USABP ViewPoint Articles

In Memoriam: Bret Lyon (1943–2025)

Mon, 21 Jul 2025 21:26:49 GMT

Bret Lyon, PhD, SEP, a pioneering force in somatic psychotherapy and co-founder of the Center for Healing Shame, passed away peacefully on January 30, 2025, in Oakland, California, at the age of 82.

Bret devoted over 50 years to teaching and developing somatic and emotional mindfulness practices. Alongside his wife and collaborator, Sheila Rubin, MA, LMFT, RDT/BCT, he co-created the Healing Shame – Lyon/Rubin Method, a groundbreaking approach that reframed shame not as a pathology but as a vital human emotion that, when understood and integrated, can foster connection and healing. Their work has been instrumental in training thousands of therapists worldwide, offering workshops, online courses, and professional development programs through their organization, the Center for Healing Shame.

In 2023, Bret and Sheila co-authored Embracing Shame: How to Stop Resisting Shame and Turn It into a Powerful Ally, a widely acclaimed book that brought their teachings to a broader audience. Together, they also created the audio series Healing Shame: How to Work with This Mysterious Emotion and Transform It into an Ally, which deepened access to the teachings. Their compassionate, body-based approach has helped countless individuals transform internalized shame into self-acceptance and resilience.

Bret held a doctorate from the Yale School of Drama and a PhD in Psychology, and he taught at institutions including Tufts University, Pomona College, and the Academy of Dramatic Arts. Before meeting Sheila, he developed the Bret Lyon Personal Power Training, focused on helping individuals embody confidence and authentic presence.

Bret's contributions extended beyond his clinical work. He was a respected voice in the therapy/somatic psychotherapy community, regularly contributing to journals and conferences, including those hosted by the United States Association for Body Psychotherapy (USABP). His recent article in Psychology Today, "We Don't Have to Be Ashamed of Aging," exemplified his commitment to addressing shame across the human lifespan.

Bret's warmth, insight, and dedication to healing left an indelible mark on the field of body psychotherapy. His legacy continues through the ongoing work of the Center for Healing Shame and the many practitioners he mentored.

A memorial service was held on February 2, 2025, at Sunset View Mortuary in El Cerrito, California. Bret is survived by his beloved wife, Sheila Rubin, , and the extended family community of students, colleagues, and clients who carry forward his mission of transforming shame into a source of strength and connection.

Treating Addiction, Trauma and Emotional Loss Together: A Clinical & Historical Perspective by Gabor Maté

Thu, 07 Jul 2022 15:02:52 GMT

USABP & IBPJ Forum: Integrating Trauma and Addiction Treatment

Treating Addiction, Trauma and Emotional Loss Together:
A Clinical & Historical Perspective by Gabor Maté

“Your addiction was your attempt to solve a problem. That problem was that of emotional pain, and hence my mantra...Ask not why the addiction, ask why the pain.” - Gabor Maté

Gabor Mate is a retired physician who after 20 years of family practice and palliative care experience worked for over a decade in Vancouver's Downtown Eastside with patients challenged by drug addiction and mental illness. The best-selling author of four books published in 30 languages, Gabor is an internationally renowned speaker, highly sought after for his expertise on addiction, trauma, childhood development, and the relationship of stress and illness. His book on addiction, In the Realm of Hungry Ghosts, received the Hubert Evans prize for literary nonfiction. For his groundbreaking medical work and writing, he has been awarded the order of Canada, his country's highest civilian distinction, and the Civic America award from his hometown Vancouver.

___________________

I've worked in Vancouver’s Downtown Eastside in British Columbia. In the few square blocks of Downtown Eastside, North America’s most concentrated area of drug use, we have more people injecting, inhaling, ingesting substances of all kinds than anywhere in the Western world. I was the physician at North America's first supervised injection site here in Vancouver. My patients were afflicted with mental illness, HIV, hepatitis, all the complications of addiction. 30% of them were Indigenous Canadians. Indigenous Canadians make up 5% of the general population but 30% of our jail population and 30% of the population in the Downtown Eastside, which already tells you that addiction isn't simply an accidental random event. It has to do with history, personal history, and the history of a culture.

Now, why is it that Indigenous people in Canada suffer so much? Because they happen to be the most traumatized segment of the Canadian population. For hundreds of years, they were subjugated, their culture was extirpated, their children were abducted from them, forced to be in residential schools under church guidance where they were beaten, sexually abused, emotionally abused, starved. Thousands died. They're just discovering the bodies right now. In those communities, there are high rates of suicide, high rates of addiction, high rates of mental illness, high rates of physical illness, and high rates of sexual abuse of children. And again, high rates of addiction.

In other words, historical and personal trauma has everything to do with addiction.

What is addiction?

I define addiction as a complex psycho-physiological process manifested in any behavior in which a person finds pleasure and relief and therefore craves, but suffers negative consequences without being able to give it up. So: craving, pleasure and relief in the short term, negative consequences in the long-term, and the inability or refusal to desist, that’s what addiction is. Note I have said nothing about substances, because clearly people can be addicted to drugs, nicotine, caffeine, crystal meth, heroin, alcohol, but also of course, to sex, pornography, work, power, profit, gambling, the internet, cell phones, and everything else you can think about. The issue is not the external target or the behavior — the issue is one’s internal relationship to it. If there's craving, pleasure and relief in the short term, harm and inability to give it up, that's what addiction is.

And now I simply ask all those of you who recognize that at some time or another, you had some kind of an addictive pattern in your life to please raise your hands. Thank you. Hardly anybody leaves their hand down if they're honest with themselves.

“The assumption is that people are consciously choosing to use certain substances illegally and therefore they deserve to be punished. Complete and utter scientific nonsense.”

______________________

Now, this is where the whole cultural bias about what addiction is shown to be totally false. People make two assumptions about addictions. Number one is that it's a choice people make, a failure of will, a character flaw, a deficiency of moral power. That's one assumption. In fact, that's the assumption that drives the legal system. The assumption is that people are consciously choosing to use certain substances illegally and therefore they deserve to be punished. Complete and utter scientific nonsense. I won't spend a moment trying to refute it. (I would if I had time.)

The second assumption is a little bit more interesting, a little bit more accurate, but still misleading. It’s that addiction is a disease of the brain that somehow is generated significantly by genetic factors. That's what the medical belief is. There are some elements of truth to it, but it's fundamentally inaccurate. Addiction is not a process that begins in the brain and there are no addiction genes, never have been, nobody's ever found one. Nobody will ever find any either, contrary to what you're told.

“Therefore, the treatment of addiction needs to be not simply stopping the behavior, which is only a symptom, but dealing with the underlying embodied trauma.”

So, what is the source of addiction then? For those of you who raised your hands, I'll ask you a question: Whatever your addiction process was focused on, behaviors, shopping, gambling, eating, drugs, whatever it was, the question is not what was wrong with it. You already know that. The question is: What was right about it? I'm going to ask you to put into the chat what that addiction temporarily gave you that you were looking for. What did you like about it?

So, let's just see some of these answers. What did the addiction provide for you that you appreciated? Okay. Numbness, relief, distraction. Thank you. Relief, escape, avoidance, sedation. Thank you. That's good enough.

When do people need to be numb? When they're in pain.

What do people need distraction from? Painful internal body states, vagal states, and emotional states.

What do people need to escape from? Distress.

In other words, it gave you self-soothing, it gave you pleasure. The addiction wasn't your primary problem. Your addiction was your attempt to solve a problem—the problem was of emotional pain. And hence my mantra: Ask not why the addiction, ask why the pain.

Of course, that pain is not just mental or emotional, it's also an embodied thing. You can feel it, the tension in your neck, in your shoulders, in your belly, in your intestines, in your throat. And of course, in your mind. So, again, not why the addiction, but why the pain. Now, if you want to understand why the pain, you can't look at people's genes or choices. You have to look at their lives.

And this is where trauma comes in. I don't think I need to review for you the voluminous literature that has linked addictions to trauma, the Adverse Childhood Experiences Study, and so on. What we know without a shadow of a doubt is that addiction is rooted in childhood trauma. I don't have time to go into it, but childhood trauma not only gives you emotional pain, it also affects the body as this group would know. And it also shapes and programs the circuits of the brain that then become more prone to addiction, the natural opiate circuits, the dopamine circuits, the stress regulation circuits, the impulse regulation circuits.

So, to bring this to a close, I‘ll sum up. Addiction is a desperate and forlorn but totally understandable attempt to deal with the impact of trauma. Addictions are far more common in this toxic culture than most of us realize. Therefore, the treatment of addiction needs to be not simply stopping the behavior, which is only a symptom, but dealing with the underlying embodied trauma. And for those of you who would like to read more about this. my book on addiction is called In the Realm of Hungry Ghosts: Close Encounters with Addiction. And the same subject is also taken up in the book to be published this fall, The Myth of Normal.

With that, I will stop. Thank you.

_____________

Gabor Maté’s next book, The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture is due to be published Autumn 2022.

The video of the USABP/IBPJ Forum Integrating Trauma and Addiction Treatment: A Paradigm Shift is available at, https://youtu.be/bB1M6J5OQcs

Homage to David Boadella

Mon, 21 Mar 2022 20:49:08 GMT

David Boadella passed away November 19, 2021.

Here is an excerpt from the International Body Psychotherapy Journal Spring/Summer 2021 Volume 20

How Biosynthesis Enriched Our Lives
Tribute from Biosynthesis Therapists

We asked the participants of the First International e-Meeting of Biosynthesis Therapists to share how Biosynthesis had enriched their lives. Here are some of their tributes.

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis brought transformation, clarity, structure, understanding, calm, and wholeness to my life. And a connection among mind, soul, heart, spirit, essence, and body. It supported my journey into therapy and helped me understand the other, not only through academic knowledge but with my heart as well. Thank you, David and Sylvia, from my whole being! Antigone Oreopoulou Greece Biosynthesis brought into my life more mindfulness and centering; it became more structured, as are David’s poems.

Diana Nikolaishvili
Georgia, Tbilisi

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis has given me a very deep and global grasp of the way I function, and as a consequence, of the way other people function. It has deepened my spiritual awareness. And mainly, it has moved the tectonic plates of my psychological organization.

Marilyn Pisante
Greece

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis gave me the opportunity to feel that I belong somewhere that embraces my whole being as it is. I feel that Biosynthesis is a community that fits every human being, accepts all feelings, all thoughts, and all differentiation. The community’s field supports its members to develop themselves.

Stavroula Sofrona
Greece

◼ ◼ ◼ ◼ ◼ ◼

He is a teacher – he was, in his younger years, also working with the young, learning from them and with them, while he was asked to educate, to teach, to accompany them, through and despite the hardships of their lives…

He is a dancer – he has learned from inspiring teachers himself, about movement(s) and moving, the body and its impulses, the diverse and fine qualities that come with dancing, and living itself…

He is a poet – he loves language and literature, is putting words, creating sentences in a most imaginary way, to express, reach out and touch life and all that comes with it…

He is a scholar – his intellectual scope is huge, his reading profound, his horizons are wide, the agility of his mind just impressive, opening new spaces, again and again…

He is a therapist – “ein Gramm Kontakt ist wichtiger alseine Tonne Energie,” this is what he showed us, this is what we have learned, what we can keep in mind, wherever we are going, whatever we are doing…

He is a citizen of the world – he never restricts himself to a national or social ground, he welcomes everybody from everywhere, welcomes learning from others, from other histories, other cultures, other countries.

He is just a great spirit, he is just – and he is human.

David, I am deeply grateful for all I could learn, witness and share with you. With love, Susanne.

Susanne Maurer
Germany

◼ ◼ ◼ ◼ ◼ ◼

I come from a multidisciplinary educational background. Different psychotherapy approaches led me to the Biosynthesis Centre, where early on I understood it was the missing piece of the puzzle for me, the one that made the picture whole, that made sense, that was missing from the other approaches I had known. It helped me bridge the gap between what my mind was thinking and what my body was telling me, and had told me throughout my life! I felt at home studying there, combining all the knowledge I had gained, connecting to my core truth, to benevolent colleagues, and to the higher purpose of life – that is, to give and receive help while enjoying the path in parallel. Thank you, David and Silvia, for creating this system that holds us all, excludes nothing and no one!

Sofia Koukidou
Greece

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis helped to bloom the Sonia that was hidden in a tangle of standards, fear of expanding, insecurities, and lack of trust in herself. To experience a deep therapeutic process in the Biosynthesis approach, to do the training, to participate in many meetings in Heiden allowed me to further integrate my multiple layers, find my place in the world, find the meaning of my existence, make contact with my qualities, and let me express them in my personal life in my work as a psychotherapist and as a member of Centro de Biossíntese da Bahia. My deep gratitude for being a part of this family. Special thanks to Eunice, David, and Silvia.

Sonia Souza Coutinho
Brasil

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis brought me to my center and saw me in my inner power as a person. It saw Me!!!!

Supriti Zanna Mantzorou
Greece

◼ ◼ ◼ ◼ ◼ ◼

A dynamic trajectory that gives new perspectives and shape to life.

Penny Zikou
Greece

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis gave me a profound understanding of healing and helped me personally transcend some difficult history, reaching back to prenatal and perinatal life. It enabled me to gain strength, confidence, and a deep, growing trust in my own inner ground! As David used to say, “There is always fire beneath the ashes!”

Carine Nussbaumer
Switzerland

◼ ◼ ◼ ◼ ◼ ◼

Meeting David has brought my life full circle. Coming from the Elsa Gindler tradition, it was an enormous enrichment to get to know David and his work, and to unite these two paths for my own unfolding and for the benefit of my patients. I am very grateful to be part of the Biosynthesis community.

Nimai
Germany

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis came into my life as a gift from heaven. It gave my life a direction, and taught me to accompany fellow humans in their journey towards healing with deep respect, gentleness, and a holistic understanding of each individual’s precious being. It has been my honor to have had the chance to meet David, feel the amazing quality of his presence, and witness his art as a therapist.

Marina Chandoutis
Greece

◼ ◼ ◼ ◼ ◼ ◼

Biosynthesis has enriched my life on many levels. On the deepest level, it has helped me connect with hope, and ground in trust of life. It has helped me in my everyday life to reconnect with my own hope when patients, clients, or loved ones lose their ground. Thank you to David and Silvia and the whole community for creating and keeping alive a method that resonates with the soul of life at its deepest.

Paz Cardín
Spain

◼ ◼ ◼ ◼ ◼ ◼

The Belonging…

The earth has dried, and the daisies have long since withered
on the zipper of your green cardigan.
The sun, a faded spot on the horizon,
like the look of your eyes…
The scared body lies, torn to pieces, on the altar
of genetic belonging, losing its essence,
while the naked soul seeks to find a place to live…
It seeks a united body, with rhythm and continuity,
solid and airy at the same time,
with a heart that beats fiercely and
hands that open like wings to embrace it.
It seeks belonging away from biological family toward a family that nourishes
the healthy belonging to You, as body, soul and entity.

Eudokia Katsiana
Greece

◼ ◼ ◼ ◼ ◼ ◼

CURIOUS COMPASSION COMPANION *

Your Trauma Narrative
Is important.

It will be
The window
You enter

In order to
Start the journey
Of recovery.

However,

This is only
The beginning.

Trauma is more about
What happened
Inside you

When you had to
Freeze,
Fawn,
Fight or Flight.

The impulses for
A healthy corrective
Experience

Are latent in
Your Body

Just waiting
For you
To show up

With a
Curious Compassion
Companion

Who has walked
Her own way

And can shine
The light

To show you reconnection.

Until,

You become your own light
You become your own regulator
You become your own saviour

You become

Free.

ABOUT
David Boadella (1931 - 2021), B.A., M.Ed., D.Sc.hon., Psychotherapist SPV, UKCP and ECP.

Studied education, psychology and literature. Trained in character- analytic vegetotherapy. Founder of Biosynthesis. Since 1985 he has undergone ongoing further training in “Psychosomatic Centering” (Robert Moore, Denmark). He has spent over 40 years in psychotherapeutic practice. He holds lectures worldwide, and is the author of numerous books and articles. In 1995 he was awarded an honorary doctorate from the “Open International University of Complementary Medicine” for his pioneering work in the development and promotion of Energy & Character, as well as for his contributions to social sciences in this context.

A selection of David Boadella’s books: “Befreite Lebensenergie/ Lifestreams” (Kösel / Routledge), “Wilhelm Reich: The evolution of his work” (Arkana).

New publication highlighting role of sustained interoception for emotion regulation

Cynthia Price — Fri, 17 Dec 2021 20:30:22 GMT

A new article is publication is available titled "Facilitating adaptive emotion processing and somatic reappraisal via sustained mindful interoceptive attention. " Published in Frontier in Psychology, this article by Drs. Cynthia Price and Helen Weng, is aimed at mental health professionals and highlights the role of sustained interoceptive attention for enhanced emotion regulation.

Listening to the Body: Pragmatic Case Studies of Body-Centered Psychotherapy

Wed, 23 Jun 2021 21:12:33 GMT

By Amelia H. Kaplan and Laurie Schwartz, Rutgers University and New York, NY

ABSTRACT
Body-centered Psychotherapy (BcP) is a developing field of academic investigation. The present research employed the Pragmatic Case Study Method (“PCS Method”) for systematically studying how verbal and somatic interventions are combined in a single therapy in two 12-session cases seen by an experienced BcP therapist. Following the PCS Method, the cases begin with a presentation of the therapist’s theoretical approach, or “guiding conception,” and a description of how it is applied to each client. The data analyzed in each case include videotapes and transcripts of selected therapy sessions; pre- and post-therapy scores on standardized, quantitative measures; a pre- and post-treatment goal-setting interview; and a semi-structured, post-therapy, outcome interview. The results revealed substantial progress and statistically-significant quantitative changes in both clients. Additionally, distinctly different patterns of progress occurred, as the therapist tailored therapy in accordance with the needs of each client.

Body-centered Psychotherapy (BcP), also known as “Body Psychotherapy” and “Somatic Psychology,” is a developing branch of psychology based on the vital connection between psychological symptoms and physiological states. Although many non-BcP therapies attend to bodily experience, what distinguishes BcP as a unique subfield within psychology is the centrality of somatic sensory experience throughout diagnosis, formulation, and treatment (e.g., see such pioneer therapists in the field as Ferenczi, 1953; Kurtz & Prestera, 1976; Lowen, 1958; Reich, 1945). Additionally, physical touch is more often used by BcP therapists, even though many BcP therapists do not use touch or only introduce it tangentially.

The most comprehensive set of references to BcP exist on a CD-ROM Bibliography developed by the European Association of Body Psychotherapy (Young, 2002). There exists extensive literature on the healing power of touch (Field, 2001; Harlow, 1974; Montagu, 1971) and on touch in psychotherapy (Hunter & Struve, 1998; Smith, 1985; Smith, Clance, & Imes, 1998), yet Somatic Psychology has mostly been developed clinically. May (1998) conducted a comprehensive literature search over the previous 30 years and found 23 empirical BcP studies. A brief review of such studies follows.

The first major prospective clinical trial is currently underway in Germany and Switzerland (Koemeda-Lutz et al., 2003). In this study, eight major BcP outpatient clinics are measuring clients to study the effectiveness of BcP under natural conditions. Preliminary results are promising, finding that after six months of BcP treatment (n=78), small to medium effect sizes were reported across all clinical categories.

Ventling and Gerhard (2000) conducted a retrospective study of 319 former patients to study outcome and stability of the efficacy of Bioenergetic therapy with adults in a private practice setting. Drawing from the patients of sixteen certified Bioenergetic therapists, the authors collected data from former patients who had a mean of 91 sessions (modal 26-50 sessions), and who terminated therapy between 6 months and 6 years previously. The responses demonstrated that for 107 (75%) of the patients, Bioenergetic therapy proved effective to very effective and that the results had lasted from at least 6 months to 6 years.

Several studies have investigated the outcome of BcP using case study designs. Bourque (2002) collected pre and post-test data on four chronic pain clients who engaged in eight weekly “Somatics” sessions and found statistically significant decreases in pain and increases in pain-free activities in three of the four subjects. Employing a qualitative analysis of a single case, Bridges (2002) found that Bioenergetic therapy addressed the client’s “somatic defenses against affect” and significantly increased affective expression in a short-term psychodynamic treatment (McCullough et al., 2003a). Finally, also studying a single case, Price (2002) examined the effects of adding an 8-week adjunctive BcP therapy alongside an ongoing verbal psychotherapy for a woman with childhood sexual and physical abuse. The client demonstrated significant improvement on such standardized quantitative measures as the SCL-90-R (also used in the present study) in such areas as depression, anxiety, and obsessive symptoms, as well as decreases in her physical symptoms. In addition, the client qualitatively reported improvement in “feelings of safety, ability to tune in to internal processes, and ability to access emotion.”

A recent meta-analysis of massage therapy (MT) research, drawing from a wide range of sources (psychology, nursing, medicine, and kinesiology), found MT significantly effective for both physiological and psychological outcomes (Moyer, Rounds, & Hannum, 2004). Additionally, reductions in trait anxiety and depression were MT’s largest effects, similar to those found in psychotherapy meta-analyses. The authors speculate that combining massage and psychotherapy may significantly increase effectiveness more than either alone.

The present research builds on previous systematic, empirical studies to help fill the need for many more such investigations in BcP in order to create a solid scientific foundation for the field. Specifically, this investigation includes in-depth, systematic case studies involving qualitative process compared with standardized quantitative measures to examine how BcP integrates the body into psychotherapy, as seen through the work of Laurie Schwartz, M.S, L.M.T. (Licensed Massage Therapist), a widely known BcP practitioner with 25 years of practice in the field. The main questions guiding this study include: What does BcP therapy look like? What themes in BcP therapy are unique or distinguishing? And how does BcP therapy integrate talk and touch in a unified therapy? In addition, by looking at what is distinctive about a BcP approach, this study can begin to contribute to the questions of whether it is effective to combine talk and touch in a single therapy, and if so, what are the mechanisms of change in such a therapy.

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Marion Woodman Comments on Addiction

Tue, 22 Jun 2021 23:37:37 GMT

CELLULAR RESONANCE AND THE SACRED FEMININE: MARION WOODMAN’S STORY by TINA STROMSTED, PH.D.

The following is an excerpt from Dr. Stromsted's full article entitled above.

Body work is soul work.
Imagination is the bridge between body and soul.

~ Marion Woodman

Pull Quote from Excerpt below...

“I always try to grasp the metaphor at the root of an addiction. That varies. With food, it can be mother; with alcohol, spirit; with cocaine, light; with sex, union. Mother, spirit, light, union—these can be archetypal images of the soul’s search for what it needs..."

~ Marion Woodman

Excerpt on Addictions

Integrating shadow elements and working through addictions play a large role in Marion’s work.

“The trouble is that we lack basic respect for our bodies. There’s a complete denial of the sacredness of matter. And that is very much connected to any addiction. That’s certainly true of eating in our culture. It’s true of workaholics, too, because they don’t pay any attention to what they’re doing to their bodies so long as they can keep working eighteen, nineteen, twenty hours a day. … I think many of us cannot face the pain of our lives. So work is an escape, or compulsive relationship is an escape, or eating is an escape, until we weep when we look in a mirror (page 20).”

In working with addictions, Marion attends to the metaphor in the behaviors, holding a larger frame of reference in helping the addict understand the meaning of the patterns that accompany the illness.

“I always try to grasp the metaphor at the root of an addiction. That varies. With food, it can be mother; with alcohol, spirit; with cocaine, light; with sex, union. Mother, spirit, light, union—these can be archetypal images of the soul’s search for what it needs. If we fail to understand the soul’s yearning, then we concretize and become compulsively driven toward an object that cannot satisfy the soul’s longing (page 21).”

Marion feels that it is through contacting this deep soul longing and bringing it to consciousness, rather than simply treating the external symptoms, that our culture may be healed of the addictions that exist on such a massive scale. Her style in working with people is honest, direct, forceful, respectful, humorous, sometimes confrontational, and deeply supportive. Though Marion’s mother “had no sense of loving being a woman,” and Marion feels sad because she herself had no child, the mother archetype has been generously expressed through her work with thousands of students, workshop participants, and analysands—“un-mothered women” and father’s daughters who have benefited a great deal from the healing her work has provided them. Her own struggle with the death wish in anorexia is a testament to the work, which she models for women who wish to recognize and value their feminine being. Marion also models a feminine mode of leadership, working collaboratively with Mary Hamilton and Ann Skinner.

Their styles weave together naturally, as each takes turns leading elements of the work as well as supporting one another in the process, seeming like mother and daughters in one moment, while at other times like sister muses as they integrate their gifts.

Read Dr. Stromsted's full article entitled above.

See more publications by Tina Stromsted here.

Interoceptive Awareness in Body Psychotherapy Practice

Cynthia Price — Sun, 13 Jun 2021 15:07:45 GMT

A recent high-profile journal, Trends in Neuroscience, put out a special issue focused on interoception. The issue includes articles written by the presenters at a NIH-sponsored 2-day meeting on the science of interoception. The article titled Interventions and Manipulations of Interoception highlights the body-psychotherapy evidence-based approach Mindful Awareness in Body-oriented Therapy (MABT), an approach designed to teach interoceptive awareness. MABT teaches fundamental skills of interoceptive awareness and the more advanced capacity to sustain mindful interoceptive attention to somatic experience. This approach is particularly useful for clients who are disconnected from their bodies due to high stress or patterns of experiential avoidance, chronic pain or trauma. The non-profit Center for Mindful Body Awareness offers trainings to therapists so that they can learn to integrate this approach into practice in order to enhance client embodiment, self-awareness, and emotion regulation. The next professional training is in September 2021, click here for information and registration.

Resilient Somatics: a NeuroSystemics Perspective

Tue, 30 Mar 2021 00:14:38 GMT

In over 100 years of therapy, very little attention has been given to two elements of clinical practice: the body and positive emotions. Thankfully, somatic psychology and positive psychology have received increasing scientific recognition over the past two decades. This paper will explore ways in which somatics can contribute to the field of therapeutic healing, growth, and empowerment.

As humans, we are complex systems, which means that our functioning is organized through multifaceted and interdependent relationships. Through evolution, simple life on Earth manifested with a basic physiological structure, affect followed and culminating with cognitive capabilities. This evolutionary process grew out of a need to complexify adaptive responses to augment chances of survival. While cognitive analysis can be of great support to heal and grow, both the weight of physiological processes such as the nervous system and the strength of emotions and moods to influence behaviour provide important therapeutic routes for resiliency and empowerment.

Through its integrative approach to therapeutic conceptualization and practice, NeuroSystemics emphasize therapeutic interventions focusing on physiology, affect, cognition, and interpersonal dynamics. This paper will first briefly summarize the meta-developmental trajectory at the heart of NeuroSystemics’ conceptualization and range of therapeutic interventions. Second, a closer analysis of biological and affective dimensions of resiliency and empowerment will be described.

A meta-therapeutic methodology

NeuroSystemics is a clinical practice that can be applied in four settings: (i) mental training, (ii) individual therapy, (iii) group therapy, and (iv) community processes. They each correspond to the concentric circles of (i) sense, (ii) self, (iii) social and (iv) societal, respectively, in the following diagram:

In whichever setting, we attempt to engage with all the parts of that system as well as the system as a whole. Biology and affect, as holonic fractals, can be both parts and wholes, depending on the breadth of attentional focus and practice setting.

For example, in mindfulness practice, the emerging sensate networks of the in-out movement of the breath can be experienced as a dynamic wholeness with many interacting features. When attention is broadened, the spectrum of awareness may include. A sense of the whole body, in which the sensate rhythms of the breath would only be a part. The key here is to provide a firm foundation for understanding the interdependence of human experience, whereby any efforts towards differentiation necessarily imply consideration for integration and contextualization.

Baring this fundamental principle of complex functioning in mind, it is of great benefit to explore mono-developmental trajectories, where a single dimension of human experience such as physiology, affect or cognition is cultivated. The next section describes the way NeuroSystemics understands resiliency and empowerment through a differentiated lens of biology and affect.

Biological development

When considering the possibilities of somatic cultivation, development, and training, it is helpful to refer back to our evolutionary process. Porges’ polyvagal theory describes a fairly linear direction in terms of physiological responses to stimuli from reflexes to social engagement. See this diagram of it.

Reflexes are the most primal physiological responses to the environment. They arise based on sensory contact of comfort and discomfort. Freeze, a shutting-down of major physiological systems, was already a more elaborate form of response to reflexes. It increased the probabilities of survival by “playing possum” and escaping one’s prey after they become disinterested. Fight-and-flight offers more opportunities for a differentiated response to threat and social engagement and is the culmination of a multi-million-year process of refinement. This last system arises out of feeling a sense of safety and promotes curiosity, playfulness, and enjoyment.

A first important therapeutic goal, based on this evolutionary framework, NeuroSystemics uses elaborate maps, therapeutic conditions and interventions to support the emergence of social engagement. Porges’ neurophysiological findings have demonstrated that the freeze-flight-fight and social engagement systems are aroused in inverse proportions.

One key practice to sustain a socially engaged nervous system state is to encourage the clients’ self-organizing impulses. These impulses, also known as Chanda in Buddhist meditative texts and Eros in Freudian meta-psychology, are generative organismic drives towards health, clarity and well-being. Supporting them implies sensing into the clients’ system as a whole, while simultaneously differentiating its parts to identify signs of arousal and deactivation: physiology (prosody, facial expressions, agitation, etc) and free-associative process, their affective variations, their bodily movements as well as their quality of presence in relation to the therapist (i.e. trust, vulnerability, appreciation).

Intensity spectrum of physiological deactivation

When we work with the autonomic nervous system, we are walking a fine line between increasing the nervous system's backlog, or reducing it. Our aim in Neurosystemics (somatic-centered therapy) is to reduce it by reaching gentle and enjoyable thresholds (the edge of our client's window of tolerance) and then deactivating the system. You can assess the intensity of the threshold reach by identifying the symptoms of deactivation, which are on that spectrum above: the most subtle and easeful deactivation symptoms are spontaneous breaths and soft heat, and the most intense are involuntary movements and shaking. While some of the more extreme symptoms may sometimes be inevitable in our work, in NeuroSystemics we aim to have easeful and smooth deactivations so that our clients can stay oriented to the here-and-now and have better chances of integrating this somatic process easily in their daily life.

All these factors (and others) will provide valuable indicators to assess whether the physiological coherence and synchronicity are growing or diminishing. Therapists then adapt their interventions to provide more or less containment to shepherd a higher level of physiological resiliency.

Complexity science has also provided a number of essential findings to support us in biological maturation. It explains that increasing levels of organization emerge from phase transitions which occur by reaching thresholds at far-from-equilibrium states. Human physiology has non-linear patterns whereby rhythmic oscillatory movements between equilibrium (homeostasis) and far-from-equilibrium states (morphogenesis) enable increasing levels of metastability.

In terms of practice, this means that we will want to support our clients, in a gentle, progressive, and positively-valenced manner, to come into contact with physiological states which feel out of balance. By listening to the multi-faceted impulses (physiological, affective and cognitive), a cushion of resource and ease can help to soften, contain and eventually convert previously overwhelming sympathetic charge into regulating and organizing patterns of coherence and synchronicity.

In summary, the two directions proposed by NeuroSystemics to encourage biological maturation is to conceive of skillful means to sustain our clients’ social engagement nervous system states, as well as to ground their physiology in gentle and progressively increasing rhythmic oscillatory movements between homeostatic and morphogenetic states. These will enable greater physiological resiliency, somatic embodiment as can be indicated by heart-rate variability.

Webinar Materials for Treating Trauma and Addiction

Wed, 17 Mar 2021 00:09:14 GMT

In preparation for the interactive part of the webinar, Treating Trauma and Addiction with the Felt Sense Polyvagal Model: A Bottom Up Approach, please -

A. Download Your Body Card and Gather Crayons
1) download and print out one of the following body cards most suited to you, and
2) have at your disposal crayons to draw/write on your body card during the webinar exercise.

Pick the body card that best represents you:

To explore in advance elements of the Felt Sense Polyvagal Model check out these resources below. Some of them will be used in the webinar.

B) Review "The Primacy of Human Presence: From The Small Steps of the Therapy Process" by Eugene Gendlin

Review

C) Familiarize yourself with The Felt Sense / Polyvagal Model
1) Read model overview
2) Download diagrams to guide sessions with clients.
3) Get links to get familiar with Focusing and its six steps process.

Read, Download and Link To

Hakomi Mindfulness Exploration Concerning Marginalization

Mon, 15 Feb 2021 19:17:12 GMT

Are you a therapist in a setting working with underserved populations? Use this mindfulness exercise and contemplation for exploring marginalization and your and others' relationship to it.

Part 1. For this exercise notice how you organize around the statements to be read. Notice that our responses may be different based on how culture has impacted us.

Part 2. In this exercise, it can be helpful to explore the parts of ourselves that resonate with dominant culture and the parts of us that have been marginalized by the dominant culture.

Post Exploration Discussion Questions:
- Share (or journal) your experience of hearing the statements.
- What do you imagine might be evoked from someone who is marginalized as they hear these statements?

If you like this Demo please like it on YouTube and subscribe to our channel. Spread the healing. Share this demo with another using this link: https://youtu.be/svAi4MWdqhw

There is a course we offer, in partnership with the Hakomi Institute, that further explores the topic of marginalization. It offers somatic activities to enhance your work with clients. For advanced students of Hakomi this webinar brings a fresh take on utilizing Hakomi with underserved populations. It is presented by Rebecca Lincoln, LPC-S, Certified Hakomi Teacher.

Earn 2 CE credits when you watch and take the course, Hakomi Mindful Somatic Psychology with Underserved Populations

You can also watch it here free... but you need to be a member of the USABP.

Learn more about the Hakomi Institute.

Video Credits include
- Presenter Bio Rebecca Lincoln, LPC-S, Certified Hakomi Teacher

Rebecca is a Licensed Professional Counselor and board-approved supervisor in the state of Texas. She specializes in working with trauma, grief, anxiety, depression, and personal growth. She is a certified therapist in Hakomi Mindful Somatic Psychology and a certified Hakomi teacher. She has additional training in several modalities including EMDR, and spiritually integrated psychotherapy. When working with Ms. Lincoln, expect to consider the aspects of mind, body, and spirit in your healing process. Ms. Lincoln is open-minded, loves to laugh, and is interested in knowing who you are and what is important to you.

She also loves mentoring interns. If you are an LPC intern looking for supervision for full licensure, send her a message to set-up a phone call to discuss details.

Edited by Liam Blume, CPRA

Learn the Possibilities of Virtual Touch: Its Power, Value & Benefit in Telehealth Care

Thu, 12 Nov 2020 19:12:43 GMT

In this video presentation below, we are excited to introduce to you the possibilities, value, benefits of using virtual touch. We will provide simple step-by-step instructions on how to incorporate the beginning experience of touch into your sessions or with others you want to connect with. A significant portion of the presentation will be dedicated to a demo from which you can experience and learn from.

Coming soon! Get the Full Home Study Training for Virtual Touch at our Somatic CE Center. 2 CE Credits will be available.

The full method of Transformative Virtual Touch in Telehealth Care recording is free to USABP members and paid registrants.

Expand your skills… Transform yourself.

Visit Our Somatic CE Center

If you like this Demo please like us on YouTube and subscribe to our channel. Spread the healing. Share this demo with another, https://youtu.be/DAMc_VHBsEs

Covid-19’s arrival has disrupted one of the ways that we touch our clients, that is, physically with our hands. This loss of physical contact creates tremendous anxiety because gentle, caring touch is the bedrock of safety. It allows for and promulgates the release of oxytocin which is a critical hormone that ameliorates sensations of feeling unsafe.

In response to this loss, we turned to the myriad of other ways we could still provide touch for our clients in order to bridge the isolation that sheltering at home was creating. We are now doing virtual sessions across the globe and have come to the recognition that virtual touch is an efficient and effective way to heal during Covid times and even when Covid becomes a distant memory. Possibilities abound!

This post is a part of our "Insider Look" and "Somatic Self Care” Series. This episode has been brought to you in part by Joe Weldon and Noel Wight Co-Founders of the Somatic Therapy Center.

The USABP has been integrating body and mind for effective psychotherapeutic health since 1996.

Our USABP Somatic Continuing Education Center offers in-depth courses for health care providers. Enroll Now. It’s Free. At https://usabp.teachable.com.

There you can take the courses from many luminaries in the field of Somatic Psychology and Therapeutic Training such as from Noel Wight & Joe Weldon Ph.D. and more. Such as Stephen W. Porges Ph.D., Babette Rothschild, MSW, Dr. Alan Schore, Judith Blackstone, Noel Wight & Joe Weldon Ph.D. Learn more about the Somatic Therapy Center work at https://www.thesomatictherapycenter.com

Become a member of the USABP (Association) first and pay just $15 per CEU. Go to https://usabp.org/Join-Us

With membership, you'll get the next 12 webinar training programs FREE, access to our library of training programs, a subscription to our peer-reviewed somatic journal, and more.

FREE Exercises, techniques, skills, case studies and more resources are available here on this site. Check out all our sections.

Subscribe to our USABP Highlights and Viewpoints email sends, at https://usabp.org/home#subscribe.

You'll be informed of our next posting, zoom webinars, book reviews, journal releases, research findings, case studies, and special VIP invites.

Video Credits include -

Presenter Bio
Joe Weldon- Co-Director, Licensed Psychologist, Master Somatic Therapist

Unable to walk until the age of five imbued in me a deep respect and regard for the traumatic experience of the loss of movement. In a Somatic Therapy session, I will help you differentiate your essence from the injuries that have happened to you. This will help you restore movements to your being that are necessary for you to live a life with ease, joy, and meaning. When full and free movement is restored then love becomes visible and viable. Come for a session and restore the lost, taken away, and forgotten movement that is your natural birthright.

Thousands of clients seeking to restore movement to their bodies and transform their lives are now moving about more freely and easily because of the gentle transformative touch I have skillfully provided them. Hundreds more have learned the fine art and skill of Transformative Touch in our one-of-a-kind somatic therapy training.

Produced, Edited and Hosted by Liam Blume, CPRA- Integrated BodyMind Therapist at https://www.Soulworkla.com
- Director of Marketing and Content Curation for the USABP

The Art of Listening, Empathy and Pause in a Somatic Psychotherapy Session

Wed, 21 Oct 2020 03:58:41 GMT

Insider Look: Watch Focusing-Oriented Therapist’s Approach to Deepening a Somatic Psychotherapy Session

This 5-minute video was created by Jan Winhall and Serge Prengel. It is based on an actual session, but the client is not visible, just the therapist. It is meant to give you an experiential sense of what a Focusing-oriented therapist might do in a session. There are different perspectives, approaches, and styles in Focusing-Oriented Therapy (FOT).

What would you do if your were a Focusing-Oriented Therapist?

connecting with the clients experience
staying with the clients experience
deepening the clients experience
staying emotionally present
making space for the clients experiences
a felt sense emerges from the experiences
staying with the feast sense
finding a handle to express the felt sense
an experience that becomes an embodied resource

View Presentation Now

3 Types of Listening and Insights on How To Use Them.

You have seen the stages of a FOT session above. One key to what went in to the therapist's response above is her listening and empathy.

