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.

I have once again heard from potential clients that they are looking for practitioners who have cutting-edge gear, thinking that these people will be the “best” practitioners. Despite the fact that most of my gear is new and pretty fancy, I’d argue that cutting-edge is just a marketing gimmick and not a way in which to choose a practitioner. Here’s why.

Some manufacturing companies market their neurofeedback gear to practitioners (and sometimes, the public at large) as the most scientific and cutting-edge. It’s mostly marketing hype, and I suspect that there are practitioners—especially those looking for a low-effort way to get in to the field—fall for this marketing fluff. That, in turn, makes me wonder what people who are potentially wanting to give neurofeedback a try might think when practitioners pass along this “latest and greatest” mindset to them.

The truth is that the basic equipment gets better and better all the time, but there really haven’t been seismic shifts in what’s available for training.

Neurofeedback is based on measuring the electrical brainwave patterns at different sites on the head, then providing feedback to the body based on those measurements. The electrical signal is picked up by electrodes, and they display on almost all neurofeedback software via an oscilloscope. Basically, all oscilloscopes, regardless of whether a person is measuring electricity from brainwaves or building wiring, show the same thing. Some may have fancier graphics (on one of my pieces of software, I have the ability to change the size of the display, the graphic display of the signal, and even the colors in which it appears), but they all perform the same basic function.

The same is true of what we call amplifiers. The brain’s electrical signal is quite faint, because it has to make it through the bones of the skull, and the signal may include non-brainwave information (called artifact) that needs to be filtered out. The amplifier literally amplifies, or boosts, the signal, and the software filters the signal to help get as clean of a measurement as possible. Amplifiers are more sophisticated than they were in the 1970s, but again, they all perform the same basic task. Some can train one channel—site on the brain—at a time, some can train two, some can train four, and a very few can train eight (though eight-channel systems are rare and not always reliable or helpful). Some come in colorful boxes. Some are bigger in size than others. But, amplifiers all basically do the same thing.

Software makes a much bigger difference than hardware. Some software is marketed as plug-and-play to practitioners, so the devices are set up to be easy for anyone to learn to use quickly. Such devices work when they work, but practitioners are left with little vision to see what’s really happening, and they do not receive a good education on what is happening to any one client, or why, because it’s all happening in a proprietary black box.

I am not a fan of dumbed-down devices and find myself often frustrated with lofty claims of superiority that are more fluff than substance.

Other types of software are more solid, but users frequently don’t receive information on how measurements of brainwave activity get translated in to how to train the brain, where, etc. It’s much simpler to say, “Do THIS,” than to explain why, and when/how to vary from that original plan.

So, if neither software nor hardware are game changers in the “this is cutting-edge” arena, it means that the greatest weakness, and biggest diversifier, in the world of neurofeedback is the education of the practitioner. I don’t mean whether a person has a master’s or a doctorate, or any degree at all, because most graduate programs in mental health do little more than mention that neurofeedback is a tool that exists. Non mental-health professions, such as chiropractic, physical or occupational therapy, or school teaching, receive even less information in their programs about neurofeedback than those in counseling or psychology programs. No degree in anything confers expertise in neurofeedback, it is training in neurofeedback that confers expertise.

As a result, it’s still a bit of a Wild West situation for practitioners, and the buyer must beware. Most learning happens in hotel conference rooms and at conferences. There is great education out there, but whew, it is a challenge to discern, and it is still incumbent upon the client/customer to know to ask about education and not the technology itself (for the most part, anyhow; some one-size-fits-all devices aren’t that helpful even for those with a solid education). There are basic, introductory classes which last about a week in most cases, but they are not enough to really understand what one is doing. Neurofeedback has a steep learning curve, and it requires dedicated effort from each practitioner who is truly trying to master it and not just take shortcuts.

Since I raise this subject, I’ll also share my own background. I started with a week-long program through a company called EEGer. Then, I studied under a psychologist in private practice who took on a few local psychotherapists as students. After that, I took another week-long class with a company called Brain Trainer International. Because I wanted to work for certification, I did a 500-hour apprenticeship with a local practitioner. I’m not quite at 20 years of experience yet, but I continue to study and learn what is happening in the field, and I help mentor future practitioners.

My equipment is new, and I have pieces of software in my toolkit that are brand new to the market this year. Despite all the shiny newness of gear, I would argue that my competitive edge is almost two decades of experience based on solid education. I base this not only on myself, but on someone I studied with who used and got great results from gear that was from the late 1970s. Like that wise teacher, I’ll put my training and experience up against anyone advertising a new kind of hardware any day.

Dutch researcher and neurofeedback practitioner Dr. Martijn Arns is well-respected internationally for his work on creating more methodologically sound examinations of the efficacy of neurofeedback. As long ago as 2009, he published an analysis indicating that neurofeedback benefits those who have focus and attention problems. He and his co-authors wrote: “we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.”

Since then, of course, more work has been done to underscore neurofeedback’s benefits—including NIH-funded work—but Dr. Arns’s work continues to stand out. You may access the abstract here, and the entire text of the meta-analysis is available behind a paywall.

Neurofeedback is a challenge to learn to do and takes years to master, but its essence is straightforward: learn the sites on the scalp where training is conducted and what brain functions lie beneath each individual address, learn the software, then discern where and how to provide training for each individual.

It’s straightforward enough that dedicated people can learn to do neurofeedback at home for themselves or a loved one when, for whatever reason, coming to an office for training is not an option.

Here’s the funny thing, though: I’ve had people come to me for training after working with other providers, and they get different results when training with me. I’ve had home trainers who are perfectly smart and capable at brain training tell me they don’t get the same results at home as they do when coming to my office for a few sessions. (I see photos and videos of what they’re doing, so I KNOW it’s right.)

There shouldn’t be a difference. It’s the same or similar technology. The same spots on the scalp. The same set of rewards.

Yet, the outcomes are not the same.

The reason why eluded me for a while, but I think I understand now.

When in graduate school for counseling, one of the things I learned was that no matter what type of counseling was done under what theoretical umbrella, the key factor that led to client improvement was the client-therapist relationship. That doesn’t mean that theory and practice do not matter; of course they do. But, human connection is the common thread that leads to progress in psychotherapy.

Even though they are not the same, I suspect that the same thing is true for neurofeedback as it is for mental health counseling—relationships matter.

In theory, neurofeedback works based on holding an electronic mirror up to the brain, then allowing the brain to make adjustments based on what it “sees.” This involves attaching electrodes, using an EEG device to measure brainwaves, then using software to reward change. It all sounds mechanistic and without a human element.

Increasingly, I’m not so sure about that. I think the person doing the training matters. I think their connection and encouragement matters.

Why wouldn’t it, when human connection matters in most other aspects of life?

I don’t want to overstate the idea. It doesn’t mean that an unskilled practitioner will get good results just because you like them, and it doesn’t mean that a skilled practitioner won’t get good results simply because you don’t connect with them well. It’s that a good relationship can help optimize good brain training.

I mentioned this to a colleague recently, and her response was to share with me that she’s had people tell her that they start to feel better as soon as they sit down next to her.

She and I don’t have clinical studies to prove this, but it makes sense.  At a time when so many people in our society feel disconnected from each other, a little connection—the feeling that another person truly cares about you and your well-being—matters.