Neurofeedback equipment is not that hard to operate, but it requires expertise to use it well.

If you’re searching for a provider, you of course want someone who has expertise, not just a rudimentary understanding of how to operate their system. The trouble is that it can be a challenge to find the right person, because there is a lot of noise about what makes for a good brain trainer.

The reality is that people from all walks of life learn to do neurofeedback. From my perspective, the largest segment of providers are mental health providers—psychologists, counselors, and social workers. Next in line are lay persons and health-care providers like chiropractors and occupational therapists. The fewest number of practitioners are MDs or DOs—and they’re usually psychiatrists, but not always. Teachers and tutors are somewhere in the mix, too. Neuroscientists in laboratories are increasingly active in researching neurofeedback, but I am only aware of a few who run neurofeedback clinics associated with their universities.

With such a diversity of people from many professional backgrounds involved, it can be confusing for someone who wants to do neurofeedback to find someone who has a solid track record of producing positive outcomes. There is no such thing as a degree in neurofeedback at this time. Looking for licensure is not possible, because no license is required to do neurofeedback. The reason for this is that neurofeedback is a tool to provide biofeedback for the brain. It is not a separate profession.

Moreover, brain training with neurofeedback is safe. The FDA determined that neurofeedback is safe enough to be considered a relaxation tool, so devices do not even need to be registered. There is no safety reason to restrict access to the tool or control who can use the tool. (There is, of course, restriction on who can practice medicine or psychology, so if one is making medical/curative claims, that person should be operating within what is called their scope of practice.)

Over the past several decades, guild organizations have stepped into the breach and tried to assert themselves as the foremost authority and gatekeeper of who is competent at neurofeedback. Associations have morphed over time, as have certification boards. Some groups have even tried to limit who is allowed to do neurofeedback, going so far as to take legal action against people and organizations. It has been a messy battle for power and control.

Sorting through this can be frustrating as a potential trainee, and it can be frustrating on the provider side, too. For example, I acquired certification by completing a 500-hour residency, completing 50 hours of supervision, and passing an examination. After all that work, the certification board folded, so I can claim to once have had that certification, but it does not exist anymore.

Now, my certification comes from a company that only certifies those who use its philosophical approach. It’s nice to have outside affirmation of my training, but at this point in my career, I do not think certification matters very much in terms of my expertise or effectiveness.

Several years ago, an individual who had been called upon as an expert witness in some of the internecine battles over neurofeedback asserted that fewer than 30% of all neurofeedback practitioners sought out certification. Most felt it didn’t add to their expertise and that it was more of a marketing tool than a sign of competence. I agree with that perspective (especially after having clients come to me in the wake of disappointment from working with certified but unskilled providers).

So, what does someone do when looking for a provider? What are the signs of competence? How does one discern and decide? I would argue that the following things matter:

• Years of experience. Look for someone who has primarily been doing neurofeedback—not merely dabbling with a few clients here and there—for a length of time that convinces you they know what they’re doing. If it’s a new practitioner, that is NOT necessarily a problem, as long as they are working under supervision with someone more experienced. Sometimes, new people have a zeal that makes them more attentive than someone for whom neurofeedback has become routine. BUT, someone new who is working on his or her own, without regular check-ins with a mentor or supervisor, is a riskier situation. Again, a license or degree in any field does not confer expertise in neurofeedback. It sounds a bit silly to say, but only training and experience in neurofeedback provide expertise in neurofeedback.

• Instructor status. If someone teaches others how to do neurofeedback, then it is highly likely that they have enough expertise to work with you. Just be sure that the person teaches more than just theory or brain science; they need to know how to DO neurofeedback, not just talk about it.

• Learning background. Ask about where and how a person received their neurofeedback training. Going to a one-week seminar is in no way enough training to be an indicator of competence. There is a steep learning curve with neurofeedback, and although It’s possible to hang out a shingle and do business after a quick seminar, it’s not wise.  That said, don’t be alarmed by people who say that they initially learned through private training. Very few universities in the United States teach neurofeedback. This means that learning is left to private companies, who often do training in hotel conference rooms and online. That is okay and not a sign of a problem. Excellent learning can happen in these environments.

• Substance, not marketing fluff. If someone has a website that makes bold sales promises without much meat in the content, it’s probably best to ask some pointed questions. Advertising (you know the sort—claiming to be the only cutting-edge organization, or the only place that has X credential or skill, or that they’re the largest and best) is not equivalent to expertise. Look for someone who is willing to share their knowledge, not just try to baffle you with superlatives.