In the audio below join Kathy McGuire and Serge Prengel as they explore deeply both listening and empathy. They look at 3 forms of listening. Serge, in connection with his exploration with Kathy, conveys in his blog the following:

"1) Even simple listening, “passive listening” without interruptions, allow speakers to naturally begin entering into direct reference to felt experience and explication from there.

2) Active empathic listening takes this natural felt sensing a step further, as the speaker checks the listeners words against their felt reference and articulates anew.

3) When the speaker knows Focusing, then empathic listening helps the Focuser stay with, check, resonate and articulate their felt sense in the deepest way."

In watching the audio below or the videos, Serge notes, "please pay attention to the central role of the pause: Notice how taking a pause opens up direct access to felt experience. In this context, felt sensing is the natural outcome of the pause. As is empathy."

Serge goes on to note that in observing these recorded exercises you will get a sense of how deeper creativity and change can come through in relationship to another using these practices. He also goes on to say, "These skills can be also brought directly into interpersonal conflicts: Somebody who has seen our passive and active listening videos might jump in as a “third person listening facilitator.” Similarly, these skills can be used in group decision-making situations, as the Quakers do with “passive listening.”

Listen Now

How to Stay Grounded and Centered in Any Situation

Wed, 21 Oct 2020 02:39:12 GMT

These two video posts come to you from our "Insider Look" and "Somatic Self Care” Series found on our USABP YouTube Channel. This episode has been brought to you in part by Judith Blackstone and the Realization Process.

GROUNDING
In this first video below, learn to Ground yourself so you can reduce anxiety, disentangle yourself from others, experience coherence, and connect better with others.

This presentation teaches the Realization Process exercise: Foundational Grounding. Because anxiety is an upward movement in the body (“my heart was in my throat”), we can alleviate anxiety by settling into seven foundations in the body: the feet, pelvic floor, respiratory diaphragm, collar bone area, base of skull and jaw, eye sockets and top of head. These foundations allow our emotional life and our mental life to settle and rest.

We do this exercise sitting and then remaining settled in the foundations while walking.

CENTERING
In the video below, learn to Center yourself so you can have a more present-day response in working with others, make deeper connections, and have the ability to stay open to more intense states of others.

This presentation teaches the Realization Process exercise: the Core Breath. Helping you to live and breathe in the core of your being. It helps you find and breathe within the center of your head, chest, and pelvis. This can help you find a place of calm and stillness within yourself, no matter what is happening around you. The subtle vertical core of the body is experienced as your deepest connection with yourself, and your deepest perspective on the world around you. To live there feels disentangled from your surroundings and from other people, but not detached. You can still respond, even more deeply, but without getting entangled in habitual modes of reaction.

We do this exercise sitting and then walking while remaining in the core points.

Additional benefits of these two exercises include helping people (such as therapists, co-workers, family members, etc.) to have a more present-day response in working with others, deeper connections, and the ability to stay open to more intense states of others.

Unpacking Shame on the Internet, Part 1

Sat, 12 Sep 2020 04:30:00 GMT

By Sheila Rubin, LMFT, RDT/BCT

(Adapted from my chapter "Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet" in the book Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients by Stephanie L. Brooke, editor.)

PART ONE

I begin this article about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Porta Pak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before this book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype or Zoom if I have met the client at least once in person. I have come a long way.

Therapy on the Phone or Internet

Therapy, on both phone and internet, is with individuals or couples. When I am not physically with a client, I find that I check more often for feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session. For example: Make a list of the coping skills from the session and put them on your calendar day by day. Or: Take the powerful objects from this session and put them out in your room at home with a note by each to remind you what we did in the session today. If the session helped them find a vision to support the marriage, we have that symbol, like a strong tree holding both of them as they deal with difficulties during the week.

Concerns about Technology

What about when technology fails? When a person just revealed something they’ve been hiding and the screen suddenly freezes? A while ago, I was in the middle of a Skype session where a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted with my frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone, and by the time I reached them, the tender moment had passed and they were fighting again. I had to slow things down and gently find the words to tell them about the negative cycle their communication was in and how to do a repair to get out of it.

As Kaufman says, shame is the rupture of the interpersonal bridge (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame. And this couple was experiencing a disruption in connection. I was eventually able to use the symbol of disconnection because of the unpredictability of the internet as a way for each of them to have a role of explorer rather than blaming each other.

What I realized was I have to let clients know ahead of time about the constraints and the benefits of using the phone or internet for therapy. It will save them time coming to my office when they are in a difficult place, but it may not be as contained as an in-person session.

One couple was struggling with the husband having had an online affair and the wife needing to check his phone in order to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get agreement before we began to talk:

Because we are not face to face, I can’t just interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying, so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, and each of us is on a cell phone, if one of us gets disconnected for any reason we need to have a plan. Are each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected. Call me back on your phone and I will use my phone to accept both calls.

Shame During the Session

In my chapter in The Self in Performance, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.”

When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the screen, I don’t know what they are experiencing and truly expressing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride, when we are seen in a good light, and shame, when we make a mistake or are seen in a less than favorable light. Diana Fosha (1992) later wrote that we call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember when a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.

Listen for Subtle Signs of Shame

In the chapter “Treating Family Systems with Shame and Addiction Problems,” Ron Potter-Efron wrote that:

Clients do not always directly communicate their experience of shame with their counselors. Rather, they may hint at their shame through relatively subtle cues, downcast eyes, sudden speech stoppages, avoidance of an apparently innocuous topic, unusual phrases, and so forth. They may also speak at length about other emotions regarding a particular experience without adding that they also or even primarily feel shame about it (p. 230).

He suggests the importance of the interactive process between the therapist and client can even be more important than the client actually disclosing the feelings of shame because the client expects that the therapist will dismiss them. He explains, “Shamed clients have a specific hope, not necessarily stated, within the counseling relationship. They desire to reveal everything within them that feels dirty, disgusting, and defective. They seldom reveal all this material immediately and may never be able to share some of it” (p. 229). He explained how the therapist needs to gently layer by layer work carefully and not reject the client as they reveal more levels of shame during the sessions.

Internet Therapy

The good news is that the internet can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of having the direct eye contact family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting and reported being filled with rage because her son didn’t call her as often after his baby came, and because the other grandparent was being invited over and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents, and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her frustration. I invited her to role play the visit with the grandchild. She rocked back and forth. Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invitations to visit increased.

Containment

Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. There are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.

Case Example of Phone Session

This client was feeling dark. Her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

Client: “He’s still in the role of letting his ex-wife rely on him. I couldn’t stop crying for hours. My emotions got all wacky or something. I see his side when he’s helping his kids. But every act of his kindness is an act of affection toward his ex-wife. One day it’s good between us, and the next day I feel ignored, neglected.”

Therapist: “How about if you choose something in your room to represent your feeling neglected and ignored.”

Client: “OK, this plant.”

Therapist: “Can you move it near you and look closer at it? And as you are looking at it, what does it say to you? What does it symbolize?”

Client: “You have to pay attention to a flower. You have to water it or it dies!”

Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be very powerful metaphor. Having it in front of her helped her to focus on it during the whole session.

Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels because he’s with his ex-lover. Why am I punishing myself? I could go out and be in another relationship!”

Therapist: “So there’s another part of you that doesn’t want to be punished any more, that wants to find another relationship, one where the guy is choosing you instead of choosing his ex. Can you look around the room and find an object that represents this part of you?”

This is another place I want to pause the session and give her time to feel the power of what she just said. I want a symbol for that part so we can talk to that part as well, maybe have a conversation with both of them.

Client: “This candle!”

Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

Client: (Surprised) “There’s a light in it! I can attract things… People! But I’m not ready to move on.”

Therapist: “Can you give each a voice? What does the flower say and what does the candle say to you?”

The candle told her that she is bright inside when she’s not so depressed, worrying what is going on with this guy she’s dating. It gives her inspiration to grow herself and step out of the relationship to a real relationship where someone could really be available for her. As she was expressing this, another feeling showed up.

Client: “I feel deep anxiety.”

Therapist: “Where is the anxiety in your body?”

Client: “My diaphragm.”

Therapist: “Can you put some space around it and take some slow deep breaths?”

Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He says kind things to me, offers to work it out. I really care about him. He’s clear about his intention that he wants to be with me!”

Therapist: “There are a lot of conflicting feelings.”

Because we are on the phone, I want to keep the connection and let her know that I am here and that I hear her.

Client: “I’m scared. Lonely.”

Therapist: “Yes, there’s a part that’s scared and lonely.”

I want to support this part.

Client: “It’s like a pouting child!”

And it feels like she is putting down that part. It is like some part of her is shaming that part of her for wanting what she is wanting.

Therapist: “I wonder… I’m curious if there is some shame around that part?”

Client: “Yes.”

Therapist: “Can you look around and find an object to represent the part that comes out and shames you when you talk about your attachment needs?”

Client: (Apparently looking around her room for a few moments) “A hat.”

Therapist: “How does a hat represent shame?”

Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

Client: “Yes. If I’d recognize those things, logically, I would leave.”

Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him, and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

Client: “He told me he couldn’t have me over because he didn’t want his neighbors to think I was a homewrecker because his ex just moved out. So now I feel shame for wanting to come to his house. It’s been over six months we’ve been dating. So when is he going to tell people?”

Therapist: “How did you feel when he said that?

Client: “Insecure! Nerves all over my body. On edge!”

Therapist: “What did the nerves say?”

Client: “Run!”

Therapist: “And what did you do when you felt that strong urge to run?”

Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

Client: “Yes. That was terrible. But I want to give this guy more opportunity, more time to show me that he can make the life for us he is always promising. I want to give him the benefit of my doubts. I want this relationship to work.”

Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

Client: “The plant says, ‘You’re making yourself suffer!’”

Therapist: “What does the hat say?”

Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

Therapist: “What does the candle say?”

Client: “It says that I don’t need to shame myself for my feelings. I have light inside me. I need to remember.”

I’m wanting her to stop here and reflect and to work to understand if maybe there is something here for her to be shameful for. That would be a form of healthy shame.

Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she is doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things in a different way. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, ‘What did I get from this session?’ Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions.”

What does the plant say?
What does the candle say?
What does the hat say about how you shame yourself?
Listen to the shame and feel if there is something of value here or if it is just putting you down.

Is there part of it that is valid?
Is there something to listen to that is actually shaming for a reason in this situation?
Is there something here from a past relationship or a situation where you felt shamed?
Is there something you feel shy about?
Is there something for you to learn about shame here?

In Dancing with Fire, A Mindful Way of Loving Relationships (2013) John Amadeo writes “Stumbling into adolescence and adulthood we may continue to hear the message that we are too selfish, needy, or flawed to be loved. The resulting isolation generates emotional suffering that is often unbearable. This begins an epic journey of scrambling to figure out who we need to be in order to win love and connection” (p.23). He writes that we lose the thread of connection with ourselves. “Shame prompts us to seek affirmation and approval rather than connection and intimacy. We look outside ourselves to sense whether we’re emotionally safe” (p 111). Many people end up looking outside themselves to find out how they feel or even what they should be doing.

See part 2 for the continuation of this article.

Unpacking Shame on the Internet, Part 2

Sat, 12 Sep 2020 03:05:10 GMT

PART TWO

Understanding Shame

Shame is a primary emotion. The role of shame is to warn us and protect us. Our nervous system shuts down and we actually lose cognitive ability when we are feeling ashamed. Two indicators of shame are confusion and stuckness. Shame can freeze both mind and body. Shame is so difficult to see and cope with because it often hides behind other emotions. Shame is wired into our nervous system to protect us by lowering our emotional intensity and capacity to act. It is important to differentiate healthy shame, which can help us pause and rethink, from toxic shame, which can produce paralysis and leave a person so frozen that he or she is incapable of action and clear thinking. Healthy shame can lead a person to take responsibility for his or her actions, reassess, and make changes.

Daniel Hughes, in Attachment Focused Family Therapy, writes that shame places a person in a fog that gets in the way of the intersubjective experience of being understood with empathy that can help a person gain understanding and acceptance. Also, shame itself can prevent a person from being able to reflect on their behavior or experience (p. 184). In the Eight Keys to Safe Trauma Recovery (2000), Babette Rothschild notes that “shame, quite simply, tells us that something is amiss” (p. 87) and that “Rather than discharge, as an example in yelling or crying, shame dissipates, when it is understood or acknowledged by a supportive other. More than any other feeling, I find that shame needs contact to diminish” (p. 92). Rothschild describes a process for deciding when to address shame, understanding the value of shame, apportioning shame fairly, and sharing shame (pp. 98–100).

Shyness

In the book The Authentic Heart, John Amadeo explains shyness can actually be a friend. “Shyness is an entrance into a tender fold within your authentic heart” (p. 110). But shame can cut both ways. “shame can be debilitating when you’re ashamed of your shame” (p.70). By replacing control with trust and by beginning to trust and express feelings, shyness can serve as a guide to use shame in a healthy way. One of my clients reported the comfort of shame like a blanket, like a burka, covering her grief after the sudden loss of her father and the shame of friends who expected her to just return to work after her three days of mourning period. Many clients let this feeling of extreme shyness, even social anxiety get in their way of making friends or living their life.

Role Development

In the chapter “Psychodrama” by Antonia Garcia and Dale Richard Buchanan in Current Approaches in Drama Therapy by David Read Johnson and Renée Emunah, editors (p. 396): “Moreno believed that the self emerges from the roles we play. He postulated that when people learn a new role, they follow a particular pattern of role development. The arc of the learning curve begins with role taking and proceeds to role playing and role creating.” The authors also say: “Dysfunction occurs when a person has a lack of either social roles or psychodramatic roles, and function is seen as having a balance of both.”

First, a person can’t imagine a certain role, so I tell them a story about someone who had that experience. Then I may suggest a conversation that that person may have. Moreno wrote that “In order to develop functionally, each of us must first be doubled as newborns” (p. 43). So much of the work I do in the therapy session is about mirroring the client.

This list is from my chapter “Almost Magic: Working with the Shame that Underlies Depression” in The Use of the Creative Therapies in Treating Depression, edited by Charles Meyers and Stephanie Brooke. I wrote a series of therapeutic processes to work with shame that can be used over the internet as well, as I describe in the case that follows (p. 236).

Working with Shame

Counter-shaming: Help the client experience a series of successes. Focus on strengths.
Grounding
Contribute some personal sharing to join with the client and show humanity, join them in imperfection.
Provide psycho-education about shame.
Mindfulness or observing ego
Use objects or symbols to externalize shame and process current shame.
Separate shame from other emotions. Objects or scarves or pillows can be used as symbols.
Use projective or embodied processes to explore where the shame may have originally come from.
Introduce a protector.
Find aesthetic distance for the client to work with the shame.
Use projective or expressive processes to work with the shame.
Find the person’s true voice.
Give back the shame to where it came from.
Witness the powerful healing taking place.
Embody the new role, the new voice. Try a posture or movement.

A teenaged client complained of feeling “a presence watching me sometimes.” As we worked, I wanted to understand about the presence she sometimes felt while undressing and also when she got home from school. I wondered if it was perhaps an externalized voice of her inner critic, so I asked general questions about how she felt at school, at home, and listened for something that said she might feel judged or criticized. I asked when she felt the presence most strongly. She said she felt it most strongly in school when, even though she knew the answer, she felt shy to raise her hand, worrying that the other person would be thinking that she would give the wrong answer and that maybe wasn’t smart. She had fears of letting herself down and letting down her family. Over time I normalized her concerns by telling her that some of the developmental jobs of this particular time in her life were about comparison and finding her way socially as well as academically. I shared briefly about my shyness in high school and ways that I overcame it. This helped to normalize what she was going through and model that it was possible to get through it.

I helped her begin to feel inside her body by doing grounding exercises and stomping her feet. At some point she could feel inside her body and began to feel lighter and more hopeful. The next time she felt the presence was on a trip, and she was able to use coping skills to put her attention on other things. During one Skype session we used symbolic imagery to represent the part of her that was afraid that if she showed up as her real self in school, and people still didn’t like her, then she would feel destroyed. Describing the imagery helped her to develop empathy for the part of her that needed protection.

In one session I asked her to imagine a movie or play with similar characters to the situation the client is coping with in her life, like a waitress and a customer. I said, “Let’s say the waitress made a mistake with the order. And in the first scene, let’s say the customer is a mom who used to work as a waitress. How would the girl who was a waitress feel? Terrible, just terrible. And if the customer left a big tip then the waitress would realize that she had gone through the whole dinner remembering her mistake and thinking about it.” I asked, “Would you have compassion for the young waitress? You know how hard a job that is and she is just learning.” My client replied, “Yes, but you know, if the woman gave her a big tip it is because she probably thought she was a loser.”

“Wow,” I said, “That’s pretty critical. Let’s change the scene. Same kind of scene, but a different movie. Let’s say it’s the same waitress and the customer is someone her same age. Let’s say he’s a guy this time, a cute guy. So how would the waitress feel if she made a mistake at his table?” “Even worse,” she said. “So much worse, because he’s someone she wants to impress. That would be horrible!!! She probably would just feel like she’s wrong for even thinking he was cute, if she made a mistake with his order.” “And what about the tip? What if he left a big tip?” “That would be the worst,” she said. “Why?” I asked. She sighed and said, “If it was someone her own age and she made a mistake, that would be horrible.” “Why?” I asked. “Because he would know how awful she really was.”

As we discussed the imaginary scenes and went into detail exploring the different levels of imagining embarrassment, my listening to her rather than judging her allowed her to share the level of inner criticism she was coping with.

“So is there something you could tell the waitress about each of those scenes?” I asked. “Given that it’s a new job with a high learning process, what would you tell the waitress, if you could, to reassure her?” I asked her to replay the scene one more time, then said, “If you could go back and change one thing after the mistake, what would it be?”

For the first scene my client had the waitress tell the female customer how sorry she was, and that she was just learning this new waitress job. I asked her to imagine how the woman would respond. She said, “She might laugh in a kind way and say that she remembers what it’s like to learn something new.”

I asked her how that felt. She paused and said, “Not so bad when we talk about it.” I had her go back into the second scene with the cute guy. She imagined telling him later that it was her first day, so of course the job was new. She imagined the waitress then joking with the guy and both of them laughing! I asked, “How does that feel?” “So much better,” she said. I asked, “So how does your body feel?” She replied, “Lighter… A little more space.” “Where is the space?” I asked. She pointed to her chest. We both breathe a sigh of relief together over Skype.

As we unpacked the scene, she admitted surprise at how easy it was to imagine the waitress talking about her mistake and saying what was happening for her instead of keeping it all inside! I asked about the feelings of embarrassment. She said they were much less. And she couldn’t wait to practice this next week. I ask what she’s taking from the session, and she reports feeling lighter and less worried about the pressure she has been feeling.

I explained that we were working on several levels. One level was giving her tools to cope with the experience of the presence and the shyness. On another level we were working with symbols to understand the role that the presence had for her and other ways to relate to it. On another level we were working developmentally about what it is to be female in high school and all the issues of dating, finding her place with the other kids socially and intellectually. She began to understand that the presence was something she could gain more control over, by shifting her focus away from it by talking to family, friends, and getting busy with schoolwork. Eventually she realized she had gained a different relationship to it and it bothered her less and less. As she became more comfortable with saying what was going on with her instead of hiding behind her shyness, friends started to reach out to her more and she didn’t feel as alone.

The power of somatic imagery helped. Role plays that we did over Skype helped. The eye contact we had over Skype helped her feel normal and that this was part of her life journey. She reported learning to laugh at herself, something that had been very hard, in a way that was counter-shaming for herself and the other person. She reported that it took the pressure off of herself and the other person when in an uncomfortable moment. She said that sometimes she wasn’t worried what the other person was thinking.

Along the way we found things she could say in her new role of power, taking her locus of control back: “I’m committed, I’m ready, I’m in control. In sessions she felt a calmness in her body and a relaxedness. That’s how I would track. I would track her aliveness returning in the sessions. She first felt like a cold fish. After each session she felt a little more hopeful and a little surer of herself. Her somatic awareness also increased. She became more hopeful and began taking a few risks by sharing more what was going on with her. We found a way for her to talk to herself in a kind counter-shaming voice inside.

Imagination Activated via Drama Therapy and Expressive Arts Therapy

From our workshops and from an unpublished paper on “Healing Shame in the Imaginal Realm,” Bret Lyon, Ph.D. and I present that:

When a person gets stuck in shame, the most powerful way to get unstuck may be to activate his or her imagination. In the imaginal realm, logic and time are fluid and flexible. What actually happened can be explored and changed. What was stuck can be reexamined and shifted. Shaming situations from the past can be revisited, excavated through writing and expressive exercises, and thereby shifted. There are ways to give back the shame to where it belongs—through drawing, writing, and imagining past shaming experiences and saying now what you wish you had said then. Structured writing and expressive processes can symbolically give back the shame. This is where to find resilience.

This work needs to be done with extra care when the session is over the internet, because the person can quietly slip into the shame vortex. I develop exercises to help them have something to hold on to during and after the session.

Renée Emunah, in her book Acting For Real (1992), writes about “Drama Therapy as the intentional and systematic use of drama and theater processes to achieve psychological growth and change.” Psychodramatist and child psychiatrist Adam Blatner, expounded in “Foundations for Psychodrama” that psychodrama can offer a place for expressing unexpressed feelings and even replaying scenes of the past, expressing feelings now that have not been expressed, and for opening new possibilities for the future.” There is the idea of surplus reality in which a person can play with and change a conversation or an event that happened in the past where they felt shame and replay it to take a new role. The idea of act hunger that can be explored where unexpressed parts of a person can be invited into the psychodrama scene. Sometimes I use psychodrama just sitting with a client and ask them to imagine some things.

Conclusion: Working with Counter-Shaming Metaphors

There is much to be explored in this new world of online therapy. There is much to be explored. There is much to be created. I am excited about being able to reach people who don’t live near me and to do work online. I am excited about developing ways to work through shyness and awkwardness and shame using a combination of drama therapy, expressive arts and attachment work/psychotherapy. What I realize is that because they are home or at work when we do the session, they can actually have a power symbol or drawing or object on the shelf that we work with during the session and put on their desk or shelf behind them to help them keep ahold of the changes between sessions.

References

Amadeo, J. (2001). The Authentic Heart: An Eightfold Path to Midlife Love. New York, John Wiley and Sons.

Amadeo. J. (2013). Dancing with Fire, A Mindful Way to Loving Relationships. Weaten, Il, Quest Books.

Blatner, A. (1988). Foundations of Psychodrama: History, Theory, and Practice. New York, NY: Springer Publishing.

Emunah, R. (1994). Acting for Real: Drama Therapy Process, Technique, and Performance. New York, NY: Brunner/Mazel.

Fosha, D. (2000). The Transforming Power of Affect: A Model for Accelerated Change. New York, NY: Basic Books.

Graham, Linda. (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being. Novato, Ca.: New World Library.

Lyon, B. and Rubin, S “Through the Looking Glass, Using Imaginal Resources to Heal Shame; A Workshop for Therapists,” an unpublished paper, Berkeley, CA

Hughes, D. A. (2007). Attachment-Focused Family Therapy. New York, NY: Norton & Company.

Potter-Efron, R. (2011) “Therapy with Shame Prone Alcoholic and Drug Dependent Clients.” In Shame in the Therapy Hour by Dearing and Tangney, APP

Johnson, S. (2005). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds, NY, NY. The Guilford Press.

Kaufman, G. (1974). “On Shame, Identity and the Dynamic of Change.” Paper presented at the annual meeting of the American Psychological Association, New Orleans, LA. Retrieved from http://files.eric.ed.gov/fulltext/ED097605.pdf

Kaufman, G. (1992). Shame: The Power of Caring (3rd ed.). Rochester, NY: Schenkman Books.

Nathanson, D. L. (1992). Shame and Pride: Affect, Sex, and the Birth of the Self. New York, NY: W. W. Norton & Company.

Rubin, S. ((2015) “Almost Magic, Working with the Shame That Underlies Depression; Using Drama Therapy in the Imaginal Realm,” in The Use of the Creative Therapies in Treating Depression, eds. Brooke S. and Meyers, Springfield Illinois, C. Charles Thomas.

Rubin, S. (2007) “Self-Revelatory Performance” in Intercalative and Improvisational

Drama: Varieties of Applied Theatre and Performance, ed. Blatner, A. Universe.

Rubin, S. (2017). “Unpacking Shame and Healthy Shame: Therapy on the Phone or Internet.” In S. L. Brooke (Ed.), Combining the Creative Therapies with Technology: Using Social Media and Online Counseling to Treat Clients (pp.187-198). Springfield, IL: Charles C. Thomas.

Schore, A. Affect Regulation and the Origin of the Self: the Neurobiology of Emotional Development. 1994 New Jersey, Lawrence Erlbaum Assoc. Publishers.

"Somatic Self Care" Series from the USABP

Thu, 02 Jul 2020 05:14:55 GMT

This series was created to empower people in challenging times and everyday life. We are bringing to the public short resourcing exercises to regulate body and mind.

In challenging times, when stress and anxiety run high, nurturing your body-brain and mind is more important than ever.

Maintaining presence and equanimity depends on your capacity to mindfully align sensations, emotions, and thoughts.

These short somatic exercises, generously offered by our members, teach you how to use your energy, emotions, and awareness so that you can face challenges with confidence, and step into your life feeling connected and empowered.

Use them for yourself and with your clients.

View this series in its entirety on Youtube.

Visit the Channel

Episode 1:
Simple Movement to Ease Your Anxiety - Dave Berger

Watch

Social Justice, Anti-Racism, Cultural Misattunement Resources

Sun, 21 Jun 2020 02:50:45 GMT

Below you will find resources for addressing this topic. There are links and people that have been referenced in USABP circles. You can also reach out to our member organizations as well. Please email us with any of your suggestions. The list and site presence will build out over time. Thank you all for your contributions.

Member Organizations often include webinars, workshops or specialize in training activity to address social justice, anti-racism, diversity, systemic racism, implicit bias, polarization and more.

See a list of our organizations and the ways in which they assist in this issue through Somatic Psychology, Body Psychotherapy and other Somatic-based Therapy Practices

VIEW ORGANIZATIONS

Radical Aliveness Institute is a USABP Official Training School addressing somatic and systemic issues world wide from US to Central and South America to Africa and the Middle East.

LEARN MORE

A List of Member Organizations' Helpful Resources

NARM & Cultural Misattunement Webinar: Addressing the Impact of Cultural Trauma from Systemic Oppression with NARM Therapist Claude Cayemitte, MSW, CCTP hosted by NARM Training Director and Senior Faculty Brad Kammer, LMFT, LPCC

Two podcasts brought to you by the NARM® Training Institute

Transforming Trauma, Episode 013:
Addressing Systemic, Cultural, Racial, and Complex Trauma with Claude Cayemitte

LISTEN

Transforming Trauma Episode 015:
Post-Traumatic Growth in Communities of Color and NARM in the Classroom with Giancarlo Simpson

LISTEN

> To view one has to be a member and logged in to there account.

Working with Polarization and Trauma in Groups: how to work cross-culturally and cross-nationally

Presented by Ann Bradney, CCEP, CPRA
Founder of the Radical Aliveness Institute

WATCH NOW

Embodied Activism: Getting a Grip on Social Justice and Moral Courage in Somatic Psychotherapy
Presented by Rae Johnson, PhD, RSW, RSMT, BCC

WATCH NOW

A Thousand Paper Cuts - Grasping and Transforming the Trauma of Embodied Micro-aggressions
Presented by Rae Johnson, PhD, RSW, RSMT, BCC

WATCH NOW

Privileges and Perils of Power

By Dr. Cedar Barstow, M.Ed., C.H.T., D.P.I.

Power, simply the ability to have an effect or to have influence, is a magnetic, addictive, and corrupting force. Research shows that taking on higher role power or having higher rank power inevitably changes you. You are given gifts, actually privileges, from the outside world that change how you see yourself, how you see and relate to others, and how they see and relate to you. The greater the power difference the greater the effect. These privileges change you whether your intentions are for service or for selfish gain.

READ ON

USABP Somatic Practitioners

Somatic Experiencing Practitioners specializing in matters related to the Criminal System

USABP MEMBER ACTION RESOURCES
Directory, Organizations, Books, Trainings, and more

Dr. Rae Johnson
Embodied Social Justice introduces a body-centered approach to working with oppression, designed for social workers, counselors, educators, and other human service professionals. Grounded in current research, this integrative approach to social justice works directly with the implicit knowledge of our bodies to address imbalances in social power.

USABP Member Nola Butler-Byrd
Nola Butler Byrd, Ph.D., LPCC is a Certified Radix Practitioner and a Licensed Professional Clinical Counselor. She is also an Associate Professor and Director of the Community-Based Block Multicultural Counseling and Social Justice Education Program

USABP Member Zeshan Mustafa, CCEP, JD, RYT
Specialties with Somatic Support:
BIPOC, Anti-Racist Activists, and Codependents.

Author of:
"When Helping Is Not Helping: a Somatic Approach to Working with Clients of Color."

Take the Implicit Association Test (IAT) to Measure Your Bias:

Test me

The IAT

At the heart of the book Blindspot: Hidden Biases of Good People is a method called the Implicit Association Test (IAT) which was designed by Tony Greenwald to detect the hidden contents of the mind. Its original application was to explore the group-based preferences, stereotype, and identities that may not be accessible to conscious awareness. Since then, it has been used widely to study preferences, beliefs, and identity, and found applications in domains of health, education, business, government, the law and law enforcement. The test is currently available at 39 country sites, in 25 languages.

Free Racialized Trauma Course

Google Drive link to comprehensive educational reading, tools, exercises and organizations to help explore this topic from many sources.

Take me to these links

Engaged Citizenry

Andrew Goodman Foundation

Research

BU Center for Anti-racism Research

Featured Body Psychotherapists, Speakers, Authors and Trainers

Resmaa Menakem
Coins the phrase White "Body" Supremacy and has exercises for one to work through to embodying trauma and work with issues around race and trauma.

We can't help ourselves to heal racialized trauma if we don't acknowledge that it even exists

WE CAN’T HELP OURSELVES EVEN BEGIN TO HEAL RACIALIZED TRAUMA IF WE DON’T ACKNOWLEDGE THAT IT EVEN EXISTS.

Resmaa Menakem, MSW, LICSW, SEP, has appeared on both The Oprah Winfrey Show and Dr. Phil as an expert on conflict and violence.

He has served as director of counseling services for the Tubman Family Alliance; as behavioral health director for African American Family Services in Minneapolis; as a domestic violence counselor for Wilder Foundation; as a certified Military and Family Life Consultant for the U.S. Armed Forces; as a trauma consultant for the Minneapolis Public Schools; and as a Cultural Somatics consultant for the Minneapolis Police Department.

Video of 2 Somatic Resourcing Strategies for Containment and Orienting

Thu, 16 Apr 2020 00:54:54 GMT

Recently the USABP and Bodynamics Institute presented a webinar that included demonstrations on how to "Use one's body to contain anxiety under times of uncertainty."

Anne Isaacs went over that in her full webinar presentation, Creating New Psychophysical Resources That Heal Developmental Disruptions: Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns.

Following that webinar attendee and USABP member Karen Kirsch stepped in to action to provide other USABP members and the larger community with some of the tools presented in the above webinar.

These tools can be useful in Teletherapy.

Use them for self care too.

This demo is also found on youtube too

Instructional Guide to Somatic Resourcing Strategies for Containment and Orienting

Wed, 15 Apr 2020 23:04:19 GMT

Instructional Guide to Somatic Resourcing Strategies for Containment and Orienting

Prepared by Sarah Schlote
An Excerpt from the Anne Isaacs', Bodynamic Institute presentation, Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns

 The following selected illustrated practices derived from Bodynamics support resilience and self-regulation through containment and present-time orientation in times that are activating or unsettling.

I have added in additional commentary drawing from Somatic Experiencing® and the polyvagal theory to elaborate and support integration of some of these ideas.

A file with visual cues is available in two formats. Download to get them:

Get the PDF Download

Get the A4 Download

CONTAINMENT
Iliotibial Tract Hold

The iliotibial tract (also known as the IT band) is a thick band of connective tissue that extends from the pelvis and hip area to the tibia and knee, along the outside of the leg. It provides a sense of social balance, in terms of pulling oneself together and also letting go, and allows us to manage our emotional energy through self- containment. Bringing intentional attention to the outer edges of our physical container can provide a settling effect when we are feeling panic, have lost a sense of our own boundaries, or are hyperventilating. This particular practice shifts anxious energy from the head and upper body and provides an embodied felt sense of our body as a container, which helps us to feel centered in our core (the abdominal cavity is a much larger space and offers more “breathing room” to be with difficult emotions than when they are up in the head). It also allows the rest of the body, in particular the limbs, to become a conduit for stuck activation, allowing that energy to move down towards the feet.

Version 1:

• Place your hands on the outsides of your lower thighs or knees, and have your feet and knees shoulder-width apart. Lean forward on your legs as you are doing this.

• Keeping your knees in place, press outwards into your hands, as your hands provide resistance against the pressure from your legs (while keeping the hands in place). This will create a sense of dynamic tension.

• Hold this position for a little while.

• The most important part of the practice: Relax slowly to a count of 10 (“one locomotive, two locomotive, three locomotive…”), gradually releasing the tension/resistance from your hands, arms and legs. If you like, lengthen your exhalations as well as you let go.

• When finished, sit upright and notice what is different.

Version 2:

• Follow the same instructions as above, only without crossing your arms.

Other Options:

• Place your feet on the inside of each chair leg, and press out with your knees. The chair legs will provide the resistance that your hands did in the other versions. This frees up your hands for other things, and can be done more discreetly (like when in a meeting or another social setting).

• When standing, with your feet flat on the floor, push outwards from your knees to your hips.

• When lying down, cross your ankles and then push outwards from your knees to your hips.

Lower Side Ribcage Expansion

At times, when we feel a surge of emotion rising up, we might sense a knot in our chest and a tightening in our throat as our body contracts around our feelings. Emotions like anxiety feel like they “get stuck” in the upper chest, and there can be a sense that things are too painful or overwhelming. This can especially be the case if we tend to become submerged in or blend with our internal experience, and lose a sense of having a grounded adult witness or access to our core Self in the present moment. Unconsciously, we might forget that we now have a much larger, grown-up body that can hold our internal experience, and instinctually respond as though our physical container was much smaller when feelings were much more overwhelming to our less developed nervous system. Our container contracts to hold things in, which gives the impression that the pain or discomfort will never end, or that we won’t be able to handle it: a somatic re-enactment of what we may have felt when we were younger. As a result, emotions and sensations become blocked and don’t move through our system as they were meant to. This exercise provides a felt sense of having a larger container, which can have a calming effect and provide a more spacious conduit for emotions to pass through and settle.

Instructions:

• Take a deep breath in, breathing into your lower side ribs so that they expand outward. Then, use your muscles to keep your ribcage open. You can continue to breathe if you like (or if you are able) while holding your ribcage in this wider position.

• After a few moments of holding your ribcage open, slowly allow your ribcage to relax as you exhale. Take all the time you need to do this.

• Allow your breath to come in normally and notice what shifts as you pay attention.

• If you like, at the same time, isometrically activate the adductor muscles (inside the thighs), and then very slowly let those go as well.

• Track what happens inside. What is different in terms of your sensations or feelings? Or, what is different about how you are experiencing them?

Serratus Anterior Superior Hold

The serratus anterior superior is a muscle located beneath the armpits on both sides of the body, starting under the shoulder blade and stretching forward along the sides of the ribcage. As babies and young children, this is the area where grownups place their hands as they pick us up in response to our need for social engagement, co- regulation, reassurance, and play. The serratus muscle is involved in connectedness, a sense of the heart opening and the physical action of reaching out towards others or nourishment.

This muscle is also connected to our desire to be wanted and loved for who we are (including our curiosity and impulses), and provides us with a felt sense of our ability to contain our sensations and emotions while also getting our needs met. Finally, it is linked to having the space to enjoy ourselves, the freedom to explore the world, and the ability to express our emotions without losing contact with ourselves and others.

From the standpoint of the polyvagal theory, early face-to-face interactions are the first step to experiencing co- regulation, since as infants we rely on the social engagement system of our caregivers to help us develop our own. The face-to-face moments we experience in the safety of our relationship with our caregivers supports the face-to- heart connection. In other words, these interactions stimulate the

ventral branch of the vagus nerve, which links the musculature of the face, neck, larynx and pharynx with the heart and lungs. When we feel safe and held, the ventral vagus acts as a pacemaker on the heart, which modulates our arousal.

This particular self-hold can help provide a sense of containment and settling when we are feeling anxious or lonely.

Instructions:

• Place your hands under your armpits and then allow your arms to come down over top of your hands.

• Press in or squeeze into that muscle on both sides, holding yourself in that place.

• If you like, lengthen your exhalations as you breathe.

• What do you notice when you hold yourself there?

ORIENTING

Orienting is a deceptively simple practice, the purpose of which is to support us to become more present. As we become more present to ourselves and our current conditions, and if these conditions are perceived by the nervous system to be safe(r), our organism can begin to settle out of whatever panic, urgent energy, or spiralling thoughts we are experiencing while in a state of hyper-vigilance.

The suboccipital muscles at the base of the skull are involved in orienting efforts, and are psychologically connected with the instinctual sense of having the right to have strength or power. Defensive orienting involves turning towards perceived dangers or threats, or looking for escape routes or objects for self-protection. Exploratory orienting involves turning towards novelty in the environment (curiosity) or seeking out resources, such as social connection, nourishment, play, comfort, delight, etc. (sucking reflexes to take in this goodness are connected to the exploratory seeking impulse). Defensive orienting can be in or out of proportion to the current conditions. For instance, when we are anxious or in a state of panic, we can experience a startle response where we pull back and hold our breath, freezing in place. Our bodies can become tight or rigid, we hold our breath, and our gaze can become fixed or our eyes can dart around frantically without really taking in our surroundings. This is another way our bodies, emotions and thoughts become stuck. Our minds begin to fixate on the future, getting caught in worry about what might happen again. Orienting can help us to recognize relative safety now.

From a polyvagal perspective, orienting allows us to engage the same parts of the face and neck involved in the social engagement system, which stimulates the ventral vagus nerve. When the ventral vagus is back online, it provides a face-heart connection that acts as a pacemaker on the heart (or a set of brakes), slowing us down and allowing us to reconnect with the here-and-now and with relationships.

Instructions:

• Taking a deep breath, slowly exhale as you let your eyes look around and take in your surroundings. Allow your eyes to slowly look where they want to look, as opposed to where you think they should look. What draws their curiosity?

• Using your occipital and neck muscles, let your head turn slowly to check out all directions, leading by your ears and exhaling slowly as you do. If you like, also see what happens if you allow your head to look up and down as well. Take all the time you need.

• Notice if there is anything dangerous or threatening in the present moment.

• What happens as you taken in your surroundings? What is different inside?

