, integrative and comprehensive. Additionally, some clients appear to respond
better to Rolling BSP while others simply prefer it. Although individual application varies from therapist to
therapist with client to client, the traditional model of Rolling Brainspotting entails initially spending more time
on each spot (one to five minutes) and gradually decreasing the amount of time as the process continues.

The theory is that early in the process greater depth of processing is the goal and that as it continues
increased movement becomes the goal. Following the dual attunement model, nothing is preordained and the
therapist’s role is to track the client process and respond according to the client’s response to the movement
from spot to spot and the therapist’s other interactions with the client. Rolling BSP can also be used as a
method of completing the more static versions of BSP. It at times reveals an eye position that is still holding
some measure of undischarged material that can be more fully processed through. At other times Rolling BSP
serves as an integration and deepening of the completed process attained on another Brainspot.

Z axis BSP brings the third dimension of depth into the location of eye positions. Inside Window first explores
the horizontal or x axis followed by the vertical or y axis looking for the highest level of activation or resource.
But the exploration of the differentiated close and far remains to be probed on the Brainspot after it has been
located. It has been observed that most clients will have greater or lesser activation either looking at the
pointer about four to six feet from their eyes versus looking through the pointer to the back wall which can be
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any distance further than the pointer. Oftentimes the spot further away on the z axis appears to have a lower
activation than looking more closely at the pointer. Perhaps the perception of an object further away feeling
less activating is based on the hard-wired experience that the further away from the danger the better. Even
more speculative is that when further away on the spot feels more activating, that the client may possess
elevated attachment issues that trigger the perception that the caretaker is more out of reach. Either way, z
axis BSP is a way to split the difference of perception between close and far directly on eye positions that
have been determined to hold the highest or lowest level of activation for the client. The quality, depth and
intensity have been observed to be different between close and far and higher and lower levels of activation.
BSP trainees are instructed to start the processing at the depth location of lower activation.

For example if a client is processing a motor vehicle accident, looking at an Inside Window Brainspot on the
pointer may be a SUDs of eight, while looking through the pointer to the back wall might be a four. It has been
observed that processing five to ten minutes on the lower SUDs distance often results in faster movement. It
has been further observed that when subsequently shifting back to the higher SUDs distance, the SUDs has
usually dropped and processing continues with greater flow. Going back to the MVA example, after working
on the far spot which started at a SUDS of four, when moving back to the close spot, the SUDs may have
dropped from an eight to a five or six. This tends to lead to a more active processing than if the closer spot
had been focused on initially. Next, following the processing on the close spot for five to ten minutes often
leads to a further diminution of the SUDs. At this point shifting back out on the z axis to the far spot often
reveals that the activation is reducing and more fluid movement occurs. This back and forth processing
continues until both distances have reached a full discharge and a resolution of the original issue.

The choice of z axis BSP, or for that matter any of the six modes of BSP, are determined by experimentation
and therapist experience. It has been repeatedly observed that some clients who were responding
incrementally to Inside Window had a noticeable increase in affective processing when the z axis was
incorporated. In his practice, the author observed some clients, often times those with dissociation, made
breakthroughs with z axis that were startling and not attained with any other form of BSP.

The sixth type of BSP is Gazespotting. This approach makes use of our natural tendency to gaze at certain
points in our visual field when talking about emotionally loaded issues. When observed, it appears like a client
is actually talking to the spot with no awareness of their behavior. The author, after five years of doing BSP,
consciously noticed this phenomenon and wondered what would happen if clients continued to fixate on these
spots while observing their inner processing. He observed a response that was both naturalistic and unique.
Although it was generally less activating than Inside and Outside Window, it was nonetheless powerful and
deep. This new method was designated as Gazespotting and became institutionalized as the sixth way of
locating relevant eye positions. It was the only form of BSP where a client choses their own spot intuitively
and unconsciously. It tends to be more gentle and resourced than the more activating spots, with occasional
exceptions. Gazespotting is also a good introduction to new BSP clients as there is no use of the pointer and
the set up process that can seem odd until the client experiences the powerful effect of BSP.

In looking ahead, BSP is an open, rapidly evolving model. By the time this article is published some new
applications may already be in development. The human system is so infinitely vast and complex that attuning
to its expressions lead to new discoveries and perspectives all the time. As BSP is in its seventh year, it is still
in its infancy and is expected to mature and take its place with the many other validated treatment methods.
Although most of what has been presented in this article has been discovered or developed by the author,
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BSP is being increasingly contributed to by many of the 2,500 therapists trained internationally to date. As this
article is being written, a variety of research projects are being planned and embarked upon. These include a
research study that cross-compares the efficacy of BSP against other therapeutic methods, an fMRI study
and pupillography observational research. Ongoing extensive research is important not only to understand
and validate BSP, but in the author’s opinion to further understand the interactive mechanisms of the eye and
the brain. In conclusion, the strength of BSP is seen in the dual attunement model which integrates the
relational practice wisdom of the ages with the current and future understanding of the brain and its genius for
self-observation and self-healing.

REFERENCES

Badenoch, B. (2008) Being a Brain-Wise Therapist: A Practical Guide to Interpersonal Neurobiology. Norton, New York.

Carter, R. (2009) The Human Brain Book. New York: DK Publishers.

Grand, D. (1999) Defining and Redefining EMDR. New York: BioLateral Books.

Grand, D. (2001) Emotional Healing at Warp Speed: The Power of EMDR. New York: Harmony Books.

Grand, D. (2002) Treating survivors of the world trade center disaster with natural flow EMDR resourcing, EMDRIA
Conference Lecture.

Grand, D. (2009) Brainspotting Phase One Training Manual

Grand, D. (2009) Brainspotting Phase Two Training Manual

Levine, P. (1997) Waking the Tiger. Berkeley, CA: North Atlantic Books.

Martinez-Conde, S. & Macknik, L. (2007) Windows on the mind. Scientific American, 56-63, (August 2007).

Scaer, R. (2005) The Trauma Spectrum, Hidden Wounds and Human Resiliency. New York: Norton Books.

Schiffer, F. (1999) Of Two Minds. London: Simon & Schuster

Schwarz, L. (2010) Brainspotting with issues of attachment and dissociation. Brainspotting training.

Shapiro, F., (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd
ed.). New York: Guilford Press

Siegel, D. (2010) The Mindful Therapist. New York: W.W. Norton.

Wolpe, J. (1969) The Practice of Behavior Therapy. New York: Pergamon Press.
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