• Your intuition about fit. I’ve written in earlier blog posts that I believe the relationship between trainer and trainee is important to outcome. If you feel like you cannot connect with your practitioner, or you’re just a number, or something else just isn’t right, then look elsewhere. There are enough practitioners in the DMV to find the right person for anyone.

I feel that because I’ve just made strong statements about how to determine who may and may not be a good provider, I should re-share my credentials:

I, like most practitioners, did not learn neurofeedback in my graduate counseling program. In the early 2000s, I had almost a month of full-time trainings with more than one organization. In addition, I studied under a clinical psychologist, and I studied under a someone who himself was a protégé of one the research pioneers for the field. I had a 500-hour residency and had over 50 hours of supervision during that time. I once had two certifications but now have one (and I have no intention of acquiring any more certifications). I practiced neurofeedback exclusively for most of my years in practice and only in the past few years added hypnosis. I teach others how to do neurofeedback, primarily through online instruction but sometimes in person. This is sometimes through a company that sells equipment and sometimes private clients who seek my help. I consult with one of my long-time mentors on complicated situations, just to remain sharp and include different perspectives.

The bottom line when you’re looking for a provider is to find someone who has solid training in neurofeedback, is seasoned or seeks guidance from a seasoned person, and is a person with whom you feel you can work. Don’t rely on credentials like degrees (MA vs PhD vs MD/DO doesn’t equate to neurofeedback training) or certifications.

If you think I might be a good fit for you, please reach out. If you’re not in the Northern Virginia area and are reading this, I can either help you with home training or may be able to help you choose a practitioner in your area.

Back when I took my first classes in how to do neurofeedback, my instructors made sure that we knew the history of neurofeedback. We were taught that, like so many scientific advances, NASA had an indirect hand in moving forward UCLA neuroscientist Dr. Barry Sterman’s research using cats and, later, a research assistant to discover that biofeedback for the brain worked. We learned that Dr. Margaret Ayers, a Beverly Hills psychologist, worked with Dr. Sterman to bring brain training to a few of her clients. We learned that Siegried and Sue Othmer, parents of one of Dr. Ayers’ neurofeedback clients, were so impressed with what neurofeedback did for their deeply distressed child that they pushed to bring neurofeedback to the broader public. (There was also a great deal of drama involved in this process, and still today, people remain upset that so-called “laypersons” like the Othmers could get away with offering neurofeedback.)

What often gets lost in the big-picture story is the Othmers’ son, Brian. He had so many problems in his short life, and neurofeedback played a significant role in alleviating some of his troubles. One can read an overview of his story in the book A Symphony in the Brain, but that book is getting old and is not read by as many people as it was when it first came out.

So, I was pleased earlier this week to stumble across Brian’s story on Siegfried Othmer’s EEGInfo site. I do what I do in many respects because of Brian’s journey; all neurofeedback practitioners owe the entire Othmer family a debt of gratitude. All Siegfried and Sue Othmer had to go on at the time was trial and error. And hope. Their courage, and Brian’s, took neurofeedback out of a UCLA neuroscience lab and brought it to the world.

I encourage you to take a few minutes to read his story, which you may find here. That link takes one to the EEGInfo newsletter page, and as new newsletters get published, older issues slide down. If you are reading this post in the future, please scroll down in time to the 24 August 2024 edition.

Although the general public seems to be much more aware of neurofeedback than it was when I first started doing brain training almost 20 years ago, I think it’s still confusing and perhaps even a bit overwhelming to be someone who’s exploring whether to try neurofeedback or has decided to try it but isn’t quite sure how to choose a trainer. One of the questions I recommend that people ask potential providers is how they get started with new trainees. The answer to that may enlighten you and help you decide which way to go. Below are the ways providers can choose from to get started:

Just Dive Right In.  If you have a practitioner who says something along the lines of trusting the equipment to know what to do with the brain so nothing more than the usual getting started paperwork (your contact info, etc.) is necessary, you have a practitioner who uses one-size-fits-all equipment. Such persons may deny it and will say that the system is so sophisticated that it knows what to do with you. But, such systems train the same spot on the scalp for every person. How these machines operate is a bit of a mystery. They do work for some people, but this type of approach falls short (in my opinion, of course) more than other approaches.