Note: in Somatic Experiencing®, the goal of orienting isn’t necessarily to become more grounded; rather, we want to develop more accurate neuroception in the present. That is, we are looking to develop a more accurate sense of safety, danger, or life threat in the here-and-now. If our organism accurately detects safety and becomes more grounded as a result, then this practice can indeed support settling and deactivation of anxiety. However, for others who have difficulty trusting themselves to accurately detect signs of danger or life threat because of a tendency to be under-attentive, this practice can also be used for the opposite purpose, especially if an individual’s orienting response was thwarted, resulting in hypo-vigilance.

ABOUT

Bodynamics is a developmental somatic psychology approach developed in Denmark, that proposes that somatic and psychological development occur simultaneously. This means that the voluntary use of specific muscles not only has a physical function but also a psychological one as well, and that psychological difficulties can be addressed by working with the muscular system and the various character structures that occur at different developmental stages.

• Bodynamics theory: https://www.bodynamic.com/theory/

• Seven developmental stages and their associated character structures:https://www.bodynamic.com/theory/the-seven-developmental-stages/

References

Foundation for Human Enrichment (2007).Somatic Experiencing® – Healing Trauma[training manual]. Boulder, CO: Somatic Experiencing® Trauma Institute.

Isaacs, A. (2020, March 26).Creating New Psychophysiological Resources that Heal Developmental Disruptions: Working with Muscle Activation and Movement to Resolve Unconscious Limiting Patterns[webinar]. Hosted by the United States Association for Body Psychotherapy.

Isaacs, A. & Isaacs, J. (2016, March 24).Healing Developmental Disruptions: Using the Body to Focus Verbal Therapy

[webinar]. Hosted by the United States Association for Body Psychotherapy.

Porges, S.W. (2018, November 3). Trauma and intimacy through the lens of the polyvagal theory: Understanding the transformative power of feeling safe [conference lecture].The Science of Connection: Honoring Our Somatic Intelligence.Santa Barbara, CA: United States Association for Body Psychotherapy Conference.

Suggested Citation

Schlote, S. (2020). Somatic Resourcing Strategies[handout]. Guelph, ON: The Refuge.

Thanks to Anne Isaacs for granting permission to develop this handout.

Video Training: Using the Body in Psychological Treatment Interventions - USABP Presentation 2018

Wed, 04 Mar 2020 00:10:13 GMT

Presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

Watch Now

USING THE BODY IN PSYCHOLOGICAL TREATMENT INTERVENTIONS - USABP PRESENTATION 2018

Note from Dr. Stacy Reuille-Dupont

Jumping off from my first career as an exercise scientist, I found somatic psychology as a way to bridge and treat physical health symptoms at the level of being. Drawing on my dissertation research regarding perception and participation in physical exercise within a clinical mental health population, I found blending Hakomi’s character analysis with locomotor developmental stages unlocked psychological core wounding and allowed for corrective experiences in the “forced mindfulness” of difficult physical challenge.

Beyond traditional therapy, these interventions also treated physical health problems of obesity, chronic pain, chronic disease management, addiction patterns, and others that often have roots in the psyche and are impeding if not distracting from deeper work. The nervous system directs it all. When the nervous system becomes dysregulated as a result of wounding (psychological or physical) the body systems adapt.

These adaptations are brilliant options for the body at the time of pain, however if left unchecked create systemic problems that may lead to chronic disease states, both physical (e.g. diabetes, obesity, pain) and/or psychological (e.g. low self-worth, addiction, stunted personal growth, rigidity in life participation). In our current culture, these adaptations become targets for interventions as independent factions rather than utilizing the intelligence of the whole system. Physical health care often separates itself from mental health due to its cause and effect, tangible nature, however taking a broader approach that includes psychology we treat the problem, not just the symptom. One finds mind present in all forms of body dysfunction from basic building blocks of cellular activity, immune dysfunction, and inflammation patterns to postural deviations as a result of psychological or physical wounding. By honoring the embodiment of personal experiences the body psychotherapist can engage in larger and often discounted conversations about what health is and is not.

In this interactive presentation, I would like to review the concept that mind lives in every cell of our body and movement patterns are expressions of mind. By looking at the physiological sciences of hormones, neurotransmitters, brain/locomotor development, anatomy, and physiology we can concretely evaluate postural dysfunction, misalignment, and tension patterns set up by physical or psychological states. These states often continue psychological distress and influence overall health. Corrective exercise patterns can be used to free not only the physical system, but the emotional body as well creating whole person health.

See the companion article for this video presentation.

https://youtu.be/N-DoXbNeYSI

Movement That Heals. 5 Exercises to add into your psychology practice today.

Tue, 03 Mar 2020 22:34:45 GMT

This article will help in understanding and incorporating physical movement systems into psychological treatment. It is presented by Stacy Reuille-Dupont, PhD, LPC, CPFT

Movement facilitates the physical wiring and structure of being. Movement creates concrete manifestation of the abstract. The embodied experience becomes tangible. Even a thought or emotional experience is movement at the cellular level.

- Stacy Reuille-Dupont, PhD, LAC, USABP presentation, 2018

Many struggle to own the power of physical experience. In fact, on average people with mental health illness die younger and use more health care services. Medical staff struggle to treat and diagnose accurately, and they engage in costly medical treatment more often than those with mental wellness. They often present to physical health care providers with 5 or more unrelated symptom presentations. This is because addiction, trauma, and experience live in the tissues. These experiences create “knots” in the system. These knots embed in layers of muscle and facia that evolve to create adaptive ways of dealing with the world, however many are powerless in their somatic experience of life. They are disembodied and look outside themselves to be fixed. As they become less connected to self they also become less connected to others, community, society, etc. The looking for external solutions to internal problems becomes a distraction. The body has everything it needs to address a problem, but many are so disembodied and scared of somatic sensation they let go of this power and become more disconnected. This is where movement helps. Movement returns focus to the body, it returns focus to deeply knowing one’s truth, and it returns focus to personal power. This article will review areas of the body and psychology impacted by movement and discuss how different movements allow for change in the whole system.

Endocrine System

Starting with subtle levels of movement we cannot underestimate the endocrine system. The area I have studied most links the endocrine system to psychological trauma disruptions (Reuille-Dupont, 2014). Whether a trauma is physical (broken bone) or psychological (emotional neglect) the Hypothalamus - Pituitary - Adrenal (HPA) Axis gets involved. As a result chemistry shifts. When chemistry shifts the perception of the situation changes. Shifts can be positive or negative, however if stress hormones are not metabolized they wreck havoc on other tissues and may contribute to increases in chronic pain, inflammation, digestive, and immune disorders (Kiecolt-Glaser, McGuire, Robles, & Glaser, 2002). Physical movement can also target the HPA axis, however does so in a way that metabolizes the bio-chemicals and dysfunctional muscle patterns (Droste, Gesing, Ulbricht, Müller, Linthorst, & Reul, 2003). The endocrine system is often dubbed the “little central nervous system” for its control and care of the body’s experience. When looking at how the endocrine system influences the perception of experience by changing how the body feels in any given state, the endocrine system becomes a tangible system influenced through thoughts, emotional states, ingestion (food, news, media, social influence, environmental items, etc), and movement. Thus as movement is introduced the body becomes an active vehicle to change perception of experiences.

Nervous System

The body is a great antenna, but the brain does not have its own direct inputs, inputs are the senses. Sense experiences all come through the body. The body collects the information, sends findings through nervous system channels and reports to the brain. The brain works tirelessly to categorize and direct responses to stimuli for survival. If one is constantly living in reaction to past events rather than response to current experience the system becomes rigid in response options. To be a responder to present moment experiences one must learn to slow down reaction. This happens by increasing capacity for physical sensation. Therefore the brain judges the situation differently based on present moment reality and not past experience reactions when the body is able to experience the situation with capacity. Movement becomes the vehicle to slow or speed the nervous system response.

The movement of the nervous system is subtle. For instance, movement can be used to shift posture. As movement increases, heart rate rises, as heart rate rises the nervous system reports to the brain which determines if this is a good situation or not. In my office (within a large community mental health and integrated care center), I found many examples of people who needed to exercise yet could not. Their brains kept registering rising heart rate, quickening breath, and sweat response as panic and would shut down the system. The physical sensations of exercise were tipping them outside the window of tolerance. Helping people understand the responses in the body is important. It gives space to pause, decide desired outcomes, and options for reaction. It can be as simple as using a pressure point. For many familiar with communication lines within the body, location points for contact are important and we know putting pressure on them influences other systems, such as the endocrine, facia, or muscular systems. An easy one I often teach my clients is the 3rd eye point. By putting pressure on this point (between the eyebrows) we have a direct way to lower heart rate and slow breathing. Depending on the client I have them get into different positions allowing pressure to be exerted on this point and notice what happens. It could look as simple as having them press on it with their hand, I can press on it for them, or have them put their head on a desk, counter, the wall, or other hard surface. There are many points we can use to shift the communication of the nervous system to the brain, and most clients can learn and discretely perform on their own at home, school, or work when needed.

Heart Rate and the Circulatory System

Slowing the heart and breath bring us to the circulatory system. All changes, mental or physical, are transmitted through the central nervous system, which controls heart rate via the sympathetic and parasympathetic responses (Appelhans & Luecken, 2006). These responses signal to the brain to expand or contract from experience. Taking a slightly wider gaze on this connection, it is the heart that influences how we respond, it is the piece of us that is in control of everything else. It is often thought the brain directs it all, and make no mistake the brain is very very very important, but it is the heart that tells the brain what to categorize. The heart is the conductor of the orchestra that is the brain. It communicates our experience through heart rate variability. Heart rate variability changes with each breath directing the brain in its categorization of experience. Safe or not? Connect or not?

The heart has its own electrical system. Looking at electrical theory one can see that electrical systems either repel or collapse into each other. If my experience of you is safe, I will expand my electrical system to meet your’s. We may become one electrical field, and we can see and feel these connections between people. As a result of connecting to you, I will mirror you, viscerally respond to you, and will “know” things about your experience. When people get stuck this system gets rigid. People become stuck in old patterns, orient from fear, or struggle to effectively manage limbic resonance experiences. Some people lack an ability to connect to the somatic experience of another (bound), some people are overly connected (unbounded). Both experiences create problems for social engagement of the nervous system. Due to respiratory sinus arrhythmia, the connection between the breath and heart rate, one influences the other (Porges, 2007). If I want someone to be more active, say to treat depression which is lethargic, heavy, slow, and often stuck energy, I can match the current heart rate with movement and raise it slightly (the next section will discuss movement as treatment).

A simple way to influence this system in your office is to slow down your breathing. By slowing your breath rate, you will slow your heart rate, by slowing your heart rate your electrical pattern changes in the field. As this happens your client (if they trust you) will match you. Thus processing difficult pieces of psychological work feels more supported and builds capacity to experience themselves and others with less reactivity.

Musculature and Facia System

If I can get connected to my client using my subtle breath, imagine what big movement systems can do. The trick to using the bigger systems is to know how to influence them. Posture impacts our psychology and our psychology impacts our posture. For example, if I am stressed I may internally rotate my shoulder joint collapsing my chest, making it more difficult to breathe. The change in my breath rate changes my heart rate and influences my sympathetic and parasympathetic systems. Over time my upper back and neck shift into what is known as forward head. This creates stress on the muscle and joint configurations. The muscles respond by tightening, eventually becoming “knotted”. These knots are deposits of different pro-inflammatory and biochemicals (Shah, Thaker, Heimur, Aredo, Sikdar, & Gerber, 2015). The muscles begin to shift movement patterns around the trigger points. The adaptation eventually results in dysfunctional movement patterns and stress on the system. This process could start as a physical injury or an emotional one. Remember the body is the vehicle through which all experience is processed.

Eliminating the adhesions in the physical structures can help eliminate them in the mind as well (many modalities exist to do this: massage, exercise, dance, yoga, tai chi, chi gong, acupressure/acupuncture, dry needling, rolfing, physical therapy, chiropractic, etc.). The trick is often in practitioner and modality connection. If the client becomes connected to the practitioner and the modality fits the client’s personality it is likely they will find relief from it. In our offices we can use the gross motor systems to program movement to access psychological healing.

Movement to Heal

As an exercise scientist and personal trainer/group exercise instructor for over 20 years, I am pretty confident at figuring out how to program someone’s physical strength and endurance. As a clinician for over a decade, I feel like I am pretty good at figuring out how to help shift behavior and belief. However, in my office many of my clients would not participate with me. I couldn’t figure it out. I was starting small, meeting them where they were, and the math of physiological change was solid. I looked deeper and did research around what was getting in the way of actually participating in physical exercise. I thought it was psychological trauma experiences, as many described symptoms while exercising that overlapped window of tolerance literature. For the population I studied, it was not trauma, it was panic that mitigated the ability to participate no matter how strong the belief in exercise as a modality to help address a variety of issues. In addition, exposure to exercise created an expanded range (larger window of tolerance to physical sensations). As a result, I learned that offering movement experiences modulated by psychological theory to address stress disorders, especially panic, helped people adhere to a movement program that addressed physical and psychological disorders (Reuille-Dupont, 2014). With these findings I was able to create a variety of movement programs and experiences clients could use to heal mental health presentations.

When choosing appropriate movement interventions one must consider the client’s current state. You cannot ask a person with deep depression to engage in high intensity “bouncy” exercise. The energy of depression is heavy, slow, lethargic, stuck. We have to start with movements that match and then increase the upward energy in small increments. For someone with ADHD or high anxiety with racing thoughts yin/yang yoga is miserable. They may even struggle with power vinyasa due to lack of ability to focus well. By programming movement to shift quickly and often, sometimes in a chaotic pattern then increasing the rhythmic content slowly we help them meet the racing mind and teach clients to direct it. In addition, we must consider physical limitations, physical health conditions, physiological understanding of heart rate, sweating, breath rate as they link to panic (findings in my research), disorganized body presentations, and psychosis. Someone having a psychotic or manic episode may be able to work with you but be ready to adapt quickly and often. Below are some ways I use movement in my office.

Walking is a big focus in my practice. I take them outside and have a treadmill in my office to help people understand heart rate training zones and teach them about the physiology of fear. This allows them to have an experience while walking in a safe environment and learn to modulate their own breath and heart rate. It also helps them get comfortable with tension in the muscles and sweat rates, both can signal danger to the brain and exacerbate psychological symptomology.

Posture. I often use posture to help determine the psychological structure of a person’s belief patterns: where are they hiding, projecting, collapsing, etc. By watching planes of movement, postural deviations, and simple movements you can see where the body is blocked, armored, or adapting. By using theory around body and psychological wounding presentations I can then choose exercise patterns that match locomotor and psychological development phases.

Here are 3 examples of movements I use in my office to engage clients in corrective experiences:

Feet are very interesting places to start. By having the client walk we can see what is happening in the pelvis, spine, chest, and head. All movement should come from the core and should be somewhat equal in gait. You should be able to see rotations throughout the foot, leg, and hip structures. This gives a lot of information about armoring and world view. When working with sexual trauma or eating disorders the feet are a great place to start because they give access to the inner thigh, perineum, and pelvic floor areas of the body that are often hyper/hypo active. By manipulating which part of the foot the client is paying attention to (different toes, heel, arches, etc) we can create sensation in the leg and pelvis. This allows for safe processing and reconnecting with these physical structures and allows healing of psychological wounding and physical issues that may also be present. In addition, it allows discussion around items like safety, security, strength, stability, etc that are often early life psychological wounds. Sometimes I do this work in my office, other times it is homework.

Tabatta. For this I would suggest you have advanced training, however, I think the example can help you conceptualize how you might adapt movement in your office. Tabatta style training is intense structured work lasting 4 minutes. It is cardiovascular in nature (see about for information on Heart Rate Variability), but can incorporate strength as well. There are a number of similar modifications/training modalities that can be adapted for use with a variety of clients. For these exercises I work with the client to determine core wounding patterns and corrective belief statements. Then I choose an exercise to represent the locomotor development at the stage of core wounding and we run intervals. During the intervals I act in ways that can be corrective - offering help and support, checking for safety, and repeating corrective statements. Often by the end of the 4 minute cycle clients have “wired” in a new pattern. Although I am still doing research on this method, so far the results are positive for corrective change, depth oriented work, and mindfulness ability.

HITT Training Exercises. I often use these for cravings. These are a variety of movements that include power training (strength and speed together). By asking clients to do a difficult movement for a short period of time we “short-circuit” the craving. Many of my clients have addictive patterns and this “gets them out of their heads”. It changes the physiology and helps get around negative thinking and habitual behavior patterns. Good examples are burpees, jumping lunges/squats, or pushups. A note of caution, make sure you understand the clients true ability and risk for injury before prescribing, and when working with eating disorders assess for ability to maintain the prescribed time limits, some folks will over use and perpetuate exercise addiction behaviors.

As said in the beginning, movement is what anchors the experience. By choosing the right movement for the right disorder, matching the person’s personality, psychological presentation, and intended corrective experience interventions, movement lends itself to effective mental health treatments and can help heal physical health problems as well. By helping people learn to move effectively, they are also taught about personal power, inspiration, personal space, boundaries, strength, healthy eating patterns (think food/mood/microbiome), and decision making skills. There are many options and ideas, some very simple to start or send the client home to explore between sessions. As you consider adding movement into your practice, where do you think you will start?

To get the full video lecture on this with more insights and ways to work with clients click here

References

Appelhans, B. M., and Luecken, L. J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229-240. DOI: 10.1037/1089-2680.10.3.229

Droste, S. K., Gesing, A., Ulbricht, S., Müller, M. B., Linthorst, C, E., & Reul, J. M. H. M. (2003). Effects of long-term voluntary exercise on the mouse hypothalamic-pituitary-adrenocortical axis. Endocrinology 144(7). 3012-3023. DOI: 10.1210/en.2003.0097

Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Psychoneuroimmuology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology 70(3). 537-547. DOI: 10.1037///0022-006X.70.3.537

Porges, S. W. (2007). A phylogenetic journey through the vague and ambiguous Xth cranial nerve: A commentary on contemporary heart rate variability research. Biological Psychology 74(2). 301-307.

Reuille-Dupont, S. (2014). Impact Psychological symptom severity on leisure time exercise behavior and perceived benefits and barriers to physical exercise. (Doctoral dissertation). Retrieved from ProQuest. (UMI Number 3686498)

Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V., Sikdar, S., & Gerber, L. (2015). Myofascial trigger points then and now: A historical and scientific perspective. PM&R The Journal of Injury, Function, and Rehabilitation 746-761. DOI: 10.1016/j.pmrj.2015.01.024

Bio

Stacy Reuille-Dupont, PhD, LPC, CPFT holds a PhD in Clinical Psychology/Somatic Psychology from The Chicago School of Professional Psychology. She is a licensed clinical psychologist and licensed addiction counselor. Her psychology practice looks at the impacts of physical exercise on mental health symptoms. More at her psychology practice website: www.stacyreuille.com or blog: www.stacyrd.com where she blogs about psychology, movement, and health from the inside out.

Boundary Exercises

Tue, 03 Dec 2019 01:16:27 GMT

Boundary exercises:

1. Toward and Away
2. Like it / Don’t like it
3. Boundary-Setting Script Rehearsal

“Toward and Away” is a well-known physical proximity exercise that can be done with groups, couples, and individual clients.

One person stands still and their partner, facing them from a few yards away, moves slowly toward the still person until the still one detects some sensation of alarm or hesitation and then tells the person coming toward them to stop. Clients usually need a few attempts at this to become sensitized to the somatic cues of their own boundaries, and it tends to be a satisfying process of self-discovery. Variations can include approaching from the sides, from the back, or with varying speeds.

In groups, two lines of participants face each other and practice with the person facing them, taking turns. Couples do this with each other. Therapists can also practice this with their individual clients, volunteering as the "still" person if the client needs a demonstration of tracking somatic cues related to boundaries, threat, and safety.

Like it/ Don’t like it

One of the ways to introduce different aspects of relational dynamics is to designate one side of the room (or piece of paper if constrained) as “like it most” and the opposite side as “don’t like it at all”. Call out likes and dislikes at intervals, especially in regard to interpersonal dynamics, and have clients organize themselves along the spectrum for each statement, evaluating and expressing how much they (and their neighbors) like or don’t like something. This exercise has endless room for creativity, but examples relevant to the setting of interpersonal boundaries include statements such as:

1) I like being alone when I’m angry;

2) I like to resolve conflict immediately;

3) I respond well to a thoughtful or expensive peace offering; and

4) I really like being held by someone safe when I’m upset.

This can be adapted to work with groups, families, couples, and individuals. It creates a safe space to playfully and honestly self-assess, understand each other, and express our individual preferences and shared neuroses.

Boundary-Setting Script Rehearsal

A fan of action methods, I have rarely been disappointed by combining somatic tracking with empty chair work to create a powerful therapeutic intervention. Using trauma physiology and affect tolerance to inform the practice of communicating interpersonal boundaries is a satisfying iterative process. The integration of somatic practice and action methods makes space for organic expressions of healthy aggression, dissociative adaptations, attachment behaviors and other coping strategies that make up the meat of therapeutic insight. This increased self-knowledge leads to a greater sense of choice and capacity for effective communication once attended to and worked through.

The process is this: A client (with moderate affect tolerance) imagines someone they need, or needed, to establish a boundary with in the empty chair. As they attempt to articulate their boundary setting, the therapist helps them identify and process the feelings and instincts that arise and inhibit their honest expression of needs in their actual relationships.

This exercise is ideal for individual sessions and group therapy. It can be useful in couple and family therapy, although it’s worth noting that the tension of the exercise increases dramatically when the invisible subject in the empty chair also happens to be visible, present and observing the exercise from the same room.

Provided by By Sonya Denise Ullrich, MS, AMFT, SEP, ABMP

Sonya Denise Ullrich, APCC, SEP is a practitioner with twelve years of experience in somatic trauma resolution and twenty years in manual therapies. She has a background in Somatic Experiencing, Feldenkrais, PACT couple therapy, and human ecology. She currently practices somatic psychotherapy throughout San Diego county, assists trainings in touch skills for trauma resolution, coordinates regional events for the California Association for Professional Clinical Counselors, and teaches workshops on touch skills for couples.

She worked in a range of addiction treatment settings in California and Arizona and has developed addiction treatment programming based on somatic trauma resolution and attachment theory. She is passionate about interdisciplinary social science and global health. She is pursuing opportunities to research the use of touch cross-culturally and use participatory methods to develop culturally appropriate programming for trauma resolution.

Learn more about her work online.

Addiction From The Bottom Up: A Felt Sense - Polyvagal Model of Addiction

Fri, 01 Nov 2019 00:00:10 GMT

Addiction From The Bottom Up: A Felt Sense/ Polyvagal Model of Addiction

Many of us working in the healing arts are exploring alternative ways of experiencing and conceptualizing the body, recognizing that the western, post Descartes view of mind/body duality is distorted and harmful. Our current way of understanding and treating addiction reflects this disembodied view. Addiction is seen as a malfunctioning of our computer-like brains.

Shifting into a bottom up approach allows us to experience the wisdom of the body, and the wisdom of addictive responses. From an embodied place of experiencing, and through the lens of Polyvagal Theory, we understand addictive behaviors as the bodies attempt to keep us alive when being present is too overwhelming.

It’s time to look at addiction with a fresh pair of eyes. I have created a new model in the conceptualizing and treatment of addiction. The current brain disease model is failing us, rates are soaring, and people are dying in the streets. We can and must do better than this!

Over forty years of keeping my client's company I have developed a model that understands addiction as an adaptive attempt to regulate emotional states. Addictive behaviors are self-soothing/self harmful ways to survive when we aren’t able to calm ourselves. These behaviors do not come from sickness: they come from a bodily response to threat and a wired in mechanism of survival. The Felt Sense/ Polyvagal Model (FSPM) addresses addiction where it lives, in the body.

Download the Felt Sense - Polyvagal Model (FSPM) Model

This graphic model draws from the work of: Stephen Porges - Polyvagal Theory, a new understanding of the autonomic nervous system, Eugene Gendlin - Felt Sense embodied psychotherapy practice, and Marc Lewis - learning model of addiction. This work is a first in bringing addiction into the exciting world of Polyvagal Theory.

The objective is to provide a graphic model of addiction that integrates new neurobiological findings in brain research, an alternative learning model of addiction (Lewis, 2015), and subsequent clinical approaches that address embodied trauma therapies. Therapists will be able to understand addiction using a sophisticated theoretical framework and treatment strategies that challenge old, pathologizing approaches. The model is adaptable to any school of psychotherapy or healing practice.

As I began to learn about Polyvagal Theory, I realized that it enhanced my understanding of what I knew intuitively: Clients were using addictive behaviors to propel themselves from a state of sympathetic arousal to a dorsal vagal response of numbing, and vice versa. Through the lens of the Autonomic Nervous System (ANS), we see these behaviors as adaptive.

The Felt Sense/Polyvagal Model

Looking at the graphic depiction of the FSPM Clinician version we can see a number of important theories overlapping.

Focusing and the Felt Sense

The term Felt Sense, named by Eugene Gendlin, PhD. (Focusing, 1978) comes from a contemplative practice called Focusing.

Focusing is a six step process that helps us to find our implicit, embodied knowing about an issue in our life. A knowing that is at first vague. Turning attention inwards and listening with compassion allows a felt sense, a whole sense of the situation, to form. See example below.

Notice on the Felt Sense Polyvagal Model that each circular state has the words thoughts, feelings, physical sensations, and memories. Each of these different aspects of experience are a pathway into the Felt Sense. In asking questions about these aspects we help the client to deepen their embodied knowing of the issue. As the felt sense forms we pause and stay with the fullness of experiencing. Sometimes a Felt Shift, a physical release happens as the client integrates a new knowing. This shift is the bodies’ knowing and pointing in the direction of growth and healing. The client feels a relief, a settling. Focusing is a natural process that happens all the time. Gendlin didn’t invent it. He found that clients who were doing well in therapy were connected to their bodies. They had access to a Felt Sense. However, because we live in such a disembodied culture, many clients need help to connect, so Gendlin created the steps.

The following is an example: A client comes in with anxious feelings and a tightening in her throat. She says that she doesn’t know why she feels this way. We begin the process of quietly turning attention inwards, down into the centre of the body. Tears come as she connects the physical sensations with the feelings of sadness and anger. A beginning of the Felt Sense starts to form. I ask “Can you welcome both feelings?’ she pauses and explores where there are no words. She puts a hand on her throat.

“ I don’t know how to be with anger”, she says. More sensing into the body.

More tears flow as she feels the physical sensations of the Felt Sense flooding into her throat and now down into her chest. A whole Felt Sense of her situation forms; thoughts, feelings, physical sensations, and memories.

“This goes way back for me. Little girl afraid to be angry, so I cry instead. This needs to stop. I need my anger.”

Her whole body moves and relaxes with a Felt Shift. She feels her throat loosening, a new piece has come for her. An explicit knowing that has great meaning for her. A need to connect with her anger. Her Felt Sense carries this meaning forward into her life as she welcomes what came in her Focusing practice session.

Now we can map the felt sense onto the Felt Sense Polyvagal Model to integrate the autonomic nervous system states. This gives us more information about the client’s journey. In the Clinician version she has moved from chaos/sympathetic meme, down to Integrated/Ventral meme in her Focusing Oriented Psychotherapy session. Together we look at the Client Version of the model as she maps her journey from Flight/Fight to Flock.

Polyvagal Theory

Looking at the graphic depiction of the FSPM Clinician version, we can see:

Three circuits of the ANS—Depicted in the solid line triangle at the bottom right legend

A) Ventral in yellow at the bottom of the page,

B) Sympathetic in red on the right, and

C) Dorsal in grey on the left.

Intertwining States---Depicted in the dotted line triangle at the bottom right legend.

Intertwining states are states in the system that utilize two pathways. The Autonomic Nervous System has the capacity to blend states creating a greater range of experiences.

Intertwining states are represented in the model in mixed colors.

Play is on the bottom right in yellow/red.

Stillness is bottom left yellow/ grey.

The FSPM proposes a third intertwining state of Addiction

Addiction is at the top of the model, red/grey

This state is a blending of sympathetic and dorsal. Without the presence of the ventral vagus, the Social Engagement System is offline. When trauma and other states of emotional dis-regulation occur, the capacity to regulate through the ventral vagus are compromised. The ANS shifts into survival mode. We can then employ addictive behaviors in an effort to seek relief from suffering.

Applying The Model

In addition to providing a new map for teaching the model, I have created a simple version for clients that uses 6 F’s to define the states of the Autonomic Nervous System. Flight/Fight, Freeze, Fixate, Flow, Fun, Flock. With time our clients learn how to identify and track the state that they are in, and to use the tools that we teach them to move more and more into the ventral vagal state.

A Call to Action

“Addiction is our teacher” says Bruce Alexander. In his new documentary, Rat Park, he shows us how we have lost connection with each other and with the natural world. He sees addiction not just as a psychological problem, but a global, political problem.

Addiction is a political problem!

I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction. I am currently writing a book about the model. For more information and questions please go to my website.

Download Felt Sense Polyvagal Model to Share with Clients

A Call to Action

Addiction is a political problem!

I invite you to join me in standing up, and speaking up about a new way of understanding and treating addiction.

I am currently writing a book about the model. For more detailed information and questions please go to my website: http://www.focusingonborden.com/

Jan Winhall, M.S.W. R.S.W. F.O.T.T. Toronto, Canada. Jan is a psychotherapist in private practice and Director of Focusing On Borden, a centre for teaching Focusing and Focusing-Oriented Therapy. Jan is the author of “Understanding and Treating Addiction with the Felt Sense Experience Model” In Emerging Practice in FOT. Jan teaches internationally and is a lecturer in the Faculty of Social Work at the University of Toronto. She is currently writing a book about her new Felt Sense/Polyvagal Model for treating addiction.

Addictive Behavior as Boundary Setting: An Overlooked but Clinically Useful Concept in Treating Addiction

Thu, 12 Sep 2019 21:39:25 GMT

By Sonya Denise Ullrich, MS, AMFT, SEP, ABMP

Here’s a thought experiment: Think of someone you know well who has struggled with addiction; it could be a client, a family member, a friend, or, perhaps, yourself. If you view this person’s addictive behavior as a way of setting boundaries, which relationships come in to focus? Which socioeconomic, structural realities? What need for change? Does the nature and focus of your support change also?

This -- addictive behavior as boundary-setting behavior -- is an overlooked but clinically useful concept for treating addiction. Centering the boundary-setting function of addictive behavior can be an important aspect of building psychosocial skills, distress tolerance, self-knowledge, interactive regulation, and, because of all of these things, sustainable recovery. It goes further than the concept of “coping strategies” and puts relationship at the center of addiction; if addiction does not start out as a relationship surrogate, it certainly ends as one. Addiction as a surrogate relationship and barrier from interpersonal stressors is costly, but it often feels more reliable than other people in the wake of relational trauma. In the words of a high ACE-scoring combat veteran friend choosing a life of alcohol use over his second wife during their divorce, “I like you some of the time. I like alcohol all of the time.” The more general example I share with clients is, “I’m so high that you can’t hurt me in here.”

The well-known ACEs study by Fellitti et al. (1998) produced one of the most compelling statistics related to addiction. Patients with an ACE score of four or more are 4000% more likely to become an intravenous drug user than someone who scores lower on the scale of childhood adversity. Four thousand percent! That makes a strong case for the argument that compulsive behaviors replace the function of social relationships in nervous system regulation when early relationships are themselves dysregulating. Furthermore, the Harm Reduction Coalition (2019) demonstrates the importance of restoring healthy relationships in reducing the harmfulness of addictive behavior with one of its central tenets. It “establishes quality of individual and community life and well-being -- not necessarily cessation of all drug use -- as the criteria for successful interventions and policies.” The decriminalization of substance use, likewise, addresses social relationships by reducing related stigma and poverty and re-engaging drug users in community participation on a larger social scale.

Clinical Application

As a specialist in trauma, attachment, and touch skills in treatment programs for both chemical dependency and process addictions, I have introduced the idea of addictive behavior as boundary setting behavior to a diverse range of clients. The usual response is a pause of momentary consideration, then a nod of agreement. Whether you can deconstruct this conceptualization through more widely discussed principles of addiction medicine is one thing. The clinical utility of these ideas is quite another. Centering the relational aspects of addictive behavior in the therapeutic frame begets reliable client endorsement and insight. This, in turn, prepares clients for the therapeutic endeavor in a threefold way: to look to the past to resolve the developmental trauma underlying so much addictive behavior, to the present to enrich and reciprocate social support, and to the future to evaluate relapse risks and take ownership of any skill-building necessary for nurturing satisfying relationships.

Practically speaking, this is a very simple clinical intervention when you understand the reasoning behind it.

Therapist: “Do you feel like you use your addictive behavior to set boundaries in relationships? Where words and less harmful actions don’t work well enough? Maybe something like, ‘I’m so high, you can’t hurt me in here?’”

Client Response: “Yeah . . . totally.”

Therapist: “Really? With whom? In what way?”

Done. And you’ve sparked a self-affirming exploration that will generate effective treatment objectives.

Let’s dig a bit deeper into the rationale behind this approach. The motivational factors most commonly emphasized in addiction treatment include: the mood-altering effects of addictive substances and behaviors; pleasure-seeking; self-medication of underlying disorders; the neurobiology of diminishing returns; social influences that normalize or incentivize addictive behaviors; and somewhat more recently and mercifully, the roles of socio-economic marginalization, traumatization and the need for external regulation of the autonomic nervous system. All of these factors are important and central to the addictive process; communicating boundaries is generally regarded as one of many subsets of skills required for successful recovery.

However, prioritizing relational skills and stressors throughout addiction treatment contributes to compassionate, effective care that is congruent with contemporary neuroscience and trauma-informed care. For someone to engage routinely in the legal, financial, and health risks associated with addiction, they tend to have relational trauma histories or current circumstances that make high-risk pleasure-seeking through altered states a necessity for relief of pain. Whether through the direct anesthetization of opiates or ketamine, the depression-staving dopamine rush of stimulants or action gambling, or the safely distant simulation of social contact that comes with sex addiction, any compulsive consequential behavior becomes a surrogate relationship. For lives deficient in attunement and empathy, the relational impact of addiction can feel like a justified protest/withdrawal or simply the only alternative. The impact of addiction on others invariably takes a backseat to the need to alleviate one’s own pain during the addictive process. Articulating relational boundaries in therapeutic recovery re-engages clients in their relationships; it empowers clients by emphasizing their own unmet needs through actionable goals and offsetting the usual waves of shame and self-recrimination.

Personal Insight and Observations

It was a sunny weekday afternoon, several decades ago. I was sixteen and my brother was eight. I was babysitting, as I often was. I loved my brother deeply, helped deliver him at birth, and I managed to share with him my values related to environmental sustainability and community. I could hear him playing outside my window soon after we arrived home. I wanted to be a loving older sister, however much I resented my parents for forcing me to provide the care for their two other children while giving so little emotional support in return. So, I inhaled a modest amount of crystal methamphetamine to offset my depression and balance the scales with my parents, and then gladly joined my brother in the yard.

As with so many who turn early and hard toward compulsive self-soothing, I was a depressed, anxious adolescent with an insidious trauma history. However, while the etiology of addiction is always multi-factorial, I was using my addictive behavior to establish very private and costly relational boundaries in a family system where many previous attempts to signal my distress, express my needs, and set reasonable boundaries essential to the task of individuation had failed. I had gotten perfect grades and been the perfect baby sitter, but nobody noticed. I spent years on the edge between ortho-and anorexia, but nobody seemed to care. I used tactics borrowed from political protests to register complaints in my home, but they fell on deaf ears. With the agency of a new driver’s license, I acted out my angst, fumbled for nervous system regulation, and fought to complete the developmental tasks of adolescence via my first stimulant addiction.

My polysubstance relapse pattern bore out this boundary-setting relational dynamic. My major relapses occurred when I lacked the psychosocial skills and the responsive social environment to establish boundaries, express needs, and say “no” in any healthier way. As a client with little resilience and an extensive trauma history, I had also been pushed over the edge of relapse by therapy I found emotionally and physiologically overwhelming. I became a practitioner of gentle somatic and attachment-based interventions because they allowed me to understand the nature of my fraught internal wilderness through developing internal tracking skills. They also let me know I was not alone through connecting me to a broader evolutionary framework of my own biology and behavior and gave me enough understanding and perspective to tolerate the risk of communicating my needs.

Case Examples from Colleagues

I have treated hundreds of clients struggling with addiction and have employed this concept to good effect. To honor their confidentiality while providing real-life case information, I introduced the concept of addictive behavior as boundary setting behavior to a range of colleagues who also share addiction histories. As an added bonus, some interviewees volunteered the progress they made through somatic psychotherapy. The case examples that follow are from colleagues, names changed, whom I have interviewed expressly for this article. As much as possible, I have left their stories in their own words.

Brian, a career paraprofessional in abstinence-based addiction treatment and golf enthusiast, used to “drink, drug, gamble and act out sexually” to escape impossible internalized perceived expectations within his family of origin. In his words, “I just needed to blow it all up because I couldn’t deal with the pressure.” In romantic relationships, he describes keeping partners away through keeping relationships superficial and engaging in infidelity, fearing commitment and anticipating not being good enough, as with his family, “even once I was in recovery.” He also describes feeling burned out as an employee in the addiction treatment industry and engaging in “resentful retaliation” by staying out all night engaging in his addictive behaviors while he was on the clock. He described addiction as a surrogate relationship as “a nice, tolerable place to go to escape the pain of isolation.”

Grant, a healthcare administrator, abstinent gambling addict/substance user, and devoted adventure athlete, has a history of sexual abuse, “I had coping mechanisms even then, acting out all the time. I thought I was unlovable and then got into drugs and alcohol in high school. Discovering gambling when I was older gave me the same escape and felt much healthier than when I was getting high. It wasn’t, of course. In relationships, I have a hard time trusting anybody. Because of my molestation history with my brother, I would push women away. Even though I still struggle with trust, I recognize these lifelong patterns. I’m able to and want to stay present after sex. Somatic psychotherapy allowed me to fully connect my adult addictive behavior to my childhood trauma history and fully process my emotions and cry that hard for the first time. It opened my eyes to how profound an impact that made on me. I don’t feel unworthy or unlovable anymore.”

Aimee, a rural crisis behavioral health clinician and motorcycle enthusiast, reflected on where she is at now, psychosocially speaking, as she celebrates a year of abstinence after her one major relapse with methamphetamine. “I just bought a new motorcycle. I realize I have these expensive hobbies that function to push my partner away. They are the hard boundaries that give me autonomy and independence. I still use alcohol as a lubricant. Those are my ‘lubricating boundaries’.” She described her current partner as “like sitting on a still lake” after a long, volatile relationship in which she began using again “to prevent abandonment, to form a bridge, and then to deal with the abandonment once she left.” She described that relationship as “a lot like my mother. She was incredibly violent. I used to peek around the corner and only come out if she, my mother, was in a good mood. I was hiding beer in my cowboy boots by the time I was twelve. She could yell and yell at me and I didn’t care. That was also the year I started getting sexually abused by a neighbor.” She described having, “a long fuse. When I get to a point, before I explode, I jump into addictive behavior to prevent the explosion. Or when my partners or my family demand I show up a certain way.” She described her ability to navigate reduced cravings and negotiate healthy boundaries with her current partner. “There’s no abandonment threat because she doesn’t generate the same highs and lows. She can talk about boundaries.” She added that her somatic therapist has her focus on her breath during moments of sexual intimacy to alleviate panic and to be present with her partner for a few moments.

