Biofeedback interface with psychotherapy

A question was raised by one of my LinkedIn connections about how best to implement biofeedback and neurofeedback in her practice as a psychotherapist. With the increasing popularity of devices and techniques offering very useful 'feedback' information, this is becoming a very relevant and more common question in health care. For the benefit of anyone who is not on LinkedIn, I have cut and paste the question and all answers to her post so far. The last response was put in an email to me, but was too long to be posted on LI, which is part of the reason for doing this blog.


Natasha Trainee Therapist (UKCP) and Neurofeedback Practioner Integrating Neurofeedback and Biofeedback into a psychotherapy practice

Hello all, I'm in conversation here in the UK with my training institute (and accrediting body further up the chain) about integrating Neurofeedback and Biofeedback into my psychotherapy practice. These modalities are relatively rare here in the UK and there is excitement and also skepticism. I'm wondering if you have experience, know of any articles, have any thoughts.. about the problems of integration of biofeedback and psychotherapy. How do you deal with power dynamics, switching from talk to bio/neuro and back again, touch, dealing with transference etc. I'd be very grateful in any comments you might have. Warm wishes to you all, Natasha Robin Hemmings

Hi Natasha, coincidently I am just up the road from you in Cheltenham at the moment.

It is an interesting question you are asking. I can only give you my opinion based on my experience as a heart coherence coach and experienced biofeedback practitioner. However, I do have a very close friend who is a practicing psychologist, who regularly uses her Emwave device for her own heart coherence. She may very well be able to offer an insight into how the modalities of biofeedback and psychotherapy can be be integrated. I will get back to you in a few days, once I have chatted with her about it.

Best wishes,

Robin Hemmings


Hi Robin, yes please, that would be great, many thanks and looking forward to hearing from you, warmly Natasha

Robin Hemmings

No problem Natasha. Chat soon


Hello Natasha, a struggle I'm familiar with. I'm BABCP accredited and did my Masters on a client who presented with acute anxiety and a dilated left ventricle. There was considerable reluctance among some faculty members of the university to accept that this was relevant to CBT. I undertook the HeartMath Certified Practitioner training in the US as I could not find anything similar in the UK to develop my practice in the UK. I suppose the key thing is does it benefit clients. I must admit that using hrv monitoring in conjunction with my clinical cbt and cft p5ractice definitely enhances the service I can deliver to my clients. Clinicians like Paul Gilbert are much more open to biofeedback techniques and I think this is a wave and that is starting to develop. Best wishes with the challenges Brian


Hi Natasha, I suggest you reach out to Stuart Black at for advice. He has offices in London, Surrey, Kent, Hertfordshire, and Buckinghamshire. They integrate neurofeedback and psychotherapy, a very common mix here in the U.S. I am in relationship with an integrative psychiatric clinic here in Los Angeles offering a wide array of holistic and complementary modalities as well as nutritional and lifestyle counseling. I believe that approach to be the future of health care.


Hi Natasha, Raymond Francis is the psychotherapist of the Apex practice in Harley st, London. He uses biofeedback for anxiety, depression and trauma and the physiology of pain.

Robin Hemmings Hi Natasha, my friend read your post and emailed me with her response. There was too much written for it all to be posted on here on LI so I made a blog post for you to read (along with anyone else who is interested) I hope it helps.

Best wishes,


Complete email response from Jane

Hi Robin,

So, these are quite interesting questions that Natasha is asking.  I think she means that she would be concerned about the therapeutic alliance being disrupted by giving someone exercises in a directive way – I could be wrong but that is how I read what she has said.

As a clinical psychologist, I don’t find this to be a problem as some of the therapy models I use work OK with this: CBT for example.  Also because I work with older people, giving some practical advice and psycho education is part of the job (eg, we have talked about some of the reasons for your anxiety, now biofeedback and a breathing technique might really help you to feel steadier and more grounded so you can manage your emotions better) then you can return to the other more psychological and process parts of the therapy when the person can have that steadiness, which makes them feel safer.

I do understand that some models may not work so well with this: I am also trained in Cognitive Analytic therapy, my main model, and this uses psychodynamic ideas and particularly works with attachment dynamics and very much within the process between myself and the client.  But on the whole I find if used sensitively there is no problem with suggesting biofeedback techniques if you can see it is right for that person – not everyone will want to accept or work with it and you should never push obviously – it has to be right for the client, not just because it is something that the therapist wants to do (and therapists can get into doing this for the best reasons if they really believe in something - so we all have to resist that!)  However, most people can see how helpful and sensible these things are – I know you find this when you are teaching ZPB to people because as you know I’ve been there at workshops when you have been explaining this and seen their reactions 😊

If you want to copy this to Natasha that’s fine, I hope it answers her questions a little.  I think she will find as long as she stays with the process, the ‘heart’ connection and interaction between herself and the client, she will instinctively know if and when it is right to use the biofeedback /neuro feedback techniques.  It is all really very exciting stuff.

Hope all going well – look forward to seeing you again when you’re around in Cheltenham

Jane x