• Systems in which equipment assesses where on the brain to train you, then uses microcurrent to “reset” the brain, are a variant of the dive right in category. Others may feel differently, but I am extremely wary of microcurrent neurofeedback to the point that I do not even appreciate that it is called feedback, as the feedback loop is not really there. Despite knowing that others may feel differently, I strongly do not recommend microcurrent work.

Clinical Interview. If you have a practitioner who tells you they will do an interview and determine where on the scalp to train based on the things you tell them about what is wrong or what you want to improve, this person adheres to a philosophy that trusts that certain symptoms are related to certain brainwave patterns. These practitioners may use infra-low training or other symptom-driven systems, and they generally train at just a couple of spots on the scalp. I think this approach is good when working with young children or other people who cannot tolerate having a brain map done, such as those who have autism or other neurodivergence. I use a variant of this sometimes myself (though I train more than just a couple of places), and I know you can get good results with this approach.

Brain Map. The category of practitioner who tells you they start with a brain map is the sort who wants to “see” what the brain is actually doing before jumping in to training. There is a level of perceived precision that comes with this approach, but there are several subsets, ranging from those who measure very little to those who measure so much and make so many comparisons that it feels like false precision.

Some practitioners use one measurement from one or maybe two spots, call it an assessment or brain map even though it is rather cursory, and go from there. This can work, but it also misses an awful lot if it isn’t accompanied by an in-depth interview to fill in the measurement gaps. People who do this can get results, but it is, in my view, just a step above the “dive right in” category unless accompanied by a long interview.

Some practitioners use something called a QEEG, or quantitative EEG recording. They measure 19 spots on the brain, then send the recording to one of a few companies in the US that maintain databases of brain measurements. Their measurements are compared with the averages in those data bases, and training is based on how far off from those averages any one measurement might be. These measurements rely on the idea that there is a normal brain and that any one person might be within the norm or a few standard deviations away from the norm.

I personally object to the idea of a normal brain and that someone’s brain could be a standard deviation off. I also have found that sometimes, huge reports of EEG findings boil down to training at just one or maybe two spots on the brain. It feels like a lot of overly precise measurement—numbers gathered that a practitioner may not even be able to explain that boil down to the same thing a clinical interview could have uncovered, but with a lot less expense.

My Approach. I use a variety of brain map called a Trainers’ QEEG. This is a QEEG that measures 20 places on the scalp, but it does NOT compare the brain to normal or average. In fact, the recorded data is not sent out to any third-party company to be compared with other brains and is instead processed in my office. I use a system that is filled with algorithms based on what optimally functioning brains resemble. It compares the brain against itself, using things like ratios that researchers have determined are associated with highly functioning people (This may be a bit technical, but one example is that we know that the alpha frequency is best when it’s at least 15% higher on the right-hand side of the brain than in similar sites on the left.).

I like this system for several reasons. One is that it is not based on the notion that there is a such thing as a normal brain. I do not believe that putting a thousand or even five or 10 thousand brain maps together, then taking averages, leads to a picture of a healthy, normal brain. In fact, in the 1950s, the US Navy wanted its jets to have cockpits designed to fit all but outlier pilots. They did thousands of measurements, then took the average numbers and built a cockpit based on the average. Designers were surprised to find that there was not a single pilot with the average measurements, and that the cockpit was more uncomfortable than older ones. The Navy made my point—a mean or median doesn’t equal health, or best.

Another reason I prefer the Trainers’ QEEG (also called the Trainers’ Q) is that it does not assign pathology to a brain. It looks at relationships in the brain that may or may not be helpful to any one person, and those relationships may not be related to mental illness or learning disabilities. Anyone can do brain training to optimize their functioning. I won’t get obnoxious about it, but I really do believe almost anyone could improve their performance in life by doing a round of brain training. You don’t need to be abnormal to work with me and derive benefits.

The TQ also advocates whole-brain training. Some systems will take measurements, then only recommend training one or two places. The TQ advocates for a system called Whole-Brain Training. It entails rotating among spots on the brain in a circuit-like fashion–one day, you might do right-hemisphere training for relaxation, a second day you might train something called coherence, a third day you might train the sensori-motor strip, etc. Many of us who use this approach consider it to be like muscle-training. You wouldn’t train quadriceps only and ignore hamstrings, you wouldn’t train bicep and not triceps, and you wouldn’t lift heavy without including at least a little cardio. In a similar fashion, training one place in the brain might make slight changes, but big, systemic changes come from training the system itself. I love this thoroughness.