Brandon, a harm reduction activist, health provider in a rural indigenous community, and musician, assumed his addictive behavior was pathological and needing to be gotten rid of rather than understanding it as a response to something. “Instead of ‘I just use drugs because I’m broken’, I began to understand that it helped me survive. It provided comfort, joy, a sense of belonging and basic human social needs that we are culturally, systemically deprived of in a capitalist culture. Family is one of the social structures is key to systemic control. I don’t blame the abusive mother and negligent father because they’re a product of the economic system that created their behavior. I don’t blame the abnormal child, either.” He described the tension between wanting to reduce the social stigma, legal consequences, and shame for his clients who use drugs while also relating to their desire to stop using heroin because that was something he needed to do to restore relationships and appropriate boundaries in his own life, as well.

Conclusion

Regardless of their philosophical approach to their own recovery or the time and perspective they have from their own compulsive self-soothing, the colleagues I interviewed were able to respond autobiographically to the concept of addictive behavior as boundary setting behavior. They did so in ways that were novel, insightful, and self-affirming. For myself, this concept has helped evaluate risk, identify skill deficits, and hold my own history with compassion. I have had hundreds of clients in addiction treatment who have found it useful, too. With vulnerability and humility, I offer it to you.

About Author Sonya Denise Ullrich, MS, SEP, ABMP.

Learn more about her work online.

TEAMWORK AND TRAUMA RECOVERY

Sat, 03 Aug 2019 00:59:29 GMT

By Nancy Alexander, MSW, LCSW-C
By Linda Ciotola, M.Ed., CHES (ret), TEP

Trauma survivors are among the most challenging, frustrating and heart-wrenching populations in any treatment setting. Treating them has been associated with vicarious traumatization of the clinician (Neumann & Gamble, 1995). Diagnosed with everything from Borderline Personality Disorder to Dissociative Identity Disorder, their often intractable, unmanageable repertoires of ‘acting out’, self-destructive and demanding behaviors, causes many a well-intended clinician to refer these clients elsewhere. However we recognize they have developed a vast array of creative survival skills, making them well suited to psychodrama and the creative arts. As helpers, we feel overwhelmed (Figley, 1995) by their lack of insight, their regressions, chronic hopelessness, neediness, rage, their re-victimization and by their complicated, ambivalent transferences, which vacillate between love and hate, trust and paranoia, idealization and devaluation. Many of us wonder if we are ‘cut out’ to work with this emotionally demanding population. Should we do as many of our colleagues have done and refuse to treat them? Perhaps the better question here is “Am I cut out to work with this population alone?”

A team approach integrating psychotherapy and psychodrama brings an enhanced array of skills, knowledge and creativity to the treatment process (Lev-Wiesel, 2008). It provides the client with innumerable corrective emotional experiences, opportunities to concretize and integrate both horrendous life experiences and fractured ego-states in a safe consistent holding environment that is adaptive, pro-active and supportive. Our collaboration grew from a mutual interest in trauma work. One of us, rooted in psychodrama, using the Therapeutic Spiral Model (Hudgins, 2002), to help trauma survivors and the other, a psychotherapist specializing in trauma. Neurons fired and we embarked on our journey of collaboration. We are co-authoring this article in an effort to let creative dedicated clinicians know about this unique treatment approach, some of its fundamentals and its many benefits, for the client and for the clinician as well.

The Role of Trauma in the Trauma Spectrum Disorders

Trauma can be induced by many situations including war, crime, domestic violence, natural disasters and child abuse. It results from being personally exposed to terrifying experiences that involve actual or threatened death or serious injury, or witnessing an event that involves death, injury or threat to another person. The individual’s response to the event involves intense fear, helplessness or horror. Most of the individuals in treatment with us are adult survivors of severe, complex and prolonged childhood trauma and carry diagnoses of Dissociative Identity Disorder and Posttraumatic Stress Disorder. Many have co-occurring diagnoses of Eating Disorders, Anxiety Disorders, Addictions and various personality disorders including Borderline Personality Disorder. All the clients we worked with have been in therapy for many years, many have had numerous psychiatric hospitalizations, many have had a history of suicide attempts and all of them present with high risk behaviors of some sort, whether by overt self-destructive actions like overdosing or cutting or slightly more subtle behaviors like gross violation of a diabetic diet or picking up strangers through internet sites.

The symptoms they report include recurrent, intrusive flashbacks, hallucinations, disorientation to time and place, inappropriate affect, memory loss, addictive behaviors, depression, anxiety, emotional detachment, misperception or distortion of reality, self-destructive behaviors and rituals, somatic disorders/body memories, distressing dreams, dissociative states, intense physiological distress and reactivity, feeling estranged from others, diminished ability to feel emotions, difficulty falling asleep or staying asleep, hyper-vigilance, exaggerated startle response, irritability or angry outbursts, difficulty concentrating or completing tasks, suicidal or homicidal ideation or behaviors. In short all of them have difficulty living their lives in a functional way and are distressed beyond what their current circumstances would warrant. As Eugene O’Neill said in A Moon for the Misbegotten, “There is no present or future, only the past, happening over and over again, now.” (O'Neill, 1970)

A central construct to consider when discussing trauma is the role of the brain. The brain is also central to understanding why psychodrama is so effective with trauma-induced disorders. When a person faces overwhelming trauma the brain absorbs information about the trauma and stores it in the limbic system (Van der Kolk, McFarlane, & Weisaeth, 1996). The limbic system is where sensations, emotions and non-verbal information are automatically stored. The body is then flooded with stress hormones, the fight, flight or freeze response takes over and when that happens cognition is blocked. The result is that the trauma experience stays stuck in the limbic system and because cognition is blocked the individual is unable to accurately process the traumatic events and make clear present-based sense of them. As long as the information is stuck in the limbic system body memories, flashbacks and dissociated affect, impulses and behaviors continue. Because psychodrama can address issues non-verbally if done properly it can provide a safe vehicle for accessing the trauma information stored in a non-verbal part of the brain and move it to the cognitive processing part of the brain where the information can be verbalized, accurately labeled and processed from a current day perspective.

The Fundamentals of Trauma-based Psychotherapy

The core of reconstructive psychotherapy begins with the therapeutic relationship; it is the core of trauma recovery work (Greenberg, 1998). Without a strong positive psychotherapeutic bond nothing transformational can occur. Reparative work requires trust and empathy be established and maintained, it’s a prerequisite before the client can internalize what body-psychotherapists call ‘a body of trust’ within the self (Ridge R. M., 1998). Cognitive-behavioral work and insight-oriented work are both important components of trauma recovery but need to occur within a strong reparative relationship. The transference–counter-transference is that dynamic intersection that generates the energy for change. The client’s emotional wounds occurred within some type of emotional bond that was violated and the individual cannot be fully restored unless healing occurs within the context of a reparative bond. J. L. Moreno asserted “we are wounded within relationship and we heal within relationship.” (Moreno Z. T., 2010) Safety and consistency are essential and maintaining strong therapeutic boundaries is critical toward that end. Clients who have experienced abuse from an early age develop adaptive skills which disintegrate into dysfunction the result of which challenges the therapist’s rules, boundaries and limitations. Clients may become preoccupied with ways to violate those boundaries and engage the therapist in non-therapeutic ways (Van der Kolk, Perry, & Herman, Childhood origins of self-destructive behavior, 1991). It is essential that the client recognize the repetitive emotional and behavioral patterns that regularly occur in their lives. By identifying their patterns and what triggers them the client takes a necessary first step toward symptom management. Guided imagery, music, relaxation or dissociative reduction techniques can be helpful in managing body memories or panic attacks (Blake & Bishop, 1994).

Beyond support and validation, beyond trust and understanding is the client’s story. Every client has a unique story which has led to deeply ingrained patterns of behavior. Some patterns are overt and clearly identifiable but intra-psychic patterns are harder to identify. Because trauma memories are ‘stuck’ in the non-verbal part of the brain, psychotherapy alone may be inadequate because psychotherapy is word-based and trauma experiences are not (Van der Kolk, 1997). If the client cannot access the information or use words to describe what they are feeling, then what can be accomplished within the confines of that approach may be limited. The client may be acting out but unable to explain why or produce enough information to describe their internal experience. It is in those swirling moments of instability that these clients become most difficult to manage and the therapist may begin to feel frustrated. At those times the therapist may resort to setting limits sometimes veiled threats, ‘if you cut yourself I’ll terminate with you’ and the client’s fear of abandonment rises along with their distrust; yet they have no better skills to manage their feelings or behavior than they did before. It is times like these that a creative team approach can move the stuck client and therapist to a higher level of competence (De Zulueta, 2006).

The Role of Psychodrama in Trauma Treatment

Psychodrama is action based, expressive and creative. It allows the client to view past events from a here and now perspective and provides support while accurately labeling and processing trauma material. Because it is action based it is uniquely able, like other expressive therapies such as art and movement therapy, to access the non-verbal part of the brain and to transfer non-verbal material from that part of the brain to the cognitive processing part of the brain (Carey, 2006). It provides an opportunity for the client’s inner world to be externalized and enacted, to be emotionally perceived, identified and understood, then to be remembered, repaired and re-internalized. When that happens the trauma memory can be stored in the cognitive part of the brain and sequentially organized along with other life events. This neutralizes its impact on the identity, perception and functioning of the trauma survivor.

One of the essential values of psychodrama is its emphasis on movement. In psychodrama it’s not just tell me it’s also show me, so the individual moves from sitting in a chair struggling for words to being able to communicate through often simple movements. Trauma memories are contained in the brain and in the body. Through mindful breathing, (Springer & Rubin, 2009) movement and specific grounding techniques flashbacks can be controlled and the frozen dissociated client can find a way toward self-expression.

Psychotherapy and psychodrama are each rich and meaningful interventions but when used appropriately together they can provide a powerful forum for trauma recovery.

Essential Psychodrama Techniques Used in Collaboration

The double is a special auxiliary role used in psychodrama. The double’s function is to support the protagonist, client or the individual whose story is being enacted. While the double originated as a classical psychodramatic role, the art of doubling can enhance the therapeutic alliance to a greater degree than empathic, reflective or supportive listening (Hudgins, 2002). The clinician assuming the double role first explains the process and then asks permission to sit beside the client. The double always works towards establishing empathic attunement by doubling the client’s breathing, posture, facial expression, gestures, verbalizations, and voice tone. The double forms a united front with the client to support the client in expressing unspoken inner feelings. The double speaks in the “I” as this inner voice of the client. Client is asked to repeat the statement if it is accurate or to correct it if it is not. So, even if doubling statement is inaccurate, it clarifies and furthers self-expression. This kind of doubling is called classical doubling. It is particularly helpful with clients who have alexithymia (Hudgins, 2002). There are two other types of doubling that are helpful in working with trauma survivors, the body double and the containing double. The body double, developed by the Therapeutic Spiral Model is used to decrease dissociation, and help people experience their bodies in a healthy state (Hudgins, 2002). The containing double also taken from the Therapeutic Spiral Model, balances cognition and affect in an effort to help clients stay oriented to the present while working on trauma material (Hudgins, 2002). Types of doubling can be used by themselves, alternatingly or in combination with each other. Linda, co-author of this article, created the triple double, which interweaves all three types of doubling techniques from moment to moment depending on the client’s needs. (Burden & Ciotola, 2002) (Ciotola & Hudgins, 2003)

Dr. Kate Hudgins who created Therapeutic Spiral Model tm defines the observing ego role as,"...a role in which people can neutrally observe and narratively label their behaviors." To make the term more user friendly for clients we call this the witness role, and teach the client its function, to allow them to give themselves neutral factual information about their thoughts, feelings, impulses and behaviors, without judgment. Once the witness role is internalized, it can be used at any time, enabling clients to step back from the trauma, view it a distance and then accurately label what occurred, something that did not happen at the time of the trauma. During a psychodrama the client can be role reversed into the witness role, as needed. role reversal occurs when participants exchange roles either interpersonally or intra-psychically.

De-roling occurs at the end of each drama to clear auxiliaries and props of any energy, feelings, projections or issues that were assumed during the drama. Each psychodrama ends with sharing; this unique event follows each drama wherein all participants share how the drama related to them. The personal information shared, relates to the work that just occurred and helps the client feel understood and empathically connected with the psychodrama team.

Following each drama the protagonist or client is asked to create a project of integration. These projects concretely express and record the drama’s meaning. Linda describes it this way "…trauma has hard-wired the brain and body to hold on to a particular belief system, to ways of reacting, to ways of being with self and others. ...like a mosaic whose pieces have been arranged in a particular pattern, psychodrama takes the old configuration apart and reorganizes traumatic experiences in a new way. But for a little while, those newly configured pieces are sort of up in the air and not glued together. The project of integration glues the transformed pieces together.” A project of integration can be as simple as a one page collage or as complex as a power point presentation, it must include words and images in order to integrate right and left brain functions. Psychodrama integrates feelings and visual images contained in the limbic system with cognitive processing of the cerebral cortex; this allows the client to combine both types of memory and move forward. We encourage clients to complete their project of integration within 48 hours of the drama. This is because the brain tends to revert to old patterns before the new one gets glued in. The project is then shared with the therapist and psychodramatist the following week to further anchor in the crucial learning. Many of the projects we’ve seen reflect the depth, beauty and creativity of these trauma survivors as they make meaning of their psychodramatic experience.

We find follow up email is especially helpful. From shortly after the drama until it is clear that the client has successfully journeyed through the process, email messages are exchanged between the psychodramatist, the psychotherapist and the client. These may answer questions about the client’s experience, provide specific suggestions or information. Most importantly they maintain emotional connection and safe containment.

Three Ways to Combine Psychodrama and Psychotherapy

Out of our collaboration we formulated three different approaches that unite psychodrama and psychotherapy.

Collaborative approach – the psychodramatist and the psychotherapist are both in session with the client at the same time. These sessions are uniquely structured so that each clinician has a distinct role. When the psychodramatist assumes The doubling role during an individual therapy session it helps the client to remain grounded, express feelings, deal with dissociated aspects of self and work more effectively with the therapist while remaining within what Bessel van der Kolk calls, the window of tolerance. (Van der Kolk, 2003) This means that there is enough stimulation of the limbic system to access the trauma material, balanced with enough containment to keep the client from being re-traumatized.

During collaborative sessions, the therapist remains in her "therapist role", interacting with the client as she would normally do, while the psychodramatist assumes the doubling role. The therapist and psychodramatist do not talk directly with one another at that time and the therapist refers to the psychodramatist as the client’s double. Both the therapist and the double focus attention on the client. The process takes some getting used to but once mastered it works perfectly. The psychodramatist sits next to client, in the double position, both face the therapist and a usual therapy session takes place while the psychodramatist uses what we call the triple double, a composite of classical doubling to help clients access and express feelings, the TSM containing double to help balance affect with cognition and the TSM body double to help the clients decrease dissociation and remain in their bodies in a more grounded state. The moment to moment flow of the three kinds of doubling takes place according to the client's needs.

When working collaboratively, clarity about role, boundary and function is essential. With a client population where boundaries have been violated and roles were confused, it is essential that the role of the psychotherapist as primary and the role of the psychodramatist as auxiliary be clearly and consistently maintained. Through the years of working together not one single client ever seemed unclear about which of us was doing what. We each played meaningful roles in the client’s recovery process and emotional life, but they were distinctive roles, complimentary and valuable but distinct.

Clients with histories of severe trauma disorder need to demonstrate grounding and containment skills and have basic trust in the therapeutic relationship before being introduced to psychodrama. They have to be able to abstract well enough to grasp the concepts necessary to engage in psychodrama and demonstrate a commitment to the recovery process which includes preventing re-traumatization, controlling regression, learning to identify and avoid shifts in ego-states, being able to differentiate and utilize both psychotherapy and psychodrama.

Case Example

Janice is a 55 year old married professional woman who was sexually abused by her father until the age of 13 and was emotionally abandoned by her mother. She had numerous therapists and a long history of depression, suicidal preoccupation and several inpatient psychiatric hospitalizations for treatment of DID and PTSD; in addition she had alcohol and nicotine dependence. Janice exemplified Tian Dayton’s observation that ‘trauma and addiction go hand in hand.’ (Dayton T. , 2000, p. xvii) Trapped in the painful cycle of trauma and addictions, being frozen and mute, she was unable to access her strengths, name the traumas and begin healing. As Tian states, “giving words to trauma begins to heal it.” (Dayton T. , 2000, p. xvi) Janice was introduced to psychodrama because during therapy sessions she was mute for long periods of time and when she spoke it was in whispers; she displayed abrupt shifts in ego states, evidenced by changes in cognition, point of view, manner of speech, body movements and facial expression; these varied dramatically from alter to alter, also called personalities or parts.

After introducing the double role to the client, explaining its function, and how she could accept or change any doubling statement, and could request an end to doubling at any time, the psychodramatist assumed the double role and began tuning in to the client's breath, posture, facial expression, and what the client was communicating energetically if not verbally.

Double: ‘I feel frozen’

Janice: (no response)

Double: ‘I cannot move’

Janice: (blinks and gives small head nod, but says nothing)

Double: ‘I cannot speak’ (double is also 'leading' the client at this point with a Body Double technique of long slow audible breaths to help give the parasympathetic nervous system the 'ok' to calm down)

Janice: (presses lips together)

Double: ‘My lips are sealed. I cannot talk about what happened to me’

Janice: (begins to cry)

Double: (using her own body to 'lead ' the client,) says ‘I can feel all four corners of my feet on the floor and look at Nancy and just let my tears be.’

Janice: (still crying, looks at feet and places soles of feet firmly on ground, says nothing)

Double: Says, (while raising eyelids to look at Nancy), ‘I can raise my eyelids and glance at Nancy and know I am ok here in this moment.’

Janice: (raises eyelids to look at Nancy, is breathing more deeply in sync with double)

Double: ‘I know I am ok in this moment’ (if that's right repeat it, if not correct it.)

Janice: nods head and says, ‘Am ok’

Double: ‘I can choose when to speak’ (if that's right repeat, if not, correct it)

Janice: nodding (double nods with her), ‘I can choose’

Double: ‘I have choice here’

Janice: ‘I have choice here’

The client then started to tell her story while remaining grounded and present. At times, vignettes, defined as short psychodramas that can be very brief or expand as indicated (Dayton, T 2005), evolve during these sessions so that specific therapeutic issues or trauma components can be addressed. The psychodramatist may also be in the director’s role and can use the triple double from the director's role to help pace the work in a safe way. Collaborative sessions are scheduled between regular ongoing individual psychotherapy sessions. i.e., client and therapist meet 3x a week and one of those sessions is collaborative and involves the psychodramatist.

Alternating approach – full length psychodramas are scheduled as needed in order to work on more complicated emotional issues. Individual therapy sessions are ongoing and used to help prepare the client for and develop goals for the dramas. The psychotherapist attends the dramas taking either a strength role e.g. courage or the witness role. In a psychodrama all participants are fully engaged serving to validate and support the client, broadening and strengthening the emotional safety net to include the entire psychodrama team who see, hear and feel the client’s story. A psychodramatic experience “…allows clients to feel deeply seen, deeply felt by another, guided safely through feared internal landscape, and also fosters a sense of mastery and authenticity…. Having an emotional experience that is shared, safe, and when processed to completion, results in clients feeling open, at peace, having a sense of clarity, self-compassion and wisdom, further strengthens the bond to the therapist which allows emotional processing to proceed to a yet deeper level.” (Schwartz, Galperin, & Gleiser, 2009, p. 19)

In our collaboration the psychodramatist adapted and modified her experience from the Therapeutic Spiral Model tm to guide the process. Our team consisted of the psychodramatist, the psychotherapist and two highly trained psychodrama auxiliaries. On average, the time frame of about 6 hours was scheduled in a private setting to do the work. Before the protagonist/client arrived the team set up the room and held a team meeting which addressed issues to be cleared so that team members could be fully present. Following the drama, de-roling and sharing occurred and the client was assigned a project of integration. Following the protagonist’s departure the team remained to process, close and cleanup.

During dramas, the witness role held by the therapist, who had largely been holding this role psychologically for the client all along, and often took notes while in role that were useful in the project of integration and in follow up therapy sessions. Those sessions were more effective since the therapist learned first-hand about the client’s psychodramatic experience.

The psychodramatist joins the therapy sessions before every drama to determine needs and goals and returns after the psychodrama to review the client’s experience, see their project of integration and formulate further goals to be accomplished.

Clarissa – is a 50 year old unmarried professional woman with a history of child abuse. She is the youngest of 8 children abused and intimidated by her alcoholic father and neglected by her frightened mother. Cast in the role of family protector from an early age she was taught to stand up to her father and take care of her mother. A bright child she did well in school, left home and worked her way through college becoming an executive at an early age. She entered therapy with complaints of forgotten sexual encounters and worried that she hurt people in her sleep. Once diagnosed with DID, we found that she had a complex system of alters, she worked actively in therapy, journaling and following assignments perfectly. After three years she integrated her system. It turned out that she had sealed over many of her symptoms because she didn’t want to admit she was still having difficulties. Once psychodrama became a part of her trauma treatment regimen, she found a place of freedom and self-expression. The approach we used with her was the alternating method. Individual therapy sessions were alternated with periodic full length psychodramas.

The contract for Clarissa’s first private psychodrama was to eliminate the ‘wall of pain.’ This is something that occurred when one of her alters, ‘Tom’, felt the need to protect her by creating pain in the form of excruciating headaches and body pain. One auxiliary was asked to hold the role of the ‘wall of pain’ while the other held the role of ‘Tom’ with Nancy in the witness role and Linda using the triple double from her director’s role. And as the drama unfolded Clarissa and her alter realized that the ‘wall of pain’ was no longer necessary in the present and the alter in fact was a child part suffering role fatigue and Clarissa was an adult who could choose to handle her feelings and situations differently. This freed her alter from that role and allowed Clarissa to access her spontaneity and creativity. As a result the physical pain created by this part ended and a sense of safety within the system was established. “For over 40 years I have tried to break through the chains of the…‘wall of pain’ and now… it is gone”

Combined approach – an adequately trained clinician can assume both roles simultaneously during one session. Props concretize roles for both the therapist/director and the client and expand role options when no auxiliaries are present. Once the client is familiar with these processes role changes can occur seamlessly.

Case Example

Suzie – a 46 year old single professional woman with a history of emotionally vacant relationships, presented with low self-esteem, anxiety, obsessive compulsive disorder and a sleep disorder. She sought therapy primarily because of a pronounced decrease in her ability to function at work and because she had become entangled in a dysfunctional romantic relationship and was unable to integrate her perception of it. She idealized ‘Mike’ and focused on every tiny exchange they had and yet had amassed a mountain of evidence that he was dishonest about his interest in her and activities with other women. Her internal battle about his truth and her hope was all consuming. Every incident intensified her focus and diminished her ability to think clearly and perceive accurately.

Therapy sessions had been reduced to yes buts and compulsive reiterations of each miniscule exchange. Though she could see and hear what the therapist reflected back to her she couldn’t let go of him and her behavior was continuing to disintegrate.

Our first psychodrama à deux, psychodrama in which only the director and protagonist are present, began by asking Suzie to write her strengths on yellow sticky notes posted around the office. Strengths were integrated in action with the help of doubling done from the director’s role. Then Mike’s positive and negative qualities were concretized in two scarf piles allowing the protagonist to identify each quality and its impact on her. When she chose a dark splotchy scarf to represent his lies and she wrapped that scarf around her head and over her face and said ‘his lies are all around my head.’ The doubling statement was ‘his lies blur my vision and cloud my judgment. I just can’t see through them.” She repeated “yes, his lies are blinding me.” Once his negative qualities were addressed, doubled and deepened, a photo was taken with her cell phone to help her remember what it was like to be wrapped up in ‘Mike’s’ negative qualities. She was then directed to dispose of the scarves in whatever way seemed right to her, making a clear statement about the quality the scarf represented and how she planned to address that quality. Some were thrown in the trash, i.e. “I’m tossing your lies in the trash” and some were stomped on. Following the drama she experienced a shift in her feelings about him and was eventually able to disengage from the relationship.

Warming Up to Collaboration

The first stage of the collaborative warm up is an interest in working differently and beyond one’s usual scope starting with the therapist’s willingness to expand into the world of psychodrama. The psychotherapist has to see the value in both approaches. Psychodramatists are more inclined toward thinking about collaboration since that modality is more group oriented by definition. Once the therapist learns about psychodrama and sees its value, there is a learning stage. Psychodrama is not just psychotherapy with movement, art or music. Psychodrama is an independently recognized field; created by J L Moreno during the 1920’s (Moreno J. L., 1977), it was designed to have many applications including recovery from trauma. It has a well-developed theory, techniques and credentialing process. Once the therapist has become sufficiently familiar with psychodrama, the next step is the decision to share the client with another professional, to encourage the client to engage in psychodrama, to become familiar with those techniques and experiences.

One of the most powerful side effects of working in tandem is that the client is provided with an opportunity to experience the relationship between the psychotherapist and the psychodramatist (De Zulueta, 2006). For individuals who have spent their lives in a world where people are in conflict, experiencing their treatment team demonstrate cooperation and good communication, show mutual support and have honest exchanges even if there are disagreements is often an amazing experience for clients. Often before or during a psychodrama ideas are openly brain stormed, even differences of opinion are valued and explored openly and without conflict.

Summary:

In summary, the collaborative work between psychotherapist and psychodramatist is beneficial because roles are mutually reinforced and clinicians feel supported in working with this complex and stressful population. We have received consistent feedback from protagonists about the safety and connection they have felt from having the exact same psychodrama team for each of their psychodramas. They felt that the team sharing and constancy of their dedication provided a unique opportunity to trust and be validated for the first time in their lives. These deeply personal experiences allow them to reformat their early attachment experiences (De Zulueta, 2006). One client affirms the process by saying “Now I am authentic…spending more time with people and less time alone and isolated… I am grateful and so very happy for being able to have these experiences. I didn’t even know people could feel like this.” And another client says [through psychodrama]... “I found my voice and was honest in a way I have not been before. I can’t express in words what a transformation it is. What you do is miraculous!”

Author Contact Information:

Nancy Alexander, MSW, LCSW-C

5658 Thicket Lane

Columbia, MD 21044

nanwecan@comcast.net

410-730-8780

Linda Ciotola, M.Ed., CHES (ret), TEP

4 Bateau Landing

Grasonville, MD 21638

linda.healingbridges@gmail.com

www.healing-bridges.com

410-827-8324

Find Out More:

www.ac-ts.com

www.healing-bridges@gmail.com

References

Bien, T. (2006). Mindful therapy: A guide for therapists and helping professionals. Somerville, MA: Wisdom Publications, Inc.

Blake, R. L., & Bishop, S. R. (1994). The bonny method of guided imagery and music (gim) in the treatment of post-traumatic stress disorder (ptsd) with adults in a psychiatric setting. Music Therapy Perspectives, 12(2), 125-129.

Blatner, A. (2000). Foundations of psychodrama: History, theory, and practice (4 ed.). New York, NY: Springer Publishing Company, Inc.

Block, S. H., & Bryant Block, C. (2010). Mind-Body workbook for ptsd: A 10-week program for healing after trauma. Oakland, CA: New Harbinger Publications, Inc.

Burden, K., & Ciotola, L. (2002). The Body Double: An Advanced Clinical Action Intervention Module in the Therapeutic Spiral Model tm to Treat Trauma.

Carey, L. J. (2006). Expressive and creative arts methods for trauma survivors. Philadelphia, PA: Jessica Kingsley Publishers.

Ciotola, L., & Hudgins, K. (2003). The Body Double an Experiential Model for Eating Disorders.

Dayton, T. (2000). Trauma and Addiction. Deerfield Beach, Florida: Health Communications, Inc.

Dayton, T. (2005). The Living Stage. Deerfield Beech, Fla: Health Communications.

De Zulueta, F. (2006). The treatment of psychological trauma from the perspective of attachment research. Journal of Family Therapy, 28(4), 334-351. doi:10.1111/j.1467-6427.2006.00356.x

Greenberg, L. S. (1998). Handbook of experiential psychotherapy. New York, NY: The Guilford Press.

Hudgins, M. K. (2002). Experimental treatment for ptsd: The therapeutic sprial model. New York, NY: Springer Publishing Company, Inc.

Kellermann, P. F., & Hudgins, M. K. (2000). Psychodrama with trauma survivors: Acting out your pain. Philadelphia, PA: Jessica Kingsley Publishers.

Lev-Wiesel, R. (2008). Child sexual abuse: A critical review of intervention and treatment modalities. Children and Youth Services Review, 30(6), 665-673. doi:10.1016/j.childyouth.2008.01.008

Moreno, J. L. (1977). Psychodrama. Beacon, NY: Beacon House, Inc.

Moreno, Z. (2012, May 12). Wife of J L Moreno and co-developer of MOrenian Arts and Sciences. (L. Ciotola, Interviewer)

Neumann, D. A., & Gamble, S. J. (1995). Issues in the professional development of psychotherapists: Countertransference and vicarious traumatization in the new trauma therapist. Psychotherapy: Theory, Research, Practice, Training, 341-347.

O'Neill, E. (1970). A Moon for the Misbegotten. In E. Rinehart and Winston, A Treasury of Theater from Isben to Lowell (p. 690). New York : Rinehart and Winston.

Ridge, R. M. (1998). Rebuilding the body of trust. The Center for Experiential Learning (Charlottesville, VA), Newsletter(Winter).

Schwartz, M., Galperin, L., & Gleiser, K. A. (2009, March 13). Attachment as a mediator of eating disorder: Implications for treatment. Retrieved from Castlewood Treatment Center for Eating Disorders: http://www.castlewoodtc.com/wp-content/uploads/2011/07/attachment_as_a_mediator.pdf

Springer, D. W., & Rubin, A. (2009). Treatment of traumatized adults and children: Clinician's guide to evidence-based practice. Hoboken, NJ: John Wiley & Sons, Inc.

Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harford Review of Psychiatry, 1(5), 253-265. doi:10.3109/10673229409017088

Van der Kolk, B. A. (1997). The psychobiology of post-traumatic stress disorder. Journal of Clinical Psychiatry, 58, Suppl. 9.

Van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics, 12, 293-317.

Van der Kolk, B. A., McFarlane, A. C., & Weisaeth, L. (1996). Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York, NY: The Guilford Press.

Van der Kolk, B. A., Perry, J. C., & Herman, J. L. (1991). Childhood origins of self-destructive behavior. The American Journal of Psychiatry, 148(12), 1665-1671.

ACKNOWLEDGMENTS

We would like to offer our profound thanks to our dedicated auxiliaries, Connie Newton and Lisa Miller, both TSM Certified Trained Auxiliary Egos for their tireless devotion to this work and for their brilliance, creativity, warmth and loving support of our protagonists and our psychodrama team. Without them this work could not have been accomplished.

We would also like to offer our admiration and appreciation to all of our protagonists for their courage and their trust. It is because of you that we do what we do.

Unpacking Shame and On the Internet, Part 2 (New Section)

Fri, 02 Aug 2019 01:42:07 GMT

A new section by Sheila Rubin, LMFT, RDT/BCT

Role Development

Role development p 396 In a chapter about Psychodrama by Antonia Garcia and Dale Richard Buchanan in Current Approaches in Drama Therapy by David Johnson and Renee Emunah, “Moreno believed that the self emerges from the roles we play. He postulated that when people learn a new role, they follow a particular pattern of role development. The arc of the learning curve begins with role taking and proceeds to role playing and role creating.” “Dysfunction occurs when a person has a lack of either social roles or pschodramatic roles and function is seen as having a balance of both.” First a person can’t imagine a certain role, so I tell them a story about someone who had that role. Then I may suggest a conversation that that person may have. P, 43- Moreno wrote that “In orer to develop functionally moreno believed that each of us must first be doubled as newborns.” So much of the work I do in the therapy session is about mirroring the client.(p. 43)

From my chapter “Self In Performance” I write:

“Each story in our lives is like a pebble splashing into the pond of our inner worlds and the water that ripples naturally outward. When there has been trauma, the stories that would naturally flow outward can get truncated, withheld, or lost.”

This list is from my chapter “Almost Magic…” I wrote a series of therapeutic processes to work with shame. This can happen over the internet as well, as I describe in the case that follows,

Working with shame

• Counter-shaming- Help the client experience a series of successes. Focus on strengths.

• Grounding

• Some personal sharing to join and show humanity, join in imperfection

• Provide psycho-education about shame

• Mindfulness or observing ego

• Use objects or symbols to externalize shame and process current shame

• Separate shame from other emotions- objects or scarves or pillows can provide symbols

• Use projective or embodied to explore where the shame came from

• Introduce a protector

• Find aesthetic distance for the client to work with the shame

• Using projective or expressive processes to work with the shame

• Find a person’s true voice

• Give back the shame to where it came from- giving the shame back

• Witness the powerful healing taking place

• Embody the new role the new voice- try a posture or movement

A teen aged client complained of feeling “a presence watching me sometimes”. As we worked, I wanted to understand about the presence she felt sometimes while undressing an also when she got home from school. I wondered if it was perhaps an externalized voice of her inner critic, so I asked general questions about how she felt at school, at home, and listened for something that said she might feel judged or criticized. I asked when she felt the presence most strongly. She felt it most strongly in school when even though she knew the answer, she felt shy to raise her hand because the other person would be thinking that she would give the wrong answer that maybe wasn’t smart. She had fears of letting herself down and letting down her family. Over time I would normalize her concerns by telling her some of the developmental jobs of this particular time in her life is about comparison and finding her way socially as well as academically. I shared briefly about my shyness in highschool and ways that I over came it. This helped to normalize what she was going through and model that it is possible to get through, I helped her begin to feel inside her body by grounding exercises and stomping her feet.

At some point she could feel inside her body near the end of the session and she began to feel lighter and more hopeful. The presence was on a trip and she was able to use coping skills to put her attention on other things. During one skpe session we used symbolic imagery symbols to represent the part of her that was afraid that if she showed up as her real self in school, and people still didn’t like her then, she would feel destroyed. The imagery to protect this tender part of herself that she was maybe protecting by listening to the presence. I had empathy for this part that needed protection.

A session I asked her to imagine a movie or play with similar characters, say a waitress and a customer. Let’s say the waitress made a mistake with the order. And in the first seen, let’s say the customer is a mom who used to work as a waitress. How would the girl who was a waitress feel- terrible, just terrible. And if the customer left a big tip then the girl would realize that she must have gone through the whole dinner remembering her mistake and thinking about it the whole time. I asked. Would she have compassion for the young waitress because she know how that is a hard job and just learning. Yes, she said, but you know, if she gave a big tip it is because she probably thought she is a looser. Wow, I said, pretty critical. And let’s change the seen, same seen, different movie. Let’s say it’s the same waitress and the customer is someone her same age. Let’s say he’s a guy this time, let’s say a cute guy. So how would the waitress feel if she made a mistake at his table? Even worse, she said. So much worse, because he’s someone she wants to impress. That would be horrible!!! She probably would just feel like she’s wrong for even thinking he was cute if she made a mistake. And what about the tip? What if he left a big tip? That would be the worst, she said. Why I asked? She sighed and said, if it was someone her own age and she made a mistake that would be horrible. Why, I asked. Because he would know how awful she really was. As we discussed feelings of being embarrassment getting more and less depending on the situation.

So is there something you could tell the waitress about each of those scenes? I said something about it being a new job and a high leaning process. I asked her what she would tell the waitress if she could, to reassure her? And I asked to replay the scene one more time and said if you could go back and change one thing after the mistake, what would it be? In the first scene she had the waitress tell the female customer how sorry she was, and that she was just learning this new waitress job. And imagine how she would respond? She might laugh in a kind way and say that she remembers that. How does it feel? She paused and said – not so bad when we talk about it. I had her go back into the other scene with the cute guy and she imagined telling him later that it was her first day so of course the job was new. She imagined the waitress then joking with the guy and both of them laughing! How does that feel? So much better, she said. So how does your body feel? Lighter…A little more space. Where is the space? She points to her chest.

As we unpack the scene in our talking she admits surprise at how easy it was to imagine the waitress talking about her mistake and saying what was happening for her instead of keeping it all inside! I asked about the feelings of embarrassment. Much less. She said she couldn’t wait to practice this next week.

I explained that we were working on several levels. One level was giving her tools to cope with the experience of the presence and the shyness. On another level we were working with symbols to understand the role that the presence has for her and other ways to relate to it. Another level we are working developmentally about what it is to be female in high school and all the issues of dating, finding her place with the other kids socially and intellectually. She began to understand that the presence was something she could gain more control over, by shifting her focus away from it by talking to family, friends, getting busy with schoolwork. Eventually she realized gained a different relationship to it and it bothered her less and less. As she became more comfortable with saying what was going on with her instead of hiding behind her shyness, friends started to reach out to her more and she didn’t feel as alone.

The power of somatic imagery helped. Role plays that we did over skype helped. The eye contact we had over skype helped her feel normal and part of her life journey.

She reported learning to begin to laugh at herself, something that had been very hard, in a way that was countershaming for herself and the other person. She reported that it took the pressure off of herself and the other person when in an uncomfortable moment. She said that sometimes she wasn’t worried what the other person was thinking anymore.

Along the way we found things to say in her new role of power taking her locus of control back , “ I’m commited, I’m ready, I’m in control” In sessions she would feel a calmness in her body and a relaxedness. That’s how I would track.

Imagination Activated via Drama Therapy and Expressive Arts Therapy

From our workshops and from an unpublished paper on “Healing Shame in the Imaginal

Realm” Bret Lyon, Ph.D., and I present that:

When a person gets stuck in shame, the most powerful way to get unstuck may be to activate his or her imagination. In the imaginal realm, logic and time are fluid and flexible. What actually happened can be explored and changed. What was stuck can be reexamined and shifted. Shaming situations from the past can be revisited, excavated through writing and expressive exercises, and thereby shifted.

There are ways to give back the shame to where it belongs—through drawing, writing, and imagining past shaming experiences and saying now what you wish you had said then. Structured writing and expressive processes can symbolically give back the shame. This is where to find resilience. This work can be done with extra care when the session is over the internet because the person can quietly slip into the shame vortex. I develop exercises to help them have something to hold on to during and after the session.”

Renee Emunah in her book Acting For Real (1992) writes about “Drama Therapy as the intentional and systematic use of drama and theater processes to achieve psychological growth and change” (p.3). Drama therapy can include play, role play, psychodrama, dramatic ritual, and psychotherapy. We are helping the client to develop an observing self, an inner director that can reflect on our life (p.32). “A dramatic enactment can include both reality and fantasy (p.27). Eva Leveton from A Clinician’s Guide to Psychodrama wrote about the therapist becoming the client’s double, and talking for the client as an emotional double or a counselor double, or an exaggerated double. Adam Blatner expounded that psychodrama offers a place for replaying scenes of the past, expressing feelings now that have not been expressed, and for opening new possibilities for the future. “Individuals are invited to engage more authentically in activities that increase their sense of being alive” (Blatner, 1988, p. 85).

Working with Counter-shaming Metaphors

There is much to be explored in this new world of online therapy. As I was writing this chapter I received an email and was invited to possibly set up some online groups for an eating disorder program. That would be an interesting population to work with online because when I work with them in person, many tended to dissociate. There is much to be discovered. There is much to be explored. There is much to be created. I am excited about being able to reach people who don’t live near me and do work online. I am excited about developing ways to work through shyness and awkwardness and shame that many clients present using combination of drama therapy, expressive arts and attachment work/psychotherapy.

Adam Blattner writes in Foundations of Psychodrama, p. 79

Activity in Psychotherapy

Blatner writes “The process of psychotherapy should not be thought of as a passive treatment in the sense of the medical model typified by receiving penicillin shots for pneumonia. Rather, it is a form of experiential learning, requiring a significant degree of courage and active partipation on the part of the patient” As a way to move beyond the typical tendency to lapse into passivity he suggested including elements of imagination, emotion, plysical, movement, and cognition and including play in therapy sessions. P.79

Metaphore

Blatner writes about the value of metaphore in psychotherapy (p.155)

Surplus Reality

Blatner writes in Foundations of Psychodrama. That one can enact not only scenes that involve real events in a person’s life, but also scenes that have never happened. The scenes can represent hopes and fears or other psychological concerns.(p178)

Homework I often suggest after online sessions dealing with shame: Draw or write in your journal, play music that is soothing or exciting, move dance, meditate, get it all out to writing and writing, and then close the book! Now begin your life!

ABOUT THE AUTHOR

Sheila Rubin, LMFT, RDT/BCT is a leading authority on Healing Shame. She co-created the Healing Shame Lyon-Rubin therapy method and has delivered talks, presentations and

workshops across the country and around the world at conferences from Canada to Romania for over 20 years. Sheila is a registered drama therapist and a board certified trainer through NADTA, adjunct faculty at John F. Kennedy University’s Somatic Psychology Department. She is an alumnus and has taught for California Institute of Integral Studies’ Drama Therapy Program.

Her expertise, teaching and writing contributions have been featured in numerous publications, including six books. Sheila is a president emeritus of San Francisco CAMFT and the Northern

California chapter of NADTA. For more information on Healing Shame workshops, certification and private therapist consultations visit www.HealingShame.com or www.SheilaRubin.com. She

integrates somatic, expressive and attachment modalities in her work with couples, families, and children who have shame and trauma. Her private practice is in San Francisco and Berkeley, CA. Sheila has trained with attachment theorists Diana Fosha and Sue Johnson, and Hakomi somatic pioneer Ron Kurtz.

Sheila and her husband, Bret Lyon, have created and co-lead "Healing Shame Workshops” for therapists in Berkeley, CA and throughout the U.S. and Canada. Sheila has written about her work in several publications. She authored the chapter "Women, Food and Feelings" in The Creative Therapies and Eating Disorders, edited by Stephanie Brooke, addressing her work incorporating drama therapy modalities into a hospital-based eating disorders program she developed. She wrote the chapter “Myth, Mask and Movement: Ritual Theater in a Community Setting” in Ritual Theater, edited by Claire Schrader. She authored a chapter on “Self-Revelatory Performance” in Interactive and Improvisational Drama; Varieties of Applied Theatre and Performance, edited by Adam Blatner. And she wrote the chapters “Almost Magic: Working with the Shame that Underlies Depression” in The Use of the Creative Therapies in Treating

Depression, edited by Charles Meyers and Stephanie Brooke, and “Embodied Life-Stories: Directing Self-Revelatory Performance to Transform Shame” in The Self in Performance, edited by Susana Pendzik, Renée Emunah and David Read Johnson, to be published in 2016.

Sheila can be reached at www.SheilaRubin.com and www.HealingShame.com.

References

Amadeo, J. (2001) The Authentic Heart; An Eightfold Path to Midlife Love,Canada, John Wiley and Sons

Blatner, A. (1988). Foundations of psychodrama: History, theory, and practice. New York, NY: Springer Publishing.

Emunah, R. (1994). Acting for real: Drama therapy process, technique, and performance. New York, NY: Brunner/Mazel.

Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York, NY: Basic Books.

Garcia, A. and Buchanan, R. (2009) Psychodrama in Johnson, D and Emunah, R. (2009), Springfield, IL: Charles Thomas Publishers.

Graham, Linda. (2013). Bouncing Back: Rewiring Your Brain for Maximum Resilience and Well-being. Novato, Ca.: New World Library.

Hughes, D. A. (2007). Attachment-focused family therapy. New York, NY: Norton & Company.

Johnson, S. (2005). Emotionally Focused Couple Therapy with Trauma Survivors; Strengthening Attachment Bonds, NY, NY. The Guilford Press.

Kaufman, G. (1974). On shame, identity and the dynamic of change. Paper presented at the annual meeting of the American Psychological Association, New Orleans,

LA. Retrieved from http://files.eric.ed.gov/fulltext/ED097605.pdf

Kaufman, G. (1992). Shame: The power of caring (3rd ed.). Rochester, NY: Schenkman

Books.

Nathanson, D. L. (1992). Shame and pride; Affect, sex, and the birth of the self. New York, NY: W. W. Norton & Company.

Rubin, S. (2007) Self revelatory performance in Intercalative and Improvisational

Drama; Varieties of applied theatre and performance, ed. Blatner, A. Universe

Schore, Allen N. Affect Regulation and the Origin of the Self: the Neurobiology of

Emotional Development. 1994 New Jersey, Laqrence Eribaum Assoc. Publishers.

Body-Mindfulness Techniques for Depression

Thu, 01 Aug 2019 02:05:45 GMT

By Marjorie L. Rand Ph.D.

If I could offer you a cure for your depression and anxiety that did not cost any money, required no special clothing nor equipment and is something you are already doing, would you want to know what it is? Or would you rather take expensive pills which have multiple side effects? There is even a hidden extra benefit which comes along with the secret cure, of which I will inform you later.

Before I tell you the secret, I also need to give you a few facts. There are various forms of depression from dysthymia (mild) to clinical (severe) with many variations in between these extremes. With extreme cases, medication in combination with psychotherapy, yoga, meditation, and exercise is the most effective treatment. But most people along the mild to moderate portion of the scale who are functioning, living a productive life, but who feel numb or just do not feel fully alive are not in need of medication. Maybe they are OK at work because it provides structure, a place to go, something to do every day. But on weekends they may isolate and hang around the house watching TV or sleeping all day, never even getting dressed all weekend. They do not shop or cook for themselves, so they tend to eat fast food or junk food, mindlessly. Does this apply, even a little bit, to you?

So part of the secret cure that most people are not aware of is that they can control their own nervous system. Many of us spend our lives trying to control other people and our environment (which is not possible), instead of trying to modulate or regulate our own states of arousal or moods. We have it completely backward. The only thing we can control is ourselves. But since our nervous systems and emotions reside in our bodies, (Pert, et.al), we cannot control or regulate our emotions from our minds.

Are you getting any closer to guessing the cure? What do meditation, yoga, and exercise have in common? You may guess breathing and you would be correct. Let me explain how the Autonomic Nervous System (ANS) works and how you can use breathing to modulate and change it. The ANS is often thought of as “automatic” because it controls functions which are usually unconscious, such as heart rate, blood pressure, digestion, circulation to name just a few. However, many of these autonomic or unconscious functions can come into conscious control through one system. By now, I think you have guessed it. Breathing is the one function in our body-mind that can be done unconsciously or consciously. Breathing is the most basic support system of living. You can live long periods of time without food and shorter periods of time without water, but only minutes without breathing.

Here are 4 basic ingredients of the secret cure for depression:

Breathing
Containment
Grounding
Presence
Breathing

Breathing

When we are hyper-aroused (sympathetic or fight or flight) we are stuck in a response which floods us with stress hormones. We can regulate our ANS down to parasympathetic (relaxation). How? Through breathing!

First, we want to relax and expand the body by parasympathetic breathing, and creating space for energy to flow. We focus the breath down in the lower abdomen (navel center) and focus on a long sighing exhale (exhaling more than we inhale).

Once the body is expanded (which I will explain in containment) we can move on to sympathetic breathing techniques. In states of hypo arousal (depression), there are different breathing techniques for heightening arousal or aliveness and energy. Sympathetic breathing techniques involve breathing into the upper chest all the way up to the upper ribs and collar bones. In this type of breathing the inhale is emphasized-almost like a runner who is panting and calling up energy to the muscles.

Optimally, we want balanced breathing equally distributed between chest and belly, but that would require a moving, flexible diaphragm muscle.

Containment

If you pour liquid into a rigid container (a glass vase, for example), there is a limit to how much liquid the container can hold before it spills over (discharges) or breaks (fragments). Your body is the container for your life energy which is generated by breathing. Your body needs to expand like a balloon which stretches and holds more air with each breath. On the exhale, tension is released from the muscles. Something like letting the air out of the balloon. So the inhale is “opening up” and the exhale is “letting go”. With each and every breath you are expanding your container and building more energy, which is the antithesis of depression. In depression, the body is closed down, the exhale is retained and there is little energy. So the secret cure for depression really is breathing!

Grounding

What is grounding? It means being (living) inside your body and not only in your head. So grounding has something to do with the feet. If you are standing your feet are on the ground. Can you imagine putting your brain in the soles of your feet? How different might your reality seem? If you are sitting, then your sitting bones, as well as your feet, are in contact with the ground. And if you are lying down, you are most grounded of all, as your whole body is being supported by the floor or bed. It is extremely important to be grounded if you intend to use your breath to lift you out of your depression.

Presence

Remember in elementary school, when the teacher would call roll and you would answer “present” if you were not absent? How many of us are really “absent” in our lives, living in a world we have created through our belief systems, instead of in the here-and-now present moment. Depression is primarily living in the past, and getting present in the moment usually results in feeling OK (right here, right now). So the mindfulness techniques help us to keep watching ourselves slide into the past and snatch ourselves back up to the present (where we are OK).

So now you have the ingredients for the secret cure to depression. If you are on medication for depression prescribed by a physician or psychiatrist, do not stop taking your meds unless you consult with that prescribing physician. It is perfectly safe to do the breathing techniques along with your meds.

You can see examples of my breathing techniques on my Marjorie Rand You Tube channel or my website www.drrandbodymindtherapy.com under Yoga Therapy.

About Marjorie L Rand, PhD

I have been a psychotherapist for 39 years, licensed in three states: California, Colorado and New Mexico, and have trained psychotherapists world-wide since 1986. My training Institutes are located in Switzerland, Canada, Germany, Israel. The IBP institutes in the US (as well as other countries mentioned) also use somatic psychotherapy, and supported yoga therapy.

The focus of my work is body/mind/spirit, using somatic psychotherapy and meditation. As a Developmental psychologist, I believe that we are influenced by events starting at conception and through the first three years of life (based on Object Relations theory).

In addition to my practice as a Marriage and Family Therapist, I am also a somatic psychotherapist, meditation teacher, supportive yoga therapy teacher and pre- and peri-natal psychologist.

Unpacking Shame and On the Internet, Part 1 of 2

Tue, 02 Jul 2019 00:49:01 GMT

By Sheila Rubin, LMFT, RDT/BCT
Get Sheila's bio in part 2 of this article.

I begin this chapter about the internet with the fact that my clients think I’m a Luddite. I grew up with a wall phone telephone that, by definition, was attached to the wall. At most, we could stand a few feet from the wall, with a few inches of cord linking us to the phone. This was in a time even before answering machines. I came of age and went to study radio and television in college during the time of the black-and-white Portapak video machine that was heavy, where we actually spliced tape using our fingers—just before electronic newsgathering. Response time to a letter was a couple of days to a couple of weeks. I’m fully aware that the words I’m writing here will likely be outdated due to technology changes before the book is out in the world. I have accepted the use of a smartphone into my private practice, along with doing therapy over the phone or Skype if I have met the client at least once in person. I have come a long way!

Who Wants Therapy over the Internet?

People who live far away, people who don’t have time to drive to a therapist’s office, and people who are shy comprise the population of those who request therapy via the internet. I use the word shy to describe people who may feel uncomfortable or even ashamed about what they want to talk about “in private.” This is a great place. The internet provides a safe venue in which shy people may feel safer about seeking help. In working with shy people, I use extra care to welcome them, help them feel safe, and am aware that they may, at some point, reveal their shameful feelings

Therapy on the Phone or Internet

On both phone and Internet, with individuals or couples. I find that I check more often for

feelings that I might be able to sense when working face-to-face. I slow things down and tend to do more somatic work, asking clients to ground and to sense somatically for part of the session. I always ask at the end, “What are you taking from this session? What was helpful?” I also give homework after each session; for example, make a list of the coping skills from the session and put them on your calendar day by day, or take the powerful symbolic objects from this session and put them out in your room at home with a note by each to remind you what each part said to you today. Or, find an object to represent the shy part of you that is afraid to speak and take the card we wrote today and put it next to it. Practice it in the mirror before you talk to your boss.

Concerns about Technology

What about when technology fails, when a person just revealed something that has been hidden and Skype freezes? In the middle of a session, a husband was telling his wife why he had trouble when she touched him. Suddenly the screen froze and this tender moment was interrupted. I was frantically trying to call them on Skype, which would not reconnect. I had to call them on my cell phone; the tender moment had passed and they were fighting again. There was a rupture that had been caused by failed technology that mirrored the rupture in their relationship. I had to slow things down and gently find the words to meet them and name the negative cycle that occurred when communication came to a standstill. I used this as a symbol of what they were both dealing with within the relationship and helped them build a bridge toward each other.

Shame is the rupture of the interpersonal bridge, says Kaufman (1974, 1992). Any disruption in connection with a significant other can disconnect the person from him- or herself, or the therapist, and activate the feeling of shame.

What I realized was I had to let them know ahead of time the constraints and the benefits of using the phone for therapy or skype for therapy. It will save them time coming to my office when they are in a difficult place in the relationship, but it may not be as contained as an in-person session. One couple who was struggling with the husband having an online affair and the wife needing to see his phone to be reassured that he wasn’t meeting the woman. I spoke slowly and carefully to them to get an agreement before we began to talk. “Because we are not face-to-face, I can’t just put up my hand to interrupt you if there is shouting. I am going to do the session slowly and have you repeat what you hear the other person saying so that I can know you heard them and they can know that you heard them. We are going to take turns. Are you both in agreement? And because the phone is not a predictable medium, each of us is on a cell-phone, if one of us gets disconnected for any reason we need to have a plan. Is each of you near a home or office line? If someone’s line dies, we will momentarily stop the session and I will wait for the call of the person who was disconnected. Call me back on your office phone and I will use my phone to accept both calls.

Shame

In my chapter in Self in Performance coming out in 2016 or 2017, I write that “Shame can be right there in the shadows. It is easy for misunderstanding.” When I can’t see the emotion on clients’ faces, because we are on the phone or they are looking away from the skype screen, I don’t know what they are experiencing. In the book Shame and Pride, Nathanson (1992) explained that throughout life we are balancing between pride when we are seen in a good light and shame when we make a mistake of being seen in a less than favorable light. Diana Fosha (1992) later wrote that we would call this our “self at best” and our “self at worst.” We strive to be seen as smart or clever or helpful, but when a mistake is made and something is unclear, suddenly the person is risking being exposed and seen as self at worst. This concept is helpful to remember as a client is sharing vulnerable revelations. I know from my own vulnerability how scary it can be to be exposed at the wrong time or without kindness and support.

Skype Therapy

I have done consultation for colleagues as well as therapy sessions on Skype. The good news is that Skype can serve as a bridge between family members who do not live within driving distance of one another. It can also get in the way of direct eye contact and physical contact those family members long for. It proved very therapeutic for an elder client to see her grandchild over Skype, even though she believed it would not “do the trick.” She had been hurting because her son didn’t call her as often after the baby came and that the other grandparent was invited and she was not. We role-played her talking to her son, but nothing shifted. She still felt left out, like something was wrong with her for not being chosen to spend time with the new family. We unpacked under all the feelings of anger toward her son for not insisting that his wife invite her at the same time as the other grandparents and under that was the feeling of shame. She felt ashamed to not be invited and fought with him on the phone when they did talk. I asked her to role-play talking to her son in a way that invited a solution instead of blaming him for her

frustration. I invited her to role-play the visit with the grandchild. She rocked back and forth.

Finally, I suggested that she use Skype as a way to visit her grandchild. She told me that I didn’t understand. She wanted to pick her up and rock her in her lap in the rocking chair. I invited her to try just one phone visit on Skype with her son and grandbaby. She sat in the rocking chair at her home and rocked during the skype session with her son and his Babby. She was delighted to see her grandchild recognize Grammy over Skype. This experience fulfilled her longing to visit with her grandchild. There were many Skype visits thereafter. Her feelings of shame about being left out decreased and invite to visit increased.

Containment

Please note that I only do sessions remotely if I have met with the client in my office and we have developed a solid therapeutic container first. When the client is in my office, I can observe a range of nonverbal cues and get a sense of his or her energy. Over the phone, there are subtle cues I may miss. Here are ways I work with the absence of the visual modality. Because I am not seeing them, there are things I need to do to contain the energy of the session and the pace of the session. Because the client isn’t seeing me, there are ways I want to structure things to help them feel me where they are sitting.

Case Example of Phone Session

This client was feeling dark; her boyfriend was spending time with his ex-lover again instead of going on the date they had planned.

Client: “He’s still in the role of letting his ex rely on him. I couldn’t stop crying for hours.

My emotions got all wacky or something. I see his side when he’s helping his kids. But

every act of his kindness is an act of affection toward his ex. One day its good between

us, and the next day I feel ignored, neglected.”

Therapist: “How about if you choose something in your room to represent your feeling

neglected and ignored.”

Client: “OK, this plant.”

Therapist: “Can you move it near you and look closer at it? And as you are looking at it,

what does it say to you? What does it symbolize?”

Client: “You have to pay attention to a flower. You have to water it or it dies!”

Therapist: “So that’s a very powerful symbol of needing to be tended and cared for.”

(I wanted to pause and have her reflect on the importance of her attachment needs. She really wanted to just rush past them in the session. Choosing an object helped me direct the session to make space for that subject. The act of choosing something took her into another part of her brain where creativity was more open to her. Having a symbol can be a very powerful metaphor. Having it in front of her helped her to focus on it during the whole session).

Client: “Yes! I want to be cared for. But when I feel this way, I don’t feel like myself. It

feels like I don’t exist. It’s too painful when he says he’s coming over and then he cancels

because he’s with his ex-lover. Why am I punishing myself? I could go out and be in

another relationship!”

Therapist: “So there’s another part of you that doesn’t want to be punished anymore, that

wants to find another relationship, one where the guy is choosing you instead of choosing

his ex. Can you look around the room and find an object that represents this part of you?”

(This is another place I want to pause the session and give her time to feel the

power of what she just said. I want a symbol for that part so we can talk to that

part as well, maybe have a conversation with both of them.)

Client: “This candle!”

Therapist: “Can you put the candle in front of you and look at it. What does it represent?”

Client: (Surprised) “There’s a light in it! I can attract things…people! But I’m not ready to move on.”

Therapist: “Can you give each a voice? What does the flower say and what does the

candle say to you?”

(The candle told her that she is bright inside when she’s not so depressed

worrying what is going on with this guy she’s dating. It gives her inspiration to

grow herself and step out of the relationship to a real relationship where someone

could really be available for her. As she was expressing this, another feeling

showed up.

Client: “I feel deep anxiety.”

Therapist: “Where is the anxiety in your body?”

Client: “My diaphragm.”

Therapist: “Can you put some space around it and take some slow deep breaths?”

Client: “I’m not being logical. I should just leave him. But I don’t want to leave him. He

says kind things to me, offers to work it out. I really care about him. He’s clear about his

intention that he wants to be with me!”

Therapist: “There are a lot of conflicting feelings.”

(Because we are on the phone, I want to keep the connection and let her know that

I am here and that I hear her.)

Client: “I’m scared. Lonely.”

Therapist: Yes, there’s a part that’s scared and lonely.”

(I want to support this part.)

Client: “It’s like a pouting child!”

(And it feels like she is putting down that part. It is like some part of her is

shaming that part of her for wanting what she is wanting.)

Therapist: “I wonder, I’m curious if there is some shame around that part?”

Client: “Yes.”

Therapist: “Can you look around and find an object to represent the part that comes out

and shames you when you talk about your attachment needs?”

Client: (Apparently looking around her room for a few moments) “A hat.”

Therapist: “How does a hat represent shame?”

Client: “I put it on myself!!! I have a hard time asking him to meet my needs and I’m scared that they won’t get met again. That he’ll cancel plans with me again!”

Therapist: “Maybe the shame comes out to put you down for feeling what you’re feeling?”

Client: “Yes. If I’d recognize those things, logically I would leave.”

Therapist: “That inner conflict is so painful. So one part of you shames you for having normal wants and needs from him and when you think he lies again or cancels plans, then that part shames you again for not leaving.”

Therapist: “How did you feel when he said that?

Client: “Insecure! Nerves all over my body. On edge!”

Therapist: “What did the nerves say?”

Client: “Run!”

Therapist: “And what did you do when you felt that strong urge to run?”

Client: “I’m feeling shame about my feelings. He’s good with his words, but his actions don’t match. Then I feel shame for wanting to leave.”

Therapist: “I wonder if this current feeling of shame reminds you of anything that happened before in your life.”

Client: “I feel so much shame in this relationship. It reminds me of my last relationship.”

Therapist: “The one where the guy was hiding his porn addiction and hiding his other lovers?”

Therapist: “Of course you want this relationship to work. Can you turn to the plant that represents your needs? What does the plant say?”

Client: “The plant says, ‘You’re making yourself suffer!’”

Therapist: “What does the hat say?”

Client: “It says that I’m ashamed of my feelings. I’m embarrassed that I want him to visit me instead of his kids. That’s terrible.”

Therapist: “What does the candle say?”

Client: “It says that I don’t need to shame myself for my feelings. I have a light inside me. I need to remember.”

(I’m wanting her to stop here and reflect and to work to understand if maybe there

is something here for her to be shameful for. That would be a form of healthy

shame.)

Therapist: “Sometimes shame can pull a person out of her deep knowing by cutting off the life force or the light. Sometimes there is healthy shame that tells a person that there is something he or she doing or another person is doing that is actually shameful, that should be shameful. And there might be helpful information here if this is healthy shame. Healthy shame can help a person make new decisions or understand things differently. Here is some homework to do before our next session. Get out your journal at the end of the session and ask yourself, “What did I get from this session?” Please write it down. And please write down some of these questions. Please do some journal writing to answer these questions:

• What does the plant say?

• What does the candle say?

• What does the hat say about how you shame yourself?

• Listen to the shame and feel if there is something of value here or if it is just putting you down.

• Is there part of it that is valid?

• Is there something to listen to that is actually shaming in the situation for a reason?

• Is there something here from a past relationship or situation where you felt shamed?

• Is there something you feel shy about?

• Is there something for you to learn about shame here?

Understanding Shame

Shame is a primary emotion. The role of shame is to warn us and protect us. Our nervous

system shuts down and we actually lose cognitive ability when we are feeling ashamed.

Two indicators of shame are confusion and stuckness. Shame can freeze both mind and body. Shame is so difficult to see and cope with because it often hides behind other emotions. Shame, like of its functions is to protect us by lowering our emotional intensity and capacity to act. It is important to differentiate healthy shame, which can help us pause and rethink, from toxic shame, which can produce paralysis and leave a person so frozen that he or she is incapable of action and clear thinking. Healthy shame can lead a person to take responsibility for his or her actions, reassess, and make changes.

Healthy Shame

John Amadeo in The Authentic Heart writes that shame can be instructive and that “properly acknowledged shame and guilt can open a doorway to understanding how you’ve hurt someone.” (p. 64)

While excessive or toxic shame can keep a person in denial, “shame overload paralyzes

your capacity for clear introspection.” He says that “No growth is possible without some

small amount of shame.” (p.65)

In my chapter “Embodied Life-Stories: Directing Self-Revelatory Performance to

Transform Shame” in the book The Self in Performance by Emunah, Johnson and

Pendzic, I wrote:

“When we become significant to another person, as happens when we are therapist,

supervisor, friend, spouse, or parent, then we can induce shame in him or her unconsciously, unintentionally, even without knowing it has happened. Failure to fully hear and understand the other’s need and to communicate its validity—a look in the other direction, a frown, a disappointing facial expression—whether or not we choose to gratify that need, can sever the bridge and induce shame.

Developmental needs that are not met over time can also lead to internalized shame. The child learns to feel shame that his or her needs don’t matter; the rupture is from outside, from the parent who fails to validate the child’s needs.”

I would add that it then is on the inside and the person learns unconsciously to shame themselves. “I am creating attachment through my witnessing, which starts from the first moment: being seen in a positive way, which is counter-shaming.” Daniel Hughes in Attachment-Focused Family Therapy writes about why shame may be a central factor in the development of pathology and a deterrent to getting help: “First, shame places one in a fog, hidden from potentially significant others, actively avoiding the exposure to another who could provide—through intersubjective experiences of acceptance, understanding, and empathy—a pathway toward both effective regulation as well as self-awareness. Second, shame prevents the development of the ability to reflect on and make sense of one’s behaviors and subjective experiences” (p. 184).

In the Eight Keys to Safe Trauma Recovery (2000), Babette Rothschild notes that “shame, quite simply, tells us that something is amiss” (p. 87) and that “Rather than discharge, as an example in yelling or crying, shame dissipates, when it is understood or acknowledged by a supportive other. More than any other feeling, I find that shame needs contact to diminish” (p. 92). Rothschild describes a process for deciding when to address shame, understanding the value of shame, apportioning shame fairly, and sharing shame (pp. 98–100).

Embracing the Body, Healing the Soul

Mon, 20 May 2019 00:17:50 GMT

by Tina Stromsted, Ph.D.

Nature as Witness

Dance was medicine, and nature my deepest container and first witness. As a child, when painful feelings arose around our family dinner table, I’d clear the table, load the dishwasher, and then dart across the street into the alfalfa field. I’d find the clearing at the center of the field and begin to spin and turn, holding the horizon line steady with my eyes as my body whirled. Blue sky, clouds, green leafy corn stalks, sweet alfalfa and the ground under my feet brought freedom, as family tension drained from my body into the soft, receptive earth. There, I’d dance, turning countless circles, my arms outspread. I felt full of abandon. Little did I know at the time that I was treating my wounded soul with core elements of Authentic Movement, which would become a cornerstone in my life and work.

A ‘shimmer’ ran through me; a life force that pulsed with spirit. Time stood still; there was a sense of oneness with the natural world all around and within me. In the natural way of childhood, I had stumbled on the whirling dance practiced by the early Sufis. Feeling free and whole, my soul restored, I’d return to the house for more chores and homework. Nature was my primary witness.

Years later, while studying and performing dance and theatre, I realized that my heart was not in ‘performing’. What really interested me was transformation, and how the body/psyche/spirit was involved in that. I sought the feeling of connection I’d experienced in my childhood fields. While teaching dance in my 20s, I began to focus not so much on the exactness of the students’ technique, but on the ‘shimmer’ that came and went in their soul expression, the movement of light in the body. As I sought ways to support them – letting their vitality come through in the dance and reflecting those moments back to them at the end of class – many began to tell me their life stories. Wanting to better hold and understand their experiences, I did volunteer work in mental health clinics and returned to graduate school to study clinical psychology and dance/movement therapy along with ongoing studies in somatic practices, creative arts therapies, Zen meditation, personal analysis, and eventually post-doctoral studies and analytic training at the C.G. Jung Institute of San Francisco. (Stromsted, 2015, pp. 341-2)

The body as transformative vessel

The journey through life is not simply metaphorical, psychological or spiritual, but also concretely experienced in the body. Together with our dreams and intuition, the body can act as a compass to guide our life’s course. When you enter into the realm of the body, you encounter your history and all that may be dwelling there. With movement signatures that express us as uniquely as our fingerprints, our bodies serve as sculptured intermediaries between our inner and outer worlds. Our physical make-up reflects not only our genetic inheritance, but also the compromises and choices we’ve made in defining a lifestyle for ourselves, first as family members and then as individuals. Our experience, if embodied, also offers us a way to connect with all of humanity. The body is not only personal, but cross-cultural and universal. Our thoughts and feelings express themselves as gestures, often striking chords of emotional and spirited recognition within people everywhere.

The body should be thought of as a major initial text. It pulses with the oldest language,

containing a deeper historical memory, which we strive to recognize through newer mediums such as neuroscience, genetics, somatic psychology, dance/movement therapy, trauma work, quantum physics, affect and attachment theories and others. ‘The body does not lie,’ said the late modern dancer and choreographer, Martha Graham. The body remembers why it is here: for healing, for embodiment, for incarnation (Stromsted, 1994/5, p. 17).

Discovering Authentic Movement

In 1982, I was introduced to Authentic Movement by Jungian analyst and dance/movement therapist Joan Chodorow, and soon engaged in many years of study with her, and with dance/therapist and scholar of mysticism Janet Adler. I felt a deep resonance with the practice, as it took me back to my spontaneous dances in nature. However, there was an essential difference: here I had a human witness. How wonderful is that? To carry the knowing of nature into the realm of human relationship. Wounding often occurs within relationship, so it is within relationship that the healing process needs to occur. Authentic Movement deepens connections with the self, with the other, and with the generative life force. The practice enables us to explore and acknowledge deeper feelings, images, relational dynamics and a more authentic

sense of self as we re-inhabit our body in the context of a living, human community; the vital web of life. This is the foundation of healing and growth.

Application of Authentic Movement

“Movement to be experienced has to be found in the body, not put on like a dress or a coat. There is that in us which has moved from the very beginning; it is that which can liberate us.” - Mary Starks Whitehouse

Authentic Movement is one of the most potent avenues I have found for recovering the body/psyche/soul connection. A Jungian form of dance therapy also known as ‘movement in depth’ or ‘active imagination in movement’, the practice provides a powerful avenue to engage the unconscious. Bodily expression brings clarity and healing to our woundedness, allowing the exploration and emergence of a new life energy.

Tina Keller-Jenny (Swan, 2011) and others explored including the body in their analysis with C. G. Jung and with Toni Wolff. Then, in the 1950s, pioneering dance/movement therapist Mary Whitehouse (1911-1979) further developed Jung’s active imagination method by engaging the body more fully in ‘movement as active imagination.’ Since then, Authentic Movement (as it came to be called) is increasingly practiced by therapists, artists, spiritual and healing practitioners, clients, educators and social activists. I believe its widespread use comes as a response to a growing need to embrace the wisdom of the body and its essential role in the process of integrative healing, development, and transformation. The ‘talking cure’ is not enough, particularly where repressed, preverbal, and/or dissociated material and traumatized affects are concerned. These take up residence in the body, until circumstances are safe enough to allow them to be felt, mirrored, brought to consciousness, and healed.

The attuned, containing presence of the witness/therapist in Authentic Movement allows the mover/client safer access to early, primary-process-oriented parts of the self. In the process, exploration of areas where development halted, together with transpersonal experience often emerge. Through this engagement, new neuropathways in the brain may be established, supporting further integration and embodiment.

This method has evolved with three major applications: as a form of psychotherapy, as a resource for artistic expression, and/or as meditation/sacred dance. Telling the story, developing healthy boundaries, engaging alternative healing modalities, creative arts practices and nurturing self-care rituals can all assist in the process of re-inhabiting the body. Illness, too, though painful, can offer a pathway to transformation and an enhanced appreciation for life, if attended to and explored consciously. As Jungian analyst Arnold Mindell puts it, “Body symptoms are dreams trying to happen in the body.” (Mindell, 1985)

AMI & Soul's Body

In 1992 dance/movement therapist Neala Haze and I established the Authentic Movement Institute (AMI) in Berkeley, California (1992–2004). Other founding faculty members, Joan Chodorow and Janet Adler, together with Joan’s husband, Jungian analyst Louis Stewart contributed their areas of expertise to the teaching and curriculum development. Elements included Jungian and developmental psychology, active imagination, somatics, dreamwork, play, arts practices, choreography, theory development, clinical applications, and mystical studies. (Stromsted and Haze, 2007). Over time, additional faculty and guest teachers joined us in offering a variety of applications such as: treatment of cancer and other diseases; deepening our connection to nature; applied anatomy and neuroscience; poetry and storytelling; and non-violent community action.

DreamDancing®

From childhood, myths, fairytales, and dreams guided my understanding of life’s challenges by showing that natural cycles of death and rebirth illuminate the path. Jung called this “individuation;” the journey toward wholeness. In the early 1980s I developed DreamDancing® as an approach that engages the energies, feelings and action of a dream, helping to further embody qualities that can guide and enhance one’s life. Exploring dreams through the body helps us ‘incarnate’ the inner life energies that are being out-pictured through the dream, seeking insight and integration into daily life. (Stromsted, 1984; 2010).

One way to work with dreams in the body is to identify key gestures which can be strung together like beads on a necklace in a dance that speaks directly from the nonverbal, emotional midbrain where the images are formed (Stromsted 1984, 2010; Wilkinson 2006). Clients can also deepen a connection by stepping into a dream character and continuing the dream through an active imagination process. When practiced within group settings, themes and stories often emerge from the ‘collective body’ (Jung 1927, par. 342; Adler, 1994/1999) bringing insight to both individuals and the group, enhancing community.

BodySoul Rhythms®

Jungian analyst Marion Woodman made a significant contribution to engaging the body in healing the body/psyche/spirit split with BodySoul Rhythms® (BSR), which she co-created with dancer Mary Hamilton and voice teacher Ann Skinner. After completing their Leadership Training Program, I was invited by the Marion Woodman Foundation to co-facilitate training programs with Meg Wilbur (a Jungian analyst, voice teacher and playwright), and Dorothy Anderson (an artist and communications specialist). Our trio furthered the evolution of the work by leading ‘Wellsprings of Feminine Renewal’ intensives, adapting myths and fairytales into plays that illuminated the feminine individuation journey, integrated with other BSR elements such as movement, voice, dreamwork, art, mask work and ritual.

The Dance of Three, an application of Authentic Movement, is a vital component of BSR. It involves a primary mover, an engaged responder, and a reflective witness who take turns moving to music, witnessing, and containing. Their reflections on their own and each other’s experience bring it to further consciousness. Inner listening combined with outer engagement enhances our ability to be present with ourselves and others in increasingly conscious relationship, inviting a level of perception that can evoke deep respect and empathy.

In both Authentic Movement and BodySoul Rhythms®, the presence of a containing, compassionate witness contributes to healing, as the client opens to his or her senses to natural movement, and to the unfinished business and unlived potentials within. The witness/therapist, in turn, is often touched by the places her mover ventures to go; in this way, both people can open to their deeper natures and to the divine, the third space that they share.

At my Soul’s Body® Center, I continue to engage and develop elements from Authentic Movement, BodySoul® work, DreamDancing®, Embodied Alchemy® and other creative, embodied healing methods. Soul’s Body® work focuses on attending to natural movement; supporting the development of a conscious, embodied container; engaging the sacred feminine and masculine; and working with the imagination, metaphor and dream images in the body. We also investigate the somatic foundations of the transmission process of multigenerational family patterns, explore body symptoms, cultural elements, and incorporate the use of non-judgmental/non-interpretive language in creative and healing work.

Conclusion

Over the years, I have come to see Authentic Movement as a ‘safe enough’ container, a kind of uterus from which the client/mover may be reborn, in the presence of an outer witness or ‘good enough’ mother figure, from the ‘symbolic mother’ of his or her own unconscious. This in turn roots him or her in the instinctual ground of nature, the Great Mother. My practice has made it clear to me that containment – psychic, physical, emotional and spiritual – is necessary in order for deep transformation to unfold. In this ‘cocoon’ the melting of old defenses, including the body-stiffening that reflected them and held them in place, can begin to soften (Stromsted, 2014, p. 50).

A more evolved awareness of self makes possible a more sensitive and nuanced relationship with your environment – interpersonally, politically and ecologically. The body plays a central role in this; for with a more vital, felt sense of our own embodied experience, we cannot help but resonate with the life force that animates all living beings. Instead of dissociating, projecting, becoming combative, and/or fleeing to spirit when feelings in the body are too uncomfortable to bear – thus passing them from generation to generation through unconscious trauma patterns – we can find a spiritual home in the body (Stromsted, 2014, p. 55). ‘Shimmer’ extends, and the seeds from my dances in the fields continue to grow.

References:

Adler, Janet. (1994). The Collective Body. In P. Pallaro (Ed.), Authentic Movement: Essays by Mary Starks Whitehouse, Janet Adler, and Joan Chodorow (pp. 190-204). Philadelphia: Jessica Kingsley Publishers, 1999.

Jung, C. G. (1927), ‘The structure of the psyche’, in Collected Works (trans R.F.C.

Hull), vol. 8, Princeton: Princeton University Press.

Mindell, Arnold. (1985). Working with the dreaming body. Abingdon-on-Thames, UK: Routledge and Kegan Paul, Ltd.

Stromsted, Tina. (1984). Dreamdancing: The use of dance/movement therapy in dreamwork.Ó Unpublished master’s thesis. John F. Kennedy University, Orinda, CA.

Stromsted, Tina. (Autumn/Winter ’94-’95). Re-Inhabiting the female body. Somatics: Journal of the Bodily Arts & Sciences X (1), 18-27.

Stromsted, Tina. & Haze, N. (2007). The road in: Elements of the study and practice of authentic movement. In P. Pallaro (Ed.), Authentic Movement: Moving the body, moving the self, being moved: A collection of essays (pp. 56-68). Volume II. Philadelphia: Jessica Kingsley Publishers. https://www.authenticmovementinstitute.com

Stromsted, Tina. (2010). ‘DreamDancing®’ In P. Bennett (Ed.), Facing Multiplicity – Psyche, Nature, Culture, Proceedings of the 18th International IAAP Congress for Analytical Psychology. Montreal, Canada. Einsiedeln, Switzerland: Daimon Verlag.

Stromsted, Tina. (2014). The alchemy of Authentic Movement: Awakening spirit in the body. In Williamson, A., Whatley, S., Batson, G., & Weber R. (Eds.), Dance, somatics and spiritualities: Contemporary sacred narratives, leading edge voices in the field: sensory experiences of the divine (pp. 35-60). Bristol, United Kingdom: Intellect Books.

Stromsted, Tina. (2015). Authentic Movement & The Evolution of Soul’s Body® Work. Journal of Dance and Somatic Practices: Authentic Movement: Defining the Field, Intellect, vol. 7 (2), 339-357.

Swan, Wendy. (Ed.) (2011). The Memoir of Tina Keller-Jenny: A Lifelong Confrontation with the Psychology of C.G. Jung. New Orleans, LA: Spring Journal Books.