Finally, I like that the Trainers’ Q includes a questionnaire of subjective goals and objective information to help build a training plan. As one of my mentors used to say, a poet may want that daydreamy, excessive theta wave to be creative, and an electrical engineer may want that high-quantity of beta wave in the front to keep that linear, logical thinking going. A poet and an engineer are almost certainly going to have very different-looking brains (and will vary still more from an engineer who writes poetry or vice versa), but they may both be high-functioning and have training goals completely unrelated to what someone else might think of as a deficit or problem to be trained away. Questionnaires help us know why people want to do brain training and where they hope to be when they finish. Your goals matter, and brain training should adapt to your goals.

Obviously, I like my approach to brain training. I believe it includes measurements to see the brain without slipping into false precision, and I believe it takes into consideration important qualitative information, too. This does not mean that I would ever say that other peoples’ approaches are insufficient. One can, indeed, get results from almost any competent, experienced provider. It’s just a matter of knowing what you want for yourself and choosing it, and discovering what the options are empowers the consumer.

I hope this gives you a sense of one thing you can ask as you’re interviewing potential providers to differentiate among us. If my approach appeals to you, consider contacting me for a consultation. If you choose an in-person consultation, I will show you the equipment, show you what a brain map looks like, and answer your questions. If you choose an online consultation, we can cover similar ground, but I obviously cannot connect you to my equipment.

Perhaps it was in graduate school, or perhaps it was when I was a resident counselor. I’m not sure at this point anymore, but somewhere along the line, long ago, I learned that researchers had explored all the most popular theoretical approaches to psychotherapy to learn which one was the best. Instead of figuring out which method was best for all things, they discovered that the single most important factor in the outcome for anyone in counseling was the relationship between the counselor and the client.

Years later, I learned that there was a place called Roseto, Pennsylvania, where heart disease was almost non-existent. Researchers studied this tight-knit community of immigrants from Italy and learned to their surprise that, despite bad diets, smoking, working in coal mines, and other unhealthy behaviors, the people in this community almost never developed heart disease. The reason their community stayed well, the study found, was that the people had solid relationships. They ate together in community. They spent time together. They were connected.

Finally, not that long ago, I learned that in Sardinia, one of the famed Blue Zones in the world in which many people live to a healthy 100 years or more, people also maintain relationships. In Sardinia, they walk, get time in nature, and they eat real food, yes, but relationships also have played a key role in their longevity.

Learning that relationship mattered most in counseling effectiveness affected my perspective in powerful ways, not just in my counseling work, but in my philosophies of dealing with everyone in my world. I built my neurofeedback practice around the notion that connection with my clients matters. Roseto and Sardinia reinforced that perspective, and I continue to operate with the idea that my EEG and HEG devices are just part of the story of why and how people retrain their brains’ energy patterns.

Also reinforcing that perspective was my primary mentor and instructor when I got started doing neurofeedback. Her practice was like mine—she worked with one person at a time, making exceptions only to train an additional family member of the client simultaneously. She had a welcoming office environment that was relaxing and comforting. Her presence itself seemed healing, and in the wake of meeting many of her former clients over the years, I know they felt the same way.

So, know that if you decide to work with me, you are most definitely going to get the high-technology touch. I am a strong believer in using technology to allow the brain to adjust itself. I like my tools and gadgets and know they work. I use them well.

Despite my love of using technology to solve problems, though, I believe it’s also important to make a human connection. I have taken to heart the idea that thriving involves good relationships with healthy boundaries. As a result, I purposely have not created a clinic in which multiple people are doing brain training at the same time, with a technician leading people in and out. Instead, you get just me. It’s pretty quiet in my space, and I’ve had more than one person say they wish they could just sit and have a mug of something warm to drink and hang out in my training room for a while.

Have I had people think I’m not scientific enough because I focus on creating a low-stress, softer environment? You bet. There are those who need a white laboratory coat to be convinced that they are working with someone who has expertise, and that is okay. There are practitioners in the area who can offer that experience. There is room for all approaches.

If, however, you’re looking for someone with deep expertise plus the ability to be a calming presence with an emphasis on human connection, I just might be the one for you. As I all-too-swiftly approach 20 years in practice, I am more convinced than ever that trust and connection with your practitioner is as important as knowing what to train, where, how, and when.

Give me a call, or schedule a consultation here.