Wilkinson, Margaret. (2006). The dreaming mind-brain: a Jungian perspective. Journal of Analytical Psychology (51), 43–59

Tina Stromsted (2019). Witnessing Practice: In the Eyes of the Beholder. The Routledge International Handbook: Embodied Perspectives in Psychotherapy: Approaches from Dance Movement and Body Psychotherapies. London, UK: Routledge.

Tina Stromsted & Daniela Seiff (2015). Dances of psyche and soma: Re-Inhabiting the body in the wake of emotional trauma. In D. F. Sieff (Ed.), Understanding and healing emotional trauma: Conversations with pioneering clinicians and researchers. London, UK: Routledge.

Tina Stromsted, Ph.D. LMFT, LPCC, BC-DMT, RSME/T is a Jungian Psychoanalyst, Board Certified Dance/Movement therapist, and Somatic psychotherapist with 40 years of experience as a clinician, trainer, and educator. With a background in theatre and dance, she was co-founder and faculty member of the Authentic Movement Institute in Berkeley (1992-2004). Currently she teaches at the C.G. Jung Institute of San Francisco, in the Depth Psychology/Somatics Doctoral program at Pacifica Graduate Institute, and is a core faculty member for the Marion Woodman Foundation.

Founder of Soul’s Body® Center her numerous articles and book chapters explore the integration of body, brain, psyche and soul in healing and transformation. She teaches internationally and has a private practice is in San Francisco. www.AuthenticMovement-BodySoul.com

Published: Tina Stromsted. (July, 2018). Embracing the Body, Healing the Soul, C.G. Jung Society of Atlanta Newsletter. http://jungatlanta.com/articles.html

The Radical Impact of Gendlin’s Philosophy: A Summary of Gendlin’s Most Important Articles on Psychotherapy Theory

Thu, 09 May 2019 01:23:53 GMT

By Dr. Leslie Ellis

Back in 2011, Eugene Gendlin, the founder of focusing-oriented therapy, received his third major award from the American Psychological Association, this one for his distinguished theoretical and philosophical contributions to psychology. In 2016, the year before he died at the age of 90, Gendlin received lifetime achievement awards from both the World Association for Person Centered and Experiential Psychotherapy and the US Association for Body Psychotherapy. His work has made a significant impact on how somatic and experiential therapies are practiced around the world. However, many of Gendlin’s ideas were ahead of his time, and some of the potential impact from his ‘philosophy of the implicit’ has not yet made its way into mainstream thinking about the practice of psychotherapy. This article brings some of Gendlin’s radical ideas to light, summarizing his three most important papers on the theory of psychotherapy.

There are three articles that focusing teachers from around the world agree are Gendlin’s most important contributions to psychotherapy theory, and although they are decades old, the ideas expressed in them continue to have a ‘radical impact’ (Ikemi, 2017) on psychotherapy theory. Many of Gendlin’s ideas have filtered into the common parlance of psychotherapy in various ways: proponents of immediacy and mindfulness in therapy, and those who encourage clients to follow their ‘felt sense’ or embodied understanding of an issue are taking their lead from Gendlin’s theories. It has been incorporated into methods like Emotion-Focusing Therapy and Somatic Experiencing. However, there are some concepts which underlie the process of psychotherapy that have not shifted appreciably since the days of Freud. One such concept, repression, is challenged and advanced by Gendlin’s philosophy.

A theory of personality change (1964)

In this ground-breaking article, Gendlin (1964) makes note of how the therapy endeavour is often a conversation between the client and therapist about what has gone wrong in their past (their experiences, development, family of origin, etc.) that has made them feel or act the way they now do. Therapy brings new awareness to the client about their past situation, and a realization that they must have felt all of this all along but kept it out of awareness because it was unacceptable or overwhelming. The concept of repression originated with Freud and has not changed much in the past 100 years.

Part of the problem with this conceptualization, said Gendlin, is that it can only explain the personality as it is, and does not in theory allow for the possibility of change. It also operates on a ‘content paradigm,’ a sense that in their unconscious, people are holding a vast storehouse of fully-formed but forgotten experiences that must be unearthed so the client can understand how they came to be the way they are. There is the inherent assumption that this insight will bring change. What has been repeatedly observed, however, is that “knowing is not the process of changing.” Gendlin (1964) and many others have observed that in fact, personality change happens in the context of an emotional process, and in relationship.

Gendlin (1964) developed a theory for this change process that updates the concept of repression with something that seems more plausible. He would say that the past experiences that still plague our clients were not experienced and then forgotten, but rather avoided or stopped before they happened. These pieces of unfinished process are tangible in the body as a felt sense that carries rich, complex and implicit meaning. When we pay direct attention in the present moment to the sense we still hold in our bodies about these unfinished aspects of our stories, it will unfold and be fully felt. Often, attending to a process that has been stopped leads to painful realizations, likely the reason the process was stopped in the first place. But even when a person comes to realize just how hard this experience is to fully feel, the process of turning toward it and allowing it to unfold most often brings a sense of relief, an easing of the anxiety surrounding it. This is surprising. Gendlin wrote, “One would have expected the opposite.”

Another surprising thing happens as a result of attending directly to the felt sense of even the most intractable issue: “Even when the solution seems further away than ever, still the physiological tension reduction occurs, and a genuine change takes place. I believe that change is really more basic than the resolution of specific problems,” (Gendlin, 1964). What changes in this process is not the external situation, but the entire way the person holds the problem. What often follows such a shift is a flood of realizations, memories and new ways of making sense of old patterns. Gendlin said this dawning of insight is often mistakenly seen as the source of change when it is actually the by-product.

How is it that such a transformative process is facilitated by the presence of another person? Gendlin said that it changes our manner of experiencing immediately when we are with someone else rather than alone. Of course, the nature of the person we are with makes a difference. With a self-oriented, impatient listener, we are apt to close off to our experience more than we normally would. However, with a listener that allows us to “feel more intensely and freely whatever we feel, we think of more things, we have the patience and the ability to go more deeply into the details, we bear better our own inward strain… If we have showered disgust and annoyance on ourselves to the point of becoming silent and deadened inside, then with this person we ‘come alive’ again.” This quality of presence that Gendlin describes is one that we as therapists endeavour to maintain. It is this quality of listening can move our clients forward in the places where their process has stopped, and the movement forward in these frozen places is what brings genuine change.

The client’s client: The edge of awareness (1984)

In this article, Gendlin (1984) differentiates feeling from the ‘felt sense’ and explains why following the felt sense, which is not as clear or intense as a feeling, is what leads to change. “People often have the same feelings over and over, quite intensely, without change-steps coming,” Gendlin wrote. Feeling things repeatedly does not discharge them as was previously thought, but actually reinforces them. On the other hand, the vague, murky felt sense leads to feelings and ideas that have not ever been consciously expressed, and this novelty is what leads to change.

Gendlin stressed that it is the immediacy of the felt sense unfolding now that gives it the power to transform, not a reworking of the past, which is so often the paradigm for therapy. “Therapeutic steps are not a re-emergence of denied experience. What matters most for change-steps is precisely the new implicit complexity of the bodily living.” The past is always contained in the present experience, but the important difference in focusing is that it asks a person to attend freshly to what the felt sense brings now, rather than speaking from a hackneyed, familiar script about one’s life experience.

Client-centered therapy encourages the therapist to follow the client’s lead, to come with no agenda and preconceived notions, but to allow the other’s process to unfold. And for a focusing client, Gendlin’s advice is to treat their felt sense the way the client-centered therapist ideally treats them. The felt sense is the ‘client’s client,’ (hence the article’s name). So as a therapist in this context, our job is the support our client to be gentle, open-minded, curious and respectful to the inner felt sense that is unfolding, to offer gentle reminders whenever they assume they already know what it’s about. (The same holds true in working with the dreams; people often make assumptions about their dream’s meaning.)

This way of approaching therapy changes the manner of the conversation in some striking ways. Clients will typically begin their session by describing all they know about their problems, while a focusing approach is more concerned with what they don’t know. As a focusing therapist, our job is to continually bring the client back to the inwardly-sensed ‘unclear edge,’ a place they may be reluctant to stay with. To encourage focusing, the therapist can inquire into the felt sense in such a way that the client has to stop and check inside.

Gendlin said, “There is a great difference between talking about and pointing.” An example he offers of pointing: when a client says something like, “I must not want to do this (get a job, meet new people, write an assignment) since when the time comes, I don’t do it.” The phrase ‘must not want to’ is speculation, an indication that the not-wanting is not directly sensed. Rather than simply reflect the not-wanting, the therapist can invite the client to stop and sense the not-wanting directly, to set aside what they think about it and see what is really there. This kind of redirection to the current sense of something can be done whenever you notice such speculation in a session. The result of pointing to something that can be directly sensed is often surprising, and moves a previously stuck process forward.

From this kind of activity, Gendlin observed that “process-steps have an intricacy and power to change us,” and that, “we have to rethink our basic concepts about the body, feeling, action, language and cognition” to explain this. In the remainder of the article, Gendlin offers ten theoretical propositions in support of this major revision in thought.

In the first few theoretical propositions, Gendlin writes about the process of finding words to convey the complexity of ‘feelings-and-situations’ in which we human beings find ourselves. The words come first in our bodies, and point to implicit in feelings-and-situations. Like feelings, “must come or we don’t have them. We can remember them and believe they ought to be there. But to have them they must come. And this is always a bodily coming.”

Gendlin views feelings, thinking, actions and words all primarily as lived experience in the body, and each bodily event as implying what comes next. He calls this ‘carrying forward’ and said, “In therapy we change not into something else, but into more truly ourselves. Therapeutic change is into what that person really ‘was’ all along… it is a second past, read retroactively from now. It is a new ‘was’ made from now.”

From this new was, steps come that change one’s conception of the past entirely. For example, in my therapy practice, I often work with early-childhood trauma, and uncover felt-senses of traumatic situations that the person, as a child, could not assimilate. Their story of childhood, when they first enter therapy, is often that it was fine and normal, but there is a lack of depth and detail which tells me they are not truly in touch with their inwardly-sensed experience. When, as an adult and with a supportive other, they do attend to the felt sense they carry of this early time, it can open up what has been termed ‘repressed memory.’

Gendlin’s formulation feels more accurate, as those with a history of repeated trauma often dissociate from their experience. The trauma is not recorded, then forgotten, but rather, not fully experienced in the first place. When, through focusing, the client’s sense of what really happened comes into their body, there is a sense of knowing, a dawning of understanding why they were so withdrawn, anxious or angry as a child. This new ‘was’ makes sense of both how they experienced their childhood and of many of their puzzling reactions in the present. It is a carrying-forward that leads to a radical re-conceptualization of their life situation, and it often precipitates a flood of feeling, insight and re-evaluation.

Gendlin carefully differentiates feeling from a felt sense. Feelings are often less complex, more recognizable and can be repetitive if nothing surrounding the feeling changes. A felt sense contains the emotion and the whole implicit complexity of a situation. It is “a much larger whole. The implicit situation as a felt sense is a single mesh from which endless detail can be differentiated: what happened to us, what someone did, why that troubled us or made us glad, what was just the also going on… and on.” If a situation feels familiar, repetitive and stuck, Gendlin said “the stuckness is a finely organized sense of why usual ways won’t do, and of what would.” So even our internally-sensed knowledge that something is wrong and feels like it can’t be fixed contains within it an implicit sense of what would carry the situation forward. When something entirely new is called for, the felt sense can lead to highly creative next steps.

There are many situations that call for novel responses to carry them forward, and the felt sense of this can be quite specific. “An odd situation’s implying is more organized than the usual routines and contains them. The novel implicit is not unrelated to familiar concepts, phrases, and actions. It includes these and exactly why they will not suffice” (Gendlin, 1984). We can’t speculate but must allow the process to unfold, “like an unfinished poem that very finely and exactly requires its next line.”

The experiential response (1968)

This article provides clear guidance for therapists in how to help our clients find the equivalent of that precise next line of their unfinished poem. We need to learn to listen in an unobtrusive way that allows them to carry their own experience forward. This process is not a simple reflection of feelings expressed by the client, but rather a reflection of the intricate felt sense; it involves not just about picking up on emotional valence, but more gathering a sense of the whole of what the client is ‘up against’ (Gendlin, 1968), including the history of the issue, thoughts about it, all its complexity. If you, as the therapist, want to support the client in focusing, you need to respond not only to the words as expressed, but to the larger felt sense that underlies the words, and in a way that allows the client to inquire further into what they are sensing. You may try many responses that appear to lead nowhere. What is more important than being right about what might lead to an experiential response is to simply keep responding to how the client reacts next. Saying something like, “That didn’t seem quite right for you… can you sense into what would feel more right?” can help move the process forward as effectively as saying something exactly right, which we can never do all of the time. Saying the wrong thing can even make the felt sense more clear to the client, because they get a clear reaction from their body that says, ‘No, it’s definitely not like that,’ which then brings a sense of what is right.

The goal in this process is not deeper understanding or a clearer definition of the issue, but a sense of the experience moving forward toward an internal release that changes how the uncomfortable sense is held in the body. When this happens, Gendlin (1968) said there is “a very distinct and unmistakeable feel of ‘give,’ easing, enlivening, releasing.” He called this referent movement but the more current term is felt shift. This is the only reliable sign of progress, and it always feels good, even when what is discovered in the process is not so good.

After a felt shift, it may be easy to go back and make sense of the progress, but before the felt shift, this would not have been possible. The experiential process itself cannot be predicted and moves forward on non-logical steps. In fact, it is not usual for someone who is focusing to contradict something they said earlier in the process and feel both were right at the time. Focusing can transform the felt sense of a situation so completely what was initially seen as a problem no longer seems to be one.

Gendlin believed that the most powerful engine for experiencing is interaction, which is why focusing works so much better with another person (although it is possible to have an interaction between oneself and one’s felt sense). Our job as the therapist is to offer our authentic reactions to the client, not our theories or even our wisdom:

What matters is that the therapist is another human person who responds, and every therapist can be confident that he can always be that. To be that, however, the therapist must be a person whose actual reactions are visible so that the client’s experiencing can be carried further by them…. Only a responsive and real human can provide that. No mere verbal wisdom can.

This does not mean the therapist’s reactions become the centre of attention; it is only the reactions to what the client is feeling, perceiving and implying that are expressed. At times, when a client has trouble sensing inside or articulating their felt sense, the therapist’s reaction can be the key element in moving the process forward. These responses to our clients don’t always feel clear or good. Gendlin (1968) said, “The therapist cannot expect always to be comfortably in the know. He must be willing to bear being confused and pained, to feel thrown off his stride, to be put in a spot and not find a good, wise, or competent way out.”

Gendlin felt that the therapist must be more open in their interaction than the focuser would typically experience, and give voice to anything that helps the client “see more clearly what he is up against.” For example, if a client’s responses typically result in rejection by many of those she encounters, the therapist must find a way for the client to succeed where she usually does not. For this to happen, Gendlin believed reassurance or “whitewashing” would not help. “What is bad must be expressed as just as bad as it then is or seems.” However, this honesty must be paired with a response by the therapist to the inherent ‘positive tendency’ Gendlin believed underlies every action.

Gendlin offered the example of how one might respond to being pressured by a client: “I am feeling pressured by you, and that makes me feel like pushing you away, but that isn’t how I usually feel or want to feel with you. So, we’ll do something to clarify it, resolve it, since that isn’t really how you and I are.” The point is not only to be honest about a challenging reaction, but also to then be willing to carry the interaction further “to a positive, life-maintaining experiential completion which was only implicit and had been stopped and troubled until then.”

Taken together, these three articles articulate some essential ways that therapists can engender an experiential response in their clients that helps them move forward in areas of their lives that were stuck or causing trouble. In addition, they go beyond mere articulation of method to explain the key aspects of the underlying philosophy that is Gendlin’s major contribution to the theory of psychotherapy.

Dr. Leslie Ellis is an author, speaker and teacher of focusing for use in therapy, with a special focusing on dreams and trauma. She is vice president and coordinator of The International Focusing Institute. She welcomes feedback and discussion and can be reached at lae@telus.net.

Three articles that the world’s top focusing teachers agree are essential:

Gendlin, E.T. (1984). The client's client: The edge of awareness. In R.L. Levant & J.M. Shlien (Eds.), Client-centered therapy and the person-centered approach. New directions in theory, research and practice, pp. 76-107. New York: Praeger.

Gendlin, E.T. (1968). The experiential response. In E. Hammer (Ed.), Use of interpretation in treatment, pp. 208-227. New York: Grune & Stratton.

Gendlin, E.T. (1964). A theory of personality change. In P. Worchel & D. Byrne (eds.), Personality change, pp. 100-148. New York: John Wiley & Sons.

Teamwork Enhanced from the Inside Out

Sun, 14 Apr 2019 22:38:51 GMT

By Alex Diaz, PhD

In any team sport, creating a robust team dynamic is always the greatest challenge for any coach. Team members differ in personality styles, attitudes, motivation, and behaviors. A coach fixated in believing that his message will equally resonate with each player will fail to create a cohesive team approach as individual’s differences are not being considered. To achieve an effective teamwork atmosphere, leaders shine in their ability to unite individuals by seeking a common goal while supporting their emotional behavioral differences.

An individual’s emotional behavior results from the combination of personal genes and life experiences, both supportive and upsetting. Such experiences mold a neurological imprint in our brains leading to the development of behaviors whose roots lie in implicit, subconscious, emotional memories. These memories cannot be intentionally brought up. According to psychologist Peter Levine, emotional memories are “felt-sense emotions such as surprise, fear, anger, disgust, sadness, and joy.” These memories lie just below the neo-cortex. Giving an oral presentation before a large audience may bring an array of felt-sense emotions, such as calmness or nervousness, which are derived from implicit memories based on prior experiences.

Hierarchically, our brain develops implicit memories first and explicit ones later. We feel butterflies in the belly and later verbalize them as anxiety. A tennis player, who is serving to win a grand slam match, will feel rapid heartbeats and shallow breathing. If the player is from Australian, such felt sense awareness will be verbalized in English; if the player is from Japan, the same felt sense sensations will be spoken in Japanese. Both players feel implicit memories based on past experiences. Human beings experience non-verbal awareness before sensations turn into a verbal language.

To be coherent between what we sense and what we express is the result of how emotionally regulated we are. When athletes are asked about the experience of losing a very close game, they rationalize their feelings by either minimizing its emotional content or expressing a rationalization aimed at, subconsciously, diverting the attention from that of feeling upset. An emotionally regulated athlete not only feels the upsetting emotion by embodying a faster heart palpitation, but also by verbalizing it. When leaders attune to the emotional needs of self and others, an implicit level relationship takes place. It is at this implicit human connection that meaningful interactions are forged, bringing trust, safety, healthy relationships.

Being emotionally met allows for channels of communication to open up between leaders and team members. A team member will be more cooperative if he/she feels an inner sense of trust. In a survey presented at the 2015 World Class Performance Conference, the first leading factor for top Olympic performances rested on the coach-athlete relationship over other factors such as athlete self-awareness and having optimal training environment. In a 2008 Coach Survey Summary Results: Evolution of Athlete Conference, it indicated that focusing on the athlete as a whole person was more valuable than seeking techniques to improve performance.

On the other hand, when leaders seek inter-connectivity by using explicit language, it leaves a sense of emotional disconnection. Hence, a perceived lack of emotional safety is felt. More importantly, it leads members to having second thoughts about their own self-worth or thinking they have done something wrong. On the other hand, connecting with team members by supporting their hard work or frustration, praising when sincere effort is performed rather than taking such a behavior for granted, and encouraging when mistakes are made lead to promoting a higher sense of understanding and appreciation.

Holistic approaches aim at self-regulating emotions by eliciting implicit language attunement. Yoga, mindfulness, breathing relaxation, visualization of positive experiences, and somatic psychology embrace connecting at a non-verbal language. These practices help to develop a greater sense of tuning in to our felt-sense awareness and, as such, enhance our capacity to regulate emotions and maintain meaningful relationships.

At the core of who we are as humans, the emotional connection is what has kept us alive and able to survive for so many years. Whether we are part of a sports or corporate team, we owe it to ourselves to enhance our capacity to regulate emotions at an implicit level as such experiences will only bring a greater sense of human connection and an enhanced present moment awareness.

Body Centered Meditations that Help During the Stressful Times

Sun, 14 Apr 2019 20:50:44 GMT

By Jan M. Bergstrom, LMHC, SEP, DaRTT

It never fails to surprise me that I receive many calls from my clients that are completely stressed out. In my 24 years of practice, I see my clients in a constant state of rev in their nervous system. Rev is when the sympathetic branch of the nervous system gets into a chronic state of hyperarousal. The sympathetic branch regulates arousal and gets us ready for action. So, when you are in a chronic state of sympathetic arousal or rev, the experience of your life feels like “always having the gas pedal on”. Here are some great interventions from my new book called Traveling the Journey Home, coming out this June 2019 for your use during these challenging times. Enjoy!

Grounding and Centering Practice in Action

Grounding and Centering are two other practices that reconnect you directly with the resources that are naturally available in your own body. It is important to reestablish your relationship to both the ground and to your body’s center, the place where action and feeling originate. These functions are compromised during trauma reactions. In trauma, you lose your ground, so an important part of healing is learning how to find your ground and center again. As you ground and center yourself before each exercise below, it will help you create a feeling of safety, and a sense that you are in charge. Here is how you do it.

Grounding Technique

Sitting in a chair, gently push the heels of your feet into the ground. Notice the sensations in your legs when you engage the muscles and release the muscles. Experiment with finding just the right amount of pressure in your feet.
Bring your awareness to what your feet feel like in your shoes as they are resting on the floor. Wiggle your toes and name the sensations that arise. Become aware of your feet on the ground.
Begin Deep slow breathing – explore pace breathing by Marsha Linehan (Linehan, DBT Skills Training, Handouts and Worksheets, Guilford Press, 2014), where you slowly inhale to a count of five, completely expanding the rib cage and belly, then slowly exhale to a count of seven until your rib cage has contracted and your shoulders have dropped. Do this at least five times.
Gain physical support from a comfortable chair. Bring your awareness to your buttocks as it sinks into the chair and your back as it is being supported. Name the sensations that arise. Experiment with slumping over and then sitting up straight, lengthening the spine as you do so. Imagine having a string pulling you up straight. Notice any and all sensations as they arise. Does your back hurt? Your vertebrae creak? Can you feel the blood leaving your head? Do you feel taller? More in control? Become aware of each sensation, whether physical or cognitive. Don’t judge these sensations, just greet them.
Focus nonjudgmentally on the sensations you can feel throughout your whole body. Start scanning your feet and slowly move up through your legs, abdomen, torso, into your arms and hands, finishing off at your neck and head. Just allowing whatever shows up to be there.
Tense, then relax your muscles. Try using an exercise ball if you have or can get one. If you don’t have one, try a beanbag, a roll of socks, a crumpled towel—anything that you can hold in your arms or between your legs and squeeze tight, hold for five seconds, then relax for five seconds. Notice the sensations and the difference between the engaging muscles and releasing muscles.

This same practice can be done with movement, such as Tai Chi, Qi Gong or Yoga. Take a class and see if you can focus on what is happening in your body moment by moment rather than thinking about your day or what is in the future. If you start thinking about the past or future, don’t worry. Just gently bring yourself back to your body awareness and breathing.

As with the Mindfulness practice, this Grounding Technique will help you to calm yourself, control your thoughts and triggers, and enable you to bring yourself to the present at will—whenever you find your thoughts and anxieties spiraling into the past or worries of the future.

The Grounding Technique becomes even more powerful when it is combined with the Centering Technique. This technique is a bit more unique, but every bit as transformative.

Centering Techniques

Place one hand on your heart and notice what happens in your body when all thoughts are dropped, and you focus on just your hand. Observe the weight of the hand, its temperature, the sensation of the hand itself and the sensation of it resting over your heart. Notice any changes in your breathing, your heartbeat, even the energy you feel in your hand. Visualize in your mind’s eye a warm ball of golden energy swirling around in your hand as it rests upon your heart.
Keeping your hand on your heart, gently place the other hand on top of your head. Apply a slight pressure on the top of your head to create a sensation of being grounded to the earth. With the hand on your heart, focus on channeling warmth and empathy throughout your body through this hand.

With practice, you will find these techniques are effective in helping you to gain and remain calm and detaching yourself from the thoughts and memories that haunt you. By learning how to become aware of your thoughts and the sensations they awaken in your body, you will gain mastery over them.

Techniques to Help Stay Grounded and Centered

There always comes a time when you find it hard to stay present with an emotion or body feeling. This is totally normal, and you may find yourself wanting to stop your investigation of the material that is coming up. No problem! In fact, it is important to know when to stop and what to do. I recommend healthy alternatives rather than medicating your feelings by eating, drinking, taking drugs or engaging in self-abusive behaviors. Here are some healthy techniques for staying grounded and centered. You may have heard these suggestions a thousand times and, like anything we hear a thousand times, they may go in one ear and out the other. But this time, try something different., Try at least three of these exercises, just once. Afterwards, reflect on how your body feels, and how your mind feels. Then do them again, another day. You’ll be surprised with the difference such simple activities can have on both your body and your mind.

Go outside and take a walk in your favorite place. If you find your thoughts spinning off into worries as your feet carry you along the pathway, bring your mind back to the moment. Observe the sky above you, the earth below you, the flora and fauna. How many birds can you see? Smile at the people you pass. When you get home, see how many things you can recall from your walk. The more alert you are to the world that surrounds you, the less space there is in your mind for worries.
If you have a dog, take your dog for a walk or go to a dog park. Use the time to truly enjoy your pet’s own joy for the outdoors.
If you have a cat, pet and play with it. There is a reason we call our pets “pets.” Just petting the fur of a dog or cat can have a comforting effect on both the pet and ourselves, as our endorphins are stimulated.
Call a close friend and reach out for support. If you are in recovery, call a fellow member or your sponsor. Be sure to listen and be there for your friend, as much as your friend is there for you. If your friend is unavailable for such an emotional call, don’t judge your friend. They might be in the middle of taking care of their own needs. Ask them to call when they have more time, and call someone else. Remember, we are all struggling. The more thoughtful you are of your friends’ time and needs, the more thoughtful they will be of yours.
Work out moderately at the gym or at home. If you haven’t worked out for some time, start small. If you find yourself watching TV, use the commercial breaks for short spurts of exercise. Try finding a five- or ten-minute YouTube video you can work out with. If you go to the gym, start with twenty minutes, work up to half an hour, and make a fifty-minute workout three times a week your goal. Don’t push yourself too hard. Be gentle with yourself. You’ll get there.
Dance to your favorite music, journal your feelings, draw or use some medium for an artistic expression of what you are feeling. Indulge in your playful side. You never lost it—you just learned to ignore it as you matured. Let it out!
Move your body and open your arms and spread them out to create a circle. Experiment with expanding the size of this ‘container’ until it is “big enough” to hold all the feelings and sensations or “all of the parts” of your pain.
Use your body to put one palm on the side of each knee: push arms against the outer part of the knees while simultaneously pushing out with the legs. Or use the arms to push against the side of the body. This creates resistance and engages your muscles to fight back, which can give you a feeling of empowerment.
If you have a flashback or start to dissociate or “fade out,” become aware or what is called “orienting” to the external environment (or room). This technique can be a helpful way to “come back” into the room. To do it, just choose and describe three things in the room that you like and reflect on why like them.
You can also turn your head and neck and slowly as you focus on objects in the window, the wall, the door, the lamp, the bookcase. Or focus on objects that might be comforting such as your most favorite object, or cues that tell you where you are.

Mind’s Eye Imagery

Mind’s eye imagery is a technique that draws on images to calm and ground the body. Remember all these resources I’m referring to are those internal or external cues that help you to find a safe place to return to when you become triggered as you navigate through your childhood trauma.

I usually ask my clients to think of a time in their life when they traveled somewhere, had a favorite animal they loved, connected with someone special and experienced a felt sense of calm, acceptance, grounding, centeredness, and safety. Once they find this experience (or several experiences), I ask them to write them down. These visual image resources will be used throughout the rest of the book for any of the processes that we journey through. They will act as anchors. An anchor is like a ballast. It gives stability in times of need. And that is just what you are seeking.

Mind’s Eye Imagery Practice in Action

While in this grounded and embodied state, sit somewhere where you are comfortable, and close your eyes to contemplate these scenes below. Allow yourself at least a minute for each scene. Notice your felt sense or bodily sensations. See if you can put words to them. Some examples might be: calm, relaxed, soft, warm, centered, tight, airy, spinning, or whatever words describe the sensations. Remember, don’t judge the sensations—just find a word that best describes the sensations you feel as you contemplate the scenes that follow.

Sitting on your favorite beach listening to the ocean waves
Hiking up your favorite mountain, reaching the top overlooking a beautiful valley
Looking across the Grand Canyon and the river that flows through it
Being on a tropical island
Sitting in a cozy cottage with a warm fire burning in the fireplace, the snow gently falling outside

Did these scenes calm you? Excite you? What changed in your internal state as you contemplated these scenes? Did you find one that brought you instant calm? If you didn’t, think of a time when you were traveling or in nature and you loved what you were seeing and feeling. If so, you have created a room in your mind where you can find instant comfort. When stressed, anxious or triggered, go to this place and relax. There’s no admission to be paid, no taxes or mortgages you must come up with, no applications to fill out. This place is yours, available to you whenever and wherever you find yourself. Welcome!

Privileges and Perils of Power

Sat, 13 Apr 2019 01:11:04 GMT

By Dr. Cedar Barstow, M.Ed., C.H.T., D.P.I.

What is it about power that is corrupting? Why are we so corruptible?

These are questions that Julie Diamond asks in Power, A User’s Guide (Diamond, 2016. It gets right down to the bottom of things. Power is the ability to have an effect or to have influence. We all have power. Even a baby has power. Think about the effect of a baby's cry or a baby's laugh. This is personal power. It is personal and unique. It is part of part of our identity. We may use it wisely and well. We, or the people around us, may inflate it or diminish our awareness or access to it, but as long as we are alive we have the ability to have an effect.

It is another kind of power that is corrupting—role power. Role power is the increased power that is embedded in a role or position you are given. Your role power is not your identity. Your role power is like a scarf or mantle of extra power that is added on to your personal power. It is attached to the role and should come off and on with the role. Teachers, Clergy, Therapists, Presidents, CEOs, Policemen, Politicians are roles that come with increased power. The power that comes with higher rank also changes people and how others experience them. Rank power can also be corrupting. Wealth, higher education, experience, celebrity, white, male and even parenting are examples of higher rank. In summary, personal power is immutable, role power is earned, won, or assigned, and rank power is mutable by culture and is sometimes earned. In this article the primary focus is on the privileges of role power and how to mediate the perils. (Barstow, 2015, p. 303-307) Some of the greatest perils of power come from the tendency to blend personal, role, and rank powers instead of seeing role and rank as add-ons to personal power.

Here's a taste of research that describes some of the changes power brings. Studies show that once people assume positions of power, they’re likely to act more selfishly, impulsively, and aggressively, and they have a harder time seeing the world from other people’s points of view. Dacher Keltner calls this the paradox of power: "The skills most important to obtaining power and leading effectively are the very skills that deteriorate once we have power” (Keltner, 2007). These skills (what most people want from leaders) are characteristics of what could be called social intelligence: modesty, empathy, engagement with the needs of others, and skill in negotiating conflict, enforcing norms, and allocating resources fairly. (Barstow, 2015, p. 316-318).

[In another study,] when researchers give people power in scientific experiments, those people are more likely to physically touch others in potentially inappropriate ways, to flirt in more direct fashion, to make risky choices and gambles, to make first offers in negotiations, to speak their mind, and to eat cookies like the Cookie Monster, with crumbs all over their chins and chests (as quoted in Keltner, 2008, Barstow, 317-318).

Research shows that power leads people to act in impulsive fashion, both good and bad, and to fail to understand other people’s feelings and desires. . . .

For instance, studies have found that people given power in experiments are more likely to rely on stereotypes when judging others, and they pay less attention to the characteristics that define those other people as individuals. Predisposed to stereotype, they also judge others’ attitudes, interests, and needs less accurately. . . . Power encourages individuals to act on their own whims, desires, and impulses. . . . Perhaps more unsettling is the wealth of evidence that having power makes people more likely to . . . interrupt others, to speak out of turn, and to fail to look at others who are speaking. . . . Surveys of organizations find that most rude behaviors—shouting, profanities, bald critiques—emanate from the offices . . . of individuals in positions of power (Keltner, 2008, Barstow, p. 318).

Some additional research does indicate that people with a moral center made up of attitudes and values such as kindness, humility, honesty, respect and fairness, are less affected by the corrupting effects of elevated power (Lammer, Stapel, 2009, pp 279-289).

I find this information both unsettling and liberating. I have long wrestled with how to understand what is called evil. With an infusion of empathy and compassion, I see, through the lens power, that, not only do we all have the capacity to misuse power, but we are all subject to the addictive trance of elevated power that reduces our empathy and inhibitions and pulls us toward prioritizing our own needs and interests because our higher role or rank allows us to. It takes a mighty commitment to self-awareness and the well-being of all to be able to mitigate these effects. This is a life-long engagement with understanding and refining your impact on others.

We have all, mostly inadvertently, caused harm in minor and sometimes major ways, and we have all been hurt by misuses and abuses of power. This is human. I'm thinking of the teacher who says she was open to feedback but gets defensive and angry when she hears critical words; the therapist who has an emotional affair with his client; the CEO who begins to think of her employees as simply cogs in a wheel; the doctor who offers choices without medically evaluating the options; the banker who makes money from giving a bad loan; the policeman who privileges people with rank; the parent who offers authority with no love, or love with no authority; the Priest who mixes up love relationships with congregant relationships; or the politician who thinks only of re-election strategies rather than what is best for her constituents.

I wonder how many of these could have been reduced or prevented if this information about the corrupting nature of power were part of everyone's basic education.

Why are we so corruptible?

This is the second part of Julie Diamond's question (Diamond, 2016, p. 49 ff.). She goes on to say that "Something happens to us like being under the influence of drugs. . . . This creates a deadly cocktail of opportunity and immunity." Since everyone is affected, we need to take a moment to feel compassion for ourselves as human beings. We are all vulnerable to the deteriorating effects of elevated power. The greater the power difference, the stronger the effects, and the more tempting the perils.

I'd like to take you on a journey to help you understand more about how the changes that come with power feel and the impact they have on you. Disneyland has a ride called Thunder Mountain. Now, please imagine that, with a group of other leaders, you are climbing not Thunder Mountain but Power Mountain. You are excited. You've just been given a role with increased power. You want to use it for the good of all. The higher you walk, the further away the village and the villagers look. The higher you climb, the greater your role power and the greater the power difference

between you and the people you are responsible for. You climb up the path, for example, from student to graduate student to teacher to assistant professor to dean to college president. The higher you get the greater the view and the rarer the air.*

Along the way you will receive four gifts or privileges that will support you in doing your job and fulfilling the responsibilities of your role. These are the four gifts that power gives to everyone, no matter what their intention. These are the gifts that will impact and change you, inevitably. You have not earned these gifts of power, although you may have earned the power role. They are not given because you are good or bad. Each weaves its own spell.

Receive now your first gift, symbolized by a coin: Access to resources and opportunities, including money, people, information, supplies, and control. The functional leadership purpose of this gift is to provide you with the support you need to fulfill the responsibilities of your role. As you take in this gift, notice how this alters your inner experience and how you see others. What perils can you feel or imagine?

Receive now your second gift, symbolized by a scarf that you put around your neck: You become bigger than yourself. You are bigger because, to others, you are now a role--an add-on to your personhood. The needed leadership purpose of this gift is to provide you with the increased ability to have an effect and to have the influence that you will need to fulfill your role. As you embody a role in addition to being a person, notice your inner experience and how others may see you. What perils can you feel or imagine?

Receive now your third gift, a piece of paper with slits cut in it to symbolize changes in your vision and how you are seen: You gain social distance and prerogative to enable you to see the big picture and not get too caught up in the details or with individuals. As you take on more distance, notice your inner experience and how it changes your perceptions of others. What perils can you feel or imagine?

Receive now your fourth gift, symbolized by a wand: Freedom to act with limited interference, and significant immunity from the impacts. This will allow you to make decisions in a timely and direct way. As you feel this freedom and immunity, notice your inner experience and how you approach making decisions and taking action. What perils can you feel or imagine?

Now you have reached the top of the mountain. You hold your gifts. You are at the summit. You have a great deal of role power. The gifts enable you to do your job. They are privileges and they are empowering. Take a minute to notice what they allow and help you to do. They also change you in corrupting ways. Take a minute to get a sense of the perils that come with the advantages. Notice the magnetic pull toward being self-serving, toward less empathy, toward impulsiveness and control.

Here at the top of Power Mountain you must choose how you will use these gifts. The gifts pull like a magnet toward being self-serving. When you have so much intoxicating power, why would you choose to use it in service to others? As in Star Wars where the dark and the light are of the same genetic pool, you must choose.

Here's where you get to decide whether or not you will fully embrace and say "yes" to your role and rank power. This is a humbling and sacred moment. You can decide that your good intentions will be enough ensure your right uses of power. You can take a "wait and see" attitude and let bumpy experiences be your teacher. You can decide to pretend these negative aspects don't exist or don't apply to you. You can make power itself the enemy and deny that you have greater power. You can choose to use your power in the service of your own wealth, fame, and ego-gratification. Or you can let the impact of the drug of power pull you to use your

powers for wealth, fame, control, or self- aggrandizement. Or you can make the most challenging and ultimately rewarding choice: owning and using your role power in service of others and for the good of all.

Here's an interesting thing: only if you choose socially responsible power, do you need to understand both the gifts and perils and how they are affecting you. (To misuse your power, you do not need to know the intentions and strategies for right use of power.) If you don't choose to monitor and mediate your own shadow tendencies and vulnerabilities, you will blindly and inevitably misuse your power. Power is a strong teacher. You will have many opportunities to look again at this choice.

If you are paying attention, you will be able to take advantage of the great teachings power has to offer you through mistakes, self-reflection, and self-correction. Your relationship with power is a life-long engagement with your impact, vulnerabilities, limitations, and mistakes. This relationship with power, in itself, will prove to be an extra gift. What do you choose?

Next we descend and return to the village where you can find out more about how you are changed and how differently you are responded to. One more thing. Choosing to understand both the privileges and perils of increased power is surely and deeply humbling. Humility is an under- acknowledged value for leaders, and yet, honored and appreciated by those they serve. "If you don't have a way to incorporate the humbling experiences that come with elevated power, you will have to depend on your role alone to carry through or to legitimize your behavior" (Rosenholtz, private conversation, 2016).

Here is a chart that describes, in the left column, the perils that come with the four gifts and privileges. The right column lists some activities that can help empower you and also mediate the changes, temptations, habits, and tendencies. This is a big light to shine on territory that has not been much named or explored. Be compassionate and curious as you look over this chart. In the perils side of the chart, think about harm caused by over-uses, under-uses or unconscious uses of power from your own life experience or that you have heard of or read about. Thoughtfully notice several perils that you may be particularly vulnerable to in your work in the world. Then look at the mediating activities and make a commitment to be self-aware and pro-active.

A few reminders as you look at this chart. First of all, since power has a neutral meaning of the ability to have an effect or to have influence, it is not power itself that is corrupting. It is role power that changes us. As Julie Diamond puts it, "Something happens to us when we step into roles of power: its like being under the influence of drugs or alcohol or having someone cast a magic spell that alters our perceptions and emotions. As though slipping on Sauron's Ring of Power, when we step into a position of power, we think, feel, and behave differently. The role itself allows for its own corruption. It is a magic that must be carefully

managed" (Diamond, 2016, p. 31).

The second reminder is that your personal power is the foundation that you need to stand on, rest in, and be nourished by. Personal power is what we all need to do things, to accomplish our goals, and to engage well with other people, and to make the world a better place. Role power "is based on the external, [while] personal power is self-sourced. . . .Your personal power can thus be independent of the validation of others. In fact, it is the only power that can transfer from context to context" (Diamond, 2016, p. 63). "Cultivating personal power starts with knowing and valuing who you are. Growing our personal power is our greatest asset for good and strongest weapon against the corrupting influence of power" (Diamond, 2016, p. 67).

The third reminder is compassion: compassion for ourselves, compassion for others. We are all affected by the magic spell of role or rank power. We all feel its pull toward being self- serving and less empathetic. The news is overloaded with horrific examples and images of abuses of power. And yet, most people care about the well-being of those close to them and have good intentions at heart. Again, drawing on Julie Diamond's wisdom, although "corruption implies an illegal act, it also refers to non-conscious, unintended, unpremeditated acts that break or stretch social and relational bonds, and in so doing, inflict harm. . . .By and large these are unconscious actions carried out by someone with high rank, good intentions, and benign neglect" (Diamond, 2016, p. 51).

Understanding the spell of role and rank power is one of the primary reasons for working with this chart.

Each bullet point ( • ) on this chart is a nugget to which numerous stories and examples could be added.

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About the Author
Cedar Barstow, member of the USABP, is the Founder and Director of the Right Use of Power Institute, she has been designing, developing, and teaching this approach since 1994. Two books explore these ideas in depth. Right Use of Power: The Heart of Ethics is a resource for people in the helping professionals. Living in the Power Zone: How Right Use of Power Can Transform Your Relationships, written with her husband, Reynold Ruslan Feldman is right use of power for everyone. Internationally, she offers Right Use of Power (RUP) workshops and trains' others to present their own RUP programs, and develop e-courses and other materials. She also serves as a consultant in ethics and power issues for individuals, groups, and organizations.

Tick-Borne Diseases and Mental Health. It’s not always what you think…

Fri, 12 Apr 2019 23:33:18 GMT

By Sharon P. Austin, PsyD

Currently, tick-borne diseases (TBDs) are the fastest growing vector-borne diseases in the US. Statistics on Lyme Disease, the most prevalent TBD, estimate over 300,000 new cases of Lyme every year in the US alone, with some estimates up to one million/year, 40% of these are children. This is not including all the possible coinfections (e.g., Anaplasmosis, Ehrlichiosis, Babesiosis and Bartonella), which are also transmitted by ticks. The Lyme pathogen has been reported in all 50 states.

We must therefore anticipate many of our clients who have either moved from high endemic areas with TBDs, or have traveled to such areas have a greater likelihood of having contracted a tick-borne disease unknowingly. Without early detection TBDs can evolve into multi-staged and multi-systemic illnesses that mimic and/or coincide with many medical and psychological conditions. Two of the primary symptoms are chronic pain and fatigue. “Chronic” TBDs wreak havoc on couples, families and individuals. Mental health practitioners can play a critical role in helping clients and their families navigate the complexity of these diseases.

The challenges faced by clients with TBDs are daunting. Some examples include:

1)     Chronic TBDs are often not considered a common or legitimate medical condition. This can mean clients often do not receive adequate support from their practitioners, friends, family or employers.
2)     Thus far there is no reliable test for the various strains of the Lyme pathogen and the co-infections.
3)     Outdated beliefs have a negative effect on treatment. These include:

a)     Lyme disease testing is seen as reliable
b)    Lyme disease is hard to catch
c)     Lyme disease is easily treated
d)    One can feel a tick bite
e)    Lyme disease always presents with a bull’s eye rash

4)     TBD symptoms may not be apparent for weeks, months or years. The early symptoms may appear flu-like, therefore dismissed. Undetected pathogens can then spread throughout the body.
5)     Because of the complexity of the symptom profile from one individual to another and no standard treatment protocol, treatment at various stages of the disease can have mixed results. Recovery is often complicated and confusing.
6)     Financially TBDs can be devastating from loss of employment, denial of insurance and disability and cost of treatments. One estimate of the financial burden is $1.3 billion/year in medical costs but could be as high as $50-100 billion annual drain on the US economy. Chronic TBDs can cause a wide range of symptoms with relapsing/remitting patterns. These can include:

Joint and muscle pain Extreme fatigue

Facial nerve palsy Meningitis

Carditis Recurrent fevers, chills, night sweats

Headaches Sensory sensitivities

Sleep disturbances Dizziness, low blood pressure

Visual impairments Gastrointestinal disorders

Neuropathic pain syndromes

Susceptibility to autoimmune conditions

“Neurological Lyme” is particularly problematic for children and adults alike. Symptoms under this category can include any of the above symptoms concurrent with reduced functioning in the following areas:

Speech and language skills “Brain fog”

Memory & concentration Information processing

Multi-tasking abilities Comprehension

Dementia

Irritability Depression

New onset ADHD Mood swings

Anxiety, Panic & OCD Suicidal ideation

Oppositional Defiant Declining school performance

Clinical studies suspect possibly one third of psychiatric clients show signs of past infection with the Lyme pathogen. As psychotherapists we can provide a vital role for these clients as we may be the first to detect the possibility of TBDs as a cause of psychiatric conditions.

Given the likely epidemic of TBDS, we could ask additional questions when there are confusing, numerous and waxing and waning symptoms. These include:

-       Have you lived in or traveled to high endemic areas?
-       Have you ever been bitten by a tick?
-       Did you have a rash? Treatment?
-       Do you have a positive family history of TBDs?

For clients with chronic TBDs, we must be aware of dual diagnoses between psychological and medical conditions. Their presentation may be more than their trauma histories driving the physical symptoms. It may be more than “schoolitis” or problematic parenting. We have been trained to recognize how trauma resides in our bodies and how critical attachment experiences are. Yet we must be willing to look at an even bigger picture that includes the role of infections such as those transmitted by ticks.

Although we cannot advise on medical or nutritional treatment we can counsel clients on factors that may be exacerbating their physical and emotional conditions. We help clients be accountable to many wellness factors such as regular medical check-ups, good nutrition, exercise & sleep hygiene, challenging negative thoughts and maintaining healthy relationships. All of these factors are critical for clients with chronic TBDs. We can also facilitate communication amongst providers. Most of all, as Terry Tempest Williams says so beautifully:

“The unexpected action of deep listening

can create a space of transformation

capable of shattering complacency and despair”

We are trained to listen, be a witness, stay attuned and be patient for our client’s story to unfold. In a time of numerous doctors, multiple assessments resulting in inconclusive diagnoses, uncertain medical treatment and outcomes clients of all ages with chronic TBDs need our comforting presence and our message, “I believe you and I’m with you!”

These are a few helpful resources: http://Lymediseaseassociation.org, https://www.ilads.org, https://globallymealliance.org, http://lymedisease.org, http://livlymefoundation.org

About the Author
Dr Sharon Austin is a Clinical Psychologist in Fort Collins, CO specializing in Somatic psychotherapy for couples, trauma and chronic medical conditions. In addition she practices Gestalt Equine Assisted Therapy. She is a volunteer for the CO Tick-Borne Diseases Awareness Association (COTBDAA) and she is an Ambassador for the Global Lyme Alliance. She is a Mom of two college students and co-hobby farm owner with her husband, tending to their horses, sheep, dogs and chickens. Dr. Austin can be reached at spaustin2@gmail.com or 970-493-4093.

Complex PTSD is Now Recognized!

Tue, 05 Feb 2019 01:21:38 GMT

From the NARM Training Institute.

In June 2018, nearly 40 years after the APA controversially yet officially recognized Post-Traumatic Stress Disorder (PTSD)as a mental disorder that required clinical treatment, the World Health Organization released the ICD-11 including a new diagnosis: Complex Post-Traumatic Stress Disorder (C-PTSD).

This diagnosis has the potential to completely revolutionize the world of mental health.

Understanding the long-term impact of unresolved early trauma is indeed a world health issue. Attachment, relational and developmental trauma – which crosses all cultures, religions and communities – impacts the neurobiological development of children and creates life-long patterns of disorganization within the body, mind and relationships. Perhaps a greater understanding of Complex Trauma can help us understand the underlying causes of the disorders our clients are struggling with, in addition to the increasing social challenges like substance abuse, systemic injustice and violence. A trauma-responsive perspective brings great hope.

While PTSD evolved the field of psychology in a major way nearly 40 years ago, those of us that have worked in this field know that there are limitations to the diagnosis and the treatments addressing it. C-PTSD helps us evolve our understanding of trauma. Now that C-PSTD has been officially recognized, the next step is to finding treatments that are specifically geared to addressing Complex Trauma.

Many of us have experienced frustration with clients dealing with complex trauma due to their lack of progress in therapy, as well as those clients who make good progress only to regress back to old, stuck patterns of self-sabotage, hopelessness and despair. These are usually the clients that therapists bring to consultation.

The question we as NARM consultants get asked repeatedly – how can I most effectively help my client?

To answer this, let’s revisit The ACEs Study (Adverse Childhood Experiences). The ACEs Study has a fascinating origin. Originally, it was designed as a weight-loss program until the head of the program, Dr. Vincent Felitti, observed that despite making successful gains toward their weight-loss goals, nearly 50% of the participants were dropping out. This did not make sense to Dr. Felitti at the time: why participants would leave the program as they were losing weight and coming close to meeting their weight-loss goals. He created a questionnaire to understand this phenomenon and discovered that a majority of those that dropped-out had experienced childhood trauma. Thus began the monumental research project we now refer to as the ACEs Study.

One fascinating aspect here is the underlying mechanism of self-sabotage. One would think that the closer a participant got to their goals the more motivated they would be to complete their program. But whether it’s weight loss, or a student dropping out their senior year of college just a few credits shy of graduating, or someone who has been sober and returns to their substance use, we see so many examples of people getting closer to health, wellness and success turn to behaviors that are self-sabotaging and self-destructive.

We are now unwinding this puzzle through recognizing the “survival” function of shame and self-hatred. As young children, everything revolves around staying connected to our caregivers via attachment – this is essential for our basic survival and well-being. When there has been failure, whether from our caregivers or from the environment, our basic survival is threatened. A child is unable to experience themselves as being a good person in a bad situation. Therefore, unconsciously, psychobiological mechanisms turn on to assure our basic survival. A main survival strategy is what we might refer to as shame and self-hatred; that children experience themselves as bad as a way to protect themselves from their failures of their caregivers and/or environment.

One of the things we have observed in consulting many somatic-oriented therapists internationally is that despite very effective and powerful somatic work, therapeutic process still gets thwarted without recognizing and working directly with the survival-based developmental strategies. Clients begin to get better and then repeatedly have set-backs or sabotage it in a number of ways. Going back to the original weight-loss program, something is threatening about moving forward in life toward greater health and well-being. That something is the way we learned to protect our early caregivers and environment through foreclosing fundamental aspects of ourselves, even if those fundamental aspects are positive like growth, healing and aliveness.

So what does this have to do with somatic therapy? What happens when a client is moving toward greater embodiment, self-regulation and empowerment (“bottom-up”), but we fail to recognize the underlying shame-based wounds that have led to the dysfunctional strategies, behaviors and symptoms? Or for traditional, talk-based therapists, what happens when we work with the psychodynamics of shame, self-hatred and self-sabotage (“top-down”) without shifting the physiological and emotional patterns that are fueling the self-limiting beliefs and behaviors? And, what happens when we are working with early attachment wounds and don’t recognize our own countertransference (our own unresolved trauma patterns and triggers) and how this impacts the therapeutic process?

The NeuroAffective Relational Model (NARM) is a therapeutic approach designed to work with the unresolved wounds and patterns leftover from early trauma. This integrated “top-down” (psychodynamic-based) and “bottom-up” (somatic-based) approach works with the psychobiological patterns of shame and self-hatred within a deeply mindful, relational context. With a framework that identifies the developmental wounds from early trauma, our clients have a possibility of moving forward unencumbered by these unconscious survival strategies that have come to dominate their lives. Freedom from childhood trauma is possible

While research on this is still in its infancy, we at the NARM Training Institute are buoyed by clinical reports and early research demonstrating how effective the NeuroAffective Relational Model (NARM) is in resolving attachment, relational and developmental trauma. We have trained thousands of mental health clinicians throughout North America and Europe, and are rapidly expanding our NARM training programs throughout the world and online.

If you have clients that are struggling from unresolved early trauma and would like more information on how to provide more effective therapeutic support for your clients, we invite you to learn more about the NeuroAffective Relational Model in our online or live training formats.

To learn more about this revolutionary method to treat this paradigm-shifting diagnosis:

Visit NARM

Early Coping Strategies: Another Addictive Behavior Which May Sabotage Connection

Tue, 05 Feb 2019 01:12:35 GMT

By Alice Kahn Ladas, EdD, CBT, lic. Psychologist, NM-505-471-6791 aladas@aol.com

Before I talk about early Coping Strategies and how they can sabotage connection, I would like to review, briefly, what I have observed happening in the Reichian branch of body psychotherapy over the past 65 years. Contemporary brain research confirms the mind-body relationship and has brought psychotherapy around to what Reich was discovering almost a century ago. Until his work challenged Viennese cultural norms and they threw him out, Reich was Freud’s star pupil. The reasons for Reich being attacked in he USA remains unclear. Conflicting versions of that story are reflected in two books, Mickey Sharaf’s Fury On Earth and James Martin’s Wilhelm Reich and the Cold War. Was it McCarthy, European Emigree Psychiatrists, Russia or all of them combined?

I am probably the oldest member of USABP, the living person who has been involved with Body Psychotherapy for the longest time and the only current member of USABP who met in person the physician who brought this form of body psychotherapy to the United States. To further connect our start with our present here is a quote from Reich’s Brief to the US Court of Appeals in 1951.

“Not protection of old financial or
Political privileges, but safeguarding the
Planet, Earth, and transforming its
Technological structure is the task of today.
Let us hope that the great industrial powers
Of our planet have retained their pioneering spirit.”

People often ask how come I am in relatively good shape at my august age and I have given the usual answers: luck, genes, diet, exercise. Now I add Body Psychotherapy. Most questioners have no clue as to what that means which gives me the opportunity to tell them. Encountering the work of Reich and many of those who followed him were, for me, life changing and I am forever grateful.

I attended my first Conference at Orgonon in 1948 and was personally examined by Reich in 1951 in order to be on the staff of his Infant Research Center. That same year, I brought orgone therapist, Dr. Alan Cott, to meet Mrs. Roosevelt because Reich believed, at the time, that Orgone energy might counteract the effects of nuclear radiation. Mrs. R ran the information by Robert Oppenheimer who said it is probably a hoax. That same year Reich learned he was wrong: the combination proved destructive.

Reich has the distinction of being the only person to have his books burned by both the Nazis and the United States, as well as being on Russia’s top hit list. I was around for the book burning and destruction of Reich’s scientific equipment but did not turn in my books or orgone accumulator. I still have those precious ancient possessions. But I left the field of psychotherapy for several years--the event was so appalling.

In 1955, I returned to join the study group of Lowen and Pierrakos and began introducing Lowen at his public lectures. My suggestion they form a not-for-profit organization was greeted favorably. After introducing Al to his first publisher, and writing the first brochure, I joined the original Board of five and remained there for many years. I also served on the Board of USABP from 2000 to 2007. So I have been involved in Body Psychotherapy for a VERY LONG time.

Reich relied on patients words at the start of therapy but very little after that. He did it to the patient and was highly evaluative. If you want to know exactly how one person’s therapy went, A.E. Hamilton kept a diary of his sessions, although Reich told his patients not to. I rescued that diary from a snowdrift and you can read it in three J.s of Orgonomy, 31(1) (2)1997 and 32 (1).

Following Freud’s dictum that only medical doctors could practice psychoanalysis, Orgonomy was also initially restricted to physicians. So Lowen got his medical degree before inventing his own version of Body Psychotherapy. Stanley Keleman was part of that original group. So were many others with whose names you are familiar.

I had therapy sessions with both Lowen and Pierrakos and can testify they followed Reich’s pattern of evaluating and doing it to the patient until a highly qualified psychiatrist-patient screwed up his courage to ask “Would you like to know what is happening to me?” After much internal struggle, Bioenergetic Analysis gradually moved towards doing the work together, a collaborative adventure based on connection. But it involved a huge struggle and a lot of hurt feelings.

For many years, there was such a strong emphasis on feelings that thinking was virtually cast aside…understandable since feelings had been neglected for eons. My article, "Using Goals in Bioenergetic Analysis," was rejected by the Bioenergetic Journal and published instead by The American Assoc. of Psychotherapists. But I believe and suspect you do too, that both feelings AND thoughts matter. My friend, colleague and founder of Radix™, Charles Kelley, discovered, to his dismay, that his seminars on feeling were well attended but those on purpose were not.

A related pattern concerns research. Yale Professor, Dr. John Bellis, was forced to resign in 1961 as Director of Training partly because he wanted to include a research project as one of the requirements for becoming a Certified Bioenergetic Analyst. The research project of my husband Harold and myself, "Women and Bioenergetic Analysis," was disowned by IIBA until the CT Society published it. At my insistence, it was included as an appendix in our NY Times bestseller The G Spot and Other Discoveries About Human Sexuality. The study, presented as "From Freud Through Hite, All Partly Wrong and Partly Right," at a meeting of SSSS, was what led to meeting our coauthors, the researchers Whipple and Perry. As a result, readers from 18 countries and almost as many languages have the opportunity to learn about Body Psychotherapy.

After 40 years of failing to persuade IIBA to establish awards for research, I joined the Board of USABP in 2000. They established two --one for practitioners and one for students--and, in 2008, named those awards after me. Unless we publish research in peer-reviewed journals other than our own, Body Psychotherapy is unlikely to get the recognition it deserves. Said Murray Bowen, in a 1980 speech entitled Psychotherapy: Past Present and Future, “A theory is just a theory until it is validated by research.” This September 2018, the new director of APA sent me an email confirming Bowen’s statement. He wrote to me saying he is not familiar with Body Psychotherapy.

Recent brain research not only confirms that working with the body is vital but that we need to engage all parts of our brain in order to recover and grow. Since my involvement with Reich and Bioenergetics, many other very helpful methods of body psychotherapy have evolved. Now that we include the brain, as an organ to address consciously, along with other parts of our bodies, we have the opportunity to include both the thinking and feeling parts of that organ, along with the primitive section that tells us to continue doing what we once did to accommodate and stay safe in our family and culture of origin.

It took me more than 60 years to come up with the idea I want to share now. Many of you work with similar concepts; it is the manner and timing of working with it that differs. I have found it exponentially increases the effectiveness of what I was already doing. Had any of my therapists, verbal or body-centered, said to me at the start of therapy “What did you do to adapt to your family and culture of origin?” we might have discovered precisely what to work on and saved lots of money and time. One of my present goals is to teach this work to other clinicians before I get too old. If you think what I write today has merit, invite me to do a workshop.

Following the medical model, we give diagnoses. Theoretically, these lead to the best methods of treatment; and get paid by insurances. My diagnosis made me feel less than worthy. Wouldn’t you rather be told there is something right about you than something wrong? By focusing early on a client’s coping strategy in the family and culture into which she/he was born and viewing it as lifesaving, you make clients right. That helps promote the positive client/therapist relationship so crucial to all successful therapy.

When clients become aware of what they had to do to cope in their family and culture of origin, it is often what they are still doing which prevents them from experiencing the kind of life they long for today. Were they freezing, running away? hiding? fighting, afraid to reach, stealing? If it helped them survive they were doing something right.

Early coping strategies show up in bodies just as clearly as they do in words. These early questions are not a replacement for bodywork. They facilitate it. “If we decide to work together and are successful, what will that look like?” is on my written form for new clients. Some can answer that question and others can’t. Since intention plays an important role in the success of therapy, I have been seeking a written answer to that question for years. Today I ask a second more difficult question early on: “In your family and culture of origin, what did you do to get along?” Since early coping strategies are often partly, if not wholly, unconscious, this can take time. Once we identify it, we know what to work on. What they did then was useful but today it gets in the way of what they long for. I view their adaptation as "right" instead of "wrong." After identifying a client’s early coping strategy (and I say client instead of patient deliberately), I warn that changing a way of responding that was once lifesaving but no longer works, is as difficult as changing any other kind of compulsive behavior. The amygdala warns us not to change any behavior that once kept us safe. It does not understand you are no longer trapped in a situation you did not choose. Pay attention to what triggers that initial coping strategy. Take small steps to modify your response to the trigger. Instead of reacting, take a breath and act in order to get what you need today. Be patient, and expect you will have to deal with anxiety, possibly severe anxiety, as you make the changes needed to create the life you seek today.

We discuss and practice many ways of handling anxiety. You know all of them.…keeping knees soft, opening stuck breathing, noticing your present surroundings, exercising, hitting, meditating, or going over the Bioenergetic stool if that was part of your training. We also do whatever is needed to free up energy blocks or increase energy. This can involve diet, exercise, stopping or adding meds, sleep patterns, new forms of brain stimulation, medical cannabis, etc.. Below is a list of possible questions to use in discovering your clients or your early coping mechanism. You might try them on a willing colleague or friend or on your clients. I hope you will find this approach as helpful as I have.

Questions and suggestions from the therapist

If we decide to work together and are successful, what would that look like? How might your life be different?

Tell me how you coped with or kept yourself safe during your early years in your family and culture of origin?

Where and how, in your behavior and your body, does this way of keeping safe manifest today?

Would you like to modify or change your early way of staying safe because it no longer helps you be or get what you want?

If you modified your early response, would that make you feel anxious?

(The primitive part of your brain will tell you not to alter any behavior that kept you safe before so you may feel very anxious.)

How will you deal with the anxiety?

(Please be patient with yourself if you are not able to change as fast as you would like)

For homework, please write a detailed description of what you did to stay safe in your family and culture of origin. Then write about how that behavior may be keeping you from creating what you would like to in your life today.

If you are working with a couple, it is very useful to have each person write about their own early way of coping and also their partners way of coping. They can then compare their understanding of themselves and each other to see if they fully understand both their own coping strategies and those of their partner. That helps them recognize when their partners are triggered and to act rather than react.

A warning is in order: Often the coping mechanisms are not fully conscious or even unconscious, so it may take time to unearth them correctly.

Transformance — What Can Happen When Shame Lifts

Tue, 05 Feb 2019 00:08:56 GMT

By Sheila Rubin, Co-founder of the Center For Healing Shame

My client was a high functioning professional. During our many months of therapy she spoke of numerous times in her life when she felt too awkward or too shy or too depressed when she felt put down by people in her family or at work. She had a part of her that believed that something was wrong with her. And yet there was another part of her from long ago that knew that what was going on in her family was not right. And that part had been frozen in shame. All her emotions and her life forward direction stayed stuck and frozen in that shame/trauma bubble.

My client had come in because she had heard Bret and I discuss healing shame on the Sounds True Self-Acceptance Summit in 2017. Listening to us talk about shame, she realized that she had done years of therapy but had never addressed her deepest issue. As she said: “I always thought there was something wrong with me!” She had kept getting more and more training in her field because she never knew when she would feel inferior and have to back up her work. And she had not dated at all because if anyone wanted to go out with her, she would wonder what was wrong with them!

* * *

NOTE: Transformance is a term coined by Diana Fosha, developer of AEDP, to describe “the force in the psyche that’s moving towards growth and expansion and transformation,” and the idea that healing is “not just an outcome but a process that exists within each person that emerges in conditions of safety.”

* * *

An active meditator, she knew how to sit with herself and track thoughts and emotions. We tracked her sessions from her first realization, during the Sounds True interview, that this emotion of shame had played a major but invisible role in her life. In early sessions she had talked about her confusion about her role as a younger daughter growing up in a large family and about having to follow the rules or be beaten—even when she didn’t know what was wrong. She would be beaten by her father for not giving him a glass in the correct way. She would be beaten by her sister for even having a thought that was different and by her mother just for looking a little different.

“Shame is a binding emotion,” I told her one day. “Maybe shame bound up with your anger and sadness to protect you in childhood when your parents beat you. Maybe you learned to hold back your emotions so deeply and you learned to hold back your thoughts, and shame was like a cover of the deeper parts of you?”

She joined my gentle curiosity as we gently unpacked the way shame had protected her. She had learned to think “Something must be wrong with me” because she had a different reaction than family members. She had a lifetime of holding back her thoughts and feelings. She had a lifetime of repeating the shame messages that had been placed on her by keeping herself small and believing that something was wrong with her. I explained that thought was actually the cognitive expression of shame.

My presence was a safe witness that she had not experienced before. And she noticed what it was like to talk about her life without feeling judged.

Shame can be like a multi-headed hydra, attacking self-esteem and self-worth and getting in the way of making life changes. It can help to have a new mirror. I mirrored the positives in her and the changes she was making in her life. I explained to her about healthy shame. And we processed the difference between that and the toxic shame that kept her stuck in the past and kept her energy system frozen for so many years.

It was exciting to watch her transform as we encountered and processed and moved a little beyond the shame each week. Our work together led to an extraordinary session in which the curtain of shame lifted and I got to see the radiant person underneath. I would like to share a moment from that session with you. (I have changed various aspects of her story to keep her identity private.)

- - -

It was an odd look I had not seen on her face before, and I wanted both of us to stay a little longer with that moment.

“Ooooooohhhhh. What’s that emotion?” I say, drawing out the sounds of my words. I’ve never seen this look before, I reflect back to her.

She shrugs and stops herself from rushing forward into words that may have been there, and she pauses in that moment and shrugs.

“That emotion,” I say with curiosity and wonder, “I have never seen on your face. Your eyes are getting big, and there’s a new lightness around your eyes.”

She shrugs again.

I ask again, more insistent, increasing my vitality affect and leaning in towards her a little.

“THAT emotion,” I say, raising my excitement level a little more. “Can you name it? Do you notice it?” We look at each other for a few moments and she sighs.

“I don’t know.”

“I don’t know,” I repeat, as if joining her in a game of hide and seek. I ask again. “I wonder what it may be?”

“I don’t know. I don’t know… I don’t know… maybe…maybe….. Oh my……. It’s happiness!!!” she says with extreme surprise.

Happiness and joy! Two emotions that are new to her. We are at a transformance moment in our session, where a lifetime of being in the grips of the shame freeze has kept her emotions frozen and her life ordinary. I join her and name the delight of her overflowing joy and the waterfall and pleasure of this incredible moment.

It touched my heart to share that moment of joyous discovery with her. It brought tears to my eyes and we cried tears of joy together.

About the Author:

Sheila Rubin is the Co-founder of the Center For Healing Shame. The Center For Healing Shame is based in Berkeley, California. Workshops are offered in Berkeley, at various other locations in the United States and Canada, and online. There is also a full training and certification program for therapists. The education is designed to help therapists show clients how to recognize shame, work through it and move on by:

Becoming more sensitive to the shaming often implicit in the therapy situation and learning how to counter shame in therapy.

Helping clients separate feelings of shame from other emotions.

Learning how to take clients back to early shaming situations and reverse the outcome.

Supporting clients to move their energy powerfully outward rather than turn it against themselves.

Sheila and Bret have been at the forefront of guiding mental health professionals to recognize and move through shame with their clients.

The Center for Healing Shame is qualified to provide CE credits for MFTs, LCSWs, LPCCs and LEPs registered in California - CAMFT Approved CE Provider #134393. PhDs in California and PhDs and licensed therapists outside of California may be able to receive CE credits through the co-sponsorship of R. Cassidy Seminars.

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Navigating the Labrynth of Love: How Attachment Styles Sneak Into Adult Relationships

Fri, 25 Jan 2019 02:37:39 GMT

This article is by Diane Poole Heller, Ph.D.,

She is an established expert in the field of Adult Attachment Theory and Models, trauma resolution, and integrative healing techniques. She is a trainer, presenter, and speaker offering workshops, teleseminars and educational materials on Trauma, Attachment Models and their dynamics in childhood and adult relationships, as well as many other topics. Learn more at https://dianepooleheller.com

“As I travel and teach around the world, I feel we are experiencing a global epidemic of loneliness.”

Once strongly tied together, families or marriages are now often fragmented, disconnected, or slowly growing farther apart. Love relationships seem to be dissolving faster than ever into divorce or separation. We all deserve to experience healthier, more resilient relationships. To do so, we need the skills, tools, and practices to heal our past wounds.

In practical terms, we may need to learn to “re-relate” into resiliency bonding versus trauma or wound bonding. Resiliency Bonding is a term I have devised to describe relationships that are based on our original design before it may have been disturbed. These relationships reflect secure, safe attachment within a Relational Field of mutual respect, appreciation of differences, acceptance of healthy interactions, and well-defined boundaries. They also include a mostly positive holding environment that allows an easy flow between aloneness and connectedness.

My sincere hope is that relationships with our partners, spouses, parents, children, friends and colleagues can be more enjoyable, fun, sustainable, mature, rewarding and loving. I want us all to have this possibility and share it with our near and dear.

We all grow up in a relational field with our original caregivers—a matrix of sorts that embodies the relational dynamics of the family and thus become “familiar” to us, as in “of the family.” These ingrained patterns may strongly influence how we see and feel in all of our later relationships. They create a “blueprint of expectations” of sorts, built out of our early encounters with others. When we are raised with secure attachment, we tend to find relationships are easier. We expect to be treated well and know that is what we deserve. We treat our partners with respect as well. We trust our partners and others realistically, and have Basic Trust in humanity and the world more or less unconditionally. Even when the chips are down, we still feel a basic optimism.

We answer “Yes!” to Einstein’s famous question, “Is the Universe friendly?”

Those of us that are fortunate to begin life in secure attachment typically find it easier to connect, to commit when we find a good potential partner, and to maintain contact. We predominantly feel safe in our relationships and partnerships. We have a sense of humor and playfulness. We can disagree, have different styles, and still respect each other. We make enough pro-relationship choices that are win-wins for each person that our “coupledom” is preserved and rich.

If the original bonding or attachment patterns were too painful, the residue of hurt often influences us from behind the scenes—without us even being aware of it.

If attachment was impaired by too many disruptions in bonding with caregivers, we may later fear that our adult relationships will bring us the same pain. We may unconsciously or consciously react based on past experiences. We may project the past onto the present without realizing that it dooms us to relive our worst moments over and over again.

“Though we may be in a present-day relationship, we expect to wake up in the living room of Mom and Dad.”

There we “know” we will be confronted with the same controlling attitudes, criticisms, lack of presence or appropriate boundaries, manipulations, or other problems we may have experienced as a child as part of the familiar family scenario. We worry we will not be seen or met or that our very essential nature will be annihilated.

Attachment patterns are so easily transmitted through the generations that it is the human condition to project the past onto our present. Because of this tendency, we may be blind to the love we actually have in our lives now. And if we cannot first sort out what belongs to the past and what is actually happening in the present, “It is possible that we cannot even believe OUR OWN STORY about what is happening in our current relationships.”

We may be more in relationship with the old hurtful patterns from our history than in relationship with our partner or friends.

“How can we change this destiny and live fully and freely in the present?”

Attachment Styles: Secure Attachment

Secure Attachment, as illuminated and defined in Dan Siegel’s book on Attachment Theory, The Developing Mind, is what we hope to encounter with our original parents. If we have not had this original experience of security, safety, and caring, we need to learn how to find our way back to it later in life. Fortunately, this can happen even after attachment disruptions have occurred in childhood.

“Later we can ‘earn’ or ‘learn’ how to reorient to Secure Attachment through a healthy relationship of any kind—such as therapist, significant other or marriage partner, good friend or even a neighbor or doctor.”

In childhood, Secure Attachment includes a “healthy holding environment” that occurs with “good enough” parents who are loving, responsive, and attuned. These caregivers are present, safe, available, and allow for the natural flow or rhythm between connection and aloneness. The child grows up and develops good boundaries, feels secure, has a sense of basic trust in others, and has a strong sense of integrated identity with self esteem intact. This is the kind of attachment I believe we are designed for.

In secure attachment, adults join children in play. They know how to initiate and repair when misattunements happen. The parent-child dyad knows how to find harmony again. Parents can contain whatever the child is experiencing: from pain, anger, and frustration to joy, bliss, and expansion of the life force.

“Secure Attachment is there waiting to be excavated from the mire and tar of past hurts. We can rediscover it because it is hard-wired as a ‘bonding blueprint’ into our psycho-physiology. We just need to ‘dust off the diamond’ of our true ‘in-light’- enment.”

Mary Ainsworth calls this our primary attachment system. The good news? If we were not lucky enough to have had a “healthy holding environment” in the beginning, with the proper support, more often than not, we can find our way home to Secure Attachment later in life. This return to our innate design for health is the basic and predominant focus of my work. I want to help answer the important question, “How do we cross that bridge from any type of attachment disruption back to Secure Attachment and reap the rewards of enjoyment and connection from enduring, stable, fulfilling and loving relationships?”

We are all social beings who need connection. We also need the alone time to connect deeply with ourselves and be in touch with the depth or our own being. We long for intimacy with others AND intimacy with self.

Disrupted attachment styles cause us to have an imprint for pain, rather than consistent love, in our relationships—especially our dyadic partner relationships which pull on our attachment histories the most. These patterns are easily imported into our adult relationships consciously or unconsciously. Unresolved early attachment disruptions may wreak havoc later. They often run our relationships into the ground before we and our partners even know what hit us.

When disruptions occur in our early years, the patterns get formed so quickly, and often occur pre-verbally and pre-cognitively. In this way, they become wired into our sensory motor awareness. For example, a child learns to block their kinesthetic and corresponding muscle movement to reach out if he or she experienced a lack of responsiveness to needs early on. She may later need to resurrect this latent or thwarted impulse.

“I had a client who had recurring dreams of having their arms chopped off when needs arose for them, due to a history with a troubled parent where having needs was severely punished.”

These examples reflect one reason why it is often crucial to include body-based therapies in healing early attachment wounds (along with emotional and cognitive work). The emerging body-oriented therapies help access and lay the groundwork for allowing the original sensory-motor patterns to eventually arise, complete, and prevail. Bringing our awareness back to secure attachment in the body as well as integrating the emotional cognitive self helps us to heal the old wounds more effectively. This healing frees us from repeating old, destructive patterns.

Unfortunately, attachment disruptions are easily transmitted through the generations. Because this happens so naturally it is best to not focus on blaming our parents or our parents’ parents. Many of our parents did not have the opportunity to do therapy and did not know how to self-reflect about this important topic in their lifetime.

“Blame would have to go back to the caveman and what is the point of that?”

The culture and the time period deeply influence our experiences as well. Many of us have children of our own now and know how difficult parenting can be. But this is not about being perfect parents or perfect partners.

According to John Gottman’s relationship research in The Seven Keys to Successful Marriage, having the empathetic attunement to realize there has been a break in the connection of a relationship and then initiating and/or receiving repair attempts to restore the connection in a more harmonious way is 80 percent of what gives relationships sustainability over long periods of time.

The art of repair is one of the best predictors of longer, happier, healthy relationships. When people develop and practice their ability to repair, this capacity results in deeper intimacy and well-being in all of our relationships. Given its 80 percent chance of improving our connectedness, this skill is definitely worth investing some time and energy in.

Of course, in all relationships, it helps to recognize that we all have unresolved history homework to do. This includes our partners and friends. Compassion for our own journey and the journeys of others is an invaluable key when exploring this tender territory. Often we need to unlearn attachment disruptions and relearn how to find our way back to Secure Attachment. How do we build and eventually cross this bridge back to Secure Attachment? If our original patterns were not healthy, we need to recognize them internally, heal the original wounding, and then practice specific exercises to help us learn Secure Attachment.

When we do the hard work of discovering the dilemmas we carry within us from childhood, we become freer and more transparent to present-day reality. We can stop watching the same old recurring movie built out of the past that we continue to project onto our lives.

When we cease calling on the “Central Casting of our Unconscious” that keeps us locked into passed down old patterns, we have the opportunity to replace those well-worn relationship blueprints with new designs. We are empowered to write new, fresh scenes to live by.

For most of us, resolving early wounding is possible. I have gathered an array of effective Corrective Experiences that help heal specific attachment disruptions.

Exercises include excavating the various elements of Secure Attachment, one by one to specifically target what may have been disturbed when we were younger. Examples include healing the attachment gaze by connecting to kind eyes, the welcome to the world exercise, and initiating bodily or emotional impulses, such as reaching out and trusting others, and several more beyond the scope of this article.

Re-discovering Secure Attachment is NOT done solely through “wound tracking,” emotional catharsis, or talk therapy alone. As therapists, we need to realize how to evoke the original healthy impulses for Secure Attachment and bonding on an intrinsic level. This means healthy impulses arise naturally in the safe context of therapy or other “safe enough” relationships. We also need to be able to “presence” Secure Attachment ourselves to be effective. Most of us have a mix of disruption styles if we did not imprint a secure style first. Let’s look briefly at the most commonly described disruptions as noted in Dan Siegel’s The Developing Mind.

Avoidant Attachment Style

Avoidant attachment results when parents have been extremely unavailable, neglectful, absent, or outright hostile toward a child. This environment teaches the child to regard relationships as unfulfilling because they do not meet their natural needs. The child learns to avoid relationships in order to survive or to diminish pain. Adults with this history often diminish the importance of relationships and focus more on work or hobbies and avoid investing emotional energy in others beyond a superficial level.

If the original “relationship restaurant” was terrible, adults adapt by minimizing the importance of all relationships and stop “eating out.” In the extreme, they stop looking for “contact nutrition” at all and go on a fast.

Why keep going back to the same bad restaurant when it is usually closed for dinner, no one is waiting the tables, the food can be toxic, the music too loud, the environment blank, and the atmosphere rejecting?

In Avoidant Attachment, a person adapts to such severe disappointment in relationships from poor bonding by no longer reaching out. They may avoid connection at all costs as it is associated with great pain of abandonment, lack of presence, or fear of rejection. Avoidantly-attached adults may “decide” they are loners and isolate by choice. They may feel that expressing few, if any, needs or dismissing support from others makes them better off, or even superior to, others who are in contact with emotions and real needs. However, this is usually a survival-based adaptation, made by default due to extreme early bonding deficits with caregivers. It’s not a conscious choice.

Avoidantly-attached children, as they move into adulthood, overly rely on themselves and dismiss others as not important. As David Wallin points out in his excellent, clinically oriented book, Attachment in Psychotherapy, this dismissing stance enters into the therapist-client relationship, too. A client might say, “Oh, you are going on vacation for three weeks? No big deal. I don’t need you anyway. Therapy with you doesn’t do anything for me. I prefer to do it myself.” These statements may be—and usually are—far from the truth.

Let’s get down to the nitty-gritty of what helps us and our clients clinically. I suggest specific Corrective Experiences that can help break the grip of a wounded past and bring other people back into the Avoidantly-attached person’s life in nourishing ways. These Corrective Experiences include the Kind Eyes Exercise that involves a person looking out into the world into the kind, loving eyes of someone looking back at them.

In this exercise, you imagine someone lighting up when they open their door and see you. You take that image and feel “into” your eyes and allow your eyes to reach out to that joy you see in the other person’s eyes. Sounds nice, right? But this exercise requires a tremendous amount of trust and the overcoming of intense fear as an Avoidantly-attached person takes the huge risk of “looking again” after years of blinding themselves to contact, especially in their eyes.

When successful, this exercise helps to restore healthy contact and reduces the defenses and/or disconnection in the eyes. The disconnection or dissociation can become a pattern from meeting too much hostility or vacancy as a child. This exercise accesses the original attachment gaze and gives it support, and perhaps emotional limbic nourishment as well, and exposes the original wound. We work with the attachment gaze to give it time to heal, discharge emotion, over-arousal and the original distress. Often the eyes have stopped “seeing” in terms of actual contact. Safety in contact has to be restored to resurrect the possibility of deeper connection and for the client to literally see anew in a way based on the reality of today.

Welcome to the World Exercise is another highly effective Corrective Experience exercise for repairing Avoidant attachment. In this exercise, clients create their version of a perfect, well-celebrated welcome of themselves as a unique being with very special contributions to make to the world. The fulfilling and “full-feeling” experience communicated by the therapist (or other) and received by the client (or person) is: “We are so glad you are here. We have been waiting for you. I celebrate you and your very existence. You have the birthright to exist. I want to be in real contact with you. I welcome you. You belong here. We want you here!”

This Welcome to the World Corrective Experience helps clients regain the sense of their existence being celebrated. Instead of having one foot on the planet and one foot off—as if they have never committed to arriving here in the first place—they can land on their feet in a more connected, embodied, grounded way. Now the life force and brilliancy predominantly residing in their heads, including their often extraordinary intelligence, can more fully inhabit their physicality and beingness.

Ambivalent or Anxious Attachment Style

The “here today, gone tomorrow” Ambivalent Attachment type of bonding leads to continual frustration and relational insecurity.

Even if, at times, the parents were authentically loving, unpredictable caregiving and emotional inconsistency may have manifested in a way that the person feels incapable of ever being truly loved or lovable.

The following story may aptly illustrate part of how Anxious Attachment is installed as a bonding style. In the story, researchers put a pigeon in a cage with a little bar at one end to access food with its foot. At first, every time the pigeon hit the bar a pellet of food came out. For a little while, the pigeon keeps hitting the bar and eating pellets until it is no longer hungry or interested. The pigeon seems to forget about it and just explores the cage. The bird goes back once in a while when it’s hungry.

Then the experimenters only change one thing—to have the pellets come irregularly (intermittent reward). The pigeon then becomes obsessive, continually hitting the bar (like many gamblers in Vegas at the slot machines).

Researchers surmised that intermittent reward was a major cause of obsessive focus. To up the ante, they electrify the floor underneath the cage where the unpredictable pellets fall out. In order to hit the bar, the pigeon has to stand on the electrified floor. The pigeon does not choose to retreat to safety of the unelectrified side of the cage away from the bar. It chooses to keep pushing the bar to see when the next pellet will arrive—even when it is very painful to do so.

I make this analogy to Anxious or Ambivalent Attachment where love from parents was, in fact, present (like the nutritional value of the pellets), but the child never knew when, why or where, or for how long until it would be gone again. This is a ”here today, gone tomorrow” parenting style.

Ironically and understandably, it is often the case that the parents are distracted or preoccupied with their own unresolved relationships histories.

The child cannot figure out what makes the relationship good or bad, so they are constantly trying to rearrange themselves to fit the parents’ changing moods and responses. Or they attempt to manipulate or control the parent to eke out the positive merging, support and/or love.

The result is the child, and later the adult, becomes obsessively over-focused on the parent or external resources and severely under-focused on themselves. They become habitually unaware of internal sources of satisfaction and fulfillment.

In adulthood this manifests as obsessive focus on the other in relationships—a bit like gambling. You keep investing more money in the game and never feel like you can win. They try to get the love they need but never feel it is enough.

The Anxiously-attached child or adult can never relax in the relationship. Instead of parents helping with affect modulation, their inconsistent behavior disrupts it. Neither self-soothing nor feeling content in the interactive regulation with another feels satisfying in any kind of sustaining way.

If they feel loved now, the question always arises, “What about tomorrow?” “Will it last?” “This is too good to be true.” There is the tremendous desire for loving connection entangled with the debilitating fear of losing it.

Corrective Experiences for this attachment style include re-establishing a felt sense of consistency and the ability to receive love and caring when these essential qualities are actually present. “I want and yearn for love and connection but cannot have it.” The basic personal identity is formed around that idea —the“parent-patterned” experience that “I can want, but cannot have”. This can result in yet another dilemma that it is critical for the Anxiously-attached person to realize:

If and when love actually presents itself, they often need to create distance themselves or dismiss the love in order to keep this original identification intact. They then create their own worst nightmare by never being available to receive the love they so actively seek because, paradoxically and predictably, it has to be rejected or deflected for self identity to remain intact.

As therapists, we need to help our clients to see this pattern if it fits and to actively “disorient them towards health.” It entails restructuring the identity to regain its capacity to actually receive love. Healing Exercises include increasing one’s capacity to receive love and nurturing from others without dismissing it. As easy as it sounds on the surface, this is very challenging. The identity of the Anxiously-attached adult is literally based on “I can want, but I cannot have.” Or, “I cannot have without the uncontrollable and unpredictable loss that I am always anxiously awaiting and anticipating.”

Another relevant exercise is to have the client look at all the ways people in their lives try to show them love. The Five Languages of Love is a good reference. Have the person see if they dismiss or minimalize others’ love for them. It is helpful to point out how painful it may be for their partners or friends to have the love they offer deflected. I had that happen in my own life when my partner said how much he loved me and how much it hurt him that I could not seem to take it in.

I initially felt insulted and was certain that he was wrong—until I took an honest look at myself and realized I did not feel deserving of love, and was determined to believe that his love could not be true.

Let me share another example of how painful this can be for an Anxiously-attached individual. I once had a friend share with me that when her boyfriend would turn over in his sleep away from her she would experience a terrible sense of abandonment and a severe sense of loss. She would lie in bed weeping even although she knew cognitively that he was simply turning in his sleep and not really leaving her.

It seems that this turning away was enough of a trigger to re-stimulate the intermittent reward patterning of the “here today, gone tomorrow” style of loving from unpredictable parents. This causes the child to be stressed while searching to attach to a moving target, never knowing when the rug will be pulled out from under them—even when the love was real and present for them because they could lose the love at any moment and not understand why. Instead of the parent’s interactions with the child increasing self or interactive regulation, the inconsistency actually increases the relational distress. This terrible unpredictability sets up a hyper-awareness of the “other,” and an over-focus on looking for need satisfaction, nurturing, or external love.

Because of this pattern, the Anxiously-attached person remains anxious because they lose contact with themselves, in fact abandon themselves, and then try to get themselves back from other people. The obvious trouble lies in the fact that you can’t get yourself back from others. You get yourself back by learning to recognize or develop your sense of self and to stay connected to yourself in the first place—when alone and in the presence of others. You include yourself in the relational field rather than all of your attention flowing out into the other.

Anxiously-attached persons want interactive regulation and affect modulation with others and prefer not, or lack the capacity, to self soothe or self-regulate. Avoidantly-attached persons prefer the opposite. In Secure Attachment both can return to having self regulation as well as interactive regulation and affect modulation in a harmonious way. This opens many more options for well-being.

Another exercise teaches clients how to stay connected to their inner self with greater ease as they learn to keep their sense of self intact when in the presence of others. This requires developing a dual awareness: one that does not eliminate the self but includes the other in the relational field without using manipulation.

Another paradox is that once you abandon yourself for another, you are in double trouble. When you leave YOU, you are, by definition, disconnected and abandoned. And in abandoning yourself, where are you going to go?

You can’t, in reality, leave yourself! REALLY, where are you going to go?

Until we learn to stay connected to ourselves in the presence of others we are doomed to be and feel abandoned. We must recognize this pattern as an internalized map that came from early bonding deficits and repair connection to self and redefine connection to others so we do not continue to see the partner or other as the Source.

It is a perceptual trick. Once you learn to stay connected to your inner core, you will naturally find it a stable, consistent source of nourishment and fulfillment, as well as finding contact nutrition from relationships outside of the self.

Disorganized Attachment Style

Disorganized Attachment can result when a parent is terrifying or overly chaotic. The relationships were so overwhelmingly scary, painful, harmful that the child had no safe holding environment in which to process or cope with this terror and pain. With the original caregivers, there was regular, devastating disruption of the attachment system without the relief of a safe haven. Because of this extreme situation, ANS regulation and Affect Modulation are severely interrupted, thus leaving the child with multiple incoherent models of the self, the other, and the relationship between them. In place of a coherent well integrated sense of self, fragmentation rules.

The main difficulty in addressing Disorganized Attachment clinically is in the major double bind of conflict between two of our major human pyscho-biological drives, 1) the deep need to attach to a safe attachment figure and 2) the strong need to survive.

Later, adults with the disorganized attachment style become very afraid when they begin to feel close or intimate because closeness is over-associated with fear of the original parents who could not be trusted. They become stuck and mired in an approach avoidance pattern. For the person to feel safe enough to stay in the relationship and enjoy it in a relaxed and nourishing way, the need for connection and fear for survival must get untangled.

A Corrective Experience may include the Installation of a Competent Protector to establish the essential quality of safety missing as resource. Ideally parents model protective sensitivities toward their offspring as most animal species are biologically designed to do. A rabbit runs from predators such as coyotes, fox, hawks, snakes etc., but once it returns safely to the rabbit hole she lavishes her affection on her young. Snuggling happens—not attack from one’s own species.

However, when children are terrified by one or both of their parents, it does not make sense biologically, psychologically, or soulfully. This terror disorganizes the attachment system, designed to operate and facilitate deep bonding in the environment of relative safety.

The need to attach is so strong that we are said to bond with any caregiver no matter what their actual behavior—even if life-threatening. This may require the child to literally override his or her own survival system or warning signals to allow them to walk into danger instead of running away from it or risking fighting back. They must be provided clarity in communication to override the original double messages presented to them by parents or caregivers. The attachment system must have a safe place to land, usually in relationships outside of the family.

This can be done in the safe context of therapy, where the defensive responses for self-protection (fight or flight) can be re-directed toward the original threat of one of both of the parents.

Allan Schore’s synthesis of research finds that the best modalities for healing attachment wounds include body-based therapies. In other words, the body needs to feel the return of safe Secure Attachment in a deeply physical way—as well as emotionally—so that the new corrective experiences of healthy relating can eventually override the original negative wounding.

The challenge is that attachment patterning happens so early, beginning in the womb. We need to develop skills to work pre-verbally, nonconceptually, within bottom-up processing for most of the session. But we also use top-down processing, to educate and help integrate the healing at the end of the session. What we need to appreciate with our clients and our relationship partners is that much of our current adult behavior can be considered a reflex from our early attachment patterning. We need to learn how to develop skills to function as securely attached adults (as partners and therapists) even if we had insecure attachment in childhood.

Somatic Experiencing® (SE) developed by Peter Levine and the Dynamic Attachment Repatterning experience (DARe) that I have developed over the past seven years are two such therapies. I believe that our original design is organized for Secure, safe attachment and that our bodies and brains can rediscover how to embody and live from this foundation.

We can then integrate this felt sense emotionally and cognitively.

This heals the scars and dysregulating impressions of the past left in our brain, autonomic nervous system, and attachment system.

My biggest passion in teaching is to help clients become “unimpressed” by the disturbing elements of their history. They literally discharge the hurtful emotions and fear from the body and brain so that they can risk opening to themselves and others again.

I believe our birthright is to give and receive love open-heartedly, and derive deep satisfaction, fulfillment, and nourishment from nurturing healthy relationships.

We can return to a state of pure transparent beingness—our deep nature and true authentic self—from where we can be truly intimate with ourselves and share intimately with others.

This is our greatest gift to ourselves and to everyone else. It takes great courage to really “show up”. I believe that, in most cases, we can heal in the context of a corrective securely attached relationship in our lives at any time, with anyone, or directly from the “universal field of being” that holds the archetype for all that is true for us as spiritual essential beings.

We are naturally social beings and need a strong relationship both to ourselves and to others. On an Essential level, we have all that we need in just Being. Part of our fulfillment comes from sharing our “beingness” with others. We need our alone time as well, some more than others. Secure Attachment allows for an easy transition between connection and aloneness.

It is this balance of the inner and outer would that gives us wholeness.

This is the journey home to secure attachment.

For more information about Diane and her upcoming teaching schedule and training DVDs please visit dianepooleheller.com

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Is There a Touch Taboo in Psychotherapy?

Wed, 23 Jan 2019 00:24:25 GMT

by Aline LaPierre, MFT, SEP, PsyD

Five arguments in favor of the use of touch in therapy

There is a widespread belief in the psychological community that the use of touch in psychotherapy is illegal. The “taboo” against the use of touch was established long ago. This prohibition, which still persists today, prevents touch from being accepted as a valuable psychotherapeutic approach.

Here, I evaluate five common questions I have encountered in my years of teaching the therapeutic use of touch:
1. Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?
2. Does touch gratify a client’s manipulative needs?
3. Can touch lead to transference and countertransference problems?
4. Is touching clients a slippery slope to sexual transgression?
5. Shouldn’t touch be reserved for family and social interactions?

Does Touching Clients Serve Or Hinder The Goals of Psychotherapy?

Current developmental research validates the use of touch as an important, if not essential, therapeutic intervention. There is now solid research indicating that critical levels of attuned touch are important for normal brain maturation and for socioemotional and cognitive development. Given that the primary importance of attachment is widely accepted, and that neuroscience provides evidence of the body’s critical role in development, the time is ripe to examine the vital contributions of touch and bodywork in the repair of relational and emotional trauma.

Argument #1

Does touch unduly foster dependent infantile wishes and gratify Oedipal fantasies?

Psychoanalytic tradition asserts that using touch to satisfy a patient’s desire for the missing comfort of the mother fosters a clinging infantile dependency, and serves as a stimulant for Oedipal fantasies.

Counter-Argument

Touch is a fundamental mode of human connection in the infant–mother relationship. In order for mother and child to relax into breastfeeding and reciprocal gazing, a baby must be securely supported in its mother’s arms. Secure holding underlies a baby’s feeding and gazing connection.

Adults who seek psychotherapy have generally experienced some form of abandonment, abuse, or neglect in early life, and often report never having had the experience of being securely held in a way that allowed them to yield into trusting support. I am reminded of a client who insisted on lying down during his sessions, yet kept lifting his head to look around. His neck soon tired, and he could barely continue to lift it. Finally, he uttered the words: “Is anybody coming?” and burst into tears. He remembered lying in his crib for hours, waiting for his mother, who never came. He finally had given up hope that she would ever come, and had fallen into a collapse that became his basic stance in life: “No use trying; it won’t happen.” For this client, being touched was an immense relief. The experience of having someone hold his weary neck and tend to his preverbal needs was transformative. He was able to release the long-held pattern of hopelessness, and open to the gratifying sensations of supportive presence. As our somatic work progressed, he reclaimed his desire to live.

On an analyst’s couch, patients face away from the analyst, away from relational contact. This helps patients focus on their inner process, and leads to insight and growing maturity. But in cases of early relational trauma, the lack of contact can exacerbate the isolation of clients who yearn for connection, or who have not experienced satisfying nurturing relationships. Abused and neglected individuals have never had the experience British pediatrician and psychoanalyst Donald Winnicott called "going on being" — the secure holding within which a baby can be fully absorbed in the intense work of its development.

Avoiding touch contact can repeat the physical neglect or rejection undergone by a client as a child. The touch taboo can rob patients of effective, perhaps critical, ways to fulfill primary needs that were never met. Early traumatized clients need neurological repatterning experiences in addition to reworking the cognitive and emotional aspects of their relational traumas. A physically close, but nonsexual, nonviolent, non-abusive, nurturing, comforting, and affect-regulating touch experience can help clients (and their nervous systems) move through the painful early deficits that often continue to bring suffering in their adult relationships.

Avoiding safe, nurturing touch
is a cruel re-creation of the original relational trauma,
a repeat of the experience of physical neglect or rejection
undergone by an individual as a child.

Argument #2

Does touch gratify a client’s manipulative needs?

It is argued that while some patients are genuinely in need of the reparative contact denied in childhood, others will use contact to avoid self-awareness, and sidestep facing painful feelings.

Counter-Argument

Psychotherapists are trained to address manipulations and enactments, and a client’s manipulative strategies are not reserved to the arena of touch alone. The fear that gratification leads to avoidance or entitlement is a residue of childrearing techniques handed down from past generations, which were mostly concerned with shaming children into becoming compliant, obedient citizens.

If the findings of Harry Harlow on the innate need for touch in baby monkeys can be extended to human beings, it should be expected that the need to be touched would arise in the therapy of clients with attachment trauma who were touch deprived. It is detrimental to the nervous system and unfulfilled early need for connection to have clients relive painful memories of “wire-mesh mothers” or “cloth mothers” without offering somatic repair. Client manipulations are a sign that basic needs have been denied, and withholding touch may repeat the original missing experience. In order to avoid painful feelings of misattunement and neglect in their therapy, there is a high likelihood that traumatized clients may depersonalize their therapist and the therapeutic relationship.

It can therefore be argued that avoiding contact is a cruel re-creation of the original relational trauma — a repeat of the experience of physical neglect or rejection undergone in infancy. Caring touch that offers gentle support may, in fact, lay the foundation that helps patients deepen their capacity for self-exploration.

The psychotherapeutic use of touch encourages the preverbal self to be cognized, and brings about a strengthening of the body ego. Far from creating dependency, touch sets the separation-individuation process in motion:

Holding and rocking allows unconscious, preverbal healing to occur. Bodily feelings arising during touching can be profoundly self-communicative, self-informing. They bridge preverbal gulfs, integrating and resolving old emotional-bodily confusions and conflicts. It is as if, in the containing hands of the manual practitioner, the body-self understands itself a little more and can relax and grow in such understanding. (Bevis, 1999)

Argument #3

Can touch lead to transference and countertransference problems and block the expression of hostile feelings?

Psychoanalysis and traditional psychodynamic models maintain that touching patients violates the therapist’s neutrality and negatively intrudes on the therapeutic process. It is argued that, when working with primitive mental states, touch can hinder and contaminate the transference by: a) blocking the expression of hostile feelings, b) triggering the need to protect personal boundaries, and c) foreclosing free association. Additionally, in cases where transference involves the enactment of an abusive past, touch can rekindle a patient’s powerlessness in the face of violation, and trigger unaddressed issues of power differentials and microaggressions. Touch, it is therefore argued, is more than likely to lead to transference and countertransference problems.

Counter-Argument

Although these concerns are valid and important, they are also one-sided arguments that reveal a lack of knowledge about the psychotherapeutic use of touch. Why would the avoidance of touch not be equally contaminating to the transference?

A somatically-trained psychotherapist is aware of situations when touch is contraindicated. In cases where the transference involves the enactment of an abusive past, touch is used with great care, if at all. If the body has been violated, it is acknowledged so that if, and when touch interventions are chosen by therapist and client, they offer a reparative experience that does not rekindle the powerlessness of the original violation. Some types of touch and movement, such as grasping or pushing away, are intended to help clients externalize hostile aggression and assertively express re-owning their integrity.

Supportive touch that elicits trust and safety can give deprived clients a caring, comforting, affect-regulating, yet nonsexual, nonviolent, and non-abusive experience that helps the body, brain, and nervous system learn to receive nurturing. Touch encourages the nonverbal self to become known, and bodily memories that arise during a touch session are profoundly self-informing. Being held and nurtured allows healing to access unconscious preverbal experience that would not otherwise be reached. In the containing hands of the somatic psychotherapist, the body-self understands itself a little more and learns to overcome the debilitating effects of overwhelming traumatic triggers.

Argument #4

Is touching clients a slippery slope to sexual transgressions?

It is a major concern to those who mistrust the use of touch that it may be interpreted by a client as an invitation to intimate contact, and lead to sexual acting out. When exploring physical, sexual, and emotional abuse, some patients might experience the therapeutic use of touch that is meant to be empathic and compassionate as an invasion of personal space, or an expression of covert aggression.

It is also argued that since abusive, violating touch is used to enforce power, establish dominance, and maintain control, therapists could fall into the trap of using touch to dominate or manipulate clients — especially in situations where male therapists are working with female clients.

Counter-Argument

Psychotherapists are trained to sustain boundaried emotional intimacy in the therapeutic relationship. One may therefore wonder why the profession has such a fear that touch, more than any other intervention, would easily sweep away the professionalism of a trained psychotherapist. Because abused individuals often do not have access to their capacity to set boundaries, the issue of boundary breach is a serious therapeutic concern to the somatic therapist. It is not, however a reason to foreclose on using touch interventions.

Therapists who use touch interventions learn to track the subtleties of biological communication. The therapeutic use of touch, like any modality, requires professional training and emphasizes the development of personal somatic self-awareness on the part of the therapist. Those who see touch as dangerous do not understand the profound respect for the intelligence of the body that somatic training inspires in its practitioners. It is the therapist who is not trained in somatic techniques and body psychotherapy who is at higher risk of transgressions.

When exploring issues of physical, sexual, and emotional abuse, a somatically-trained therapist is aware that touch can trigger experiences of personal boundary breach that could shut down a client’s capacity to trust the therapeutic process. The touch taboo speaks to the violation of boundaries, and untold suffering caused by sexual and physical abuse. These tragic touch dysfunctions bring mistrust to the use of touch as a therapeutic intervention. Unfortunately, they also foreclose on the deep yearning and disappointment that neglect and the lack of loving touch leave in client lives.

Few of us have been touched in aware and attuned ways.
Our fears about touch reveal the pervasive dysfunctions of touch
that bring therapists to mistrust it as a therapeutic intervention.

Most body-centered disciplines, such as medicine, surgery, chiropractic, nursing, bodywork, and physical therapy, use some form of touch for which practitioners are professionally trained. Each of these disciplines has a code of ethics to safeguard the patient and ensure the practitioner’s professionalism. The ethical criteria for the use of touch in psychotherapy follow similar guidelines to those in other health professions:

Professional training in the modality employed
Proficiency in using the chosen techniques
Obtaining client-informed consent
Attunement to the client's therapeutic issues and needs, and maintaining open communication
Confidence in the choice of the therapeutic intervention

Argument #5

Should touch be reserved for family and social interactions?

This argument holds that touching is a natural expression of emotional connection, and should therefore be reserved for family and social interactions such as handshakes to express friendship, a touch on the shoulder for empathy, or a congratulatory hug to express joy.

Counter-Argument

Avoiding touch can have the effect of perpetuating the belief that psychological issues do not concern the body, thereby reinforcing the split between psychological and somatic dimensions. Avoiding touch maintains the impression that psychological issues are more important than bodily experience.

The therapeutic use of touch and bodywork connects the cognitive self with its biological intelligence to help clients understand how thoughts, emotions, and sensations work as a unified whole. The therapeutic use of touch is an implicit language that directly addresses and integrates nonverbal physiological needs with psychodynamic awareness. Like attachment parenting, it puts a premium on giving individuals what they need to grow their capacity to be strong, independent, and loving.

In Conclusion

The following words by Bessel van der Kolk encapsulate the healing needs of the early traumatized self:

"How do you quiet down the frightened animal inside of you? The answer to that is probably in the same way that you quiet down babies. You quiet them by holding and touching them, by being very much in tune with them, by feeding and rocking them, and by very gradual exposure to trying new things."

References available on request: aline@neuroaffectivetouch.com

Dr. Aline LaPierre, PsyD, MFT, SEP is the founder and director of The NeuroAffective Touch® Institute which offers trainings in the therapeutic use of touch. She is past faculty in the Somatic Doctoral Program, Santa Barbara Graduate Institute (2000-2010). Aline is the coauthor of Healing Developmental Trauma: How Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship now available in ten languages. She is currently Vice-President of the United States Association for Body Psychotherapy (USABP) and Deputy Editor of the International Body Psychotherapy Journal (IBPJ).

NeuroAffective Touch® (NATouch™) is a neurologically informed psychotherapy that uses somatic psychology, touch, and body-centered approaches as vital psychobiological interventions.

The Body Holds the Key- Psychosomatic Muscle Pain and Tension

Mon, 31 Dec 2018 00:42:01 GMT

By Reza Mohammed B.S. with Dr. Andrew Hahn, Psy.D. and Joan Beckett, LMHC

Sarah was a 42 year old mother of two who came in for a session because of profound anxiety, that she described as “the most anxious I have ever felt in my life.”

“I feel like I am going to jump out of my skin, this anxiety is paralyzing and overcoming my soul/being. I can’t breathe, I am having a hard time concentrating and I don’t feel like I can be around my in-laws and family this week at Thanksgiving,” she said.

“We just had a pre-thanksgiving meal where I had a confrontation with my father. I told him I forgive you for everything you have done to me, and the only thing he responded was I don’t recall being mean to you. He has dementia so that was the end of the confrontation...There is just this unrest inside my being, I can’t seem to calm it down. I woke up at 4AM today and couldn’t fall back asleep, it’s too difficult to function in my life right now. I have no idea what is causing this unrest.”

“There is a lot of fear along with anxiety that makes things doubly difficult, the only comforting thing is cuddling with my family. That is all I want to do, I don’t want to do anything else,” she said with an exasperated look on her face before breaking out in tears.

“Now I’m sensing some anger inside, which I have been unaware of. It’s coming from my spine, there is a lot of emotion there. Yoga brings up a lot of emotion for me, it feels like that. After I saw my father and family yesterday, I felt pain in my upper right back, and my inner right ear inexplicably...It’s interesting because when I was a teen, my father struck my head and ruptured my eardrum.”

“I’ll do anything to make this stop, I am desperate.”

Muscle Testing indicated that Sarah’s highest priority intention was nothing she said, and we could not work directly on anything she said. It indicated that Sarah’s highest priority intention was a deathwish. A deathwish pattern is present when some part of the client wants to die. It typically results from one of two situations:

Something so terrible happened that a part of the client wishes to be dead. And/or

A parent cannot stand something about themselves, projects it onto the child and wants to destroy it. The child perceives that in order to receive the parent’s love, it must let itself be destroyed, i.e. they must die.

A deathwish pattern can manifest as mental hopelessness and suicidal intention, emotional despair and depression and/or physical illness.

After I explained this to Sarah, and asked her if it resonated in anyway, she began crying. “Both my sister and I attempted suicide as teenagers because of our parents,” she said through her tears.

MT indicated that the inducting statements were to be “ A part of me wants to die, A part of me wishes I were dead, Someone who was supposed to love me wants me dead, and in order to receive their love a part of me has to die.” MT also indicated that the root cause was at age 11. When I asked Sarah if this resonated, she said she immediately felt “[her] back on fire.”

As she fully allowed and experienced “ A part of me wants to die, A part of me wishes I was dead, Someone who was supposed to love me wants me dead, and in order to receive their love a part of me has to die,” she immediately felt a “pressure right around vagina, heat and tension in mid-upper back, a nervous inner angst in mid-upper back, and feeling like screaming at the top of [her] lungs and hitting something, spazzing out”.

As she fully allowed and experienced the sensations, a narrative came to her:

“I feel like I am having a nervous breakdown, I give up, it’s like I am competing and I surrender. I think this is when the sexual abuse began, I am feeling strong sensations in my vagina. I can’t remember how early it was when it began...I thought it began when I was being groomed to be abused and molested sexually. I did everything my father and my friend’s father wanted me to do, to please them. I talk about knowing myself and taking care of myself all the time, but I didn’t truly know myself. I am feeling this throbbing energy in my crotch...yes, this sexual abuse began at age 11. I am feeling sensation in my left inner ear, right inner ear, tension in jaw..”

“When my friend’s father touched me, fondled me, and brought me to orgasm, I would contain the orgasm. He would ask if I came, and I would say yes. Although it felt good, I was afraid. I am feeling strong sensations in crotch/ inner ears, the focus is flipping back and forth...I’m remembering that when I smoked my father’s cigarette, he hit me as hard as he could in the ear, and tore my ear drum. That has stayed with me.”

“I’m experiencing a throbbing sensation in my vaginal croch, and I’m now remembering sitting on the couch at my friends house with her sister, and their father. Their father fondled me and went into my vagina as I sat next to his sleeping daughters’ watching TV. I feel petrified as I was succumbing to a man fondling me, and I was afraid my friend and sister would wake up, so I laid as still as I could.”

“My friend’s father frequently asked me if I came/ orgasmed because I didn’t know how to freely orgasm, and I always contained the sensation in my body. And so, I was pleasing him by allowing him to do that. Part of me felt good to finally be noticed, but another part of me felt violated, polluted and dirty. I always had conflicting feelings.”

“I was seeing my best friend’s father from age 11-18 before I stopped. I attempted suicide when I was 16 from the inner toil and stress of the relationship...I’d like help where to go from here”

This was a crucial point in the session. One of the gems of Life Centered Therapy is that everything is part of the process even those statements or beliefs that the client is sure are simply content level statements about the here and now. What Sarah may believe she means is that she was unable to do this process because she felt she needed guidance on where to go from this point, it was much more likely that her content level reaction was in reality a process level comment, i.e she was in a story where she needed guidance on where to go.

Muscle Testing indicated that this content level statement was a part of the narrative itself. We gained movement by saying, “You’re still in the story. You’d likehelp where to go from here. What happens next?”

“I have trouble feeling alone, and I never want to leave my acupuncturist. I always feel alone, needing help, I needed a lot of help when younger, I needed to be saved, rescued. The abuse I endured on a regular basis always left me so alone...both my inner ears are killing me.”

“ I have a chronic problem of grinding my teeth when I sleep. It’s from the angst of enduring the hell of my younger victimization. There is this intense tension in my Jaw right now.”

MT indicated that an acupressure intervention called boundary tapping was necessary. Sarah intuitively felt that the necessary statements were: “I am in full control of my body and who touches me, I am at full choice about taking on other people’s emotions, and I am not truly alone when I am with myself. I have the ability to comfort myself in a way so that I don’t feel alone.”

When she checked in with the “paralyzing anxiety” she reported that it had moved from the worst in her life, a 10, to “total calm, a 0”. The pressure right around her vagina had lessened, as had the mid-upper back heat and tension, nervous inner angst in mid-upper back. The feeling of screaming at the top of lungs and hitting something, spazzing out, had gone completely”.

This session is a powerful example of how efficient and effective the therapeutic process can be when the mind and body are properly utilized together. The wisdom of Sarah’s body held the key to her healing; the powerful sensations that arose for her were a window into a series of traumatic sexual and physical abuses that she had been unable to handle at a younger age. The unexplainable pain in her inner ear was a remembering of her father striking her in the ear and rupturing her eardrum, and the throbbing energy in her crotch may have been a crystallization of the molestation by her best friend’s father, during which she had to contain herself to avoid waking her up.

Due to the fact that the anxiety completely vanished, we can assume it was a direct result of these crystallizing experiences that were unconsciously playing out in her mind-body system. By tapping into the deeper wisdom of the body, Sarah was able to access what she needed to heal and release it so that the worst anxiety she had experienced in her life dissipated from a 10 to a 0. If we were to use cognitive behavioral or other forms of talk therapy that only utilized the conscious mind, we’d be unlikely to get the same results because of one foundational premise: the body holds a memory of any experience we have had that we couldn’t handle, and we have to tap into our unconscious minds and a deeper level of wisdom in order to heal most efficiently.

Every time we experience some kind of shock, it creates an imprint in our body. Sooner or later, this imprint leads to some kind of difficulties in our life. The difficulties get stored in our body as a discomfort and present themselves in our sessions as body sensations. In this way, the body holds the key to our healing, as it is a direct doorway into where exactly we got stuck and our difficulty crystallized.

Learn More About Life Centered Therapy

Body Centered Meditations that Help During Stressful Times

Tue, 04 Dec 2018 01:47:58 GMT

This is an article from Jan M. Bergstrom, LMHC, SEP, DaRTT. It is based on her new book that covers specific body based interventions for dealing with stress.

It never fails to surprise me that during the holiday season I receive so many calls from my clients that are stressed out. In my 23 years of practice, I see my clients come in and are in a state of "rev" in their nervous system. Here are some great interventions from my new book coming out this Spring 2019 for use with your clients or with yourself during stressful times, including the holidays. Enjoy!

Grounding and Centering Practice in Action

Grounding and Centering are two other practices that reconnect you directly with the resources that are naturally available in your own body. It is important to reestablish your relationship to both the ground and to your body’s center, the place where action and feeling originate. These functions are compromised during trauma reactions. In trauma, you lose your ground, so an important part of healing is learning how to find your ground and center again. As you ground and center yourself before each exercise or process in this book, it will help you create a feeling of safety, and a sense that you are in charge. Here is how you do it.

Grounding Technique

1. Sitting in a chair, gently push the heels of your feet into the ground. Notice the sensations in your legs when you engage the muscles and release the muscles. Experiment with finding just the right amount of pressure in your feet.

2. Bring your awareness to what your feet feel like in your shoes as they are resting on the floor. Wiggle your toes and name the sensations that arise. Become aware of your feet on the ground.

3. Begin Deep slow breathing – explore pace breathing by Marsha Linehan, where you slowly inhale to a count of five, completely expanding the rib cage and belly, then slowly exhale to a count of seven until your rib cage has contracted and your shoulders have dropped. Do this at least five times.

4. Gain physical support from a comfortable chair. Bring your awareness to your buttocks as it sinks into the chair and your back as it is being supported. Name the sensations that arise. Experiment with slumping over and then sitting up straight, lengthening the spine as you do so. Imagine having a string pulling you up straight. Notice any and all sensations as they arise. Does your back hurt? Your vertebrae creak? Can you feel the blood leaving your head? Do you feel taller? More in control? Become aware of each sensation, whether physical or cognitive. Don’t judge these sensations, just greet them.

5. Focus non-judgmentally on the sensations you can feel throughout your whole body. Start scanning your feet and slowly move up through your legs, abdomen, torso, into your arms and hands, finishing off at your neck and head. Just allowing whatever shows up to be there.

6. Tense, then relax your muscles. Try using an exercise ball if you have or can get one. If you don’t have one, try a beanbag, a roll of socks, a crumpled towel—anything that you can hold in your arms or between your legs and squeeze tight, hold for five seconds, then relax for five seconds. Notice the sensations and the difference between the engaging muscles and releasing muscles.

The Grounding Technique becomes even more powerful when it is combined with the Centering Technique. This technique is a bit more unique, but every bit as transformative.

Centering Techniques

1. Place one hand on your heart and notice what happens in your body when all thoughts are dropped, and you focus on just your hand. Observe the weight of the hand, its temperature, the sensation of the hand itself and the sensation of it resting over your heart. Notice any changes in your breathing, your heartbeat, even the energy you feel in your hand. Visualize in your mind’s eye a warm ball of golden energy swirling around in your hand as it rests upon your heart.

2. Keeping your hand on your heart, gently place the other hand on top of your head. Apply a slight pressure on the top of your head to create a sensation of being grounded to the earth. With the hand on your heart, focus on channeling warmth and empathy throughout your body through this hand.

Techniques to Help Stay Grounded and Centered

1. Go outside and take a walk in your favorite place. If you find your thoughts spinning off into worries as your feet carry you along the pathway, bring your mind back to the moment. Observe the sky above you, the earth below you, the flora and fauna. How many birds can you see? Smile at the people you pass. When you get home, see how many things you can recall from your walk. The more alert you are to the world that surrounds you, the less space there is in your mind for worries.

2. If you have a dog, take your dog for a walk or go to a dog park. Use the time to truly enjoy your pet’s own joy for the outdoors.

3. If you have a cat, pet and play with it. There is a reason we call our pets “pets.” Just petting the fur of a dog or cat can have a comforting effect on both the pet and ourselves, as our endorphins are stimulated.

4. Call a close friend and reach out for support. If you are in recovery, call a fellow member or your sponsor. Be sure to listen and be there for your friend, as much as your friend is there for you. If your friend is unavailable for such an emotional call, don’t judge your friend. They might be in the middle of taking care of their own needs. Ask them to call when they have more time, and call someone else. Remember, we are all struggling. The more thoughtful you are of your friends’ time and needs, the more thoughtful they will be of yours.

5. Work out moderately at the gym or at home. If you haven’t worked out for some time, start small. If you find yourself watching TV, use the commercial breaks for short spurts of exercise. Try finding a five- or ten-minute YouTube video you can work out with. If you go to the gym, start with twenty minutes, work up to half an hour, and make a fifty-minute workout three times a week your goal. Don’t push yourself too hard. Be gentle with yourself. You’ll get there.

6. Dance to your favorite music, journal your feelings, draw or use some medium for an artistic expression of what you are feeling. Indulge in your playful side. You never lost it—you just learned to ignore it as you matured. Let it out!

7. Move your body and open your arms and spread them out to create a circle. Experiment with expanding the size of this ‘container’ until it is “big enough” to hold all the feelings and sensations or “all of the parts” of your pain.

8. Use your body to put one palm on the side of each knee: push arms against the outer part of the knees while simultaneously pushing out with the legs. Or use the arms to push against the side of the body. This creates resistance and engages your muscles to fight back, which can give you a feeling of empowerment .

9. If you have a flashback or start to dissociate or “fade out,” become aware or what is called “orienting” to the external environment (or room). This technique can be a helpful way to “come back” into the room. To do it, just choose and describe three things in the room that you like and reflect on why like them.

10. You can also turn your head and neck and slowly as you focus on objects in the window, the wall, the door, the lamp, the bookcase. Or focus on objects that might be comforting such as your most favorite object, or cues that tell you where you are.

Mind’s Eye Imagery

Mind’s Eye Imagery Practice in Action

1.     Sitting on your favorite beach listening to the ocean waves
2.     Hiking up your favorite mountain, reaching the top overlooking a beautiful valley
3.     Looking across the Grand Canyon and the river that flows through it
4.     Being on a tropical island
5.     Sitting in a cozy cottage with a warm fire burning in the fireplace, the snow gently falling outside

About the Author:
Jan M. Bergstrom, LMHC, SEP, DaRTT has been in private practice for 23 years working with individuals and couples. She is a Licensed Mental Health Counselor and has a master’s degree in counseling psychology. She enjoy her work and brings years of experience and expertise to all her clients.

Find out more:

www.janbergstrom.com
www.healingtraumanetwork.net
www.healingourcoreissuesinstitute.com

________________

1 Linehan, DBT Skills Training, Handouts and Worksheets, Guilford Press, 2014

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Body Centered Meditations that Help During Stressful Times

This is an article from Jan M. Bergstrom, LMHC, SEP, DaRTT. It is based on her new book that covers specific body based interventions for dealing with stress.